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Nicosia L, Gnocchi G, Gorini I, Venturini M, Fontana F, Pesapane F, Abiuso I, Bozzini AC, Pizzamiglio M, Latronico A, Abbate F, Meneghetti L, Battaglia O, Pellegrino G, Cassano E. History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century. Healthcare (Basel) 2023; 11:healthcare11111596. [PMID: 37297735 DOI: 10.3390/healthcare11111596] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Breast cancer is the most common forms of cancer and a leading cause of mortality in women. Early and correct diagnosis is, therefore, essential to save lives. The development of diagnostic imaging applied to the breast has been impressive in recent years and the most used diagnostic test in the world is mammography, a low-dose X-ray technique used for imaging the breast. In the first half of the 20th century, the diagnosis was in practice only clinical, with consequent diagnostic delay and an unfavorable prognosis in the short term. The rise of organized mammography screening has led to a remarkable reduction in mortality through the early detection of breast malignancies. This historical review aims to offer a complete panorama of the development of mammography and breast imaging during the last century. Through this study, we want to understand the foundations of the pillar of radiology applied to the breast through to the most modern applications such as contrast-enhanced mammography (CEM), artificial intelligence, and radiomics. Understanding the history of the development of diagnostic imaging applied to the breast can help us understand how to better direct our efforts toward an increasingly personalized and effective diagnostic approach. The ultimate goal of imaging applied to the detection of breast malignancies should be to reduce mortality from this type of disease as much as possible. With this paper, we want to provide detailed documentation of the main steps in the evolution of breast imaging for the diagnosis of breast neoplasms; we also want to open up new scenarios where the possible current and future applications of imaging are aimed at being more precise and personalized.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Gnocchi
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Ilaria Gorini
- Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, 3, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ida Abiuso
- Radiology Department, Università degli Studi di Torino, 10129 Turin, Italy
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Antuono Latronico
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Francesca Abbate
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenza Meneghetti
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ottavia Battaglia
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Giuseppe Pellegrino
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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Eby PR, Ghate S, Hooley R. The Benefits of Early Detection: Evidence From Modern International Mammography Service Screening Programs. JOURNAL OF BREAST IMAGING 2022; 4:346-356. [PMID: 38416986 DOI: 10.1093/jbi/wbac041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 03/01/2024]
Abstract
Research from randomized controlled trials initiated up to 60 years ago consistently confirms that regular screening with mammography significantly reduces breast cancer mortality. Despite this success, there is ongoing debate regarding the efficacy of screening, which is confounded by technologic advances and concerns about cost, overdiagnosis, overtreatment, and equitable care of diverse patient populations. More recent screening research, designed to quell the debates, derives data from variable study designs, each with unique strengths and weaknesses. This article reviews observational population-based screening research that has followed the early initial long-term randomized controlled trials that are no longer practical or ethical to perform. The advantages and disadvantages of observational data and study design are outlined, including the three subtypes of population-based observational studies: cohort/case-control, trend, and incidence-based mortality/staging. The most recent research, typically performed in countries that administer screening mammography to women through centralized health service programs and directly track patient-specific outcomes and detection data, is summarized. These data are essential to understand and inform construction of effective new databases that facilitate continuous assessment of optimal screening techniques in the current era of rapidly developing medical technology, combined with a focus on health care that is both personal and equitable.
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Affiliation(s)
- Peter R Eby
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | - Sujata Ghate
- Duke University School of Medicine, Department of Radiology, Durham, NC, USA
| | - Regina Hooley
- Yale New Haven Hospital, Department of Radiology and Biomedical Imaging, New Haven, CT, USA
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3
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Karzai S, Port E, Siderides C, Valente C, Ahn S, Moshier E, Ru M, Pisapati K, Couri R, Margolies L, Schmidt H, Cate S. Impact of Screening Mammography on Treatment in Young Women Diagnosed with Breast Cancer. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11581-6. [PMID: 35364765 DOI: 10.1245/s10434-022-11581-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/21/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is little data exploring the impact of screening mammography on subsequent treatment in the 40-49-year age group with breast cancer. We sought to assess the association between frequency of mammography in young women and extent of surgery and chemotherapy required. METHODS An IRB-approved retrospective review was performed of patients diagnosed with breast cancer between ages 40 and 49 years from 1 January 2010 to 19 November 2018 within a single health system. Patients were grouped based on last screening 1-24 months prior to diagnosis (1-24 group), > 25 months prior to diagnosis (> 25 group), never screened, and > 25+ never screened (combination group). Multivariate logistic regression models were used to assess for associations between screening intervals and tumor and nodal stage, chemotherapy use, and extent of surgery. RESULTS Of 869 patients included for analysis, 20% were never screened, 60% screened 1-24 months, and 19% screened > 25 months prior to diagnosis. Compared with the 1-24 months group, the never-screened group, > 25 months group, and combined group were more likely to receive chemotherapy. The never-screened and combined groups were more likely to undergo mastectomy and/or axillary lymph node dissection. Of patients undergoing upfront surgery, the > 25 months and combined groups were more likely to receive adjuvant chemotherapy, while the never-screened and combined groups were more likely to have nodal disease. CONCLUSION Our findings support the initiation of screening mammography at age 40 years to reduce the risk of aggressive treatments for newly diagnosed breast cancers in this group.
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Affiliation(s)
- Shkala Karzai
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elisa Port
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cleo Siderides
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Valente
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Soojin Ahn
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin Moshier
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meng Ru
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kereeti Pisapati
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald Couri
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie Margolies
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hank Schmidt
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Cate
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Duffy SW. Mammography Screening and Research Evidence: The Swedish Contribution. JOURNAL OF BREAST IMAGING 2021; 3:637-644. [PMID: 38424929 DOI: 10.1093/jbi/wbab067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 03/02/2024]
Abstract
Sweden has made a contribution to mammography screening research considerably disproportionate to its size. With 0.13% of the world's population, Sweden contributed almost half of the randomized trial evidence on mammography screening. In addition to the fundamental efficacy of screening in preventing deaths from breast cancer, Swedish researchers have produced a considerable volume of research evaluating mammography screening in the routine healthcare services setting and illuminating issues of breast cancer progression and natural history. The basic result that screening prevents deaths from breast cancer has informed policy and led to substantial preservation of life internationally.
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Affiliation(s)
- Stephen W Duffy
- Queen Mary University of London, Centre for Prevention, Detection and Diagnosis, London, UK
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5
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Burnell M, Gentry-Maharaj A, Skates SJ, Ryan A, Karpinskyj C, Kalsi J, Apostolidou S, Singh N, Dawnay A, Woolas R, Fallowfield L, Campbell S, McGuire A, Jacobs IJ, Parmar M, Menon U. UKCTOCS update: applying insights of delayed effects in cancer screening trials to the long-term follow-up mortality analysis. Trials 2021; 22:173. [PMID: 33648562 PMCID: PMC7919310 DOI: 10.1186/s13063-021-05125-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND During trials that span decades, new evidence including progress in statistical methodology, may require revision of original assumptions. An example is the continued use of a constant-effect approach to analyse the mortality reduction which is often delayed in cancer-screening trials. The latter led us to re-examine our approach for the upcoming primary mortality analysis (2020) of long-term follow-up of the United Kingdom Collaborative Trial of Ovarian Cancer Screening (LTFU UKCTOCS), having initially (2014) used the proportional hazards (PH) Cox model. METHODS We wrote to 12 experts in statistics/epidemiology/screening trials, setting out current evidence, the importance of pre-specification, our previous mortality analysis (2014) and three possible choices for the follow-up analysis (2020) of the mortality outcome: (A) all data (2001-2020) using the Cox model (2014), (B) new data (2015-2020) only and (C) all data (2001-2020) using a test that allows for delayed effects. RESULTS Of 11 respondents, eight supported changing the 2014 approach to allow for a potential delayed effect (option C), suggesting various tests while three favoured retaining the Cox model (option A). Consequently, we opted for the Versatile test introduced in 2016 which maintains good power for early, constant or delayed effects. We retained the Royston-Parmar model to estimate absolute differences in disease-specific mortality at 5, 10, 15 and 18 years. CONCLUSIONS The decision to alter the follow-up analysis for the primary outcome on the basis of new evidence and using new statistical methodology for long-term follow-up is novel and has implications beyond UKCTOCS. There is an urgent need for consensus building on how best to design, test, estimate and report mortality outcomes from long-term randomised cancer screening trials. TRIAL REGISTRATION ISRCTN22488978 . Registered on 6 April 2000.
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Affiliation(s)
- Matthew Burnell
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Aleksandra Gentry-Maharaj
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Steven J Skates
- MGH Biostatistics, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Andy Ryan
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Chloe Karpinskyj
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Jatinderpal Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, 84-86 Chenies Mews, London, WC1E 6HU, UK
| | - Sophia Apostolidou
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Naveena Singh
- Department of Pathology, Barts Health National Health Service Trust, The Royal Hospital, Whitechapel Rd, London, E1 1BB, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health National Health Service Trust, Barts Health, 4th floor, Pathology and Pharmacy, 80 Newark St, London, E1 2ES, UK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, PO6 3LY, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Science Park Road, Falmer, Brighton, BN1 9RX, UK
| | | | - Alistair McGuire
- Department of Social Policy, London School of Economics, Houghton Street, London, WC2A 2AE, UK
| | - Ian J Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, 84-86 Chenies Mews, London, WC1E 6HU, UK
- University of New South Wales, Sydney, NSW, 2052, Australia
| | - Mahesh Parmar
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Usha Menon
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK.
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Huang Y, Tong Z, Chen K, Wang Y, Liu P, Gu L, Liu J, Yu J, Song F, Zhao W, Shi Y, Li H, Xiao H, Hao X. Interpretation of breast cancer screening guideline for Chinese women. Cancer Biol Med 2019; 16:825-835. [PMID: 31908899 PMCID: PMC6936244 DOI: 10.20892/j.issn.2095-3941.2019.0322] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/26/2019] [Indexed: 12/19/2022] Open
Abstract
Breast cancer is the most common malignant tumor in Chinese women. Early screening is the best way to improve the rates of early diagnosis and survival of breast cancer patients. The peak onset age for breast cancer in Chinese women is considerably younger than those in European and American women. It is imperative to develop breast cancer screening guideline that is suitable for Chinese women. By summarizing the current evidence on breast cancer screening in Chinese women, and referring to the latest guidelines and consensus on breast cancer screening in Europe, the United States, and East Asia, the China Anti-Cancer Association and National Clinical Research Center for Cancer (Tianjin Medical University Cancer Institute and Hospital) have formulated population-based guideline for breast cancer screening in Chinese women. The guideline provides recommendations on breast cancer screening for Chinese women at average or high risk of breast cancer according to the following three aspects: age of screening, screening methods, and screening interval. This article provides more detailed information to support the recommendations in this guideline and to provide more direction for current breast cancer screening practices in China.
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Affiliation(s)
| | | | - Kexin Chen
- Department of Epidemiology and Statistics
| | - Ying Wang
- Department of Epidemiology and Statistics
- China Anti-Cancer Association, Tianjin 300060, China
| | | | - Lin Gu
- The 2 Surgery Department of Breast Oncology
| | | | - Jinpu Yu
- Cancer Molecular Diagnostics Core
| | | | - Wenhua Zhao
- Department of Epidemiology and Statistics
- China Anti-Cancer Association, Tianjin 300060, China
| | - Yehui Shi
- Medicine Department of Breast Oncology
| | - Hui Li
- Department of Gastrointestinal Cancer Biology
| | - Huaiyuan Xiao
- Department of Research and Education, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xishan Hao
- Department of Epidemiology and Statistics
- China Anti-Cancer Association, Tianjin 300060, China
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Matters of fact and politics: Generating expectations of cancer screening. Soc Sci Med 2019; 232:408-416. [PMID: 31151027 DOI: 10.1016/j.socscimed.2019.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 05/11/2019] [Accepted: 05/16/2019] [Indexed: 11/20/2022]
Abstract
Many countries, including Australia, the United Kingdom and the United States have established national screening programs in the effort to advance the early diagnosis of cancers. Australia has population screening programs for breast, bowel and cervical cancers, and this article focuses on breast and cervical cancer screening as the two longest running programs in Australia. While these screening programs are well-established and report relatively high participation rates, the effectiveness of population screening is a contested issue, subject to significant, ongoing debate about its purported benefits (Armstrong, 2019). In this article, we draw on ideas from sociology of science on the construction of scientific facts to analyse how evidentiary claims are presented in policy documents for Australia's breast and cervical cancer screening programs, and the implications for those who are the targets of screening. We explore how screening-related information assumes the status of scientific 'facts', and argue that presenting information as neutral and objective obscures the political choices involved in its generation. Importantly, some of the claims presented in the policy documents have a tendency to emphasise the benefits, and minimise the risks and harms of population-based screening. In doing so, we suggest that the current national policies may be contributing to sustaining expectations of screening that are higher than warranted. Higher expectations may bring with them unintended societal and economic costs to the public. We conclude by noting how deeply ingrained socio-cultural meanings of cancer shape public expectations of the protective value of screening, which allows current screening approaches to become further entrenched and resistant to challenge.
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Lee-Felker S. Underutilization of Supplemental Magnetic Resonance Imaging Screening Among Patients at High Breast Cancer Risk. J Womens Health (Larchmt) 2018; 27:733-734. [DOI: 10.1089/jwh.2017.6906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephanie Lee-Felker
- Department of Radiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California
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Wald N, Chamberlain J, Hackshaw A. Report of the European Society of Mastology Breast Cancer Screening Evaluation Committee. TUMORI JOURNAL 2018; 79:371-9. [PMID: 8171734 DOI: 10.1177/030089169307900601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N Wald
- Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St. Batholomew's Hospital Medical College, Charterhouse Square, London, U.K
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10
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Takkar N, Kochhar S, Garg P, Pandey AK, Dalal UR, Handa U. Screening methods (clinical breast examination and mammography) to detect breast cancer in women aged 40-49 years. J Midlife Health 2017; 8:2-10. [PMID: 28458473 PMCID: PMC5367219 DOI: 10.4103/jmh.jmh_26_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: The aim of this study is to detect breast cancer rate, nodal status, tumor size, and associated risk factors using clinical breast examination (CBE) and mammography as screening tools in women aged 40–49 years. Materials and Methods: A total of 500 women were screened in a time period of 2 years, between the ages of 40–49 years for breast cancer. Screening tools used were CBE and mammography. Clinical history and risk factors related to breast cancer were recorded. CBE was performed to detect any breast pathology followed by mammographic screening. Breast Imaging Reporting and Data System (BI-RADS) mammographic density categories were used for reporting breast imaging on mammography. For women with dense breasts or an inconclusive mammography report, ultrasonography was performed to assess the lesion/s. Suspicious lesion was subjected to fine-needle aspiration cytology or an open surgical biopsy for a confirmatory diagnosis. Women with history of breast cancer were excluded from the study. Results: CBE was normal in almost 90% of the women. Screening mammography revealed Breast Imaging Reporting and Data System (BI-RADS) I and BI-RADS II in 58.4% and 34.6% of women, respectively. Only 7% of women belonged to BI-RADS III and none in BI-RADS IV category. Conclusion: The study findings are in agreement with the recommendations of the World Health Organization, US preventive task force and UK guidelines that recommend screening mammography in women starting at 50 years.
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Affiliation(s)
| | | | | | - A K Pandey
- Department of Radiotherapy, GMCH, Chandigarh, India
| | | | - Uma Handa
- Department of Pathology, GMCH, Chandigarh, India
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Altunkeser A, Körez MK. Usefulness of grayscale inverted images in addition to standard images in digital mammography. BMC Med Imaging 2017; 17:26. [PMID: 28420325 PMCID: PMC5395830 DOI: 10.1186/s12880-017-0196-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/04/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Mammography is essential for early diagnosis of breast cancer, which is the most common type of cancer in females that is associated with a high mortality rate. We investigated whether evaluation of the grayscale inverted images of mammograms would aid in increasing the diagnostic sensitivity of the mammographic imaging technique. METHODS Our study included 636 mammograms of 159 women who had undergone digital mammography. Standard, grayscale inverted, and standard plus grayscale inverted images were sequentially examined three times, at 15-day intervals, for the presence or assessment of pathological changes in the skin, calcification, asymmetric density, mass lesions, structural distortions, and intramammary and axillary lymph nodes. To determine whether grayscale inverted image assessment improved detection rates, the results of the three assessment modes were compared using Cochran's Q test and the McNemar test (p < 0.05 was considered statistically significant). RESULTS The average age of 159 patients was 50.4 years (range, 35-80 years). There were significant differences among the three assessment modes with respect to calcification and intramammary lymph nodes (p < 0.05); however, no significant differences were observed for the detection of other parameters. CONCLUSIONS Assessment of grayscale inverted images in addition to standard images facilitates the detection of microcalcification.
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Affiliation(s)
- Ayşegül Altunkeser
- Department of Radiology, Konya Education and Research Hospital, Konya, Turkey
- Konya Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Hacı Şaban Mah, Meram Yeni Yol Caddesi, No: 97, PK: 42090 Meram, Konya Turkey
| | - M. Kazım Körez
- Department of Statistics, Faculty of Science, Selcuk University, Konya, Turkey
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12
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Nyström L, Bjurstam N, Jonsson H, Zackrisson S, Frisell J. Reduced breast cancer mortality after 20+ years of follow-up in the Swedish randomized controlled mammography trials in Malmö, Stockholm, and Göteborg. J Med Screen 2016; 24:34-42. [PMID: 27306511 DOI: 10.1177/0969141316648987] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To analyze the age- and trial-specific effects of the breast cancer screening trials with mammography in Malmö, Stockholm, and Göteborg. Methods The original trial files were linked to the Swedish Cancer and Cause of Death Registers to obtain date of breast cancer diagnosis and date and cause of death. Relative risks and 95% confidence intervals were calculated using the evaluation model (only breast cancers diagnosed between date of randomization and date when the first screening round of the control group was completed were included in the analysis). Results Women aged 40-70 at randomization in the Malmö I and II, Stockholm, and Göteborg trials were followed-up for an average of 30, 22, 25, and 24 years, respectively. The overview of all trials resulted in a significant decrease of 15% in breast cancer mortality. The variation by consecutive 10-year age group at randomization was small-from 21% in the age group 40-49 to 11% in the age group 50-59. After adjustment for age, there was a significant reduction in breast cancer mortality in the Göteborg trial (26%), and a non-significant reduction in the Malmö I and II and Stockholm trials (12%, 15%, and 5.8%, respectively). Conclusions The overview showed a 15% significant relative reduction in breast cancer mortality due to invitation to mammography screening. Heterogeneity in age, trial time, attendance rates, and length of screening intervals may have contributed to the variation in effect between the trials.
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Affiliation(s)
- Lennarth Nyström
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Nils Bjurstam
- 2 Department of Radiology, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
| | - Håkan Jonsson
- 3 Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Sophia Zackrisson
- 4 Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.,5 Diagnostic Radiology, Lund University, Lund, Sweden
| | - Jan Frisell
- 6 Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
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13
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Hamashima C, Hamashima C C, Hattori M, Honjo S, Kasahara Y, Katayama T, Nakai M, Nakayama T, Morita T, Ohta K, Ohnuki K, Sagawa M, Saito H, Sasaki S, Shimada T, Sobue T, Suto A. The Japanese Guidelines for Breast Cancer Screening. Jpn J Clin Oncol 2016; 46:482-492. [PMID: 27207993 DOI: 10.1093/jjco/hyw008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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14
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Akande HJ, Olafimihan BB, Oyinloye OI. A five year audit of mammography in a tertiary hospital, North Central Nigeria. Niger Med J 2015; 56:213-7. [PMID: 26229232 PMCID: PMC4518340 DOI: 10.4103/0300-1652.160401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Breast imaging plays a vital role in the multidisciplinary approach to management of breast disease. A baseline data is apt and necessary for collaborative studies. Materials and Methods: This is a prospective descriptive study carried out between January 2009 and December 2013 at our institution. Patients who had breast imaging were recruited into the study. Film-screen mammograms were acquired with a General Electric (GE) Senographe DMR machine. Breast ultrasound done using an Aloka Prosound SSD-350+ ultrasound machine equipped with linear and curvilinear 7.5–10 MHz transducer. Findings were categorized using the ACR-BIRADS (American college of Radiologists-Breast imaging reporting and data system). Data was collated and analysed using social statistical package (SPSS) version 17. Result: The mammograms of 824 patients were evaluated during this study period. Their age ranged from 40–85 years with a mean age of 50.9 ± 8.1 years. Eight hundred and sixteen (99%) were females and eight (1%) were males. The commonest clinical indication was breast lump (23.9%). The commonest density pattern was BIRADS 2-scattered fibroglandular pattern (43.9%). Mammograms were normal in 266 (32.3%) and positive in 558 (67.7%). The final BIRADS assessment showed BIRADS 0, 1, 2, 3, 4, 5 and 6 constituted 6.6%, 30.1%, 29.7%, 22.2%, 5.9%, 5.0% and 0.5% respectively. Conclusion: The level of awareness of breast cancer is quite high with the positive mammographic yield emphasizing the value of a multidisciplinary approach in the management of breast diseases.
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Affiliation(s)
- Halimat Jumai Akande
- Department of Radiology, College of Health Sciences, Faculty of Clinical Science, University of Ilorin/Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Bola Bamidele Olafimihan
- Department of Radiology, College of Health Sciences, Faculty of Clinical Science, University of Ilorin/Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Olalekan Ibikun Oyinloye
- Department of Radiology, College of Health Sciences, Faculty of Clinical Science, University of Ilorin/Teaching Hospital, Ilorin, Kwara, Nigeria
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Autier P, Boniol M, Smans M, Sullivan R, Boyle P. Statistical analyses in Swedish randomised trials on mammography screening and in other randomised trials on cancer screening: a systematic review. J R Soc Med 2015; 108:440-50. [PMID: 26152677 DOI: 10.1177/0141076815593403] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We compared calculations of relative risks of cancer death in Swedish mammography trials and in other cancer screening trials. PARTICIPANTS Men and women from 30 to 74 years of age. SETTING Randomised trials on cancer screening. DESIGN For each trial, we identified the intervention period, when screening was offered to screening groups and not to control groups, and the post-intervention period, when screening (or absence of screening) was the same in screening and control groups. We then examined which cancer deaths had been used for the computation of relative risk of cancer death. MAIN OUTCOME MEASURES Relative risk of cancer death. RESULTS In 17 non-breast screening trials, deaths due to cancers diagnosed during the intervention and post-intervention periods were used for relative risk calculations. In the five Swedish trials, relative risk calculations used deaths due to breast cancers found during intervention periods, but deaths due to breast cancer found at first screening of control groups were added to these groups. After reallocation of the added breast cancer deaths to post-intervention periods of control groups, relative risks of 0.86 (0.76; 0.97) were obtained for cancers found during intervention periods and 0.83 (0.71; 0.97) for cancers found during post-intervention periods, indicating constant reduction in the risk of breast cancer death during follow-up, irrespective of screening. CONCLUSIONS The use of unconventional statistical methods in Swedish trials has led to overestimation of risk reduction in breast cancer death attributable to mammography screening. The constant risk reduction observed in screening groups was probably due to the trial design that optimised awareness and medical management of women allocated to screening groups.
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Affiliation(s)
- Philippe Autier
- Institute of Global Public Health at iPRI, International Prevention Research Institute, University of Strathclyde, Ecully Lyon 69130, France International Prevention Research Institute (iPRI), Lyon 69006, France
| | - Mathieu Boniol
- Institute of Global Public Health at iPRI, International Prevention Research Institute, University of Strathclyde, Ecully Lyon 69130, France International Prevention Research Institute (iPRI), Lyon 69006, France
| | - Michel Smans
- International Prevention Research Institute (iPRI), Lyon 69006, France
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Cancer Centre, London SE1 9RT, UK
| | - Peter Boyle
- Institute of Global Public Health at iPRI, International Prevention Research Institute, University of Strathclyde, Ecully Lyon 69130, France International Prevention Research Institute (iPRI), Lyon 69006, France
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Hamashima C, Ohta K, Kasahara Y, Katayama T, Nakayama T, Honjo S, Ohnuki K. A meta-analysis of mammographic screening with and without clinical breast examination. Cancer Sci 2015; 106:812-8. [PMID: 25959787 PMCID: PMC4520631 DOI: 10.1111/cas.12693] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/19/2015] [Accepted: 05/02/2015] [Indexed: 12/29/2022] Open
Abstract
Mammographic screening with clinical breast examination has been recommended in Japan since 2000. Although mammographic screening without clinical breast examination has not been recommended, its introduction is anticipated. The efficacies of mammographic screening with and without clinical breast examination were evaluated based on the results of randomized controlled trials. PubMed and other databases for studies published between 1985 and 2014 were searched. The study design was limited to randomized controlled trials to evaluate mortality reduction from breast cancer. Five studies were eligible for meta-analysis of mammographic screening without clinical breast examination. The relative risk for women aged 40-74 years was 0.75 (95% confidence interval, 0.67-0.83). Three studies evaluated the efficacy of mammographic screening with clinical breast examination. The relative risk for women aged 40-64 years was 0.87 (95% confidence interval, 0.77-0.98). The number needed to invite was always lower in mammographic screening without clinical breast examination than in mammographic screening with clinical breast examination. In both screening methods, the number needed to invite was higher in women aged 40-49 years than in women aged 50-70 years. These results suggest that mammographic screening without clinical breast examination can afford higher benefits to women aged 50 years and over. Although evidence of the efficacy of mammographic screening without clinical breast examination was confirmed based on the results of the randomized controlled trials, a Japanese study is needed to resolve local problems.
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Affiliation(s)
- Chisato Hamashima
- Cancer Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Koji Ohta
- Department of Surgery, Fukui Prefecture Hospital, Fukui, Japan
| | - Yoshio Kasahara
- Division of Breast Surgery, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Takafumi Katayama
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Tomio Nakayama
- Center of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Koji Ohnuki
- Division of Breast Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
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Choi WJ, Cha JH, Kim HH, Shin HJ, Chae EY. Analysis of prior mammography with negative result in women with interval breast cancer. Breast Cancer 2015; 23:583-9. [PMID: 25820217 DOI: 10.1007/s12282-015-0606-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/20/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of our study was to review mammographic findings which were previously negative in women with interval breast cancer and to analyze the histopathological features of the interval breast cancer. MATERIALS AND METHODS A total of 5521 women underwent surgery for breast cancer between January 2009 and December 2011. Among them, 240 women who had undergone available, previous mammography studies reported as normal or benign (mean interval between examinations, 9.7 months) were included in our study. We reviewed the previous mammographic features and categorized as true interval breast cancer, minimal sign, and missed interval breast cancer. Histopathological findings were also reviewed. RESULTS Of the 240 diagnosed cancers, 78 (32.5 %) were classified as true interval breast cancer, 78 (32.5 %) as minimal sign, and 84 (35 %) as missed interval breast cancer. True interval breast cancer occurred in a younger age and showed dense breast compared with missed breast cancer. The breast density of 169 patients (70.4 %) was dense. In the minimal sign group, the most common finding was normal appearing tissue (61/78), followed by benign-appearing calcification (17/78). There were no significant differences in the histopathological findings in each of the three groups and tended to have smaller tumor size, negative nodal status, a lower AJCC stage, and frequent luminal A subtype. CONCLUSION The majority of interval breast cancers was not detectable in patients with dense breast or showed subtle mammographic findings on previous mammography. Although the majority of breast cancers showed a low grade in the histopathological findings, a better understanding of the mammographic findings will influence the sensitivity of mammography.
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Affiliation(s)
- Woo Jung Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea
| | - Joo Hee Cha
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea.
| | - Hak Hee Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea
| | - Hee Jung Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea
| | - Eun Young Chae
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea
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Machida Y, Tozaki M, Shimauchi A, Yoshida T. Breast density: the trend in breast cancer screening. Breast Cancer 2015; 22:253-61. [DOI: 10.1007/s12282-015-0602-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/04/2015] [Indexed: 11/28/2022]
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Bleyer A. Were our estimates of overdiagnosis with mammography screening in the United States "based on faulty science"? Oncologist 2014; 19:113-26. [PMID: 24536052 DOI: 10.1634/theoncologist.2013-0383] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Archie Bleyer
- St. Charles Health System, Central Oregon, Oregon Health and Science University, Portland, Oregon, USA
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Kayhan A, Gurdal SO, Ozaydin N, Cabioglu N, Ozturk E, Ozcinar B, Aribal E, Ozmen V. Successful first round results of a Turkish breast cancer screening program with mammography in Bahcesehir, Istanbul. Asian Pac J Cancer Prev 2014; 15:1693-7. [PMID: 24641392 DOI: 10.7314/apjcp.2014.15.4.1693] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Bahcesehir Breast Cancer Screening Project is the first organized population based breast cancer mammographic screening project in Turkey. The objective of this prospective observational study was to demonstrate the feasibility of a screening program in a developing country and to determine the appropriate age (40 or 50 years old) to start with screening in Turkish women. MATERIALS AND METHODS Between January 2009 to December 2010, a total of 3,758 women aged 40-69 years were recruited in this prospective study. Screening was conducted biannually, and five rounds were planned. After clinical breast examination (CBE), two-view mammograms were obtained. True positivity, false positivity, positive predictive values (PPV) according to ACR, cancer detection rate, minimal cancer detection rate, axillary node positivity and recall rate were calculated. Breast ultrasound and biopsy were performed in suspicious cases. RESULTS Breast biopsy was performed in 55 patients, and 18 cancers were detected in the first round. The overall cancer detection rate was 4.8 per 1,000 women. Most of the screened women (54%) and detected cancers (56%) were in women aged 40- 49. Ductal carcinoma in situ (DCIS) and stage I cancer and axillary node positivity rates were 22%, 61%, and 16.6%, respectively. The positive predictivity for biopsy was 32.7%, whereas the overall recall rate was 18.4 %. CONCLUSIONS Preliminary results of the study suggest that population based organized screening are feasible and age of onset of mammographic screening should be 40 years in Turkey.
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Affiliation(s)
- Arda Kayhan
- Department of Radiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey E-mail :
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Abstract
Numerous clinical studies have confirmed that screening women age 40 years and older reduces breast cancer mortality by 30% to 50%. Several factors including faster breast cancer growth rates and lower breast cancer incidence among younger women, as well as shorter life expectancy and more comorbid conditions among older women, should also be considered in screening guidelines. Annual screening beginning at age 40 years and continuing with no upper age limit, as long as a woman has a life expectancy of at least 5 years and no significant comorbid conditions, is currently recommended.
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Affiliation(s)
- Stephen A Feig
- Department of Radiological Sciences, University of California Irvine Medical Center, 101 City Drive South, Orange, CA 92869-3298, USA.
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Ohta K, Kasahara Y, Tanaka F, Maeda H. Is clinical breast examination effective in Japan? Consideration from the age-specific performance of breast cancer screening combining mammography with clinical breast examination. Breast Cancer 2014; 23:183-9. [PMID: 24925524 DOI: 10.1007/s12282-014-0544-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is controversy about the value of clinical breast examination (CBE) in breast cancer screening programs that include mammography. METHODS In Fukui Prefecture, a screening combining mammography with CBE was employed on 62,447 women from 2004 to 2009. We examined the sensitivity and specificity of mammography alone, and mammography and CBE together for each age group (40-49, 50-59, 60-69, and 70-79). RESULTS 167 breast cancers and 49 false-negative cancers were detected during 5 years. For the combined screening, the sensitivities were 73.1, 74.1, 78.3, and 86.5 %, and the specificities were 83.8, 87.5, 89.8, and 90.9 % in the groups of 40-49, 50-59, 60-69, and 70-79 years, respectively. In the mammography-specific analysis, sensitivity decreased to 69.8 % (-3.3 %), 66.7 % (-7.7 %), 77.3 % (-1.0 %), and 83.8 % (-2.7 %) in the groups of 40-49, 50-59, 60-69, and 70-79 years, respectively. There were greater reductions in the groups of 40-49 and 50-59 years than in those of 60-69 and 70-79 years, but there was no statistically significant decrease. Specificity generally increased with increasing age and there was a significant improvement in specificity among all age groups, except that of 70-79 years. CONCLUSIONS Our findings suggest that there is a trade-off between sensitivity and specificity associated with CBE added to mammography. This tendency is greater in those 40-50 years of age than in those 60-70 years of age. We consider that CBE may be omitted from breast cancer screening among women aged 60 and 70 years. Furthermore, another modality to complement mammography screening in younger Japanese women is expected.
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Affiliation(s)
- Kouji Ohta
- Department of Surgery, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui, 910-8526, Japan.
| | - Yoshio Kasahara
- Department of Surgery, Fukui Saiseikai Hospital, Fukui, Japan
| | - Fumie Tanaka
- Department of Surgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Hiroyuki Maeda
- Department of Surgery 1, Fukui University Graduate School of Medicine, Fukui, Japan
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Shastri SS, Mittra I, Mishra GA, Gupta S, Dikshit R, Singh S, Badwe RA. Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J Natl Cancer Inst 2014; 106:dju009. [PMID: 24563518 DOI: 10.1093/jnci/dju009] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer mortality among women in India. Because Pap smear screening is not feasible in India, we need to develop effective alternatives. METHODS A cluster-randomized controlled study was initiated in 1998 in Mumbai, India, to investigate the efficacy of visual inspection with acetic acid (VIA) performed by primary health workers in reducing cervical cancer mortality. Four rounds of cancer education and VIA screening were conducted at 24-month intervals in the screening group, whereas cancer education was offered once at entry to the control group. The study was planned for 16 years to include four screening rounds followed by four monitoring rounds. We present results after 12 years of follow-up. Poisson regression method was used to calculate the rate ratios (RRs); two-sided χ(2) was used to calculate the probability. RESULTS We recruited 75360 women from 10 clusters in the screening group and 76178 women from 10 comparable clusters in the control group. In the screening group, we achieved 89% participation for screening and 79.4% compliance for diagnosis confirmation. The incidence of invasive cervical cancer was 26.74 per 100000 (95% confidence interval [CI] = 23.41 to 30.74) in the screening group and 27.49 per 100000 (95% CI = 23.66 to 32.09) in the control group. Compliance to treatment for invasive cancer was 86.3% in the screening group and 72.3% in the control group. The screening group showed a statistically significant 31% reduction in cervical cancer mortality (RR = 0.69; 95% CI = 0.54 to 0.88; P = .003). CONCLUSIONS VIA screening by primary health workers statistically significantly reduced cervical cancer mortality. Our study demonstrates the efficacy of an easily implementable strategy that could prevent 22000 cervical cancer deaths in India and 72600 deaths in resource-poor countries annually.
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Affiliation(s)
- Surendra S Shastri
- Affiliations of authors: Tata Memorial Centre, Parel, Mumbai, India (SSS, IM, GAM, SG, RD, RAB); Novartis Pharmaceuticals UK Limited, PharmaOps Horsham, West Sussex, UK (SS)
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24
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Section editor's notebook: breast cancer screening and overdiagnosis unmasked. AJR Am J Roentgenol 2014; 202:259-61. [PMID: 24450663 DOI: 10.2214/ajr.13.12052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Guideline-inconsistent breast cancer screening for women over 50: a vignette-based survey. J Gen Intern Med 2014; 29:82-9. [PMID: 23943421 PMCID: PMC3889955 DOI: 10.1007/s11606-013-2567-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/18/2013] [Accepted: 06/27/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Professional organizations have issued guidelines recommending breast cancer screening for women 50 years of age. OBJECTIVE This study examines the percent of U.S. primary care physicians who report breast cancer screening practices that are not consistent with guidelines, and the characteristics of physicians who reported offering extra test modalities. DESIGN We analyzed a subset of a 2008 cross-sectional Women's Health Care survey sent to primary care physicians randomly selected from the national American Medical Association (AMA) Physician Masterfile. A subset of physicians received a survey that presented a vignette of a health maintenance visit for an asymptomatic 51-year-old woman who was not at high risk for breast cancer. Responses were weighted to represent physicians nationally. PARTICIPANTS 1,654 U.S. family physicians, general internists, and obstetrician-gynecologists under age 65, who practiced in office or hospital based settings (62.8 % response rate). After exclusions, 553 study physicians remained for analysis. MAIN MEASURE Physician self-report of breast cancer screening practices that are not consistent with the recommendations of the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), defined as almost always offering mammography. KEY RESULTS 36.0 % (95 % CI: 31.8 %-40.5 %) of physicians reported offering breast cancer screening tests inconsistent with national guidelines, with most offering extra tests (magnetic resonance imaging [MRI] and/or ultrasound) (33.2 %, 95 % CI 29.1 %-37.6 %). In adjusted analysis, risk-averse physicians and those who believed in the clinical effectiveness of MRI were more likely to offer extra breast cancer screening tests. CONCLUSIONS Physicians often report offering breast cancer screening test modalities beyond those recommended for a 51-year-old woman. Strategies, such as academic detailing regarding appropriate use of technology and provision of clinical decision support for breast cancer screening, could decrease overuse of resources.
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Abstract
BACKGROUND A variety of estimates of the benefits and harms of mammographic screening for breast cancer have been published and national policies vary. OBJECTIVES To assess the effect of screening for breast cancer with mammography on mortality and morbidity. SEARCH METHODS We searched PubMed (22 November 2012) and the World Health Organization's International Clinical Trials Registry Platform (22 November 2012). SELECTION CRITERIA Randomised trials comparing mammographic screening with no mammographic screening. DATA COLLECTION AND ANALYSIS Two authors independently extracted data. Study authors were contacted for additional information. MAIN RESULTS Eight eligible trials were identified. We excluded a trial because the randomisation had failed to produce comparable groups.The eligible trials included 600,000 women in the analyses in the age range 39 to 74 years. Three trials with adequate randomisation did not show a statistically significant reduction in breast cancer mortality at 13 years (relative risk (RR) 0.90, 95% confidence interval (CI) 0.79 to 1.02); four trials with suboptimal randomisation showed a significant reduction in breast cancer mortality with an RR of 0.75 (95% CI 0.67 to 0.83). The RR for all seven trials combined was 0.81 (95% CI 0.74 to 0.87). We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death. The trials with adequate randomisation did not find an effect of screening on total cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all-cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).Total numbers of lumpectomies and mastectomies were significantly larger in the screened groups (RR 1.31, 95% CI 1.22 to 1.42), as were number of mastectomies (RR 1.20, 95% CI 1.08 to 1.32). The use of radiotherapy was similarly increased whereas there was no difference in the use of chemotherapy (data available in only two trials). AUTHORS' CONCLUSIONS If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings. To help ensure that the women are fully informed before they decide whether or not to attend screening, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk. Because of substantial advances in treatment and greater breast cancer awareness since the trials were carried out, it is likely that the absolute effect of screening today is smaller than in the trials. Recent observational studies show more overdiagnosis than in the trials and very little or no reduction in the incidence of advanced cancers with screening.
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Affiliation(s)
- Peter C Gøtzsche
- The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark.
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Kadivar H, Goff BA, Phillips WR, Andrilla CHA, Berg AO, Baldwin LM. Nonrecommended breast and colorectal cancer screening for young women: a vignette-based survey. Am J Prev Med 2012; 43:231-9. [PMID: 22898115 DOI: 10.1016/j.amepre.2012.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/19/2012] [Accepted: 05/11/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little is known about the prevalence of physicians offering nonrecommended breast or colorectal cancer screening for young women. PURPOSE The goal of the current paper was to examine the percentage of primary care physicians nationally who self-report offering breast or colorectal cancer screening tests for young women, and physician/practice characteristics associated with such recommendations. METHODS Analysis was performed in 2011 on data from a 2008 cross-sectional survey presenting a vignette of a health maintenance visit by an asymptomatic woman aged 35 years. This study included surveys sent to 1546 U.S. family physicians, general internists, and obstetrician-gynecologists aged <65 years, randomly selected from the AMA Physician Masterfile (60.6% response rate). Relevant respondent subsamples were used for the breast (n=505) and colorectal (n=721) cancer screening analyses. Responses were weighted to represent physicians nationally. The main outcome was physician self-report of offering breast or colorectal cancer screening tests. RESULTS 75.3% (95% CI =71.0%, 79.2%) of physicians offered breast cancer screening tests; most commonly these physicians reported offering mammography alone (76.5%, 95% CI= 71.6%, 80.8%). A total of 39.3% (95% CI=35.5%, 43.2%) of physicians offered colorectal cancer screening tests; most commonly these physicians reported offering FOBT alone (43.3%, 95% CI=37.2%, 49.6%). In adjusted analysis, physician factors associated with offering breast and colorectal cancer screening tests were: estimating higher patient breast/colorectal cancer risk, and not listing the U.S. Preventive Services Task Force as a top influential organization. CONCLUSIONS A high percentage of physicians report offering nonrecommended breast or colorectal cancer screening tests for young women. Physicians' higher cancer-risk estimation accounted for some overscreening, but even physicians who estimated the patient to be at the same risk as the general population reported offering nonrecommended screening tests.
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Affiliation(s)
- Hajar Kadivar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA.
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Farshbaf Khalili A, Shahnazi M. Clinical breast exam, and mammography in women referred to health centers in Tabriz, Iran. J Caring Sci 2012; 1:37-45. [PMID: 25276674 DOI: 10.5681/jcs.2012.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 03/27/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Breast cancer is the most common cancer and the second principal cause of cancer death in women as well as the most common cause of death in Iranian women aged 35-55 years. Detection of breast cancer in its early stages is amenable to almost complete cure. Breast cancer screening comprises breast self-examination (BSE), clinical breast examination (CBE) and mammography. The study aimed to examine the performance of CBE and mammography among women referring to health centers of Tabriz, Iran. METHODS This was a descriptive-analytical research carried out on 400 women aged 20-50 years. The samples were chosen through random multistage sampling among health centers of Tabriz then active records of women. A questionnaire and observational checklist was used to elicit socio-demographic information and performance of women towards breast cancer screening methods. Descriptive and inferential statistics (chi-square and Fisher’s exact test) were used to analyze the data through SPSS 13. RESULTS Only 19.1% of women had clinical breast examination and 3.3% had mammogram. The main reasons why women had not performed breast cancer screening were as follows: being unaware of breast screening methods, not having a breast problem and not feeling the necessity... There was a significant correlation between performing CBE and history of breast tumor and also, between performing the mammography and family history of breast cancer and history of breast tumor (P < 0.05). CONCLUSION The findings showed that the performance of breast cancer screening methods was not satisfactory. In addition, their performance in high risk women was very desirable than others. The presentation of imperative education about breast cancer screening methods through health staff especially in pregnancy, post-partum and even in premarriage councelling periods seems necessary.
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Affiliation(s)
- Azizeh Farshbaf Khalili
- MSc, Department of Midwifery, Faculty of Nursing and Midwifery,Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahnaz Shahnazi
- MSc, Instructor, Department of Midwifery, Faculty of Nursing and Midwifery,Tabriz University of Medical Sciences, Tabriz, Iran
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Morrell S, Taylor R, Roder D, Dobson A. Mammography screening and breast cancer mortality in Australia: an aggregate cohort study. J Med Screen 2012; 19:26-34. [PMID: 22345322 DOI: 10.1258/jms.2012.011127] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Evidence that mammography screening reduces breast cancer mortality derives from trials, with observational studies broadly supporting trial findings. The purpose of this study was to evaluate the national mammographic screening programme, BreastScreen Australia, using aggregate screening and breast cancer mortality data. METHODS Breast cancer mortality from 1990 to 2004 in the whole Australian population was assessed in relation to screening exposure in the target of women aged 50-69 years. Population cohorts were defined by year of screening (and diagnosis), five-year age group at screening (and diagnosis), and local area of residence at screening (and diagnosis). Biennial screening data for BreastScreen Australia were related to cumulated mortality from breast cancer in an event analysis using Poisson regression, and in a time-to-event analysis using Cox proportional hazards regression. Results were adjusted for repeated measures and the potential effects of mammography outside BreastScreen Australia, regionality, and area socio-economic status. RESULTS From the adjusted Poisson regression model, a 22% (95% CI:12-31%) reduction in six-year cumulated mortality from breast cancer was predicted for screening participation of approximately 60%, compared with no screening; 21% (95% CI:11-30%) for the most recently reported screening participation of 56%; and 25% (95% CI:15-35%) for the programme target of 70% biennial screening participation. Corresponding estimates from the Cox proportional hazard regression model were 30% (95% CI:17-41%), 28% (95% CI:16-38%) and 34% (95% CI:20-46%). CONCLUSIONS Despite data limitations, the results of this nationwide study are consistent with the trial evidence, and with results of other service studies of mammography screening. With sufficient participation, mammography screening substantially reduces mortality from breast cancer.
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Affiliation(s)
- Stephen Morrell
- School of Public Health and Community Medicine, Faculty of Medicine University of New South Wales, Kensington Campus, Randwick (Sydney) NSW 2052, Australia
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Magnus MC, Ping M, Shen MM, Bourgeois J, Magnus JH. Effectiveness of mammography screening in reducing breast cancer mortality in women aged 39-49 years: a meta-analysis. J Womens Health (Larchmt) 2011; 20:845-52. [PMID: 21413892 DOI: 10.1089/jwh.2010.2098] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mammography screening of women >50 years of age significantly reduces breast cancer mortality in randomized controlled trials (RCTs). We sought to evaluate the effectiveness of mammography screening in women aged 39-49 years in reducing breast cancer mortality and to discuss previously published meta-analyses. METHODS PubMed/MEDLINE, OVID, COCHRANE, and Educational Resources Information Center (ERIC) databases were searched, and extracted references were reviewed. Dissertation abstracts and clinical trials databases available online were assessed to identify unpublished works. All assessments were independently done by two reviewers. All trials included were RCTs, published in English, included data on women aged 39-49, and reported relative risk (RR)/odds ratio (OR) or frequency data. RESULTS Nine studies were identified: the Kopparberg, Ostergotland (The Two-County study), Health Insurance Plan (HIP), Canada, Stockholm, Gothenburg, Edinburgh, Age, and Malmo trials. The individual trials were quality assessed, and the data were extracted using predefined forms. Using the DerSimonian and Laird random effects model, the results from the seven RCTs with the highest quality score were combined, and a significant pooled RR estimate of 0.83 (95% confidence interval [CI] 0.72-0.97) was calculated. Post hoc sensitivity analyses excluding studies with randomization before 1980 caused a loss of statistical significance (RR 0.87, 95% CI: 0.56, 1.13). CONCLUSIONS Mammography screenings are effective and generate a 17% reduction in breast cancer mortality in women 39-49 years of age. The quality of the trials varies, and providers should inform women in this age group about the positive and negative aspects of mammography screenings.
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Affiliation(s)
- Maria C Magnus
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
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Abstract
BACKGROUND A variety of estimates of the benefits and harms of mammographic screening for breast cancer have been published and national policies vary. OBJECTIVES To assess the effect of screening for breast cancer with mammography on mortality and morbidity. SEARCH STRATEGY We searched PubMed (November 2008). SELECTION CRITERIA Randomised trials comparing mammographic screening with no mammographic screening. DATA COLLECTION AND ANALYSIS Both authors independently extracted data. Study authors were contacted for additional information. MAIN RESULTS Eight eligible trials were identified. We excluded a biased trial and included 600,000 women in the analyses. Three trials with adequate randomisation did not show a significant reduction in breast cancer mortality at 13 years (relative risk (RR) 0.90, 95% confidence interval (CI) 0.79 to 1.02); four trials with suboptimal randomisation showed a significant reduction in breast cancer mortality with an RR of 0.75 (95% CI 0.67 to 0.83). The RR for all seven trials combined was 0.81 (95% CI 0.74 to 0.87). We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death. The trials with adequate randomisation did not find an effect of screening on cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all-cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).Numbers of lumpectomies and mastectomies were significantly larger in the screened groups (RR 1.31, 95% CI 1.22 to 1.42) for the two adequately randomised trials that measured this outcome; the use of radiotherapy was similarly increased. AUTHORS' CONCLUSIONS Screening is likely to reduce breast cancer mortality. As the effect was lowest in the adequately randomised trials, a reasonable estimate is a 15% reduction corresponding to an absolute risk reduction of 0.05%. Screening led to 30% overdiagnosis and overtreatment, or an absolute risk increase of 0.5%. This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress for many months because of false positive findings. It is thus not clear whether screening does more good than harm. To help ensure that the women are fully informed of both benefits and harms before they decide whether or not to attend screening, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk.
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Affiliation(s)
- Peter C Gøtzsche
- The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 3343, Copenhagen, Denmark, DK-2100
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32
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Baines CJ. Rational and irrational issues in breast cancer screening. Cancers (Basel) 2011; 3:252-66. [PMID: 24212617 PMCID: PMC3756360 DOI: 10.3390/cancers3010252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 01/03/2011] [Accepted: 01/06/2011] [Indexed: 11/19/2022] Open
Abstract
Evidence on the efficacy of breast screening from randomized controlled trials conducted in the last decades of the 1900s is reviewed. For decades, controversy about their results has centered on the magnitude of benefit in terms of breast cancer mortality reduction that can be achieved. However more recently, several expert bodies have estimated the benefits to be smaller than initially expected and concerns have been raised about screening consequences such as over-diagnosis and unnecessary treatment. Trials with substantial mortality reduction have been lauded and others with null effects have been critiqued. Critiques of the Canadian National Breast Screening Study are refuted. Extreme responses by screening advocates to the United States Preventive Services Task Force 2009 guidelines are described. The role vested interests play in determining health policy is clearly revealed in the response to the guidelines and should be more generally known. A general reluctance to explore unexpected results or to accept new paradigms is briefly discussed.
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Affiliation(s)
- Cornelia J Baines
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Ste 576, Toronto, Ontario, M5T 3M7, Canada.
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Computer-aided System of Evaluation for Population-based All-in-One Service Screening (CASE-PASS): From Study Design to Outcome Analysis with Bias Adjustment. Ann Epidemiol 2010; 20:786-96. [DOI: 10.1016/j.annepidem.2010.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 06/21/2010] [Accepted: 06/23/2010] [Indexed: 11/22/2022]
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Hellquist BN, Duffy SW, Abdsaleh S, Björneld L, Bordás P, Tabár L, Viták B, Zackrisson S, Nyström L, Jonsson H. Effectiveness of population-based service screening with mammography for women ages 40 to 49 years: evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort. Cancer 2010; 117:714-22. [PMID: 20882563 DOI: 10.1002/cncr.25650] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/16/2010] [Accepted: 08/10/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND The effectiveness of mammography screening for women ages 40 to 49 years still is questioned, and few studies of the effectiveness of service screening for this age group have been conducted. METHODS Breast cancer mortality was compared between women who were invited to service screening at ages 40 to 49 years (study group) and women in the same age group who were not invited during 1986 to 2005 (control group). Together, these women comprise the Mammography Screening of Young Women (SCRY) cohort, which includes all Swedish counties. A prescreening period was defined to facilitate a comparison of mortality in the absence of screening. The outcome measure was refined mortality, ie, breast cancer death for women who were diagnosed during follow-up at ages 40 to 49 years. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated. RESULTS There was no significant difference in breast cancer mortality during the prescreening period. During the study period, there were 803 breast cancer deaths in the study group (7.3 million person-years) and 1238 breast cancer deaths in the control group (8.8 million person-years). The average follow-up was 16 years. The estimated RR for women who were invited to screening was 0.74 (95% CI, 0.66-0.83), and the RR for women who attended screening was 0.71 (95% CI, 0.62-0.80). CONCLUSIONS In this comprehensive study, mammography screening for women ages 40 to 49 years was efficient for reducing breast cancer mortality.
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Abstract
The most rigorous and valid approach to evaluating cancer screening modalities is the randomized controlled trial (RCT). RCTs are major undertakings and the intricacies of trial design, operations, and management are generally underappreciated by the typical researcher. The purpose of this article is to inform the reader of the "nuts and bolts" of designing and conducting cancer screening RCTs. Following a brief introduction as to why RCTs are critical in evaluating screening modalities, we discuss design considerations, including the choice of design type and duration of follow-up. We next present an approach to sample-size calculations. We then discuss aspects of trial implementation, including recruitment, randomization, and data management. A discussion of commonly employed data analyses comes next, and includes methods for the primary analysis (comparison of cause-specific mortality rates between the screened and control arms for the cancer of interest), as well as for secondary endpoints such as sensitivity. We follow with a discussion of sequential monitoring and interim analysis techniques, which are used to examine the primary outcome while the trial is ongoing. We close with thoughts on lessons learned from past cancer screening RCTs and provide recommendations for future trials. Throughout the presentation we illustrate topics with examples from completed or ongoing RCTs, including the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and the National Lung Screening Trial (NLST).
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Affiliation(s)
- Philip C Prorok
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA.
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Mavi A, Cermik TF, Urhan M, Puskulcu H, Basu S, Cucchiara AJ, Yu JQ, Alavi A. The effect of age, menopausal state, and breast density on (18)F-FDG uptake in normal glandular breast tissue. J Nucl Med 2010; 51:347-52. [PMID: 20150253 DOI: 10.2967/jnumed.109.068718] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Theoretically, the degree of (18)F-FDG uptake in the glandular tissues of the normal breast can affect the detection of breast cancer. The aim of this prospective study was to investigate relationships among age, menopausal state, and breast density and determine whether they affect (18)F-FDG uptake in normal glandular breast tissue. METHODS Among 250 newly diagnosed breast cancer patients, 149 patients (mean age +/- SD, 50.9 +/- 9.70 y; range, 32-77 y) were analyzed because they had normal contralateral breasts confirmed by MRI, mammography, and (18)F-FDG PET examinations. PET images were acquired 60 +/- 2 min after the administration of (18)F-FDG (5.2 MBq/kg of body weight). The maximum and average standardized uptake value (SUVmax and SUVavg, respectively) of (18)F-FDG were calculated in the normal breast. Patients were divided into groups according to qualitative breast density and menopausal state. Descriptive statistics and 2-factorial analysis of covariance were used to assess the effects of qualitative breast density, menopausal state, and age on SUVmax and SUVavg. Pearson chi(2) was used to test the relationship between menopausal state and qualitative breast density. RESULTS The average age of patients with nondense breasts was significantly higher than that of patients with dense breasts (P < 0.01). Also, breast density related to menopausal state (P < 0.05). Dense breasts had an average SUVmax of 1.243 and mean SUVavg of 0.694, whereas nondense breasts had a mean SUVmax of 0.997 and mean SUVavg of 0.592. Analysis of covariance indicated that density and the linear effect of age were significant with regard to both SUVmax and SUVavg. After removing the linear effect of age, menopausal state had no effect on SUVmax and SUVavg. CONCLUSION (18)F-FDG uptake significantly decreases as age increases and breast density decreases. Age and qualitative breast density are independent factors and significantly affect (18)F-FDG uptake for both SUVmax and SUVavg. Menopausal state had no effect on SUVmax and SUVavg.
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Affiliation(s)
- Ayse Mavi
- Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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37
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Pluvinage A, Morin C, Devineau L, Migeot V, Coste D, Jouhanneaud A, Tasu JP. [Evaluation of a fully integrated digital screening mammography program in the Vienne region]. JOURNAL DE RADIOLOGIE 2009; 90:1837-1842. [PMID: 20032826 DOI: 10.1016/s0221-0363(09)73589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To evaluate a fully integrated digital screening mammography program (image acquisition, transfer and over-read). MATERIALS AND METHODS between april 2005 and December 2007, two imaging sites were authorized by the Department of Health to use digital mammography units (Senographe 2000D and 2000DS, GEMS) for screening mammography. the initial interpretation was made on a workstation with accompanying digital films. The images were also transmitted via the internet on the same day for over-read on a workstation. In addition, a <<classical>> over-read was also performed from printed mammographic images using a viewbox. Differences in interpretation and BIRADS classification as well as economical considerations were analyzed between the types of interpretation setups. RESULTS A total of 7008 screening mammograms were included. No significant problem was reported with regards to internet image transfers. No significant interpretation difference was noted related to the fully integrated digital imaging process. This technology could generate cost savings estimated in 2007 at 3.793/year (mailing fee). CONCLUSION A fully integrated digital screening mammography program results in improved organisational processes and significant cost reductions without reduced diagnostic accuracy.
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Affiliation(s)
- A Pluvinage
- Service d'Imagerie Médicale du CHU de Poitiers, 2, rue de Milétrie, 86000 Poitiers.
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Lakhani P, Maidment ADA, Weinstein SP, Kung JW, Alavi A. Correlation between quantified breast densities from digital mammography and 18F-FDG PET uptake. Breast J 2009; 15:339-47. [PMID: 19601942 DOI: 10.1111/j.1524-4741.2009.00737.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To correlate breast density quantified from digital mammograms with mean and maximum standardized uptake values (SUVs) from positron emission tomography (PET). This was a prospective study that included 56 women with a history of suspicion of breast cancer (mean age 49.2 +/- 9.3 years), who underwent 18F-fluoro-2-deoxyglucose (FDG)-PET imaging of their breasts as well as digital mammography. A computer thresholding algorithm was applied to the contralateral nonmalignant breasts to quantitatively estimate the breast density on digital mammograms. The breasts were also classified into one of four Breast Imaging Reporting and Data System categories for density. Comparisons between SUV and breast density were made using linear regression and the Student's t-test. Linear regression of mean SUV versus average breast density showed a positive relationship with a Pearson's correlation coefficient of R(2) = 0.83. The quantified breast densities and mean SUVs were significantly greater for mammographically dense than nondense breasts (p < 0.0001 for both). The average quantified densities and mean SUVs of the breasts were significantly greater for premenopausal than postmenopausal patients (p < 0.05). 8/51 (16%) of the patients had maximum SUVs that equaled 1.6 or greater. There is a positive linear correlation between quantified breast density on digital mammography and FDG uptake on PET. Menopausal status affects the metabolic activity of normal breast tissue, resulting in higher SUVs in pre- versus postmenopausal patients.
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Affiliation(s)
- Paras Lakhani
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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39
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Onega T, MacKenzie T, Weiss J, Goodrich M, Titus-Ernstoff L. Screening mammography intervals among postmenopausal hormone therapy users and nonusers. Cancer Causes Control 2009; 21:147-52. [PMID: 19844798 DOI: 10.1007/s10552-009-9444-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 09/29/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND The recent decline in US breast cancer incidence rates has been attributed to the marked reduction in use of postmenopausal hormone therapy (HT). An alternative explanation is that women who are not routinely seeking medical care to renew HT prescriptions may be less adherent to recommendations for mammographic screening. To investigate the latter possibility, we compared mammographic intervals according to HT use. METHODS Using data (1995-2007) from the New Hampshire Mammography Network (NHMN), a state-based mammography registry, we assessed mammographic intervals corresponding to HT use or nonuse among postmenopausal women. We used linear mixed effects models to assess whether the length of screening mammogram intervals differed according to HT use. RESULTS A total of 310,185 mammograms, representing 76,192 postmenopausal women and 319,353 person-years of screening, were included in the analysis. The median screening interval corresponding to HT use overall was 13.0 months (interquartile range: 12.4-15.1) and for nonuse was 13.1 (interquartile range: 12.4-15.8). Virtually, all screening mammograms occurred within a 2-year interval regardless of HT use or nonuse (98.5 and 98.1%, respectively). CONCLUSIONS Our findings indicate that screening mammography intervals are similar whether or not women are using HT. Thus, reduced utilization of screening mammography is unlikely to account for the decrease in breast cancer incidence seen soon after the WHI report.
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Affiliation(s)
- Tracy Onega
- Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA.
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40
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Abstract
BACKGROUND A variety of estimates of the benefits and harms of mammographic screening for breast cancer have been published and national policies vary. OBJECTIVES To assess the effect of screening for breast cancer with mammography on mortality and morbidity. SEARCH STRATEGY We searched PubMed (November 2008). SELECTION CRITERIA Randomised trials comparing mammographic screening with no mammographic screening. DATA COLLECTION AND ANALYSIS Both authors independently extracted data. Study authors were contacted for additional information. MAIN RESULTS Eight eligible trials were identified. We excluded a biased trial and included 600,000 women in the analyses. Three trials with adequate randomisation did not show a significant reduction in breast cancer mortality at 13 years (relative risk (RR) 0.90, 95% confidence interval (CI) 0.79 to 1.02); four trials with suboptimal randomisation showed a significant reduction in breast cancer mortality with an RR of 0.75 (95% CI 0.67 to 0.83). The RR for all seven trials combined was 0.81 (95% CI 0.74 to 0.87). We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death. The trials with adequate randomisation did not find an effect of screening on cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all-cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).Numbers of lumpectomies and mastectomies were significantly larger in the screened groups (RR 1.31, 95% CI 1.22 to 1.42) for the two adequately randomised trials that measured this outcome; the use of radiotherapy was similarly increased. AUTHORS' CONCLUSIONS Screening is likely to reduce breast cancer mortality. As the effect was lowest in the adequately randomised trials, a reasonable estimate is a 15% reduction corresponding to an absolute risk reduction of 0.05%. Screening led to 30% overdiagnosis and overtreatment, or an absolute risk increase of 0.5%. This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress for many months because of false positive findings. It is thus not clear whether screening does more good than harm. To help ensure that the women are fully informed of both benefits and harms before they decide whether or not to attend screening, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk.
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Affiliation(s)
- Peter C Gøtzsche
- The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 3343, Copenhagen, Denmark, 2100
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Törnberg S, Kemetli L, Lynge E, Helene Olsen A, Hofvind S, Wang H, Anttila A, Hakama M, Nyström L. Breast cancer incidence and mortality in the Nordic capitals, 1970-1998. Trends related to mammography screening programmes. Acta Oncol 2009; 45:528-35. [PMID: 16864165 DOI: 10.1080/02841860500501610] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the present study was to relate the time trends in breast cancer incidence and mortality to the introduction of mammography screening in the Nordic capitals. Helsinki offered screening to women aged 50-59 starting in 1986. The other three capitals offered screening to women aged 50-69 starting in 1989 in Stockholm, 1991 in Copenhagen, and 1996 in Oslo. Prevalence peaks in breast cancer incidence depended on the age groups covered by the screening, the length of the implementation of screening, and the extent of background opportunistic screening. No mortality reduction following the introduction of screening was visible after seven to 12 years of screening in any of the three capitals where significant effects of the screening on the breast cancer mortality had already been demonstrated by using other analytical methods for the evaluation. No visible effect on mortality reduction was expected in Oslo due to too short an observation period. The study showed that the population-based breast cancer mortality trend is too crude a measure to detect the effect of screening on breast cancer mortality during the first years after the start of a programme.
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Affiliation(s)
- Sven Törnberg
- Cancer Screening Unit, Oncologic Centre, Karolinska University Hospital, S-171 76, Stockholm, Sweden.
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Abstract
Breast cancer is the commonest cancer in most countries in Asia. The incidence rates remain low, although increasing at a more rapid rate than in western countries, due to changes in the lifestyle and diet. There are many differences between breast cancer in Asia compared with western countries. The mean age at onset is younger than in the west, and unlike the west, the age-specific incidence decreases after the age of 50 years. Because there is no population-based breast cancer screening program in the majority of Asian countries, the majority of patients present with advanced disease. There is a higher proportion of hormone receptor-negative patients, and some evidence that the cancers in Asia are of a higher grade. Most of the Asian countries are low- and middle-income countries, where access to effective care is limited. Because of the late detection and inadequate access to care, survival of women with breast cancer in Asia is lower than in western countries. Improving breast health in most of the Asian countries remains a challenge that may be overcome with collaboration from multiple sectors, both public and private.
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Tracey E, Roder D, Zorbas H, Villanueva E, Jelfs P, Bishop J. Survival and degree of spread for female breast cancers in New South Wales from 1980 to 2003: implications for cancer control. Cancer Causes Control 2008; 19:1121-30. [DOI: 10.1007/s10552-008-9177-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 05/02/2008] [Indexed: 11/30/2022]
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Evaluation of service mammography screening impact in Italy. The contribution of hazard analysis. Eur J Cancer 2008; 44:858-65. [PMID: 18359222 DOI: 10.1016/j.ejca.2008.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 02/16/2008] [Accepted: 02/22/2008] [Indexed: 11/20/2022]
Abstract
12,987 invasive breast cancer cases were diagnosed in women aged 50-69 upto the year 2001 in nine Italian areas where a screening programme was active. Cases were followed up in 2005 for a total of 1921 breast cancer failures. The 10-year survival rates were 85.3% for the invited group against 75.6% for the non-invited. A time dependent analysis was performed using 5-year intervals. Crude hazard ratios for the invited group in comparison to the not invited group were 0.52 and 0.64 respectively in the (0-5) year and [5-10] year time windows. Hazard ratio adjusted for tumour characteristics was 0.96 in the [5-10] year time window, suggesting minimal or any length bias. Consistent with the results of randomised trials, these analyses of service screening data document a mortality reduction of 36% at 5-10 years after diagnosis.
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Palmedo H, Grohé C, Ko Y, Tasci S. PET and PET/CT with F-18 fluoride in bone metastases. Recent Results Cancer Res 2008; 170:213-224. [PMID: 18019629 DOI: 10.1007/978-3-540-31203-1_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- H Palmedo
- Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Bonn, Germany
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Roder D, Houssami N, Farshid G, Gill G, Luke C, Downey P, Beckmann K, Iosifidis P, Grieve L, Williamson L. Population screening and intensity of screening are associated with reduced breast cancer mortality: evidence of efficacy of mammography screening in Australia. Breast Cancer Res Treat 2007; 108:409-16. [DOI: 10.1007/s10549-007-9609-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Accepted: 04/23/2007] [Indexed: 11/28/2022]
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Kumar R, Chauhan A, Zhuang H, Chandra P, Schnall M, Alavi A. Standardized uptake values of normal breast tissue with 2-deoxy-2-[F-18]fluoro-D: -glucose positron emission tomography: variations with age, breast density, and menopausal status. Mol Imaging Biol 2007; 8:355-62. [PMID: 17053861 DOI: 10.1007/s11307-006-0060-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study was conducted to assess the effect of breast density, age, and menopausal status on the 2-deoxy-2-[F-18]fluoro-D: -glucose (FDG) uptake in normal breast tissue by quantitative standardized uptake values (SUV). METHODS A total of 96 patients (premenopausal 54; postmenopausal 42) with histologically proven unilateral breast cancer who underwent FDG-positron emission tomography (PET) scans for staging were included in this study. The median age was 52+/-11 years (range 32-79 years). Fifty-nine patients had grade III or IV mammographic density (dense breast), whereas 37 patients had grade I or II breast density (nondense) according to the ACR Lexicon criteria. In the present study, we analyzed maximum and average SUVs for contralateral normal breast. RESULTS Maximum and average SUVs for normal dense breasts were 1.02+/-0.30 and 0.84+/-0.27, respectively. Similar values for the nondense breasts were 0.66+/-0.24 and 0.53+/-0.23, respectively. Both maximum and average SUVs of dense breasts were significantly higher than those of nondense breasts (p<0.001). There was no significant difference in SUVs of nipple in patients with dense and nondense breasts. There was no significant effect of age and menopausal status on SUVs of normal breast. However, there were trends of negative relationship, i.e., decreasing SUVs with increasing age. CONCLUSION There was a significant difference in SUVs between the dense and nondense normal breast. However, the maximum SUVs in the dense breasts were well below the threshold of 2.5, a widely used cutoff value for malignancy. Menopausal status and age do not significantly affect the uptake of FDG.
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Affiliation(s)
- Rakesh Kumar
- Department of Nuclear Medicine, All-India Institute of Medical Sciences, New Delhi, 110029, India.
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Tan SM, Evans AJ, Lam TP, Cheung KL. How relevant is breast cancer screening in the Asia/Pacific region? Breast 2006; 16:113-9. [PMID: 17081753 DOI: 10.1016/j.breast.2006.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 08/01/2006] [Accepted: 08/02/2006] [Indexed: 11/16/2022] Open
Abstract
Nationwide breast cancer screening with mammography is well-established in many western countries. Many studies have shown its benefit in mortality reduction. However, breast cancer screening in Asia has been slow to implement, as it was perceived that the breast cancer incidence was low and the parenchyma of Asian women was difficult to assess mammographically. With changing disease patterns, breast cancer is now one of the most common cancers amongst women in Asia. Breast cancer screening has become an important and relevant health problem. However, apart from biological differences between western and Asian women, cultural and economic considerations need to be addressed. This paper looks at the various issues pertaining to the feasibility and relevance of population-based screening in the Asia/Pacific region.
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Affiliation(s)
- S M Tan
- Department of Surgery, Head, Breast Service, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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Abstract
BACKGROUND A variety of estimates of the benefits and harms of mammographic screening for breast cancer have been published and national policies vary. OBJECTIVES To assess the effect of screening for breast cancer with mammography on mortality and morbidity. SEARCH STRATEGY We searched PubMed (June 2005). SELECTION CRITERIA Randomised trials comparing mammographic screening with no mammographic screening. DATA COLLECTION AND ANALYSIS Both authors independently extracted data. Study authors were contacted for additional information. MAIN RESULTS Seven completed and eligible trials involving half a million women were identified. We excluded a biased trial from analysis. Two trials with adequate randomisation did not show a significant reduction in breast cancer mortality, relative risk (RR) 0.93 (95% confidence interval 0.80 to 1.09) at 13 years; four trials with suboptimal randomisation showed a significant reduction in breast cancer mortality, RR 0.75 (0.67 to 0.83) (P = 0.02 for difference between the two estimates). RR for all six trials combined was 0.80 (0.73 to 0.88). The two trials with adequate randomisation did not find an effect of screening on cancer mortality, including breast cancer, RR 1.02 (0.95 to 1.10) after 10 years, or on all-cause mortality, RR 1.00 (0.96 to 1.04) after 13 years. We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death. Numbers of lumpectomies and mastectomies were significantly larger in the screened groups, RR 1.31 (1.22 to 1.42) for the two adequately randomised trials; the use of radiotherapy was similarly increased. AUTHORS' CONCLUSIONS Screening likely reduces breast cancer mortality. Based on all trials, the reduction is 20%, but as the effect is lower in the highest quality trials, a more reasonable estimate is a 15% relative risk reduction. Based on the risk level of women in these trials, the absolute risk reduction was 0.05%. Screening also leads to overdiagnosis and overtreatment, with an estimated 30% increase, or an absolute risk increase of 0.5%. This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm. Women invited to screening should be fully informed of both benefits and harms.
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Affiliation(s)
- P C Gøtzsche
- The Nordic Cochrane Centre, Rigshospitalet, Dept. 7112, Blegdamsvej 9, Copenhagen Ø 2100 Denmark.
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Carney PA, Harwood BG, Greene MA, Goodrich ME. Impact of a telephone counseling intervention on transitions in stage of change and adherence to interval mammography screening (United States). Cancer Causes Control 2006; 16:799-807. [PMID: 16132790 DOI: 10.1007/s10552-005-2612-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Accepted: 02/22/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Interventions to improve adherence to regular mammography screening have had conflicting results. Many studies have depended on women's self-report rather than clinical evidence of a mammography encounter. METHODS We tested the impact of two interventions on a population-based sample of NH women who were not receiving routine mammography to determine if adherence to screening could be improved. The interventions included a mailing of women's health information and a telephone counseling intervention based on the Transtheoretical Model. Participant eligibility and outcome measures were based on clinical events obtained from a population-based mammography registry. RESULTS Two hundred and fifty eight women completed all aspects of the intervention study. The women were randomly assigned to one of two study groups: 51% received the mail intervention and 49% received the telephone intervention. Among women who received the telephone counseling intervention, 67% percent reported being in either an action or maintenance stage at Call 1, which increased to 84% at Call 2 (p<0.001). Seventy-six percent of women identified barriers to screening mammography at Call 1, which decreased to 44% at Call 2 (p<0.01). The most frequently identified barrier was confusion over the guidelines for screening mammography. At the first assessment time interval, greater than 60% of women were up-to-date for screening mammography in the group that received telephone counseling versus 48% in the group that received health information by mail (p = 0.04). However, women's status as up-to-date fell for both groups between the first and second assessment time intervals. CONCLUSIONS Tailored telephone counseling based on the Transtheoretical Model can improve adherence to screening mammography, though the duration of this effect is in question.
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Affiliation(s)
- Patricia A Carney
- Department of Community and Family Medicine, Dartmouth Medical School, Norris Cotton Cancer Center, 1 Medical Center Dr, Lebanon, NH 30756, USA.
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