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Farber R, Houssami N, McGeechan K, Barratt A, Bell KJL. Breast Cancer Stage and Size Detected with Film versus Digital Mammography in New South Wales, Australia: A Population-Based Study Using Routinely Collected Data. Cancer Epidemiol Biomarkers Prev 2024; 33:671-680. [PMID: 38407377 DOI: 10.1158/1055-9965.epi-23-0813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/25/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Digital mammography has replaced film mammography in breast-screening programs globally, including Australia. This led to an increase in the rate of detection, but whether there was increased detection of clinically important cancers is uncertain. METHODS In this population-wide retrospective cohort study in New South Wales, Australia spanning 2004 to 2016 and including 4,631,656 screens, there were 22,965 cancers in women screened with film (n = 11,040) or digital mammography (n = 11,925). We examined the change in tumor characteristics overall and how these rates changed over time, accounting for changes in background rates using an interrupted time-series. Comparisons were made with unscreened women (n = 26,326) during this time. RESULTS We found increased detection of in situ cancer (3.36 per 10,000 screens), localized invasive, and smaller-sized breast cancers attributable to the change in mammography technology, whereas screen-detected intermediate-sized and metastatic breast cancers decreased. Rates of early-stage and intermediate-sized interval cancers increased, and late-stage (-1.62 per 10,000 screens) and large interval cancers decreased. In unscreened women, there were small increases in the temporal trends of cancers across all stages. CONCLUSIONS At least some of the increased detection of smaller early-stage cancers may have translated into a reduction in larger and late-stage cancers, indicating beneficial detection of cancers that would have otherwise progressed. However, the increased detection of smaller early-stage and small cancers may also have increased over-diagnosis of lesions that would otherwise have not caused harm. IMPACT Robust evaluation of potential benefits and harms is needed after changes to screening programs. See related In the Spotlight, p. 638.
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Affiliation(s)
- Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katy J L Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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2
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Lord SJ, Daniels B, O'Connell DL, Kiely BE, Beith J, Smith AL, Pearson SA, Chiew KL, Bulsara MK, Houssami N. Decline in the Incidence of Distant Recurrence of Breast Cancer: A Population-Based Health Record Linkage Study, Australia 2001-2016. Cancer Epidemiol Biomarkers Prev 2024; 33:314-324. [PMID: 38015752 DOI: 10.1158/1055-9965.epi-23-0942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/29/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND We investigated differences in cumulative incidence of first distant recurrence (DR) following non-metastatic breast cancer over a time period when new adjuvant therapies became available in Australia. METHODS We conducted a health record linkage study of females with localized (T1-3N0) or regional (T4 or N+) breast cancer in the New South Wales Cancer Registry in 2001 to 2002 and 2006 to 2007. We linked cancer registry records with administrative records from hospitals, dispensed medicines, radiotherapy services, and death registrations to estimate the 9-year cumulative incidence of DR and describe use of adjuvant treatment. RESULTS The study included 13,170 women (2001-2002 n = 6,338, 2006-2007 n = 6,832). The 9-year cumulative incidence of DR was 3.6% [95% confidence interval (CI), 2.3%-4.9%] lower for 2006-2007 diagnoses (15.0%) than 2001-2002 (18.6%). Differences in the annual hazard of DR between cohorts were largest in year two. DR incidence declined for localized and regional disease. Decline was largest for ages <40 years (absolute difference, 14.4%; 95% CI, 8.3%-20.6%), whereas their use of adjuvant chemotherapy (2001-2002 49%, 2006-2007 75%) and HER2-targeted therapy (2001-2002 0%, 2006-2007 16%) increased. DR did not decline for ages ≥70 years (absolute difference, 0.9%; 95% CI, -3.6%-1.8%) who had low use of adjuvant chemotherapy and HER2-targeted therapy. CONCLUSIONS This whole-of-population study suggests that DR incidence declined over time. Decline was largest for younger ages, coinciding with changes to adjuvant breast cancer therapy. IMPACT Study findings support the need for trials addressing questions relevant to older people and cancer registry surveillance of DR to inform cancer control programs.
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Affiliation(s)
- Sarah J Lord
- The National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, Australia
- The School of Medicine, University of Notre Dame Australia, Darlinghurst, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, UNSW Sydney, Australia
| | - Benjamin Daniels
- NHMRC Centre of Research Excellence in Medicines Intelligence, UNSW Sydney, Australia
- Health Systems Research, School of Population Health, UNSW Sydney, Australia
| | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Australia
| | - Belinda E Kiely
- The National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, Australia
| | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, The University of Sydney, Camperdown, Australia
| | - Andrea L Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Sallie-Anne Pearson
- NHMRC Centre of Research Excellence in Medicines Intelligence, UNSW Sydney, Australia
- Health Systems Research, School of Population Health, UNSW Sydney, Australia
| | - Kim-Lin Chiew
- Cancer Services Division, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Max K Bulsara
- The Institute of Health Research and the School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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3
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Fitzgerald J, Spuur K, Singh C, Hayre C, Al Mousa DS. Australian radiographers' awareness of cardiac implantable electronic devices (CIEDs) in mammographic imaging. Radiography (Lond) 2023; 29:984-991. [PMID: 37597465 DOI: 10.1016/j.radi.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Women presenting for mammography occasionally have pacemakers or other cardiac-implantable electronic devices (CIEDs) in situ. This research investigates Australian radiographers' awareness of CIEDs in the diagnostic and screening settings. METHODS A survey of radiographers with mammography experience in Australia was conducted using SurveyMonkey™. Respondents were asked if they could confidently identify images of devices and whether they had imaged them mammographically. A Chi-squared test of independence was used to compare the association between demographics and CIED awareness. A value of p < 0.05 was deemed statistically significant. RESULTS There were 220 valid responses. All CIED types had been imaged. Most respondents had imaged a pacemaker (94.5%) and implantable cardioverter-defibrillator (ICD) (85.6%), compared to the three different implantable loop recorders (ILRs) (ILR-1: 63.4%; ILR-2: 14.1%; and IRL-3: 26.9% and the emerging subcutaneous ICDs (S-ICDs) (11.9%). Most respondents felt confident identifying the pacemaker (95%) and the ICD (86.1%). Only 19.4% of respondents could confidently identify the emerging S-ICD. CONCLUSION A lack of awareness of new and emerging devices may impact approaches to imaging and present significant risk to patients. The lack of studies comprehensively describing devices and their mammographic appearance to support radiographers' knowledge and awareness highlights an urgent need to progress research in this area. IMPLICATIONS FOR PRACTICE As a part of continuing professional development, radiographers performing mammography must ensure they remain up to date with current and emerging technology, including CIEDs. This study has identified a lack of awareness of the different types of CIEDs currently being implanted and imaged, which may translate to unsafe imaging practices. There is an urgent need for further education to bridge this knowledge gap and ensure the safety of practice in imaging women with CIEDs. FOOTLINE Mammography: CIED Imaging.
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Affiliation(s)
- J Fitzgerald
- Charles Sturt University, School of Dentistry and Medical Sciences, 7 Major Innes Rd, Port Macquarie, NSW 2444, Australia.
| | - K Spuur
- Charles Sturt University, School of Dentistry and Medical Sciences, Locked Bag 588, Wagga Wagga, NSW 2678, Australia.
| | - C Singh
- Charles Sturt University, School of Dentistry and Medical Sciences, Locked Bag 588, Wagga Wagga, NSW 2678, Australia.
| | - C Hayre
- Charles Sturt University, School of Dentistry and Medical Sciences, Locked Bag 588, Wagga Wagga, NSW 2678, Australia.
| | - D S Al Mousa
- Charles Sturt University, School of Dentistry and Medical Sciences, Locked Bag 588, Wagga Wagga, NSW 2678, Australia.
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Stuart GW, Chamberlain JA, te Marvelde L. The contribution of prognostic factors to socio-demographic inequalities in breast cancer survival in Victoria, Australia. Cancer Med 2023; 12:15371-15383. [PMID: 37458115 PMCID: PMC10417162 DOI: 10.1002/cam4.6092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Breast cancer survival in Australia varies according to socio-economic status (SES) and between rural and urban places of residence. Part of this disparity may be due to differences in prognostic factors at the time of diagnosis. METHODS Women with invasive breast cancer diagnosed from 2008 until 2012 (n = 14,165) were identified from the Victorian Cancer Registry and followed up for 5 years, with death from breast cancer or other causes recorded. A prognostic score, based on stage at diagnosis, cancer grade, whether the cancer was detected via screening, reported comorbidities and age at diagnosis, was constructed for use in a mediation analysis. RESULTS Five-year breast cancer mortality for women with breast cancer who were in the lowest quintile of SES (10.3%) was almost double that of those in the highest quintile (5.7%). There was a small survival advantage (1.7% on average, within each socio-economic quintile) of living in inner-regional areas compared with major cities. About half of the socio-economic disparity was mediated by prognostic factors, particularly stage at diagnosis and the presence of comorbidities. The inner-regional survival advantage was not due to differences in prognostic factors. CONCLUSIONS Part of the socio-economic disparity in breast cancer survival could be addressed by earlier detection in, and improved general health for, more disadvantaged women. Further research is required to identify additional causes of socio-economic disparities as well as the observed inner-regional survival advantage.
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Affiliation(s)
- Geoffrey W. Stuart
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- School of Psychological Sciences, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneVictoriaMelbourneAustralia
| | | | - Luc te Marvelde
- Victorian Cancer RegistryCancer Council VictoriaMelbourneVictoriaAustralia
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5
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Stuart GW, Chamberlain JA, Milne RL. Socio-economic and ethnocultural influences on geographical disparities in breast cancer screening participation in Victoria, Australia. Front Oncol 2022; 12:980879. [PMID: 36523975 PMCID: PMC9745803 DOI: 10.3389/fonc.2022.980879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/31/2022] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE To examine the socio-economic and ethnocultural characteristics of geographical areas that may influence variation in breast cancer screening participation. METHODS In a cross-sectional analysis breast cancer screening participation for statistical areas in Victoria, Australia (2015-2017) was linked with data from the 2016 Australian Census. We selected four commonly used area-level measures of socio-economic status from the Australian Census (i) income (ii) educational level (iii) occupational status and (iv) employment profile. To assess the ethnocultural characteristics of statistical areas we used the Census measures (i) country of birth (ii) language spoken at home (iii) fluency in English (iv) religion and (v) the proportion of immigrants in an area, together with their recency of migration. RESULTS All the selected measures were related to screening participation. There was a high degree of association both within and between socio-economic and ethnocultural characteristics of areas as they relate to screening. Ethnocultural characteristics alone accounted for most of the explained geographical disparity in screening participation. CONCLUSIONS Geographical disparities in breast cancer screening participation may be due to ethnocultural factors that are confounded with socio-economic factors.
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Affiliation(s)
- Geoffrey W. Stuart
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - James A. Chamberlain
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Roger L. Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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6
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Survival Outcomes and Care Equity among Patients with Advanced Breast Cancer in Auckland, New Zealand. J Cancer Epidemiol 2022; 2022:7116040. [DOI: 10.1155/2022/7116040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
Aim. The Auckland Advanced Breast Cancer Review (AABC) was a review of patients diagnosed with advanced inoperable/metastatic breast cancer (ABC) within the Auckland region of New Zealand, commissioned in response to a Breast Cancer Registry report (BCFNZR) that showed poor and inequitable survival outcomes. The review was aimed at assessing equity of care and identifying healthcare delivery gaps for patients with ABC in the Auckland region. Method. In this retrospective study, patients living within the Auckland region, diagnosed with ABC between the 1st January 2013 to the 31st December 2015 were identified from the Breast Cancer Registry. Data censorship date was 30th January 2019 to allow a minimum of 3 years of follow-up. Demographic, diagnostic, treatment, and survival data were extracted from electronic records for statistical analysis. Results. Of the 388 patients that met inclusion criteria for this study, median overall survival (medOS) was 18.9 months in the total population, with no difference between patients with de novo metastatic disease (dnMBC -18.9 m) and recurrent metastatic disease (rMBC -18.7 m). No statistically significant differences in medOS was found amongst Maori (16.2 m), Pacific People (17.3 m), and NZ European (18.9 m) or when patients were stratified according domicile district health board. Median number of lines of systemic treatment was two, with similar treatment exposure between ethnic groups. Conclusion. While treatment uptake and survival outcomes were generally comparable across ethnicity and district health boards, dnMBC survival outcomes were considerably poorer than expected, earmarking this subset of patients with ABC for more in-depth research.
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7
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Duque G, Manterola C, Otzen T, Arias C, Palacios D, Mora M, Galindo B, Holguín JP, Albarracín L. Cancer Biomarkers in Liquid Biopsy for Early Detection of Breast
Cancer: A Systematic Review. Clin Med Insights Oncol 2022; 16:11795549221134831. [PMCID: PMC9634213 DOI: 10.1177/11795549221134831] [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: 04/19/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Breast cancer (BC) is the most common neoplasm in women worldwide. Liquid
biopsy (LB) is a non-invasive diagnostic technique that allows the analysis
of biomarkers in different body fluids, particularly in peripheral blood and
also in urine, saliva, nipple discharge, volatile respiratory fluids, nasal
secretions, breast milk, and tears. The objective was to analyze the
available evidence related to the use of biomarkers obtained by LB for the
early diagnosis of BC. Methods: Articles related to the use of biomarkers for the early diagnosis of BC due
to LB, published between 2010 and 2022, from the databases (WoS, EMBASE,
PubMed, and SCOPUS) were included. The MInCir diagnostic scale was applied
in the articles to determine their methodological quality (MQ). Descriptive
statistics were used, as well as determination of weighted averages of each
variable, to analyze the extracted data. Sensitivity, specificity, and area
under the curve values for specific biomarkers (individual or in panels) are
described. Results: In this systematic review (SR), 136 articles met the selection criteria,
representing 17 709 patients with BC. However, 95.6% were case-control
studies. In 96.3% of cases, LB was performed in peripheral blood samples.
Most of the articles were based on microRNA (miRNA) analysis. The mean MQ
score was 25/45 points. Sensitivity, specificity, and area under the curve
values for specific biomarkers (individual or in panels) have been
found. Conclusions: The determination of biomarkers through LB is a useful mechanism for the
diagnosis of BC. The analysis of miRNA in peripheral blood is the most
studied methodology. Our results indicate that LB has a high sensitivity and
specificity for the diagnosis of BC, especially in early stages.
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Affiliation(s)
- Galo Duque
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador,Galo Duque, Faculty of Medicine,
Universidad del Azuay. Postal address: Av. 24 de Mayo y Hernán Malo, Cuenca,
Ecuador 010107.
| | - Carlos Manterola
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Center of Excellence in Morphological
and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | - Tamara Otzen
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Center of Excellence in Morphological
and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | - Cristina Arias
- Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador
| | | | - Miriann Mora
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador
| | - Bryan Galindo
- Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador
| | - Juan Pablo Holguín
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador
| | - Lorena Albarracín
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile
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8
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Epidemiology of De Novo Metastatic Breast Cancer. Clin Breast Cancer 2021; 21:302-308. [PMID: 33750642 DOI: 10.1016/j.clbc.2021.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/27/2020] [Accepted: 01/24/2021] [Indexed: 11/22/2022]
Abstract
Most cases of metastatic breast cancer (MBC) arise as a recurrence of a previously treated early breast cancer. Distinct from recurrent MBC is de novo MBC (dnMBC), which describes patients who present with distant sites of disease at initial diagnosis and is reviewed here. dnMBC represents approximately 3% to 6% of new breast cancer diagnoses in high-income countries. This incidence has not declined despite decades of widespread use of population-based mammography screening. Overrepresentation of both biologically aggressive tumors and patients negatively impacted by social determinants of health are characteristics of dnMBC. Survival has generally been superior for patients with dnMBC compared with those with recurrent MBC, although it is similar to that for patients with recurrent MBC with long disease-free intervals. Subgroups of patients with dnMBC who experience prolonged survival include those with human epidermal growth factor receptor-2-positive disease or hormone receptor-positive bone-only disease. Opportunities to decrease dnMBC presentation may include novel screening modalities suited for biologically aggressive breast tumors and improved access to health care. Recognizing that there will remain some women diagnosed with dnMBC, refining our ability to identify those likely to be long-term survivors could allow for appropriate escalation or de-escalation of care. Finally, evaluation of tumor genomics in robust sample sizes has the potential to advance our knowledge of the biology of dnMBC as an entity distinct from recurrent MBC.
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Li H, Tang L, Chen Y, Mao L, Xie H, Wang S, Guan X. Development and validation of a nomogram for prediction of lymph node metastasis in early-stage breast cancer. Gland Surg 2021; 10:901-913. [PMID: 33842235 DOI: 10.21037/gs-20-782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Lymph node status is an important factor in determining the prognosis of early-stage breast cancer. We endeavored to build and validate a simple nomogram to predict lymph node metastasis (LNM) in patients with early-stage breast cancer. Methods Patients with T1-2 and non-metastasis (M0) breast cancer registered in the Surveillance, Epidemiology, and End Results (SEER) database were enrolled. All patients were divided into primary cohort and validation cohort in a 2:1 ratio. In order to assess risk factors for LNM, we performed univariate and multivariate binary logistic regression, and based on results of multivariable analysis, we built the predictive nomogram model. The C-index, receiver operating characteristic (ROC) and calibration plots were applied to assess LNM model performance. Moreover, the nomogram efficiency was further validated through the validation cohort, part of which was from the First Affiliated Hospital of Nanjing Medical University database. Results Totally, 184,531 female breast cancer with T1-2 tumor size from SEER database and 1,222 patients from the Chinese institutional data were included. There were 123,019 patients in the primary cohort and 62,734 patients in validation cohort. The LNM nomogram was composed of seven features including age at diagnosis, race, primary site, histologic type, grade, tumor size and subtype. The model showed good discrimination, with a C-index of 0.720 [95% confidence interval (CI): 0.717-0.723] and good calibration. Similar C-index was 0.718 (95% CI: 0.713-0.723) in validation cohort. Consistently, ROC curves presented good discrimination in the primary cohort [area under the curve (AUC) =0.720] and the validation set (AUC =0.718) for the LNM nomogram. Calibration curve of the nomogram demonstrated good agreement. Conclusions With the prediction of novel validated nomogram for women with early-stage breast cancer, doctors may distinguish patients with high possibility of LNM and devise individualize treatments.
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Affiliation(s)
- Huan Li
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lin Tang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yajuan Chen
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ling Mao
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoxiang Guan
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Mukama T, Fallah M, Brenner H, Xu X, Sundquist K, Sundquist J, Kharazmi E. Risk of invasive breast cancer in relatives of patients with breast carcinoma in situ: a prospective cohort study. BMC Med 2020; 18:295. [PMID: 33148280 PMCID: PMC7643418 DOI: 10.1186/s12916-020-01772-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Wide implementation of mammography screening has resulted in increased numbers of women diagnosed with breast carcinoma in situ. We aimed to determine the risk of invasive breast cancer in relatives of patients with breast carcinoma in situ in comparison to the risk in relatives of patients with invasive breast cancer. METHODS We analyzed the occurrence of cancer in a nationwide cohort including all 5,099,172 Swedish women born after 1931 with at least one known first-degree relative. This was a record linkage study of Swedish family cancer datasets, including cancer registry data collected from January 1, 1958, to December 31, 2015. We calculated standardized incidence ratios (SIRs) and 10-year cumulative risk of breast cancer diagnosis for women with a family history of in situ and invasive breast cancer. RESULTS Having one first-degree relative with breast carcinoma in situ was associated with 50% increased risk of invasive breast cancer (SIR = 1.5, 95% CI 1.4-1.7) when compared to those who had no family history of invasive breast cancer or breast carcinoma in situ in either first- or second-degree relatives. Similarly, having one first-degree relative with invasive breast cancer was associated with 70% (1.7, 1.7-1.8) increased risk. The 10-year cumulative risk for women at age 50 with a relative with breast carcinoma in situ was 3.5% (2.9-3.9%) and was not significantly different from 3.7% (3.6-3.8%) risk for 50-year-old women with a relative with invasive breast cancer (95% confidence intervals overlapped). CONCLUSIONS The risk of invasive breast cancer for women with a family history of breast carcinoma in situ was comparable to that for women with a family history of invasive breast cancer. Therefore, family history of breast carcinoma in situ should not be overlooked in recommendations for breast cancer prevention for women with a family history of breast cancer.
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Affiliation(s)
- Trasias Mukama
- Division of Preventive Oncology, Risk Adapted Prevention (RAD) Group, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.,Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mahdi Fallah
- Division of Preventive Oncology, Risk Adapted Prevention (RAD) Group, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany. .,Center for Primary Health Care Research, Lund University, Malmö, Sweden.
| | - Hermann Brenner
- Division of Preventive Oncology, Risk Adapted Prevention (RAD) Group, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Xing Xu
- Division of Preventive Oncology, Risk Adapted Prevention (RAD) Group, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Izumo, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Izumo, Japan
| | - Elham Kharazmi
- Division of Preventive Oncology, Risk Adapted Prevention (RAD) Group, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Statistical Genetics Group, Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
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Burton R, Stevenson C. Assessment of Breast Cancer Mortality Trends Associated With Mammographic Screening and Adjuvant Therapy From 1986 to 2013 in the State of Victoria, Australia. JAMA Netw Open 2020; 3:e208249. [PMID: 32573707 PMCID: PMC7312387 DOI: 10.1001/jamanetworkopen.2020.8249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Diagnosis of early breast cancer (EBC) in women by mammographic screening and postsurgical adjuvant endocrine therapy and chemotherapy (termed adjuvant therapy) began simultaneously in many countries in the 1990s. Subsequent breast cancer mortality declines were variously attributed to mammographic screening and/or adjuvant therapy. OBJECTIVE To determine the relative mortality reductions associated with these 2 interventions in women with EBC who had been exposed to both. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of cross-sectional studies assessed groups of women with invasive breast cancer in the State of Victoria, Australia, from January 1, 1982, to December 31, 2013, who were included in the Victorian Cancer Registry (VCR). The population consisted of participants in population-based studies of female breast cancer from 1986 to 2013 using data from 4 VCR population-based surveys of breast cancer treatment from 1986 to 1999; VCR data on breast cancer incidence, mortality, and TNM stage at diagnosis from 1986 to 2013; and Victorian mammographic screening program (BreastScreen Victoria) data from 1992 to 2007. Breast cancer incidence and mortality data were analyzed for all 76 630 women registered with invasive breast cancer with the VCR from January 1, 1982, to December 31, 2013, and breast cancer treatment and screening data were analyzed additionally for the groups of surveyed women as described above. EXPOSURES Participation in BreastScreen Victoria and receipt of adjuvant therapy after surgery for EBC. MAIN OUTCOMES AND MEASURES Data were analyzed for associations between crude breast cancer mortality trends and uptake of adjuvant therapy and downstaging by mammographic screening. RESULTS Of all 76 630 women registered with breast cancer with the VCR from January 1, 1982, to December 31, 2013. Joinpoint analyses of the time trend in crude mortality showed an increase from 31.6 per 100 000 women in 1982 to 34.3 per 100 000 women in 1994, with a single joinpoint at 1994, followed by a significant declining trend to 23.9 per 100 000 women in 2013 (annual percentage change, -1.3%; 95% CI, -1.6% to -0.9%). By 1999, 74% of all Victorian women with EBC (737 of 1001) had commenced adjuvant endocrine therapy, and 72% (187 of 260) of premenopausal and 29% (215 of 741) of postmenopausal women with EBC had commenced adjuvant chemotherapy. Crude incidence of advanced-stage breast cancer almost doubled from 12.2 per 100 000 women in 1986 to 23.9 per 100 000 women in 2013. CONCLUSIONS AND RELEVANCE This study found that mammographic screening did not downstage breast cancer in Victoria from advanced to early, so population mortality benefit is lacking. Adjuvant therapy uptake was associated with all of the decline in Victorian breast cancer mortality since 1994. Given these findings, monitoring the relative contributions of mammographic screening and adjuvant therapy for EBC to breast cancer mortality reductions in populations of women exposed to both should be mandatory.
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Affiliation(s)
- Robert Burton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Chen Z, Xu L, Shi W, Zeng F, Zhuo R, Hao X, Fan P. Trends of female and male breast cancer incidence at the global, regional, and national levels, 1990-2017. Breast Cancer Res Treat 2020; 180:481-490. [PMID: 32056055 DOI: 10.1007/s10549-020-05561-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/31/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Breast cancer is a major public health concern worldwide and shows significant heterogeneity between male and female. Knowing the global incidence landscape in both sexes is critical for the breast cancer prevention and the reduction in disease burden. METHODS We retrieved the incidence data of breast cancer in both sexes from the Global Burden of Disease 2017 database. Average annual percentage change was used to quantify the temporal trends of breast cancer incidence. RESULTS Between 1990 and 2017, the number of newly diagnosed female breast cancer (FBC) cases increased from 870.2 thousand to 1937.6 thousand, with the age-standardized incidence rate (ASR) significantly increased from 39.2/100,000 to 45.9/100,000. A total of 166 countries experienced a significant increase in FBC-ASR. The most pronounced increase was mainly found in developing countries. The decrease was mostly detected in several developed countries, such as the USA and the UK. Male breast cancer (MBC) is a rare carcinoma and has no evident cluster across the world. Worldwide, the number of newly diagnosed MBC cases increased from 8.5 thousand in 1990 to 23.1 thousand in 2017, with the ASR significantly increased from 0.46/100,000 to 0.61/100,000. A total of 123 countries showed a significant increasing trend in MBC-ASR. CONCLUSIONS Breast cancer incidence rates are increasing in most countries in both sexes, although the epidemiological features were not completely shared between FBC and MBC. More emphases should be placed on breast cancer primary prevention and the prevention strategies might need to be tailored for both FBC and MBC.
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Affiliation(s)
- Zhilin Chen
- Department of Breast and Thoracic Oncological Surgery, The First Affiliated Hospital of Hainan Medical University, 31, Longhua RD, Haikou, 570102, Hainan, China
| | - Lu Xu
- Nanjing Medical University, Nanjing, 210000, Jiangsu, China.,Department of Hematology, The First Affiliated Hospital of Hainan Medical University, Haikou, 570102, Hainan, China
| | - Wenjie Shi
- Department of Breast Surgery, Pius Hospital of Oldenburg, 26129, Oldenburg, Germany
| | - Fanyu Zeng
- Department of Breast Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541000, Guangxi, China
| | - Rui Zhuo
- Department of Breast Surgery, Pius Hospital of Oldenburg, 26129, Oldenburg, Germany
| | - Xinbao Hao
- Nanjing Medical University, Nanjing, 210000, Jiangsu, China. .,Department of Hematology, Center for Translational Medicine, The First Affiliated Hospital of HMC Cancer Institute and Academician Research Workstation of Hainan Medical University, Haikou, 570102, Hainan, China.
| | - Pingming Fan
- Department of Breast and Thoracic Oncological Surgery, The First Affiliated Hospital of Hainan Medical University, 31, Longhua RD, Haikou, 570102, Hainan, China.
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Katalinic A, Eisemann N, Kraywinkel K, Noftz MR, Hübner J. Breast cancer incidence and mortality before and after implementation of the German mammography screening program. Int J Cancer 2019; 147:709-718. [DOI: 10.1002/ijc.32767] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/04/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Alexander Katalinic
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
- Institute for Cancer EpidemiologyUniversity of Lübeck Lübeck Germany
| | - Nora Eisemann
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
| | - Klaus Kraywinkel
- Department for Epidemiology and Health ReportingGerman Centre for Cancer Registry Data, Robert Koch‐Institute Berlin Germany
| | - Maria R. Noftz
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
| | - Joachim Hübner
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
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Steponaviciene L, Briediene R, Vanseviciute R, Smailyte G. Trends in Breast Cancer Incidence and Stage Distribution Before and During the Introduction of the Mammography Screening Program in Lithuania. Cancer Control 2019; 26:1073274818821096. [PMID: 30808202 PMCID: PMC6327347 DOI: 10.1177/1073274818821096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to analyze the incidence trends of localized and advanced breast cancer (BC) before and during the implementation of the mammography screening program (MSP) in Lithuania. Methods: The study period was divided into 2 intervals: the prescreening period (1998-2005) and implementation period (2006-2012). Analysis was performed for 3 age-groups: 0 to 49 years, 50 to 69 (target population), and older than 70. Results: In all age-groups, the incidence of localized BC has shown a steady increase, while the incidence of advanced stage BC has decreased. In the target population, during the study period, the stage I BC incidence increased statistically significantly by 10.3% per year (from 3.3 per 100 000 in 1998 to 12.2 per 100 000 in 2012). The increase in localized BC was faster in the period before the implementation of the MSP than during the implementation in 2006 to 2012 (10.3% and 5.7%). A slightly statistically significant decrease was observed for advanced BC during the study period (−1.1% per year), while during the implementation of the MSP, significant changes were not seen. Conclusions: The results of our study indicate that the implementation of the MSP in Lithuania did not significantly influence trends of localized and advanced BC. Changes observed during the study period, including the prescreening and screening introduction periods, may reflect the general trends in the awareness of BC and improvements in diagnostics.
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Affiliation(s)
- Laura Steponaviciene
- 1 Laboratory of cancer epidemiology, National Cancer Institute, Vilnius, Lithuania.,2 Department of Public Health, Institute of Health Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Ruta Briediene
- 3 Department of Radiology, National Cancer Institute, Vilnius, Lithuania.,4 Department of Radiology, Medical Physics and Nuclear Medicine, Vilnius University, Vilnius, Lithuania
| | - Rasa Vanseviciute
- 5 Department of Consulting Clinic, National Cancer Institute, Vilnius, Lithuania
| | - Giedre Smailyte
- 1 Laboratory of cancer epidemiology, National Cancer Institute, Vilnius, Lithuania.,2 Department of Public Health, Institute of Health Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
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Accuracy of Breast Magnetic Resonance Imaging Compared to Mammography in the Preoperative Detection and Measurement of Pure Ductal Carcinoma In Situ: A Retrospective Analysis. Acad Radiol 2019; 26:760-765. [PMID: 30149976 DOI: 10.1016/j.acra.2018.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Ductal carcinoma in situ (DCIS) hinders imaging detection due to multifocal appearance and discontinuous growth. Preoperative determination of its extent is therefore challenging. Aim of this study was to investigate the additional benefit of breast magnetic resonance imaging (MRI) to mammography (MG) in the diagnosis of DCIS according to size and grading. MATERIALS AND METHODS Retrospective analysis of 295 patients with biopsy-proven, pure DCIS. Mean patient age was 57.0 years (27-87 years). All patients obtained MG. Additional MRI was performed in 41.7% (123/295). Mammographic breast density, background parenchymal enhancement (BPE), tumor size and grading were analysed. Tumor size on MG and MRI were compared to histopathological size of the surgical specimen. RESULTS Mean tumor size was 39.6 mm. DCIS was occult on MG in 24.4% (30/123) and on MRI in 1.6% (2/123). Size was underestimated by 4.6 mm (mean) mammographically. DCIS was high grade in 54.5% (67/123), intermediate grade in 40.7% (50/123) and low grade in 4.9% (6/123). MG was exact regarding tumor size in low grade DCIS, underestimated intermediate grade DCIS by 1 mm (median) and high grade DCIS by 10.5 mm. MRI overestimated low grade DCIS by 1 mm (median), was exact regarding intermediate grade DCIS and underestimated high grade DCIS by 1 mm. BPE did not influence tumor detection and measurement. CONCLUSION MRI outperforms MG in the detection and size estimation of DCIS and can reduce positive margin rates.
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An X, Quan H, Lv J, Meng L, Wang C, Yu Z, Han J. Serum microRNA as potential biomarker to detect breast atypical hyperplasia and early-stage breast cancer. Future Oncol 2018; 14:3145-3161. [PMID: 30220214 DOI: 10.2217/fon-2018-0334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIM The present study aimed to identify microRNA (miRNA) that can be used for not only detecting early-stage breast cancer (BC) but also diagnosing atypical hyperplasia (AH). MATERIALS & METHODS RT-qPCR detected the expression levels of miRNAs and receiver operating characteristic curves were constructed to evaluate sensitivity and specificity of the assay. RESULTS miR-24 and miR-103a were expressed in an upward trend in serum of benign proliferative tumor subjects, while they were downregulated significantly in serum of AH (p < 0.005) and early-stage BC subjects (p < 0.005) with high sensitivity and specificity as compared with controls. Bioinformatics analysis also revealed the potential molecular mechanism through which miR-24 and miR-103a regulate tumorigenesis in BC. CONCLUSION miR-24 and miR-103a were valuable biomarkers for distinguishing AH and early-stage BC from healthy individuals/benign proliferative tumor patients.
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Affiliation(s)
- Xuefeng An
- Department of Breast Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, PR China
| | - Hong Quan
- Department of Breast Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, PR China
| | - Jinhui Lv
- Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, PR China
| | - Lingyu Meng
- Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, PR China
| | - Cheng Wang
- Department of Breast Surgery, Shanghai Huangpu Central Hospital, Shanghai 200002, PR China
| | - Zuoren Yu
- Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, PR China
| | - Jing Han
- Department of Breast Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, PR China
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Jacklyn G, McGeechan K, Houssami N, Bell K, Glasziou PP, Barratt A. Overdiagnosis due to screening mammography for women aged 40 years and over. Hippokratia 2018. [DOI: 10.1002/14651858.cd013076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Gemma Jacklyn
- The University of Sydney; Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health; Edward Ford Building (A27) Sydney NSW Australia 2006
| | - Kevin McGeechan
- The University of Sydney; Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health; Edward Ford Building (A27) Sydney NSW Australia 2006
| | - Nehmat Houssami
- The University of Sydney; Sydney School of Public Health, Faculty of Medicine and Health; Sydney NSW Australia
| | - Katy Bell
- The University of Sydney; Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health; Edward Ford Building (A27) Sydney NSW Australia 2006
| | - Paul P Glasziou
- Bond University; Centre for Research in Evidence-Based Practice (CREBP); University Drive Gold Coast Queensland Australia 4229
| | - Alexandra Barratt
- The University of Sydney; Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health; Edward Ford Building (A27) Sydney NSW Australia 2006
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