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Giorgi Rossi P, Mancuso P, Pattacini P, Campari C, Nitrosi A, Iotti V, Ponti A, Frigerio A, Correale L, Riggi E, Giordano L, Segnan N, Di Leo G, Magni V, Sardanelli F, Fornasa F, Romanucci G, Montemezzi S, Falini P, Auzzi N, Zappa M, Ottone M, Mantellini P, Duffy SW, Armaroli P, Coriani C, Pescarolo M, Stefanelli G, Tondelli G, Beretti F, Caffarri S, Marchesi V, Canovi L, Colli M, Boschini M, Bertolini M, Ragazzi M, Pattacini P, Giorgi Rossi P, Iotti V, Ginocchi V, Ravaioli S, Vacondio R, Campari C, Caroli S, Nitrosi A, Braglia L, Cavuto S, Mancuso P, Djuric O, Venturelli F, Vicentini M, Braghiroli MB, Lonetti J, Davoli E, Bonelli E, Fornasa F, Montemezzi S, Romanucci G, Lucchi I, Martello G, Rossati C, Mantellini P, Ambrogetti D, Iossa A, Carnesciali E, Mazzalupo V, Falini P, Puliti D, Zappa M, Battisti F, Auzzi N, Verdi S, Degl'Innocenti C, Tramalloni D, Cavazza E, Busoni S, Betti E, Peruzzi F, Regini F, Sardanelli F, Di Leo G, Carbonaro LA, Magni V, Cozzi A, Spinelli D, Monaco CG, Schiaffino S, Benedek A, Menicagli L, Ferraris R, Favettini E, Dettori D, Falco P, Presti P, Segnan N, Ponti A, Frigerio A, Armaroli P, Correale L, Marra V, Milanesio L, Artuso F, Di Leo A, Castellano I, Riggi E, Casella D, Pitarella S, Vergini V, Giordano L, Duffy SW, Graewingholt A, Lang K, Falcini F. Comparing accuracy of tomosynthesis plus digital mammography or synthetic 2D mammography in breast cancer screening: baseline results of the MAITA RCT consortium. Eur J Cancer 2024; 199:113553. [PMID: 38262307 DOI: 10.1016/j.ejca.2024.113553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/01/2024] [Accepted: 01/06/2024] [Indexed: 01/25/2024]
Abstract
AIM The analyses here reported aim to compare the screening performance of digital tomosynthesis (DBT) versus mammography (DM). METHODS MAITA is a consortium of four Italian trials, REtomo, Proteus, Impeto, and MAITA trial. The trials adopted a two-arm randomised design comparing DBT plus DM (REtomo and Proteus) or synthetic-2D (Impeto and MAITA trial) versus DM; multiple vendors were included. Women aged 45 to 69 years were individually randomised to one round of DBT or DM. FINDINGS From March 2014 to February 2022, 50,856 and 63,295 women were randomised to the DBT and DM arm, respectively. In the DBT arm, 6656 women were screened with DBT plus synthetic-2D. Recall was higher in the DBT arm (5·84% versus 4·96%), with differences between centres. With DBT, 0·8/1000 (95% CI 0·3 to 1·3) more women received surgical treatment for a benign lesion. The detection rate was 51% higher with DBT, ie. 2·6/1000 (95% CI 1·7 to 3·6) more cancers detected, with a similar relative increase for invasive cancers and ductal carcinoma in situ. The results were similar below and over the age of 50, at first and subsequent rounds, and with DBT plus DM and DBT plus synthetic-2D. No learning curve was appreciable. Detection of cancers >= 20 mm, with 2 or more positive lymph nodes, grade III, HER2-positive, or triple-negative was similar in the two arms. INTERPRETATION Results from MAITA confirm that DBT is superior to DM for the detection of cancers, with a possible increase in recall rate. DBT performance in screening should be assessed locally while waiting for long-term follow-up results on the impact of advanced cancer incidence.
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Affiliation(s)
| | | | | | - Cinzia Campari
- Screening coordinating centre, AUSL - IRCCS di Reggio Emilia, Italy
| | - Andrea Nitrosi
- Medical Physics unit, AUSL - IRCCS di Reggio Emilia, Italy
| | | | - Antonio Ponti
- SSD Epidemiologia e Screening. AOU Città della Salute e della Scienza, CPO Piemonte Torino, Italy
| | - Alfonso Frigerio
- SSD Senologia di Screening AOU Città della Salute e della Scienza, CPO Piemonte Torino, Italy
| | - Loredana Correale
- SSD Epidemiologia e Screening. AOU Città della Salute e della Scienza, CPO Piemonte Torino, Italy
| | - Emilia Riggi
- SSD Epidemiologia e Screening. AOU Città della Salute e della Scienza, CPO Piemonte Torino, Italy
| | - Livia Giordano
- SSD Epidemiologia e Screening. AOU Città della Salute e della Scienza, CPO Piemonte Torino, Italy
| | - Nereo Segnan
- SSD Epidemiologia e Screening. AOU Città della Salute e della Scienza, CPO Piemonte Torino, Italy
| | - Giovanni Di Leo
- IRCC Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Francesco Sardanelli
- IRCC Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Francesca Fornasa
- Breast Unit ULSS9 Scaligera, Ospedale Fracastoro, Via Circonvallazione, 1, 37047 San Bonifacio, VR, Italy
| | - Giovanna Romanucci
- Breast Unit ULSS9 Scaligera, Ospedale Fracastoro, Via Circonvallazione, 1, 37047 San Bonifacio, VR, Italy
| | | | - Patrizia Falini
- ISPRO - Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Firenze, Italy
| | - Noemi Auzzi
- ISPRO - Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Firenze, Italy
| | - Marco Zappa
- ISPRO - Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Firenze, Italy
| | - Marta Ottone
- Epidemiology Unit, AUSL - IRCCS di Reggio Emilia, Italy
| | - Paola Mantellini
- ISPRO - Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Firenze, Italy
| | - Stephen W Duffy
- Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Paola Armaroli
- SSD Epidemiologia e Screening. AOU Città della Salute e della Scienza, CPO Piemonte Torino, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Francesca Fornasa
- Breast Unit ULSS9 Scaligera, Ospedale Fracastoro, Via Circonvallazione, 1, 37047 San Bonifacio, VR, Italy
| | | | - Giovanna Romanucci
- Breast Unit ULSS9 Scaligera, Ospedale Fracastoro, Via Circonvallazione, 1, 37047 San Bonifacio, VR, Italy
| | - Ilaria Lucchi
- Breast Unit ULSS9 Scaligera, Ospedale Fracastoro, Via Circonvallazione, 1, 37047 San Bonifacio, VR, Italy
| | - Gessica Martello
- Breast Unit ULSS9 Scaligera, Ospedale Fracastoro, Via Circonvallazione, 1, 37047 San Bonifacio, VR, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giovanni Di Leo
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Veronica Magni
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Andrea Cozzi
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Diana Spinelli
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | - Adrienn Benedek
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Laura Menicagli
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Axel Graewingholt
- Mammographiescreening-Zentrum Paderborn, Breast Cancer Screening, Paderborn, NRW, Germany
| | - Kristina Lang
- Departement of Translational Medicine, Lund University, Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden
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Chiorino G, Petracci E, Sehovic E, Gregnanin I, Camussi E, Mello-Grand M, Ostano P, Riggi E, Vergini V, Russo A, Berrino E, Ortale A, Garena F, Venesio T, Gallo F, Favettini E, Frigerio A, Matullo G, Segnan N, Giordano L. Plasma microRNA ratios associated with breast cancer detection in a nested case-control study from a mammography screening cohort. Sci Rep 2023; 13:12040. [PMID: 37491482 PMCID: PMC10368693 DOI: 10.1038/s41598-023-38886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/17/2023] [Indexed: 07/27/2023] Open
Abstract
Mammographic breast cancer screening is effective in reducing breast cancer mortality. Nevertheless, several limitations are known. Therefore, developing an alternative or complementary non-invasive tool capable of increasing the accuracy of the screening process is highly desirable. The objective of this study was to identify circulating microRNA (miRs) ratios associated with BC in women attending mammography screening. A nested case-control study was conducted within the ANDROMEDA cohort (women of age 46-67 attending BC screening). Pre-diagnostic plasma samples, information on life-styles and common BC risk factors were collected. Small-RNA sequencing was carried out on plasma samples from 65 cases and 66 controls. miR ratios associated with BC were selected by two-sample Wilcoxon test and lasso logistic regression. Subsequent assessment by RT-qPCR of the miRs contained in the selected miR ratios was carried out as a platform validation. To identify the most promising biomarkers, penalised logistic regression was further applied to candidate miR ratios alone, or in combination with non-molecular factors. Small-RNA sequencing yielded 20 candidate miR ratios associated with BC, which were further assessed by RT-qPCR. In the resulting model, penalised logistic regression selected seven miR ratios (miR-199a-3p_let-7a-5p, miR-26b-5p_miR-142-5p, let-7b-5p_miR-19b-3p, miR-101-3p_miR-19b-3p, miR-93-5p_miR-19b-3p, let-7a-5p_miR-22-3p and miR-21-5p_miR-23a-3p), together with body mass index (BMI), menopausal status (MS), the interaction term BMI * MS, life-style score and breast density. The ROC AUC of the model was 0.79 with a sensitivity and specificity of 71.9% and 76.6%, respectively. We identified biomarkers potentially useful for BC screening measured through a widespread and low-cost technique. This is the first study reporting circulating miRs for BC detection in a screening setting. Validation in a wider sample is warranted.Trial registration: The Andromeda prospective cohort study protocol was retrospectively registered on 27-11-2015 (NCT02618538).
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Affiliation(s)
- Giovanna Chiorino
- Cancer Genomics Lab, Fondazione Edo ed Elvo Tempia, Via Malta 3, 13900, Biella, Italy
| | - Elisabetta Petracci
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Emir Sehovic
- Cancer Genomics Lab, Fondazione Edo ed Elvo Tempia, Via Malta 3, 13900, Biella, Italy.
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy.
| | - Ilaria Gregnanin
- Cancer Genomics Lab, Fondazione Edo ed Elvo Tempia, Via Malta 3, 13900, Biella, Italy
| | - Elisa Camussi
- SSD Epidemiologia Screening, CPO-AOU Città della Salute e della Scienza di Torino, Via Camillo Benso Di Cavour 31, 10123, Turin, Italy
| | - Maurizia Mello-Grand
- Cancer Genomics Lab, Fondazione Edo ed Elvo Tempia, Via Malta 3, 13900, Biella, Italy
| | - Paola Ostano
- Cancer Genomics Lab, Fondazione Edo ed Elvo Tempia, Via Malta 3, 13900, Biella, Italy
| | - Emilia Riggi
- SSD Epidemiologia Screening, CPO-AOU Città della Salute e della Scienza di Torino, Via Camillo Benso Di Cavour 31, 10123, Turin, Italy
| | - Viviana Vergini
- SSD Epidemiologia Screening, CPO-AOU Città della Salute e della Scienza di Torino, Via Camillo Benso Di Cavour 31, 10123, Turin, Italy
| | - Alessia Russo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrico Berrino
- Department of Medical Sciences, University of Turin, Turin, Italy
- Pathology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Andrea Ortale
- SSD Epidemiologia Screening, CPO-AOU Città della Salute e della Scienza di Torino, Via Camillo Benso Di Cavour 31, 10123, Turin, Italy
| | - Francesca Garena
- SSD Epidemiologia Screening, CPO-AOU Città della Salute e della Scienza di Torino, Via Camillo Benso Di Cavour 31, 10123, Turin, Italy
| | - Tiziana Venesio
- Pathology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Federica Gallo
- Epidemiology Unit, Staff Health Direction, Local Health Authority 1 of Cuneo, Cuneo, Italy
| | | | - Alfonso Frigerio
- SSD Epidemiologia Screening, CPO-AOU Città della Salute e della Scienza di Torino, Via Camillo Benso Di Cavour 31, 10123, Turin, Italy
| | - Giuseppe Matullo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Nereo Segnan
- SSD Epidemiologia Screening, CPO-AOU Città della Salute e della Scienza di Torino, Via Camillo Benso Di Cavour 31, 10123, Turin, Italy.
| | - Livia Giordano
- SSD Epidemiologia Screening, CPO-AOU Città della Salute e della Scienza di Torino, Via Camillo Benso Di Cavour 31, 10123, Turin, Italy
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Armaroli P, Frigerio A, Correale L, Ponti A, Artuso F, Casella D, Falco P, Favettini E, Fonio P, Giordano L, Marra V, Milanesio L, Morra L, Presti P, Riggi E, Vergini V, Segnan N. A randomised controlled trial of digital breast tomosynthesis vs digital mammography as primary screening tests: Screening results over subsequent episodes of the Proteus Donna study. Int J Cancer 2022; 151:1778-1790. [PMID: 35689673 DOI: 10.1002/ijc.34161] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022]
Abstract
Proteus Donna is a randomised controlled trial aimed at prospectively evaluating screening with digital breast tomosynthesis (DBT), including interval cancer detection (ICD) and cancer detection (CD) in the analysis as a cumulative measure over subsequent screening episodes. Consenting women aged 46 to 68 attending the regional Breast Screening Service were randomly assigned to conventional digital mammography (DM, control arm) or DBT in addition to DM (DBT, study arm). At the subsequent round all participants underwent DM. Thirty-six months follow-up allowed for the identification of cancers detected in the subsequent screening and interscreening interval. Relative risk (RR) and 95% confidence interval (95% CI) were computed. Cumulative CD and Nelson-Aalen incidence were analysed over the follow-up period. Between 31 December 2014 and 31 December 2017, 43 022 women were randomised to DM and 30 844 to DBT. At baseline, CD was significantly higher (RR: 1.44, 95% CI: 1.21-1.71) in the study arm. ICD did not differ significantly between the two arms (RR: 0.92, 95% CI: 0.62-1.35). At subsequent screening with DM, the CD was lower (nearly significant) in the study arm (RR: 0.83, 95% CI: 0.65-1.06). Over the follow-up period, the cumulative CD (comprehensive of ICD) was slightly higher in the study arm (RR: 1.15, 95% CI: 1.01-1.31). The Nelson-Aalen cumulative incidence over time remained significantly higher in the study arm for approximately 24 months. Benign lesions detection was higher in the study arm at baseline and lower at subsequent tests. Outcomes are consistent with a lead time gain of DBT compared to DM, with an increase in false positives and moderate overdiagnosis.
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Affiliation(s)
- Paola Armaroli
- S.S.D. Epidemiologia Screening, CPO AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alfonso Frigerio
- S.S.D. Senologia di Screening, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Loredana Correale
- S.S.D. Epidemiologia Screening, CPO AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Ponti
- S.S.D. Epidemiologia Screening, CPO AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Franca Artuso
- S.S.D. Senologia di Screening, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Denise Casella
- S.S.D. Epidemiologia Screening, CPO AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Paolo Fonio
- Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Livia Giordano
- S.S.D. Epidemiologia Screening, CPO AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Vincenzo Marra
- S.C. Radiologia Sant'Anna, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisella Milanesio
- S.S.D. Senologia di Screening, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lia Morra
- Dipartimento di Automatica e Informatica, Politecnico di Torino, Turin, Italy
| | | | - Emilia Riggi
- S.S.D. Epidemiologia Screening, CPO AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Viviana Vergini
- S.S.D. Epidemiologia Screening, CPO AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Nereo Segnan
- S.S.D. Epidemiologia Screening, CPO AOU Città della Salute e della Scienza di Torino, Turin, Italy
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