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Kregting LM, Vrancken Peeters NJMC, Clarijs ME, Koppert LB, Korfage IJ, van Ravesteyn NT. Health utility values of breast cancer treatments and the impact of varying quality of life assumptions on cost-effectiveness. Int J Cancer 2024; 155:117-127. [PMID: 38478916 DOI: 10.1002/ijc.34899] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/01/2023] [Accepted: 02/06/2024] [Indexed: 05/04/2024]
Abstract
In breast cancer research, utility assumptions are outdated and inconsistent which may affect the results of quality adjusted life year (QALY) calculations and thereby cost-effectiveness analyses (CEAs). Four hundred sixty four female patients with breast cancer treated at Erasmus MC, the Netherlands, completed EQ-5D-5L questionnaires from diagnosis throughout their treatment. Average utilities were calculated stratified by age and treatment. These utilities were applied in CEAs analysing 920 breast cancer screening policies differing in eligible ages and screening interval simulated by the MISCAN-Breast microsimulation model, using a willingness-to-pay threshold of €20,000. The CEAs included varying sets on normative, breast cancer treatment and screening and follow-up utilities. Efficiency frontiers were compared to assess the impact of the utility sets. The calculated average patient utilities were reduced at breast cancer diagnosis and 6 months after surgery and increased toward normative utilities 12 months after surgery. When using normative utility values of 1 in CEAs, QALYs were overestimated compared to using average gender and age-specific values. Only small differences in QALYs gained were seen when varying treatment utilities in CEAs. The CEAs varying screening and follow-up utilities showed only small changes in QALYs gained and the efficiency frontier. Throughout all variations in utility sets, the optimal strategy remained robust; biennial for ages 40-76 years and occasionally biennial 40-74 years. In sum, we recommend to use gender and age stratified normative utilities in CEAs, and patient-based breast cancer utilities stratified by age and treatment or disease stage. Furthermore, despite varying utilities, the optimal screening scenario seems very robust.
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Affiliation(s)
- Lindy M Kregting
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Noëlle J M C Vrancken Peeters
- Academic Breast Cancer Center, Department of Oncologic and Gastro-intestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marloes E Clarijs
- Academic Breast Cancer Center, Department of Oncologic and Gastro-intestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Academic Breast Cancer Center, Department of Oncologic and Gastro-intestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Beck JJ, Slunecka JL, Johnson BN, Van Asselt AJ, Finnicum CT, Ageton C, Krie A, Nickles H, Cowan K, Maxwell J, Boomsma DI, de Geus E, Ehli EA, Hottenga JJ. Breast Cancer Polygenic Risk Score Validation and Effects of Variable Imputation. Cancers (Basel) 2024; 16:1578. [PMID: 38672660 PMCID: PMC11048743 DOI: 10.3390/cancers16081578] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/30/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Breast cancer (BC) is a complex disease affecting one in eight women in the USA. Advances in population genomics have led to the development of polygenic risk scores (PRSs) with the potential to augment current risk models, but replication is often limited. We evaluated 2 robust PRSs with 313 and 3820 SNPs and the effects of multiple genotype imputation replications in BC cases and control populations. Biological samples from BC cases and cancer-free controls were drawn from three European ancestry cohorts. Genotyping on the Illumina Global Screening Array was followed by stringent quality control measures and 20 genotype imputation replications. A total of 468 unrelated cases and 4337 controls were scored, revealing significant differences in mean PRS percentiles between cases and controls (p < 0.001) for both SNP sets (313-SNP PRS: 52.81 and 48.07; 3820-SNP PRS: 55.45 and 49.81), with receiver operating characteristic curve analysis showing area under the curve values of 0.596 and 0.603 for the 313-SNP and 3820-SNP PRS, respectively. PRS fluctuations (from ~2-3% up to 9%) emerged across imputation iterations. Our study robustly reaffirms the predictive capacity of PRSs for BC by replicating their performance in an independent BC population and showcases the need to average imputed scores for reliable outcomes.
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Affiliation(s)
- Jeffrey J. Beck
- Avera Genetics, Avera McKennan Hospital & University Health Center, Sioux Falls, SD 57105, USA (E.A.E.)
| | - John L. Slunecka
- Avera Genetics, Avera McKennan Hospital & University Health Center, Sioux Falls, SD 57105, USA (E.A.E.)
| | - Brandon N. Johnson
- Avera Genetics, Avera McKennan Hospital & University Health Center, Sioux Falls, SD 57105, USA (E.A.E.)
| | - Austin J. Van Asselt
- Avera Genetics, Avera McKennan Hospital & University Health Center, Sioux Falls, SD 57105, USA (E.A.E.)
| | - Casey T. Finnicum
- Avera Genetics, Avera McKennan Hospital & University Health Center, Sioux Falls, SD 57105, USA (E.A.E.)
| | | | - Amy Krie
- Avera Cancer Institute, Sioux Falls, SD 57105, USA
| | | | - Kenneth Cowan
- Fred and Pamela Buffet Cancer Center and Eppley Institute for Research in Cancer at University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Jessica Maxwell
- Fred and Pamela Buffet Cancer Center and Eppley Institute for Research in Cancer at University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Dorret I. Boomsma
- Department of Biological Psychology, Netherlands Twin Register, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands (J.-J.H.)
| | - Eco de Geus
- Department of Biological Psychology, Netherlands Twin Register, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands (J.-J.H.)
| | - Erik A. Ehli
- Avera Genetics, Avera McKennan Hospital & University Health Center, Sioux Falls, SD 57105, USA (E.A.E.)
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, Netherlands Twin Register, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands (J.-J.H.)
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Burnside ES, Lasarev MR, Sprague BL, Miglioretti DL, Alexandridis RA, Lee JM, Pisano ED, Smith RA. The Importance of Outcomes Ascertainment for Accurate Assessment of the Mammography Screening Cancer Detection Rate: A Simulation Study. J Am Coll Radiol 2024; 21:376-386. [PMID: 37922974 DOI: 10.1016/j.jacr.2023.09.014] [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: 06/07/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Cancer detection rate (CDR), an important metric in the mammography screening audit, is designed to ensure adequate sensitivity. Most practices use biopsy results as the reference standard; however, commonly ascertainment of biopsy results is incomplete. We used simulation to determine the relationship between the cancer ascertainment rate of biopsy (AR-biopsy), CDR estimation, and associated error rates in classifying whether practices and radiologists meet the established ACR benchmark of 2.5 per 1,000. MATERIALS AND METHODS We simulated screening mammography volume, number of cancers detected, and CDR, using negative binomial and beta-binomial distributions, respectively. Simulations were performed at both the practice and radiologist level. Average CDR was based on linearly rescaling a published CDR by the AR-biopsy. CDR distributions were simulated for AR-biopsy between 5% and 100% in steps of five percentage points and were summarized with boxplots and smoothed histograms over the range of AR-biopsy, to quantify the proportion of practices and radiologists meeting the ACR benchmark at each level of AR-biopsy. RESULTS Decreasing AR-biopsy led to an increasing probability of categorizing CDR performance as being below the ACR benchmark. Our simulation predicts that at the practice level, an AR-biopsy of 65% categorizes 17.6% below the benchmark (compared to 1.6% at an AR-biopsy of 100%), and at the radiologist level, an AR-biopsy of 65% categorizes 34.7% as being below the benchmark (compared to 11.6% at an AR-biopsy of 100%). CONCLUSIONS Our simulation demonstrates that decreasing the AR-biopsy (in currently clinically relevant ranges) has the potential to artifactually lower the assessed CDR on both the practice and radiologist levels and may, in turn, increase the chance of erroneous categorization of underperformance per the ACR benchmark.
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Affiliation(s)
- Elizabeth S Burnside
- Associate Dean, Team Science and Interdisciplinary Research, School of Medicine and Public Health, University of Wisconsin, Madison, Madison, Wisconsin.
| | | | - Brian L Sprague
- Director of the Vermont Breast Cancer Surveillance System, University of Vermont, Burlington, Vermont
| | - Diana L Miglioretti
- Division Chief of Biostatistics, Co-lead, Population Sciences and Health Disparities Program, Comprehensive Cancer Center, University of California, Davis, Davis, California
| | | | - Janie M Lee
- Section Chief of Breast Imaging, Department of Radiology, Director of Breast Imaging, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Etta D Pisano
- University of Pennsylvania, Philadelphia, Pennsylvania; and Chief Research Officer of the ACR
| | - Robert A Smith
- Senior Vice President of Early Cancer Detection Science, American Cancer Society
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Rezkallah E, Mekhaeil K, Tin SMM, Hanna RS. The Role of MRI in Assessing Residual Breast Cancer After Neoadjuvant Chemotherapy. Am Surg 2024; 90:238-244. [PMID: 37611928 DOI: 10.1177/00031348231198108] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Breast cancer is the most common malignancy among women in the world. The role of neoadjuvant chemotherapy (NAC) in the management of breast cancer is increasing. The decision about the management after NAC depends mainly on the tumor response to NAC. OBJECTIVES The role of the current study is to evaluate the role of the MRI scan in assessing the residual disease after NAC, which would help in decision making regarding the best treatment plan for the patient. PATIENTS AND METHODS We did this retrospective review for all patients who were diagnosed with breast cancer in our center and had NAC over four years. All patients in our study had a post-NAC magnetic resonance imaging (MRI) scan to assess the residual tumor size. A 2×2 table was used to calculate the diagnostic accuracy, and SPSS software version 25 was used to get the correlation coefficients between the post-NAC MRI measurements and pathological size. RESULTS 28 female patients were included in our study. The average age was 45.25 ± 10 years. We utilized the tumor size on histology as the standard for comparison. We calculated MRI sensitivity, specificity, PPV, and NPV rates of 90.9%, 100%, 100%, and 94.4%, respectively. The correlation coefficient was strong (r = 0.859, P = 0.01). CONCLUSION Magnetic resonance imaging is a good test to assess the residual tumor disease after NAC in breast cancer patients. However, cases of under- and overestimation are still seen, which require more caution when making a decision regarding the management of such cases.
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Affiliation(s)
- Emad Rezkallah
- General Surgery Department, James Cook University Hospital, Middlesbrough, UK
| | - Kamel Mekhaeil
- Vascular Department, James Cook University Hospital, Middlesbrough, UK
| | - Su Min Min Tin
- General Surgery Department, James Cook University Hospital, Middlesbrough, UK
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Duijm LEM, Strobbe LJA, van Breest Smallenburg V, Op de Coul-Froger CL, Setz-Pels W, Vreuls W, van Beek HC, van Bommel RMG, Voogd AC. Trends in the pre-operative diagnosis and surgical management of axillary lymph node metastases in women with screen-detected breast cancer. Breast 2023; 72:103593. [PMID: 37890215 PMCID: PMC10624574 DOI: 10.1016/j.breast.2023.103593] [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: 08/02/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
AIM The aim of the current study was to investigate time-trends in pre-operative diagnosis and surgical treatment of axillary lymph node metastases in breast cancers detected at screening mammography. METHODS We included all women who underwent screening mammography in the South of the Netherlands between 2005 and 2020. During a follow-up period of at least two years, data on clinical radiological examinations, biopsy procedures and surgical interventions were obtained. The 15 years of inclusion were divided into five cohorts of three years each. RESULTS Of the 4049 women with invasive breast cancer, 22.1 % (896/4049) had axillary lymph node metastasis at pathology (ALN+). Percutaneous axillary biopsy was performed in 39.6 % (355/896) of these women, with the proportions of fine needle aspiration biopsy (FNAB) decreasing from 97.6 % (40/41) in 2005-2007 to 41.6 % (37/89) in 2017-2019 and core needle biopsy (CNB) rising from 2.4 % (1/41) in 2005-2007 to 58.4 % (52/89) in 2017-2019 (P < 0.001). Sensitivity of FNAB and CNB was comparable (77.4 % (188/243, 95%CI = 71%-82 %) versus 82.4 % (103/125), 95%CI = 74%-88 %) (P = 0.26). Pre-operative confirmation of ALN + by percutaneous biopsy ranged from 27.3 % (56/205) in 2011-2013 to 39.0 % (80/205) in 2017-2019, with no significant trend changes over time (P = 0.103). The proportion of ALN + women who underwent axillary lymph node dissection (ALND) decreased from 96.0 % (97/101) in 2005-2007 to 16.6 % (34/205) in 2017-2019 (P < 0.001). CONCLUSION Pre-operative confirmation of axillary lymph node metastasis by ultrasound-guided biopsy did not rise despite the increased use of CNB at the expense of less invasive FNAB. A significant reduction in ALND was observed through the years.
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Affiliation(s)
- Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands
| | | | | | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623, EJ, Eindhoven, the Netherlands
| | - Willem Vreuls
- Department of Pathology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands
| | - Hermen C van Beek
- Department of Radiology, Maxima Medical Center, De Run 4600, 5504, DB Veldhoven, the Netherlands
| | - Rob M G van Bommel
- Department of Radiology, St Anna Hospital, Bogardeind 2, 5664, EH, Geldrop, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
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Al-Mousa DS. Contrast Enhanced Mammography: Another Step Forward in Reducing Breast Cancer Mortality. Acad Radiol 2023; 30:2252-2253. [PMID: 37633817 DOI: 10.1016/j.acra.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Dana S Al-Mousa
- Jordan University of Science and Technology, Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Irbid, Jordan (D.S.A.-M.); School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia (D.S.A.-M.).
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7
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van der Veer EL, Lameijer J, Coolen AMP, Bluekens AMJ, Nederend J, Gielens M, Voogd A, Duijm L. Causes and consequences of delayed diagnosis in breast cancer screening with a focus on mammographic features and tumour characteristics. Eur J Radiol 2023; 167:111048. [PMID: 37634439 DOI: 10.1016/j.ejrad.2023.111048] [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: 05/18/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To study the prevalence, causes and consequences of delayed breast cancer diagnosis in the screening population. METHODS This retrospective study was performed in women who underwent biennial screening mammography between January 1, 2009 and June 30, 2019. Patients were divided into 3 groups; screen-detectedbreast cancer (SDC) without a diagnostic delay, a primary diagnostic delay(i.e. missed cancer at previous screening round)and a delay in diagnostic work-up after recall. Women with a true interval cancer (IC; i.e. not visible on prior examinations) were excluded. Outcome parameters included mammographic and tumour characteristics, lymph node status and surgical treatment. RESULTS In our sample of 4491 women with breast cancer (4292 SDC and 199 'missed' IC), respectively, a total of 1112 women experienced a diagnostic delay of ≥ 4 months. Compared to women without a diagnostic delay (n = 2720), the 176 women with a delay in diagnostic work-up showed overall similar mammographic abnormalities (P = 0.052). These groups show similar distributions in invasive tumours, tumour stage and lymph node status (P = 0.25, P = 0.95 and P = 0.93, respectively). Women with a primary diagnostic delay (n = 936) showed less calcifications (P < 0.001), and more masses with calcifications and architectural distortions on mammography (P = 0.01 and P = 0.04, respectively). Moreover, this group comprised larger tumours (P < 0.001) and lymph node metastases (P < 0.001), and more often underwent mastectomy (P < 0.001). CONCLUSIONS A primary diagnostic delay in breast cancer diagnosis results in less favourable tumour characteristics and relatively more mastectomies compared to no delay in breast cancer diagnosis and a delay in diagnostic work-up after recall.
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Affiliation(s)
- Eline L van der Veer
- Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, Netherlands.
| | - Joost Lameijer
- Christchurch Hospital, 2 Riccarton Avenue, Christchurch Central City, Christchurch 4710, New-Zealand
| | - Angela M P Coolen
- Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, Netherlands
| | - Adriana M J Bluekens
- Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, Netherlands
| | - Joost Nederend
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, Netherlands
| | - Maaike Gielens
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, Netherlands
| | - Adri Voogd
- Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands
| | - Lucien Duijm
- Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, Netherlands
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Polikarpov M, Vila-Comamala J, Wang Z, Pereira A, van Gogh S, Gasser C, Jefimovs K, Romano L, Varga Z, Lång K, Schmeltz M, Tessarini S, Rawlik M, Jermann E, Lewis S, Yun W, Stampanoni M. Towards virtual histology with X-ray grating interferometry. Sci Rep 2023; 13:9049. [PMID: 37270642 DOI: 10.1038/s41598-023-35854-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/24/2023] [Indexed: 06/05/2023] Open
Abstract
Breast cancer is the most common type of cancer worldwide. Diagnosing breast cancer relies on clinical examination, imaging and biopsy. A core-needle biopsy enables a morphological and biochemical characterization of the cancer and is considered the gold standard for breast cancer diagnosis. A histopathological examination uses high-resolution microscopes with outstanding contrast in the 2D plane, but the spatial resolution in the third, Z-direction, is reduced. In the present paper, we propose two high-resolution table-top systems for phase-contrast X-ray tomography of soft-tissue samples. The first system implements a classical Talbot-Lau interferometer and allows to perform ex-vivo imaging of human breast samples with a voxel size of 5.57 μm. The second system with a comparable voxel size relies on a Sigray MAAST X-ray source with structured anode. For the first time, we demonstrate the applicability of the latter to perform X-ray imaging of human breast specimens with ductal carcinoma in-situ. We assessed image quality of both setups and compared it to histology. We showed that both setups made it possible to target internal features of breast specimens with better resolution and contrast than previously achieved, demonstrating that grating-based phase-contrast X-ray CT could be a complementary tool for clinical histopathology.
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Affiliation(s)
- M Polikarpov
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland.
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland.
| | - J Vila-Comamala
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
| | - Z Wang
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
- Department of Engineering Physics, Tsinghua University, Haidian District, Beijing, 100080, China
| | - A Pereira
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
| | - S van Gogh
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
| | - C Gasser
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
| | - K Jefimovs
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
| | - L Romano
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
| | - Z Varga
- Department of Pathology and Molecular Pathology, University Hospital Zürich, 8091, Zurich, Switzerland
| | - K Lång
- Department of Diagnostic Radiology, Translational Medicine, Lund University, Lund, Sweden
- Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden
| | - M Schmeltz
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
| | - S Tessarini
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
| | - M Rawlik
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
| | | | - S Lewis
- Sigray Inc., Concord, CA, 94520, USA
| | - W Yun
- Sigray Inc., Concord, CA, 94520, USA
| | - M Stampanoni
- Swiss Light Source, Paul Scherrer Institut, 5232, Villigen-PSI, Switzerland
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
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Maas CC, van Klaveren D, Visser O, Merkx MA, Lingsma HF, Lemmens VE, Dinmohamed AG. Number of life-years lost at the time of diagnosis and several years post-diagnosis in patients with solid malignancies: a population-based study in the Netherlands, 1989-2019. EClinicalMedicine 2023; 60:101994. [PMID: 37214634 PMCID: PMC10196760 DOI: 10.1016/j.eclinm.2023.101994] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Background Loss of life expectancy (LOLE) may provide more intuitive information on the impact of cancer than relative survival over a fixed time horizon (e.g., 5-year relative survival). We aimed to assess the evolution of the LOLE using a nationwide, population-based cohort including patients diagnosed with one of 17 most frequent solid malignancies. Methods From the Netherlands Cancer Registry, we selected adult patients diagnosed with one of the 17 most frequent solid malignancies in the Netherlands during 1989-2019, with survival follow-up until 2022. We used flexible parametric survival models to estimate the LOLE at diagnosis and the LOLE after surviving several years post-diagnosis (conditional LOLE; CLOLE) by cancer type, calendar year, age, sex, and disease stage. Findings For all cancers combined, the LOLE consistently decreased from 1989 to 2019. This decrease was most pronounced for males with prostate cancer (e.g., from 6.9 [95% confidence interval [CI], 6.7-7.1] to 2.7 [95% CI, 2.5-3.0] for 65-year-olds) and females with breast cancer (e.g., from 6.6 [95% CI, 6.4-6.7] to 1.9 [95% CI, 1.8-2.0] for 65-year-olds). The LOLE among patients with cancers of the head and neck or the central nervous system remained constant over time. Overall, the CLOLE showed that the life years lost among patients with cancer decreased with each additional year survived post-diagnosis. For example, the LOLE at diagnosis for 65-year-old females diagnosed with breast cancer in 2019 was 1.9 [95% CI, 1.8-2.0] compared with 1.7 [95% CI, 1.6-1.8], 1.0 [95% CI, 0.9-1.1], and 0.5 [95% CI, 0.5-0.6] when surviving one, five, and ten years post-diagnosis, respectively. Estimates for other combinations of patient and tumour characteristics are available in a publicly available web-based application. Interpretation Our findings suggested that the evolution of LOLE substantially varies across cancer type, age, and disease stage. LOLE estimates help patients better understand the impact of their specific cancer diagnosis on their life expectancy. Funding None.
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Affiliation(s)
- Carolien C.H.M. Maas
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Matthias A.W. Merkx
- Department of Oral and Maxillofacial Surgery and IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Hester F. Lingsma
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Valery E.P.P. Lemmens
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Avinash G. Dinmohamed
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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Geertse TD, van der Waal D, Vreuls W, Tetteroo E, Duijm LEM, Pijnappel RM, Broeders MJM. The dilemma of recalling well-circumscribed masses in a screening population: A narrative literature review and exploration of Dutch screening practice. Breast 2023:S0960-9776(23)00451-4. [PMID: 37169601 DOI: 10.1016/j.breast.2023.05.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND In Dutch breast cancer screening, solitary, new or growing well-circumscribed masses should be recalled for further assessment. This results in cancers detected but also in false positive recalls, especially at initial screening. The aim of this study was to determine characteristics of well-circumscribed masses at mammography and identify potential methods to improve the recall strategy. METHODS A systematic literature search was performed using PubMed. In addition, follow-up data were retrieved on all 8860 recalled women in a Dutch screening region from 2014 to 2019. RESULTS Based on 15 articles identified in the literature search, we found that probably benign well-circumscribed masses that were kept under surveillance had a positive predictive value (PPV) of 0-2%. New or enlarging solitary well-circumscribed masses had a PPV of 10-12%. In general the detected carcinomas had a favorable prognosis. In our exploration of screening practice, 25% of recalls (2133/8860) were triggered by a well-circumscribed mass. Those recalls had a PPV of 2.0% for initial and 10.6% for subsequent screening. Most detected carcinomas had a favorable prognosis as well. CONCLUSION To recognize malignancies presenting as well-circumscribed masses, identifying solitary, new or growing lesions is key. This information is missing at initial screening since prior examinations are not available, leading to a low PPV. Access to prior clinical examinations may therefore improve this PPV. In addition, given the generally favorable prognosis of screen-detected malignant well-circumscribed masses, one may opt to recall these lesions at subsequent screening, if grown, rather than at initial screening.
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Affiliation(s)
- Tanya D Geertse
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands.
| | - Daniëlle van der Waal
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands
| | - Willem Vreuls
- Canisius Wilhelmina Hospital, Department of Radiology Weg Door, Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - Eric Tetteroo
- Amphia Hospital, Department of Radiology Molengracht 21, 4818 CK, Breda, the Netherlands
| | - Lucien E M Duijm
- Canisius Wilhelmina Hospital, Department of Radiology Weg Door, Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - Ruud M Pijnappel
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; University Medical Centre Utrecht, Utrecht UniversityDepartment of Radiology, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Mireille J M Broeders
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Radboud University Medical CenterDepartment for Health Evidence Geert Grooteplein 21, 6525 EZ, Nijmegen, the Netherlands
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11
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Dassen RRE, Pelders S, de Munck L, Jager A, Hooning MJ, van Dam JH, Heemskerk-Gerritsen BAM. The effect of attendance in the Dutch breast cancer screening program on breast tumor characteristics among migrant women. Breast 2023; 69:290-298. [PMID: 36940631 PMCID: PMC10034141 DOI: 10.1016/j.breast.2023.03.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/10/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND In general, migrant women have a lower breast cancer (BC) incidence rate and higher BC mortality than autochthonous women. Further, migrant women show lower participation in the national BC screening program. To further investigate those aspects, we aimed to determine differences in incidence and tumor characteristics between autochthonous and migrant BC patients in Rotterdam, the Netherlands. METHODS We selected women diagnosed with BC in Rotterdam during 2012-2015 from the Netherlands Cancer Registry. Incidence rates were calculated by migrant status (i.e., women with or without migration background). Multivariable analyses revealed adjusted odds ratios (OR) and 95% confidence intervals (CI) on the association between migration status and patient and tumor characteristics, additionally stratified by screening attendance (yes/no). RESULTS In total 1372 autochthonous and 450 migrant BC patients were included for analysis. BC incidence was lower among migrants than among autochthonous women. Overall, migrant women were younger at BC diagnosis (53 vs. 64 years, p < 0.001), and had higher risks of positive lymph nodes (OR 1.76, 95% CI 1.33-2.33) and high grade tumors (OR 1.35, 95% CI 1.04-1.75). Especially non-screened migrant women had higher risk of positive nodes (OR 2.73, 95% CI 1.43-5.21). Among the subgroup of screened women, we observed no significant differences between migrant and autochthonous patients. CONCLUSION Migrant women have lower BC incidence than autochthonous women, but diagnosis was more often at younger age and with unfavorable tumor characteristics. Attending the screening program strongly reduces the latter. Therefore, promotion of participation in the screening program is recommended.
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Affiliation(s)
- R R E Dassen
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - S Pelders
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - L de Munck
- Netherlands Comprehensive Cancer Organization, Research and Development, Utrecht, Netherlands
| | - A Jager
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - M J Hooning
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - J H van Dam
- Erasmus MC Cancer Institute, Oncological Surgery, Rotterdam, Netherlands
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12
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Duijm LEM, Strobbe LJA, van Breest Smallenburg V, Vreuls W, Boerman T, van Beek HC, Op de Coul-Froger CL, Setz-Pels W, Voogd AC. Failure of stereotactic core needle biopsy in women recalled for suspicious calcifications at screening mammography: frequency, causes, and final outcome in a multi-institutional, observational follow-up study. Eur Radiol 2022; 32:7420-7429. [PMID: 35486173 DOI: 10.1007/s00330-022-08806-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We determined the failure rate of stereotactic core needle biopsy (SCNB) and its causes and final outcome in women recalled for calcifications at screening mammography. METHODS We included a consecutive series of 624,039 screens obtained in a Dutch screening region between January 2009 and July 2019. Radiology reports and pathology results were obtained of all recalled women during 2-year follow-up. RESULTS A total of 3495 women (19.6% of 17,809 recalls) were recalled for suspicious calcifications. SCNB was indicated in 2818 women, of whom 12 had incomplete follow-up and another 12 women refused biopsy. DCIS or invasive cancer was diagnosed in 880 of the remaining 2794 women (31.5%). SCNB failed in 62 women (2.2%, 36/2794). These failures were mainly due to a too posterior (n = 30) or too superficial location (n = 17) of the calcifications or calcifications too faint for biopsy (n = 13). Of these 62 women, 10 underwent surgical biopsy, yielding one DCIS (intermediate grade) and two invasive cancers (one intermediate grade and one high grade) and another two women were diagnosed with DCIS (both high grade) at follow-up. Thus, the malignancy rate after SCNB failure was 8.1% (5/62). Calcifications were depicted neither at SCNB specimen radiography nor at pathology in 16 women after (repeated) SCNB (0.6%, 31/2732). None of them proved to have breast cancer at 2-year follow-up. CONCLUSIONS The failure rate of SCNB for suspicious calcifications is low but close surveillance is warranted, as breast cancer may be present in up to 8% of these women. KEY POINTS • The failure rate of stereotactic core needle biopsy (SCNB) for calcifications recalled at screening mammography was 2.2%. • Failures were mainly due to calcifications that could not be reached by SCNB or calcifications too faint for biopsy. • The management after failed SCNB was various. At least, close surveillance with a low threshold for surgical biopsy is recommended as breast cancer may be present in up to 8% of women with SCNB failure.
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Affiliation(s)
- Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | | | - Willem Vreuls
- Department of Pathology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Thom Boerman
- Department of Pathology, PAMM Laboratories, De Run 6250, 5504 DL, Veldhoven, The Netherlands
| | - Hermen C van Beek
- Department of Radiology, Maxima Medical Center, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | | | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Heggland T, Vatten LJ, Opdahl S, Weedon-Fekjær H. Interpreting Breast Cancer Mortality Trends Related to Introduction of Mammography Screening: A Simulation Study. MDM Policy Pract 2022; 7:23814683221131321. [PMID: 36225967 PMCID: PMC9549205 DOI: 10.1177/23814683221131321] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/10/2022] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Background. Several studies have evaluated the effect of mammography screening on breast cancer mortality based on overall breast cancer mortality trends, with varied conclusions. The statistical power of such trend analyses is, however, not carefully studied. Methods. We estimated how the effect of screening on overall breast cancer mortality is likely to unfold. Because a screening effect is based on earlier treatment, screening can affect only new incident cases after screening introduction. To evaluate the likelihood of detecting screening effects on overall breast cancer mortality time trends, we calculated the statistical power of joinpoint regression analysis on breast cancer mortality trends around screening introduction using simulations. Results. We found that a very gradual increase in population-level screening effect is expected due to prescreening incident cases. Assuming 25% effectiveness of a biennial screening program in reducing breast cancer mortality among women 50 to 69 y of age, the expected reduction in overall breast cancer mortality was 3% after 2 y and reached a long-term effect of 18% after 20 y. In common settings, the statistical power to detect any screening effects using joinpoint regression analysis is very low (<50%), even in an artificial setting of constant risk of baseline breast cancer mortality over time. Conclusions. Population effects of screening on breast cancer mortality emerge very gradually and are expected to be considerably lower than the effects reported in trials excluding women diagnosed before screening. Studies of overall breast cancer mortality time trends have too low statistical power to reliably detect screening effects in most populations. Implications. Researchers and policy makers evaluating mammography screening should avoid using breast cancer mortality trend analysis that does not separate pre- and postscreening incident cases. HIGHLIGHTS Population-level mammography screening effects on breast cancer mortality emerge gradually following screening introduction, resulting in very low statistical power of trend analysis.Researchers and policy makers evaluating mammography screening should avoid relying on population-wide breast cancer mortality trends.Expected mammography screening effects at population level are lower than those from screening trials, as many cases of breast cancer fall outside the screening age range.
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Affiliation(s)
- Torunn Heggland
- Torunn Heggland, Oslo Centre for
Biostatistics and Epidemiology (OCBE), Research Support Services, Oslo
University Hospital, Postboks 4950 Nydalen, Oslo, 0424, Norway;
()
| | - Lars Johan Vatten
- Department of Public Health and Nursing,
Faculty of Medicine and Health Science, Norwegian University of Science and
Technology, Trondheim, Norway
| | - Signe Opdahl
- Department of Public Health and Nursing,
Faculty of Medicine and Health Science, Norwegian University of Science and
Technology, Trondheim, Norway
| | - Harald Weedon-Fekjær
- Oslo Centre for Biostatistics and Epidemiology,
Research Support Services, Oslo University Hospital, Oslo, Norway
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14
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Duijm LE, Broeders MJ, Setz-pels W, van Breest Smallenburg V, van Beek HC, Donkers-van Rossum AB, Slob MJ, Kuipers TP, Mann RM, Voogd AC. Effects of nonparticipation at previous screening rounds on the characteristics of screen-detected breast cancers. Eur J Radiol 2022; 154:110391. [DOI: 10.1016/j.ejrad.2022.110391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/15/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
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Gommers JJ, Voogd AC, Broeders MJ, van Breest Smallenburg V, Strobbe LJ, Donkers-van Rossum AB, van Beek HC, Mann RM, Duijm LE. Breast magnetic resonance imaging as a problem solving tool in women recalled at biennial screening mammography: A population-based study in the Netherlands. Breast 2021; 60:279-286. [PMID: 34823112 PMCID: PMC8628012 DOI: 10.1016/j.breast.2021.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose Problem solving magnetic resonance imaging (MRI) is used to exclude malignancy in women with equivocal findings on conventional imaging. However, recommendations on its use for women recalled after screening are lacking. This study evaluates the impact of problem solving MRI on diagnostic workup among women recalled from the Dutch screening program, as well as time trends and inter-hospital variation in its use. Methods Women who were recalled at screening mammography in the South of the Netherlands (2008–2017) were included. Two-year follow-up data were collected. Diagnostic-workup and accuracy of problem solving MRI were evaluated and time trends and inter-hospital variation in its use were examined. Results In the study period 16,175 women were recalled, of whom 906 underwent problem solving MRI. Almost half of the women (45.4%) who underwent problem solving MRI were referred back to the screening program without further workup. The sensitivity, specificity, and positive and negative predictive values of problem solving MRI were 98.2%, 70.0%, 31.1%, and 99.6%, respectively. The percentage of recalled women receiving problem solving MRI fluctuated over time (4.7%–7.2%) and significantly varied among hospitals (2.2%–7.0%). Conclusion The use of problem solving MRI may exclude malignancy in recalled women. The use of problem solving MRI varied over time and among hospitals, which indicates the need for guidelines on problem solving MRI. Problem solving MRI did correctly refer back women to the screening program. The sensitivity and specificity of problem solving MRI were 98.2% and 70.0%. Positive and negative predictive values of problem solving MRI were 31.1% and 99.6%. By excluding malignancy, problem solving MRI may reduce invasive diagnostic workup.
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Affiliation(s)
- Jessie Jj Gommers
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Universiteitssingel 60, 6229, ER, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511, DT, Utrecht, the Netherlands
| | - Mireille Jm Broeders
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands; Dutch Expert Center for Screening, Wijchenseweg 101, 6538, SW, Nijmegen, the Netherlands
| | | | - Luc Ja Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands
| | | | - Hermen C van Beek
- Department of Radiology, Maxima Medical Center, De Run 4600, 5504, MB, Veldhoven, the Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands; Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Lucien Em Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
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16
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Su SY. Nationwide mammographic screening and breast cancer mortality in Taiwan: an interrupted time-series analysis. Breast Cancer 2021. [PMID: 34837139 DOI: 10.1007/s12282-021-01315-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In Taiwan, breast cancer is the third leading cause of cancer death in women. A nationwide screening program with biennial mammography for women aged 40-69 in Taiwan was implemented since July 2004, but the impact on breast cancer mortality has not been investigated. METHODS The interrupted time-series analysis was used to estimate the impact of mammographic screening on temporal trends of breast cancer mortality and to calculate the level of temporal changes due to the mammographic screening. RESULTS The annual average percentage changes of the age-standardized breast cancer mortality rates for all women aged 40-69 were 1.06% from 1991 to 2004 (before mammographic screening) and 0.33-0.34% from 2005 to 2019 (after mammographic screening). For all women aged 40-69, the results of interrupted time-series analysis showed that the increasing trends of breast cancer mortality were all attenuated after the implementation of mammographic screening. An estimation of 2114 women prevented from death of breast cancer may be attributable to screening. For women aged 40-44, 55-59, 60-64 and 65-69, the percentage changes in mortality rates were - 12.1% (- 5.1 to - 19.6%), - 20.8% (- 16.5 to - 25.2%), - 12.8% (- 8.5 to - 17.3%) and - 13.0% (- 7.9 to - 18.3%), respectively, after screening. For women aged 45-49 and 50-54, the reduction of deaths and mortality rates of breast cancer were a little. CONCLUSIONS This study revealed that the nationwide screening program with biennial mammography may be associated with the attenuation of breast cancer mortality trends in women aged 40-69 in Taiwan.
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Geertse TD, Setz-Pels W, van der Waal D, Nederend J, Korte B, Tetteroo E, Pijnappel RM, Broeders MJM, Duijm LEM. Added Value of Prereading Screening Mammograms for Breast Cancer by Radiologic Technologists on Early Screening Outcomes. Radiology 2021; 302:276-283. [PMID: 34751612 DOI: 10.1148/radiol.2021210746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background In the Dutch breast cancer screening program, mammograms are preread by technologists to identify possible abnormalities, leading to "warning signals" (an audible and visual alert if the technologist observed an abnormality suspicious for cancer) for radiologists. The best moment to present these warning signals is unknown. Purpose To determine the effect that blinding of technologists' warning signals has on radiologists' early screening outcome measures during interpretation of mammograms. Materials and Methods In this prospective study from September 2017 to May 2019, on alternating months, radiologists were either blinded or nonblinded to the warning signals of the technologist when interpreting screening mammograms for breast cancer. All discrepancies between radiologists and technologists were reviewed during quality assurance sessions every 6 weeks, which could result in secondary recalls. The outcome measures of this study were recall rate, cancer detection rate, and positive predictive value of recall. A χ2 test was used to test for differences between the two groups. Results During the study period, 109 596 women (mean age, 62 years ± 7 [standard deviation]), including 53 291 in the blinded and 56 305 in the nonblinded groups, participated. The overall recall rate (including secondary recalls) was lower for women in the blinded group than in the nonblinded group (blinded: 1140 of 53 291 women [2.1%], nonblinded: 1372 of 56 305 women [2.4%]; P = .001). There was no evidence of cancer detection rate differences between the groups (blinded: 349 of 53 291 women [6.5 per 1000 screening examinations], nonblinded: 360 of 56 305 women [6.4 per 1000 screening examinations]; P = .75). The blinded group thus had a higher positive predictive value of recall (blinded: 349 of 1140 women [30.6%], nonblinded: 360 of 1372 women [26.2%]; P = .02). Conclusion While interpreting screening mammograms for breast cancer, radiologists blinded to technologists' warning signals had lower recall rates with higher positive predictive values than nonblinded radiologists, yet cancer detection rates seemed to remain unchanged. See also the editorial by Hofvind and Lee in this issue. © RSNA, 2021.
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Affiliation(s)
- Tanya D Geertse
- From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Wikke Setz-Pels
- From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Daniëlle van der Waal
- From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Joost Nederend
- From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Bram Korte
- From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Eric Tetteroo
- From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Ruud M Pijnappel
- From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Mireille J M Broeders
- From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Lucien E M Duijm
- From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
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den Dekker BM, Bakker MF, de Lange SV, Veldhuis WB, van Diest PJ, Duvivier KM, Lobbes MBI, Loo CE, Mann RM, Monninkhof EM, Veltman J, Pijnappel RM, van Gils CH. Reducing False-Positive Screening MRI Rate in Women with Extremely Dense Breasts Using Prediction Models Based on Data from the DENSE Trial. Radiology 2021; 301:283-292. [PMID: 34402665 DOI: 10.1148/radiol.2021210325] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background High breast density increases breast cancer risk and lowers mammographic sensitivity. Supplemental MRI screening improves cancer detection but increases the number of false-positive screenings. Thus, methods to distinguish true-positive MRI screening results from false-positive ones are needed. Purpose To build prediction models based on clinical characteristics and MRI findings to reduce the rate of false-positive screening MRI findings in women with extremely dense breasts. Materials and Methods Clinical characteristics and MRI findings in Dutch breast cancer screening participants (age range, 50-75 years) with positive first-round MRI screening results (Breast Imaging Reporting and Data System 3, 4, or 5) after a normal screening mammography with extremely dense breasts (Volpara density category 4) were prospectively collected within the randomized controlled Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial from December 2011 through November 2015. In this secondary analysis, prediction models were built using multivariable logistic regression analysis to distinguish true-positive MRI screening findings from false-positive ones. Results Among 454 women (median age, 52 years; interquartile range, 50-57 years) with a positive MRI result in a first supplemental MRI screening round, 79 were diagnosed with breast cancer (true-positive findings), and 375 had false-positive MRI results. The full prediction model (area under the receiver operating characteristics curve [AUC], 0.88; 95% CI: 0.84, 0.92), based on all collected clinical characteristics and MRI findings, could have prevented 45.5% (95% CI: 39.6, 51.5) of false-positive recalls and 21.3% (95% CI: 15.7, 28.3) of benign biopsies without missing any cancers. The model solely based on readily available MRI findings and age had a comparable performance (AUC, 0.84; 95% CI: 0.79, 0.88; P = .15) and could have prevented 35.5% (95% CI: 30.4, 41.1) of false-positive MRI screening results and 13.0% (95% CI: 8.8, 18.6) of benign biopsies. Conclusion Prediction models based on clinical characteristics and MRI findings may be useful to reduce the false-positive first-round screening MRI rate and benign biopsy rate in women with extremely dense breasts. Clinical trial registration no. NCT01315015 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Imbriaco in this issue.
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Affiliation(s)
- Bianca M den Dekker
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Marije F Bakker
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Stéphanie V de Lange
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Wouter B Veldhuis
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Paul J van Diest
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Katya M Duvivier
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Marc B I Lobbes
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Claudette E Loo
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Ritse M Mann
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Evelyn M Monninkhof
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Jeroen Veltman
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Ruud M Pijnappel
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Carla H van Gils
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
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- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
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Chen HL, Zhou JQ, Chen Q, Deng YC. Comparison of the sensitivity of mammography, ultrasound, magnetic resonance imaging and combinations of these imaging modalities for the detection of small (≤2 cm) breast cancer. Medicine (Baltimore) 2021; 100:e26531. [PMID: 34190189 PMCID: PMC8257894 DOI: 10.1097/md.0000000000026531] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/14/2021] [Indexed: 01/04/2023] Open
Abstract
The aim of this study was to compare the sensitivity of mammography (MG), ultrasound (US), magnetic resonance imaging (MRI), and combinations of these imaging modalities for the detection of small (≤2 cm) breast cancer and to evaluate the benefit of preoperative breast MRI after performing conventional imaging techniques for small breast cancer.This was an observational retrospective review of 475 patients with pathologically confirmed breast cancer. We reviewed the medical records; assessed the preoperative reports of MG, US, and MRI; and categorized them as benign features (BI-RADS 1-3) or malignant features (BI-RADS 4 or 5). The criterion standard for detection was the pathologic assessment of the surgical specimen. The sensitivities of the different techniques were compared using the McNemar test.Among the 475 women, the sensitivity of MG was significantly greater in patients with low breast density than in those with high breast density (84.5% vs 65.8%, P < .001). US had higher sensitivity than MG (P < .001), and the combination of MG + US showed better sensitivity than MG or US alone (P < .001). Further addition of MRI to the combination of MG and US statistically contributed to the sensitivity yield (from 93.3% to 98.2%; P < .001) but did not significantly increase the mastectomy rate (from 48.2% to 49.3%; P = .177).MG has limited diagnostic sensitivity in patients with small breast cancer, especially in those with dense breast tissue. US is better than MG at detecting small breast cancer, regardless of breast density. The addition of MRI to MG and US could increase sensitivity without increasing the mastectomy rate. This study suggests performing MRI routinely on the basis of MG and US for small (≤2 cm) breast cancer.
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Affiliation(s)
- Hai-long Chen
- Department of Breast Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine
| | - Jiao-qun Zhou
- Department of Breast Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine
- Department of Surgical oncology, the First People's Hospital of Fuyang Hangzhou, Zhejiang Province, China
| | - Qiang Chen
- Department of Breast Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine
| | - Yong-chuan Deng
- Department of Breast Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine
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Lameijer JRC, Voogd AC, Broeders MJM, Pijnappel RM, Setz-Pels W, Strobbe LJ, Jansen FH, Tjan-Heijnen VCG, Duijm LEM. Trends in delayed breast cancer diagnosis after recall at screening mammography. Eur J Radiol 2021; 136:109517. [PMID: 33421886 DOI: 10.1016/j.ejrad.2020.109517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/22/2020] [Revised: 12/19/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the extent and characteristics of delay in breast cancer diagnosis in women recalled at screening mammography. METHODS We included a consecutive series of 817,656 screens of women who received biennial screening mammography in a Dutch breast cancer screening region between 1997 and 2016. During at least 3.5 years follow-up, radiological reports and biopsy reports were collected of all recalled women. The inclusion period was divided into four cohorts of four years each. We determined the number of screen-detected cancers and their characteristics, and assessed the proportion of recalled women who experienced a diagnostic delay of at least 4 months in breast cancer confirmation. RESULTS The proportion of recalled women who experienced diagnostic delay decreased from 7.5 % in 1997-2001 (47/623) to 3.0 % in 2012-2016 (67/2223, P < 0.001). The proportion of women with a delay of at least two years increased from 27.7 % (13/47) in 1997-2001 to 75.7 % (53/70) in 2012-2016 (P < 0.001). Cancers with a diagnostic delay > 2 years were more frequently invasive (P = 0.009) than cancers with a diagnostic delay of 4-24 months. The most frequent cause of diagnostic delays was incorrect radiological classifications by clinical radiologists (55.2 % overall) after recall. CONCLUSIONS The proportion of recalled women with a delayed breast cancer diagnosis has more than halved during two decades of screening mammography. Delays in breast cancer diagnosis are characterized by longer delay intervals, although the proportion of these delays among all screen-detected cancers has not increased. Preventing longer delays in breast cancer confirmation may help improve breast cancer survival.
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Affiliation(s)
- J R C Lameijer
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands.
| | - A C Voogd
- Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - M J M Broeders
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - R M Pijnappel
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - W Setz-Pels
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - L J Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, the Netherlands
| | - F H Jansen
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - V C G Tjan-Heijnen
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, the Netherlands
| | - L E M Duijm
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
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Al‐Mousa DS, Alakhras M, Spuur KM, Alewaidat H, Abdelrahman M, Rawashdeh M, Brennan PC. The implications of increased mammographic breast density for breast screening in Jordan. J Med Radiat Sci 2020; 67:277-283. [PMID: 32578380 PMCID: PMC7753846 DOI: 10.1002/jmrs.414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Mammographic breast density is associated with a four to six times increased risk for breast cancer. Mammographic breast density varies by ethnicity, geographical region and age. The aim of this study was to document for the first time the mammographic breast density of Jordanian women and to explore its relationship with age. METHODS Mammograms completed at King Abdullah University Hospital (Irbid, Jordan) between January 2016 and August 2018 were retrospectively reviewed and classified for breast density using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS). Descriptive analyses and Kurskal-Wallis test were used to examine the association between age and mammographic breast density. RESULTS A total of 659 mammograms were reviewed. A significant inverse relationship was observed between age and breast density (P < 0.001). In women aged 40-49 years, 83.2% had dense breasts (ACR BI-RADS (c) and (d)). This percentage decreased to 59.8% of women aged 50-59 years; 38.4% of women in their 60s and 37.9% of women aged 70 years or older (ACR BI-RADS (c) only). CONCLUSION The mammographic breast density of Jordanian women has been shown to be high across all age groups. Increased mammographic breast density is associated with increased breast cancer risk and renders mammography a less effective technique for the early detection of breast cancer. Breast cancer screening of Jordanian women should be individualised to develop screening protocols and include additional adjunct imaging to best manage women at high risk.
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Affiliation(s)
- Dana S. Al‐Mousa
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Maram Alakhras
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Kelly M. Spuur
- School of Dentistry and Health SciencesCharles Sturt UniversityWagga WaggaNSWAustralia
| | - Haytham Alewaidat
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Mostafa Abdelrahman
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Mohammad Rawashdeh
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
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Heck L, Herzen J. Recent advances in X-ray imaging of breast tissue: From two- to three-dimensional imaging. Phys Med 2020; 79:69-79. [PMID: 33171371 DOI: 10.1016/j.ejmp.2020.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/13/2020] [Accepted: 10/24/2020] [Indexed: 11/20/2022] Open
Abstract
Breast cancer is a globally widespread disease whose detection has already been significantly improved by the introduction of screening programs. Nevertheless, mammography suffers from low soft tissue contrast and the superposition of diagnostically relevant anatomical structures as well as from low values for sensitivity and specificity especially for dense breast tissue. In recent years, two techniques for X-ray breast imaging have been developed that bring advances for the early detection of breast cancer. Grating-based phase-contrast mammography is a new imaging technique that is able to provide three image modalities simultaneously (absorption-contrast, phase-contrast and dark-field signal). Thus, an enhanced detection and delineation of cancerous structures in the phase-contrast image and an improved visualization and characterization of microcalcifications in the dark-field image is possible. Furthermore, latest studies about this approach show that dose-compatible imaging with polychromatic X-ray sources is feasible. In order to additionally overcome the limitations of projection-based imaging, efforts were also made towards the development of breast computed tomography (BCT), which recently led to the first clinical installation of an absorption-based BCT system. Further research combining the benefits of both imaging technologies is currently in progress. This review article summarizes the latest advances in phase-contrast imaging for the female breast (projection-based and three-dimensional view) with special focus on possible clinical implementations in the future.
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Cheung YC, Chen SC, Ueng SH, Yu CC. Ductal Carcinoma In Situ Underestimation of Microcalcifications Only by Stereotactic Vacuum-Assisted Breast Biopsy: A New Predictor of Specimens without Microcalcifications. J Clin Med 2020; 9:E2999. [PMID: 32957459 DOI: 10.3390/jcm9092999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022] Open
Abstract
The mammographic appearance of ductal carcinoma in situ (DCIS) is mostly observed as microcalcifications. Although stereotactic vacuum-assisted breast biopsy (VABB) is a reliable alternative to surgical biopsy for suspicious microcalcifications, underestimation of VABB-proven DCIS is inevitable in clinical practice. We therefore retrospectively analyzed the variables in the prediction of DCIS underestimation manifesting as microcalcifications only proved by stereotactic VABB. In 1147 consecutive VABB on microcalcification-only lesions from 2010 to 2016, patients diagnosed with DCIS were selected to evaluate the underestimation rate. The analyzed variables included clinical characteristics, mammographic features, VABB procedure, and biomarkers. Univariate and multivariate analyses were used, and a p value < 0.05 was considered statistically significant. Of the 131 VABB-proven DCIS, 108 cases were diagnosed with DCIS and 23 were upgraded to invasive ductal carcinoma (IDC) after subsequent surgery. The small extent of microcalcification, grouped microcalcifications distribution, nearly complete microcalcification removal, and non-calcified specimens without DCIS were low for DCIS underestimation. Among them, the results of non-calcified specimens with or without DICS were the only statistically significant variables by multivariate logistic regression. These results indicate that the histology of non-calcified specimens was highly predictive of DCIS underestimation. Specimens without DCIS had a low upgrade rate to IDC.
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Lu Q, Wu X, Zhu Y, Yang J, Wang X, Ye C, Cai R, Zhang K, Xu T, Wang B, Veeramootoo JS, Xia T, Liu X. Effects of Chemotherapy on Serum Lipids in Chinese Postoperative Breast Cancer Patients. Cancer Manag Res 2020; 12:8397-8408. [PMID: 32982433 PMCID: PMC7494007 DOI: 10.2147/cmar.s253397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose Chemotherapy is a comprehensive therapy for breast cancer; nevertheless, its associated adverse effects are drawing increasing attention with the continuous improvement of the efficacy. The changes in serum lipids of breast cancer patients caused by chemotherapy have been reported by previous studies, whereby the former increase the incidence rate of cardiovascular disorders. However, the variations in the changes of serum lipids with different chemotherapy regimens have seldom been reported. Methods From January 2011 to December 2017, 1740 breast cancer patients treated with chemotherapy were recruited at the First Affiliated Hospital of Nanjing Medical University. The chemotherapy regimens included anthracycline-based, taxane-based, and anthracycline-plus-taxane-based regimens, dose-dense and standard-interval regimens. Lipid profiles that contained TG (triglyceride), TC (total cholesterol), HDL-C (high-density lipoprotein cholesterol), LDL-C (low-density lipoprotein cholesterol) and Lpa (lipoprotein a) levels were collected prior to the first, second and last cycles of chemotherapy. The changes of serum lipids with the same or different chemotherapy regimens were analyzed and compared. Results It was observed that the levels of TG, TC, LDL-C and Lpa increased significantly while that of HDL-C decreased after adjuvant chemotherapy in breast cancer patients (P<0.05). Besides, dose-dense regimens had more influence in TG and HDL-C and less influence in TC and LDL-C than standard-interval regimens. HDL-C was more sensitive to anthracycline-based regimens than taxane-based regimens. The level of TG with anthracycline-plus-taxane-based regimens was higher than that with only anthracycline-based or taxane-based regimens, and the level of HDL-C with anthracycline-plus-taxane-based regimen showed lower than that with taxane-based regimen. Conclusion In summary, this study proposed that dyslipidemia was strongly associated with chemotherapy in Chinese breast cancer patients after operative treatment. Furthermore, the changes in levels of serum lipids varied among patients with different chemotherapy regimens and taxane had less effect on dyslipidemia than anthracycline.
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Affiliation(s)
- Qi Lu
- Department of Thyroid and Breast Surgery, The Second People's Hospital of Kunshan, Kunshan Jiangsu 215300, People's Republic of China
| | - Xian Wu
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Yanhui Zhu
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Junzhe Yang
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Xingmeng Wang
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Chaoran Ye
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Ruyu Cai
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Kai Zhang
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Tingyu Xu
- Department of Information, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Bing Wang
- Department of Information, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Jordee S Veeramootoo
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Tiansong Xia
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China
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Lynge E, Beau AB, von Euler-Chelpin M, Napolitano G, Njor S, Olsen AH, Schwartz W, Vejborg I. Breast cancer mortality and overdiagnosis after implementation of population-based screening in Denmark. Breast Cancer Res Treat 2020; 184:891-9. [PMID: 32862304 DOI: 10.1007/s10549-020-05896-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/18/2020] [Indexed: 11/04/2022]
Abstract
Introduction Service breast cancer screening is difficult to evaluate because there is no unscreened control group. Due to a natural experiment, where 20% of women were offered screening in two regions up to 17 years before other women, Denmark is in a unique position. We utilized this opportunity to assess outcome of service screening. Materials and methods Screening was offered in Copenhagen from 1991 and Funen from 1993 to women aged 50–69 years. We used difference-in-differences methodology with a study group offered screening; a historical control group; a regional control group; and a regional–historical control group, comparing breast cancer mortality and incidence, including ductal carcinoma in situ, between study and historical control group adjusted for changes in other regions, and calculating ratios of rate ratios (RRR) with 95% confidence intervals (CI). Data came from Central Population Register; mammography screening databases; Cause of Death Register; and Danish Cancer Register. Results For breast cancer mortality, the study group accumulated 1,551,465 person-years and 911 deaths. Long-term breast cancer mortality in Copenhagen was 20% below expected in absence of screening; RRR 0.80 (95% CI 0.71–0.90), and in Funen 22% below; RRR 0.78 (95% CI 0.68–0.89). Combined, cumulative breast cancer incidence in women followed 8+ years post-screening was 2.3% above expected in absence of screening; RRR 1.023 (95% CI 0.97–1.08). Discussion Benefit-to-harm ratio of the two Danish screening programs was 2.6 saved breast cancer deaths per overdiagnosed case. Screening can affect only breast cancers diagnosed in screening age. Due to high breast cancer incidence after age 70, only one-third of breast cancer deaths after age 50 could potentially be affected by screening. Increasing upper age limit could be considered, but might affect benefit-to-harm ratio negatively.
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26
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Getaneh AM, Heijnsdijk EAM, Roobol MJ, de Koning HJ. Assessment of harms, benefits, and cost-effectiveness of prostate cancer screening: A micro-simulation study of 230 scenarios. Cancer Med 2020; 9:7742-7750. [PMID: 32813910 PMCID: PMC7571827 DOI: 10.1002/cam4.3395] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
Background Prostate cancer screening incurs a high risk of overdiagnosis and overtreatment. An organized and age‐targeted screening strategy may reduce the associated harms while retaining or enhancing the benefits. Methods Using a micro‐simulation analysis (MISCAN) model, we assessed the harms, benefits, and cost‐effectiveness of 230 prostate‐specific antigen (PSA) screening strategies in a Dutch population. Screening strategies were varied by screening start age (50, 51, 52, 53, 54, and 55), stop age (51‐69), and intervals (1, 2, 3, 4, 8, and single test). Costs and effects of each screening strategy were compared with a no‐screening scenario. Results The most optimum strategy would be screening with 3‐year intervals at ages 55–64 resulting in an incremental cost‐effectiveness ratio (ICER) of €19 733 per QALY. This strategy predicted a 27% prostate cancer mortality reduction and 28 life years gained (LYG) per 1000 men; 36% of screen‐detected men were overdiagnosed. Sensitivity analyses did not substantially alter the optimal screening strategy. Conclusions PSA screening beyond age 64 is not cost‐effective and associated with a higher risk of overdiagnosis. Similarly, starting screening before age 55 is not a favored strategy based on our cost‐effectiveness analysis.
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Affiliation(s)
- Abraham M Getaneh
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, 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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27
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Lameijer JRC, Nederend J, Voogd AC, Tjan-Heijnen VCG, Duijm LEM. Frequency and diagnostic outcome of bilateral recall at screening mammography. Int J Cancer 2020; 148:48-56. [PMID: 32621785 PMCID: PMC7689830 DOI: 10.1002/ijc.33187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022]
Abstract
Our study was performed to determine the frequency of recall for bilateral breast lesions at screening mammography and compare its outcome with respect to unilateral recall. We included 329 132 screening mammograms (34 889 initial screens and 294 243 subsequent screens) from a Dutch screening mammography program between January 2013 and January 2018. During a 2‐year follow‐up, we collected radiological data, pathology reports and surgical reports of all recalled women. At bilateral recall, the lesion with the highest Breast Imaging Reporting and Data System score was used as the index lesion when comparing screening mammography characteristics at bilateral vs unilateral recall. A total of 9806 women were recalled at screening (recall rate, 3.0%). Bilateral recall comprised 2.8% (271/9806) of all recalls. Biopsy was more frequently performed after bilateral recall than unilateral recall (54.6% [148/271] vs 44.1% [4201/9535], P < .001), yielding a lower positive predictive value (PPV) of biopsy after bilateral recall (42.6% vs 51.7%, P = .029). The PPV of recall was comparable for both groups (23.2% [63/271] vs 22.8% [2173/9535], P = .85). Invasive cancers after bilateral recall were larger than those diagnosed after unilateral recall (P = .02), but histological subtype, histologic grading, receptor status and proportions of lymph node positive cancers were comparable. Bilateral recall infrequently occurs at screening mammography. Biopsy is more frequently performed following bilateral recall, but the PPV of recall is similar for unilateral and bilateral recall. Invasive cancers of both groups show comparable pathological features except of a larger tumor size after bilateral recall. What's new? Data on bilateral breast cancer in a screened population is sparse, and information on bilateral recall is lacking. Based on more than 329,000 screening mammograms, our study shows that bilateral recall occurs infrequently at screening mammography, and that the majority of these recalls are false positives. Invasive cancer has comparable pathological features in bilateral and unilateral breast cancer patients, except larger tumour size after bilateral recall. Altogether, the results highlight the need for screening radiologists to pay vigorous attention to the contralateral breast after detecting a screening mammographic abnormality in order to facilitate a timely diagnosis of bilateral breast cancer.
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Affiliation(s)
- Joost R C Lameijer
- Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Breast Cancer Screening, Dutch Expert Centre for Screening, Nijmegen, The Netherlands
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McDonald AM, Chen Y, Wu J, Hageman L, Francisco L, Kung M, Wong FL, Ness E, Landier W, Battles K, Salzman D, Weisdorf DJ, Forman SJ, Arora M, Armenian SH, Bhatia S. Total Body Irradiation and Risk of Breast Cancer After Blood or Marrow Transplantation: A Blood or Marrow Transplantation Survivor Study Report. J Clin Oncol 2020; 38:2872-2882. [PMID: 32673169 DOI: 10.1200/jco.20.00231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the association between total body irradiation (TBI) and subsequent breast cancer in women treated with blood or marrow transplantation (BMT) for hematologic malignancies. PATIENTS AND METHODS Participants were drawn from the BMT Survivor Study (BMTSS), a retrospective cohort study that included patients who underwent transplantation between 1974 and 2014 and survived for ≥ 2 years after BMT. Patients with pre-BMT chest radiation or a history of breast cancer were excluded. Participants completed the BMTSS survey, which included details regarding breast cancer diagnosis. Subsequent breast cancer was confirmed by pathology report review or physician notes. Cox proportional hazards models assessed the association between TBI and subsequent breast cancer. Standardized incidence ratios were calculated to determine the excess risk of subsequent breast cancer compared with that in the general population. RESULTS A total of 1,464 female BMT survivors (allogeneic: n = 788; autologous: n = 676) participated, with a median follow-up of 9.3 years from BMT. TBI was used in 660 patients (46%). Thirty-seven women developed subsequent breast cancer (allogeneic: n = 19; autologous: n = 18). Multivariable analysis revealed that exposure to TBI was associated with an increased risk of subsequent breast cancer among allogeneic BMT survivors (hazard ratio [HR], 3.7 [95% CI, 1.2 to 11.8]; P = .03) and autologous BMT survivors (HR, 2.6 [95% CI, 1.0 to 6.8]; P = .048). Pre-BMT exposure to alkylating agents was associated with an increased risk of subsequent breast cancer among autologous BMT survivors (HR, 3.3 [95% CI, 1.0 to 9.0]; P = .05). Compared with that in the general population, exposure to TBI at age < 30 years was associated with a 4.4-fold higher risk of subsequent breast cancer in allogeneic BMT survivors and a 4.6-fold higher risk in autologous BMT survivors. CONCLUSION The association between TBI and subsequent breast cancer, especially among those exposed at a young age, as well as pre-BMT exposure to alkylating agents, should inform breast cancer screening for early detection.
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Affiliation(s)
- Andrew M McDonald
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica Wu
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Michelle Kung
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Los Angeles, CA
| | - Emily Ness
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Kevin Battles
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Donna Salzman
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel J Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Los Angeles, CA
| | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Saro H Armenian
- Department of Population Sciences, City of Hope, Los Angeles, CA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
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Lameijer JRC, Voogd AC, Pijnappel RM, Setz-Pels W, Broeders MJ, Tjan-Heijnen VCG, Duijm LEM. Delayed breast cancer diagnosis after repeated recall at biennial screening mammography: an observational follow-up study from the Netherlands. Br J Cancer 2020; 123:325-332. [PMID: 32390006 PMCID: PMC7374543 DOI: 10.1038/s41416-020-0870-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background Delay in detection of breast cancer may worsen tumour characteristics, with progression of tumour size and a higher risk of metastatic lymph nodes. The purpose of this study was to investigate delayed breast cancer diagnosis after repeated recall for the same mammographic abnormality at screening. Methods This was a retrospective study performed in two cohorts of women enrolled in a mammography screening programme in the Netherlands. All women aged 50−75 who underwent biennial screening mammography either between January 1, 1997 and December 31, 2006 (cohort 1) or between January 1, 2007 and December 31, 2016 (cohort 2) were included. Results The cohorts showed no difference in proportions of women with delayed breast cancer diagnosis of at least 2 years (2.2% versus 2.8%, P = 0.29). Most delays were caused by incorrect BI-RADS classifications after recall (74.2%). An increase in mean tumour size was seen when comparing sizes at initial false-negative recall and at diagnosis of breast cancer (P < 0.001). Conclusions The proportion of women with a long delay in breast cancer confirmation following repeated recall at screening mammography has not decreased during 20 years of screening. These delays lead to larger tumour size at detection and may negatively influence prognosis.
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Affiliation(s)
- Joost R C Lameijer
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Adri C Voogd
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands.,Department of Epidemiology, GROW, Maastricht University, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands
| | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Mireille J Broeders
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands.,Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands.,Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
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Coolen AMP, Korte B, Tjan-Heijnen VCG, Bodewes HW, Voogd AC, Duijm LEM. Additional Breast Cancer Detection at Digital Screening Mammography through Quality Assurance Sessions between Technologists and Radiologists. Radiology 2020; 294:509-517. [DOI: 10.1148/radiol.2019191388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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31
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Zielonke N, Gini A, Jansen EEL, Anttila A, Segnan N, Ponti A, Veerus P, de Koning HJ, van Ravesteyn NT, Heijnsdijk EAM; EU-TOPIA consortium. Evidence for reducing cancer-specific mortality due to screening for breast cancer in Europe: A systematic review. Eur J Cancer 2020; 127:191-206. [PMID: 31932175 DOI: 10.1016/j.ejca.2019.12.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/02/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study was to quantify the impact of organised mammography screening on breast cancer mortality across European regions. Therefore, a systematic review was performed including different types of studies from all European regions and stringently used clearly defined quality appraisal to summarise the best evidence. METHODS Six databases were searched including Embase, Medline and Web of Science from inception to March 2018. To identify all eligible studies which assessed the effect of organised screening on breast cancer mortality, two reviewers independently applied predefined inclusion and exclusion criteria. Original studies in English with a minimum follow-up of five years that were randomised controlled trials (RCTs) or observational studies were included. The Cochrane risk of bias instrument and the Newcastle-Ottawa Scale were used to assess the risk of bias. RESULTS Of the 5015 references initially retrieved, 60 were included in the final analysis. Those comprised 36 cohort studies, 17 case-control studies and 7 RCTs. None were from Eastern Europe. The quality of the included studies varied: Nineteen of these studies were of very good or good quality. Of those, the reduction in breast cancer mortality in attenders versus non-attenders ranged between 33% and 43% (Northern Europe), 43%-45% (Southern Europe) and 12%-58% (Western Europe). The estimates ranged between 4% and 31% in invited versus non-invited. CONCLUSION This systematic review provides evidence that organised screening reduces breast cancer mortality in all European regions where screening was implemented and monitored, while quantification is still lacking for Eastern Europe. The wide range of estimates indicates large differences in the evaluation designs between studies, rather than in the effectiveness of screening.
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Miret C, Domingo L, Louro J, Barata T, Baré M, Ferrer J, Carmona-García MC, Castells X, Sala M. Factors associated with readmissions in women participating in screening programs and treated for breast cancer: a retrospective cohort study. BMC Health Serv Res 2019; 19:940. [PMID: 31805926 PMCID: PMC6896282 DOI: 10.1186/s12913-019-4789-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/28/2019] [Indexed: 01/15/2023] Open
Abstract
Background We aimed to identify the risk factors associated with early, late and long-term readmissions in women diagnosed with breast cancer participating in screening programs. Methods We performed a multicenter cohort study of 1055 women aged 50–69 years participating in Spanish screening programs, diagnosed with breast cancer between 2000 and 2009, and followed up to 2014. Readmission was defined as a hospital admission related to the disease and/or treatment complications, and was classified as early (< 30 days), late (30 days-1 year), or long-term readmission (> 1 year). We used logistic regression to estimate the adjusted odds ratios (aOR), and 95% confidence intervals (95% CI) to explore the factors associated with early, late and long-term readmissions, adjusting by women’s and tumor characteristics, detection mode, treatments received, and surgical and medical complications. Results Among the women included, early readmission occurred in 76 (7.2%), late readmission in 87 (8.2%), long-term readmission in 71 (6.7%), and no readmission in 821 (77.8%). Surgical complications were associated with an increased risk of early readmissions (aOR = 3.62; 95%CI: 1.27–10.29), and medical complications with late readmissions (aOR = 8.72; 95%CI: 2.83–26.86) and long-term readmissions (aOR = 4.79; 95%CI: 1.41–16.31). Conclusion Our results suggest that the presence of surgical or medical complications increases readmission risk, taking into account the detection mode and treatments received. Identifying early complications related to an increased risk of readmission could be useful to adapt the management of patients and reduce further readmissions. Trial Registration ClinicalTrials.govIdentifier: NCT03165006. Registration date: May 22, 2017 (Retrospectively registered).
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Affiliation(s)
- Carme Miret
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Parc de Salut Mar, Agència de Salut Pública de Barcelona, Pompeu Fabra University, Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Barcelona, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain. .,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain.
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Teresa Barata
- General Directorate of Health Care Programs, Canary Islands Health Service, C/ Juan XXIII,13, 35005, Las Palmas de Gran Canaria, Spain
| | - Marisa Baré
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain.,Cancer Screening and Clinical Epidemiology, Corporació Sanitària Parc Taulí, 08208, Sabadell, Spain
| | - Joana Ferrer
- Department of Radiology, Hospital de Santa Caterina, C/ Dr. Castany, s/n, 17190 Salt, Girona, Spain
| | - Maria Carmen Carmona-García
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Catalan Institute of Oncology, C/ Sol, 15, 17004, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), C/ Dr Castany s/n, 17190 Salt, Girona, Spain.,Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Dr Josep Trueta, Av. França, S/N, 17007, Girona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain
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Katalinic A, Eisemann N, Kraywinkel K, Noftz MR, Hübner J. Breast cancer incidence and mortality before and after implementation of the German mammography screening program. Int J Cancer 2019; 147:709-718. [DOI: 10.1002/ijc.32767] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/04/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Alexander Katalinic
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
- Institute for Cancer EpidemiologyUniversity of Lübeck Lübeck Germany
| | - Nora Eisemann
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
| | - Klaus Kraywinkel
- Department for Epidemiology and Health ReportingGerman Centre for Cancer Registry Data, Robert Koch‐Institute Berlin Germany
| | - Maria R. Noftz
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
| | - Joachim Hübner
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
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Yuan C, Kulkarni K, Dashevsky BZ. Preventive Care: How Mammography Utilization Changes as Women Age. J Am Coll Radiol 2019; 17:238-247. [PMID: 31628897 DOI: 10.1016/j.jacr.2019.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/29/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of comorbid conditions and age on mammography use. METHODS We used data from the 2011 to 2015 Medical Expenditure Panel Survey, which contained records for 40,752 women over the age of 40. Use was defined as a mammogram within the previous 1 or 2 years, analyzed separately. A logit model was employed to evaluate associations between use and comorbidities and age. Statistical significance was defined by a P < .05 by two-sided test. RESULTS Of the 36,575 women in our study sample, 45.9%, 43.6%, 3.9%, and 5.7% reported a history of hypertension (HTN), hyperlipidemia (HLD), prior heart attack (MI), and prior stroke, respectively. Among women without a comorbid condition, there was 47.3% annual mammography use. HTN and HLD were associated with increased use (2.5 and 6.8 percentage points [pp], P< .01). In comparison, prior MI was associated with decreased annual use (-8.2 pp, P < .01). Prior stroke was not significantly associated with annual mammography (-1.5 pp, P = .42). Results were similar for biennial use. The age trend in use showed that the age with maximum screening use was approximately 60 years. DISCUSSION Mammography use was higher in patients with HTN and HLD and lower in patients with prior MI and stroke, which may reflect differences in comorbidity-related general health care use. Use increased until it peaked around age 60. An understanding of how mammography use naturally evolves as people age may help better target specific populations and improve overall use of preventive care.
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Affiliation(s)
- Cindy Yuan
- Department of Radiology, University of Chicago, Chicago, Illinois.
| | - Kirti Kulkarni
- Department of Radiology, University of Chicago, Chicago, Illinois
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ditsch N, Untch M, Thill M, Müller V, Janni W, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Diel I, Fasching PA, Fehm T, Friedrich M, Gerber B, Hanf V, Harbeck N, Huober J, Jackisch C, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Müller-Schimpfle M, Mundhenke C, Nitz U, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Wenz F, Witzel I, Wöckel A. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2019. Breast Care (Basel) 2019; 14:224-245. [PMID: 31558897 PMCID: PMC6751475 DOI: 10.1159/000501000] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/16/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nina Ditsch
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kassel, Kassel, Germany
| | | | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Ingo Diel
- Praxisklinik am Rosengarten, Mannheim, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Klinik für Gynäkologie und Geburtshilfe, St. Vinzenz-Krankenhaus GmbH Paderborn, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Markus Müller-Schimpfle
- Klinik für Radiologie, Neuroradiologie und Nuklearmedizin, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Senologie, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Gynäkologische Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | | | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
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Iwamoto Y, Kaucher S, Lorenz E, Bärnighausen T, Winkler V. Development of breast cancer mortality considering the implementation of mammography screening programs - a comparison of western European countries. BMC Public Health 2019; 19:823. [PMID: 31242882 DOI: 10.1186/s12889-019-7166-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/13/2019] [Indexed: 12/29/2022] Open
Abstract
Background Triggered by the successive implementation of organized mammography screening programs (MSPs) throughout western European countries over the last decades, there is an ongoing debate questioning their effectiveness. Since it is difficult to assess the effect of MSPs on a population level, we rather aim to assess the impact of the implementation itself on breast cancer mortality rates utilizing an ecological study design. Methods We analyzed age group-specific (50–59, 60–69 and 70–79 years) female breast cancer mortality rates in 14 western European countries between 1980 and 2017 using Joinpoint regression, interrupted time series (ITS) regression and multivariable Poisson regression. Results The Joinpoint analysis demonstrated decreasing trends resulting in annual percentage changes ranging from − 1.5% to − 5.4% (50–59), − 0.2% to − 8.1% (60–69) and 0% to − 7.1% (70–79) depending on the country within 3 years after MSP implementation. The ITS analysis results in highly significant interaction terms (calendar year * binary MSP indicator) for all age groups. The multivariable regression using “calendar year”, “year of MSP implementation” and “years with MSP” as independent variables yielded a significant yearly decrease for “years with MSP” ranging from 0.9 to 1.2%. Conclusions The results of this study suggest a positive association between the implementation of MSPs and the (accelerated) reduction of breast cancer mortality rates. Measuring and quantifying the isolated effect of MSPs on a population level will require additional studies using individual data.
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van Zelst JCM, Vreemann S, Witt HJ, Gubern-Merida A, Dorrius MD, Duvivier K, Lardenoije-Broker S, Lobbes MBI, Loo C, Veldhuis W, Veltman J, Drieling D, Karssemeijer N, Mann RM. Multireader Study on the Diagnostic Accuracy of Ultrafast Breast Magnetic Resonance Imaging for Breast Cancer Screening. Invest Radiol 2018; 53:579-86. [PMID: 29944483 DOI: 10.1097/RLI.0000000000000494] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Breast cancer screening using magnetic resonance imaging (MRI) has limited accessibility due to high costs of breast MRI. Ultrafast dynamic contrast-enhanced breast MRI can be acquired within 2 minutes. We aimed to assess whether screening performance of breast radiologist using an ultrafast breast MRI-only screening protocol is as good as performance using a full multiparametric diagnostic MRI protocol (FDP). MATERIALS AND METHODS The institutional review board approved this study, and waived the need for informed consent. Between January 2012 and June 2014, 1791 consecutive breast cancer screening examinations from 954 women with a lifetime risk of more than 20% were prospectively collected. All women were scanned using a 3 T protocol interleaving ultrafast breast MRI acquisitions in a full multiparametric diagnostic MRI protocol consisting of standard dynamic contrast-enhanced sequences, diffusion-weighted imaging, and T2-weighted imaging. Subsequently, a case set was created including all biopsied screen-detected lesions in this period (31 malignant and 54 benign) and 116 randomly selected normal cases with more than 2 years of follow-up. Prior examinations were included when available. Seven dedicated breast radiologists read all 201 examinations and 153 available priors once using the FDP and once using ultrafast breast MRI only in 2 counterbalanced and crossed-over reading sessions. RESULTS For reading the FDP versus ultrafast breast MRI alone, sensitivity was 0.86 (95% confidence interval [CI], 0.81-0.90) versus 0.84 (95% CI, 0.78-0.88) (P = 0.50), specificity was 0.76 (95% CI, 0.74-0.79) versus 0.82 (95% CI, 0.79-0.84) (P = 0.002), positive predictive value was 0.40 (95% CI, 0.36-0.45) versus 0.45 (95% CI, 0.41-0.50) (P = 0.14), and area under the receiver operating characteristics curve was 0.89 (95% CI, 0.82-0.96) versus 0.89 (95% CI, 0.82-0.96) (P = 0.83). Ultrafast breast MRI reading was 22.8% faster than reading FDP (P < 0.001). Interreader agreement is significantly better for ultrafast breast MRI (κ = 0.730; 95% CI, 0.699-0.761) than for the FDP (κ = 0.665; 95% CI, 0.633-0.696). CONCLUSIONS Breast MRI screening using only an ultrafast breast MRI protocol is noninferior to screening with an FDP and may result in significantly higher screening specificity and shorter reading time.
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Luiten JD, Korte B, Voogd AC, Vreuls W, Luiten EJT, Strobbe LJ, Rutten MJCM, Plaisier ML, Lohle PN, Hooijen MJH, Tjan-Heijnen VCG, Duijm LEM. Trends in frequency and outcome of high-risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study. Int J Cancer 2019; 145:2720-2727. [PMID: 31001821 PMCID: PMC6766874 DOI: 10.1002/ijc.32353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/21/2019] [Accepted: 04/11/2019] [Indexed: 11/18/2022]
Abstract
Between January 1, 2011, and December 31, 2016, we studied the incidence, management and outcome of high‐risk breast lesions in a consecutive series of 376,519 screens of women who received biennial screening mammography. During the 6‐year period covered by the study, the proportion of women who underwent core needle biopsy (CNB) after recall remained fairly stable, ranging from 39.2% to 48.1% (mean: 44.2%, 5,212/11,783), whereas the proportion of high‐risk lesions at CNB (i.e., flat epithelial atypia, atypical ductal hyperplasia, lobular carcinoma in situ and papillary lesions) gradually increased from 3.2% (25/775) in 2011 to 9.5% (86/901) in 2016 (p < 0.001). The mean proportion of high‐risk lesions at CNB that were subsequently treated with diagnostic surgical excision was 51.4% (169/329) and varied between 41.0% and 64.3% through the years, but the excision rate for high‐risk lesions per 1,000 screens and per 100 recalls increased from 0.25 (2011) to 0.70 (2016; p < 0.001) and from 0.81 (2011) to 2.50 (2016; p < 0.001), respectively. The proportion of all diagnostic surgical excisions showing in situ or invasive breast cancer was 29.0% (49/169) and varied from 22.2% (8/36) in 2014 to 38.5% (5/13) in 2011. In conclusion, the proportion of high‐risk lesions at CNB tripled in a 6‐year period, with a concomitant increased excision rate for these lesions. As the proportion of surgical excisions showing in situ or invasive breast cancer did not increase, a rising number of screened women underwent invasive surgical excision with benign outcome. What's new? Screening mammography aims to catch breast cancer early to reduce associated morbidity and mortality. Women with suspect findings at mammography frequently are recalled for further testing with core needle biopsy (CNB). In this investigation, the proportion of high‐risk lesions detected at CNB was found to have tripled among women in the Netherlands who underwent mammographic screening between 2011 and 2016. This increase was accompanied by an increase in lesion excision rates. Of excised lesions, little more than 14% proved to be malignant at two‐year follow‐up. The remainder of lesions exhibited benign pathology, suggesting that many women underwent potentially unnecessary surgery.
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Affiliation(s)
- Jacky D Luiten
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,School for Oncology and Developmental Biology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands
| | - Bram Korte
- Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Willem Vreuls
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ernest J T Luiten
- Department of Surgical Oncology, Amphia Hospital, Breda, The Netherlands
| | - Luc J Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Menno L Plaisier
- Department of Radiology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Paul N Lohle
- Department of Radiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Vivianne C G Tjan-Heijnen
- School for Oncology and Developmental Biology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, Nijmegen, The Netherlands
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Lameijer JR, Coolen AM, Nederend J, Voogd AC, Tjan-Heijnen VC, Duijm LE. Frequency and characteristics of additionally detected ipsilateral breast lesions following recall at screening mammography. Breast 2018; 42:94-101. [PMID: 30216838 DOI: 10.1016/j.breast.2018.08.104] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the frequency and outcome of additionally detected ipsilateral breast abnormalities following recall at screening mammography. METHODS AND MATERIALS We included a consecutive series of 130,338 screening mammograms obtained between January 1, 2014 and January 1, 2016. During 2-year follow-up, clinical data were collected of all recalls. Women with a bilateral recall (115) and women recalled for multiple lesions in one breast (165) were excluded from the analyses. Screening outcome parameters were determined for recalled women with or without evaluation of additional ipsilateral breast abnormalities following recall. RESULTS A total of 3995 women were recalled (recall rate, 3.1%). In 258 (6.4%) of these women, another lesion was detected in the ipsilateral breast than the one for which she had been recalled. Biopsy was more frequently performed of additionally detected ipsilateral lesions than of recalled lesions (55.8% (144/258)) versus 39.7% (1375/3457), (p < 0.001)). The proportion of malignancy in recalled lesions and additionally detected lesions was comparable (21.5% (743/3457) versus 19.0% (49/258), p = 0.34). Of all 144 biopsies of additionally detected ipsilateral lesions, 9 revealed a synchronous tumour in addition to a malignant recalled lesion, and 33 biopsies revealed multicentric or multifocal tumours. In 5 women, the recalled lesion turned out to be benign, whereas the additional lesion in a different quadrant was malignant at biopsy. A total of 97 biopsies showed benign findings. CONCLUSION A substantial proportion of women are analyzed for additional ipsilateral breast lesions following recall. These lesions are more frequently biopsied than recalled lesions, but have a comparable probability of being malignant. The majority of additionally detected cancerous lesions are part of multifocal or multicentric malignancies.
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Affiliation(s)
- Joost Rc Lameijer
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Angela Mp Coolen
- Department of Radiology, Elisabeth-Tweesteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands; Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Vivianne Cg Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands
| | - Lucien Em Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands
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Coolen AMP, Voogd AC, Strobbe LJ, Louwman MWJ, Tjan-Heijnen VCG, Duijm LEM. Impact of the second reader on screening outcome at blinded double reading of digital screening mammograms. Br J Cancer 2018; 119:503-507. [PMID: 30038325 PMCID: PMC6134129 DOI: 10.1038/s41416-018-0195-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/27/2018] [Accepted: 07/04/2018] [Indexed: 11/12/2022] Open
Abstract
Background To determine the impact of the second reader on screening outcome at blinded double reading of digital screening mammograms. Methods We included a consecutive series of 99,013 digital screening mammograms, obtained between July 2013 and January 2015 and double read in a blinded fashion. During 2-year follow-up, we collected radiology, surgery and pathology reports of recalled women. Results Single reading resulted in 2928 recalls and 616 screen-detected cancers (SDCs). The second reader recalled another 612 women, resulting in 82 additional SDCs. Addition of the second reader increased the recall rate (3.0% to 3.6%, p < 0.001), cancer detection rate (6.2–7.0 per 1000 screens, p < 0.001) and false positive recall rate (24.4–28.7 per 1000 screens, p < 0.001). Positive predictive value of recall (21.0% vs. 19.7%, p = 0.20) and of biopsy (52.1% vs. 50.9%, p = 0.56) were comparable for single reading and blinded double reading. Tumour characteristics were comparable for cancers detected by the first reader and cancers additionally detected by the second reader, except of a more favourable tumour grade in the latter group. Conclusions At blinded double reading, the second reader significantly increases the cancer detection rate, at the expense of an increased recall rate and false positive recall rate.
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Affiliation(s)
- Angela M P Coolen
- Department of Radiology, Elisabeth-Tweesteden Hospital (ETZ), PO Box 90151, 5000 LC, Tilburg, The Netherlands.
| | - Adri C Voogd
- Department of Epidemiology, GROW, Maastricht University, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Luc J Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands
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Coolen AMP, Lameijer JRC, Voogd AC, Strobbe LJ, Louwman MWJ, Tjan-Heijnen VCG, Duijm LEM. Incorporation of the technologist’s opinion for arbitration of discrepant assessments among radiologists at screening mammography. Breast Cancer Res Treat 2018; 171:143-149. [DOI: 10.1007/s10549-018-4800-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/21/2018] [Indexed: 11/28/2022]
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Zhang Q, Ding L, Liang X, Wang Y, Jiao J, Lu W, Guo X. Comparison of pathological characteristics between self-detected and screen-detected invasive breast cancers in Chinese women: a retrospective study. PeerJ 2018; 6:e4567. [PMID: 29713563 PMCID: PMC5924684 DOI: 10.7717/peerj.4567] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background In China, there is insufficient evidence to support that screening programs can detect breast cancer earlier and improve outcomes compared with patient self-reporting. Therefore, we compared the pathological characteristics at diagnosis between self-detected and screen-detected cases of invasive breast cancer at our institution and determined whether these characteristics were different after the program's introduction (vs. prior to). Methods Three databases were selected (breast cancer diagnosed in 1995-2000, 2010, and 2015), which provided a total of 3,014 female patients with invasive breast cancer. The cases were divided into self-detected and screen-detected groups. The pathological characteristics were compared between the two groups and multiple imputation and complete randomized imputation were used to deal with missing data. Results Compared with patient self-reporting, screening was associated with the following factors: a higher percentage of stage T1 tumors (75.0% vs 17.1%, P = 0.109 in 1995-2000; 66.7% vs 40.4%, P < 0.001 in 2010; 67.8% vs 35.7%, P < 0.001 in 2015); a higher percentage of tumors with stage N0 lymph node status (67.3% vs. 48.4%, P = 0.007 in 2010); and a higher percentage of histologic grade I tumors (22.9% vs 13.9%, P = 0.017 in 2010). Conclusion Screen-detected breast cancer was associated with a greater number of favorable pathological characteristics. However, although screening had a beneficial role in early detection in China, we found fewer patients were detected by screening in this study compared with those in Western and Asian developed countries.
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Affiliation(s)
- Qi Zhang
- Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lanjun Ding
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Xuan Liang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Jiao Jiao
- Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Xiaojing Guo
- Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Lameijer JRC, Coolen AM, Voogd AC, Strobbe LJ, Louwman MWJ, Venderink D, Tjan-Heijnen VC, Duijm LEM. Frequency and characteristics of contralateral breast abnormalities following recall at screening mammography. Eur Radiol 2018; 28:4205-4214. [PMID: 29666991 PMCID: PMC6132700 DOI: 10.1007/s00330-018-5370-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To determine the frequency and characteristics of contralateral, non-recalled breast abnormalities following recall at screening mammography. METHODS We included a series of 130,338 screening mammograms performed between 1 January 2014 and 1 January 2016. During the 1-year follow-up, clinical data were collected for all recalls. Screening outcome was determined for recalled women with or without evaluation of contralateral breast abnormalities. RESULTS Of 3,995 recalls (recall rate 3.1%), 129 women (3.2%) underwent assessment of a contralateral, non-recalled breast abnormality. Most lesions were detected at clinical mammography and/or breast tomosynthesis (101 women, 78.3%). The biopsy rate was similar for recalled lesions and contralateral, non-recalled lesions, but the positive predictive value of biopsy was higher for recalled lesions (p = 0.01). A comparable proportion of the recalled lesions and contralateral, non-recalled lesions were malignant (p = 0.1). The proportion of ductal carcinoma in situ was similar for both groups, as well as invasive cancer characteristics and type of surgical treatment. CONCLUSIONS About 3% of recalled women underwent evaluation of contralateral, non-recalled breast lesions. Evaluation of the contralateral breast after recall is important as we found that 15.5% of contralateral, non-recalled lesions were malignant. Contralateral cancers and screen-detected cancers show similar characteristics, stage and surgical treatment. KEY POINTS • 3% of recalled women underwent evaluation of contralateral, non-recalled lesions • One out of seven contralateral, non-recalled lesions was malignant • A contralateral cancer was diagnosed in 0.5% of recalls • Screen-detected cancers and non-recalled, contralateral cancers showed similar histological characteristics • Tumour stage and surgical treatment were similar for both groups.
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Affiliation(s)
- Joost R C Lameijer
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
| | - Angela Mp Coolen
- Department of Radiology, Elisabeth-Tweesteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022, GC, Tilburg, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, P Debyelaan 1, 6229, HA, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501, DB, Utrecht, The Netherlands.,Department of Internal Medicine, Division of Medical Oncology, GROW Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Luc J Strobbe
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501, DB, Utrecht, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, The Netherlands
| | - Vivian C Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, PO Box 6873, 6503, GJ, Nijmegen, The Netherlands
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Autier P, Boniol M. Questionable method for estimating the influence of mammography screening on breast cancer mortality in the Netherlands. Int J Cancer 2017; 141:1707-1708. [PMID: 28681417 DOI: 10.1002/ijc.30874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/16/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at iPRI, International Prevention Research Institute, Espace Européen, Allée Claude Debussy, Ecully Lyon, 69130, France.,International Prevention Research Institute (iPRI), Lyon, 69006, France
| | - Mathieu Boniol
- University of Strathclyde Institute of Global Public Health at iPRI, International Prevention Research Institute, Espace Européen, Allée Claude Debussy, Ecully Lyon, 69130, France.,International Prevention Research Institute (iPRI), Lyon, 69006, France
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Sankatsing V, van Ravesteyn N, Heijnsdijk E, de Koning H. Authors' reply to: “Questionable method for estimating the influence of mammography screening on breast cancer mortality in the Netherlands”. Int J Cancer 2017; 141:1709-1710. [DOI: 10.1002/ijc.30873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/16/2017] [Indexed: 11/06/2022]
Affiliation(s)
- V.D.V. Sankatsing
- Department of Public Health; Erasmus MC, University Medical Center Rotterdam; Rotterdam The Netherlands
| | - N.T. van Ravesteyn
- Department of Public Health; Erasmus MC, University Medical Center Rotterdam; Rotterdam The Netherlands
| | - E.A.M. Heijnsdijk
- Department of Public Health; Erasmus MC, University Medical Center Rotterdam; Rotterdam The Netherlands
| | - H.J. de Koning
- Department of Public Health; Erasmus MC, University Medical Center Rotterdam; Rotterdam The Netherlands
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