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Dai JY, Zhang J, Braun JV, Simon N, Hubbell E, Zhang N. Clinical performance and utility: A microsimulation model to inform the design of screening trials for a multi-cancer early detection test. J Med Screen 2024; 31:140-149. [PMID: 38304990 PMCID: PMC11330083 DOI: 10.1177/09691413241228041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Designing cancer screening trials for multi-cancer early detection (MCED) tests presents a significant methodology challenge, as natural histories of cell-free DNA-shedding cancers are not yet known. A microsimulation model was developed to project the performance and utility of an MCED test in cancer screening trials. METHODS Individual natural history of preclinical progression through cancer stages for 23 cancer classes was simulated by a stage-transition model under a broad range of cancer latency parameters. Cancer incidences and stage distributions at clinical presentation in simulated trials were set to match the data from Surveillance, Epidemiology, and End Results program. One or multiple rounds of annual screening using a targeted methylation-based MCED test (GalleriⓇ) was conducted to detect preclinical cancers. Mortality benefit of early detection was simulated by a stage-shift model. RESULTS In simulated trials, accounting for healthy volunteer effect and varying test sensitivity, positive predictive value in the prevalence screening round reached 48% to 61% in 6 natural history scenarios. After 3 rounds of annual screening, the cumulative proportions of stage I/II cancers increased by approximately 9% to 14%, the incidence of stage IV cancers was reduced by 37% to 46%, the reduction of stages III and IV cancer incidences was 9% to 24%, and the reduction of mortality reached 13% to 16%. Greater reductions of late-stage cancers and cancer mortality were achieved by five rounds of MCED screening. CONCLUSIONS Simulation results guide trial design and suggest that adding this MCED test to routine screening in the United States may shift cancer detection to earlier stages, and potentially save lives.
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Affiliation(s)
| | | | | | - Noah Simon
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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Lee CI, Elmore JG. Beyond survival: a closer look at lead-time bias and disease-free intervals in mammography screening. J Natl Cancer Inst 2024; 116:343-344. [PMID: 38145456 DOI: 10.1093/jnci/djad254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Joann G Elmore
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Migowski A, Nadanovsky P, Manso de Mello Vianna C. Harms and benefits of mammographic screening for breast cancer in Brazil. PLoS One 2024; 19:e0297048. [PMID: 38271392 PMCID: PMC10810469 DOI: 10.1371/journal.pone.0297048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION In the absence of evidence on the effect of mammographic screening on overall mortality, comparing the number of deaths avoided with the number of deaths caused by screening would be ideal, but the only existing models of this type adopt a very narrow definition of harms. The objective of the present study was to estimate the number of deaths prevented and induced by various mammography screening protocols in Brazil. METHODS A simulation study of cohorts of Brazilian women screened, considering various age groups and screening interval protocols, was performed based on life tables. The number of deaths avoided and caused by screening was estimated, as was the absolute risk reduction, the number needed to invite for screening-NNS, the net benefit of screening, and the ratio of "lives saved" to "lives lost". Nine possible combinations of balances between benefits and harms were performed for each protocol, in addition to other sensitivity analyses. RESULTS AND CONCLUSIONS The most efficient protocol was biennial screening from 60 to 69 years of age, with almost three times more deaths avoided than biennial screening from 50 to 59 years of age, with a similar number of deaths avoided by biennial screening from 50 to 69 years of age and with the greatest net benefit. Compared with the best scenario of annual screening from 40 to 49 years of age, the NNS of the protocol with biennial screening from 60 to 69 years of age was three-fold lower. Even in its best scenario, the addition of annual screening from 40 to 49 years of age to biennial screening from 50 to 69 years of age results in a decreased net benefit. However, even in the 50-69 year age group, the estimated reduction in breast cancer mortality for Brazil was half that estimated for the United Kingdom.
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Affiliation(s)
- Arn Migowski
- Professional Master’s Program in Health Technology Assessment, Teaching and Research Coordination, Instituto Nacional de Cardiologia (INC), Ministry of Health, Rio de Janeiro, Brazil
- Division of Clinical Research and Technological Development, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Escola Nacional de Saúde Pública (ENSP), FIOCRUZ, Rio de Janeiro, Brazil
| | - Cid Manso de Mello Vianna
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Breast Implant-Related Adverse Events During Mammography: An Assessment of the Food and Drug Administration Manufacturer and User Facility Device Experience Database. Ann Plast Surg 2022; 89:261-266. [PMID: 35993683 DOI: 10.1097/sap.0000000000003243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adverse events arising in patients with breast implants during mammography reported by the Food and Drug Administration include implant rupture, pain, and impaired visualization. However, data supporting these claims were collected in 2004, and since, newer implant generations have been developed with overall rate of implantation increasing by 48%. OBJECTIVES This article aims to determine the current incidence of implant-related adverse events arising during mammography. METHODS We analyzed reports regarding silicone and saline breast implants published in the Food and Drug Administration Manufacturer and User Facility Device Experience database between 2008 and November 2018. Search terms included "mammogram," "mammography," "radiograph," "breast cancer screening," "breast cancer test," and "x-ray." RESULTS Of the 20 539 implant-related adverse events available in the Manufacturer and User Facility Device Experience database, 427 were retrieved using our search strategy and 41 were related to mammography. Thirty-five of identified cases (85.4%) reported implant rupture, of which 19 (54.3%) were confirmed by a healthcare professional, 9 (25.7%) were clinically confirmed by saline implant deflation, and 7 (20.0%) were unverified reports by patients. Sixteen ruptures (45.7%) occurred with silicone implants, whereas 19 ruptures (54.3%) occurred with saline. Other adverse events included pain (29.3%), change in implant appearance (14.6%), and swelling (7.3%). CONCLUSIONS Although implant rupture, pain, change in implant appearance, and swelling may occur, minimal implant-related adverse events arise during mammography. Given the extremely low reported risk of implant rupture, this should neither prevent patients from adhering to breast cancer screening programs nor deter patients from seeking breast implants. Patients should be aware of these reported risks and discuss screening options with their breast cancer screening team.
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Christiansen SR, Autier P, Støvring H. Change in effectiveness of mammography screening with decreasing breast cancer mortality: a population-based study. Eur J Public Health 2022; 32:630-635. [PMID: 35732293 PMCID: PMC9341840 DOI: 10.1093/eurpub/ckac047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reductions in breast cancer mortality observed over the last three decades are partly due to improved patient management, which may erode the benefit-harm balance of mammography screening. METHODS We estimated the numbers of women needed to invite (NNI) to prevent one breast cancer death within 10 years. Four scenarios of screening effectiveness (5-20% mortality reduction) were applied on 10,580 breast cancer deaths among Norwegian women aged 50-75 years from 1986 to 2016. We used three scenarios of overdiagnosis (10-40% excess breast cancers during screening period) for estimating ratios of numbers of overdiagnosed breast cancers for each breast cancer death prevented. RESULTS Under the base case scenario of 20% breast cancer mortality reduction and 20% overdiagnosis, the NNI rose from 731 (95% CI: 644-830) women in 1996 to 1364 (95% CI: 1181-1577) women in 2016, while the number of women with overdiagnosed cancer for each breast cancer death prevented rose from 3.2 in 1996 to 5.4 in 2016. For a mortality reduction of 8.7%, the ratio of overdiagnosed breast cancers per breast cancer death prevented rose from 7.4 in 1996 to 14.0 in 2016. For a mortality reduction of 5%, the ratio rose from 12.8 in 1996 to 25.2 in 2016. CONCLUSIONS Due to increasingly potent therapeutic modalities, the benefit in terms of reduced breast cancer mortality declines while the harms, including overdiagnosis, are unaffected. Future improvements in breast cancer patient management will further deteriorate the benefit-harm ratio of screening.
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Affiliation(s)
| | - Philippe Autier
- Institute of Global Public Health, University of Strathclyde at the International Prevention Research Institute, Lyon 69570, France
| | - Henrik Støvring
- Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark
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Safiri S, Nejadghaderi SA, Karamzad N, Carson-Chahhoud K, Bragazzi NL, Sullman MJM, Almasi-Hashiani A, Mansournia MA, Collins GS, Kaufman JS, Kolahi AA. Global, regional, and national cancer deaths and disability-adjusted life-years (DALYs) attributable to alcohol consumption in 204 countries and territories, 1990-2019. Cancer 2022; 128:1840-1852. [PMID: 35239973 DOI: 10.1002/cncr.34111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol consumption is a risk factor for a number of communicable and non-communicable diseases, including several types of cancer. This article reports the burden of cancers attributable to alcohol consumption by age, sex, location, sociodemographic index (SDI), and cancer type from 1990 to 2019. METHODS The Comparative Risk Assessment approach was used in the 2019 Global Burden of Disease study to report the burden of cancers attributable to alcohol consumption between 1990 and 2019. RESULTS In 2019, there were globally an estimated 494.7 thousand cancer deaths (95% uncertainty interval [UI], 439.7 to 554.1) and 13.0 million cancer disability-adjusted life-years (DALYs; 95% UI, 11.6 to 14.5) that were attributable to alcohol consumption. The alcohol-attributable DALYs were much higher in men (10.5 million; 95% UI, 9.2 to 11.8) than women (2.5 million; 95% UI, 2.2 to 2.9). The global age-standardized death and DALY rates of cancers attributable to alcohol decreased by 14.7% (95% UI, 6.4% to 23%) and 18.1% (95% UI, 9.2% to 26.5%), respectively, over the study period. Central Europe had the highest age-standardized death rates that were attributable to alcohol consumption(10.3; 95% UI, 8.7 to12.0). Moreover, there was an overall positive association between SDI and the regional age-standardized DALY rate for alcohol-attributable cancers. CONCLUSIONS Despite decreases in age-standardized deaths and DALYs, substantial numbers of cancer deaths and DALYs are still attributable to alcohol consumption. Because there is a higher burden in males, the elderly, and developed regions (based on SDI), these groups and regions should be prioritized in any prevention programs.
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Affiliation(s)
- Saeid Safiri
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nahid Karamzad
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kristin Carson-Chahhoud
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Gary S Collins
- Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wright JL, Rahbar H, Obeng-Gyasi S, Carlos R, Tjoe JA, Wolff A. Reply to I. Jatoi. J Clin Oncol 2022; 40:1595-1596. [PMID: 35245080 DOI: 10.1200/jco.22.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jean L Wright
- Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Habib Rahbar, MD, University of Washington, Seattle, WA; Samilia Obeng-Gyasi, MD, The Ohio State University, Columbus, OH; Ruth Carlos, MD, University of Michigan, Ann Arbor, MI; Judy A. Tjoe, MD, Novant Health, Greensboro, NC; and Antonio Wolff, MD, Johns Hopkins University, Baltimore, MD
| | - Habib Rahbar
- Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Habib Rahbar, MD, University of Washington, Seattle, WA; Samilia Obeng-Gyasi, MD, The Ohio State University, Columbus, OH; Ruth Carlos, MD, University of Michigan, Ann Arbor, MI; Judy A. Tjoe, MD, Novant Health, Greensboro, NC; and Antonio Wolff, MD, Johns Hopkins University, Baltimore, MD
| | - Samilia Obeng-Gyasi
- Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Habib Rahbar, MD, University of Washington, Seattle, WA; Samilia Obeng-Gyasi, MD, The Ohio State University, Columbus, OH; Ruth Carlos, MD, University of Michigan, Ann Arbor, MI; Judy A. Tjoe, MD, Novant Health, Greensboro, NC; and Antonio Wolff, MD, Johns Hopkins University, Baltimore, MD
| | - Ruth Carlos
- Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Habib Rahbar, MD, University of Washington, Seattle, WA; Samilia Obeng-Gyasi, MD, The Ohio State University, Columbus, OH; Ruth Carlos, MD, University of Michigan, Ann Arbor, MI; Judy A. Tjoe, MD, Novant Health, Greensboro, NC; and Antonio Wolff, MD, Johns Hopkins University, Baltimore, MD
| | - Judy A Tjoe
- Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Habib Rahbar, MD, University of Washington, Seattle, WA; Samilia Obeng-Gyasi, MD, The Ohio State University, Columbus, OH; Ruth Carlos, MD, University of Michigan, Ann Arbor, MI; Judy A. Tjoe, MD, Novant Health, Greensboro, NC; and Antonio Wolff, MD, Johns Hopkins University, Baltimore, MD
| | - Antonio Wolff
- Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Habib Rahbar, MD, University of Washington, Seattle, WA; Samilia Obeng-Gyasi, MD, The Ohio State University, Columbus, OH; Ruth Carlos, MD, University of Michigan, Ann Arbor, MI; Judy A. Tjoe, MD, Novant Health, Greensboro, NC; and Antonio Wolff, MD, Johns Hopkins University, Baltimore, MD
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Ramírez-Parada K, Lopez-Garzon M, Sanchez-Rojel C, Petric-Guajardo M, Alfaro-Barra M, Fernández-Verdejo R, Reyes-Ponce A, Merino-Pereira G, Cantarero-Villanueva I. Effect of Supervised Resistance Training on Arm Volume, Quality of Life and Physical Perfomance Among Women at High Risk for Breast Cancer-Related Lymphedema: A Study Protocol for a Randomized Controlled Trial (STRONG-B). Front Oncol 2022; 12:850564. [PMID: 35299753 PMCID: PMC8921986 DOI: 10.3389/fonc.2022.850564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 01/31/2023] Open
Abstract
Objectives To determine the preventive effects of supervised resistance training on arms volume, quality of life, physical performance, and handgrip strength in Chilean women at high risk for breast cancer-related lymphedema (BCRL) undergoing chemotherapy. Design Randomized control trial. Participants One hundred and six women at high risk for breast cancer-related lymphedema aged 18 to 70 years. Interventions Participants will be randomized into two groups: [a] intervention, who will receive 12 weeks of supervised resistance training (STRONG-B) during adjuvant chemotherapy; and [b] control, who will receive education to promote lymphatic and venous return, maintain range of motion, and promote physical activity. Main Outcome Measures The primary outcome will be arms volume measured with an optoelectric device (perometer NT1000). Secondary outcomes will be quality of life, handgrip strength, and physical performance. Primary and secondary outcomes will be measured at baseline, just after the intervention, and 3 and 6 months after. Statistical analysis will be performed following intention-to-treat and per-protocol approaches. The treatment effect will be calculated using linear mixed models. Discussion The STRONG-B will be a tailored supervised resistance training that attempts to prevent or mitigate BCRL in a population that, due to both intrinsic and extrinsic factors, will commonly suffer from BCRL. Clinical Trial Registration [https://clinicaltrials.gov/ct2/show/NCT04821609], identifier NCT04821609.
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Affiliation(s)
- Karol Ramírez-Parada
- Carrera de Kinesiología, Departamento Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Lopez-Garzon
- 'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Cesar Sanchez-Rojel
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Militza Petric-Guajardo
- Department of Surgery Dr Sótero del Río Hospital, Santiago, Chile
- Department of Surgery Davila Clinic, Santiago, Chile
| | - Margarita Alfaro-Barra
- Centro de Cáncer, Red de Salud U- Christus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Fernández-Verdejo
- Laboratorio de Fisiología del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Alvaro Reyes-Ponce
- Escuela de Kinesiología, Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, Viña del Mar, Chile
| | - Gina Merino-Pereira
- Departamento Manejo Integral del Cáncer y Otros Tumores, Subsecretaria de Salud Pública, Ministerio de Salud de Chile, Santiago, Chile
- Escuela de Medicina, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile
| | - Irene Cantarero-Villanueva
- 'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
- Sport and Health Research Center (iMUDS), Granada, Spain
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Prior L, Featherstone H, O’Reilly D, Nugent K, Lim M, McCaffrey J, Higgins MJ, Kelly CM. Competing mortality risks: predicted cardiovascular disease risk versus predicted risk of breast cancer mortality in patients receiving adjuvant chemotherapy in a single Irish center. CARDIO-ONCOLOGY 2021; 7:8. [PMID: 33622415 PMCID: PMC7901187 DOI: 10.1186/s40959-021-00096-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/07/2021] [Indexed: 12/25/2022]
Abstract
Background Due to advances in care, most women diagnosed with breast cancer do not die from the disease itself. Instead, cardiovascular disease (CVD) remains the most frequent cause of death. Many breast cancer patients are older and have established CVD risk factors. They are at further risk due to exposure to anthracyclines, HER2 targeted agents, endocrine therapy and radiotherapy. In this study, we compared the 10-year predicted risk of breast cancer mortality versus that of cardiovascular (CV) morbidity/mortality in breast cancer patients receiving adjuvant chemotherapy using online predictive risk calculators. Furthermore, we evaluated the predicted outcome of CV risk factor optimisation on their overall CV risk. Methods This was a cross sectional study. All patients with resected Stage I-III breast cancer who received adjuvant chemotherapy at our centre from September 2015 to November 2016 were identified. Data recorded included demographics, tumor characteristics, treatments and CV risk factors. To calculate predicted 10-year risk of CVD and impact of lifestyle changes, we used the JBS3 (Joint British Society) online risk calculator. To calculate the predicted 10-year risk of breast cancer mortality, we used the PREDICT calculator. Biostatistical methods included Wilcoxon signed rank test for predicted CVD risk pre and post cardiovascular risk optimization. Results We identified 102 patients. Of this cohort, 76 patients were ≥ 50 years & 26 were < 50 years of age. The group had significant baseline cardiovascular risk factors: increased BMI (68 %, n = 70), ex-smoking (34 %, n = 35), current smoking (13 %, n = 13), hypertension (47 %, n = 47) and dyslipidemia (57 %). Of the total group, 48 % had a high (> 20 %) and 37 % had a moderate (10–20 %) 10-year predicted breast cancer mortality risk. Regarding 10-year predicted risk of CVD, 11 % and 22 % fell into the high (> 20 %) and moderate (10–20 %) risk categories, respectively. Assuming CV risk factor optimisation, there was a predicted improvement in median 10-year CV risk from 26.5 to 9.9 % (p = .005) in the high CVD risk group and from 14.0 to 6.6 % (p < .001) in the moderate CVD risk group. Conclusions Benefits predicted with a CVD risk intervention model indicates that this should be incorporated into routine breast oncology care.
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Mühlberger N, Sroczynski G, Gogollari A, Jahn B, Pashayan N, Steyerberg E, Widschwendter M, Siebert U. Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1311-1344. [PMID: 34342797 DOI: 10.1007/s10198-021-01338-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Benefit and cost effectiveness of breast cancer screening are still matters of controversy. Risk-adapted strategies are proposed to improve its benefit-harm and cost-benefit relations. Our objective was to perform a systematic review on economic breast cancer models evaluating primary and secondary prevention strategies in the European health care setting, with specific focus on model results, model characteristics, and risk-adapted strategies. METHODS Literature databases were systematically searched for economic breast cancer models evaluating the cost effectiveness of breast cancer screening and prevention strategies in the European health care context. Characteristics, methodological details and results of the identified studies are reported in evidence tables. Economic model outputs are standardized to achieve comparable cost-effectiveness ratios. RESULTS Thirty-two economic evaluations of breast cancer screening and seven evaluations of primary breast cancer prevention were included. Five screening studies and none of the prevention studies considered risk-adapted strategies. Studies differed in methodologic features. Only about half of the screening studies modeled overdiagnosis-related harms, most often indirectly and without reporting their magnitude. All models predict gains in life expectancy and/or quality-adjusted life expectancy at acceptable costs. However, risk-adapted screening was shown to be more effective and efficient than conventional screening. CONCLUSIONS Economic models suggest that breast cancer screening and prevention are cost effective in the European setting. All screening models predict gains in life expectancy, which has not yet been confirmed by trials. European models evaluating risk-adapted screening strategies are rare, but suggest that risk-adapted screening is more effective and efficient than conventional screening.
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Affiliation(s)
- Nikolai Mühlberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Artemisa Gogollari
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Nora Pashayan
- Institute of Epidemiology and Healthcare, Department of Applied Health Research, UCL-University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, PO Box 9600, 3000 CA, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Widschwendter
- Department of Women's Cancer, EGA Institute for Women's Health, UCL - University College London, 74 Huntley St, Rm 340, London, WC1E 6AU, UK
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria.
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
- Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Nunes PSG, da Silva G, Nascimento S, Mantoani SP, de Andrade P, Bernardes ES, Kawano DF, Leopoldino AM, Carvalho I. Synthesis, biological evaluation and molecular docking studies of novel 1,2,3-triazole-quinazolines as antiproliferative agents displaying ERK inhibitory activity. Bioorg Chem 2021; 113:104982. [PMID: 34020277 DOI: 10.1016/j.bioorg.2021.104982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 12/24/2022]
Abstract
ERK1/2 inhibitors have attracted special attention concerning the ability of circumventing cases of innate or log-term acquired resistance to RAF and MEK kinase inhibitors. Based on the 4-aminoquinazoline pharmacophore of kinases, herein we describe the synthesis of 4-aminoquinazoline derivatives bearing a 1,2,3-triazole stable core to bridge different aromatic and heterocyclic rings using copper-catalysed azide-alkyne cycloaddition reaction (CuAAC) as a Click Chemistry strategy. The initial screening of twelve derivatives in tumoral cells (CAL-27, HN13, HGC-27, and BT-20) revealed that the most active in BT-20 cells (25a, IC50 24.6 μM and a SI of 3.25) contains a more polar side chain (sulfone). Furthermore, compound 25a promoted a significant release of lactate dehydrogenase (LDH), suggesting the induction of cell death by necrosis. In addition, this compound induced G0/G1 stalling in BT-20 cells, which was accompanied by a decrease in the S phase. Western blot analysis of the levels of p-STAT3, p-ERK, PARP, p53 and cleaved caspase-3 revealed p-ERK1/2 and p-STA3 were drastically decreased in BT-20 cells under 25a incubation, suggesting the involvement of these two kinases in the mechanisms underlying 25a-induced cell cycle arrest, besides loss of proliferation and viability of the breast cancer cell. Molecular docking simulations using the ERK-ulixertinib crystallographic complex showed compound 25a could potentially compete with ATP for binding to ERK in a slightly higher affinity than the reference ERK1/2 inhibitor. Further in silico analyses showed comparable toxicity and pharmacokinetic profiles for compound 25a in relation to ulixertinib.
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Affiliation(s)
| | - Gabriel da Silva
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sofia Nascimento
- Radiopharmacy Center, Nuclear and Energy Research Institute (IPEN/CNEN-SP), São Paulo, São Paulo, Brazil
| | | | - Peterson de Andrade
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Emerson Soares Bernardes
- Radiopharmacy Center, Nuclear and Energy Research Institute (IPEN/CNEN-SP), São Paulo, São Paulo, Brazil
| | - Daniel Fábio Kawano
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Andreia Machado Leopoldino
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ivone Carvalho
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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12
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Castellano CR, Aguilar Angulo PM, Hernández LC, González-Carrato PSC, González RG, Alvarez J, Chacón JI, Ruiz J, Fuentes Guillén MÁ, Gutiérrez Ávila G. Breast cancer mortality after eight years of an improved screening program using digital breast tomosynthesis. J Med Screen 2021; 28:456-463. [PMID: 33775181 PMCID: PMC8573629 DOI: 10.1177/09691413211002556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess screening quality metrics and to describe mortality rates eight years after redesign of breast cancer screening and diagnosis pathways, and the introduction of digital breast tomosynthesis. SETTING Breast Unit of the Toledo Health Area in the region of Castilla-La Mancha (Spain). METHODS We recorded screening metrics and mortality data following the introduction of digital breast tomosynthesis in 2011 for screening and diagnosis pathways. We then compared the mortality between Toledo Health Area and the rest of Castilla-La Mancha, where digital breast tomosynthesis is not available. RESULTS All screening quality metrics improved following the introduction of digital breast tomosynthesis. The cancer detection rate significantly increased from 2.3 (95% confidence interval (CI): 1.9-3.6) to 4.5 per 1000 women (95% CI: 3.2-5.2) on average between the periods 2005-2009 and 2015-2018, while the recall rate significantly decreased from 7.0% (95% CI: 6.8%-8.2%) to 2.6% (95% CI: 2.0%-3.6%). Comparing breast cancer mortality rates for 2014-2018 in the Toledo Health Area with the rest of Castilla-La Mancha, which had similar cancer treatment access and management protocols but without digital breast tomosynthesis, the crude mortality rate was 17.79 (95% CI: 15.38 -20.19) vs. 24.76 per 100,000 (95% CI: 26.12-23.39), respectively. The cumulative risk of death was also significantly lower for the Toledo Health Area than for Castilla-La Mancha. CONCLUSION The introduction of digital breast tomosynthesis improved screening quality indicators. Breast cancer mortality simultaneously decreased with respect to the rest of Castilla-La Mancha. Further research is needed to assess the long-term results, and the role that the redesign may have played in reducing mortality.
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Affiliation(s)
| | | | | | | | | | - Justo Alvarez
- Breast Unit - Surgery Service, Virgen de la Salud Hospital, Toledo, Spain
| | | | - Juan Ruiz
- Breast Unit - Anatomic Pathology Service, Virgen de la Salud Hospital, Toledo, Spain
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13
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Abstract
In recommending and offering screening, health services make a health claim ('it's good for you'). This article considers ethical aspects of establishing the case for cancer screening, building a service programme, monitoring its operation, improving its quality and integrating it with medical progress. The value of (first) screening is derived as a function of key parameters: prevalence of the target lesion in the detectable pre-clinical phase, the validity of the test and the respective net utilities or values attributed to four health states-true positives, false positives, false negatives and true negatives. Decision makers as diverse as public regulatory agencies, medical associations, health insurance funds or individual screenees can legitimately come up with different values even when presented with the same evidence base. The main intended benefit of screening is the reduction of cause-specific mortality. All-cause mortality is not measurably affected. Overdiagnosis and false-positive tests with their sequelae are the main harms. Harms and benefits accrue to distinct individuals. Hence the health claim is an invitation to a lottery with benefits for few and harms to many, a violation of the non-maleficence principle. While a public decision maker may still propose a justified screening programme, respect for individual rights and values requires preference-sensitive, autonomy-enhancing educational materials-even at the expense of programme effectiveness. Opt-in recommendations and more 'consumer-oriented' qualitative research are needed.
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Affiliation(s)
- Bernt-Peter Robra
- Institute for Social Medicine and Health Services Research, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, D-39140, Magdeburg, Germany.
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14
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Zeng X, Liu C, Yao J, Wan H, Wan G, Li Y, Chen N. Breast cancer stem cells, heterogeneity, targeting therapies and therapeutic implications. Pharmacol Res 2020; 163:105320. [PMID: 33271295 DOI: 10.1016/j.phrs.2020.105320] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023]
Abstract
Both hereditary and sporadic breast cancer are suggested to develop from a stem cell subcomponent retaining most key stem cell properties but with dysregulation of self-renewal pathways, which drives tumorigenic differentiation and cellular heterogeneity. Cancer stem cells (CSCs), characterized by their self-renewal and differentiation potential, have been reported to contribute to chemo-/radio-resistance and tumor initiation and to be the main reason for the failure of current therapies in breast cancer and other CSC-bearing cancers. Thus, CSC-targeted therapies, such as those inducing CSC apoptosis and differentiation, inhibiting CSC self-renewal and division, and targeting the CSC niche to combat CSC activity, are needed and may become an important component of multimodal treatment. To date, the understanding of breast cancer has been extended by advances in CSC biology, providing more accurate prognostic and predictive information upon diagnosis. Recent improvements have enhanced the prospect of targeting breast cancer stem cells (BCSCs), which has shown promise for increasing the breast cancer remission rate. However, targeted therapy for breast cancer remains challenging due to tumor heterogeneity. One major challenge is determining the CSC properties that can be exploited as therapeutic targets. Another challenge is identifying suitable BCSC biomarkers to assess the efficacy of novel BCSC-targeted therapies. This review focuses mainly on the characteristics of BCSCs and the roles of BCSCs in the formation, maintenance and recurrence of breast cancer; self-renewal signaling pathways in BCSCs; the BCSC microenvironment; potential therapeutic targets related to BCSCs; and current therapies and clinical trials targeting BCSCs.
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Affiliation(s)
- Xiaobin Zeng
- Center Lab of Longhua Branch and Department of Infectious Disease, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, 518020, PR China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Medicine School of Shenzhen University, Shenzhen, Guangdong Province, 518037, PR China
| | - Chengxiao Liu
- Center Lab of Longhua Branch and Department of Infectious Disease, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, 518020, PR China
| | - Jie Yao
- Center Lab of Longhua Branch and Department of Infectious Disease, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, 518020, PR China
| | - Haoqiang Wan
- Center Lab of Longhua Branch and Department of Infectious Disease, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, 518020, PR China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Medicine School of Shenzhen University, Shenzhen, Guangdong Province, 518037, PR China; Department of Gastroenterology, (Longhua Branch), Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong Province, 518120, PR China
| | - Guoqing Wan
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, PR China
| | - Yingpeng Li
- Department of Gastroenterology, (Longhua Branch), Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong Province, 518120, PR China.
| | - Nianhong Chen
- Center Lab of Longhua Branch and Department of Infectious Disease, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, 518020, PR China; Department of Cell Biology & University of Pittsburgh Cancer Institute, School of Medicine, University of Pittsburgh, PA, 15261, USA; Laboratory of Signal Transduction, Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, 10065, USA.
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15
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Gogebakan KC, Berry EG, Geller AC, Sonmez K, Leachman SA, Etzioni R. Strategizing Screening for Melanoma in an Era of Novel Treatments: A Model-Based Approach. Cancer Epidemiol Biomarkers Prev 2020; 29:2599-2607. [PMID: 32958498 DOI: 10.1158/1055-9965.epi-20-0881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Benefit-harm tradeoffs of melanoma screening depend on disease risk and treatment efficacy. We developed a model to project outcomes of screening for melanoma in populations with different risks under historic and novel systemic treatments. METHODS Computer simulation model of a screening program with specified impact on overall and advanced-stage incidence. Inputs included meta-analyses of treatment trials, cancer registry data, and a melanoma risk prediction study RESULTS: Assuming 50% reduction in advanced stage under screening, the model projected 59 and 38 lives saved per 100,000 men under historic and novel treatments, respectively. With 10% increase in stage I, the model projects 2.9 and 4.7 overdiagnosed cases per life saved and number needed to be screened (NNS) equal to 1695 and 2632 under historical and novel treatments. When screening was performed only for the 20% of individuals with highest predicted risk, 34 and 22 lives per 100,000 were saved under historic and novel treatments. Similar results were obtained for women, but lives saved were lower. CONCLUSIONS Melanoma early detection programs must shift a substantial fraction of cases from advanced to localized stage to be sustainable. Advances in systemic therapies for melanoma might noticeably reduce benefits of screening, but restricting screening to individuals at highest risk will likely reduce intervention efforts and harms while preserving >50% of the benefit of nontargeted screening. IMPACT Our accessible modeling framework will help to guide population melanoma screening programs in an era of novel treatments for advanced disease.
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Affiliation(s)
- Kemal Caglar Gogebakan
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth G Berry
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Alan C Geller
- Division of Public Health Practice, Harvard School of Public Health, Boston, Massachusetts
| | - Kemal Sonmez
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. .,Department of Statistics, University of Washington, Seattle, Washington
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16
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Van Ourti T, O'Donnell O, Koç H, Fracheboud J, de Koning HJ. Effect of screening mammography on breast cancer mortality: Quasi-experimental evidence from rollout of the Dutch population-based program with 17-year follow-up of a cohort. Int J Cancer 2019; 146:2201-2208. [PMID: 31330046 PMCID: PMC7065105 DOI: 10.1002/ijc.32584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 06/12/2019] [Accepted: 07/02/2019] [Indexed: 12/29/2022]
Abstract
There is uncertainty about the magnitude of the effect of screening mammography on breast cancer mortality. The relevance and validity of evidence from dated randomized controlled trials has been questioned, whereas observational studies often lack a valid comparison group. There is no estimate of the effect of one screening invitation only. We exploited the geographic rollout of the Dutch screening mammography program across municipalities to estimate the effects of one additional biennial screening invitation on breast cancer and all‐cause mortality. Population administrative data provided vital status and cause of death of a cohort of women aged 49–63 in 1995 over 17 years. Linear probability models were used to estimate the mortality effects. We estimated 154 fewer breast cancer deaths (95% confidence interval: 40–267; p = 0.01) over 17 years in a population of 100,000 women aged 49–63 who received one additional biennial screening invitation, which corresponds to an 9.6% risk reduction for a woman of age 56. The estimated effect on all‐cause mortality was negative but not close to statistical significance. Our study shows that one single invitation for breast cancer screening is effective in reducing breast cancer mortality, which is important for health policy. The effect is smaller than previous estimates of the effect of invitation for multiple screens, which further emphasizes the importance of achieving regular participation. What's new? To date, there is still uncertainty about the magnitude of the effect of screening mammography on breast cancer mortality. Here, the authors exploited the geographic rollout of the Dutch screening mammography program and high‐quality national population, cancer, and death registries to avoid limitations of observational research by comparing breast cancer mortality across groups of women of the same age who joined the mammography program at different dates. The analysis provides a unique estimate of the effect of one additional invitation for screening mammography on breast cancer mortality (around 10%) and delivers evidence in favour of the effectiveness of such screening.
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Affiliation(s)
- Tom Van Ourti
- Erasmus School of Economics, Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Owen O'Donnell
- Erasmus School of Economics, Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hale Koç
- Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jacques Fracheboud
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Feig SA. Evidence of Benefit from Mammography Screening of Average-Risk Women Ages 40-49 Years: Science, Metrics, and Value Judgments. JOURNAL OF BREAST IMAGING 2019; 1:78-83. [PMID: 38424920 DOI: 10.1093/jbi/wbz010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Indexed: 03/02/2024]
Abstract
The majority of randomized control trials and service-based screening studies of women ages 40-49 years demonstrate reductions in mortality of 29%-48% when long-term outcome is assessed. Annual screening is preferable in these younger women due to faster tumor-doubling times. Advances in mammography technique and breast ultrasound may allow even better results in the future.
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Affiliation(s)
- Stephen A Feig
- University of California Irvine, Department of Radiological Sciences, Orange, CA
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18
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Birnbaum JK, Duggan C, Anderson BO, Etzioni R. Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study. LANCET GLOBAL HEALTH 2019; 6:e885-e893. [PMID: 30012269 DOI: 10.1016/s2214-109x(18)30257-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Poor breast cancer survival in low-income and middle-income countries (LMICs) can be attributed to advanced-stage presentation and poor access to systemic therapy. We aimed to estimate the outcomes of different early detection strategies in combination with systemic chemotherapy and endocrine therapy in LMICs. METHODS We adapted a microsimulation model to project outcomes of three early detection strategies alone or in combination with three systemic treatment programmes beyond standard of care (programme A): programme B was endocrine therapy for all oestrogen-receptor (ER)-positive cases; programme C was programme B plus chemotherapy for ER-negative cases; programme D was programme C plus chemotherapy for advanced ER-positive cases. The main outcomes were reductions in breast cancer-related mortality and lives saved per 100 000 women relative to the standard of care for women aged 30-49 years in a low-income setting (East Africa; using incidence data and life tables from Uganda and data on tumour characteristics from various East African countries) and for women aged 50-69 years in a middle-income setting (Colombia). FINDINGS In the East African setting, relative mortality reductions were 8-41%, corresponding to 23 (95% uncertainty interval -12 to 49) to 114 (80 to 138) lives saved per 100 000 women over 10 years. In Colombia, mortality reductions were 7-25%, corresponding to 32 (-29 to 70) to 105 (61 to 141) lives saved per 100 000 women over 10 years. INTERPRETATION The best projected outcomes were in settings where access to both early detection and adjuvant therapy is improved. Even in the absence of mammographic screening, improvements in detection can provide substantial benefit in settings where advanced-stage presentation is common. FUNDING Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Cancer Center Support Grant of the US National Institutes of Health.
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Affiliation(s)
- Jeanette K Birnbaum
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Surgery, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Statistics, University of Washington, Seattle, WA, USA.
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19
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Assessment of Quantitative Magnetic Resonance Imaging Background Parenchymal Enhancement Parameters to Improve Determination of Individual Breast Cancer Risk. J Comput Assist Tomogr 2019; 43:85-92. [PMID: 30052617 DOI: 10.1097/rct.0000000000000774] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aims of this study were to identify optimal quantitative breast magnetic resonance imaging background parenchymal enhancement (BPE) parameters associated with breast cancer risk and compare performance to qualitative assessments. METHODS Using a matched case-control cohort of 46 high-risk women who underwent screening magnetic resonance imaging (23 who developed breast cancer matched to 23 who did not), fibroglandular tissue area, BPE area, and intensity metrics (mean, SD, quartiles, skewness, and kurtosis) were quantitatively measured at varying enhancement thresholds. Optimal thresholds for discriminating between cancer and control cohorts were identified for each metric and performance summarized using area under the receiver operating characteristic curve. RESULTS Women who developed breast cancer exhibited greater BPE area (adjusted P = 0.004) and higher intensity statistics (adjusted P < 0.004, except skewness and kurtosis with P > 0.99) than did control subjects, with areas under the receiver operating characteristic curve ranging from 0.75 to 0.78 at optimized thresholds. CONCLUSIONS Elevated quantitative BPE parameters, related to both area and intensity of enhancement, are associated with breast cancer development.
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20
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Jatoi I, Anderson WF, Miller AB, Brawley OW. The history of cancer screening. Curr Probl Surg 2019; 56:138-163. [PMID: 30922446 DOI: 10.1067/j.cpsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology, Dale H. Dorn Endowed Chair in Surgery, University of Texas Health Science Center, San Antonio, TX.
| | - William F Anderson
- National Institutes of Health/National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MA
| | - Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Otis W Brawley
- Michael Bloomberg Distinguished Professor of Oncology and Public Health, Johns Hopkins University, Baltimore, MA
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21
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Baeyens-Fernández JA, Molina-Portillo E, Pollán M, Rodríguez-Barranco M, Del Moral R, Arribas-Mir L, Sánchez-Cantalejo Ramírez E, Sánchez MJ. Trends in incidence, mortality and survival in women with breast cancer from 1985 to 2012 in Granada, Spain: a population-based study. BMC Cancer 2018; 18:781. [PMID: 30068302 PMCID: PMC6090958 DOI: 10.1186/s12885-018-4682-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of breast cancer has increased since the 1970s. Despite favorable trends in prognosis, the role of changes in clinical practice and the introduction of screening remain controversial. We examined breast cancer trends to shed light on their determinants. METHODS Data were obtained for 8502 new cases of breast cancer in women between 1985 and 2012 from a population-based cancer registry in Granada (southern Spain), and for 2470 breast cancer deaths registered by the Andalusian Institute of Statistics. Joinpoint regression analyses of incidence and mortality rates were obtained. Observed and net survival rates were calculated for 1, 3 and 5 years. The results are reported here for overall survival and survival stratified by age group and tumor stage. RESULTS Overall, age-adjusted (European Standard Population) incidence rates increased from 48.0 cases × 100,000 women in 1985-1989 to 83.4 in 2008-2012, with an annual percentage change (APC) of 2.5% (95%CI, 2.1-2.9) for 1985-2012. The greatest increase was in women younger than 40 years (APC 3.5, 95%CI, 2.4-4.8). For 2000-2012 the incidence trend increased only for stage I tumors (APC 3.8, 95%CI, 1.9-5.8). Overall age-adjusted breast cancer mortality decreased (APC - 1, 95%CI, - 1.4 - - 0.5), as did mortality in the 50-69 year age group (APC - 1.3, 95%CI, - 2.2 - - 0.4). Age-standardized net survival increased from 67.5% at 5 years in 1985-1989 to 83.7% in 2010-2012. All age groups younger than 70 years showed a similar evolution. Five-year net survival rates were 96.6% for patients with tumors diagnosed in stage I, 88.2% for stage II, 62.5% for stage III and 23.3% for stage IV. CONCLUSIONS Breast cancer incidence is increasing - a reflection of the evolution of risk factors and increasing diagnostic pressure. After screening was introduced, the incidence of stage I tumors increased, with no decrease in the incidence of more advanced stages. Reductions were seen for overall mortality and mortality in the 50-69 year age group, but no changes were found after screening implementation. Survival trends have evolved favorably except for the 70-84 year age group and for metastatic tumors.
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Affiliation(s)
- José Antonio Baeyens-Fernández
- Departamento de Urgencias y Emergencias, Área de Gestión Sanitaria Noreste, Hospital Regional de Baza, Carretera de Murcia s/n, 18800 Baza, Spain
| | - Elena Molina-Portillo
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - Marina Pollán
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
- Environmental and Cancer Epidemiology Department, National Center of Epidemiology - Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - Rosario Del Moral
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
- Department of Radiotherapy and Oncology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Lorenzo Arribas-Mir
- Centro de Salud La Chana, Área de Gestión Sanitaria Granada-Metropolitano, Granada, Spain
- Department of Epidemiology and Public Health, University of Granada, Granada, Spain
| | - Emilio Sánchez-Cantalejo Ramírez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - María-José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
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22
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Jacklyn G, McGeechan K, Houssami N, Bell K, Glasziou PP, Barratt A. Overdiagnosis due to screening mammography for women aged 40 years and over. Hippokratia 2018. [DOI: 10.1002/14651858.cd013076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Gemma Jacklyn
- The University of Sydney; Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health; Edward Ford Building (A27) Sydney NSW Australia 2006
| | - Kevin McGeechan
- The University of Sydney; Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health; Edward Ford Building (A27) Sydney NSW Australia 2006
| | - Nehmat Houssami
- The University of Sydney; Sydney School of Public Health, Faculty of Medicine and Health; Sydney NSW Australia
| | - Katy Bell
- The University of Sydney; Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health; Edward Ford Building (A27) Sydney NSW Australia 2006
| | - Paul P Glasziou
- Bond University; Centre for Research in Evidence-Based Practice (CREBP); University Drive Gold Coast Queensland Australia 4229
| | - Alexandra Barratt
- The University of Sydney; Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health; Edward Ford Building (A27) Sydney NSW Australia 2006
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Suen SC, Goldhaber-Fiebert JD, Basu S. Matching Microsimulation Risk Factor Correlations to Cross-sectional Data: The Shortest Distance Method. Med Decis Making 2018; 38:452-464. [PMID: 29185378 PMCID: PMC5913001 DOI: 10.1177/0272989x17741635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Microsimulation models often compute the distribution of a simulated cohort's risk factors and medical outcomes over time using repeated waves of cross-sectional data. We sought to develop a strategy to simulate how risk factor values remain correlated over time within individuals, and compare it to available alternative methods. METHODS We developed a method using shortest-distance matching for modeling changes in risk factors in individuals over time, which preserves both the cohort distribution of each risk factor as well as the cross-sectional correlation between risk factors observed in repeated cross-sectional data. We compared the performance of the method with rank stability and regression methods, using both synthetic data and data from the Framingham Offspring Heart Study (FOHS) to simulate a cohort's atherosclerotic cardiovascular disease (ASCVD) risk. RESULTS The correlation between risk factors was better preserved using the shortest distance method than with rank stability or regression (root mean squared difference = 0.077 with shortest distance, v. 0.126 with rank stability and 0.146 with regression in FOHS, and 0.052, 0.426 and 0.352, respectively, in the synthetic data). The shortest distance method generated population ASCVD risk estimate distributions indistinguishable from the true distribution in over 99.8% of cases (Kolmogorov-Smirnov, P > 0.05), outperforming some existing regression methods, which produced ASCVD distributions statistically distinguishable from the true one at the 5% level around 15% of the time. LIMITATIONS None of the methods considered could predict individual longitudinal trends without error. The shortest-distance method was not statistically inferior to rank stability or regression methods for predicting individual risk factor values over time in the FOHS. CONCLUSIONS A shortest distance method may assist in preserving risk factor correlations in microsimulations informed by cross-sectional data.
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Affiliation(s)
- Sze-chuan Suen
- Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jeremy D. Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Sanjay Basu
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
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A modelling study to evaluate the costs and effects of lowering the starting age of population breast cancer screening. Maturitas 2018; 109:81-88. [DOI: 10.1016/j.maturitas.2017.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 10/09/2017] [Accepted: 12/08/2017] [Indexed: 01/28/2023]
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Miller AB. The role of screening mammography in the era of modern breast cancer treatment. Climacteric 2018; 21:204-208. [DOI: 10.1080/13697137.2017.1392503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A. B. Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Autier P, Boniol M. Mammography screening: A major issue in medicine. Eur J Cancer 2017; 90:34-62. [PMID: 29272783 DOI: 10.1016/j.ejca.2017.11.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/03/2017] [Indexed: 01/20/2023]
Abstract
Breast cancer mortality is declining in most high-income countries. The role of mammography screening in these declines is much debated. Screening impacts cancer mortality through decreasing the incidence of number of advanced cancers with poor prognosis, while therapies and patient management impact cancer mortality through decreasing the fatality of cancers. The effectiveness of cancer screening is the ability of a screening method to curb the incidence of advanced cancers in populations. Methods for evaluating cancer screening effectiveness are based on the monitoring of age-adjusted incidence rates of advanced cancers that should decrease after the introduction of screening. Likewise, cancer-specific mortality rates should decline more rapidly in areas with screening than in areas without or with lower levels of screening but where patient management is similar. These two criteria have provided evidence that screening for colorectal and cervical cancer contributes to decreasing the mortality associated with these two cancers. In contrast, screening for neuroblastoma in children was discontinued in the early 2000s because these two criteria were not met. In addition, overdiagnosis - i.e. the detection of non-progressing occult neuroblastoma that would not have been life-threatening during the subject's lifetime - is a major undesirable consequence of screening. Accumulating epidemiological data show that in populations where mammography screening has been widespread for a long time, there has been no or only a modest decline in the incidence of advanced cancers, including that of de novo metastatic (stage IV) cancers at diagnosis. Moreover, breast cancer mortality reductions are similar in areas with early introduction and high penetration of screening and in areas with late introduction and low penetration of screening. Overdiagnosis is commonplace, representing 20% or more of all breast cancers among women invited to screening and 30-50% of screen-detected cancers. Overdiagnosis leads to overtreatment and inflicts considerable physical, psychological and economic harm on many women. Overdiagnosis has also exerted considerable disruptive effects on the interpretation of clinical outcomes expressed in percentages (instead of rates) or as overall survival (instead of mortality rates or stage-specific survival). Rates of radical mastectomies have not decreased following the introduction of screening and keep rising in some countries (e.g. the United States of America (USA)). Hence, the epidemiological picture of mammography screening closely resembles that of screening for neuroblastoma. Reappraisals of Swedish mammography trials demonstrate that the design and statistical analysis of these trials were different from those of all trials on screening for cancers other than breast cancer. We found compelling indications that these trials overestimated reductions in breast cancer mortality associated with screening, in part because of the statistical analyses themselves, in part because of improved therapies and underreporting of breast cancer as the underlying cause of death in screening groups. In this regard, Swedish trials should publish the stage-specific breast cancer mortality rates for the screening and control groups separately. Results of the Greater New York Health Insurance Plan trial are biased because of the underreporting of breast cancer cases and deaths that occurred in women who did not participate in screening. After 17 years of follow-up, the United Kingdom (UK) Age Trial showed no benefit from mammography screening starting at age 39-41. Until around 2005, most proponents of breast screening backed the monitoring of changes in advanced cancer incidence and comparative studies on breast cancer mortality for the evaluation of breast screening effectiveness. However, in an attempt to mitigate the contradictions between results of mammography trials and population data, breast-screening proponents have elected to change the criteria for the evaluation of cancer screening effectiveness, giving precedence to incidence-based mortality (IBM) and case-control studies. But practically all IBM studies on mammography screening have a strong ecological component in their design. The two IBM studies done in Norway that meet all methodological requirements do not document significant reductions in breast cancer mortality associated with mammography screening. Because of their propensity to exaggerate the health benefits of screening, case-control studies may demonstrate that mammography screening could reduce the risk of death from diseases other than breast cancer. Numerous statistical model approaches have been conducted for estimating the contributions of screening and of patient management to reductions in breast cancer mortality. Unverified assumptions are needed for running these models. For instance, many models assume that if screening had not occurred, the majority of screen-detected asymptomatic cancers would have progressed to symptomatic advanced cancers. This assumption is not grounded in evidence because a large proportion of screen-detected breast cancers represent overdiagnosis and hence non-progressing tumours. The accumulation of population data in well-screened populations diminishes the relevance of model approaches. The comparison of the performance of different screening modalities - e.g. mammography, digital mammography, ultrasonography, magnetic resonance imaging (MRI), three-dimensional tomosynthesis (TDT) - concentrates on detection rates, which is the ability of a technique to detect more cancers than other techniques. However, a greater detection rate tells little about the capacity to prevent interval and advanced cancers and could just reflect additional overdiagnosis. Studies based on the incidence of advanced cancers and on the evaluation of overdiagnosis should be conducted before marketing new breast-imaging technologies. Women at high risk of breast cancer (i.e. 30% lifetime risk and more), such as women with BRCA1/2 mutations, require a close breast surveillance. MRI is the preferred imaging method until more radical risk-reduction options are eventually adopted. For women with an intermediate risk of breast cancer (i.e. 10-29% lifetime risk), including women with extremely dense breast at mammography, there is no evidence that more frequent mammography screening or screening with other modalities actually reduces the risk of breast cancer death. A plethora of epidemiological data shows that, since 1985, progress in the management of breast cancer patients has led to marked reductions in stage-specific breast cancer mortality, even for patients with disseminated disease (i.e. stage IV cancer) at diagnosis. In contrast, the epidemiological data point to a marginal contribution of mammography screening in the decline in breast cancer mortality. Moreover, the more effective the treatments, the less favourable are the harm-benefit balance of screening mammography. New, effective methods for breast screening are needed, as well as research on risk-based screening strategies.
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Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at IPRI, International Prevention Research Institute, Espace Européen, Building G, Allée Claude Debussy, 69130 Ecully Lyon, France; International Prevention Research Institute (iPRI), 95 Cours Lafayette, 69006 Lyon, France.
| | - Mathieu Boniol
- University of Strathclyde Institute of Global Public Health at IPRI, International Prevention Research Institute, Espace Européen, Building G, Allée Claude Debussy, 69130 Ecully Lyon, France; International Prevention Research Institute (iPRI), 95 Cours Lafayette, 69006 Lyon, France
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Autier P, Boniol M, Koechlin A, Pizot C, Boniol M. Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. BMJ 2017; 359:j5224. [PMID: 29208760 PMCID: PMC5712859 DOI: 10.1136/bmj.j5224] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To analyse stage specific incidence of breast cancer in the Netherlands where women have been invited to biennial mammography screening since 1989 (ages 50-69) and 1997 (ages 70-75), and to assess changes in breast cancer mortality and quantified overdiagnosis.Design Population based study.Setting Mammography screening programme, the Netherlands.Participants Dutch women of all ages, 1989 to 2012.Main outcome measures Stage specific age adjusted incidence of breast cancer from 1989 to 2012. The extra numbers of in situ and stage 1 breast tumours associated with screening were estimated by comparing rates in women aged 50-74 with those in age groups not invited to screening. Overdiagnosis was estimated after subtraction of the lead time cancers. Breast cancer mortality reductions and overdiagnosis during 2010-12 were computed without (scenario 1) and with (scenario 2) a cohort effect on mortality secular trends.Results The incidence of stage 2-4 breast cancers in women aged 50 or more was 168 per 100 000 in 1989 and 166 per 100 000 in 2012. Screening would be associated with a 5% mortality reduction in scenario 1 and with no influence on mortality in scenario 2. In both scenarios, improved treatments would be associated with 28% reductions in mortality. Overdiagnosis has steadily increased over time with the extension of screening to women aged 70-75 and with the introduction of digital mammography. After deduction of clinical lead time cancers, 33% of cancers found in women invited to screening in 2010-12 and 59% of screen detected cancers would be overdiagnosed.Conclusions The Dutch mammography screening programme seems to have little impact on the burden of advanced breast cancers, which suggests a marginal effect on breast cancer mortality. About half of screen detected breast cancers would represent overdiagnosis.
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Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
| | - Magali Boniol
- International Prevention Research Institute, Lyon, France
| | - Alice Koechlin
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
| | - Cécile Pizot
- International Prevention Research Institute, Lyon, France
| | - Mathieu Boniol
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
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Jacklyn G, Howard K, Irwig L, Houssami N, Hersch J, Barratt A. Impact of extending screening mammography to older women: Information to support informed choices. Int J Cancer 2017; 141:1540-1550. [PMID: 28662267 DOI: 10.1002/ijc.30858] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/24/2017] [Accepted: 06/22/2017] [Indexed: 01/19/2023]
Abstract
From 2013 through 2017, the Australian national breast cancer screening programme is gradually inviting women aged 70-74 years to attend screening, following a policy decision to extend invitations to older women. We estimate the benefits and harms of the new package of biennial screening from age 50-74 compared with the previous programme of screening from age 50-69. Using a Markov model, we applied estimates of the relative risk reduction for breast cancer mortality and the risk of overdiagnosis from the Independent UK Panel on Breast Cancer Screening review to Australian breast cancer incidence and mortality data. We estimated screening specific outcomes (recalls for further imaging, biopsies, false positives, and interval cancer rates) from data published by BreastScreen Australia. When compared with stopping at age 69, screening 1,000 women to age 74 is likely to avert one more breast cancer death, with an additional 78 women receiving a false positive result and another 28 women diagnosed with breast cancer, of whom eight will be overdiagnosed and overtreated. The extra 5 years of screening results in approximately 7 more overdiagnosed cancers to avert one more breast cancer death. Thus extending screening mammography in Australia to older women results in a less favourable harm to benefit ratio than stopping at age 69. Supporting informed decision making for this age group should be a public health priority.
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Affiliation(s)
- Gemma Jacklyn
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Les Irwig
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
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Kim SY, Han BK, Kim EK, Choi WJ, Choi Y, Kim HH, Moon WK. Breast Cancer Detected at Screening US: Survival Rates and Clinical-Pathologic and Imaging Factors Associated with Recurrence. Radiology 2017; 284:354-364. [PMID: 28387638 DOI: 10.1148/radiol.2017162348] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose To determine the survival rates and clinical-pathologic and imaging factors associated with recurrence in women with breast cancer detected at screening ultrasonography (US). Materials and Methods This study was approved by the institutional review board, and the requirement to obtain informed consent was waived. A retrospective review of the databases of four institutions identified 501 women (median age, 47 years; range, 27-74 years) with breast cancer (425 invasive cancers and 76 ductal carcinoma in situ) detected at screening US between January 2004 and March 2011. Five-year overall survival (OS) and recurrence-free survival (RFS) rates were estimated, and the clinical-pathologic and imaging data were collected. Multivariate analysis was performed by using Cox proportional hazard regression to determine factors associated with recurrence. Results At a median follow-up of 7.0 years (range, 5.0-12.1 years), 15 (3.0%) recurrences were detected: five in ipsilateral breast and 10 in contralateral breast. The 5-year OS and RFS rates were 100% and 98.0% (95% confidence interval [CI]: 96.8%, 99.2%), respectively. In patients with invasive cancers, age younger than 40 years (hazard ratio: 3.632 [95% CI: 1.099, 11.998]; P = .032), the triple-negative subtype (hazard ratio: 7.498 [95% CI: 2.266, 24.816]; P = .001), and Breast Imaging Reporting and Data System (BI-RADS) category 4A lesions (hazard ratio: 5.113 [95% CI: 1.532, 17.195]; P = .008) were associated with recurrence. Conclusion Women with breast cancers detected at screening US have excellent outcomes, with a 5-year RFS rate of 98.0%. However, in patients with invasive breast cancer, age younger than 40 years, the triple-negative subtype, and BI-RADS category 4A lesions were associated with recurrence. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Soo-Yeon Kim
- From the Department of Radiology (S.Y.K., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (B.K.H.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.K.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (W.J.C., H.H.K.)
| | - Boo-Kyung Han
- From the Department of Radiology (S.Y.K., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (B.K.H.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.K.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (W.J.C., H.H.K.)
| | - Eun-Kyung Kim
- From the Department of Radiology (S.Y.K., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (B.K.H.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.K.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (W.J.C., H.H.K.)
| | - Woo Jung Choi
- From the Department of Radiology (S.Y.K., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (B.K.H.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.K.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (W.J.C., H.H.K.)
| | - Yunhee Choi
- From the Department of Radiology (S.Y.K., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (B.K.H.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.K.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (W.J.C., H.H.K.)
| | - Hak Hee Kim
- From the Department of Radiology (S.Y.K., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (B.K.H.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.K.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (W.J.C., H.H.K.)
| | - Woo Kyung Moon
- From the Department of Radiology (S.Y.K., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (B.K.H.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.K.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (W.J.C., H.H.K.)
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Mustacchi G, Generali D. Cost-effectiveness and sustainability of breast cancer screening and new anti-cancer drugs. J Med Econ 2017; 20:405-408. [PMID: 28105869 DOI: 10.1080/13696998.2017.1285306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Shieh Y, Eklund M, Sawaya GF, Black WC, Kramer BS, Esserman LJ. Population-based screening for cancer: hope and hype. Nat Rev Clin Oncol 2016; 13:550-65. [PMID: 27071351 PMCID: PMC6585415 DOI: 10.1038/nrclinonc.2016.50] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Several important lessons have been learnt from our experiences in screening for various cancers. Screening programmes for cervical and colorectal cancers have had the greatest success, probably because these cancers are relatively homogenous, slow-growing, and have identifiable precursors that can be detected and removed; however, identifying the true obligate precursors of invasive disease remains a challenge. With regard to screening for breast cancer and for prostate cancer, which focus on early detection of invasive cancer, preferential detection of slower-growing, localized cancers has occurred, which has led to concerns about overdiagnosis and overtreatment; programmes for early detection of invasive lung cancers are emerging, and have faced similar challenges. A crucial consideration in screening for breast, prostate, and lung cancers is their remarkable phenotypic heterogeneity, ranging from indolent to highly aggressive. Efforts have been made to address the limitations of cancer-screening programmes, providing an opportunity for cross-disciplinary learning and further advancement of the science. Current innovations are aimed at identifying the individuals who are most likely to benefit from screening, increasing the yield of consequential cancers on screening and biopsy, and using molecular tests to improve our understanding of disease biology and to tailor treatment. We discuss each of these concepts and outline a dynamic framework for continuous improvements in the field of cancer screening.
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Affiliation(s)
- Yiwey Shieh
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1545 Divisadero Street, San Francisco, California 94115, USA
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17177 Stockholm, Sweden
| | - George F Sawaya
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, California 94158, USA
| | - William C Black
- Department of Radiology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756, USA
| | - Barnett S Kramer
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Bethesda, Maryland 20892, USA
| | - Laura J Esserman
- Departments of Surgery and Radiology, University of California, San Francisco, 1600 Divisadero Street, Box 1710, San Francisco, California 94115, USA
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Rahbar H, McDonald ES, Lee JM, Partridge SC, Lee CI. How Can Advanced Imaging Be Used to Mitigate Potential Breast Cancer Overdiagnosis? Acad Radiol 2016; 23:768-73. [PMID: 27017136 DOI: 10.1016/j.acra.2016.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 02/08/2023]
Abstract
Radiologists, as administrators and interpreters of screening mammography, are considered by some to be major contributors to the potential harms of screening, including overdiagnosis and overtreatment. In this article, we outline current efforts within the breast imaging community toward mitigating screening harms, including the widespread adoption of tomosynthesis and potentially adjusting screening frequency and thresholds for image-guided breast biopsy. However, the emerging field of breast radiomics may offer the greatest promise for reducing overdiagnosis by identifying imaging-based biomarkers strongly associated with tumor biology, and therefore helping prevent the harms of unnecessary treatment for indolent cancers.
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Autier P, Boniol M, Smans M, Sullivan R, Boyle P. Observed and Predicted Risk of Breast Cancer Death in Randomized Trials on Breast Cancer Screening. PLoS One 2016; 11:e0154113. [PMID: 27100174 PMCID: PMC4839680 DOI: 10.1371/journal.pone.0154113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 04/08/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The role of breast screening in breast cancer mortality declines is debated. Screening impacts cancer mortality through decreasing the number of advanced cancers with poor diagnosis, while cancer treatment works through decreasing the case-fatality rate. Hence, reductions in cancer death rates thanks to screening should directly reflect reductions in advanced cancer rates. We verified whether in breast screening trials, the observed reductions in the risk of breast cancer death could be predicted from reductions of advanced breast cancer rates. PATIENTS AND METHODS The Greater New York Health Insurance Plan trial (HIP) is the only breast screening trial that reported stage-specific cancer fatality for the screening and for the control group separately. The Swedish Two-County trial (TCT)) reported size-specific fatalities for cancer patients in both screening and control groups. We computed predicted numbers of breast cancer deaths, from which we calculated predicted relative risks (RR) and (95% confidence intervals). The Age trial in England performed its own calculations of predicted relative risk. RESULTS The observed and predicted RR of breast cancer death were 0.72 (0.56-0.94) and 0.98 (0.77-1.24) in the HIP trial, and 0.79 (0.78-1.01) and 0.90 (0.80-1.01) in the Age trial. In the TCT, the observed RR was 0.73 (0.62-0.87), while the predicted RR was 0.89 (0.75-1.05) if overdiagnosis was assumed to be negligible and 0.83 (0.70-0.97) if extra cancers were excluded. CONCLUSIONS In breast screening trials, factors other than screening have contributed to reductions in the risk of breast cancer death most probably by reducing the fatality of advanced cancers in screening groups. These factors were the better management of breast cancer patients and the underreporting of breast cancer as the underlying cause of death. Breast screening trials should publish stage-specific fatalities observed in each group.
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Affiliation(s)
- Philippe Autier
- Strathclyde Institute of Global Public Health at iPRI, Lyon, France
- International Prevention Research Institute (iPRI), Lyon, France
- * E-mail:
| | - Mathieu Boniol
- Strathclyde Institute of Global Public Health at iPRI, Lyon, France
- International Prevention Research Institute (iPRI), Lyon, France
| | - Michel Smans
- International Prevention Research Institute (iPRI), Lyon, France
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Cancer Centre, Bermondsey Wing, Guy’s Campus, London, United Kingdom
| | - Peter Boyle
- Strathclyde Institute of Global Public Health at iPRI, Lyon, France
- International Prevention Research Institute (iPRI), Lyon, France
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