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van der Veer EL, Lameijer J, Coolen AMP, Bluekens AMJ, Nederend J, Gielens M, Voogd A, Duijm L. Causes and consequences of delayed diagnosis in breast cancer screening with a focus on mammographic features and tumour characteristics. Eur J Radiol 2023; 167:111048. [PMID: 37634439 DOI: 10.1016/j.ejrad.2023.111048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To study the prevalence, causes and consequences of delayed breast cancer diagnosis in the screening population. METHODS This retrospective study was performed in women who underwent biennial screening mammography between January 1, 2009 and June 30, 2019. Patients were divided into 3 groups; screen-detectedbreast cancer (SDC) without a diagnostic delay, a primary diagnostic delay(i.e. missed cancer at previous screening round)and a delay in diagnostic work-up after recall. Women with a true interval cancer (IC; i.e. not visible on prior examinations) were excluded. Outcome parameters included mammographic and tumour characteristics, lymph node status and surgical treatment. RESULTS In our sample of 4491 women with breast cancer (4292 SDC and 199 'missed' IC), respectively, a total of 1112 women experienced a diagnostic delay of ≥ 4 months. Compared to women without a diagnostic delay (n = 2720), the 176 women with a delay in diagnostic work-up showed overall similar mammographic abnormalities (P = 0.052). These groups show similar distributions in invasive tumours, tumour stage and lymph node status (P = 0.25, P = 0.95 and P = 0.93, respectively). Women with a primary diagnostic delay (n = 936) showed less calcifications (P < 0.001), and more masses with calcifications and architectural distortions on mammography (P = 0.01 and P = 0.04, respectively). Moreover, this group comprised larger tumours (P < 0.001) and lymph node metastases (P < 0.001), and more often underwent mastectomy (P < 0.001). CONCLUSIONS A primary diagnostic delay in breast cancer diagnosis results in less favourable tumour characteristics and relatively more mastectomies compared to no delay in breast cancer diagnosis and a delay in diagnostic work-up after recall.
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Affiliation(s)
- Eline L van der Veer
- Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, Netherlands.
| | - Joost Lameijer
- Christchurch Hospital, 2 Riccarton Avenue, Christchurch Central City, Christchurch 4710, New-Zealand
| | - Angela M P Coolen
- Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, Netherlands
| | - Adriana M J Bluekens
- Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, Netherlands
| | - Joost Nederend
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, Netherlands
| | - Maaike Gielens
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, Netherlands
| | - Adri Voogd
- Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands
| | - Lucien Duijm
- Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, Netherlands
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Han HJ, Chu YC, Wang J, Lai YC, Tseng LM, Huang CC. Characteristics of breast cancers detected by screening mammography in Taiwan: a single institute's experience. BMC Womens Health 2023; 23:330. [PMID: 37344800 DOI: 10.1186/s12905-023-02445-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND/AIM Breast cancer is the most common female malignancy in the world. Nearly ninety percent of screening-detected breast cancers were diagnosed with earlier stages of 0 to II in Taiwan. It's widely acknowledged that mammography screening of breast cancer can achieve the goal of early diagnosis and treatment in terms of preventive task while neglected interval cancers are associated with unfavorable tumor characteristics and worse outcomes. The purpose of this study was to explore the characteristics of screening-detected breast cancers in Taiwan. MATERIALS AND METHODS Both screening and diagnostic mammography examinations with accompanied BI-RADS (breast imaging-reporting and data system) classification were extracted from the health information system and linked to cancer registry in Taiwan. Enrolled population included those attending their first mammography between 2012 and 2016, excluding subjects with previous breast cancer, or with missing or incomplete data. We compared treatment outcomes between breast cancers with either initial screening or diagnostic mammography (control group), and investigated the compositions of breast cancers detected by screening mammography through direct chart reviews. RESULTS A total of 84,246 screening and 61,230 diagnostic mammography sessions were performed from 2010 to 2020. More positive results (BI-RADS 0, 3, 4 and 5) were observed for those attending the first diagnostic than the first screening mammography (43.58% versus 16.12%, p < 0.001). Earlier stages (0 and I) distribution (92% versus 81%, p < 0.0001), better survivorship (overall survival: 96.91% versus 92.17%, p = 0.007) and a lower HER2 (human epidermal growth factor receptor II) positive status and lower tumor grade were noted in breast cancers with initial screening rather than diagnostic mammography. Among 26,103 mammography screening invitees between 2012 and 2016, 325 breast cancers were ascertained from cancer registry. Of these, 234 had one, 72 had two and 19 had three episodes of mammography before cancer diagnosis. Extensive chart reviews revealed that women with and without breast symptoms constituted 29.9 and 70.1% of the 325 screening-detected breast cancers, with the latter further divided into false negative results (interval cancer), diagnosed at the first mammography, diagnostic at the secondary or subsequent mammography and those with a delayed biopsy or confirmatory imaging constituted (5.2, 47, 10.5 and 7.4%). CONCLUSION Screening-detected breast cancers were a mixture of women with and without symptoms, those with a false negative result, true negative results with cancer detected at subsequent mammography and non-adherers. Despite this, efficacy of mammography screening was ascertained in Taiwan from this study. To further enhance earlier detection and decrease false negativity, the impact of repeated mammography, and additional sonography for symptomatic women, compliance following a positive screening mammography should not be overemphasized.
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Affiliation(s)
- Hsin-Ju Han
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Chia Chu
- Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan
- Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Jane Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Radiology, National Taiwan University College of Medicine Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Nurse-Midwifery and Women Health, Taipei, Taiwan
- Department of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ling-Ming Tseng
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
| | - Chi-Cheng Huang
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan.
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
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Mukherjee Das A, Shrivastav KD, Taneja N, Awasthi AA, Rashid S, Gogia A, Janardhanan R. Knowledge and awareness of breast cancer and breast self-examination among college-going female students in Delhi-NCR: a cross sectional study. HEALTH EDUCATION 2022. [DOI: 10.1108/he-10-2021-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeBreast cancer (BC) presents a major public health challenge world-over including India. While several risk-factors, early signs and symptoms of BC are known, the knowledge and awareness of this disease remains poor among the population. The present study aimed to determine the extent of knowledge and awareness of BC, its risk factors, early signs and symptoms and breast self-examination (BSE) practice as an early detection method among Indian college-going female students.Design/methodology/approachThe authors conducted a cross-sectional survey at a University in Delhi-NCR. Data on socio-demographic, knowledge and awareness of BC including BSE was collected using a pretested questionnaire. Chi-square test and logistic regression analysis was performed. All tests were two-sided and significance was set at p < 0.05.FindingsA total of 866 female students participated in the study with mean age of 22.32 (±0.146) years having mean body mass index (BMI) of 21.22 (±3.52). As high as 82.1% of the participants had heard of BC but while 74.8% thought early detection is possible, 70.7% believed BC cannot be prevented. Gene mutations (60.2%) were identified as a significant risk factor, while breast pain (61.4%) was commonly recognized as a sign of BC. Only 29.8% of students ever performed BSE. Increased odds of performing BSE (OR = 3.4) was found among students who recognized gene mutations as an important BC risk factor.Research limitations/implicationsKnowledge and awareness of BC including BSE among female college students were found to be below average. It is suggested that there is an urgent need for increasing BC awareness among young girls through workshops and mobile-health interventions.Practical implicationsThis study provides new information on the level of knowledge and awareness of BC risk factors, sign and symptoms and self-examination practice among young college girls. Moreover, this study advocates the need for design and implementation of a sustainable digital health model for active population BC screening, which is not being done currently.Social implicationsBC is a highly aggressive disease, which is now one of the leading causes of morbidity and mortality in India and world over. Although the knowledge of BC risk factors and its signs and symptoms have increased, the awareness of these elements among the general population at large is low and/or missing, especially in India. Furthermore, as a consequence of unorganized screening programs in the country, majority of women are presenting young with locally advanced disease. Understanding the existing level of knowledge and educating school, college and University students of the pertinent factors and screening practices such as BSE could drastically help in improving the self-screening and/or clinical examination rates. This could potentially lead to early detection and improved prognosis, thus ameliorating disease burden.Originality/valueThis study is one of the few studies conducted in India among young female college students belonging to non-medical backgrounds, delineating the level of knowledge and awareness of BC risk factors and signs and symptoms along with practice of early detection method such as BSE. The study has a considerable sample size and provides valuable evidence for a need to implement programs incorporating digital health models for accelerating awareness and screening of young girls in both rural and urban settings.
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4
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Affiliation(s)
- Jianxia Gong
- School of Economics and Management, Southeast University, No.2 Sipailou, Nanjing 210096, China
| | | | - Qingxia Kong
- Rotterdam School of Management, Erasmus University, Burgemeester Oudlaan 50, Rotterdam 3062 PA, The Netherlands
| | - Wolfert Spijker
- Dutch Foundation of Population Screening Region South-West, Maasstadweg 124, Rotterdam 3079DZ, The Netherlands
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Lameijer JRC, Voogd AC, Broeders MJM, Pijnappel RM, Setz-Pels W, Strobbe LJ, Jansen FH, Tjan-Heijnen VCG, Duijm LEM. Trends in delayed breast cancer diagnosis after recall at screening mammography. Eur J Radiol 2021; 136:109517. [PMID: 33421886 DOI: 10.1016/j.ejrad.2020.109517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/19/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the extent and characteristics of delay in breast cancer diagnosis in women recalled at screening mammography. METHODS We included a consecutive series of 817,656 screens of women who received biennial screening mammography in a Dutch breast cancer screening region between 1997 and 2016. During at least 3.5 years follow-up, radiological reports and biopsy reports were collected of all recalled women. The inclusion period was divided into four cohorts of four years each. We determined the number of screen-detected cancers and their characteristics, and assessed the proportion of recalled women who experienced a diagnostic delay of at least 4 months in breast cancer confirmation. RESULTS The proportion of recalled women who experienced diagnostic delay decreased from 7.5 % in 1997-2001 (47/623) to 3.0 % in 2012-2016 (67/2223, P < 0.001). The proportion of women with a delay of at least two years increased from 27.7 % (13/47) in 1997-2001 to 75.7 % (53/70) in 2012-2016 (P < 0.001). Cancers with a diagnostic delay > 2 years were more frequently invasive (P = 0.009) than cancers with a diagnostic delay of 4-24 months. The most frequent cause of diagnostic delays was incorrect radiological classifications by clinical radiologists (55.2 % overall) after recall. CONCLUSIONS The proportion of recalled women with a delayed breast cancer diagnosis has more than halved during two decades of screening mammography. Delays in breast cancer diagnosis are characterized by longer delay intervals, although the proportion of these delays among all screen-detected cancers has not increased. Preventing longer delays in breast cancer confirmation may help improve breast cancer survival.
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Affiliation(s)
- J R C Lameijer
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands.
| | - A C Voogd
- Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - M J M Broeders
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - R M Pijnappel
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - W Setz-Pels
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - L J Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, the Netherlands
| | - F H Jansen
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - V C G Tjan-Heijnen
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, the Netherlands
| | - L E M Duijm
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
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Vernet-Tomás M, Louro J, Román M, Saladié F, Posso M, Prieto M, Vázquez I, Baré M, Peñalva L, Vidal C, Bargalló X, Sánchez M, Ferrer J, A Espinàs J, Quintana MJ, Rodríguez-Arana A, Castells X. Risk of breast cancer two years after a benign biopsy depends on the mammographic feature prompting recall. Maturitas 2020; 144:53-59. [PMID: 33358209 DOI: 10.1016/j.maturitas.2020.10.024] [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: 08/01/2019] [Revised: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to explore whether the type of mammographic feature prompting a false-positive recall (FPR) during mammography screening influences the risk and timing of breast cancer diagnosis, particularly if assessed with invasive procedures. STUDY DESIGN We included information on women screened and recalled for further assessment in Spain between 1994 and 2015, with follow-up until 2017, categorizing FPRs by the assessment (noninvasive or invasive) and mammographic feature prompting the recall. MAIN OUTCOME MEASURES Breast cancer rates in the first two years after FPR (first period) and after two years (second period). RESULTS The study included 99,825 women with FPRs. In both periods, the breast cancer rate was higher in the invasive assessment group than in the noninvasive group (first period 12 ‰ vs 1.9 ‰, p < 0.001; second period 4.4‰ vs 3.1‰, p < 0.001). During the first period, the invasive assessment group showed diverse breast cancer rates for each type of mammographic feature, with a higher rate for asymmetric density (31.9‰). When the second period was compared with the first, the breast cancer rate decreased in the invasive assessment group (from 12‰ to 4.4‰, p < 0.001) and increased in the noninvasive assessment group (from 1.9‰ to 3.1‰, p < 0.001). CONCLUSION In the context of mammography screening, the risk of breast cancer diagnosis during the first two years after FPR was particularly high for women undergoing invasive assessment; importantly, the risk was modified by type of mammographic feature prompting the recall. This information could help to individualize follow-up after exclusion of malignancy.
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Affiliation(s)
- Maria Vernet-Tomás
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain.
| | - Javier Louro
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Marta Román
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Francina Saladié
- Fundació Lliga per a La Investigació i Prevenció del Càncer (FUNCA), Avinguda Josep Laporte, 2, 43204, Reus, Spain
| | - Margarita Posso
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Miguel Prieto
- Consejería de Sanidad, Gobierno de Asturias. Calle Ciriaco Miguel Vigil, 9, 33005, Oviedo, Spain
| | - Ivonne Vázquez
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Marisa Baré
- Consorci Corporació Sanitaria Parc Taulí, Parc Taulí, 1, 08208, Sabadell, Spain
| | - Lupe Peñalva
- Hospital General de Granollers, Av. Francesc Ribas, s/n, 08402, Granollers, Spain
| | - Carmen Vidal
- Programa de Prevenció i Control del Càncer de l'Institut Català d'Oncologia, Gran Via de l'Hospitalet, 199-203, 08908, L'Hospitalet de Llobregat, Spain
| | - Xavier Bargalló
- Centro de Diagnóstico por la Imagen Clínic (CDIC) del Hospital Clínic de Barcelona. Calle Villarroel 170, 08036, Barcelona, Spain
| | - Mar Sánchez
- Dirección General de Salud Pública del Gobierno de Cantabria, C/ Federico Vial 13, 39009, Santander, Spain
| | - Joana Ferrer
- Hospital de Santa Caterina, Carrer del Dr. Castany, s/n, 17190, Salt, Girona, Spain
| | - Josep A Espinàs
- Pla Director d'Oncologia del Departament de Salut de la Generalitat de Catalunya, Travessera de les Corts, 131-159, 08028, Barcelona, Spain
| | - M Jesús Quintana
- Departament d'Epidemiologia de l'Hospital de la Santa Creu i Sant Pau, c/ San Antoni M. Claret 167, 08025, Barcelona, Spain
| | - Ana Rodríguez-Arana
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Xavier Castells
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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Lameijer JRC, Voogd AC, Pijnappel RM, Setz-Pels W, Broeders MJ, Tjan-Heijnen VCG, Duijm LEM. Delayed breast cancer diagnosis after repeated recall at biennial screening mammography: an observational follow-up study from the Netherlands. Br J Cancer 2020; 123:325-332. [PMID: 32390006 PMCID: PMC7374543 DOI: 10.1038/s41416-020-0870-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background Delay in detection of breast cancer may worsen tumour characteristics, with progression of tumour size and a higher risk of metastatic lymph nodes. The purpose of this study was to investigate delayed breast cancer diagnosis after repeated recall for the same mammographic abnormality at screening. Methods This was a retrospective study performed in two cohorts of women enrolled in a mammography screening programme in the Netherlands. All women aged 50−75 who underwent biennial screening mammography either between January 1, 1997 and December 31, 2006 (cohort 1) or between January 1, 2007 and December 31, 2016 (cohort 2) were included. Results The cohorts showed no difference in proportions of women with delayed breast cancer diagnosis of at least 2 years (2.2% versus 2.8%, P = 0.29). Most delays were caused by incorrect BI-RADS classifications after recall (74.2%). An increase in mean tumour size was seen when comparing sizes at initial false-negative recall and at diagnosis of breast cancer (P < 0.001). Conclusions The proportion of women with a long delay in breast cancer confirmation following repeated recall at screening mammography has not decreased during 20 years of screening. These delays lead to larger tumour size at detection and may negatively influence prognosis.
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Affiliation(s)
- Joost R C Lameijer
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Adri C Voogd
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands.,Department of Epidemiology, GROW, Maastricht University, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands
| | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Mireille J Broeders
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands.,Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands.,Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
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Tumour characteristics of bilateral screen-detected cancers and bilateral interval cancers in women participating at biennial screening mammography. Eur J Radiol 2018; 108:215-221. [PMID: 30396659 DOI: 10.1016/j.ejrad.2018.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Unilateral interval breast cancers show less favourable prognostic features than unilateral screen-detected cancers, but data on tumour characteristics of bilateral interval cancers in a systematically screened population are sparse. Therefore, we compared tumour characteristics of bilateral interval cancers with those of bilateral screen-detected cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all recalled women and of all women who presented with interval breast cancer. In women with synchronous bilateral breast cancer, the tumour with the highest tumour stage was defined as the index cancer. For comparison of data between both groups Fisher exact test and Chi-square test were used. RESULTS Synchronous bilateral cancer was diagnosed in 2.2% of screen-detected cancers (64/2947) and in 3.2% of interval cancers (24/753) (P = 0.1). Index tumours of bilateral screen-detected cancers and interval cancers showed similar characteristics, except for a larger proportion of T-stage 2 or worse (T2+) cancers among interval cancers (16/24 (66.7%) versus 23/58 (39.7%) (P = 0.03). Index cancers, compared to contralateral cancers, were less frequently stage T1 in both bilateral screen-detected cancers and bilateral interval cancers (35/64 (60.3%) versus 40/64 (88.9%) (P = 0.001) and 8/24 (33.3%) versus 18/24 (85.7%) (P < 0.001), respectively). In bilateral screen-detected cancers, contralateral cancers were more often stage 1a-c (P < 0.001) compared to index cancers. In bilateral index cancers, index cancers were more often of the lobular subtype (P < 0.001). CONCLUSION Index cancers of bilateral screen-detected cancers and bilateral interval cancers show significant differences in tumour size, whereas nodal status, receptor status and final surgical treatment are comparable. In bilateral screen-detected cancer, index cancers had a significantly higher tumour stage. In bilateral screen-detected cancer, index cancers were more often the ductal invasive subtype compared to contralateral cancers.
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Heywang-Köbrunner SH, Hacker A, Jänsch A, Kates R, Wulz-Horber S. Use of single-view digital breast tomosynthesis (DBT) and ultrasound vs. additional views and ultrasound for the assessment of screen-detected abnormalities: German multi-reader study. Acta Radiol 2018; 59:782-788. [PMID: 28929783 DOI: 10.1177/0284185117732600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Data on the value of digital breast tomosynthesis (DBT) for further assessment of screen-detected lesions are still limited. Purpose To compare screening mammography, single-view DBT and ultrasound-information (TS) vs. screening mammography, additional views and ultrasound-information (AV) for assessment of screen-detected abnormalities. Material and Methods The use of wide-angle DBT for screen-detected, soft-tissue abnormalities requiring additional views was investigated: 241 cases (206 benign and 35 malignant lesions), verified by histology or two-year follow-up, were read by ten readers as TS and as AV sets, yielding 2410 diagnoses for each set. Readings were randomly sequenced. Results The mean interval between readings was nine weeks (random sequence). Evaluation was breast-based. Overall, in terms of area under receiver operating characteristic (AUC; varying degree of suspicion cutoff), TS and AV readings showed similar performance: for TS, AUC was 0.889 (95% confidence interval [CI] = 0.871-0.907) and for AV, AUC was 0.903 (95% CI = 0.886-0.921). TS readings had slightly higher sensitivity than AV readings (96.9% vs. 95.4%) but lower specificity (50% vs. 58.1%) and more variations between reader performance; absolute false negatives (FN) were reduced in 8/16 readers, equal in 5/16, and increased in only 3/16. Conclusion This study broadly confirms previous data showing equivalence of DBT to AV. However, bias against TS may have occurred since the region of interest was not indicated in the TS set as compared to its obvious identification on the AV set by the selected spot views. A key finding is that reader experience with DBT may be more important than so far reported.
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Affiliation(s)
| | - Astrid Hacker
- National Reference Centre Mammography Munich, Munich, Germany
- Brustdiagnostik München, Munich, Germany
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10
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van Bommel RMG, Voogd AC, Nederend J, Setz-Pels W, Louwman MWJ, Strobbe LJ, Venderink D, Tjan-Heijnen VCG, Duijm LEM. Incidence and tumour characteristics of bilateral and unilateral interval breast cancers at screening mammography. Breast 2018; 38:101-106. [PMID: 29306176 DOI: 10.1016/j.breast.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/23/2017] [Accepted: 12/26/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Detected by screening mammography, bilateral breast cancer has a different pathological profile compared to unilateral breast cancer. We investigated the incidence of bilateral interval breast cancers and compared their characteristics with those of unilateral interval breast cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all referred women and of all women who presented with interval breast cancer. The tumour with the highest tumour stage (index cancer) was used for comparison with unilateral interval cancers. RESULTS A total of 753 interval cancers were detected, of which 24 (3.2%) were bilateral. Among the invasive interval cancers, bilateral cancers more frequently showed a lobular histology than unilateral cancers (37.5% (9/24) vs. 16.1% (111/691), P = .01). There is a trend towards a larger proportion of bilateral than unilateral interval cancers graded 1 (45.8% (11/24) vs. 27.8% (192/691), P = .08). There were no other statistically significant differences in tumour characteristics. Also, the proportion of interval cancers showing significant mammographic abnormalities at the latest screen was comparable for unilateral and bilateral interval cancers (23.0% vs. 25.0%, P = .9). DISCUSSION Bilateral interval cancers comprise a small proportion of all interval cancers. Except of a higher proportion of invasive lobular cancers and a more favourable histological grade of invasive cancers, tumour characteristics are comparable for bilateral and unilateral interval breast cancers.
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Affiliation(s)
- Rob M G van Bommel
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Luc J Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands
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11
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Diagnosis and treatment delays among elderly breast cancer patients with pre-existing mental illness. Breast Cancer Res Treat 2017; 166:267-275. [PMID: 28726159 DOI: 10.1007/s10549-017-4399-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/11/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE This study aimed to compare diagnosis and treatment delays in elderly breast cancer patients with and without pre-existing mental illness. METHODS A retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results-Medicare data including 16,636 women 68+ years, who were diagnosed with stage I-IIIa breast cancer in the United States from 2005 to 2007. Mental illness was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes recorded on inpatient and outpatient claims during the 3 years prior to breast cancer diagnosis. Patients were classified as having no mental illness, anxiety, depression, anxiety and depression, or severe mental illness (bipolar disorder, schizophrenia, and other psychotic disorder). Multivariable binomial regression was used to assess the association between mental illness and delays of ≥60 and ≥90 days after adjustment for confounders. RESULTS Patients with comorbid anxiety and depression had an increased risk for diagnosis delay of ≥90 days from symptom recognition (RR 1.11; 95% CI 1.00, 1.23), and those with severe mental illness had an increased risk for initial treatment delay of ≥60 days from diagnosis (RR 1.36; 95% CI 1.06, 1.74). Patients with any mental illness experienced an increased risk for adjuvant chemotherapy delay of ≥90 days from last operation (RR 1.13; 95% CI 1.01, 1.26) and each category of mental illness, except depression, showed a non-significant trend for this association. CONCLUSION Breast cancer patients with mental illness should be closely managed by a cross-functional care team, including a psychiatrist, a primary care physician, and an oncologist, to ensure adequate care is received within an appropriate timeframe.
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12
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van Bommel RMG, Weber R, Voogd AC, Nederend J, Louwman MWJ, Venderink D, Strobbe LJA, Rutten MJC, Plaisier ML, Lohle PN, Hooijen MJH, Tjan-Heijnen VCG, Duijm LEM. Interval breast cancer characteristics before, during and after the transition from screen-film to full-field digital screening mammography. BMC Cancer 2017; 17:315. [PMID: 28476109 PMCID: PMC5420149 DOI: 10.1186/s12885-017-3294-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/24/2017] [Indexed: 12/02/2022] Open
Abstract
Background To determine the proportion of “true” interval cancers and tumor characteristics of interval breast cancers prior to, during and after the transition from screen-film mammography screening (SFM) to full-field digital mammography screening (FFDM). Methods We included all women with interval cancers detected between January 2006 and January 2014. Breast imaging reports, biopsy results and breast surgery reports of all women recalled at screening mammography and of all women with interval breast cancers were collected. Two experienced screening radiologists reviewed the diagnostic mammograms, on which the interval cancers were diagnosed, as well as the prior screening mammograms and determined whether or not the interval cancer had been missed on the most recent screening mammogram. If not missed, the cancer was considered an occult (“true”) interval cancer. Results A total of 442 interval cancers had been diagnosed, of which 144 at SFM with a prior SFM (SFM-SFM), 159 at FFDM with a prior SFM (FFDM-SFM) and 139 at FFDM with a prior FFDM (FFDM-FFDM). The transition from SFM to FFDM screening resulted in the diagnosis of more occult (“true”) interval cancers at FFDM-SFM than at SFM-SFM (65.4% (104/159) versus 49.3% (71/144), P < 0.01), but this increase was no longer statistically significant in women who had been screened digitally for the second time (57.6% (80/139) at FFDM-FFDM versus 49.3% (71/144) at SFM-SFM). Tumor characteristics were comparable for the three interval cancer cohorts, except of a lower porportion (75.7 and 78.0% versus 67.2% af FFDM-FFDM, P < 0.05) of invasive ductal cancers at FFDM with prior FFDM. Conclusions An increase in the proportion of occult interval cancers is observed during the transition from SFM to FFDM screening mammography. However, this increase seems temporary and is no longer detectable after the second round of digital screening. Tumor characteristics and type of surgery are comparable for interval cancers detected prior to, during and after the transition from SFM to FFDM screening mammography, except of a lower proportion of invasive ductal cancers after the transition.
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Affiliation(s)
- Rob M G van Bommel
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
| | - Roy Weber
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos, 100, Nijmegen, The Netherlands
| | - Luc J A Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Matthieu J C Rutten
- Department of Radiology, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW, 's-Hertogenbosch, The Netherlands
| | - Menno L Plaisier
- Department of Radiology, Maxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Paul N Lohle
- Department of Radiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Marianne J H Hooijen
- Department of Radiology, St Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos, 100, Nijmegen, The Netherlands.,Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands
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13
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Heywang-Köbrunner S, Jaensch A, Hacker A, Wulz-Horber S, Mertelmeier T, Hölzel D. Value of Digital Breast Tomosynthesis versus Additional Views for the Assessment of Screen-Detected Abnormalities - a First Analysis. Breast Care (Basel) 2017; 12:92-97. [PMID: 28559765 DOI: 10.1159/000456649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The purpose of this study was to countercheck the equivalence of single-view digital breast tomosynthesis (DBT) or DBT with additional views (DBT+AV) compared to traditional standard assessment by additional views (AV) in patients with a screen-detected abnormality. PATIENTS AND METHODS Patients with a screen-detected abnormality were consecutively invited to obtain 1 single-view wide-angle DBT in addition to the indicated AV. The study was approved by the local ethics committee and by the Federal Office for Radiation Protection. RESULTS This study is based on 311 lesions in 285 patients with a follow-up of > 2 years and/or biopsy. Counting BI-RADS 0 and 3 as positive calls, the sensitivity/specificity of DBT+AV versus DBT only versus AV only were 96.4/54.3%, 96.4/56.6%, and 90.9/42.2%, respectively. The specificities and BI-RADS classifications differed significantly (p < 0.01). AV appeared unnecessary in 88.8% of the cases. CONCLUSION DBT appeared to be at least equivalent to AV for assessing indeterminate screen-detected lesions and could replace AV for most lesions. To obtain the extra information appears possible without increasing the overall radiation dose. Subsequent blinded reader studies are ongoing.
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Affiliation(s)
- Sylvia Heywang-Köbrunner
- Em. Head of IBE Institute of Biomathematics and Epidemiology, National Reference Centre Mammography Munich, Munich, Germany.,Em. Head of IBE Institute of Biomathematics and Epidemiology, Brustdiagnostik München, Munich, Germany
| | - Alexander Jaensch
- Em. Head of IBE Institute of Biomathematics and Epidemiology, National Reference Centre Mammography Munich, Munich, Germany.,Em. Head of IBE Institute of Biomathematics and Epidemiology, Brustdiagnostik München, Munich, Germany
| | - Astrid Hacker
- Em. Head of IBE Institute of Biomathematics and Epidemiology, National Reference Centre Mammography Munich, Munich, Germany
| | - Sabina Wulz-Horber
- Em. Head of IBE Institute of Biomathematics and Epidemiology, Brustdiagnostik München, Munich, Germany
| | - Thomas Mertelmeier
- Em. Head of IBE Institute of Biomathematics and Epidemiology, Siemens Healthcare GmbH, Erlangen, Germany
| | - Dieter Hölzel
- Em. Head of IBE Institute of Biomathematics and Epidemiology, Clinical Cancer Registry, Munich, Germany
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14
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van Bommel R, Voogd AC, Louwman MW, Strobbe LJ, Venderink D, Duijm LEM. Screening outcome in women repeatedly recalled for the same mammographic abnormality before, during and after the transition from screen-film to full-field digital screening mammography. Eur Radiol 2016; 27:553-561. [PMID: 27180183 DOI: 10.1007/s00330-016-4399-y] [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: 03/08/2016] [Revised: 04/08/2016] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to retrospectively determine screening outcome in women recalled twice for the same mammographic lesion before, during, and after transition from screen-film (SFM) to full-field digital screening mammography (FFDM). METHODS We included women with a repeated recall for the same mammographic abnormality (37 at subsequent SFM-screening, obtained between January 2000-April 2010; respectively 54 and 65 women with a prior SFM-screen or FFDM-screen followed by subsequent FFDM-screening, obtained between May 2009-July 2013). RESULTS At SFM-screening, repeated recalls for the same lesion comprised 1.2 % of recalls (37/3217), including 13 malignancies (positive predictive value (PPV), 35.1 %). During the SFM to FFDM transition (SFM-screen followed by FFDM-screen), FFDM recalls comprised more repeated recalls for the same lesion (2.2 %, P = 0.002), with a lower PPV (14.8 %, P = 0.02). This proportion increased to 2.8 % after transition to FFDM (i.e., two successive FFDM-screens), with 16 malignancies (PPV, 24.6 %). Invasive cancers at repeated recall were smaller than interval cancers (T1a-c, 79.4 versus 46.8 %, P = 0.001), with less lymph node involvement (20.6 versus 46.5 %, P = 0.007). CONCLUSIONS More women are repeatedly recalled for the same mammographic abnormality during and after the transition from SFM to FFDM-screening, with comparable cancer risks before and after the transition. These cancers show better prognostic characteristics than interval cancers. KEY POINTS • FFDM-screening increases the number of repeated recalls for the same mammographic abnormality. • The PPV of these recalls is comparable before and after transition to FFDM-screening. • Cancers diagnosed after a repeated recall are smaller than interval cancers. • These cancers also show less lymph node involvement than interval cancers.
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Affiliation(s)
- Rob van Bommel
- Department of Radiology, Catharina Hospital, PO Box 1530, 5602 ZA, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Marieke W Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Luc J Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, PO Box 9015, 6500 GS, Nijmegen, The Netherlands. .,Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands.
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15
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Breast Cancer Characteristics Associated With Digital Versus Film-Screen Mammography for Screen-Detected and Interval Cancers. AJR Am J Roentgenol 2015; 205:676-84. [PMID: 26295657 DOI: 10.2214/ajr.14.13904] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether pathologic findings of screen-detected and interval cancers differ for digital versus film mammography. MATERIALS AND METHODS Breast Cancer Surveillance Consortium data from 2003-2011 on 3,021,515 screening mammograms (40.3% digital, 59.7% film) of women 40-89 years old were reviewed. Cancers were considered screen detected if diagnosed within 12 months of an examination with positive findings and interval if diagnosed within 12 months of an examination with negative findings. Tumor characteristics for screen-detected and interval cancers were compared for digital versus film mammography by use of logistic regression models to estimate the odds ratio and 95% CI with adjustment for age, race and ethnicity, hormone therapy use, screening interval, examination year, and registry. Generalized estimating equations were used to account for correlation within facilities. RESULTS Among 15,729 breast cancers, 85.3% were screen detected and 14.7% were interval. Digital and film mammography had similar rates of screen-detected (4.47 vs 4.42 per 1000 examinations) and interval (0.73 vs 0.79 per 1000 examinations) cancers for digital versus film. In adjusted analyses, interval cancers diagnosed after digital examinations with negative findings were less likely to be American Joint Committee on Cancer stage IIB or higher (odds ratio, 0.69; 95% CI, 0.52-0.93), have positive nodal status (odds ratio, 0.78; 95% CI, 0.64-0.95), or be estrogen receptor negative (odds ratio, 0.71; 95% CI, 0.56-0.91) than were interval cancers diagnosed after a film examination with negative findings. CONCLUSION Screen-detected cancers diagnosed after digital and film mammography had similar rates of unfavorable tumor characteristics. Interval-detected cancers diagnosed after a digital examination were less likely to have unfavorable tumor features than those diagnosed after film mammography, but the absolute differences were small.
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16
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Sharpe RE, Venkataraman S, Phillips J, Dialani V, Fein-Zachary VJ, Prakash S, Slanetz PJ, Mehta TS. Increased Cancer Detection Rate and Variations in the Recall Rate Resulting from Implementation of 3D Digital Breast Tomosynthesis into a Population-based Screening Program. Radiology 2015; 278:698-706. [PMID: 26458206 DOI: 10.1148/radiol.2015142036] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the recall and cancer detection rates (CDRs) at screening with digital breast tomosynthesis (DBT) with those at screening with two-dimensional (2D) mammography and to evaluate variations in the recall rate (RR) according to patient age, risk factors, and breast density and among individual radiologists at a single U.S. academic medical center. MATERIALS AND METHODS This institutional review board-approved, HIPAA-compliant prospective study with a retrospective cohort included 85 852 asymptomatic women who presented for breast cancer screening over a 3-year period beginning in 2011. A DBT unit was introduced into the existing 2D mammography screening program, and patients were assigned to the first available machine. Ten breast-subspecialized radiologists interpreted approximately 90% of the examinations. RRs were calculated overall and according to patient age, breast density, and individual radiologist. CDRs were calculated. Single and multiple mixed-effect logistic regression analyses, χ(2) tests, and Bonferroni correction were utilized, as appropriate. RESULTS The study included 5703 (6.6%) DBT examinations and 80 149 (93.4%) 2D mammography examinations. The DBT subgroup contained a higher proportion of patients with risk factors for breast cancer and baseline examinations. DBT was used to detect 54.3% more carcinomas (+1.9 per 1000, P < .0018) than 2D mammography. The RR was 7.51% for 2D mammography and 6.10% for DBT (absolute change, 1.41%; relative change, -18.8%; P < .0001). The DBT subgroup demonstrated a significantly lower RR for patients with extremely or heterogeneously dense breasts and for patients in their 5th and 7th decades. CONCLUSION Implementing DBT into a U.S. breast cancer screening program significantly decreased the screening RR overall and for certain patient subgroups, while significantly increasing the CDR. These findings may encourage more widespread adoption and reimbursement of DBT and facilitate improved patient selection.
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Affiliation(s)
- Richard E Sharpe
- From the Department of Radiology, Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Shapiro Clinical Center, 4th Floor, Breast Imaging, Boston, MA 02215
| | - Shambavi Venkataraman
- From the Department of Radiology, Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Shapiro Clinical Center, 4th Floor, Breast Imaging, Boston, MA 02215
| | - Jordana Phillips
- From the Department of Radiology, Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Shapiro Clinical Center, 4th Floor, Breast Imaging, Boston, MA 02215
| | - Vandana Dialani
- From the Department of Radiology, Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Shapiro Clinical Center, 4th Floor, Breast Imaging, Boston, MA 02215
| | - Valerie J Fein-Zachary
- From the Department of Radiology, Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Shapiro Clinical Center, 4th Floor, Breast Imaging, Boston, MA 02215
| | - Seema Prakash
- From the Department of Radiology, Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Shapiro Clinical Center, 4th Floor, Breast Imaging, Boston, MA 02215
| | - Priscilla J Slanetz
- From the Department of Radiology, Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Shapiro Clinical Center, 4th Floor, Breast Imaging, Boston, MA 02215
| | - Tejas S Mehta
- From the Department of Radiology, Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Shapiro Clinical Center, 4th Floor, Breast Imaging, Boston, MA 02215
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17
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Yuan Y, Li M, Yang J, Winget M. Using administrative data to estimate time to breast cancer diagnosis and percent of screen-detected breast cancers - a validation study in Alberta, Canada. Eur J Cancer Care (Engl) 2014; 24:367-75. [DOI: 10.1111/ecc.12277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Yuan
- School of Public Health; University of Alberta; Edmonton Alberta Canada
| | - M. Li
- School of Public Health; University of Alberta; Edmonton Alberta Canada
| | - J. Yang
- Cancer Control Alberta; Alberta Health Services; Edmonton Alberta Canada
| | - M. Winget
- Department of Medicine; Stanford University School of Medicine; Palo Alto California USA
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18
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Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol 2014; 5:465-477. [PMID: 25114860 PMCID: PMC4127616 DOI: 10.5306/wjco.v5.i3.465] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/23/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages I and II, only 20%-50% patients in the majority of low- and middle-income countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existent in these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.
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Chang HJ, Chen WX, Lin ECL, Tung YY, Fetzer S, Lin MF. Delay in seeking medical evaluations and predictors of self-efficacy among women with newly diagnosed breast cancer: A longitudinal study. Int J Nurs Stud 2014; 51:1036-47. [DOI: 10.1016/j.ijnurstu.2013.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 10/31/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
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20
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Lacombe J, Mangé A, Bougnoux AC, Prassas I, Solassol J. A multiparametric serum marker panel as a complementary test to mammography for the diagnosis of node-negative early-stage breast cancer and DCIS in young women. Cancer Epidemiol Biomarkers Prev 2014; 23:1834-42. [PMID: 24957886 DOI: 10.1158/1055-9965.epi-14-0267] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The sensitivity of mammography for the detection of small lesions, including node-negative early-stage (T1N0) primary breast cancer (PBC) and ductal carcinoma in situ (DCIS), is significantly decreased in young patients. From a clinical standpoint, an inconclusive mammogram reflects the inability of clinicians to confidently decide whether patients should be referred for biopsy or for follow-up with repeat imaging. METHODS Specific ELISAs were developed for a panel of 13 well-recognized breast autoantigens (HSP60, FKBP52, PRDX2, PPIA, MUC1, GAL3, PAK2, P53, CCNB1, PHB2, RACK1, RUVBL1, and HER2). Circulating autoantibody levels were measured in a cohort of 396 serum samples from histologically confirmed DCIS (n = 87) or T1N0 PBC (n = 153) and healthy controls (n = 156). RESULTS Individually, antibodies against CCNB1, FKBP52, GAL3, PAK2, PRDX2, PPIA, P53, and MUC1 demonstrated discriminatory power between breast cancer and healthy control groups. At 90% sensitivity, the overall combined specificity of the autoantibody serum screening test was 42%. Adjustment for higher sensitivities of 95% and 99% resulted in 30% and 21% specificities, respectively (33% and 18% in T1N0 PBC and 28% and 21% in DCIS). Finally, in patients with node-negative early-stage breast cancer younger than 50 years, the autoantibody assay exhibited 59% specificity with a fixed sensitivity at 90%. CONCLUSIONS Our autoantibody panel allows accurate detection of early breast cancer and DCIS, notably in younger patients. IMPACT Clinical assessment of this autoantibody panel displays a potential to facilitate clinical management of early-stage breast cancer detection in cases of inconclusive mammogram.
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Affiliation(s)
- Jérôme Lacombe
- CHU Montpellier, Arnaud de Villeneuve, Department of Biopathology, Montpellier, France. University of Montpellier I, Montpellier, France. CRLC Val d'Aurelle, Department of Clinical Oncoproteomics, Montpellier, France
| | - Alain Mangé
- CHU Montpellier, Arnaud de Villeneuve, Department of Biopathology, Montpellier, France. University of Montpellier I, Montpellier, France. CRLC Val d'Aurelle, Department of Clinical Oncoproteomics, Montpellier, France
| | - Anne-Claire Bougnoux
- CHU Montpellier, Arnaud de Villeneuve, Department of Biopathology, Montpellier, France. University of Montpellier I, Montpellier, France. CRLC Val d'Aurelle, Department of Clinical Oncoproteomics, Montpellier, France
| | - Ioannis Prassas
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Lunenfeld Tanenbaum Research Institute, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jérôme Solassol
- CHU Montpellier, Arnaud de Villeneuve, Department of Biopathology, Montpellier, France. University of Montpellier I, Montpellier, France. CRLC Val d'Aurelle, Department of Clinical Oncoproteomics, Montpellier, France.
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Nederend J, Duijm LEM, Louwman MWJ, Roumen RMH, Jansen FH, Voogd AC. Trends in surgery for screen-detected and interval breast cancers in a national screening programme. Br J Surg 2014; 101:949-58. [DOI: 10.1002/bjs.9530] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/12/2022]
Abstract
Abstract
Background
This population-based study aimed to evaluate trends in surgical approach for screen-detected cancer versus interval breast cancer, and to determine the factors associated with positive resection margins.
Methods
Screening mammograms of women aged 50–75 years, who underwent biennial screening in a Dutch breast-screening region between 1997 and 2011, were included. Patient and tumour characteristics were compared between women who underwent mastectomy or breast-conserving surgery (BCS) for screen-detected or interval cancer, and women with a negative or positive resection margin after BCS.
Results
Some 417 013 consecutive screening mammograms were included. A total of 2224 screen-detected and 825 interval cancers were diagnosed. The BCS rate remained stable (mean 6·1 per 1000 screened women; P = 0·099), whereas mastectomy rates increased significantly during the study from 0·9 (1997–1998) to 1·9 (2009–2010) per 1000 screened women (P < 0·001). The proportion of positive resection margins for invasive cancer was 19·6 and 7·6 per cent in 1997–1998 and 2009–2010 respectively (P < 0·001), with significant variation between hospitals. Dense breasts, preoperative magnetic resonance imaging, microcalcifications, architectural distortion, tumour size over 20 mm, axillary lymph node metastasis and treating hospital were independent risk factors for mastectomy. Interval cancer, image-guided tumour localization, microcalcifications, breast parenchyma asymmetry, tumour size greater than 20 mm, lobular tumour histology, low tumour grade, extensive invasive component and treating hospital were independent risk factors for positive resection margins.
Conclusion
Mastectomy rates doubled during a 14-year period of screening mammography and the proportion of positive resection margins decreased, with variation among hospitals. The latter observation stresses the importance of quality control programmes for hospitals treating women with breast cancer.
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Affiliation(s)
- J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - L E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M W J Louwman
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Eindhoven, The Netherlands
| | - R M H Roumen
- Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands
| | - F H Jansen
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - A C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
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Variations in screening outcome among pairs of screening radiologists at non-blinded double reading of screening mammograms: a population-based study. Eur Radiol 2014; 24:1097-104. [PMID: 24500086 DOI: 10.1007/s00330-014-3102-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/10/2013] [Accepted: 01/17/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Substantial inter-observer variability in screening mammography interpretation has been reported at single reading. However, screening results of pairs of screening radiologists have not yet been published. We determined variations in screening performances among pairs of screening radiologists at non-blinded double reading. METHODS We included pairs of screening radiologists with at least 7,500 screening examinations per pair, obtained between 1997 and 2011. During 2-year follow-up, breast imaging reports, surgical reports and pathology results were collected of all referred women and interval cancers. Referral rate, cancer detection rate, positive predictive value and sensitivity were calculated for each pair. RESULTS A total of 310,906 screening mammograms, read by 26 pairs of screening radiologists, were included for analysis. The referral rate ranged from 1.0 % (95 % CI 0.8 %-1.2 %) to 1.5 % (95 % CI 1.3 %-1.8 %), the cancer detection rate from 4.0 (95 % CI 2.8-5.2) to 6.3 (95 % CI 4.5-8.0) per 1,000 screens. The programme sensitivity and positive predictive value of referral ranged from 55.1 % (95 % CI 45.1 %-65.1 %) to 81.5 % (95 % CI 73.4 %-89.6 %) and from 28.7 % (95 % CI 20.8 %-36.6 %) to 49.5 % (95 % CI 39.7 %-59.3 %), respectively. CONCLUSION We found significant variations in screening outcomes among pairs of screening radiologists at non-blinded double reading. This stresses the importance of monitoring screening results on a local scale. KEY POINTS • Substantial inter-observer variability in screening mammography interpretation is known at single reading • Population-based study showed significant variations in outcomes among pairs of screening radiologists • Local monitoring and regular feedback are important to optimise screening outcome.
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Interval breast cancers: absolute and proportional incidence and blinded review in a community mammographic screening program. Eur J Radiol 2013; 83:e84-91. [PMID: 24369953 DOI: 10.1016/j.ejrad.2013.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 11/15/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the performance of the first years since the beginning of a mammographic population-based screening program. MATERIALS AND METHODS Women aged 49-69 were invited biennially for two-view film-screen mammography and double reading without arbitration was performed. Interval cancers (ICs) from 2001 to 2006 were identified using screening archives, local pathology archives, and hospital discharge records. The proportional incidence of IC was determined considering breast cancers expected without screening. Three offsite radiologists experienced in breast cancer screening blindly evaluated mammograms prior to diagnosis, randomly mixed with negative mammograms (1:2 ratio). Cases unrecalled at review were considered as true ICs, those recalled by only one reviewer as minimal signs, and those recalled by two or three reviewers as missed cancers. T and N stage of the reviewed ICs were evaluated and compared. RESULTS A total of 86,276 first level mammograms were performed. Mean recall rate was 6.8% at first and 4.6% at repeat screening. We had 476 screen-detected cancers and 145 ICs (10 of them ductal carcinomas in situ). Absolute incidence was 17 per 10,000 screening examinations. Invasive proportional incidence was 19% (44/234) in the first year, 39% (91/234) in the second year, and 29% (135/468) in the two-year interval. Of 145 ICs, 130 (90%) were reviewed mixed with 287 negative controls: 55% (71/130) resulted to be true ICs, 24% (31/130) minimal signs, and 22% (28/130) missed cancers. The rate of ICs diagnosed in the first year interval was 21% (15/71) for true ICs, 46% (13/28) for missed cancers, and 39% (12/31) for minimal signs, with a significant difference of true ICs rate compared to missed cancers rate (p=0.012). A higher rate of T3 and T4 stages was found for missed cancers (18%, 5/28) compared to minimal signs (6%, 2/31) or true ICs (8%, 6/71), while the rate of N2 and N3 stage for both minimal signs (19%, 6/31) or missed cancers (25%, 7/28) was higher than that for true ICs (10%, 7/71), although all these differences were not significant (p ≥ 0.480). CONCLUSION These results showed the possibility to comply with European Community standards in the first years of a screening program implementation.
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Nederend J, Duijm LEM, Louwman MWJ, Coebergh JW, Roumen RMH, Lohle PN, Roukema JA, Rutten MJCM, van Steenbergen LN, Ernst MF, Jansen FH, Plaisier ML, Hooijen MJHH, Voogd AC. Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment - a population based study from the Netherlands. Eur J Cancer 2013; 50:31-9. [PMID: 24275518 DOI: 10.1016/j.ejca.2013.09.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 08/17/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In most breast screening programmes screen-film mammography (SFM) has been replaced by full-field digital mammography (FFDM). We compared interval cancer characteristics at SFM and FFDM screening mammography. PATIENTS AND METHODS We included all 297 screen-detected and 104 interval cancers in 60,770 SFM examinations and 427 screen-detected and 124 interval cancers in 63,182 FFDM examinations, in women screened in the period 2008-2010. Breast imaging reports, biopsy results and surgical reports of all cancers were collected. Two radiologists reviewed prior and diagnostic mammograms of all interval cancers. They determined breast density, described mammographic abnormalities and classified interval cancers as missed, showing a minimal sign abnormality or true negative. RESULTS The referral rate and cancer detection at SFM were 1.5% and 4.9‰ respectively, compared to 3.0% (p<0.001) and 6.6‰ (p<0.001) at FFDM. Screening sensitivity was 74.1% at SFM (297/401, 95% confidence interval (CI)=69.8-78.4%) and 77.5% at FFDM (427/551, 95% CI=74.0-81.0%). Significantly more interval cancers were true negative at prior FFDM than at prior SFM screening mammography (65.3% (81/124) versus 47.1% (49/104), p=0.02). For interval cancers following SFM or FFDM screening mammography, no significant differences were observed in breast density or mammographic abnormalities at the prior screen, tumour size, lymph node status, receptor status, Nottingham tumour grade or surgical treatment (mastectomy versus breast conserving therapy). CONCLUSION FFDM resulted in a significantly higher cancer detection rate, but sensitivity was similar for SFM and FFDM. Interval cancers are more likely to be true negative at prior FFDM than at prior SFM screening mammography, whereas their tumour characteristics and type of surgical treatment are comparable.
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Affiliation(s)
- Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands.
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Marieke W J Louwman
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands
| | - Jan Willem Coebergh
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Paul N Lohle
- Department of Radiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Jan A Roukema
- Department of Surgery, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Matthieu J C M Rutten
- Department of Radiology, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands
| | - Liza N van Steenbergen
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands
| | - Miranda F Ernst
- Department of Surgery, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands
| | - Frits H Jansen
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands
| | - Menno L Plaisier
- Department of Radiology, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Marianne J H H Hooijen
- Department of Radiology, St. Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The Netherlands
| | - Adri C Voogd
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, P Debyelaan 1, 6229 HA Maastricht, The Netherlands
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Domingo L, Romero A, Blanch J, Salas D, Sánchez M, Rodríguez-Arana A, Ferrer J, Ibáñez J, Vega A, Laso MS, Castells X, Sala M. Clinical and radiological features of breast tumors according to history of false-positive results in mammography screening. Cancer Epidemiol 2013; 37:660-5. [DOI: 10.1016/j.canep.2013.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 12/01/2022]
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Trends in breast biopsies for abnormalities detected at screening mammography: a population-based study in the Netherlands. Br J Cancer 2013; 109:242-8. [PMID: 23695018 PMCID: PMC3708556 DOI: 10.1038/bjc.2013.253] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/26/2013] [Accepted: 04/26/2013] [Indexed: 01/07/2023] Open
Abstract
Background: Diagnostic surgical breast biopsies have several disadvantages, therefore, they should be used with hesitation. We determined time trends in types of breast biopsies for the workup of abnormalities detected at screening mammography. We also examined diagnostic delays. Methods: In a Dutch breast cancer screening region 6230 women were referred for an abnormal screening mammogram between 1 January 1997 and 1 January 2011. During two year follow-up clinical data, breast imaging-, biopsy-, surgery- and pathology-reports were collected of these women. Furthermore, breast cancers diagnosed >3 months after referral (delays) were examined, this included review of mammograms and pathology specimens to determine the cause of the delays. Results: In 41.1% (1997–1998) and in 44.8% (2009–2010) of referred women imaging was sufficient for making the diagnosis (P<0.0001). Fine-needle aspiration cytology decreased from 12.7% (1997–1998) to 4.7% (2009–2010) (P<0.0001), percutaneous core-needle biopsies (CBs) increased from 8.0 to 49.1% (P<0.0001) and surgical biopsies decreased from 37.8 to 1.4% (P<0.0001). Delays in breast cancer diagnosis decreased from 6.7 to 1.8% (P=0.003). Conclusion: The use of diagnostic surgical breast biopsies has decreased substantially. They have mostly been replaced by percutaneous CBs and this replacement did not result in an increase of diagnostic delays.
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Mammographic changes resulting from benign breast surgery impair breast cancer detection at screening mammography. Eur J Cancer 2012; 48:2097-103. [DOI: 10.1016/j.ejca.2012.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 03/15/2012] [Indexed: 11/19/2022]
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Smallenburg VVB, Duijm LE, den Heeten GJ, Groenewoud JH, Jansen FH, Fracheboud J, Plaisier ML, van Doorne-Nagtegaal HJ, Broeders MJ. Two-view versus single-view mammography at subsequent screening in a region of the Dutch breast screening programme. Eur J Radiol 2012; 81:2189-94. [DOI: 10.1016/j.ejrad.2011.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 07/15/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
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Setz-Pels W, Duijm LEM, Louwman MWJ, Roumen RMH, Jansen FH, Voogd AC. Characteristics and screening outcome of women referred twice at screening mammography. Eur Radiol 2012; 22:2624-32. [PMID: 22696156 DOI: 10.1007/s00330-012-2523-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/20/2012] [Accepted: 05/06/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To determine the characteristics and screening outcome of women referred twice at screening mammography. METHODS We included 424,703 consecutive screening mammograms and collected imaging, biopsy and surgery reports of women with screen-detected breast cancer. Review of screening mammograms was performed to determine whether or not an initial and second referral comprised the same lesion. RESULTS The overall positive predictive value of referral for cancer was 38.6% (95% CI 37.3-39.8%). Of 147 (2.6%) women referred twice, 86 had been referred for a different lesion at second referral and 32 of these proved malignant (37.2%, 95% CI 27.0-47.4%). Sixty-one women had been referred twice for the same lesion, of which 22 proved malignant (36.1%, 95% CI 24.1-48.0%). Characteristics of these women were comparable to women with cancer diagnosed after first referral. Compared with women without cancer at second referral for the same lesion, women with cancer more frequently showed suspicious densities at screening mammography (86.4% vs 53.8%, P = 0.02) and work-up at first referral had less frequently included biopsy (22.7% vs 61.5%, P = 0.004). CONCLUSIONS Cancer risk in women referred twice for the same lesion is similar to that observed in women referred once, or referred for a second time but for a different lesion. KEY POINTS Cancer risk was 36% for lesions referred twice at screening mammography. The cancer risk was similar for lesions referred only once at screening. Densities at first referral were associated with increased cancer risk at second referral. No biopsy at first referral was associated with increased cancer risk at second referral. Patient and tumour characteristics were similar for women with and without diagnostic delay.
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Affiliation(s)
- Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
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van Breest Smallenburg V, Setz-Pels W, Groenewoud JH, Voogd AC, Jansen FH, Louwman MWJ, Tielbeek AV, Duijm LEM. Malpractice claims following screening mammography in The Netherlands. Int J Cancer 2012; 131:1360-6. [PMID: 22173962 DOI: 10.1002/ijc.27398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 11/28/2011] [Indexed: 01/12/2023]
Abstract
Although malpractice lawsuits are frequently related to a delayed breast cancer diagnosis in symptomatic patients, information on claims at European screening mammography programs is lacking. We determined the type and frequency of malpractice claims at a Dutch breast cancer screening region. We included all 85,274 women (351,009 screens) who underwent biennial screening mammography at a southern breast screening region in The Netherlands between 1997 and 2009. Two screening radiologists reviewed the screening mammograms of all screen detected cancers and interval cancers and determined whether the cancer had been missed at the previous screen or at the latest screen, respectively. We analyzed all correspondence between the screening organization, clinicians and screened women, and collected complaints and claims until September 2011. At review, 20.9% (308/1,475) of screen detected cancers and 24.3% (163/670) of interval cancers were considered to be missed at a previous screen. A total of 19 women (of which 2, 6 and 11 women had been screened between 1997 and 2001 (102,439 screens), 2001 and 2005 (114,740 screens) and 2005 and 2009 (133,830 screens), respectively) had contacted the screening organization for additional information about their screen detected cancer or interval cancer, but filed no claim. Three other women directly initiated an insurance claim for financial compensation of their interval cancer without previously having contacted the screening organization. We conclude that screening-related claims were rarely encountered, although many screen detected cancers and interval cancers had been missed at a previous screen. A small but increasing proportion of women sought additional information about their breast cancer from the screening organization.
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Nederend J, Duijm LE, Voogd AC, Groenewoud JH, Jansen FH, Louwman MW. Trends in incidence and detection of advanced breast cancer at biennial screening mammography in The Netherlands: a population based study. Breast Cancer Res 2012; 14:R10. [PMID: 22230363 PMCID: PMC3496125 DOI: 10.1186/bcr3091] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 01/09/2012] [Indexed: 11/16/2022] Open
Abstract
Introduction The aims of this study were to determine trends in the incidence of advanced breast cancer at screening mammography and the potential of screening to reduce it. Methods We included a consecutive series of 351,009 screening mammograms of 85,274 women aged 50-75 years, who underwent biennial screening at a Dutch breast screening region in the period 1997-2008. Two screening radiologists reviewed the screening mammograms of all advanced screen detected and advanced interval cancers and determined whether the advanced cancer (tumor > 20 mm and/or lymph node positive tumor) had been visible at a previous screen. Interval cancers were breast cancers diagnosed in women after a negative screening examination (defined as no recommendation for referral) and before any subsequent screen. Patient and tumor characteristics were compared between women with advanced cancer and women with non-advanced cancer, including ductal carcinoma in situ. Results A total of 1,771 screen detected cancers and 669 interval cancers were diagnosed in 2,440 women. Rates of advanced cancer remained stable over the 12-year period; the incidence of advanced screen-detected cancers fluctuated between 1.5 - 1.9 per 1,000 screened women (mean 1.6 per 1,000) and of advanced interval cancers between 0.8 - 1.6 per 1,000 screened women (mean 1.2 per 1,000). Of the 570 advanced screen-detected cancers, 106 (18.6%) were detected at initial screening; 265 (46.5%) cancers detected at subsequent screening had been radiologically occult at the previous screening mammogram, 88 (15.4%) had shown a minimal sign, and 111 (19.5%) had been missed. Corresponding figures for advanced interval cancers were 50.9% (216/424), 24.3% (103/424) and 25.1% (105/424), respectively. At multivariate analysis, women with a ≥ 30 months interval between the latest two screens had an increased risk of screen-detected advanced breast cancer (OR 1.63, 95%CI: 1.07-2.48) and hormone replacement therapy increased the risk of advanced disease among interval cancers (OR 3.04, 95%CI: 1.22-7.53). Conclusion We observed no decline in the risk of advanced breast cancer during 12 years of biennial screening mammography. The majority of these cancers could not have been prevented through earlier detection at screening.
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Affiliation(s)
- Joost Nederend
- Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
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Solbjør M, Forsmo S, Skolbekken JA, Sætnan AR. Experiences of Recall After Mammography Screening—A Qualitative Study. Health Care Women Int 2011; 32:1009-27. [DOI: 10.1080/07399332.2011.565530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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How reassuring is a normal breast ultrasound in assessment of a screen-detected mammographic abnormality? A review of interval cancers after assessment that included ultrasound evaluation. Clin Radiol 2011; 66:928-39. [DOI: 10.1016/j.crad.2011.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/07/2011] [Accepted: 03/23/2011] [Indexed: 11/21/2022]
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Setz-Pels W, Duijm LEM, Groenewoud JH, Voogd AC, Jansen FH, Hooijen MJHH, Louwman MWJ. Detection of Bilateral Breast Cancer at Biennial Screening Mammography in the Netherlands: A Population-based Study. Radiology 2011; 260:357-63. [PMID: 21474705 DOI: 10.1148/radiol.11102117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
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Hafström L, Johansson H, Ahlberg J. Diagnostic delay of breast cancer - an analysis of claims to Swedish Board of Malpractice (LÖF). Breast 2011; 20:539-42. [PMID: 21764312 DOI: 10.1016/j.breast.2011.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 06/09/2011] [Accepted: 06/26/2011] [Indexed: 11/24/2022] Open
Abstract
AIM Delay in the diagnosis of breast cancer may have important clinical and medico-legal implications. This study examined the decisions made by reviewers at the Swedish agency (LÖF) that handles claims of medical malpractice where claimants seek compensation for alleged suffering and/or negative clinical impacts of diagnostic delays. MATERIAL AND METHODS In 1995-2006 a total of 134 women filed claims for negative effects resulting from delays in the diagnosis of breast cancer. Review of the claims led to approval of delay in the primary diagnosis for 62 women and of recurrence for 28 women. The clinical symptoms that were overlooked and other causes of delay that had any relation to therapy, prognosis and economic compensation were identified. The verdicts reached were analysed. RESULTS The median delay in the diagnosis of the primary disease was 11 months and for recurrent disease 3.5 months. Delay in diagnosis of the primary disease was considered to have an impact on the therapy in 23%. The prognosis was postulated to have been adversely affected 11% of the patients for whom the delay was longer than 12 months. Delay in diagnosing the recurrence was contributing to delay in starting therapy and to unnecessary suffering in 32%. The delay in diagnosis was mainly caused by incomplete clinical or radiological examination and by misinterpretations of the examination results. Economic compensation was given in 90%. There was a warning or admonition to the responsible doctor in a third of the cases referred to the judgement court. CONCLUSION This study demonstrates that claims for compensation for delay in diagnosis of breast cancer in Sweden occur in about 1/1000 new patient. The delay in the diagnosis of the primary tumour was considered to have an impact on the magnitude of therapeutic measures in almost 25% of the women who filed claims. Economic compensation for the patients' injuries was given in ninety percent of the cases. In women for whom there was a delay in diagnosing the recurrence there was consequently a delay in starting the palliative therapy.
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Affiliation(s)
- Larsolof Hafström
- Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
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Population-based mammography screening below age 50: balancing radiation-induced vs prevented breast cancer deaths. Br J Cancer 2011; 104:1214-20. [PMID: 21364575 PMCID: PMC3068504 DOI: 10.1038/bjc.2011.67] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Exposure to ionizing radiation at mammography screening may cause breast cancer. Because the radiation risk increases with lower exposure age, advancing the lower age limit may affect the balance between screening benefits and risks. The present study explores the benefit-risk ratio of screening before age 50. METHODS The benefits of biennial mammography screening, starting at various ages between 40 and 50, and continuing up to age 74 were examined using micro-simulation. In contrast with previous studies that commonly used excess relative risk models, we assessed the radiation risks using the latest BEIR-VII excess absolute rate exposure-risk model. RESULTS The estimated radiation risk is lower than previously assessed. At a mean glandular dose of 1.3 mGy per view that was recently measured in the Netherlands, biennial mammography screening between age 50 and 74 was predicted to induce 1.6 breast cancer deaths per 100,000 women aged 0-100 (range 1.3-6.3 extra deaths at a glandular dose of 1-5 mGy per view), against 1121 avoided deaths in this population. Advancing the lower age limit for screening to include women aged 40-74 was predicted to induce 3.7 breast cancer deaths per 100,000 women aged 0-100 (range 2.9-14.4) at biennial screening, but would also prevent 1302 deaths. CONCLUSION The benefits of mammography screening between age 40 and 74 were predicted to outweigh the radiation risks.
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