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Pediconi F, Galati F, Bernardi D, Belli P, Brancato B, Calabrese M, Camera L, Carbonaro LA, Caumo F, Clauser P, Girardi V, Iacconi C, Martincich L, Panizza P, Petrillo A, Schiaffino S, Tagliafico A, Trimboli RM, Zuiani C, Sardanelli F, Montemezzi S. Breast imaging and cancer diagnosis during the COVID-19 pandemic: recommendations from the Italian College of Breast Radiologists by SIRM. LA RADIOLOGIA MEDICA 2020; 125:926-930. [PMID: 32661780 PMCID: PMC7357257 DOI: 10.1007/s11547-020-01254-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022]
Abstract
The Italian College of Breast Radiologists by the Italian Society of Medical Radiology (SIRM) provides recommendations for breast care provision and procedural prioritization during COVID-19 pandemic, being aware that medical decisions must be currently taken balancing patient's individual and community safety: (1) patients having a scheduled or to-be-scheduled appointment for in-depth diagnostic breast imaging or needle biopsy should confirm the appointment or obtain a new one; (2) patients who have suspicious symptoms of breast cancer (in particular: new onset palpable nodule; skin or nipple retraction; orange peel skin; unilateral secretion from the nipple) should request non-deferrable tests at radiology services; (3) asymptomatic women performing annual mammographic follow-up after breast cancer treatment should preferably schedule the appointment within 1 year and 3 months from the previous check, compatibly with the local organizational conditions; (4) asymptomatic women who have not responded to the invitation for screening mammography after the onset of the pandemic or have been informed of the suspension of the screening activity should schedule the check preferably within 3 months from the date of the not performed check, compatibly with local organizational conditions. The Italian College of Breast Radiologists by SIRM recommends precautions to protect both patients and healthcare workers (radiologists, radiographers, nurses, and reception staff) from infection or disease spread on the occasion of breast imaging procedures, particularly mammography, breast ultrasound, breast magnetic resonance imaging, and breast intervention procedures.
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Affiliation(s)
- Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Daniela Bernardi
- Breast Imaging and Screening Unit, Department of Radiology, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Paolo Belli
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Beniamino Brancato
- Struttura Complessa di Senologia Clinica, Istituto per lo Studio la Prevenzione e la Rete Oncologica (ISPRO), Via Cosimo il Vecchio, 2, 50139, Florence, Italy
| | - Massimo Calabrese
- UOC Senologia Diagnostica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Camera
- Department of Pathology and Diagnostics - Radiology Unit, University Hospital of Verona, Verona, Italy
| | - Luca A Carbonaro
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | | | - Paola Clauser
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Veronica Girardi
- Breast Unit Eusoma Certificated, Department of Breast Imaging and Intervention, Istituto clinico S. Anna, Via del Franzone 31, 25127, Brescia, Italy
| | | | - Laura Martincich
- Unit of Radiodiagnostics, Ospedale Cardinal G. Massaia -ASL AT, Via Conte Verde 125, 14100, Asti, Italy
| | - Pietro Panizza
- Breast Imaging Unit, Scientific Institute (IRCCS) Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Antonella Petrillo
- Radiology Division, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - Alberto Tagliafico
- Department of Health Sciences (DISSAL)- Radiology Section, University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
- IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi. 10, 16132, Genoa, Italy
| | - Rubina M Trimboli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - Chiara Zuiani
- Institute of Radiology, University of Udine, Piazzale S. M. della Misericordia 15, 33100, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
| | - Stefania Montemezzi
- Department of Pathology and Diagnostics - Radiology Unit, University Hospital of Verona, Verona, Italy
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152
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Trimboli RM, Giorgi Rossi P, Battisti NML, Cozzi A, Magni V, Zanardo M, Sardanelli F. Do we still need breast cancer screening in the era of targeted therapies and precision medicine? Insights Imaging 2020; 11:105. [PMID: 32975658 PMCID: PMC7519022 DOI: 10.1186/s13244-020-00905-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/20/2020] [Indexed: 12/27/2022] Open
Abstract
Breast cancer (BC) is the most common female cancer and the second cause of death among women worldwide. The 5-year relative survival rate recently improved up to 90% due to increased population coverage and women's attendance to organised mammography screening as well as to advances in therapies, especially systemic treatments. Screening attendance is associated with a mortality reduction of at least 30% and a 40% lower risk of advanced disease. The stage at diagnosis remains the strongest predictor of recurrences. Systemic treatments evolved dramatically over the last 20 years: aromatase inhibitors improved the treatment of early-stage luminal BC; targeted monoclonal antibodies changed the natural history of anti-human epidermal growth factor receptor 2-positive (HER2) disease; immunotherapy is currently investigated in patients with triple-negative BC; gene expression profiling is now used with the aim of personalising systemic treatments. In the era of precision medicine, it is a challenging task to define the relative contribution of early diagnosis by screening mammography and systemic treatments in determining BC survival. Estimated contributions before 2000 were 46% for screening and 54% for treatment advances and after 2000, 37% and 63%, respectively. A model showed that the 10-year recurrence rate would be 30% and 25% using respectively chemotherapy or novel treatments in the absence of screening, but would drop to 19% and 15% respectively if associated with mammography screening. Early detection per se has not a curative intent and systemic treatment has limited benefit on advanced stages. Both screening mammography and systemic therapies continue to positively contribute to BC prognosis.
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Affiliation(s)
- Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Nicolò Matteo Luca Battisti
- Breast Unit–Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT UK
- Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Veronica Magni
- Medical School, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
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153
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Carethers JM, Sengupta R, Blakey R, Ribas A, D'Souza G. Disparities in Cancer Prevention in the COVID-19 Era. Cancer Prev Res (Phila) 2020; 13:893-896. [PMID: 32943438 DOI: 10.1158/1940-6207.capr-20-0447] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/01/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
Screening for cancer is a proven and recommended approach to prevent deaths from cancer; screening can locate precursor lesions and/or cancer at early stages when it is potentially curable. Racial and ethnic minorities and other medically underserved populations exhibit lower uptake of cancer screening than nonminorities in the United States. The COVID-19 pandemic, which disproportionately affected minority communities, has curtailed preventive services including cancer screening to preserve personal protective equipment and prevent spread of infection. While there is evidence for a rebound from the pandemic-driven reduction in cancer screening nationally, the return may not be even across all populations, with minority population screening that was already behind becoming further behind as a result of the community ravages from COVID-19. Fear of contracting COVID-19, limited access to safety-net clinics, and personal factors like, financial, employment, and transportation issues are concerns that are intensified in medically underserved communities. Prolonged delays in cancer screening will increase cancer in the overall population from pre-COVID-19 trajectories, and elevate the cancer disparity in minority populations. Knowing the overall benefit of cancer screening versus the risk of acquiring COVID-19, utilizing at-home screening tests and keeping the COVID-19-induced delay in screening to a minimum might slow the growth of disparity.
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Affiliation(s)
- John M Carethers
- Departments of Internal Medicine and Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.
| | - Rajarshi Sengupta
- American Association for Cancer Research, Philadelphia, Pennsylvania
| | - Rea Blakey
- Oncology Center of Excellence, Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Antoni Ribas
- Departments of Medicine, Surgery, and Molecular and Medical Pharmacology, and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California
| | - Gypsyamber D'Souza
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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154
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Tabár L, Chen THH, Yen AMF, Dean PB, Smith RA, Jonsson H, Törnberg S, Chen SLS, Chiu SYH, Fann JCY, Ku MMS, Wu WYY, Hsu CY, Chen YC, Svane G, Azavedo E, Grundström H, Sundén P, Leifland K, Frodis E, Ramos J, Epstein B, Åkerlund A, Sundbom A, Bordás P, Wallin H, Starck L, Björkgren A, Carlson S, Fredriksson I, Ahlgren J, Öhman D, Holmberg L, Duffy SW. Early detection of breast cancer rectifies inequality of breast cancer outcomes. J Med Screen 2020; 28:34-38. [PMID: 32370610 PMCID: PMC7905745 DOI: 10.1177/0969141320921210] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives To explain apparent differences among mammography screening services in Sweden using individual data on participation in screening and with breast cancer–specific survival as an outcome. Methods We analysed breast cancer survival data from the Swedish Cancer Register on breast cancer cases from nine Swedish counties diagnosed in women eligible for screening. Data were available on 38,278 breast cancers diagnosed and 4312 breast cancer deaths. Survival to death from breast cancer was estimated using the Kaplan–Meier estimate, for all cases in each county, and separately for cases of women participating and not participating in their last invitation to screening. Formal statistical comparisons of survival were made using proportional hazards regression. Results All counties showed a reduction in the hazard of breast cancer death with participation in screening, but the reductions for individual counties varied substantially, ranging from 51% (95% confidence interval 46–55%) to 81% (95% confidence interval 74–85%). Survival rates in nonparticipating women ranged from 53% (95% confidence interval 40–65%) to 74% (95% confidence interval 72–77%), while the corresponding survival in women participating in screening varied from 80% (95% confidence interval 77–84%) to 86% (95% confidence interval 83–88%), a considerably narrower range. Conclusions Differences among counties in the effect of screening on breast cancer outcomes were mainly due to variation in survival in women not participating in screening. Screening conferred similarly high survival rates in all counties. This indicates that the performance of screening services was similar across counties and that detection and treatment of breast cancer in early-stage reduces inequalities in breast cancer outcome.
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Affiliation(s)
| | | | | | - Peter B Dean
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | | | - Håkan Jonsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Sven Törnberg
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden
| | | | | | | | | | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | | | - Gunilla Svane
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden
| | - Edward Azavedo
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden
| | | | | | | | - Ewa Frodis
- Västerås Central Hospital, Västerås, Sweden
| | | | | | | | | | - Pál Bordás
- Sunderby Hospital, Department of Radiology, Norrbotten County, Sweden
| | | | | | | | | | | | - Johan Ahlgren
- Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden
| | - Daniel Öhman
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden
| | - Lars Holmberg
- Uppsala University, Uppsala, Sweden and Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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