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Liu T, Liu CA, Zhang QS, Zhang Q, Wang YM, Song MM, Lin SQ, Deng L, Wu SL, Shi HP. Early-onset and later-onset cancer: trends, risk factors, and prevention in Northern China. SCIENCE CHINA. LIFE SCIENCES 2024; 67:1928-1940. [PMID: 38809499 DOI: 10.1007/s11427-023-2523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/07/2023] [Indexed: 05/30/2024]
Abstract
The characteristics of early-onset (onset age <50 years) and later-onset (onset age ≽ 50 years) cancers differ significantly. Identifying novel risk factors for both types of cancer is crucial for increasing awareness of cancer prevention and for reducing its burden. This study aimed to analyze the trends in incidence and risk factors for early-onset and late-onset cancers. We conducted a prospective study by drawing data from the Kailuan Study. This study included 6,741 participants with cancer (624 with early-onset cancer and 6,117 with later-onset cancer) and 6,780 matched controls among the 186,249 participants who underwent Kailuan health examinations from 2006 to 2019. The primary outcomes were cancer incidence rates, and associated risk factors for early- and later-onset cancer. Weighted Cox regression was used to calculate hazard ratios and 95% confidence intervals of each exposure factor for early- and later-onset cancer by cancer type. Population-attributable risk proportions were used to estimate the number of cases that could be prevented by eliminating a risk factor from the population. Except for liver cancer, incidence rates for nearly all types of cancer increased during the study period. Smoking, alcohol consumption, lipid metabolism disorders, hypertension, diabetes mellitus, fatty liver, and inflammation were associated with a significantly increased risk of cancer at multiple sites, but risk factors for cancer incidence differed by site. Smoking, alcohol consumption, inflammation, and hypertension were the major contributors to preventable cancer. The incidence of several different types of cancer, including early-onset cancer, is increasing in northeastern China. Differences in risk factors between early-onset and later-onset malignancies may contribute to the divergence in the observed changes in incidence trends between these two specific types of cancer.
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Affiliation(s)
- Tong Liu
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, 100038, China
| | - Chen-An Liu
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, 100038, China
| | - Qing-Song Zhang
- Department of General Surgery, Kailuan General Hospital, Tangshan, 063000, China
| | - Qi Zhang
- Department of Genetics, Yale School of Medicine, New Haven, 06510, USA
| | - Yi-Ming Wang
- Department of Hepatobiliary Surgery, Kailuan General Hospital, Tangshan, 063000, China
| | - Meng-Meng Song
- Cardiovascular Research Institute, University of California, San Francisco, 94158, USA
| | - Shi-Qi Lin
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, 100038, China
| | - Li Deng
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, 100038, China.
| | - Shou-Ling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, 063000, China.
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, 100038, China.
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Tan N, Wu Y, Li B, Chen W. Burden of cancers in six female organs in China and worldwide. Chin Med J (Engl) 2024:00029330-990000000-01202. [PMID: 39207303 PMCID: PMC11407822 DOI: 10.1097/cm9.0000000000003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Cancers in female organs remain a substantial burden in China and worldwide. GLOBOCAN 2022 has recently updated the estimates of cancer burden. This study aims to depict the profiles of disease burden and to compare the age-specific rates of cancers in female organs in China with those in other countries. METHODS The latest estimates of incidence and mortality of cancers in female organs from various regions and countries were extracted from the GLOBOCAN 2022 database. We compared the proportion of total cases or deaths for cancers affecting six female organs and other tumor types in China and globally. Correlation analysis was conducted to evaluate the relationship between age-standardized incidence rate (ASIR) or age-standardized mortality rate (ASMR) and the Human Development Index (HDI). Additionally, age-specific rate curves were plotted for ten exemplary countries with different income levels. RESULTS Globally, there are varying burdens of female organ cancers, with higher incidence rates in Northern America and elevated rates of cervical cancer in Africa. Female organ cancers in China remain a significant burden due to their large proportion of the six tumors. A positive correlation between socioeconomic development and the incidence of breast, uterine corpus, ovarian, and vulvar cancers was noted, whereas a negative association between the HDI tiers and mortality rates was found for cervical and vaginal cancers. In 2022, Chinese women aged 50-54 years are experiencing high incidence rates of breast, cervix uteri, corpus uteri, and ovarian cancers. CONCLUSIONS Cancers in female organs continue to be a significant health concern for women in China and worldwide. It is crucial to implement comprehensive prevention strategies tailored to address the increasing trend among younger individuals and reduce regional disparities.
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Affiliation(s)
- Nuopei Tan
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - You Wu
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bin Li
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Zuley ML, Bandos AI, Duffy SW, Logue D, Bhargava R, McAuliffe PF, Brufsky AM, Nishikawa RM. Breast Cancer Screening Interval: Effect on Rate of Late-Stage Disease at Diagnosis and Overall Survival. J Clin Oncol 2024:JCO2400285. [PMID: 39167740 DOI: 10.1200/jco.24.00285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/28/2024] [Accepted: 07/03/2024] [Indexed: 08/23/2024] Open
Abstract
PURPOSE Controversy continues regarding the effect of screening mammography on breast cancer outcomes. We evaluated late-stage cancer rate and overall survival (OS) for different screening intervals using a real-world institutional research data mart. METHODS Patients having both a cancer registry record of new breast cancer diagnosis and prediagnosis screening history between 2004 and 2019 were identified from our institutional research breast data mart. Time interval between the two screening mammograms immediately preceding diagnosis and the time to cancer diagnosis were determined. Screening interval was deemed annual if ≤15 months, biennial if >15 and ≤27 months, intermittent if >27 months, and baseline if only one prediagnosis screen was known. The primary end point was late-stage cancer (TNM stage IIB or worse), and the secondary end point was OS. The association of screening interval and late-stage cancer was analyzed using multivariable logistic regression adjusting for prediagnosis characteristics. Proportional hazards regression was used for survival analysis. Potential lead time was analyzed using survival from a uniform fixed time point. RESULTS In total, 8,145 patients with breast cancer had prediagnosis screening mammography in the timeframe. The percentage of late-stage cancers diagnosed increased significantly with screening interval with 9%, 14%, and 19% late stages for annual, biennial, and intermittent groups (P < .001), respectively. The trend persisted regardless of age, race, and menopausal status. Biennial and intermittent groups had substantially worse OS than the annual screened group, with relative hazards of 1.42 (95% CI, 1.11 to 1.82) and 2.69 (95% CI, 2.11 to 3.43), respectively, and 1.39 (95% CI, 1.08 to 1.78) and 2.01 (95% CI, 1.58 to 2.55) after adjustment for potential lead time. CONCLUSION Annual mammographic screening was associated with lower risk of late-stage cancer and better OS across clinical and demographic subgroups. Our study suggests benefit of annual screening for women 40 years and older.
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Affiliation(s)
- Margarita L Zuley
- Department of Radiology, Division of Breast Imaging, School of Medicine & University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Andriy I Bandos
- Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Stephen W Duffy
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Durwin Logue
- Imaging Research, Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rohit Bhargava
- Department of Pathology and Pathology at Magee-Womens Hospital of the University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Priscilla F McAuliffe
- Department of Surgery and Breast Surgical Oncology at Magee-Womens Hospital of the University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Adam M Brufsky
- Division of Hematology/Oncology, School of Medicine & University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Nishikawa
- Imaging Research, Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Lavik E, Minasian L. Bioconjugates for Cancer Prevention: Opportunities for Impact. Bioconjug Chem 2024; 35:1148-1153. [PMID: 39116257 DOI: 10.1021/acs.bioconjchem.4c00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Cancer prevention encompasses both screening strategies to find cancers early when they are likely to be most treatable and prevention and interception strategies to reduce the risk of developing cancers. Bioconjugates, here defined broadly as materials and molecules that have synthetic and biological components, have roles to play across the cancer-prevention spectrum. In particular, bioconjugates may be developed as affordable, accessible, and effective screening strategies or as novel vaccines and drugs to reduce one's risk of developing cancers. Developmental programs are available for taking novel technologies and evaluating them for clinical use in cancer screening and prevention. While a variety of different challenges exist in implementing cancer-prevention interventions, a thoughtful approach to bioconjugates could improve the delivery and acceptability of the interventions.
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Affiliation(s)
- Erin Lavik
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Dr, Rockville, Maryland 20850, United States
| | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Dr, Rockville, Maryland 20850, United States
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Kim HJ, Kim HH, Eom HJ, Choi WJ, Chae EY, Shin HJ, Cha JH, Choi YW, Choi YJ, Kim KH, Min J, Shim WH, Lee S, Cho S. Optimizing angular range in digital breast tomosynthesis: A phantom study investigating lesion detection across varied breast density and thickness. Phys Med 2024; 124:103419. [PMID: 38986262 DOI: 10.1016/j.ejmp.2024.103419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/29/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
PURPOSE To determine the optimal angular range (AR) for digital breast tomosynthesis (DBT) systems that provides highest lesion visibility across various breast densities and thicknesses. METHOD A modular DBT phantom, consisting of tissue-equivalent adipose and glandular modules, along with a module embedded with test objects (speckles, masses, fibers), was used to create combinations simulating different breast thicknesses, densities, and lesion locations. A prototype DBT system operated at four ARs (AR±7.5°, AR±12.5°, AR±19°, and AR±25°) to acquire 11 projection images for each combination, with separate fixed doses for thin and thick combinations. Three blinded radiologists independently assessed lesion visibility in reconstructed images; assessments were averaged and compared using linear mixed models. RESULTS Speckle visibility was highest with AR±7.5° or AR±12.5°, decreasing with wider ARs in all density and thickness combinations. The difference between AR±7.5° and AR±12.5° was not statistically significant, except for the tube-side speckles in thin-fatty combinations (5.83 [AR±7.5°] vs. 5.39 [AR±12.5°], P = 0.019). Mass visibility was not affected by AR in thick combinations, while AR±12.5° exhibited the highest mass visibility for both thin-fatty and thin-dense combinations (P = 0.032 and 0.007, respectively). Different ARs provided highest fiber visibility for different combinations; however, AR±12.5° consistently provided highest or comparable visibility. AR±12.5° showed highest overall lesion visibility for all density and thickness combinations. CONCLUSIONS AR±12.5° exhibited the highest overall lesion visibility across various phantom thicknesses and densities using a projection number of 11.
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Affiliation(s)
- Hee Jeong Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Hye Joung Eom
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Young Wook Choi
- Electro-Medical Equipment Research Division, Korea Electrotechnology Research Institute (KERI), 111, Hanggaul-ro, Sangrok-gu, Ansan-si, Gyeonggi-do 15588, South Korea.
| | - Young Jin Choi
- Electro-Medical Equipment Research Division, Korea Electrotechnology Research Institute (KERI), 111, Hanggaul-ro, Sangrok-gu, Ansan-si, Gyeonggi-do 15588, South Korea.
| | - Kee Hyun Kim
- Electro-Medical Equipment Research Division, Korea Electrotechnology Research Institute (KERI), 111, Hanggaul-ro, Sangrok-gu, Ansan-si, Gyeonggi-do 15588, South Korea.
| | - Joongkee Min
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Woo Hyun Shim
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Seoyoung Lee
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291, Daehak-ro, Yuseong-gu, Daejeon 34141, South Korea.
| | - Seungryong Cho
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291, Daehak-ro, Yuseong-gu, Daejeon 34141, South Korea.
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Pinto-Carbó M, Vanaclocha-Espí M, Martín-Pozuelo J, Romeo-Cervera P, Hernández-García M, Ibáñez J, Castán-Cameo S, Salas D, van Ravesteyn NT, de Koning H, Zurriaga Ó, Molina-Barceló A. Impact of different age ranges on the benefits and harms of the breast cancer screening programme by the EU-TOPIA tool. Eur J Public Health 2024; 34:806-811. [PMID: 38578614 PMCID: PMC11293820 DOI: 10.1093/eurpub/ckae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The recommendation for the implementation of mammography screening in women aged 45-49 and 70-74 is conditional with moderate certainty of the evidence. The aim of this study is to simulate the long-term outcomes (2020-50) of using different age range scenarios in the breast cancer screening programme of the Valencia Region (Spain), considering different programme participation rates. METHODS Three age range scenarios (S) were simulated with the EU-TOPIA tool, considering a biennial screening interval: S1, 45-69 years old (y); S2, 50-69 y and S3, 45-74 y. Simulations were performed for four participation rates: A = current participation (72.7%), B = +5%, C = +10% and D = +20%. Considered benefits: number (N°) of in situ and invasive breast cancers (BC) (screen vs. clinically detected), N° of BC deaths and % BC mortality reduction. Considered harms: N° of false positives (FP) and % overdiagnosis. RESULTS The results showed that BC mortality decreased in all scenarios, being higher in S3A (32.2%) than S1A (30.6%) and S2A (27.9%). Harms decreased in S2A vs. S1A (N° FP: 236 vs. 423, overdiagnosis: 4.9% vs. 5.0%) but also benefits (BC mortality reduction: 27.9% vs. 30.6%, N° screen-detected invasive BC 15/28 vs. 18/25). In S3A vs. S1A, an increase in benefits was observed (BC mortality reduction: 32.2% vs. 30.6%), N° screen-detected in situ B: 5/2 vs. 4/3), but also in harms (N° FP: 460 vs. 423, overdiagnosis: 5.8% vs. 5.0%). Similar trends were observed with increased participation. CONCLUSIONS As the age range increases, so does not only the reduction in BC mortality, but also the probability of FP and overdiagnosis.
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Affiliation(s)
- Marina Pinto-Carbó
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
| | - Mercedes Vanaclocha-Espí
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
| | - Javier Martín-Pozuelo
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
| | - Paula Romeo-Cervera
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
| | - Marta Hernández-García
- Environmental Health Service, Utiel Public Health Centre, Ministry of Universal and Public Health, Utiel, Valencia Region, Spain
| | - Josefa Ibáñez
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
- Healthcare Integration Service, Directorate General for Health Care, Regional Ministry of Health, Valencia, Spain
| | - Susana Castán-Cameo
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
- Screening Programs Service, General Directorate of Public Health, Regional Ministry of Health, Valencia, Spain
| | - Dolores Salas
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
| | | | - Harry de Koning
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Óscar Zurriaga
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, University of Valencia, Valencia, Spain
- Joint Research Unit on Rare Diseases, FISABIO-University of Valencia (FISABIO-UVEG), Valencia, Spain
| | - Ana Molina-Barceló
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
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7
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Chen C, Tseng J, Amersi F, Silberman AW. Second primary malignancies in women with breast cancer. J Surg Oncol 2024. [PMID: 39031014 DOI: 10.1002/jso.27785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/04/2024] [Accepted: 06/25/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Increased screening and treatment advancements have resulted in improved survival rates in women with breast cancer (BC). However, recent data suggests these women have elevated risk of developing a second primary malignancy (SPM) compared to the general population. Limited data exists on factors associated with BC patients developing a SPM. METHOD A retrospective review of a prospective single institution database (1990-2016) identified 782 patients with a history of BC. One hundred and ninety-four BC patients developed a SPM. Clinicopathologic and treatment characteristics were analyzed. RESULTS Of the 194 patients (24.8%) who developed a SPM, 56 (28.9%) BC patients were <50 years old (range: 24-87 years). Two-thirds (64.9%) had at least one first or second degree relative with a malignancy (no relatives-35.1%; ≥1 relative-62.9%). Most patients had invasive ductal carcinoma (n = 117, 60.3%) or ductal carcinoma in situ (n = 39, 20.1%). Twenty-two patients (11.3%) had pathogenic genetic mutations. Mean time to developing a SPM was 8.9 years (range: 4 months-50 years). Eighty (47.6%) patients received chemotherapy with 91 (54.5%) completing radiation. The most common SPMs were breast (22%), melanoma (17.8%), gynecologic (14.1%), colorectal (12.6%), hematologic (8.9%), and sarcoma (6.5%). Most breast tumors were estrogen receptor (ER) (n = 99, 78.0%) or progesterone receptor (PR) positive (n = 87, 73.1%) but not HER2-neu positive (n = 13, 14.0%). CONCLUSION Most BC patients who developed a SPM had ER/PR positive tumors and a family history of malignancy, with most <50 years old. Although chemotherapy and radiation increase cancer risk, there were an equal number of patients with SPMs who did or did not receive either treatment. Most SPMs were breast, soft tissue, gynecologic, hematologic, or colorectal. BC patients should be followed closely given an elevated propensity for developing SPMs.
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Affiliation(s)
- Courtney Chen
- Department of Surgery, Cedars-Sinai Medical Center, Division of Surgical Oncology, Los Angeles, CA, USA
| | - Joshua Tseng
- Department of Surgery, Cedars-Sinai Medical Center, Division of Surgical Oncology, Los Angeles, CA, USA
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Division of Surgical Oncology, Los Angeles, CA, USA
| | - Allan W Silberman
- Department of Surgery, Cedars-Sinai Medical Center, Division of Surgical Oncology, Los Angeles, CA, USA
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Youngs A, Forman A, Elms M, Kohut K, Hlaing MT, Short J, Hanson H, Snape K. Digital innovation for cancer risk assessment allows large-scale service redevelopment of regional cancer genetics service delivery. Fam Cancer 2024:10.1007/s10689-024-00407-x. [PMID: 38954285 DOI: 10.1007/s10689-024-00407-x] [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: 01/22/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024]
Abstract
Family-history assessment can identify individuals above population-risk for cancer to enable targeted Screening, Prevention and Early Detection (SPED). The online patient-facing cancer Family History Questionnaire Service (cFHQS) is a digitalised, resource efficient tool for family history data capture to facilitate this. The capturing of digital data from cFHQS allows for data interrogation of patients referred to Clinical Genetics for the purposes of service improvement. Digital data from 4,044 cFHQS respondents over a three-year period was collected and interrogated with respect to the number and type of familial tumour diagnoses to enable service improvement and streamlining of referral pathways. 81% of colorectal and 71% of breast screening assessments were population- or moderate-risk. Most patients who completed cFHQS reported more than one diagnosis of cancer/tumour/polyps in their family. 2.5% of family history assessment patients had a second indication that required assessment that would have been missed if single tumour type assessment was undertaken. Implementation of an innovative, digital family history data collection pathway has allowed large scale interrogation of referral patterns and assessment outcomes to enable service development. The high volume of inappropriate referrals to Clinical Genetics for population and moderate risk patients highlighted the need for dedicated secondary care pathway provision for these patients. The use of cFHQS streamlined family history assessment allows for redistribution of resources to improve equity and access to genetic cancer risk assessment.
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Affiliation(s)
- Alice Youngs
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Andrea Forman
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Marisa Elms
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Kelly Kohut
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Min Theik Hlaing
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - John Short
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Helen Hanson
- Peninsula Clinical Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, EX1 2ED, Exeter, England
| | - Katie Snape
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England.
- St George's University, London, UK.
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9
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Saffie-Vega I, Muñoz-Navarro S, Manríquez-Mimica M, Sapunar-Zenteno J. Effect of age of initiation of mammography breast cancer screening. Ecancermedicalscience 2024; 18:1723. [PMID: 39021538 PMCID: PMC11254401 DOI: 10.3332/ecancer.2024.1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Indexed: 07/20/2024] Open
Abstract
Introduction Mammography is an excellent resource to reduce the burden of premature death associated with breast cancer; however, screening is only recommended between the ages of 50 and 69 years. General objective To compare the frequency of suspicious and non-diagnostic mammograms for breast cancer when screening Chilean women between the ages of 40 and 50 years. Patients and methods Cross-sectional study nested in a breast cancer screening programme in Chilean women >40 years old, conducted between 2017 and 2021. Demographic variables and risk factors are described. To establish the effect of age on screening, we calculated the number needed to screen for a Breast Imaging Reporting and Data Reporting System 4 or 5 mammogram when screening over 40 years or over 50 years. Results We studied 137,690 women screened for breast cancer since the age of 40 years. The median age was 54 years (range 40-93 years). 64.7% of women were postmenopausal, 4.79% were nulliparous and 14% of post-menopausal women were receiving hormone replacement therapy. To find a suspicious mammogram, 170 women over 40 years and 149 women over 50 years would have to be screened. Conclusion By changing the starting age of screening from 50 to 40 years 21 more women would have to be screened to detect a suspicious mammogram and if screened from age 50 and not from age 40 years 21% of total suspicious mammograms would remain unidentified.
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Affiliation(s)
- Isabel Saffie-Vega
- Departamento de Investigación del Cáncer, Instituto Oncológico Fundación Arturo López Pérez, Unidad de Investigación Epidemiológica, Santiago 7500000, Chile
- Instituto Oncológico Fundación Arturo López Pérez, Unidad de Cirugía Oncológica de la Mama, Santiago 7500000, Chile
- https://orcid.org/0000-0002-4723-5750
| | - Sergio Muñoz-Navarro
- Centro de Excelencia CIGES, Facultad de Medicina, Universidad de La Frontera, Temuco 4780000, Chile
- https://orcid.org/0000-0003-0663-0575
| | - Macarena Manríquez-Mimica
- Departamento de Investigación del Cáncer, Instituto Oncológico Fundación Arturo López Pérez, Unidad de Investigación Epidemiológica, Santiago 7500000, Chile
- https://orcid.org/0009-0007-3540-1487
| | - Jorge Sapunar-Zenteno
- Departamento de Investigación del Cáncer, Instituto Oncológico Fundación Arturo López Pérez, Unidad de Investigación Epidemiológica, Santiago 7500000, Chile
- Centro de Excelencia CIGES, Facultad de Medicina, Universidad de La Frontera, Temuco 4780000, Chile
- https://orcid.org/0000-0001-9908-8054
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10
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Park EK, Lee H, Kim M, Kim T, Kim J, Kim KH, Kooi T, Chang Y, Ryu S. Artificial Intelligence-Powered Imaging Biomarker Based on Mammography for Breast Cancer Risk Prediction. Diagnostics (Basel) 2024; 14:1212. [PMID: 38928628 PMCID: PMC11202482 DOI: 10.3390/diagnostics14121212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
The purposes of this study were to develop an artificial intelligence (AI) model for future breast cancer risk prediction based on mammographic images, investigate the feasibility of the AI model, and compare the AI model, clinical statistical risk models, and Mirai, a state of-the art deep learning algorithm based on screening mammograms for 1-5-year breast cancer risk prediction. We trained and developed a deep learning model using a total of 36,995 serial mammographic examinations from 21,438 women (cancer-enriched mammograms, 17.5%). To determine the feasibility of the AI prediction model, mammograms and detailed clinical information were collected. C-indices and area under the receiver operating characteristic curves (AUCs) for 1-5-year outcomes were obtained. We compared the AUCs of our AI prediction model, Mirai, and clinical statistical risk models, including the Tyrer-Cuzick (TC) model and Gail model, using DeLong's test. A total of 16,894 mammograms were independently collected for external validation, of which 4002 were followed by a cancer diagnosis within 5 years. Our AI prediction model obtained a C-index of 0.76, with AUCs of 0.90, 0.84, 0.81, 0.78, and 0.81, to predict the 1-5-year risks. Our AI prediction model showed significantly higher AUCs than those of the TC model (AUC: 0.57; p < 0.001) and Gail model (AUC: 0.52; p < 0.001), and achieved similar performance to Mirai. The deep learning AI model using mammograms and AI-powered imaging biomarkers has substantial potential to advance accurate breast cancer risk prediction.
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Affiliation(s)
- Eun Kyung Park
- Department of Radiology, We Comfortable Clinic, Seoul 07327, Republic of Korea
| | - Hyeonsoo Lee
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Minjeong Kim
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Taesoo Kim
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Junha Kim
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Ki Hwan Kim
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Thijs Kooi
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Yoosoo Chang
- Center of Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; (Y.C.); (S.R.)
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Seungho Ryu
- Center of Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; (Y.C.); (S.R.)
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
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11
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Kai C, Morita T, Sato I, Yoshida A, Kodama N, Kasai S. The Usefulness of the Breast Density Assessment Application Used by Breast Radiologists. Cureus 2024; 16:e62560. [PMID: 39027798 PMCID: PMC11254854 DOI: 10.7759/cureus.62560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/20/2024] Open
Abstract
Breast density determined by breast radiologists and also automatically estimated by applications has been widely investigated. However, no study has yet clarified whether the use of these applications by breast radiologists improves reading efficacy. Therefore, this study aimed to assess the usefulness of applications when used by breast radiologists. A Breast Density Assessment application (App) developed by Konica Minolta, Inc. (Tokyo, Japan) was used. Independent and sequential tests were conducted to assess the usefulness of the concurrent- and second-look modes. Fifty and 100 cases were evaluated using sequential and independent tests, respectively. Each dataset was configured based on the evaluation by an expert breast radiologist who developed the Japanese guidelines for breast density. Nine breast radiologists evaluated the mammary gland content ratio and breast density; the inter-observer and expert-to-observer variability were calculated. The time required to complete the experiments was also recorded. The inter-observer variability was significant with the App, as revealed by the independent test. The use of the App significantly improved the agreement between the responses of the observers for the mammary gland content ratio and those of the expert by 6.6% and led to a reduction of 186.9 seconds in the average time required by the observers to evaluate 100 cases. However, the results of the sequential test did not suggest the effectiveness of the App. These findings suggest that the concurrent use of the App improves reading efficiency.
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Affiliation(s)
- Chiharu Kai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, JPN
- Department of Health and Welfare, Graduate School, Niigata University of Health and Welfare, Niigata, JPN
| | - Takako Morita
- Department of Breast Surgery, National Hospital Organization, Nagoya Medical Center, Aichi, JPN
| | - Ikumi Sato
- Department of Health and Welfare, Graduate School, Niigata University of Health and Welfare, Niigata, JPN
- Department of Nursing, Faculty of Nursing, Niigata University of Health and Welfare, Niigata, JPN
| | - Akifumi Yoshida
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, JPN
| | - Naoki Kodama
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, JPN
| | - Satoshi Kasai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, JPN
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12
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Bayrakçeken E, Yaralı S, Alkan Ö. Identify risk factors affecting participation of Turkish women in mammography screening for breast cancer prevention. Breast Cancer Res Treat 2024; 205:487-495. [PMID: 38453780 PMCID: PMC11101495 DOI: 10.1007/s10549-024-07296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Cancer screening is a public health intervention aiming to reduce cancer-caused deaths. This study aims to determine the factors affecting the mammography screening time among women aged 40-69. METHODS The micro dataset obtained from the Türkiye Health Survey conducted by the Turkish Statistical Institute (TurkStat) in 2019 and 2022 was used in the present study. Stereotype logistic regression was used to determine the variables affecting mammography screening and period for breast cancer prevention in women in Türkiye. RESULTS Given the results achieved from the analysis, it was found that factors such as age, marital status, general health condition, comorbidity, receiving psychosocial support, high blood lipid levels, and performing breast self-examinations affected women's adherence to cancer screening programs. CONCLUSION Since adherence to mammography increases with age, it is recommended to pay importance to education for women approaching the age of mammography screening. Educated individuals are expected to have access to multiple sources of information as to cancer and to access this information more easily. In order to gain more insight into the recommended preventive measures and outcomes related to cancer, it is suggested to review policies, which will increase the educational level of women, and provide privileges in the field of education.
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Affiliation(s)
- Esra Bayrakçeken
- Department of Medical Services and Techniques, Vocational School of Health Services, Ataturk University, Yakutiye/Erzurum, Türkiye
| | - Süheyla Yaralı
- Department of Public Health Nursing, Faculty of Nursing, Ataturk University, 2nd Floor, No:49, Yakutiye/Erzurum, Türkiye
| | - Ömer Alkan
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, 2nd Floor, No:222, Yakutiye/Erzurum, Türkiye.
- Master Araştırma Eğitim ve Danışmanlık Hizmetleri Ltd. şti., Ata Teknokent, Erzurum, TR-25240, Türkiye.
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13
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Kai C, Kondo S, Otsuka T, Yoshida A, Sato I, Futamura H, Kodama N, Kasai S. Development of a Subtraction Processing Technology for Assistance in the Comparative Interpretation of Mammograms. Diagnostics (Basel) 2024; 14:1131. [PMID: 38893657 PMCID: PMC11171532 DOI: 10.3390/diagnostics14111131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
A comparative interpretation of mammograms has become increasingly important, and it is crucial to develop subtraction processing and registration methods for mammograms. However, nonrigid image registration has seldom been applied to subjects constructed with soft tissue only, such as mammograms. We examined whether subtraction processing for the comparative interpretation of mammograms can be performed using nonrigid image registration. As a preliminary study, we evaluated the results of subtraction processing by applying nonrigid image registration to normal mammograms, assuming a comparative interpretation between the left and right breasts. Mediolateral-oblique-view mammograms were taken from noncancer patients and divided into 1000 cases for training, 100 cases for validation, and 500 cases for testing. Nonrigid image registration was applied to align the horizontally flipped left-breast mammogram with the right one. We compared the sum of absolute differences (SAD) of the difference of bilateral images (Difference Image) with and without the application of nonrigid image registration. Statistically, the average SAD was significantly lower with the application of nonrigid image registration than without it (without: 0.0692; with: 0.0549 (p < 0.001)). In four subgroups using the breast area, breast density, compressed breast thickness, and Difference Image without nonrigid image registration, the average SAD of the Difference Image was also significantly lower with nonrigid image registration than without it (p < 0.001). Nonrigid image registration was found to be sufficiently useful in aligning bilateral mammograms, and it is expected to be an important tool in the development of a support system for the comparative interpretation of mammograms.
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Affiliation(s)
- Chiharu Kai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata City 950-3198, Japan; (C.K.); (A.Y.); (N.K.)
- Major in Health and Welfare, Graduate School of Niigata University of Health and Welfare, Niigata City 950-3198, Japan;
| | - Satoshi Kondo
- Graduate School of Engineering, Muroran Institute of Technology, Muroran City 050-8585, Japan
| | | | - Akifumi Yoshida
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata City 950-3198, Japan; (C.K.); (A.Y.); (N.K.)
| | - Ikumi Sato
- Major in Health and Welfare, Graduate School of Niigata University of Health and Welfare, Niigata City 950-3198, Japan;
- Department of Nursing, Faculty of Nursing, Niigata University of Health and Welfare, Niigata City 950-3198, Japan
| | | | - Naoki Kodama
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata City 950-3198, Japan; (C.K.); (A.Y.); (N.K.)
| | - Satoshi Kasai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata City 950-3198, Japan; (C.K.); (A.Y.); (N.K.)
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14
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Hussein D, Oyato BT, Gashaw K, Geleta TA, Tufa DG, Geleta LA. Practice of breast self-examination and associated factors among women of reproductive age in the North Shoa Zone, Oromia, Ethiopia, 2022: a convergent mixed-methods study. BMJ Open 2024; 14:e073951. [PMID: 38749697 PMCID: PMC11097837 DOI: 10.1136/bmjopen-2023-073951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To assess practice of breast self-examination (BSE) and associated factors among women of reproductive age in the North Shoa Zone, Oromia, Ethiopia. DESIGN Community-based cross-sectional study with a convergent mixed-methods approach. SETTING The study was conducted in the North Shoa Zone of Oromia, Central Ethiopia, between 1 May 2022 and 30 June 2022. PARTICIPANTS 1076 women of reproductive age were selected using simple random sampling technique for the quantitative study. For the qualitative part, a total of 46 women were approached purposively to elicit rich ideas and insight into the issue. The quantitative data were collected using an interviewer-administered questionnaire, and focus group discussions were used for the qualitative part. Quantitative data were analysed using SPSS V.26. An adjusted OR with a 95% CI was employed. Thematic analysis approach was applied for the qualitative data analysis. OUTCOME MEASURES Participants were interviewed to respond whether they practised BSE. RESULTS Overall, 192 (18.2%; 15.7%-20.5%) of the participants had ever performed BSE. Having a family history of breast cancer (BC) (adjusted OR (AOR)=6.9, 95% CI 4.6 to 10.3), being knowledgeable on BSE (AOR=3, 95% CI 1.9 to 4.3), having high perceived susceptibility (AOR=1.7, 95% CI 1.2 to 2.5), having high self-efficacy (AOR=1.5, 95% CI 1.1 to 2.3) and having a high perceived benefit to BSE (AOR=1.5, 95% CI 1.1 to 2.3) were significantly associated with increased odds of BSE practice.Four main themes emerged from the qualitative analysis: BC and BSE-related knowledge, perceived benefits of treatment, barriers to BSE practice and enablers of BSE practice. CONCLUSION The practice of BSE in this area was considerably low. The North Shoa Zonal Health Office and other stakeholders should disseminate instructional materials that cover the techniques and benefits of regularly performing BSE. Healthcare professionals should engage in the community to address the obstacles women face in practising BSE.
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Affiliation(s)
- Dursa Hussein
- Public Health, Salale University, Fitche, Oromia, Ethiopia
| | | | - Ketema Gashaw
- Public Health, Salale University, Fitche, Oromia, Ethiopia
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15
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Ehrhorn EG, Lovell P, Svechkarev D, Romanova S, Mohs AM. Optimizing the performance of silica nanoparticles functionalized with a near-infrared fluorescent dye for bioimaging applications. NANOTECHNOLOGY 2024; 35:10.1088/1361-6528/ad3fc5. [PMID: 38631329 PMCID: PMC11216106 DOI: 10.1088/1361-6528/ad3fc5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/17/2024] [Indexed: 04/19/2024]
Abstract
Modified fluorescent nanoparticles continue to emerge as promising candidates for drug delivery, bioimaging, and labeling tools for various biomedical applications. The ability of nanomaterials to fluorescently label cells allow for the enhanced detection and understanding of diseases. Silica nanoparticles have a variety of unique properties that can be harnessed for many different applications, causing their increased popularity. In combination with an organic dye, fluorescent nanoparticles demonstrate a vast range of advantageous properties including long photostability, surface modification, and signal amplification, thus allowing ease of manipulation to best suit bioimaging purposes. In this study, the Stöber method with tetraethyl orthosilicate (TEOS) and a fluorescent dye sulfo-Cy5-amine was used to synthesize fluorescent silica nanoparticles. The fluorescence spectra, zeta potential, quantum yield, cytotoxicity, and photostability were evaluated. The increased intracellular uptake and photostability of the dye-silica nanoparticles show their potential for bioimaging.
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Affiliation(s)
- Evie G. Ehrhorn
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, 68198, United States
| | - Paul Lovell
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, 68198, United States
| | - Denis Svechkarev
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
- Department of Chemistry, University of Nebraska at Omaha, Omaha, Nebraska 68182, United States
| | - Svetlana Romanova
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Aaron M. Mohs
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, 68198, United States
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, 68198, United States
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16
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Park EK, Kwak S, Lee W, Choi JS, Kooi T, Kim EK. Impact of AI for Digital Breast Tomosynthesis on Breast Cancer Detection and Interpretation Time. Radiol Artif Intell 2024; 6:e230318. [PMID: 38568095 PMCID: PMC11140510 DOI: 10.1148/ryai.230318] [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: 08/14/2023] [Revised: 02/28/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024]
Abstract
Purpose To develop an artificial intelligence (AI) model for the diagnosis of breast cancer on digital breast tomosynthesis (DBT) images and to investigate whether it could improve diagnostic accuracy and reduce radiologist reading time. Materials and Methods A deep learning AI algorithm was developed and validated for DBT with retrospectively collected examinations (January 2010 to December 2021) from 14 institutions in the United States and South Korea. A multicenter reader study was performed to compare the performance of 15 radiologists (seven breast specialists, eight general radiologists) in interpreting DBT examinations in 258 women (mean age, 56 years ± 13.41 [SD]), including 65 cancer cases, with and without the use of AI. Area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and reading time were evaluated. Results The AUC for stand-alone AI performance was 0.93 (95% CI: 0.92, 0.94). With AI, radiologists' AUC improved from 0.90 (95% CI: 0.86, 0.93) to 0.92 (95% CI: 0.88, 0.96) (P = .003) in the reader study. AI showed higher specificity (89.64% [95% CI: 85.34%, 93.94%]) than radiologists (77.34% [95% CI: 75.82%, 78.87%]) (P < .001). When reading with AI, radiologists' sensitivity increased from 85.44% (95% CI: 83.22%, 87.65%) to 87.69% (95% CI: 85.63%, 89.75%) (P = .04), with no evidence of a difference in specificity. Reading time decreased from 54.41 seconds (95% CI: 52.56, 56.27) without AI to 48.52 seconds (95% CI: 46.79, 50.25) with AI (P < .001). Interreader agreement measured by Fleiss κ increased from 0.59 to 0.62. Conclusion The AI model showed better diagnostic accuracy than radiologists in breast cancer detection, as well as reduced reading times. The concurrent use of AI in DBT interpretation could improve both accuracy and efficiency. Keywords: Breast, Computer-Aided Diagnosis (CAD), Tomosynthesis, Artificial Intelligence, Digital Breast Tomosynthesis, Breast Cancer, Computer-Aided Detection, Screening Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Bae in this issue.
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Affiliation(s)
- Eun Kyung Park
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - SooYoung Kwak
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Weonsuk Lee
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Joon Suk Choi
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Thijs Kooi
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Eun-Kyung Kim
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
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Dunlop KLA, Singh N, Robbins HA, Zahed H, Johansson M, Rankin NM, Cust AE. Implementation considerations for risk-tailored cancer screening in the population: A scoping review. Prev Med 2024; 181:107897. [PMID: 38378124 PMCID: PMC11106520 DOI: 10.1016/j.ypmed.2024.107897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Risk-tailored screening has emerged as a promising approach to optimise the balance of benefits and harms of existing population cancer screening programs. It tailors screening (e.g., eligibility, frequency, interval, test type) to individual risk rather than the current one-size-fits-all approach of most organised population screening programs. However, the implementation of risk-tailored cancer screening in the population is challenging as it requires a change of practice at multiple levels i.e., individual, provider, health system levels. This scoping review aims to synthesise current implementation considerations for risk-tailored cancer screening in the population, identifying barriers, facilitators, and associated implementation outcomes. METHODS Relevant studies were identified via database searches up to February 2023. Results were synthesised using Tierney et al. (2020) guidance for evidence synthesis of implementation outcomes and a multilevel framework. RESULTS Of 4138 titles identified, 74 studies met the inclusion criteria. Most studies in this review focused on the implementation outcomes of acceptability, feasibility, and appropriateness, reflecting the pre-implementation stage of most research to date. Only six studies included an implementation framework. The review identified consistent evidence that risk-tailored screening is largely acceptable across population groups, however reluctance to accept a reduction in screening frequency for low-risk informed by cultural norms, presents a major barrier. Limited studies were identified for cancer types other than breast cancer. CONCLUSIONS Implementation strategies will need to address alternate models of delivery, education of health professionals, communication with the public, screening options for people at low risk of cancer, and inequity in outcomes across cancer types.
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Affiliation(s)
- Kate L A Dunlop
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
| | - Nehal Singh
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Hilary A Robbins
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Hana Zahed
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mattias Johansson
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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18
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Ahsan MD, Webster EM, Wolfe IA, McGonigle R, Brewer JT, Chandler IR, Weiss JM, Enriquez A, Cantillo E, Holcomb K, Chapman-Davis E, Blank SV, Sharaf RN, Frey MK. Personalized survivorship care: Routine breast cancer risk assessment in the gynecologic oncology clinic. Gynecol Oncol 2024; 183:47-52. [PMID: 38503141 DOI: 10.1016/j.ygyno.2024.03.004] [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: 01/29/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Gynecologic and breast cancers share several risk factors. Breast cancer risk assessment tools can identify those at elevated risk and allow for enhanced breast surveillance and chemoprevention, however such tools are underutilized. We aim to evaluate the use of routine breast cancer risk assessment in a gynecologic oncology clinic. METHODS A patient-facing web-based tool was used to collect personal and family history and run four validated breast cancer risk assessment models (Tyrer-Cuzick (TC), Gail, BRCAPRO, and Claus) in a gynecologic oncology clinic. We evaluated completion of the tools and identification of patients at elevated risk for breast cancer using the four validated models. RESULTS A total of 99 patients were included in this analysis. The BRCAPRO model had the highest completion rate (84.8%), followed by the TC model (74.7%), Gail model (74.7%), and the Claus model (52.1%). The TC model identified 21.6% of patients completing the model as having ≥20% lifetime risk of breast cancer, compared to 6.8% by the Gail model, and 0% for both the BRCAPRO and Claus models. The Gail model identified 52.5% of patients as having ≥1.67% 5-year risk of breast cancer. Among patients identified as high-risk for breast cancer and eligible for screening, 9/9 (100%) were referred to a high-risk breast clinic. CONCLUSION Among patients that completed the TC breast cancer risk assessment in a gynecologic oncology clinic, approximately 1 in 5 were identified to be at significantly elevated lifetime risk for breast cancer. The gynecologic oncologist's office might offer a convenient and feasible setting to incorporate this risk assessment into routine patient care, as gynecologic oncologists often have long-term patient relationships and participate in survivorship care.
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Affiliation(s)
| | - Emily M Webster
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Isabel A Wolfe
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Rylee McGonigle
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Jesse T Brewer
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | | | - Jessica M Weiss
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Allan Enriquez
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Evelyn Cantillo
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Kevin Holcomb
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | | | - Stephanie V Blank
- Icahn School of Medicine at Mount Sinai - 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Ravi N Sharaf
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Melissa K Frey
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States.
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19
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Kai C, Otsuka T, Nara M, Kondo S, Futamura H, Kodama N, Kasai S. Identifying factors that indicate the possibility of non-visible cases on mammograms using mammary gland content ratio estimated by artificial intelligence. Front Oncol 2024; 14:1255109. [PMID: 38505584 PMCID: PMC10949406 DOI: 10.3389/fonc.2024.1255109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/12/2024] [Indexed: 03/21/2024] Open
Abstract
Background Mammography is the modality of choice for breast cancer screening. However, some cases of breast cancer have been diagnosed through ultrasonography alone with no or benign findings on mammography (hereby referred to as non-visibles). Therefore, this study aimed to identify factors that indicate the possibility of non-visibles based on the mammary gland content ratio estimated using artificial intelligence (AI) by patient age and compressed breast thickness (CBT). Methods We used AI previously developed by us to estimate the mammary gland content ratio and quantitatively analyze 26,232 controls and 150 non-visibles. First, we evaluated divergence trends between controls and non-visibles based on the average estimated mammary gland content ratio to ensure the importance of analysis by age and CBT. Next, we evaluated the possibility that mammary gland content ratio ≥50% groups affect the divergence between controls and non-visibles to specifically identify factors that indicate the possibility of non-visibles. The images were classified into two groups for the estimated mammary gland content ratios with a threshold of 50%, and logistic regression analysis was performed between controls and non-visibles. Results The average estimated mammary gland content ratio was significantly higher in non-visibles than in controls when the overall sample, the patient age was ≥40 years and the CBT was ≥40 mm (p < 0.05). The differences in the average estimated mammary gland content ratios in the controls and non-visibles for the overall sample was 7.54%, the differences in patients aged 40-49, 50-59, and ≥60 years were 6.20%, 7.48%, and 4.78%, respectively, and the differences in those with a CBT of 40-49, 50-59, and ≥60 mm were 6.67%, 9.71%, and 16.13%, respectively. In evaluating mammary gland content ratio ≥50% groups, we also found positive correlations for non-visibles when controls were used as the baseline for the overall sample, in patients aged 40-59 years, and in those with a CBT ≥40 mm (p < 0.05). The corresponding odds ratios were ≥2.20, with a maximum value of 4.36. Conclusion The study findings highlight an estimated mammary gland content ratio of ≥50% in patients aged 40-59 years or in those with ≥40 mm CBT could be indicative factors for non-visibles.
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Affiliation(s)
- Chiharu Kai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Niigata, Japan
- Major in Health and Welfare, Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | | | - Miyako Nara
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Satoshi Kondo
- Graduate School of Engineering, Muroran Institute of Technology, Muroran, Hokkaido, Japan
| | - Hitoshi Futamura
- Healthcare Business Headquarters, Konica Minolta, Inc., Tokyo, Japan
| | - Naoki Kodama
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Satoshi Kasai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Niigata, Japan
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20
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Geoghegan C, Horan M, Crilly E, Kelly A, Lyons R, Geoghegan L, Duke D, Sweeney L, McCartan D, O'Keeffe S. A multicentre review of the direct-access mammography programme in Ireland for women with breast pain. Clin Radiol 2024; 79:e227-e231. [PMID: 38007335 DOI: 10.1016/j.crad.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/27/2023]
Abstract
AIM To assess the current use of the direct access mammography pathway for breast pain and the rate of breast cancer detection in this patient cohort. MATERIALS AND METHODS A retrospective review of general practitioner (GP)-referred mammograms performed during a 12-month period from January to December 2022 across four tertiary referral centres. With the use of medical records and GP referrals, patient demographics, presenting symptoms, family history, and clinical outcomes were recorded. RESULTS The present study comprised 2,046 patients of which 21.6% did not report breast pain at the time of referral. Thirty-five per cent had a positive family history with 40% of these patients having no breast pain. Twelve per cent were recalled with 30% of these patients requiring biopsy. An overall cancer detection rate (CDR) of 7 per 1000 was determined for women with mastalgia. A CDR of 0 per 1,000 was determined for women <50 years with mastalgia alone and no additional risk factors for malignancy. Fisher's exact test showed no statistically significant association between breast pain and breast cancer. CONCLUSION There was no statistically significant relationship found between breast pain and breast cancer. This review suggests a low cancer detection rate in women <50 years. In women <50 years with mastalgia without additional symptoms or family history, breast imaging is not required.
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Affiliation(s)
- C Geoghegan
- Radiology Department, St. James's Hospital, Dublin 8, Ireland; University of Galway, Galway, Ireland.
| | - M Horan
- Radiology Department, St. James's Hospital, Dublin 8, Ireland
| | - E Crilly
- Beaumont Breast Centre, Beaumont Hospital, Dublin 9, Ireland
| | - A Kelly
- Radiology Department, University Hospital Waterford, Waterford, Ireland
| | - R Lyons
- Breast Surgery Department, St. Vincent's Hospital, Dublin 4, Ireland
| | - L Geoghegan
- Radiology Department, St. James's Hospital, Dublin 8, Ireland
| | - D Duke
- Beaumont Breast Centre, Beaumont Hospital, Dublin 9, Ireland
| | - L Sweeney
- Radiology Department, University Hospital Waterford, Waterford, Ireland
| | - D McCartan
- Breast Surgery Department, St. Vincent's Hospital, Dublin 4, Ireland
| | - S O'Keeffe
- Radiology Department, St. James's Hospital, Dublin 8, Ireland
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21
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Migowski A, Nadanovsky P, Manso de Mello Vianna C. Harms and benefits of mammographic screening for breast cancer in Brazil. PLoS One 2024; 19:e0297048. [PMID: 38271392 PMCID: PMC10810469 DOI: 10.1371/journal.pone.0297048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION In the absence of evidence on the effect of mammographic screening on overall mortality, comparing the number of deaths avoided with the number of deaths caused by screening would be ideal, but the only existing models of this type adopt a very narrow definition of harms. The objective of the present study was to estimate the number of deaths prevented and induced by various mammography screening protocols in Brazil. METHODS A simulation study of cohorts of Brazilian women screened, considering various age groups and screening interval protocols, was performed based on life tables. The number of deaths avoided and caused by screening was estimated, as was the absolute risk reduction, the number needed to invite for screening-NNS, the net benefit of screening, and the ratio of "lives saved" to "lives lost". Nine possible combinations of balances between benefits and harms were performed for each protocol, in addition to other sensitivity analyses. RESULTS AND CONCLUSIONS The most efficient protocol was biennial screening from 60 to 69 years of age, with almost three times more deaths avoided than biennial screening from 50 to 59 years of age, with a similar number of deaths avoided by biennial screening from 50 to 69 years of age and with the greatest net benefit. Compared with the best scenario of annual screening from 40 to 49 years of age, the NNS of the protocol with biennial screening from 60 to 69 years of age was three-fold lower. Even in its best scenario, the addition of annual screening from 40 to 49 years of age to biennial screening from 50 to 69 years of age results in a decreased net benefit. However, even in the 50-69 year age group, the estimated reduction in breast cancer mortality for Brazil was half that estimated for the United Kingdom.
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Affiliation(s)
- Arn Migowski
- Professional Master’s Program in Health Technology Assessment, Teaching and Research Coordination, Instituto Nacional de Cardiologia (INC), Ministry of Health, Rio de Janeiro, Brazil
- Division of Clinical Research and Technological Development, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Escola Nacional de Saúde Pública (ENSP), FIOCRUZ, Rio de Janeiro, Brazil
| | - Cid Manso de Mello Vianna
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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22
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Selvam M, Sundaram S. Breast self-examination practices among young rural women and its associated knowledge and attitudes in Tirunelveli District, Tamil Nadu. J Cancer Res Ther 2024; 20:62-70. [PMID: 38554300 DOI: 10.4103/jcrt.jcrt_713_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/29/2022] [Indexed: 04/01/2024]
Abstract
CONTEXT Breast self-examination (BSE) is a simple and cost-effective screening procedure in downstaging breast tumors. AIM To assess the BSE practices and its associated knowledge and attitudes of rural women from Tirunelveli District, Tamil Nadu during the COVID-19 pandemic. SETTINGS AND DESIGN A descriptive cross-sectional survey design was employed, and snowball sampling was used to recruit the sample of rural women from Tirunelveli. MATERIALS AND METHODS Women ages 18-60 willing to take part were included. Data were collected online through a self-developed questionnaire. STATISTICAL ANALYSIS Responses were analyzed using SPSS Version 20. Descriptive statistical analysis was used to present the general details and responses of the rural women through percentages. Using the appropriate tests, the mean differences of the BSE attitudes based on the personal variables were computed using one-way ANOVA. RESULTS A total of 433 rural women (Mean age: 29.20 ± 9.35 years) from Tirunelveli responded to the online Knowledge, Attitude and Practice (KAP) questionnaire. Regular health checkups were undergone by 27.48% of women and 9.24% underwent breast cancer (BC) screening in the past. While 68.36% had heard of BC, 61% knew it could be detected in the early stages. Insufficient knowledge regarding BSE techniques was evident among the women. Knowledge about BC was highest among those earning more than 20,001 INR, women aged 36-45, widowed/separated/divorced women, and diploma graduates. Overall, BSE and BC knowledge score was low, with correspondingly low attitudes and practices. CONCLUSION Findings showed the KAP among rural Tirunelveli women to be low.
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Affiliation(s)
- Mahalakshmi Selvam
- Department of Applied Psychology, Rajiv Gandhi National Institute for Youth Development, Sriperumpudur, Kanchipuram, Tamil Nadu, India
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23
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Irzaldy A, Gvamichava R, Beruchashvili T, Sturua L, van Ravesteyn NT, de Koning HJ, Heijnsdijk EAM. Breast Cancer Screening in Georgia: Choosing the Most Optimal and Cost-Effective Strategy. Value Health Reg Issues 2024; 39:66-73. [PMID: 37992568 DOI: 10.1016/j.vhri.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES To define the optimal and cost-effective breast cancer screening strategy for Georgia. METHODS We used the Microsimulation Screening Analysis-Breast (MISCAN-Breast) model that has been adapted to the Georgian situation to evaluate 736 mammography screening strategies varied by interval (biennial and triennial), starting ages (40-60 years), stopping ages (64-84 years), and screening modality (with and without clinical breast examination [CBE]). Quality-adjusted life-years (QALYs) and additional cost (healthcare perspective) compared with no screening per 1000 women were calculated with 3% discount. Major uncertainties (eg, costs) are addressed as sensitivity analyses. RESULTS Strategies using a combination of mammography and CBE yielded in substantially higher costs with minimal differences in outcomes compared with mammography-only strategies. The current screening strategy, biennial mammography screening from the age of 40 until 70 years with CBE, is close to the frontier line but requires high additional cost given the QALY gains (€16 218/QALY), well above the willingness-to-pay threshold of €12 720. The optimal strategy in Georgia would be triennial mammography-only screening from age 45 to 66 years with an incremental cost-effectiveness ratio of €12 507. CONCLUSIONS Biennial screening strategies are resource-intensive strategies and may not be feasible for Georgia. By switching to triennial mammography-only strategy from the age of 45 until 66 years, it is possible to offer screening to more eligible women while still gaining substantial screening benefits. This is to address capacity issues which is a common barrier for many Eastern European countries.
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Affiliation(s)
- Abyan Irzaldy
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | | | | | - Lela Sturua
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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24
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Liu Y, Wu Z, Lin J, Wang Z. Correlation between the risk of lymph node metastasis and the expression of GBP1 in breast cancer patients. Pak J Med Sci 2024; 40:159-164. [PMID: 38196488 PMCID: PMC10772427 DOI: 10.12669/pjms.40.1.8251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 01/11/2024] Open
Abstract
Objective To explore the prognostic value and correlation between the risk of lymph node metastasis (LNM) and Guanylate-binding Protein 1 (GBP1) in breast cancer (BC) patients. Methods In this retrospective study, the clinical data of 150 patients with BC who were surgically resected in The Affiliated Qingdao Central Hospital of Qingdao University from January 2019 to December 2021 were included. Patients were divided into metastasis group (n=110) or non-metastasis group (n=40) according to whether there was LNM post-surgery. Logistic regression was used to analyze the risk factors for LNM in BC, and Kaplan-Meier was used to assess the risk of disease progression 12 months post-operation in both groups. Patients were divided into a GBP1 low expression-group (n=75) or a GBP1 high expression-group (n=75). The risk of disease progression, one-year post-surgery was analyzed, and the predictive value of GBP1 in BC tissue was assessed by the receiver operating characteristics (ROC) curve. Results Independent risk factors for BC with LNM were GBP1, CEA and TNM stage (P<0.05). There is a linear relationship between GBP1 expression and LNM risk in BC (χ2=0.88, P<0.05). Patients with high expression of GBP1 had a higher risk of LNM (χ2=3.204, P<0.001) and early postoperative progression (χ2=7.412, P<0.05). The AUC of GBP1 in predicting the risk of LNM was 0.840. Conclusions Patients with BC and a higher expression of GBP1 could be at an increased risk of LNM. Elevations in GBP1 expression can also suggest a poor prognosis for patients with BC.
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Affiliation(s)
- Yukun Liu
- Yukun Liu Department of Breast Surgery, Breast Disease Center, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao 266042, Shandong Province, P.R. China
| | - Ziying Wu
- Ziying Wu Department of Colorectal and Anal Surgery, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao 266042, Shandong Province, P.R. China
| | - Jun Lin
- Jun Lin Department of Breast Surgery, Breast Disease Center, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao 266042, Shandong Province, P.R. China
| | - Zhimei Wang
- Zhimei Wang Department of Gynecological Neoplasms, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao 266042, Shandong Province, P.R. China
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25
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Lakkis NA, Abdallah RM, Musharrafieh UM, Issa HG, Osman MH. Epidemiology of Breast, Corpus Uteri, and Ovarian Cancers in Lebanon With Emphasis on Breast Cancer Incidence Trends and Risk Factors Compared to Regional and Global Rates. Cancer Control 2024; 31:10732748241236266. [PMID: 38419342 PMCID: PMC10903209 DOI: 10.1177/10732748241236266] [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: 08/07/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES This study explores the incidence and trends of breast (Bca), corpus uteri (CUca), and ovarian (Oca) cancer in Lebanon, a Middle Eastern country. It compares the Bca rates to regional and global ones and discusses Bca risk factors in Lebanon. INTRODUCTION Globally, Bca is the premier cause of cancer morbidity and mortality in women. METHODS Data on female Bca, CUca, and Oca published by the Lebanese national cancer registry were obtained (ie, for the years of 2005 to 2016). The age-standardized incidence rates (ASIRw) and age-specific rates per 100,000 female population were computed. RESULTS From 2005 to 2016, Bca, Oca, and CUca ranked first, sixth, and seventh, respectively, for cancer incidence among women in Lebanon. Bca alone accounted for 39.4% of all new female cancer cases. The ASIRw increased significantly for Bca and CUca (APC: 3.60 and 3.73, P < .05) but not for Oca (APC: 1.27, P > .05). The Bca ASIRw (per 100,000) increased significantly from 71.0 in 2005 to 115.6 in 2013 (P < .05), then decreased steadily but non-significantly to reach 96.8 in 2016 (P > .05). Lebanon's Bca ASIRw is comparable to developed countries. This may reflect altered sociological and reproductive patterns as the country transitions from regional to global trends. The five-year age-specific rates analysis revealed that Bca rates rose steeply from 35-39 to 50-54, dropped slightly between 55 and 64, then rose till 75+. The five-year age-specific rates between 35 and 54 among Lebanese women were amongst the highest worldwide from 2008 to 2012, even higher than the rates in Belgium, which had the highest ASIRw of Bca worldwide in 2020. CONCLUSION Lebanon's Bca ASIRw is among the highest globally. It's important to investigate the contributing factors and develop a national Bca control strategy. This study supports the national recommendation in initiating Bca screening at age 40 for women.
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Affiliation(s)
- Najla A. Lakkis
- Department of Family Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Reem M. Abdallah
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Umayya M. Musharrafieh
- Department of Family Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Hanane G. Issa
- Institute of Health Informatics, University College London, London, UK
| | - Mona H. Osman
- Department of Family Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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26
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Zhao Z, Yang Y, Wu W, Dong H. Willingness to pay for cancer prevention versus treatment in China: implications for cost-effectiveness threshold. Expert Rev Pharmacoecon Outcomes Res 2024; 24:155-160. [PMID: 37754783 DOI: 10.1080/14737167.2023.2262141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Empirical support for the appropriate cost-effectiveness threshold (CET) in China remains sparse. OBJECTIVE This study aimed to estimate the willingness to pay (WTP) for cancer prevention and treatment from the perspective of healthcare policy-makers (i.e. supply side) and to investigate whether there is a difference between the estimated WTP in two scenarios. METHODS We conducted a web-based survey from May to July 2022 among experts who offering consultation to the government. We surveyed 79 experts from a national think-tank (84.81% response rate) using contingent valuation method, a method for estimating the monetary value that individuals place on a non-market service. RESULTS The mean WTP for two scenarios were estimated at 1.29 times of per capita Gross Domestic Product (GDP) of China and 1.90 times of per capita GDP, respectively. There was a difference between the WTP in the two scenarios and the WTP for treatment was significantly higher than prevention. CONCLUSION The findings suggest that though there is a smaller gap between the two scenarios in China as compared to other countries, the WTP may vary under different scenarios. So there's a need to further refine the development of CET by adding parameters like prevention instead of defining one universal threshold.
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Affiliation(s)
- Zixuan Zhao
- Department of Public Administration, School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yi Yang
- Department of Science and Education of the Fourth Affiliated Hospital, and Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Weijia Wu
- Department of Science and Education of the Fourth Affiliated Hospital, and Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Hengjin Dong
- Department of Science and Education of the Fourth Affiliated Hospital, and Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
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Abstract
Breast cancer is the most common cancer among U.S. women and its incidence increases with age. Endogenous estrogen exposure, proliferative benign breast disease, breast density, and family history may also indicate increased risk for breast cancer. Early detection with screening mammography reduces breast cancer mortality, but the net benefits vary by age. Assessing a patient's individual breast cancer risk can guide decisions regarding breast cancer screening. All women benefit from healthy behaviors which may reduce breast cancer risk. Some women at increased risk for breast cancer may benefit from risk-reducing medications. Use of screening measures remains suboptimal, especially for uninsured women.
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Affiliation(s)
- Amy H Farkas
- Medical College of Wisconsin, Milwaukee, Wisconsin (A.H.F., A.B.N.)
| | - Ann B Nattinger
- Medical College of Wisconsin, Milwaukee, Wisconsin (A.H.F., A.B.N.)
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Jhangiani N, Philip M, Jatoi I. Breast cancer screening guidelines: discrepancies raise concerns about validity. Breast Cancer 2023; 30:869-871. [PMID: 37578598 DOI: 10.1007/s12282-023-01493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Nikita Jhangiani
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Megha Philip
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Science Center, San Antonio, TX, 78229, USA.
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Kim H, Choi JS, Kim K, Ko ES, Ko EY, Han BK. Effect of artificial intelligence-based computer-aided diagnosis on the screening outcomes of digital mammography: a matched cohort study. Eur Radiol 2023; 33:7186-7198. [PMID: 37188881 DOI: 10.1007/s00330-023-09692-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate whether artificial intelligence-based computer-aided diagnosis (AI-CAD) can improve radiologists' performance when used to support radiologists' interpretation of digital mammography (DM) in breast cancer screening. METHODS A retrospective database search identified 3158 asymptomatic Korean women who consecutively underwent screening DM between January and December 2019 without AI-CAD support, and screening DM between February and July 2020 with image interpretation aided by AI-CAD in a tertiary referral hospital using single reading. Propensity score matching was used to match the DM with AI-CAD group in a 1:1 ratio with the DM without AI-CAD group according to age, breast density, experience level of the interpreting radiologist, and screening round. Performance measures were compared with the McNemar test and generalized estimating equations. RESULTS A total of 1579 women who underwent DM with AI-CAD were matched with 1579 women who underwent DM without AI-CAD. Radiologists showed higher specificity (96% [1500 of 1563] vs 91.6% [1430 of 1561]; p < 0.001) and lower abnormal interpretation rates (AIR) (4.9% [77 of 1579] vs 9.2% [145 of 1579]; p < 0.001) with AI-CAD than without. There was no significant difference in the cancer detection rate (CDR) (AI-CAD vs no AI-CAD, 8.9 vs 8.9 per 1000 examinations; p = 0.999), sensitivity (87.5% vs 77.8%; p = 0.999), and positive predictive value for biopsy (PPV3) (35.0% vs 35.0%; p = 0.999) according to AI-CAD support. CONCLUSIONS AI-CAD increases the specificity for radiologists without decreasing sensitivity as a supportive tool in the single reading of DM for breast cancer screening. CLINICAL RELEVANCE STATEMENT This study shows that AI-CAD could improve the specificity of radiologists' DM interpretation in the single reading system without decreasing sensitivity, suggesting that it can benefit patients by reducing false positive and recall rates. KEY POINTS • In this retrospective-matched cohort study (DM without AI-CAD vs DM with AI-CAD), radiologists showed higher specificity and lower AIR when AI-CAD was used to support decision-making in DM screening. • CDR, sensitivity, and PPV for biopsy did not differ with and without AI-CAD support.
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Affiliation(s)
- Haejung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.
| | - Kyunga Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
- Department of Data Convergence & Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
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You C, Shen Y, Sun S, Zhou J, Li J, Su G, Michalopoulou E, Peng W, Gu Y, Guo W, Cao H. Artificial intelligence in breast imaging: Current situation and clinical challenges. EXPLORATION (BEIJING, CHINA) 2023; 3:20230007. [PMID: 37933287 PMCID: PMC10582610 DOI: 10.1002/exp.20230007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/30/2023] [Indexed: 11/08/2023]
Abstract
Breast cancer ranks among the most prevalent malignant tumours and is the primary contributor to cancer-related deaths in women. Breast imaging is essential for screening, diagnosis, and therapeutic surveillance. With the increasing demand for precision medicine, the heterogeneous nature of breast cancer makes it necessary to deeply mine and rationally utilize the tremendous amount of breast imaging information. With the rapid advancement of computer science, artificial intelligence (AI) has been noted to have great advantages in processing and mining of image information. Therefore, a growing number of scholars have started to focus on and research the utility of AI in breast imaging. Here, an overview of breast imaging databases and recent advances in AI research are provided, the challenges and problems in this field are discussed, and then constructive advice is further provided for ongoing scientific developments from the perspective of the National Natural Science Foundation of China.
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Affiliation(s)
- Chao You
- Department of RadiologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yiyuan Shen
- Department of RadiologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Shiyun Sun
- Department of RadiologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Jiayin Zhou
- Department of RadiologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Jiawei Li
- Department of RadiologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Guanhua Su
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghaiChina
- Department of Breast SurgeryKey Laboratory of Breast Cancer in ShanghaiFudan University Shanghai Cancer CenterShanghaiChina
| | | | - Weijun Peng
- Department of RadiologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yajia Gu
- Department of RadiologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Weisheng Guo
- Department of Minimally Invasive Interventional RadiologyKey Laboratory of Molecular Target and Clinical PharmacologySchool of Pharmaceutical Sciences and The Second Affiliated HospitalGuangzhou Medical UniversityGuangzhouChina
| | - Heqi Cao
- Department of Health SciencesNational Natural Science Foundation of ChinaBeijingChina
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Hölzel D, Halfter K, Schubert-Fritschle G, Engel J. Expanding mammography screening for women aged 40-80 years: evidence from a modeling approach using real-world data. Sci Rep 2023; 13:16229. [PMID: 37758770 PMCID: PMC10533880 DOI: 10.1038/s41598-023-42820-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
If a mammography screening program (MS) is to be expanded, the benefit must be demonstrated for each additional age cohort. For the age interval between 40 and 80 years, the association between tumor-related and tumor-independent mortality of 21 2-year cohorts is modeled using up-to-date, valid data to determine MS outcome. Disease trajectories with and without biennial MS are extrapolated for each age cohort using the available data and knowledge on MS. The competing mortality is randomly generated for each age cohort with and without MS for a follow-up period of 20 years. Analyses of the modeled cohorts describe incremental change for each year, quantifying the changing benefits of MS. With increasing age, the proportion of tumor-independent mortality before and with metastatic disease increases and the benefit decreases. The simulations with 21 studies on the age interval 40-80 years provide four parameters to determine the benefits and costs of MS: The number of prevented deaths, required mammography screening exams (MSE) and their costs, life-years gained, and the required MSEs. If one additional MSE is offered for age groups 48/70 years, this will result in 311/320 prevented breast cancer (BC) deaths with 1742/1494 required MSEs or 8784/4168 life-years gained with 64/140 required MSEs. A rational cutoff cannot be quantified. The mortality effect of MS between 40 and 80 years is quantified in 21 steps using two metrics, number of MSEs per tumor-related mortality prevented and per life-year gained. This provides a decision support for stepwise expansions. Given this real-world evidence no rational age cutoffs for MS becomes evident. A society has to decide which MS costs, including side effects of MS for women who remain BC-free, it is willing and able to accept in order to reduce breast cancer mortality.
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Affiliation(s)
- Dieter Hölzel
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians University Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Kathrin Halfter
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians University Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Gabriele Schubert-Fritschle
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians University Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Jutta Engel
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians University Munich, Marchioninistraße 15, 81377, Munich, Germany
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Shi HY, Li CH, Chen YC, Chiu CC, Lee HH, Hou MF. Quality of life and cost-effectiveness of different breast cancer surgery procedures: a Markov decision tree-based approach in the framework of Predictive, Preventive, and Personalized Medicine. EPMA J 2023; 14:457-475. [PMID: 37605647 PMCID: PMC10439868 DOI: 10.1007/s13167-023-00326-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/14/2023] [Indexed: 08/23/2023]
Abstract
Purpose Breast cancer is a complex disease with heterogeneous outcomes that may benefit from the implementation of Predictive, Preventive, and Personalized Medicine (PPPM/3PM) strategies. In this study, we aimed to explore the potential of PPPM approaches by investigating the 10-year trends in quality of life (QOL) and the cost-effectiveness of different types of surgeries for patients with breast cancer. Methods This prospective cohort study recruited 144 patients undergoing breast conserving surgery (BCS), 199 undergoing modified radical mastectomy (MRM), and 44 undergoing total mastectomy with transverse rectus abdominis myocutaneous flap (TRAMF) from three medical centers in Taiwan between June 2007 and June 2010. Results All patients exhibited a significant decrease in most QOL dimension scores from before surgery to 6 months postoperatively (p < 0.05); however, from postoperative year 1 to 2, improvement in most QOL dimension scores was significantly better in the TRAMF group than in the BCS and MRM groups (p < 0.05). At 2, 5, and 10 years after surgery, the patients' QOL remained stable. In the Markov decision tree model, the TRAMF group had higher total direct medical costs than the MRM and BCS groups (US$ 32,426, US$ 29,487, and US$ 28,561, respectively) and higher average QALYs gained (7.771, 6.773, and 7.385, respectively), with an incremental cost-utility ratio (ICUR) of US$ 2,944.39 and US$ 10,013.86 per QALY gained. Conclusions TRAMF appeared cost effective compared with BCS and MRM, and it has been proved with considerable QOL improvements in the framework of PPPM. Future studies should continue to explore the potential of PPPM approaches in breast cancer care. By incorporating predictive models, personalized treatment plans, and preventive strategies into routine clinical practice, we can further optimize patient outcomes and reduce healthcare costs associated with breast cancer treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00326-4.
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Affiliation(s)
- Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, 80420 Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 80708 Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402 Taiwan
| | - Chiu-Hui Li
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
- Superintendent Office Secretary Admission Service Center, Health Management and Occupational Safety and Health Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 81267 Taiwan
| | - Yen-Chen Chen
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445 Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445 Taiwan
- Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445 Taiwan
| | - Hao-Hsien Lee
- Department of Surgery, Chi Mei Medical Center, Liouying, Tainan 73658 Taiwan
| | - Ming-Feng Hou
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, No. 100, Shih-Chuan 1St Road, Kaohsiung, 80708 Taiwan
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
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Zhou W, Zhang X, Ding J, Deng L, Cheng G, Wang X. Improved breast lesion detection in mammogram images using a deep neural network. Diagn Interv Radiol 2023; 29:588-595. [PMID: 36994940 PMCID: PMC10679640 DOI: 10.4274/dir.2022.22826] [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: 09/02/2021] [Accepted: 08/27/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE This study aimed to investigate the effect of using a deep neural network (DNN) in breast cancer (BC) detection. METHODS In this retrospective study, a DNN-based model was constructed from a total of 880 mammograms that 220 patients underwent between April and June 2020. The mammograms were reviewed by two senior and two junior radiologists with and without the aid of the DNN model. The performance of the network was assessed by comparing the area under the curve (AUC) and receiver operating characteristic curves for the detection of four features of malignancy (masses, calcifications, asymmetries, and architectural distortions), with and without the aid of the DNN model and by the senior and junior radiologists. Additionally, the effect of utilizing the DNN on diagnosis time for both the senior and junior radiologists was evaluated. RESULTS The AUCs of the model for the detection of mass and calcification were 0.877 and 0.937, respectively. In the senior radiologist group, the AUC values for evaluation of mass, calcification, and asymmetric compaction were significantly higher with the DNN model than those obtained without the model. Similar effects were observed in the junior radiologist group, but the increase in the AUC values was even more dramatic. The median mammogram assessment time of the junior and senior radiologists was 572 (357-951) s, and 273.5 (129-469) s, respectively, with the DNN model, and the corresponding assessment time without the model, was 739 (445-1003) s and 321 (195-491) s, respectively. CONCLUSION The DNN model exhibited high accuracy in detecting the four named features of BC and effectively shortened the review time by both senior and junior radiologists.
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Affiliation(s)
- Wen Zhou
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Jia Ding
- Beijing Yizhun Medical AI Co., Ltd, Beijing, China
| | - Lingbo Deng
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Guanxun Cheng
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
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Pansa E, Guzzardi G, Santocono S, Carriero A. Vascular Complications following Vacuum-Assisted Breast Biopsy (VABB): A Case Report and Review of the Literature. Tomography 2023; 9:1246-1253. [PMID: 37489467 PMCID: PMC10366872 DOI: 10.3390/tomography9040099] [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: 03/29/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Vacuum-assisted breast biopsy (VABB) has been evaluated as a minimally invasive, safe, and accurate procedure with low complication risks; the most frequent one is the mild/moderate hematoma, which occurs with a low-frequency rate, and the majority of patients who experienced it can be treated successfully with only manual compression and dressing. Although cases of uncontrollable catastrophic bleeding are exceedingly rare, local breast vessel involvement is a concrete risk, even in patients with no bleeding propensity. CASE PRESENTATION In this article, we aimed to describe a 60 years-old woman who, following VABB, experienced a massive hematoma without external bleeding and was successfully treated with embolization. The woman was called back for a cluster of suspicious microcalcifications identified in the left breast's upper-outer quadrant; however, following histopathological analysis, the few samples collected were negative. She had a silent past medical history, 100% performance status, and no active pharmacotherapy. Approximately 15-30 min after VABB, the patient complained of weakness, pain, and lipothymia. A physical examination revealed a massive hematoma without external bleeding. Clinical data reported PaO 65/40 mmHg and blood chemistry Hb < 10 g/dL. The emergency team was alerted to stabilize the patient, and after that, the breast hemorrhage was controlled by endovascular embolization. Despite this being a rare occurrence, it is important to draw up and follow an appropriate protocol to ensure proper patient management and early treatment. DISCUSSION This case illustrates the prompt and accurate management of a rare complication following VABB. Due to the very high number of patients undergoing this particular procedure, we aim to point out the concrete risk of vascular injury; other similar cases are described to support our thesis and provide different clinical manifestations of this rare occurrence.
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Affiliation(s)
- Ernesto Pansa
- Specializzando in Radiodiagnostica UPO, 28100 Novara, Italy
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Kılıç ME, Özcan S, Kılıç G, Bolat Küçükzeybek B, Atmalar Y, Koç BT. Diagnosis Rates Through Cancer Screening Programs in Patients with Breast Carcinoma. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2023; 31:91-96. [PMID: 37404211 PMCID: PMC10440967 DOI: 10.5152/fnjn.2023.22271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/07/2023] [Indexed: 07/06/2023]
Abstract
AIM This study investigated whether breast cancer patients had ever applied for Cancer Early Diagnosis Screening and Training Centers (KETEM). METHOD This study, conducted from November 2020 to April 2021, adopts a cross-sectional research design and is planned as a survey study. The "Diagnosis Rates with Screening Programs in Breast Cancer Patients" survey was conducted on women over 45 who were diagnosed with breast cancer in the Medical Oncology Clinic of İzmir Katip Çelebi University Atatürk Education and Research Hospital. Further information about the cancer stage was gathered from the Medical Oncology outpatient clinic file records. Data obtained in the study were evaluated using the the Statistical Package for Social Sciences version 26.0 software (IBM Corp.; Armonk, NY, USA), using the number, percentage distribution, arithmetic mean, and chi-square test methods. RESULTS It has been determined that most patients diagnosed did not receive a diagnosis through screening programs, were not aware of KETEM, and did not apply to KETEM. A positive relationship was found between the level of education and participation in screening programs. It was observed that women who knew about the KETEM's participated more often in the scans. CONCLUSION The study discovered a lack of knowledge and inadequacy in screening programs for patients with breast cancer. We believe that it is essential to introduce and disseminate KETEMs so that cancers can be detected early through screening.
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Affiliation(s)
| | - Sena Özcan
- İzmir Katip Çelebi University, Faculty of Medicine, İzmir, Turkey
| | - Göksu Kılıç
- İzmir Katip Çelebi University, Faculty of Medicine, İzmir, Turkey
| | | | - Yusuf Atmalar
- İzmir Katip Çelebi University, Faculty of Medicine, İzmir, Turkey
| | - Badesu Talia Koç
- İzmir Katip Çelebi University, Faculty of Medicine, İzmir, Turkey
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Chinniah S, Chiam M, Mani K, Liang M, Trifiletti DM, Spratt DE, Prasad VK, Wang M, Tchelebi LT, Zaorsky NG. Unknown Causes of Death in Cancer Patients. Am J Clin Oncol 2023; 46:246-253. [PMID: 37038261 DOI: 10.1097/coc.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Deaths from an unknown cause are difficult to adjudicate and oncologic studies of comparative effectiveness often demonstrate inconsistencies in incorporating these deaths and competing events (eg, heart disease and stroke) in their analyses. In this study, we identify cancer patients most at risk for death of an unknown cause. METHODS This retrospective, population-based study used cancer registry data from the Surveillance, Epidemiology, and End Results database (1992-2015). The absolute rate of unknown causes of death (COD) cases stratified by sex, marital status, race, treatment, and cancer site were calculated and a multivariable logistic regression model was applied to obtain adjusted odds ratios with 95% CIs. RESULTS Out of 7,154,779 cancer patients across 22 cancer subtypes extracted from Surveillance, Epidemiology, and End Results, 3,448,927 died during follow-up and 276,068 (7.4%) of these deaths were from unknown causes. Patients with an unknown COD had a shorter mean survival time compared with patients with known COD (36.3 vs 65.7 mo, P < 0.001). The contribution of unknown COD to total mortality was highest in patients with more indolent cancers (eg, prostate [12.7%], thyroid [12.3%], breast [10.7%]) and longer follow-up (eg, >5 to 10 y). One, 3, and 5-year cancer-specific survival (CSS) calculations including unknown COD were significantly decreased compared with CSS estimates excluding cancer patients with unknown COD. CONCLUSION Of the patients, 7.4% died of unknown causes during follow-up and the proportion of death was higher with longer follow-up and among more indolent cancers. The attribution of high percentages of unknown COD to cancer or non-cancer causes could impact population-based cancer registry studies or clinical trial outcomes with respect to measures involving CSS and mortality.
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Affiliation(s)
- Siven Chinniah
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - Mckenzee Chiam
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA
| | - Kyle Mani
- Albert Einstein College of Medicine, The Bronx, NY
| | - Menglu Liang
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University
| | | | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Vinayak K Prasad
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University
| | - Leila T Tchelebi
- Department of Radiation Medicine, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Lake Success, New York
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH
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Santos ROMD, Assis MD, Dias MBK, Tomazelli JG. [Risk of false-positive result in mammography screening in Brazil]. CAD SAUDE PUBLICA 2023; 39:e00117922. [PMID: 37255192 PMCID: PMC10641911 DOI: 10.1590/0102-311xpt117922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 06/01/2023] Open
Abstract
False-positive results on mammography screening are common, putting a burden on both women and the health care system. This study aimed to estimate the risk of false-positive results in Brazilian mammography screening based on data from the Brazilian Unified National Health System (SUS) information systems. A retrospective cohort study was conducted with women aged 40-69 years, who underwent mammography screening and breast histopathological examination at SUS from 2017 to 2019. The rate of false-positive results was estimated based on the prevalence of altered BI-RADS results on mammography screening and the proportion of benign results on breast histopathological examination. Of the 10,671 women with histopathological examination at SUS, 46.2% had a benign result, and this proportion was significantly higher in women aged 40-49 years compared to women aged 50-69 years. The estimate of false-positive results was 8.18 cases per 100 women aged 40-49 years and 6.06 per 100 women aged 50-69 years. This information is useful for public managers in evaluating mammography screening programs, as well as for health care providers to guide women on the implications of mammography screening.
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Affiliation(s)
| | - Mônica de Assis
- Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer, Rio de Janeiro, Brasil
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Menon U, Gentry-Maharaj A, Burnell M, Ryan A, Kalsi JK, Singh N, Dawnay A, Fallowfield L, McGuire AJ, Campbell S, Skates SJ, Parmar M, Jacobs IJ. Mortality impact, risks, and benefits of general population screening for ovarian cancer: the UKCTOCS randomised controlled trial. Health Technol Assess 2023:1-81. [PMID: 37183782 PMCID: PMC10542866 DOI: 10.3310/bhbr5832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Background Ovarian and tubal cancers are lethal gynaecological cancers, with over 50% of the patients diagnosed at advanced stage. Trial design Randomised controlled trial involving 27 primary care trusts adjacent to 13 trial centres based at NHS Trusts in England, Wales and Northern Ireland. Methods Postmenopausal average-risk women, aged 50-74, with intact ovaries and no previous ovarian or current non-ovarian cancer. Interventions One of two annual screening strategies: (1) multimodal screening (MMS) using a longitudinal CA125 algorithm with repeat CA125 testing and transvaginal scan (TVS) as second line test (2) ultrasound screening (USS) using TVS alone with repeat scan to confirm any abnormality. The control (C) group had no screening. Follow-up was through linkage to national registries, postal follow-up questionnaires and direct communication with trial centres and participants. Objective To assess comprehensively risks and benefits of ovarian cancer screening in the general population. Outcome Primary outcome was death due to ovarian or tubal cancer as assigned by an independent outcomes review committee. Secondary outcomes included incidence and stage at diagnosis of ovarian and tubal cancer, compliance, performance characteristics, harms and cost-effectiveness of the two screening strategies and a bioresource for future research. Randomisation The trial management system confirmed eligibility and randomly allocated participants using computer-generated random numbers to MMS, USS and C groups in a 1:1:2 ratio. Blinding Investigators and participants were unblinded and outcomes review committee was masked to randomisation group. Analyses Primary analyses were by intention to screen, comparing separately MMS and USS with C using the Versatile test. Results 1,243,282 women were invited and 205,090 attended for recruitment between April 2001 and September 2005. Randomised 202,638 women: 50,640 MMS, 50,639 USS and 101,359 C group. Numbers analysed for primary outcome 202,562 (>99.9%): 50,625 (>99.9%) MMS, 50,623 (>99.9%) USS, and 101,314 (>99.9%) C group. Outcome Women in MMS and USS groups underwent 345,570 and 327,775 annual screens between randomisation and 31 December 2011. At median follow-up of 16.3 (IQR 15.1-17.3) years, 2055 women developed ovarian or tubal cancer: 522 (1.0% of 50,625) MMS, 517 (1.0% of 50,623) USS, and 1016 (1.0% of 101314) in C group. Compared to the C group, in the MMS group, the incidence of Stage I/II disease was 39.2% (95% CI 16.1 to 66.9) higher and stage III/IV 10.2% (95% CI -21.3 to 2.4) lower. There was no difference in stage in the USS group. 1206 women died of the disease: 296 (0.6%) MMS, 291 (0.6%) USS, and 619 (0.6%) C group. There was no significant reduction in ovarian and tubal cancer deaths in either MMS (p = 0.580) or USS (p = 0.360) groups compared to the C group. Overall compliance with annual screening episode was 80.8% (345,570/420,047) in the MMS and 78.0% (327,775/420,047) in the USS group. For ovarian and tubal cancers diagnosed within one year of the last test in a screening episode, in the MMS group, the sensitivity, specificity and positive predictive values were 83.8% (95% CI 78.7 to 88.1), 99.8% (95% CI 99.8 to 99.9), and 28.8% (95% CI 25.5 to 32.2) and in the USS group, 72.2% (95% CI 65.9 to 78.0), 99.5% (95% CI 99.5 to 99.5), and 9.1% (95% CI 7.8 to 10.5) respectively. The final within-trial cost-effectiveness analysis was not undertaken as there was no mortality reduction. A bioresource (UKCTOCS Longitudinal Women's Cohort) of longitudinal outcome data and over 0.5 million serum samples including serial annual samples in women in the MMS group was established and to date has been used in many new studies, mainly focused on early detection of cancer. Harms Both screening tests (venepuncture and TVS) were associated with minor complications with low (8.6/100,000 screens MMS; 18.6/100,000 screens USS) complication rates. Screening itself did not cause anxiety unless more intense repeat testing was required following abnormal screens. In the MMS group, for each screen-detected ovarian or tubal cancer, an additional 2.3 (489 false positives; 212 cancers) women in the MMS group had unnecessary false-positive (benign adnexal pathology or normal adnexa) surgery. Overall, 14 (489/345,572 annual screens) underwent unnecessary surgery per 10,000 screens. In the USS group, for each screen-detected ovarian or tubal cancer, an additional 10 (1630 false positives; 164 cancers) underwent unnecessary false-positive surgery. Overall, 50 (1630/327,775 annual screens) women underwent unnecessary surgery per 10,000 screens. Conclusions Population screening for ovarian and tubal cancer for average-risk women using these strategies should not be undertaken. Decreased incidence of Stage III/IV cancers during multimodal screening did not translate to mortality reduction. Researchers should be cautious about using early stage as a surrogate outcome in screening trials. Meanwhile the bioresource provides a unique opportunity to evaluate early cancer detection tests. Funding Long-term follow-up UKCTOCS (2015-2020) - National Institute for Health and Care Research (NIHR HTA grant 16/46/01), Cancer Research UK, and The Eve Appeal. UKCTOCS (2001-2014) - Medical Research Council (MRC) (G9901012/G0801228), Cancer Research UK (C1479/A2884), and the UK Department of Health, with additional support from The Eve Appeal. Researchers at UCL were supported by the NIHR UCL Hospitals Biomedical Research Centre and by MRC Clinical Trials Unit at UCL core funding (MR_UU_12023).
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Affiliation(s)
- Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Service Trust, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | - Steven J Skates
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mahesh Parmar
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian J Jacobs
- Department of Women's Health, University of New South Wales, Sydney, NSW, Australia
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Voss T, Krag M, Martiny F, Heleno B, Jørgensen KJ, Brandt Brodersen J. Quantification of overdiagnosis in randomised trials of cancer screening: an overview and re-analysis of systematic reviews. Cancer Epidemiol 2023; 84:102352. [PMID: 36963292 DOI: 10.1016/j.canep.2023.102352] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/26/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Abstract
The degree of overdiagnosis in common cancer screening trials is uncertain due to inadequate design of trials, varying definition and methods used to estimate overdiagnosis. Therefore, we aimed to quantify the risk of overdiagnosis for the most widely implemented cancer screening programmes and assess the implications of design limitations and biases in cancer screening trials on the estimates of overdiagnosis by conducting an overview and re-analysis of systematic reviews of cancer screening. We searched PubMed and the Cochrane Library from their inception dates to November 29, 2021. Eligible studies included systematic reviews of randomised trials comparing cancer screening interventions to no screening, which reported cancer incidence for both trial arms. We extracted data on study characteristics, cancer incidence and assessed the risk of bias using the Cochrane Collaboration's risk of bias tool. We included 19 trials described in 30 articles for review, reporting results for the following types of screening: mammography for breast cancer, chest X-ray or low-dose CT for lung cancer, alpha-foetoprotein and ultrasound for liver cancer, digital rectal examination, prostate-specific antigen, and transrectal ultrasound for prostate cancer, and CA-125 test and/or ultrasound for ovarian cancer. No trials on screening for melanoma were eligible. Only one trial (5%) had low risk in all bias domains, leading to a post-hoc meta-analysis, excluding trials with high risk of bias in critical domains, finding the extent of overdiagnosis ranged from 17% to 38% across cancer screening programmes. We conclude that there is a significant risk of overdiagnosis in the included randomised trials on cancer screening. We found that trials were generally not designed to estimate overdiagnosis and many trials had high risk of biases that may draw the estimates of overdiagnosis towards the null. In effect, the true extent of overdiagnosis due to cancer screening is likely underestimated.
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Affiliation(s)
- Theis Voss
- The Centre of General Practice in Copenhagen, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Post box 2099, DK-1014 Copenhagen K, Denmark.
| | - Mikela Krag
- The Centre of General Practice in Copenhagen, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Post box 2099, DK-1014 Copenhagen K, Denmark
| | - Frederik Martiny
- The Centre of General Practice in Copenhagen, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Post box 2099, DK-1014 Copenhagen K, Denmark; Center for Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Bruno Heleno
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM , Universidade Nova de Lisboa, Lisbon, Portugal
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, JB Winsløwsvej 9b, 3rd Floor, 5000 Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - John Brandt Brodersen
- The Centre of General Practice in Copenhagen, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Post box 2099, DK-1014 Copenhagen K, Denmark; The Research Unit for General Practice in Region Zealand, Øster Farimagsgade 5, Post box 2099, DK-1014 Copenhagen K, Denmark; Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø
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Dassen RRE, Pelders S, de Munck L, Jager A, Hooning MJ, van Dam JH, Heemskerk-Gerritsen BAM. The effect of attendance in the Dutch breast cancer screening program on breast tumor characteristics among migrant women. Breast 2023; 69:290-298. [PMID: 36940631 PMCID: PMC10034141 DOI: 10.1016/j.breast.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/10/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND In general, migrant women have a lower breast cancer (BC) incidence rate and higher BC mortality than autochthonous women. Further, migrant women show lower participation in the national BC screening program. To further investigate those aspects, we aimed to determine differences in incidence and tumor characteristics between autochthonous and migrant BC patients in Rotterdam, the Netherlands. METHODS We selected women diagnosed with BC in Rotterdam during 2012-2015 from the Netherlands Cancer Registry. Incidence rates were calculated by migrant status (i.e., women with or without migration background). Multivariable analyses revealed adjusted odds ratios (OR) and 95% confidence intervals (CI) on the association between migration status and patient and tumor characteristics, additionally stratified by screening attendance (yes/no). RESULTS In total 1372 autochthonous and 450 migrant BC patients were included for analysis. BC incidence was lower among migrants than among autochthonous women. Overall, migrant women were younger at BC diagnosis (53 vs. 64 years, p < 0.001), and had higher risks of positive lymph nodes (OR 1.76, 95% CI 1.33-2.33) and high grade tumors (OR 1.35, 95% CI 1.04-1.75). Especially non-screened migrant women had higher risk of positive nodes (OR 2.73, 95% CI 1.43-5.21). Among the subgroup of screened women, we observed no significant differences between migrant and autochthonous patients. CONCLUSION Migrant women have lower BC incidence than autochthonous women, but diagnosis was more often at younger age and with unfavorable tumor characteristics. Attending the screening program strongly reduces the latter. Therefore, promotion of participation in the screening program is recommended.
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Affiliation(s)
- R R E Dassen
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - S Pelders
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - L de Munck
- Netherlands Comprehensive Cancer Organization, Research and Development, Utrecht, Netherlands
| | - A Jager
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - M J Hooning
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - J H van Dam
- Erasmus MC Cancer Institute, Oncological Surgery, Rotterdam, Netherlands
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Pereslucha AM, Wenger DM, Morris MF, Aydi ZB. Invasive Lobular Carcinoma: A Review of Imaging Modalities with Special Focus on Pathology Concordance. Healthcare (Basel) 2023; 11:healthcare11050746. [PMID: 36900751 PMCID: PMC10000992 DOI: 10.3390/healthcare11050746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most common type of breast cancer. It is characterized by a unique growth pattern making it difficult to detect on conventional breast imaging. ILC can be multicentric, multifocal, and bilateral, with a high likelihood of incomplete excision after breast-conserving surgery. We reviewed the conventional as well as newly emerging imaging modalities for detecting and determining the extent of ILC- and compared the main advantages of MRI vs. contrast-enhanced mammogram (CEM). Our review of the literature finds that MRI and CEM clearly surpass conventional breast imaging in terms of sensitivity, specificity, ipsilateral and contralateral cancer detection, concordance, and estimation of tumor size for ILC. Both MRI and CEM have each been shown to enhance surgical outcomes in patients with newly diagnosed ILC that had one of these imaging modalities added to their preoperative workup.
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Affiliation(s)
- Alicia M Pereslucha
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
| | - Danielle M Wenger
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA
| | - Michael F Morris
- Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Department of Radiology, Banner University Medical Center-Phoenix, Phoenix, AZ 85006, USA
| | - Zeynep Bostanci Aydi
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
- Department of Surgical Oncology, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Correspondence:
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Hadžikadić-Gušić L, Cerić T, Marijanović I, Iljazović E, Koprić D, Zorlak A, Tanović M, Mekić-Abazović A, Šišić I, Delić U, Mustedanagić-Mujanović J, Aginčić A, Bećiragić E, L Greene F. Guidelines for breast cancer management in Bosnia and Herzegovina. BIOMOLECULES AND BIOMEDICINE 2023; 23:2-14. [PMID: 35880400 PMCID: PMC9901905 DOI: 10.17305/bjbms.2022.7504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/12/2022] [Indexed: 02/08/2023]
Abstract
Breast cancer is the most common cancer among women. In Bosnia and Herzegovina, accurate data on the status of breast cancer are lacking due to the absence of a central registry. Multiple international guidelines imply that institutions that monitor breast cancer patients should have optimal therapeutic options for treatment. In addition, there have been several international consensus guidelines written on the management of breast cancer. Application of consensus guidelines has previously been demonstrated to have a positive influence on breast cancer care. The importance of specialty breast centers has previously been reported. As part of the 2021 Bosnian-Herzegovinian American Academy of Arts and Sciences (BHAAAS) conference in Mostar, a round table of multidisciplinary specialists from Bosnia and Herzegovina and the diaspora was held. All were either members of BHAAAS or regularly participate in collaborative projects. The focus of the consortium was to write the first multidisciplinary guidelines for the general management of breast cancer in Bosnia and Herzegovina. Guidelines were developed for each area of breast cancer treatment and management. These guidelines will serve as a resource for practitioners managing breast cancer in the Bosnia and Herzegovina region. This might also be of benefit to the ministry of health and any future investors interested in developing breast cancer care policies in this region of the world.
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Affiliation(s)
- Lejla Hadžikadić-Gušić
- Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA,Correspondence to Lejla Hadžikadić-Gušić:
| | - Timur Cerić
- Department of Medical Oncology, University Clinical Center, Sarajevo, Bosnia and Herzegovina
| | - Inga Marijanović
- Clinic of Oncology, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Ermina Iljazović
- Department of Pathology, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Dijana Koprić
- Department of Medical Oncology and Radiation Oncology, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Anela Zorlak
- Genetics Counseling, Genetika, Sarajevo, Bosnia and Herzegovina
| | - Mahira Tanović
- Plastic and Reconstructive Surgery, Advanced Plastic Surgery of North Shore, NY, USA
| | - Alma Mekić-Abazović
- Department of Medical Oncology, Kanton Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Ibrahim Šišić
- Department of Medical Oncology, Kanton Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Una Delić
- Department of Radiology, University Clinical Center, Sarajevo, Bosnia and Herzegovina
| | | | - Alija Aginčić
- Plastic and Reconstructive Surgery, Center for Aesthetic Surgery, Nasa Mala Klinika (Our Little Clinic), Sarajevo, Bosnia and Heregovina
| | - Edin Bećiragić
- Department of Surgery, Dr. Abdulah Nakas General Hospital, Sarajevo, Bosnia and Herzegovina
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Trapani D, Sandoval J, Aliaga PT, Ascione L, Maria Berton Giachetti PP, Curigliano G, Ginsburg O. Screening Programs for Breast Cancer: Toward Individualized, Risk-Adapted Strategies of Early Detection. Cancer Treat Res 2023; 188:63-88. [PMID: 38175342 DOI: 10.1007/978-3-031-33602-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Early detection of breast cancer (BC) comprises two approaches: screening of asymptomatic women in a specified target population at risk (usually a target age range for women at average risk), and early diagnosis for women with BC signs and symptoms. Screening for BC is a key health intervention for early detection. While population-based screening programs have been implemented for age-selected women, the pivotal clinical trials have not addressed the global utility nor the improvement of screening performance by utilizing more refined parameters for patient eligibility, such as individualized risk stratification. In addition, with the exception of the subset of women known to carry germline pathogenetic mutations in (high- or moderately-penetrant) cancer predisposition genes, such as BRCA1 and BRCA2, there has been less success in outreach and service provision for the unaffected relatives of women found to carry a high-risk mutation (i.e., "cascade testing") as it is in these individuals for whom such actionable information can result in cancers (and/or cancer deaths) being averted. Moreover, even in the absence of clinical cancer genetics services, as is the case for the immediate and at least near-term in most countries globally, the capacity to stratify the risk of an individual to develop BC has existed for many years, is available for free online at various sites/platforms, and is increasingly being validated for non-Caucasian populations. Ultimately, a precision approach to BC screening is largely missing. In the present chapter, we aim to address the concept of risk-adapted screening of BC, in multiple facets, and understand if there is a value in the implementation of adapted screening strategies in selected women, outside the established screening prescriptions, in the terms of age-range, screening modality and schedules of imaging.
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Affiliation(s)
- Dario Trapani
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy.
| | - Josè Sandoval
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pamela Trillo Aliaga
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Liliana Ascione
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Pier Paolo Maria Berton Giachetti
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Giuseppe Curigliano
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
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Lee ES, Kim Y, Shin HC, Hwang KT, Min J, Kim MK, Ahn S, Jung SY, Shin H, Chung M, Yoo TK, Jung S, Woo SU, Kim JY, Noh DY, Moon HG. Diagnostic accuracy of a three-protein signature in women with suspicious breast lesions: a multicenter prospective trial. Breast Cancer Res 2023; 25:20. [PMID: 36788595 PMCID: PMC9930228 DOI: 10.1186/s13058-023-01616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Mammography screening has been proven to detect breast cancer at an early stage and reduce mortality; however, it has low accuracy in young women or women with dense breasts. Blood-based diagnostic tools may overcome the limitations of mammography. This study assessed the diagnostic performance of a three-protein signature in patients with suspicious breast lesions. FINDINGS This trial (MAST; KCT0004847) was a prospective multicenter observational trial. Three-protein signature values were obtained using serum and plasma from women with suspicious lesions for breast malignancy before tumor biopsy. Additionally, blood samples from women who underwent clear or benign mammography were collected for the assays. Among 642 participants, the sensitivity, specificity, and overall accuracy values of the three-protein signature were 74.4%, 66.9%, and 70.6%, respectively, and the concordance index was 0.698 (95% CI 0.656, 0.739). The diagnostic performance was not affected by the demographic features, clinicopathologic characteristics, and co-morbidities of the participants. CONCLUSIONS The present trial showed an accuracy of 70.6% for the three-protein signature. Considering the value of blood-based biomarkers for the early detection of breast malignancies, further evaluation of this proteomic assay is warranted in larger, population-level trials. This Multi-protein Assessment using Serum to deTermine breast lesion malignancy (MAST) was registered at the Clinical Research Information Service of Korea with the identification number of KCT0004847 ( https://cris.nih.go.kr ).
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Affiliation(s)
- Eun-Shin Lee
- grid.222754.40000 0001 0840 2678Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yumi Kim
- grid.410886.30000 0004 0647 3511Division of Breast Surgery, Cha Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Hee-Chul Shin
- grid.412480.b0000 0004 0647 3378Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki-Tae Hwang
- grid.412479.dDepartment of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Junwon Min
- grid.411982.70000 0001 0705 4288Department of Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Min Kyoon Kim
- grid.254224.70000 0001 0789 9563Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - SooKyung Ahn
- grid.256753.00000 0004 0470 5964Department of Surgery, Breast and Thyroid Center, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
| | - So-Youn Jung
- grid.410914.90000 0004 0628 9810Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hyukjai Shin
- grid.416355.00000 0004 0475 0976Breast and Thyroid Care Center, Myongji Hospital, Goyang, Republic of Korea
| | - MinSung Chung
- grid.49606.3d0000 0001 1364 9317Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae-Kyung Yoo
- grid.411947.e0000 0004 0470 4224Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungpil Jung
- grid.222754.40000 0001 0840 2678Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Uk Woo
- grid.222754.40000 0001 0840 2678Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ju-Yeon Kim
- grid.256681.e0000 0001 0661 1492Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Dong-Young Noh
- grid.410886.30000 0004 0647 3511Division of Breast Surgery, Cha Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea ,grid.412484.f0000 0001 0302 820XDepartment of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul, Republic of Korea. .,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
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Liu Y, Tong Y, Wan Y, Xia Z, Yao G, Shang X, Huang Y, Chen L, Chen DQ, Liu B. Identification and diagnosis of mammographic malignant architectural distortion using a deep learning based mask regional convolutional neural network. Front Oncol 2023; 13:1119743. [PMID: 37035200 PMCID: PMC10075355 DOI: 10.3389/fonc.2023.1119743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Background Architectural distortion (AD) is a common imaging manifestation of breast cancer, but is also seen in benign lesions. This study aimed to construct deep learning models using mask regional convolutional neural network (Mask-RCNN) for AD identification in full-field digital mammography (FFDM) and evaluate the performance of models for malignant AD diagnosis. Methods This retrospective diagnostic study was conducted at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2011 and December 2020. Patients with AD in the breast in FFDM were included. Machine learning models for AD identification were developed using the Mask RCNN method. Receiver operating characteristics (ROC) curves, their areas under the curve (AUCs), and recall/sensitivity were used to evaluate the models. Models with the highest AUCs were selected for malignant AD diagnosis. Results A total of 349 AD patients (190 with malignant AD) were enrolled. EfficientNetV2, EfficientNetV1, ResNext, and ResNet were developed for AD identification, with AUCs of 0.89, 0.87, 0.81 and 0.79. The AUC of EfficientNetV2 was significantly higher than EfficientNetV1 (0.89 vs. 0.78, P=0.001) for malignant AD diagnosis, and the recall/sensitivity of the EfficientNetV2 model was 0.93. Conclusion The Mask-RCNN-based EfficientNetV2 model has a good diagnostic value for malignant AD.
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Affiliation(s)
- Yuanyuan Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunfei Tong
- Department of Engineering, Shanghai Yanghe Huajian Artificial Intelligence Technology Co., Ltd, Shanghai, China
| | - Yun Wan
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziqiang Xia
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoyan Yao
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojing Shang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan Huang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lijun Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Daniel Q. Chen
- Artificial Intelligence (AI), Research Lab, Boston Meditech Group, Burlington, MA, United States
- *Correspondence: Bo Liu, ; Daniel Q. Chen,
| | - Bo Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Bo Liu, ; Daniel Q. Chen,
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Li Y, Chen H, He J, Fan Z, Zhang H. The outcome of neoadjuvant chemotherapy and the current trend of surgical treatment in young women with breast cancer: A multicenter real-world study (CSBrS-012). Front Public Health 2023; 11:1100421. [PMID: 36895689 PMCID: PMC9988895 DOI: 10.3389/fpubh.2023.1100421] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
Background and objectives The relationship between age and the outcome of breast cancer neoadjuvant chemotherapy (NAC) remains controversial, and little is known about the choice of surgical treatment for young patients. In this multicenter real-world study, we sought to analyze the outcome of NAC as well as the current status and trend of surgical decision-making after NAC in young breast cancer patients. Methods The medical records of patients from 20 hospitals in different regions of China were collected retrospectively. The study population included females diagnosed with cT1-4N0-3M0 breast cancer who received NAC from January 2010 to December 2020. Results A total of 9,643 eligible patients were included, 1,945 (20.2%) of whom were ≤40 years old. Young patients tend to have a higher tumor stage and a higher proportion of Luminal B and triple-negative breast cancer (TNBC) tumors compared with the >40-year-old group. The breast pathological complete response (pCR) rate in the young group was 20.3%, and Luminal B tumor was more likely to obtain pCR in young patients. The implementation rate of breast-conserving surgery (BCS) and breast reconstruction surgery was higher in young patients and tended to increase over time. In different regions of China, there were great differences in the choice of surgical treatment after NAC among young patients. Conclusion Breast cancer in young women has unique clinical characteristics, but age does not affect the overall pCR rate. In China, the BCS rate after NAC is increasing over time but is still at a low level.
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Affiliation(s)
- Yijun Li
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Heyan Chen
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jianjun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhimin Fan
- Department of Breast Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Huimin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Kim YS, Jang MJ, Lee SH, Kim SY, Ha SM, Kwon BR, Moon WK, Chang JM. Use of Artificial Intelligence for Reducing Unnecessary Recalls at Screening Mammography: A Simulation Study. Korean J Radiol 2022; 23:1241-1250. [PMID: 36447412 PMCID: PMC9747265 DOI: 10.3348/kjr.2022.0263] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/05/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To conduct a simulation study to determine whether artificial intelligence (AI)-aided mammography reading can reduce unnecessary recalls while maintaining cancer detection ability in women recalled after mammography screening. MATERIALS AND METHODS A retrospective reader study was performed by screening mammographies of 793 women (mean age ± standard deviation, 50 ± 9 years) recalled to obtain supplemental mammographic views regarding screening mammography-detected abnormalities between January 2016 and December 2019 at two screening centers. Initial screening mammography examinations were interpreted by three dedicated breast radiologists sequentially, case by case, with and without AI aid, in a single session. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and recall rate for breast cancer diagnosis were obtained and compared between the two reading modes. RESULTS Fifty-four mammograms with cancer (35 invasive cancers and 19 ductal carcinomas in situ) and 739 mammograms with benign or negative findings were included. The reader-averaged AUC improved after AI aid, from 0.79 (95% confidence interval [CI], 0.74-0.85) to 0.89 (95% CI, 0.85-0.94) (p < 0.001). The reader-averaged specificities before and after AI aid were 41.9% (95% CI, 39.3%-44.5%) and 53.9% (95% CI, 50.9%-56.9%), respectively (p < 0.001). The reader-averaged sensitivity was not statistically different between AI-unaided and AI-aided readings: 89.5% (95% CI, 83.1%-95.9%) vs. 92.6% (95% CI, 86.2%-99.0%) (p = 0.053), although the sensitivities of the least experienced radiologists before and after AI aid were 79.6% (43 of 54 [95% CI, 66.5%-89.4%]) and 90.7% (49 of 54 [95% CI, 79.7%-96.9%]), respectively (p = 0.031). With AI aid, the reader-averaged recall rate decreased by from 60.4% (95% CI, 57.8%-62.9%) to 49.5% (95% CI, 46.5%-52.4%) (p < 0.001). CONCLUSION AI-aided reading reduced the number of recalls and improved the diagnostic performance in our simulation using women initially recalled for supplemental mammographic views after mammography screening.
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Affiliation(s)
- Yeon Soo Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National College of Medicine, Seoul, Korea
| | - Myoung-jin Jang
- Medical Research Collaborating Center, Seoul National University, Seoul, Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National College of Medicine, Seoul, Korea
| | - Soo-Yeon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National College of Medicine, Seoul, Korea
| | - Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National College of Medicine, Seoul, Korea
| | - Bo Ra Kwon
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National College of Medicine, Seoul, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National College of Medicine, Seoul, Korea
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Qiao EM, Guram K, Kotha NV, Voora RS, Qian AS, Ahn GS, Kalavacherla S, Pindus R, Banegas MP, Stewart TF, Johnson ML, Murphy JD, Rose BS. Association Between Primary Care Use Prior to Cancer Diagnosis and Subsequent Cancer Mortality in the Veterans Affairs Health System. JAMA Netw Open 2022; 5:e2242048. [PMID: 36374497 PMCID: PMC9664263 DOI: 10.1001/jamanetworkopen.2022.42048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Primary care physicians (PCPs) are significant contributors of early cancer detection, yet few studies have investigated whether consistent primary care translates to improved downstream outcomes. OBJECTIVE To evaluate the association of prediagnostic primary care use with metastatic disease at diagnosis and cancer-specific mortality (CSM). DESIGN, SETTING, AND PARTICIPANTS This cohort study used databases with primary care and referral linkage from multiple Veterans' Affairs centers from 2004 to 2017 and had a 68-month median follow-up. Analysis was completed between July 2021 and September 2022. Participants included veterans older than 39 years who had been diagnosed with 1 of 12 cancers. Inclusion criteria included known clinical staging, survival follow-up, cause of death, and receiving care at the Veterans Affairs health system (VA). EXPOSURES Prediagnostic PCP use, measured in the 5 years prior to diagnosis. PCP visits were binned into none (0 visits), some (1-4 visits), and annual (5 visits). MAIN OUTCOMES AND MEASURES Metastatic disease at diagnosis, cancer-specific mortality (CSM) for entire cohort and stratified by tumor subtype. RESULTS Among 245 425 patients representing 12 tumor subtypes, mean age was 65.8 (9.3) years, and the cohort skewed male (97.6%), and White (76.1%), with higher levels of comorbidity (58.6% with Charlson Comorbidity Index scores ≥2). Compared with no prior visit, some PCP use was associated with 26% decreased odds of metastatic disease at diagnosis (odds ratio [OR], 0.74; 95% CI, 0.71-0.76; P < .001) and 12% reduced risk of CSM (subdistribution hazard ratio [SHR], 0.88; 95% CI, 0.86-0.89; P < .001). Annual PCP use was associated with 39% decreased odds of metastatic disease (OR, 0.61; 95% CI, 0.59-0.63; P < .001) and 21% reduced risk of CSM (SHR, 0.79; 95% CI, 0.77-0.81; P < .001). Among tumor subtypes, prostate cancer had the largest effect size for prior PCP use on metastatic disease at diagnosis (OR for annual use, 0.32; 95% CI, 0.30-0.35; P < .001) and CSM (SHRfor annual use, 0.51; 95% CI, 0.48-0.55; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, increased primary care use before cancer diagnosis was associated with significant decreases in metastatic disease at diagnosis and cancer-related death, with potentially the greatest difference from annual use. PCPs play a vital role in cancer prevention, and additional resources should be allocated to assist these physicians.
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Affiliation(s)
- Edmund M. Qiao
- VA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Kripa Guram
- VA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Nikhil V. Kotha
- VA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Rohith S. Voora
- VA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Alexander S. Qian
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Grace S. Ahn
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Sandhya Kalavacherla
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Ramona Pindus
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Matthew P. Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Tyler F. Stewart
- Division of Hematology-Oncology, Department of Internal Medicine, University of California, San Diego, La Jolla
| | - Michelle L. Johnson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - James D. Murphy
- VA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Brent S. Rose
- VA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
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Daily A, Ravishankar P, Wang W, Krone R, Harms S, Klimberg VS. Development and validation of a short-term breast health measure as a supplement to screening mammography. Biomark Res 2022; 10:76. [PMID: 36284356 PMCID: PMC9594920 DOI: 10.1186/s40364-022-00420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background There is a growing body of evidence to support tears as a non-traditional biological fluid in clinical laboratory testing. In addition to the simplicity of tear fluid processing, the ability to access key cancer biomarkers in high concentrations quickly and inexpensively is significantly enhanced. Tear fluid is a dynamic environment rich in both proteomic and genomic information, making it an ideal medium for exploring the potential for biological testing modalities. Methods All protocols involving human subjects were reviewed and approved by the University of Arkansas IRB committee (13-11-289) prior to sample collection. Study enrollment was open to women ages 18 and over from October 30, 2017-June 19, 2019 at The Breast Center, Fayetteville, AR and Bentonville, AR. Convenience sampling was used and samples were age/sex matched, with enrollment open to individuals at any point of the breast health continuum of care. Tear samples were collected using the Schirmer strip method from 847 women. Concentration of selected tear proteins were evaluated using standard sandwich ELISA techniques and the resulting data, combined with demographic and clinical covariates, was analyzed using logistic regression analysis to build a model for classification of samples. Results Logistic regression analysis produced three models, which were then evaluated on cases and controls at two diagnostic thresholds and resulted in sensitivity ranging from 52 to 90% and specificity from 31 to 79%. Sensitivity and specificity variation is dependent on the model being evaluated as well as the selected diagnostic threshold providing avenues for assay optimization. Conclusions and relevance The work presented here builds on previous studies focused on biomarker identification in tear samples. Here we show successful early classification of samples using two proteins and minimal clinical covariates. Supplementary Information The online version contains supplementary material available at 10.1186/s40364-022-00420-1.
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Affiliation(s)
| | | | | | | | - Steve Harms
- The Breast Center-Medical Associates of Northwest Arkansas, Fayetteville, AR USA
| | - V. Suzanne Klimberg
- grid.176731.50000 0001 1547 9964Department of Surgery, University of Texas Medical Branch, Galveston, TX USA ,grid.240145.60000 0001 2291 4776Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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Shubayr N, Khmees R, Alyami A, Majrashi N, Alomairy N, Abdelwahab S. Knowledge and Factors Associated with Breast Cancer Self-Screening Intention among Saudi Female College Students: Utilization of the Health Belief Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013615. [PMID: 36294192 PMCID: PMC9603714 DOI: 10.3390/ijerph192013615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/17/2022] [Accepted: 10/08/2022] [Indexed: 06/01/2023]
Abstract
Breast cancer (BC) screening is vital, as it is linked to a greater likelihood of survival, more effective treatment, and better quality of life. One of the most extensively applied models for conceptualizing probable barriers and facilitators to the adoption of desired health behavior is the health belief model (HBM). This study aimed to assess the impact of health perception and knowledge on breast self-examination intention (BSE) using HBM. HBM measures specific factors (perceived susceptibility, severity, barriers, benefits, cues to action, and self-efficacy) that impact one's intention to use BSE. Data were collected from female undergraduate students (n = 680) using a cross-sectional design, stratified simple random sampling, and a self-administered structured online questionnaire. We used multivariable logistic regression to evaluate our assumptions for students who intended to self-examine for BC. For demographic factors, we modified the multivariate model. Most respondents (93%) were under the age of 24 years. Female students from health colleges (48.5%), in their fourth academic year (42.6%), and from the southern region (57.6%) accounted for the majority of the sample. Respondents with a family history of BC were 9.7% of the total. Categories for age, college, region, residency, and BSE intention showed significant differences in their average knowledge scores. The survey revealed that 72.4% were aware of abnormal breast changes. Three constructs of the health belief model (perceived benefit, perceived barriers, and self-efficacy) are good predictors of BSE intention. Theory-based behavioral change interventions are urgently required for students to improve their prevention practices. Furthermore, these interventions will be effective if they are designed to remove barriers to BSE intention, improve female students' self-efficacy, and enlighten them on the benefits of self-examination.
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Affiliation(s)
- Nasser Shubayr
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
- Medical Research Centre, Jazan University, Jazan 45142, Saudi Arabia
| | - Rola Khmees
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Ali Alyami
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Naif Majrashi
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Nada Alomairy
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Siddig Abdelwahab
- Medical Research Centre, Jazan University, Jazan 45142, Saudi Arabia
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