Stage distribution of breast cancer: a basis for the evaluation of breast screening programmes

Short-term impact of cancer prevention and screening activities on quality of life

PURPOSE

There are few data on the short-term effects of participating in cancer prevention activities, undergoing genetic risk assessment, or having routine screening. The objective of this article is to systematically review existing research on short-term effects of prevention, genetic counseling and testing, and screening activities on quality of life.

METHODS

We conducted a MEDLINE search for original research studies that were published between January 1, 1985, and December 31, 2002, and conducted in North America or Western Europe. Data were abstracted and summarized using a standardized format.

RESULTS

We reviewed 210 publications. Most studies focused on psychological states (anxiety, depression), symptoms, or general health status. One hundred thirty-one studies used 51 previously validated noncancer instruments. Many researchers (12.6%) also added cancer-specific measures, such as perceived cancer risk or symptom indices. Only one study measured satisfaction or quality of provider-client communication. While one report examined lost workdays, no other economic consequences of short-term outcomes were evaluated. Among seven studies that assessed short-term outcomes preferences, only four specifically used time trade-off or linear rating scale methods. No study used standard gamble or willingness-to-pay methods. The overwhelming majority of research indicated that short-term effects were transient. Only two studies linked short-term effects to long-term cancer-related health behaviors such as repeat screening.

CONCLUSION

There is considerable heterogeneity in short-term outcome measurement. Clinicians need to be aware of potential for short-term, transient adverse effects. The impact of short-term experiences should to be linked to long-term health status and use of services.

Medical audit after 26,711 breast imaging studies: improved rate of detection of small breast carcinomas (classified as Tis or T1a,b)

BACKGROUND

Patients with breast carcinomas 1 cm or smaller are known to have the highest long term survival rates. This pathologic measurement was used as a quality indicator of the performance of different reporting radiologists.

METHODS

A total of 26,711 diagnostic breast imaging studies were performed over a period of 5 years. Within the first 18 months, several general radiologists reported mammograms, whereas during the rest of the evaluated period only 1 radiologist was responsible for all mammography reporting. Radiologic findings leading to open biopsy were correlated with the histologic results. The cancer sizes from the histologic reports were recorded, and the number of Tis, T1a, and T1b cancers were correlated with all cancers found at open biopsy. The change in the relative percentage of small cancers was evaluated, along with the positive predictive value (PPV).

RESULTS

Between 1991 and 1995, 26,711 breast imaging studies were performed. This resulted in 2698 open biopsies with 620 breast carcinomas detected. In the first 2 years, the percentages of small cancers detected (Tis or T1a,b) were 27.2% and 25.7%, respectively. In the third, fourth, and fifth years, the percentages increased to 38.8%, 34.5%, and 38.8%, respectively. At the same time, the PPV increased slightly, from 0.23 in 1991 to 0.27 in 1995.

CONCLUSIONS

The detection of curable early stage breast carcinomas requires the dedication and commitment of a small group of radiologists who are willing to spend most of their time on this single subject. This will increase considerably the number of early stage cancers found and reduce the number of false-positive diagnoses. [See editorial counterpoint on pages 2430-1 and reply to counterpoint on pages 2432-3.]

[The effectiveness of breast cancer screening in our country]

The aim of this paper is to review the current state of breast cancer screening in our country, as well as to discuss the most appropriate approaches for its development. Firstly, the impact of breast cancer in Spain is presented, as well as the current evidence about the efficacy of the screening. The major programs and initiatives addressed to promote screening are described. Finally, a few recommendations are given in order to achieve that breast cancer screening be, not only efficacious, but also effective. It is concluded that it is necessary that health and professional authorities coordinate and monitor breast cancer screening programs.