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Luo J, Tang L, Chen Y, Yang L, Shen R, Cheng Y, Zhang Z, Lv Z, Yuan L, Yang Y, Cheng Y, Bai B, Luo J, Chen Q. A Prospective Multicenter Study on the Additive Value of Contrast-Enhanced Ultrasound for Biopsy Decision of Ultrasound BI-RADS 4 Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00187-X. [PMID: 38796340 DOI: 10.1016/j.ultrasmedbio.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE The main aim of this study was to determine whether the use of contrast-enhanced ultrasound (CEUS) could improve the categorization of suspicious breast lesions based on the Breast Imaging Reporting and Data System (BI-RADS), thereby reducing the number of benign breast lesions referred for biopsy. METHODS This prospective study, conducted between January 2017 and December 2018, enrolled consenting patients from eight teaching hospitals in China, who had been diagnosed with solid breast lesions classified as BI-RADS 4 using conventional ultrasound. CEUS was performed within 1 wk of diagnosis for reclassification of breast lesions. Histopathological results obtained from core needle biopsies or surgical excision samples served as the reference standard. The simulated biopsy rate and cancer-to-biopsy yield were used to compare the accuracy of CEUS and conventional ultrasound (US). RESULTS Among the 1490 lesions diagnosed as BI-RADS 4 with conventional ultrasound, 486 malignant and 1004 benign lesions were confirmed based on histology. Following CEUS, 2, 395, and 211 lesions were reclassified as CEUS-based BI-RADS 2, 3, and 5, respectively, while 882 (59%) remained as BI-RADS 4. The actual cancer-to-biopsy yield based on US was 32.6%, which increased to 43.4% when CEUS-based BI-RADS 4A was used as the cut-off point to recommend biopsy. The simulated biopsy rate decreased to 73.4%. Overall, in this preselected BI-RADS 4 population, only 2.5% (12/486) of malignant lesions would have been miscategorized as BI-RADS 3 using CEUS-based reclassification. The diagnostic accuracy, sensitivity, and specificity of contrast-enhanced ultrasound reclassification were 57.65%, 97.53%, and 38.35%, respectively. CONCLUSION Our collective findings indicate that CEUS is a valuable tool in further triage of BI-RADS category 4 lesions and facilitates a reduction in the number of biopsies while increasing the cancer-to-biopsy yield.
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Affiliation(s)
- Jun Luo
- Ultrasound Department, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Lina Tang
- Department of Ultrasound, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yijie Chen
- Department of Ultrasound, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Lichun Yang
- Department of Ultrasound, the Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Hospital, Kunming, China
| | - Ruoxia Shen
- Department of Ultrasound, the Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Hospital, Kunming, China
| | - Yan Cheng
- Department of Ultrasound, Qujing City First People's Hospital, Qujing, China
| | - Zizhen Zhang
- Department of Ultrasound, Qujing City First People's Hospital, Qujing, China
| | - Zhihong Lv
- Department of Ultrasound, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| | - Lijun Yuan
- Departments of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yong Yang
- Departments of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yinrong Cheng
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, China
| | - Baoyan Bai
- Department of Ultrasound, Yanan University Affiliated Hospital, Yan'an, China
| | - Jing Luo
- Department of Breast Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Qin Chen
- Ultrasound Department, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China.
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Rögnvaldsson S, Thorsteinsdóttir S, Kristinsson SY. Screening in Multiple Myeloma and Its Precursors: Are We There Yet? Clin Chem 2024; 70:128-139. [PMID: 38175579 DOI: 10.1093/clinchem/hvad148] [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: 01/25/2023] [Accepted: 06/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Multiple myeloma (MM) is a hematological malignancy that develops over years from the asymptomatic precursors, monoclonal gammopathy of undetermined significance, and smoldering multiple myeloma. Recent evidence shows that by initiating treatment at an asymptomatic stage, outcomes in MM can be significantly improved. However, a vast majority of MM patients are diagnosed after the development of symptomatic end-organ damage and cannot reap the benefits of early treatment. The precursors of MM are easily detected by serum protein electrophoresis and free light chain assay of the serum, raising the question of whether population-based screening could detect MM at an asymptomatic stage and significantly expand the availability of early treatment in MM. Screening is a hallmark of care in many malignancies, and there are accepted criteria for when screening is appropriate. CONTENT Here we review the available relevant evidence for the introduction of screening and discuss whether screening for MM and its precursors fulfills these criteria. We also highlight gaps in our current knowledge, most notably a lack of data on the benefits and harms of screening and the lack of a defined target population. There are ongoing studies that may fill these critical gaps in the literature, but their results are still pending. SUMMARY Screening could lead to a paradigm shift in the care of patients with MM, but critical scientific questions need to be answered before screening of healthy individuals can be recommended. In short, we should not screen for MM and its precursors-yet.
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Affiliation(s)
- Sæmundur Rögnvaldsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
| | - Sigrún Thorsteinsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Sigurður Yngvi Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
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Senevirathna P, Pires DEV, Capurro D. Data-driven overdiagnosis definitions: A scoping review. J Biomed Inform 2023; 147:104506. [PMID: 37769829 DOI: 10.1016/j.jbi.2023.104506] [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: 01/05/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Adequate methods to promptly translate digital health innovations for improved patient care are essential. Advances in Artificial Intelligence (AI) and Machine Learning (ML) have been sources of digital innovation and hold the promise to revolutionize the way we treat, manage and diagnose patients. Understanding the benefits but also the potential adverse effects of digital health innovations, particularly when these are made available or applied on healthier segments of the population is essential. One of such adverse effects is overdiagnosis. OBJECTIVE to comprehensively analyze quantification strategies and data-driven definitions for overdiagnosis reported in the literature. METHODS we conducted a scoping systematic review of manuscripts describing quantitative methods to estimate the proportion of overdiagnosed patients. RESULTS we identified 46 studies that met our inclusion criteria. They covered a variety of clinical conditions, primarily breast and prostate cancer. Methods to quantify overdiagnosis included both prospective and retrospective methods including randomized clinical trials, and simulations. CONCLUSION a variety of methods to quantify overdiagnosis have been published, producing widely diverging results. A standard method to quantify overdiagnosis is needed to allow its mitigation during the rapidly increasing development of new digital diagnostic tools.
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Affiliation(s)
- Prabodi Senevirathna
- School of Computing and Information Systems, The University of Melbourne, Melbourne, 3053, Victoria, Australia
| | - Douglas E V Pires
- School of Computing and Information Systems, The University of Melbourne, Melbourne, 3053, Victoria, Australia; Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, 3053, Victoria, Australia.
| | - Daniel Capurro
- School of Computing and Information Systems, The University of Melbourne, Melbourne, 3053, Victoria, Australia; Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, 3053, Victoria, Australia; Department of General Medicine, Royal Melbourne Hospital, Melbourne, 3053, Victoria, Australia.
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Clift AK, Collins GS, Lord S, Petrou S, Dodwell D, Brady M, Hippisley-Cox J. Predicting 10-year breast cancer mortality risk in the general female population in England: a model development and validation study. Lancet Digit Health 2023; 5:e571-e581. [PMID: 37625895 DOI: 10.1016/s2589-7500(23)00113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Identifying female individuals at highest risk of developing life-threatening breast cancers could inform novel stratified early detection and prevention strategies to reduce breast cancer mortality, rather than only considering cancer incidence. We aimed to develop a prognostic model that accurately predicts the 10-year risk of breast cancer mortality in female individuals without breast cancer at baseline. METHODS In this model development and validation study, we used an open cohort study from the QResearch primary care database, which was linked to secondary care and national cancer and mortality registers in England, UK. The data extracted were from female individuals aged 20-90 years without previous breast cancer or ductal carcinoma in situ who entered the cohort between Jan 1, 2000, and Dec 31, 2020. The primary outcome was breast cancer-related death, which was assessed in the full dataset. Cox proportional hazards, competing risks regression, XGBoost, and neural network modelling approaches were used to predict the risk of breast cancer death within 10 years using routinely collected health-care data. Death due to causes other than breast cancer was the competing risk. Internal-external validation was used to evaluate prognostic model performance (using Harrell's C, calibration slope, and calibration in the large), performance heterogeneity, and transportability. Internal-external validation involved dataset partitioning by time period and geographical region. Decision curve analysis was used to assess clinical utility. FINDINGS We identified data for 11 626 969 female individuals, with 70 095 574 person-years of follow-up. There were 142 712 (1·2%) diagnoses of breast cancer, 24 043 (0·2%) breast cancer-related deaths, and 696 106 (6·0%) deaths from other causes. Meta-analysis pooled estimates of Harrell's C were highest for the competing risks model (0·932, 95% CI 0·917-0·946). The competing risks model was well calibrated overall (slope 1·011, 95% CI 0·978-1·044), and across different ethnic groups. Decision curve analysis suggested favourable clinical utility across all age groups. The XGBoost and neural network models had variable performance across age and ethnic groups. INTERPRETATION A model that predicts the combined risk of developing and then dying from breast cancer at the population level could inform stratified screening or chemoprevention strategies. Further evaluation of the competing risks model should comprise effect and health economic assessment of model-informed strategies. FUNDING Cancer Research UK.
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Affiliation(s)
- Ash Kieran Clift
- Cancer Research UK Oxford Centre, University of Oxford, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Simon Lord
- Department of Oncology, University of Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, UK
| | | | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Gram EG, Manso TFR, Heleno B, Siersma V, Á Rogvi J, Brodersen JB. The long-term psychosocial consequences of screen-detected ductal carcinoma in situ and invasive breast cancer. Breast 2023; 70:41-48. [PMID: 37307773 DOI: 10.1016/j.breast.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE Ductal carcinoma in situ (DCIS) is a risk factor for invasive breast cancer (IBC). The prognosis of DCIS is considerably better than for IBC, yet women do not distinguish between the threat. We aimed to compare the psychosocial consequences of screen-detected DCIS and IBC, and to examine this comparison over time. METHODS We surveyed a Danish mammography-screening cohort from 2004 to 2018. We assessed outcomes at six-time points: baseline, 1, 6, 18, 36 months, and 14 years after the screening. We measured psychosocial consequences with the Consequences Of Screening - Breast Cancer (COS-BC): a condition-specific questionnaire that is psychometrically validated and encompasses 14 psychosocial dimensions. We used weighted linear models with generalized estimating equations to compare responses between groups. We used a 1% level of significance. RESULTS 170 out of 1309 women were diagnosed with breast cancer (13.0%). 23 were diagnosed with DCIS (13.5%) and 147 with IBC (86.5%). From baseline to six months after diagnosis, there were no significant differences between women with DCIS and IBC. However, mean scores indicated that IBC generally was more affected than DCIS. After six months, we observed that women with DCIS and IBC might be affected differently in the long term; mean scores and mean differences showed that IBC were more affected on some scales, while DCIS were on others. CONCLUSION Overall, the DCIS and IBC experienced similar levels of psychosocial consequences. Women might benefit from renaming DCIS to exclude cancer nomenclature.
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Affiliation(s)
- Emma Grundtvig Gram
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Primary Health Care Research Unit, Region Zealand, Denmark.
| | - Túlia Filipa Roberto Manso
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Bruno Heleno
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Volkert Siersma
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Á Rogvi
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Primary Health Care Research Unit, Region Zealand, Denmark; Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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Flemban AF. Overdiagnosis Due to Screening Mammography for Breast Cancer among Women Aged 40 Years and Over: A Systematic Review and Meta-Analysis. J Pers Med 2023; 13:jpm13030523. [PMID: 36983705 PMCID: PMC10051653 DOI: 10.3390/jpm13030523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/03/2023] [Accepted: 03/11/2023] [Indexed: 03/16/2023] Open
Abstract
The current systematic review and meta-analysis was conducted to estimate the incidence of overdiagnosis due to screening mammography for breast cancer among women aged 40 years and older. A PRISMA systematic search appraisal and meta-analysis were conducted. A systematic literature search of English publications in PubMed, Web of Science, EMBASE, Scopus, and Google Scholar was conducted without regard to the region or time period. Generic, methodological, and statistical data were extracted from the eligible studies. A meta-analysis was completed by utilizing comprehensive meta-analysis software. The effect size estimates were calculated using the fail-safe N test. The funnel plot and the Begg and Mazumdar rank correlation tests were employed to find any potential bias among the included articles. The strength of the association between two variables was assessed using Kendall’s tau. Heterogeneity was measured using the I-squared (I2) test. The literature search in the five databases yielded a total of 4214 studies. Of those, 30 articles were included in the final analysis, with sample sizes ranging from 451 to 1,429,890 women. The vast majority of the articles were retrospective cohort designs (24 articles). The age of the recruited women ranged between 40 and 89 years old. The incidence of overdiagnosis due to screening mammography for breast cancer among women aged 40 years and older was 12.6%. There was high heterogeneity among the study articles (I2 = 99.993), and the pooled event rate was 0.126 (95% CI: 15 0.101–0.156). Despite the random-effects meta-analysis showing a high degree of heterogeneity among the articles, the screening tests have to allow for a certain degree of overdiagnosis (12.6%) due to screening mammography for breast cancer among women aged 40 years and older. Furthermore, efforts should be directed toward controlling and minimizing the harmful consequences associated with breast cancer screening.
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Affiliation(s)
- Arwa F Flemban
- Pathology Department, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
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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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Onyiba CI, Scarlett CJ, Weidenhofer J. The Mechanistic Roles of Sirtuins in Breast and Prostate Cancer. Cancers (Basel) 2022; 14:cancers14205118. [PMID: 36291902 PMCID: PMC9600935 DOI: 10.3390/cancers14205118] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary There are diverse reports of the dual role of sirtuin genes and proteins in breast and prostate cancers. This review discusses the current information on the tumor promotion or suppression roles of SIRT1–7 in breast and prostate cancers. Precisely, we highlight that sirtuins regulate various proteins implicated in proliferation, apoptosis, autophagy, chemoresistance, invasion, migration, and metastasis of both breast and prostate cancer. We also provide evidence of the direct regulation of sirtuins by miRNAs, highlighting the consequences of this regulation in breast and prostate cancer. Overall, this review reveals the potential value of sirtuins as biomarkers and/or targets for improved treatment of breast and prostate cancers. Abstract Mammalian sirtuins (SIRT1–7) are involved in a myriad of cellular processes, including apoptosis, proliferation, differentiation, epithelial-mesenchymal transition, aging, DNA repair, senescence, viability, survival, and stress response. In this review, we discuss the current information on the mechanistic roles of SIRT1–7 and their downstream effects (tumor promotion or suppression) in cancers of the breast and prostate. Specifically, we highlight the involvement of sirtuins in the regulation of various proteins implicated in proliferation, apoptosis, autophagy, chemoresistance, invasion, migration, and metastasis of breast and prostate cancer. Additionally, we highlight the available information regarding SIRT1–7 regulation by miRNAs, laying much emphasis on the consequences in the progression of breast and prostate cancer.
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Affiliation(s)
- Cosmos Ifeanyi Onyiba
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, NSW 2258, Australia
- Correspondence:
| | - Christopher J. Scarlett
- School of Environmental and Life Sciences, College of Engineering, Science and Environment, University of Newcastle, Ourimbah, NSW 2258, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Judith Weidenhofer
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, NSW 2258, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
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Zahl PH, Jørgensen KJ. Estimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort. Ann Intern Med 2022; 175:W114-W115. [PMID: 36252259 DOI: 10.7326/l22-0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Overdiagnosis of invasive breast cancer in population-based breast cancer screening: A short- and long-term perspective. Eur J Cancer 2022; 173:1-9. [PMID: 35839596 DOI: 10.1016/j.ejca.2022.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/30/2022] [Accepted: 06/12/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Overdiagnosis of invasive breast cancer (BC) is a contentious issue. OBJECTIVE The aim of this paper is to estimate the overdiagnosis rate of invasive BC in an organised BC screening program and to evaluate the impact of age and follow-up time. METHODS The micro-simulation model SiMRiSc was calibrated and validated for BC screening in Flanders, where women are screened biennially from age 50 to 69. Overdiagnosis rate was defined as the number of invasive BC that would not have been diagnosed in the absence of screening per 100,000 screened women during the screening period plus follow-up time (which was set at 5 years and varied from 2 to 15 years). Overdiagnosis rate was calculated overall and stratified by age. RESULTS The overall overdiagnosis rate for women screened biennially from 50 to 69 was 20.1 (95%CI: 16.9-23.2) per 100,000 women screened at 5-year follow-up from stopping screening. Overdiagnosis at 5-year follow-up time was 12.9 (95%CI: 4.6-21.1) and 74.2 (95%CI: 50.9-97.5) per 100,000 women screened for women who started screening at age 50 and 68, respectively. At 2- and 15-year follow-up time, overdiagnosis rate was 98.5 (95%CI: 75.8-121.3) and 13.4 (95%CI: 4.9-21.9), respectively, for women starting at age 50, and 297.0 (95%CI: 264.5-329.4) and 34.2 (95%CI: 17.5-50.8), respectively, for those starting at age 68. CONCLUSIONS Sufficient follow-up time (≥10 years) after screening stops is key to obtaining unbiased estimates of overdiagnosis. Overdiagnosis of invasive BC is a larger problem in older compared to younger women.
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Ding L, Greuter M, Truyen I, Goossens M, De Schutter H, de Bock G, Van Hal G. Irregular screening participation increases advanced stage breast cancer at diagnosis: A population-based study. Breast 2022; 65:61-66. [PMID: 35820298 PMCID: PMC9284440 DOI: 10.1016/j.breast.2022.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the effect of irregular screening behaviour on the risk of advanced stage breast cancer at diagnosis in Flanders. METHODS All women aged 50-69 who were invited to the organized breast cancer screening and diagnosed with breast cancer before age 72 from 2001 to 2018 were included. All prevalent screen and interval cancers within 2 years of a prevalent screen were excluded. Screening behaviour was categorized based on the number of invitations and performed screenings. Four groups were defined: regular, irregular, only-once, and never attenders. Advanced stage cancer was defined as a stage III + breast cancer. The association between screening regularity and breast cancer stage at diagnosis was evaluated in multivariable logistic regression models, taking age of diagnosis and socio-economic status into account. RESULTS In total 13.5% of the 38,005 breast cancer cases were diagnosed at the advanced stage. Compared to the regular attenders, the risk of advanced stage breast cancer for the irregular attenders, women who participated only-once, and never attenders was significantly higher with ORadjusted:1.17 (95%CI:1.06-1.29) and ORadjusted:2.18 (95%CI:1.94-2.45), and ORadjusted:5.95 (95%CI:5.33-6.65), respectively. CONCLUSIONS In our study, never attenders were nearly six times more likely to be diagnosed with advanced stage breast cancer than regular attenders, which was much higher than the estimates published thus far. An explanation for this is that the ever screened women is a heterogeneous group regarding the participation profiles which also includes irregular and only-once attenders. The benefit of regular screening should be informed to all women invited for screening.
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Affiliation(s)
- L. Ding
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - M.J.W. Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands
| | - I. Truyen
- Belgian Cancer Registry, Brussels, Belgium
| | - M. Goossens
- Center for Cancer Detection (CvKO) in Flanders, Belgium,Vrije Universiteit Brussel, Brussels, Belgium
| | | | - G.H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,Corresponding author.
| | - G. Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium,Center for Cancer Detection (CvKO) in Flanders, Belgium
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Tunç S, Alagoz O, Burnside ES. A new perspective on breast cancer diagnostic guidelines to reduce overdiagnosis. PRODUCTION AND OPERATIONS MANAGEMENT 2022; 31:2361-2378. [PMID: 35915601 PMCID: PMC9313854 DOI: 10.1111/poms.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/19/2022] [Indexed: 06/15/2023]
Abstract
Overdiagnosis of breast cancer, defined as diagnosing a cancer that would otherwise not cause symptoms or death in a patient's lifetime, costs U.S. health care system over $1.2 billion annually. Overdiagnosis rates, estimated to be around 10%-40%, may be reduced if indolent breast findings can be identified and followed with noninvasive imaging rather than biopsy. However, there are no validated guidelines for radiologists to decide when to choose imaging options recognizing cancer grades and types. The aim of this study is to optimize breast cancer diagnostic decisions based on cancer types using a large-scale finite-horizon Markov decision process (MDP) model with 4.6 million states to help reduce overdiagnosis. We prove the optimality of a divide-and-search algorithm that relies on tight upper bounds on the optimal decision thresholds to find an exact optimal solution. We project the high-dimensional MDP onto two lower dimensional MDPs and obtain feasible upper bounds on the optimal decision thresholds. We use real data from two private mammography databases and demonstrate our model performance through a previously validated simulation model that has been used by the policy makers to set the national screening guidelines in the United States. We find that a decision-analytical framework optimizing diagnostic decisions while accounting for breast cancer types has a strong potential to improve the quality of life and alleviate the immense costs of overdiagnosis. Our model leads to a 20 % reduction in overdiagnosis on the screening population, which translates into an annual savings of approximately $300 million for the U.S. health care system.
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Affiliation(s)
- Sait Tunç
- Grado Department of Industrial and Systems EngineeringVirginia TechBlacksburgVirginiaUSA
| | - Oguzhan Alagoz
- Department of Industrial and Systems EngineeringUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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13
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Clift AK, Dodwell D, Lord S, Petrou S, Brady SM, Collins GS, Hippisley-Cox J. The current status of risk-stratified breast screening. Br J Cancer 2022; 126:533-550. [PMID: 34703006 PMCID: PMC8854575 DOI: 10.1038/s41416-021-01550-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/25/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022] Open
Abstract
Apart from high-risk scenarios such as the presence of highly penetrant genetic mutations, breast screening typically comprises mammography or tomosynthesis strategies defined by age. However, age-based screening ignores the range of breast cancer risks that individual women may possess and is antithetical to the ambitions of personalised early detection. Whilst screening mammography reduces breast cancer mortality, this is at the risk of potentially significant harms including overdiagnosis with overtreatment, and psychological morbidity associated with false positives. In risk-stratified screening, individualised risk assessment may inform screening intensity/interval, starting age, imaging modality used, or even decisions not to screen. However, clear evidence for its benefits and harms needs to be established. In this scoping review, the authors summarise the established and emerging evidence regarding several critical dependencies for successful risk-stratified breast screening: risk prediction model performance, epidemiological studies, retrospective clinical evaluations, health economic evaluations and qualitative research on feasibility and acceptability. Family history, breast density or reproductive factors are not on their own suitable for precisely estimating risk and risk prediction models increasingly incorporate combinations of demographic, clinical, genetic and imaging-related parameters. Clinical evaluations of risk-stratified screening are currently limited. Epidemiological evidence is sparse, and randomised trials only began in recent years.
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Affiliation(s)
- Ash Kieran Clift
- Cancer Research UK Oxford Centre, Department of Oncology, University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Simon Lord
- Department of Oncology, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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14
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Mammography screening and mortality by risk status in the California teachers study. BMC Cancer 2021; 21:1341. [PMID: 34922473 PMCID: PMC8684058 DOI: 10.1186/s12885-021-09071-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
Background The debate continues among medical professionals regarding the frequency, starting age, and stopping age for mammography screening. Some experts suggest tailoring recommendations based on individuals’ personal breast cancer risk. Previous studies have not compared the impact of annual versus biennial mammography stratified by age group and risk category. The purpose of this study was to examine the relationship between mammography frequency and mortality by age group and risk category in the California Teachers Study. Methods Using data from study questionnaires from 93,438 women between the ages of 40 and 85 and linkages to the California Cancer Registry and other indices, overall and breast cancer-specific mortality by mammography frequency were estimated using multivariable Cox proportional hazards models, stratified by age group and risk category at baseline as determined by the Gail breast cancer risk model. Results During the follow-up period of 20 years, overall mortality risk was lower in women who had annual or biennial mammography compared to less frequent or no mammography in all age groups. Annual mammography was associated with lower overall mortality risk compared to biennial mammography among women age 50–85. This difference was especially apparent in women age 60–74, regardless of estimated Gail risk category at baseline. Breast cancer-specific mortality was lower among women who had annual mammography compared to biennial or less frequent mammography among women age 60–74, regardless of their baseline risk. Conclusions Our findings suggest that at least biennial mammography is beneficial to most women age 40–85 and that annual mammography is more beneficial than biennial mammography to most women age 50–85 in terms of overall mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09071-1.
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15
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Hooshmand S, Reed WM, Suleiman ME, Brennan PC. SCREENING MAMMOGRAPHY: DIAGNOSTIC EFFICACY-ISSUES AND CONSIDERATIONS FOR THE 2020S. RADIATION PROTECTION DOSIMETRY 2021; 197:54-62. [PMID: 34729603 DOI: 10.1093/rpd/ncab160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
Diagnostic efficacy in medical imaging is ultimately a reflection of radiologist performance. This can be influenced by numerous factors, some of which are patient related, such as the physical size and density of the breast, and machine related, where some lesions are difficult to visualise on traditional imaging techniques. Other factors are human reader errors that occur during the diagnostic process, which relate to reader experience and their perceptual and cognitive oversights. Given the large-scale nature of breast cancer screening, even small increases in diagnostic performance equate to large numbers of women saved. It is important to identify the causes of diagnostic errors and how detection efficacy can be improved. This narrative review will therefore explore the various factors that influence mammographic performance and the potential solutions used in an attempt to ameliorate the errors made.
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Affiliation(s)
- Sahand Hooshmand
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
| | - Warren M Reed
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
| | - Mo'ayyad E Suleiman
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
| | - Patrick C Brennan
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
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16
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Migowski A. Pink October's success in Brazil: good news for breast cancer control in the country? CAD SAUDE PUBLICA 2021; 37:e00247121. [PMID: 34816956 DOI: 10.1590/0102-311x00247121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Arn Migowski
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil.,Coordenação de Ensino e Pesquisa, Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
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17
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Ian TWM, Tan EY, Chotai N. Role of mammogram and ultrasound imaging in predicting breast cancer subtypes in screening and symptomatic patients. World J Clin Oncol 2021; 12:808-822. [PMID: 34631444 PMCID: PMC8479344 DOI: 10.5306/wjco.v12.i9.808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/24/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast cancer (BC) radiogenomics, or correlation analysis of imaging features and BC molecular subtypes, can complement genetic analysis with less resource-intensive diagnostic methods to provide an early and accurate triage of BC. This is pertinent because BC is the most prevalent cancer amongst adult women, resulting in rising demands on public health resources.
AIM To find combinations of mammogram and ultrasound imaging features that predict BC molecular subtypes in a sample of screening and symptomatic patients.
METHODS This retrospective study evaluated 328 consecutive patients in 2017-2018 with histologically confirmed BC, of which 237 (72%) presented with symptoms and 91 (28%) were detected via a screening program. All the patients underwent mammography and ultrasound imaging prior to biopsy. The images were retrospectively read by two breast-imaging radiologists with 5-10 years of experience with no knowledge of the histology results to ensure statistical independence. To test the hypothesis that imaging features are correlated with tumor subtypes, univariate binomial and multinomial logistic regression models were performed. Our study also used the multivariate logistic regression (with and without interaction terms) to identify combinations of mammogram and ultrasound (US) imaging characteristics predictive of molecular subtypes.
RESULTS The presence of circumscribed margins, posterior enhancement, and large size is correlated with triple-negative BC (TNBC), while high-risk microcalcifications and microlobulated margins is predictive of HER2-enriched cancers. Ductal carcinoma in situ is characterized by small size on ultrasound, absence of posterior acoustic features, and architectural distortion on mammogram, while luminal subtypes tend to be small, with spiculated margins and posterior acoustic shadowing (Luminal A type). These results are broadly consistent with findings from prior studies. In addition, we also find that US size signals a higher odds ratio for TNBC if presented during screening. As TNBC tends to display sonographic features such as circumscribed margins and posterior enhancement, resulting in visual similarity with benign common lesions, at the screening stage, size may be a useful factor in deciding whether to recommend a biopsy.
CONCLUSION Several imaging features were shown to be independent variables predicting molecular subtypes of BC. Knowledge of such correlations could help clinicians stratify BC patients, possibly enabling earlier treatment or aiding in therapeutic decisions in countries where receptor testing is not readily available.
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Affiliation(s)
- Tay Wei Ming Ian
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore 101070, Singapore
| | - Ern Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Niketa Chotai
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
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18
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Jatoi I, Pinsky PF. Breast Cancer Screening Trials: Endpoints and Overdiagnosis. J Natl Cancer Inst 2021; 113:1131-1135. [PMID: 32898241 PMCID: PMC8633447 DOI: 10.1093/jnci/djaa140] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 10/04/2023] Open
Abstract
Screening mammography was assessed in 9 randomized trials initiated between 1963 and 1990, with breast cancer-specific mortality as the primary endpoint. In contrast, breast cancer detection has been the primary endpoint in most screening trials initiated during the past decade. These trials have evaluated digital breast tomosynthesis, magnetic resonance imaging, and ultrasound, and novel screening strategies have been recommended solely on the basis of improvements in breast cancer detection rates. Yet, the assumption that increases in tumor detection produce reductions in cancer mortality has not been validated, and tumor-detection endpoints may exacerbate the problem of overdiagnosis. Indeed, the detection of greater numbers of early stage breast cancers in the absence of a subsequent decline in rates of metastatic cancers and cancer-related mortality is the hallmark of overdiagnosis. There is now evidence to suggest that both ductal carcinoma in situ and invasive cancers are overdiagnosed as a consequence of screening. For each patient who is overdiagnosed with breast cancer, the adverse consequences include unnecessary anxiety, financial hardships, and a small risk of morbidity and mortality from unnecessary treatments. Moreover, the overtreatment of breast cancer, as a consequence of overdiagnosis, is costly and contributes to waste in health-care spending. In this article, we argue that there is a need to establish better endpoints in breast cancer screening trials, including quality of life and composite endpoints. Tumor-detection endpoints should be abandoned, because they may lead to the implementation of screening strategies that increase the risk of overdiagnosis.
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Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
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19
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Abstract
BACKGROUND Published estimations of the extent of breast cancer overdiagnosis vary widely, and there have been heated debates around these estimations. Some high estimates have even been the basis of campaigns against national breast cancer screening programmes. Identifying some of the sources of heterogeneity between different estimates would help to clarify the issue. METHODS The simple case of neuroblastoma-a childhood cancer-screening is used to describe the basic principle of overdiagnosis estimation. The more complicated mechanism of breast cancer overdiagnosis is described based on data from Denmark, taking into account the type of data used, individual or aggregated. FINDINGS The type of data used in overdiagnosis studies has a meaningful effect on the estimation: no study based on individual data provides an estimate higher than 17%, while studies based on aggregated data often provide estimates higher than 40%. This is too systematic to be random. The analysis of two Danish studies, one of each kind, highlights the biases that come with the use of aggregated data and shows how they can lead to overdiagnosis. INTERPRETATION Many estimates of overdiagnosis associated with breast cancer screening programmes are serious overestimations.
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Affiliation(s)
- Dan Chaltiel
- Bureau de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Équipe Labellisée Ligue Contre le Cancer, Université Paris-Saclay, Villejuif, France
| | - Catherine Hill
- Bureau de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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20
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Habib AR, Grady D, Redberg RF. Recommendations From Breast Cancer Centers for Frequent Screening Mammography in Younger Women May Do More Harm Than Good. JAMA Intern Med 2021; 181:588-589. [PMID: 33720278 DOI: 10.1001/jamainternmed.2021.0161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anand R Habib
- Department of Medicine, University of California, San Francisco, San Francisco.,Editorial Fellow, JAMA Internal Medicine
| | - Deborah Grady
- Department of Epidemiology, University of California, San Francisco, San Francisco.,Clinical and Translational Science Institute, University of California, San Francisco, San Francisco.,Women's Health Clinical Research Center, University of California, San Francisco, San Francisco.,Deputy Editor, JAMA Internal Medicine
| | - Rita F Redberg
- Department of Cardiology, University of California, San Francisco, San Francisco.,Editor, JAMA Internal Medicine
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21
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[Intelligent early prostate cancer detection in 2021: more benefit than harm]. Urologe A 2021; 60:602-609. [PMID: 33881554 DOI: 10.1007/s00120-021-01519-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Prostate-specific antigen (PSA) is used for early detection of prostate cancer which represents the most frequent cancer diagnosed in men in Germany and Europe. Results of the largest screening trials revealed that PSA testing reduces the incidence of locally advanced and metastatic prostate cancer and shows an effect on cancer-specific mortality. However, since early diagnosis also results in overdiagnosis and overtreatment of insignificant cancers with associated morbidities, there is a need for a more individualized and risk-tailored modern strategy. The PSA at baseline is an important part of this strategy although the German Federal Joint Committee declined its financial coverage by health insurances. Available validated instruments should accompany the baseline PSA to optimize detection of clinically significant prostate cancer.
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22
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Esmaeili M, Ayyoubzadeh SM, Javanmard Z, R Niakan Kalhori S. A systematic review of decision aids for mammography screening: Focus on outcomes and characteristics. Int J Med Inform 2021; 149:104406. [PMID: 33640838 DOI: 10.1016/j.ijmedinf.2021.104406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE Decision Aid systems (DAs) provide information on the pros and cons of mammography. This study aimed to review the research on mammography DAs, synthesize the findings related to their outcomes and characteristics, and address the existed research gap. METHODS Relevant studies were identified through a comprehensive search on some e-databases, including PubMed, EMBASE, Scopus, and Web of Science in August 2020; by searching the keywords of "Breast cancer", "Screening", and "Decision aid systems" as well as their synonyms in the titles and abstracts of the papers with no time limits. Among the selected English journal papers with the interventional study design, those measuring outcome values of using mammography DAs were recognized as eligible for being included in this review. RESULTS The systematic search results in 16 DAs regarding mammography that were designed and then evaluated from 18 selected studies. The results showed that DAs provide improvements in knowledge and informed choice, the decreased decisional conflicts and decisional confidence, almost without changing any attitude towards mammography, mammography participation rates, psychological issues, anticipated regret, and perceived risk of breast cancer. The DAs' effects on women's inclination to screening were divergent. In other words, the DAs affect individuals' inclination in rare cases; however, on occasion, they could affect women's decision to undergo screening. CONCLUSION DAs could correct the bias attached to the existing knowledge on mammography and breast cancer in women so that they are more likely to make a precise decision. Additionally, it might be of central importance in shared decision-making and assisting health providers, in order to promote the quality of care. Accordingly, performing more studies is needed to develop more professional DAs in various countries with different facilities, cultures, and languages.
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Affiliation(s)
- Marzieh Esmaeili
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohammad Ayyoubzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zohreh Javanmard
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Information Technology, Ferdows School of Paramedical and Health, Birjand University of Medical Sciences, Birjand, Iran.
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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23
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Shin HJ, Lee SH, Park VY, Yoon JH, Kang BJ, Yun BL, Kim TH, Ko ES, Han BK, Chu AJ, Park SY, Kim HH, Moon WK. Diffusion-Weighted Magnetic Resonance Imaging for Breast Cancer Screening in High-Risk Women: Design and Imaging Protocol of a Prospective Multicenter Study in Korea. J Breast Cancer 2021; 24:218-228. [PMID: 33913277 PMCID: PMC8090809 DOI: 10.4048/jbc.2021.24.e19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Interest in unenhanced magnetic resonance imaging (MRI) screening for breast cancer is growing due to concerns about gadolinium deposition in the brain and the high cost of contrast-enhanced MRI. The purpose of this report is to describe the protocol of the Diffusion-Weighted Magnetic Resonance Imaging Screening Trial (DWIST), which is a prospective, multicenter, intraindividual comparative cohort study designed to compare the performance of mammography, ultrasonography, dynamic contrast-enhanced (DCE) MRI, and diffusion-weighted (DW) MRI screening in women at high risk of developing breast cancer. Methods A total of 890 women with BRCA mutation or family history of breast cancer and lifetime risk ≥ 20% are enrolled. The participants undergo 2 annual breast screenings with digital mammography, ultrasonography, DCE MRI, and DW MRI at 3.0 T. Images are independently interpreted by trained radiologists. The reference standard is a combination of pathology and 12-month follow-up. Each image modality and their combination will be compared in terms of sensitivity, specificity, accuracy, positive predictive value, rate of invasive cancer detection, abnormal interpretation rate, and characteristics of detected cancers. The first participant was enrolled in April 2019. At the time of manuscript submission, 5 academic medical centers in South Korea are actively enrolling eligible women and a total of 235 women have undergone the first round of screening. Completion of enrollment is expected in 2022 and the results of the study are expected to be published in 2026. Discussion DWIST is the first prospective multicenter study to compare the performance of DW MRI and conventional imaging modalities for breast cancer screening in high-risk women. DWIST is currently in the patient enrollment phase. Trial Registration ClinicalTrials.gov Identifier: NCT03835897
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Affiliation(s)
- Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Vivian Youngjean Park
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Seoul, Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Korea
| | - Tae Hee Kim
- Department of Radiology, Ajou University Medical Center, Suwon, Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul, Korea
| | - Boo Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul, Korea
| | - A Jung Chu
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
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24
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Agustsson AS, Birgisson H, Agnarsson BA, Jonsson T, Stefansdottir H, Wärnberg F, Lambe M, Tryggvadottir L, Sverrisdottir A. In situ breast cancer incidence patterns in Iceland and differences in ductal carcinoma in situ treatment compared to Sweden. Sci Rep 2020; 10:17623. [PMID: 33077767 PMCID: PMC7572374 DOI: 10.1038/s41598-020-74134-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 09/22/2020] [Indexed: 01/12/2023] Open
Abstract
The purpose was to review the incidence of in situ carcinoma in Iceland after initiating population-based mammography screening in 1987 and to compare management of ductal carcinoma in situ (DCIS) between Iceland and the Uppsala-Örebro region (UÖR) in Central Sweden. The Icelandic Cancer Registry provided data on in situ breast carcinomas for women between 1957 and 2017. Clinical data for women with DCIS between 2008 and 2014 was extracted from hospital records and compared to women diagnosed in UÖR. In Iceland, in situ carcinoma incidence increased from 7 to 30 per 100 000 women per year, following the introduction of organised mammography screening. The proportion of in situ carcinoma of all breast carcinomas increased from 4 to 12%. More than one third (35%) of women diagnosed with DCIS in Iceland were older than 70 years versus 18% in UÖR. In Iceland, 49% of all DCIS women underwent mastectomy compared to 40% in UÖR. The incidence of in situ carcinoma in Iceland increased four-fold after the uptake of population-based mammography screening causing considerable risk of overtreatment. Differences in treatment of DCIS were seen between Iceland and UÖR, revealing the importance of quality registration for monitoring patterns of management.
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Affiliation(s)
| | - Helgi Birgisson
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavík, Iceland
| | - Bjarni A Agnarsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Landspitali, The National University Hospital of Iceland, Reykjavík, Iceland
| | - Thorvaldur Jonsson
- Landspitali, The National University Hospital of Iceland, Reykjavík, Iceland
| | | | | | - Mats Lambe
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadottir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavík, Iceland
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25
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Tan PS, Ali MA, Eriksson M, Hall P, Humphreys K, Czene K. Mammography features for early markers of aggressive breast cancer subtypes and tumor characteristics: A population-based cohort study. Int J Cancer 2020; 148:1351-1359. [PMID: 32976625 PMCID: PMC7891615 DOI: 10.1002/ijc.33309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
Current breast cancer risk models identify mostly less aggressive tumors, although only women developing fatal breast cancer will greatly benefit from early identification. Here, we evaluated the use of mammography features (microcalcification clusters, computer-generated Breast Imaging Reporting and Data System [cBIRADS] density and lack of breast density reduction) as early markers of aggressive subtypes and tumor characteristics. Mammograms were retrieved from a population-based cohort of women that were diagnosed with breast cancer from 2001 to 2008 in Stockholm-Gotland County, Sweden. Tumor and patient characteristics were obtained from Stockholm Breast Cancer Quality Register and the Swedish Cancer Registry. Multinomial logistic regression was used to individually model each mammographic feature as a function of molecular subtypes, tumor characteristics and detection mode. A total of 4546 women with invasive breast cancer were included in the study. Women with microcalcification clusters in the affected breast were more likely to have human epidermal growth factor receptor 2 subtype (odds ratio [OR] 1.78; 95% confidence interval [CI] 1.24-2.54) and potentially less likely to have basal subtype (OR 0.54; 0.30-0.96) compared to Luminal A subtype. High mammographic cBIRADS showed association with larger tumor size and interval vs screen-detected cancers. Lack of density reduction was associated with interval vs screen-detected cancers (OR 1.43; 1.11-1.83) and potentially of Luminal B subtype vs Luminal A subtype (OR 1.76; 1.04-2.99). In conclusion, microcalcification clusters, cBIRADS density and lack of breast density reduction could serve as early markers of particular subtypes and tumor characteristics of breast cancer. This information has the potential to be integrated into risk models to identify women at risk for developing aggressive breast cancer in need of supplemental screening.
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Affiliation(s)
- Pui San Tan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Maya Alsheh Ali
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.,Swedish eScience Research Centre (SeRC), Karolinska Institute, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.,Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.,Swedish eScience Research Centre (SeRC), Karolinska Institute, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
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Breast cancer mortality and overdiagnosis after implementation of population-based screening in Denmark. Breast Cancer Res Treat 2020; 184:891-899. [PMID: 32862304 PMCID: PMC7655583 DOI: 10.1007/s10549-020-05896-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/18/2020] [Indexed: 11/04/2022]
Abstract
Introduction Service breast cancer screening is difficult to evaluate because there is no unscreened control group. Due to a natural experiment, where 20% of women were offered screening in two regions up to 17 years before other women, Denmark is in a unique position. We utilized this opportunity to assess outcome of service screening. Materials and methods Screening was offered in Copenhagen from 1991 and Funen from 1993 to women aged 50–69 years. We used difference-in-differences methodology with a study group offered screening; a historical control group; a regional control group; and a regional–historical control group, comparing breast cancer mortality and incidence, including ductal carcinoma in situ, between study and historical control group adjusted for changes in other regions, and calculating ratios of rate ratios (RRR) with 95% confidence intervals (CI). Data came from Central Population Register; mammography screening databases; Cause of Death Register; and Danish Cancer Register. Results For breast cancer mortality, the study group accumulated 1,551,465 person-years and 911 deaths. Long-term breast cancer mortality in Copenhagen was 20% below expected in absence of screening; RRR 0.80 (95% CI 0.71–0.90), and in Funen 22% below; RRR 0.78 (95% CI 0.68–0.89). Combined, cumulative breast cancer incidence in women followed 8+ years post-screening was 2.3% above expected in absence of screening; RRR 1.023 (95% CI 0.97–1.08). Discussion Benefit-to-harm ratio of the two Danish screening programs was 2.6 saved breast cancer deaths per overdiagnosed case. Screening can affect only breast cancers diagnosed in screening age. Due to high breast cancer incidence after age 70, only one-third of breast cancer deaths after age 50 could potentially be affected by screening. Increasing upper age limit could be considered, but might affect benefit-to-harm ratio negatively.
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Cancer Screening Among Older Adults: a Geriatrician's Perspective on Breast, Cervical, Colon, Prostate, and Lung Cancer Screening. Curr Oncol Rep 2020; 22:108. [PMID: 32803486 DOI: 10.1007/s11912-020-00968-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We summarize the evidence of benefits, harms, and tools to assist in individualized decisions among older adults in screening for breast, prostate, colon, lung, and cervical cancer. RECENT FINDINGS The benefits of cancer screening in older adults remain unclear due to minimal inclusion of adults > 75 years old in most randomized controlled trials. Indirect evidence suggests that the benefits of screening seen in younger adults (< 70 years old) can be extrapolated to older adults when they have an estimated life expectancy of at least 10 years. However, older adults, especially those with limited life expectancy, may be at increased risk for experiencing harms of screening, including overdiagnosis of clinically unimportant diseases, complications from diagnostic procedures, and distress after false positive test results. We provide a framework to integrate key factors such as health status, risks and benefits of specific tests, and patient preferences to guide clinicians in cancer screening decisions in older adults.
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28
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Gupta P, Gupta M, Koul N. Overdiagnosis and overtreatment; how to deal with too much medicine. J Family Med Prim Care 2020; 9:3815-3819. [PMID: 33110773 PMCID: PMC7586591 DOI: 10.4103/jfmpc.jfmpc_433_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/25/2020] [Accepted: 05/18/2020] [Indexed: 12/26/2022] Open
Abstract
The past few decades have seen medical science making rapid strides in the field of diagnostic technologies, thus making it possible to detect some conditions at a very early stage. An unwanted effect of these developments is overdiagnosis which occurs when a true abnormality is discovered, but detection of that abnormality and its treatment does not benefit the patient. Overdiagnosis is encountered as a result cancer screening, in genetic diseases and in some chronic conditions when disease definition is broadened. There is urgent need of development of evidence based decision-making tools for clinicians which will help patients understand the benefits and harms of different screening and treatment methods. And the treating physician has to play a important role to convince the patient that watchful waiting, for some of the lesions may be the best option available in some circumstances.
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Affiliation(s)
- Puneeta Gupta
- Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, J&K, India
| | - Meeta Gupta
- Department of Obstetrics and Gynaecology, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, J&K, India
| | - Neeraj Koul
- Department of Surgery, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, J&K, India
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29
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Autier P, Sullivan R. Population Screening for Cancer in High-Income Settings: Lessons for Low- and Middle-Income Economies. J Glob Oncol 2020; 5:1-5. [PMID: 30715958 PMCID: PMC6426516 DOI: 10.1200/jgo.18.00235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at International Prevention Research Institute, Ecully, Lyon, France.,International Prevention Research Institute, Lyon, France
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30
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Hou H, Lyu Y, Jiang J, Wang M, Zhang R, Liew CC, Wang B, Cheng C. Peripheral blood transcriptome identifies high-risk benign and malignant breast lesions. PLoS One 2020; 15:e0233713. [PMID: 32497068 PMCID: PMC7272048 DOI: 10.1371/journal.pone.0233713] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/11/2020] [Indexed: 01/22/2023] Open
Abstract
Background Peripheral blood transcriptome profiling is a potentially important tool for disease detection. We utilize this technique in a case-control study to identify candidate transcriptomic biomarkers able to differentiate women with breast lesions from normal controls. Methods Whole blood samples were collected from 50 women with high-risk breast lesions, 57 with breast cancers and 44 controls (151 samples). Blood gene expression profiling was carried out using microarray hybridization. We identified blood gene expression signatures using AdaBoost, and constructed a predictive model differentiating breast lesions from controls. Model performance was then characterized by AUC sensitivity, specificity and accuracy. Biomarker biological processes and functions were analyzed for clues to the pathogenesis of breast lesions. Results Ten gene biomarkers were identified (YWHAQ, BCLAF1, WSB1, PBX2, DDIT4, LUC7L3, FKBP1A, APP, HERC2P2, FAM126B). A ten-gene panel predictive model showed discriminatory power in the test set (sensitivity: 100%, specificity: 84.2%, accuracy: 93.5%, AUC: 0.99). These biomarkers were involved in apoptosis, TGF-beta signaling, adaptive immune system regulation, gene transcription and post-transcriptional protein modification. Conclusion A promising method for the detection of breast lesions is reported. This study also sheds light on breast cancer/immune system interactions, providing clues to new targets for breast cancer immune therapy.
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Affiliation(s)
- Hong Hou
- Qingdao Central Hospital/Qingdao Cancer Hospital, Qingdao, Shandong Province, People’s Republic of China
| | - Yali Lyu
- Huaxia Bangfu Technology Incorporated, Beijing, People’s Republic of China
| | - Jing Jiang
- Qingdao Lianchi Maternity and Infant Hospital, Qingdao, Shandong Province, People’s Republic of China
| | - Min Wang
- Huaxia Bangfu Technology Incorporated, Beijing, People’s Republic of China
| | - Ruirui Zhang
- Huaxia Bangfu Technology Incorporated, Beijing, People’s Republic of China
| | - Choong-Chin Liew
- Golden Health Diagnostics Incorporated, Jiangsu, People’s Republic of China
- Late of Department of Clinical Pathology and Laboratory Medicine, University of Toronto, Canada
- Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Binggao Wang
- Qingdao Central Hospital/Qingdao Cancer Hospital, Qingdao, Shandong Province, People’s Republic of China
- * E-mail: (BW); (CC)
| | - Changming Cheng
- Huaxia Bangfu Technology Incorporated, Beijing, People’s Republic of China
- * E-mail: (BW); (CC)
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31
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Yang L, Wang S, Zhang L, Sheng C, Song F, Wang P, Huang Y. Performance of ultrasonography screening for breast cancer: a systematic review and meta-analysis. BMC Cancer 2020; 20:499. [PMID: 32487106 PMCID: PMC7268243 DOI: 10.1186/s12885-020-06992-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 05/21/2020] [Indexed: 01/04/2023] Open
Abstract
Background To investigate the performance of primary ultrasound (P-US) screening for breast cancer, and that of supplemental ultrasound (S-US) screening for breast cancer after negative mammography (MAM). Methods Electronic databases (PubMed, Scopus, Web of Science, and Embase) were systematically searched to identify relevant studies published between January 2003 and May 2018. Only high-quality or fair-quality studies reporting any of the following performance values for P-US or S-US screening were included: sensitivity, specificity, cancer detected rate (CDR), recall rate (RR), biopsy rate (BR), proportion of invasive cancers among screening-detected cancers (ProIC), and proportion of node-negative cancers among screening-detected invasive cancers (ProNNIC). Results Twenty-three studies were included, including 12 studies in which S-US screening was used after negative MAM and 11 joint screening studies in which both primary MAM (P-MAM) and P-US were used. Meta-analyses revealed that S-US screening could detect 96% [95% confidential intervals (CIs): 82 to 99%] of occult breast cancers missed by MAM and identify 93% (95% CIs: 89 to 96%) of healthy women, with a CDR of 3.0/1000 (95% CIs: 1.8/1000 to 4.6/1000), RR of 8.8% (95% CIs: 5.0 to 13.4%), BR of 3.9% (95% CIs: 2.7 to 5.4%), ProIC of 73.9% (95% CIs: 49.0 to 93.7%), and ProNNIC of 70.9% (95% CIs: 46.0 to 91.6%). Compared with P-MAM screening, P-US screening led to the recall of significantly more women with positive screening results [1.5% (95% CIs:0.6 to 2.3%), P = 0.001] and detected significantly more invasive cancers [16.3% (95% CIs: 10.6 to 22.1%), P < 0.001]. However, there were no significant differences for other performance measures between the two screening methods, including sensitivity, specificity, CDR, BR, and ProNNIC. Conclusions Current evidence suggests that S-US screening could detect occult breast cancers missed by MAM. P-US screening has shown to be comparable to P-MAM screening in women with dense breasts in terms of sensitivity, specificity, cancer detection rate, and biopsy rate, but with higher recall rates and higher detection rates for invasive cancers.
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Affiliation(s)
- Lei Yang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Shengfeng Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Liwen Zhang
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Key Laboratory of Breast Cancer Prevention and Therapy (National Ministry of Education), Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Chao Sheng
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Key Laboratory of Breast Cancer Prevention and Therapy (National Ministry of Education), Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Fengju Song
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Key Laboratory of Breast Cancer Prevention and Therapy (National Ministry of Education), Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Ping Wang
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Key Laboratory of Breast Cancer Prevention and Therapy (National Ministry of Education), Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Yubei Huang
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Key Laboratory of Breast Cancer Prevention and Therapy (National Ministry of Education), Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China. .,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.
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32
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Kopans DB, Biggs KW, Pyatt RS, Smetherman D, Friedberg EB. The State of Breast Cancer Screening Guidelines: A Question and Answer Summary. J Am Coll Radiol 2020; 17:629-632. [DOI: 10.1016/j.jacr.2019.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 10/24/2022]
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33
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Zahl PH, Kalager M, Suhrke P, Nord E. Quality-of-life effects of screening mammography in Norway. Int J Cancer 2020; 146:2104-2112. [PMID: 31254388 DOI: 10.1002/ijc.32539] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022]
Abstract
Mammography screening may save women from dying of breast cancer, although it has not been shown to reduce all-cause mortality. Screening also leads to overdiagnosis and many false positive mammograms aggravating women's quality-of-life. Quality adjusted life years (QALY) analyses of mammography screening have so far, calculated life years gained assuming that all prevented breast cancer deaths translate into a reduction in all-cause mortality. We calculated net QALYs in two hypothesized cohorts of 100,000 Norwegian women; one screened biennially from age 50 to 69 years and one not screened. We followed both cohorts to age 85 years. We used EQ-5D and an alternative equity weighted QALY instrument to estimate utility losses. In the screening cohort, we assumed 20% false positive tests during screening, different levels of overdiagnosis (20-75%) and different levels of breast cancer mortality reduction (10-30%). We assumed that reductions in breast cancer mortality only to a limited extent (20, 50 or 80%), resulted in reductions in all-cause mortality. We calculated both undiscounted and discounted (4%) QALYs. Assuming that 50% of the reduction in breast cancer mortality translated to a reduction in all-cause mortality and using estimated levels of benefits and harms in modern screening programs (50-75% overdiagnosis and 10% reduction in breast cancer mortality), undiscounted equity weighted QALY loss varied from 437 to 875 per 100,000 women. Using the levels of benefit and harms as reported in 30-40 years old randomized trials (30% overdiagnosis and 15% reduction in breast cancer mortality), undiscounted equity weighted QALY gain was 535 per 100,000. Net QALY in modern mammography screening in Norway is negative. Results could also be representative for Sweden, Denmark, UK and the US.
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Affiliation(s)
| | - Mette Kalager
- Department of Research, Telemark Hospital, Skien, Norway.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Pål Suhrke
- Department of Pathology, Oslo University Hospital, Oslo, Norway.,Department of Pathology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Erik Nord
- Norwegian Institute of Public Health, Oslo, Norway
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34
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Yang L, Wang S, Huang Y. An exploration for quantification of overdiagnosis and its effect for breast cancer screening. Chin J Cancer Res 2020; 32:26-35. [PMID: 32194302 PMCID: PMC7072016 DOI: 10.21147/j.issn.1000-9604.2020.01.04] [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] [Indexed: 12/02/2022] Open
Abstract
Objective To redefine overdiagnosis and reestimate the proportion of overdiagnosis of breast cancer caused by screening based on the Surveillance, Epidemiology, and End Results (SEER, 1973−2015) Program data. Methods The breast cancer diagnosed before 1977 was defined as the no-screening cohort since America had initiated breast cancer screening from 1977. The breast cancer diagnosed in 1999 was defined as the screening cohort due to no increases in both the proportion of early-stage breast cancer until 1999 and the overall survival of early-stage breast cancer diagnosed over the three years since 1999. The magnitude of overdiagnosis was calculated as the difference in the proportions of early-stage breast cancer patients with long-time (15-year) survival to all breast cancer patients between two cohorts. Results Over 23 years before and after widespread screening in America, the proportion of early-stage breast cancer patients increased from 52.1% (16,891/32,443) to 72.7% (16,021/22,025) (P<0.001). The 15-year survival rate of early-stage breast cancer patients increased from 51.1% to 61.5% (P<0.001), while the proportions of early-stage breast cancer patients with long-time survival to all breast cancer patients increased from 26.6% (52.1%×51.1%) to 44.7% (72.7%×61.5%). Assuming no improvements in cancer screening technology and treatment technology, 18.1% (44.7%−26.6%) of breast cancer patients were overdiagnosed associated with screening. The age-specific overdiagnosis rates were 18.9%, 24.7%, 24.5%, 20.5%, and 8.3% for breast cancer patients aged 40−49, 50−59, 60−69, 70−74, and ≥75 years old, respectively. Conclusions Overdiagnosis caused by mammographic screening is probably overestimated in current screening practices. Further trials with more sophisticated designs and analyses are needed to validate our findings in the future.
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Affiliation(s)
- Lei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shengfeng Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Yubei Huang
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
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35
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When Is an Effect Size Too Small? Response to Commentary on “Pay-for-Performance and Employee Mental Health”. ACADEMY OF MANAGEMENT DISCOVERIES 2020. [DOI: 10.5465/amd.2019.0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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36
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Taylor-Phillips S, Stinton C. Double reading in breast cancer screening: considerations for policy-making. Br J Radiol 2020; 93:20190610. [PMID: 31617741 PMCID: PMC7055445 DOI: 10.1259/bjr.20190610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 01/04/2023] Open
Abstract
In this article, we explore the evidence around the relative benefits and harms of breast cancer screening using a single radiologist to examine each female's mammograms for signs of cancer (single reading), or two radiologists (double reading). First, we briefly explore the historical evidence using film-screen mammography, before providing an in-depth description of evidence using digital mammography. We classify studies according to which exact version of double reading they use, because the evidence suggests that effectiveness of double reading is contingent on whether the two radiologists are blinded to one another's decisions, and how the decisions of the two radiologists are integrated. Finally, we explore the implications for future mammography, including using artificial intelligence as the second reader, and applications to more complex three-dimensional imaging techniques such as tomosynthesis.
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Affiliation(s)
| | - Chris Stinton
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
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37
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Zahl PH, Kalager M. Reply to: Loss of QALY in mammography screening reported by Zahl et al. Int J Cancer 2019; 146:1177. [PMID: 31652342 DOI: 10.1002/ijc.32755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | - Mette Kalager
- Department of Research, Telemark Hospital, Skien, Norway.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Epidemiology, Harvard School of Public Health, Boston, MA
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38
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Qiu C, Wang P, Wang B, Shi J, Wang X, Li T, Qin J, Dai L, Ye H, Zhang J. Establishment and validation of an immunodiagnostic model for prediction of breast cancer. Oncoimmunology 2019; 9:1682382. [PMID: 32002291 PMCID: PMC6959442 DOI: 10.1080/2162402x.2019.1682382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/25/2019] [Accepted: 10/14/2019] [Indexed: 02/07/2023] Open
Abstract
Serum autoantibodies that react with tumor-associated antigens (TAAs) can be used as potential biomarkers for diagnosis of cancer. This study aims to evaluate the immunodiagnostic value of 11 anti-TAAs autoantibodies for detection of breast cancer (BC) and establish a diagnostic model for distinguishing BC from normal human controls (NHC) and benign breast diseases (BBD). Sera from 10 BC patients and 10 NHC were used to detect 11 anti-TAAs autoantibodies by western blotting. The 11 anti-TAAs autoantibodies were further assessed in 983 sera by relative quantitative enzyme-linked immunosorbent assay (ELISA). Binary logistic regression and Fisher linear discriminant analysis were conducted to establish a prediction model by using 184 BC and 184 NHC (training cohort, n = 568) and validated by leave-one-out cross-validation. Logistic regression model was selected to establish the prediction model. Results were validated using an independent validation cohort (n = 415). The five anti-TAAs (p53, cyclinB1, p16, p62, 14-3-3ξ) autoantibodies were selected to construct the model with the area under the curve (AUC) of 0.943 (95% CI, 0.919–0.967) in training cohort and 0.916 (95% CI, 0.886–0.947) in the validation cohort. In the identification of BC and BBD, AUCs were 0.881 (95% CI, 0.848–0.914) and 0.849 (95% CI, 0.803–0.894) in training and validation cohort, respectively. In summary, our study indicates that the immunodiagnostic model can distinguish BC from NHC and BC from BBD and this model may have a potential application in immunodiagnosis of breast cancer.
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Affiliation(s)
- Cuipeng Qiu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.,College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China
| | - Peng Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.,College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China
| | - Bofei Wang
- College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China
| | - Jianxiang Shi
- College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China.,Henan Academy of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiao Wang
- College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China.,Henan Academy of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Tiandong Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.,College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China
| | - Jiejie Qin
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.,College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China
| | - Liping Dai
- College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China.,Henan Academy of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Hua Ye
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.,College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China
| | - Jianying Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.,College of Public Health, Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, China.,Henan Academy of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
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Klarenbach S, Sims-Jones N, Lewin G, Singh H, Thériault G, Tonelli M, Doull M, Courage S, Garcia AJ, Thombs BD. Recommendations on screening for breast cancer in women aged 40-74 years who are not at increased risk for breast cancer. CMAJ 2019; 190:E1441-E1451. [PMID: 30530611 DOI: 10.1503/cmaj.180463] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Scott Klarenbach
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
| | - Nicki Sims-Jones
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
| | - Gabriela Lewin
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
| | - Harminder Singh
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
| | - Guylène Thériault
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
| | - Marcello Tonelli
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
| | - Marion Doull
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
| | - Susan Courage
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
| | - Alejandra Jaramillo Garcia
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
| | - Brett D Thombs
- Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que
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Yang K, Zeng L, Ge A, Chen Z, Bao T, Long Z, Ge J, Huang L. Investigating the regulation mechanism of baicalin on triple negative breast cancer's biological network by a systematic biological strategy. Biomed Pharmacother 2019; 118:109253. [PMID: 31545288 DOI: 10.1016/j.biopha.2019.109253] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the regulation mechanism of baicalin on triple negative breast cancer (TNBC)'s biological network by a systematic biological strategy and cytology experiment. METHODS A systematic biological methodology is utilized to predict the potential targets of baicalin, collect the genes of TNBC, and analyze the TNBC and baicalin's network. After the systematic biological analysis is performed, the cytology experiment, real-time quantitative PCR (qPCR) is used to validate the key biological processes and signaling pathways. RESULTS After systematic biological analysis, two networks were constructed and analyzed: (1) TNBC network; (2) Baicalin-TNBC protein-protein interaction (PPI) network. Several TNBC-related, treatment-related targets, clusters, signaling pathways and biological processes were found. Cytology experiment shows that baicalin can inhibit the proliferation, migration and invasion of breast cancer MDA-MB-231 cells in vitro (P < 0.05). The results of qPCR showed that baicalin increase the expression of E-cadherin mRNA, and decrease the expression of vimentin, β-catenin, c-Myc and MMP-7 mRNA in LPS-induced breast cancer MDA-MB-231 cells (P < 0.05). CONCLUSION Baicalin may achieve anti-tumor effects through regulating the targets, biological processes and pathways found in this research.
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Affiliation(s)
- Kailin Yang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; Capital Medical University, Beijing, China
| | - Liuting Zeng
- Hunan University of Chinese Medicine, Changsha, Hunan Province, China.
| | - Anqi Ge
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Zhouhua Chen
- The Second People's Hospital of Xiangtan City, Xiangtan, Hunan Province, China
| | - Tingting Bao
- Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyong Long
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Jinwen Ge
- Hunan University of Chinese Medicine, Changsha, Hunan Province, China.
| | - Lizhong Huang
- Hunan University of Chinese Medicine, Changsha, Hunan Province, China.
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41
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Steponaviciene L, Briediene R, Vanseviciute R, Smailyte G. Trends in Breast Cancer Incidence and Stage Distribution Before and During the Introduction of the Mammography Screening Program in Lithuania. Cancer Control 2019; 26:1073274818821096. [PMID: 30808202 PMCID: PMC6327347 DOI: 10.1177/1073274818821096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to analyze the incidence trends of localized and advanced breast cancer (BC) before and during the implementation of the mammography screening program (MSP) in Lithuania. Methods: The study period was divided into 2 intervals: the prescreening period (1998-2005) and implementation period (2006-2012). Analysis was performed for 3 age-groups: 0 to 49 years, 50 to 69 (target population), and older than 70. Results: In all age-groups, the incidence of localized BC has shown a steady increase, while the incidence of advanced stage BC has decreased. In the target population, during the study period, the stage I BC incidence increased statistically significantly by 10.3% per year (from 3.3 per 100 000 in 1998 to 12.2 per 100 000 in 2012). The increase in localized BC was faster in the period before the implementation of the MSP than during the implementation in 2006 to 2012 (10.3% and 5.7%). A slightly statistically significant decrease was observed for advanced BC during the study period (−1.1% per year), while during the implementation of the MSP, significant changes were not seen. Conclusions: The results of our study indicate that the implementation of the MSP in Lithuania did not significantly influence trends of localized and advanced BC. Changes observed during the study period, including the prescreening and screening introduction periods, may reflect the general trends in the awareness of BC and improvements in diagnostics.
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Affiliation(s)
- Laura Steponaviciene
- 1 Laboratory of cancer epidemiology, National Cancer Institute, Vilnius, Lithuania.,2 Department of Public Health, Institute of Health Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Ruta Briediene
- 3 Department of Radiology, National Cancer Institute, Vilnius, Lithuania.,4 Department of Radiology, Medical Physics and Nuclear Medicine, Vilnius University, Vilnius, Lithuania
| | - Rasa Vanseviciute
- 5 Department of Consulting Clinic, National Cancer Institute, Vilnius, Lithuania
| | - Giedre Smailyte
- 1 Laboratory of cancer epidemiology, National Cancer Institute, Vilnius, Lithuania.,2 Department of Public Health, Institute of Health Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
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42
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Waheed KB, Hassan MZU, Hassan DA, Shamrani AAGA, Bassam MA, Elbyali AA, Shams TM, Demiati ZA, Arulanatham ZJ. Breast cancers missed during screening in a tertiary-care hospital mammography facility. Ann Saudi Med 2019; 39:236-243. [PMID: 31381361 PMCID: PMC6838646 DOI: 10.5144/0256-4947.2019.236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in females worldwide. Screening with mammography for early breast cancer detection is standard community practice in many countries. OBJECTIVE Identify causes of missed breast cancers during screening. DESIGN Retrospective, observational. SETTING Department of radiology at a tertiary-care hospital mammographic screening facility. PATIENTS AND METHODS All women who came with initial negative screens from July 2015 to July 2018 were retrospectively reviewed and followed-up for their second or subsequent mammographic screening. Missed breast cancer was defined as a cancer that was detected on a subsequent mammogram with an initial negative screen. Mammograms were interpreted by two radiologists as per BIRADS (Breast Imaging Reporting and Data System) lexicon. Causes of missed breast cancers were categorized as imaging acquisition (IA), imaging feature (IF) and imaging interpretation (II). True (occult) incident breast cancers were also documented. Percentage estimations for these causes were calculated. MAIN OUTCOME MEASURES Breast cancer detection on follow-up screening. SAMPLE SIZE 943 women. RESULTS Of 15 (1.6%) screening-detected breast cancers, 7 cases (46.6%) were missed on the initial screen; 3 (43%) of these were II related, 2 (28.5%) of each were IA and IF. The remaining true (occult) cases were detected on either the second (5 cases) or third screens (3 cases). CONCLUSION Improved screening facilities, quality mammographic acquisition and interpretation, double reading, and implementation of an organized screening program may help to avoid missed breast cancers. LIMITATIONS Retrospective, small sample, single center, and short duration study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Khawaja Bilal Waheed
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Muhammad Zia Ul Hassan
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Donya Al Hassan
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | | | - Muneera Al Bassam
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Ahmed Aly Elbyali
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Tamer Mohamed Shams
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Zainab Ahmed Demiati
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
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43
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Chan C, Guo N, Duan X, Han W, Xue L, Bryan D, Wightman SC, Khodarev NN, Weichselbaum RR, Lin W. Systemic miRNA delivery by nontoxic nanoscale coordination polymers limits epithelial-to-mesenchymal transition and suppresses liver metastases of colorectal cancer. Biomaterials 2019; 210:94-104. [PMID: 31060867 PMCID: PMC6579118 DOI: 10.1016/j.biomaterials.2019.04.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/21/2019] [Accepted: 04/24/2019] [Indexed: 12/31/2022]
Abstract
Though early detection and treatment of primary tumors has significantly improved in recent years, metastatic disease remains among the most significant challenges in cancer therapy. Cancer cells can disseminate before the primary tumor is detected to form micro or gross metastases, requiring toxic systemic therapies. To prevent and suppress metastases, we have developed a nontoxic, long-circulating nanoscale coordination polymer (NCP) protecting microRNA (miRNA) in circulation and releasing it in tumors. PtIV(en)2 [en = ethylenediamine] containing NCPs (PtEN) can release a nontoxic, kinetically inert PtII(en)2 compound and carbon dioxide which aids the endosomal escape of its miRNA cargo, miR-655-3p. Without the presence of the PtEN core, the miRNA showed cellular uptake but no effect. When transfected into human colorectal HCT116 cells by NCPs, this oligometastatic miRNA limited proliferation and epithelial-to-mesenchymal transition by preventing β-catenin nuclear translocation and tumor cell invasion. Systemic administrations of PtEN/miR-655-3p sustained effective transfection to reduce liver colonization and tumor burden in a xenogenic hepatic metastatic model of HCT116 without any observable toxicity.
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Affiliation(s)
- Christina Chan
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA
| | - Nining Guo
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA; Department of Radiation and Cellular Oncology and the Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL, 60637, USA
| | - Xiaopin Duan
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA
| | - Wenbo Han
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA
| | - Lai Xue
- Department of Surgery, The University of Chicago, Chicago, IL, 60637, USA
| | - Darren Bryan
- Department of Surgery, The University of Chicago, Chicago, IL, 60637, USA
| | - Sean C Wightman
- Department of Surgery, The University of Chicago, Chicago, IL, 60637, USA
| | - Nikolai N Khodarev
- Department of Radiation and Cellular Oncology and the Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL, 60637, USA
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology and the Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL, 60637, USA.
| | - Wenbin Lin
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA; Department of Radiation and Cellular Oncology and the Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL, 60637, USA.
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Lefeuvre D, Catajar N, Le Bihan Benjamin C, Ifrah N, De Bels F, Viguier J, Bousquet PJ. Breast cancer screening: Impact on care pathways. Cancer Med 2019; 8:4070-4078. [PMID: 31172693 PMCID: PMC6639186 DOI: 10.1002/cam4.2283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/01/2019] [Accepted: 05/06/2019] [Indexed: 02/03/2023] Open
Abstract
Background Controversy persists concerning screening programs (SPs), related to a potential risk of overdiagnosis or the impact on survival. One of the main questions to be addressed concerns the aggressiveness of the related treatments. Methods Using the "Cancer Cohort,” a national‐based cohort (medico‐administrative database), all women between the ages of 50 and 74 years and treated in 2014 for incident breast cancer were compared, according to whether their diagnosis was made following a mammogram performed within the framework of the SP (SP group) or outside it (NSP group). Results A total of 23 788 women were identified: 13 530 (57%) in the SP group and 10 258 (43%) in the NSP group. The women in the SP group had a higher rate of in situ or localized invasive breast cancer. They had a higher rate of breast‐conserving surgery (82% vs 70%), and a lower rate of chemotherapy (34% vs 53%). These findings were observed irrespective of the stage. They had a higher rate of pathways involving breast‐conserving surgery followed by radiotherapy. Among women with metastatic cancer, those in the SP group had a lower proportion of liver, lung, brain, and bone metastases, and a higher proportion of lymph node metastases (other than axillary), irrespective of the time to onset of the metastases. Conclusion The women in whom cancer was diagnosed following a mammogram performed in the context of the SP had less advanced cancer and less aggressive treatments. This observational study helps illustrate the benefit of the SP in France using a different approach.
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Affiliation(s)
- Delphine Lefeuvre
- Health Data and Assessment Department, Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Nathalie Catajar
- Screening Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Christine Le Bihan Benjamin
- Health Data and Assessment Department, Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Norbert Ifrah
- Presidency, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Frédéric De Bels
- Screening Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Jérôme Viguier
- Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.,Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
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Rodrigues DCN, Freitas-Junior R, Rahal RMS, Correa RDS, Peixoto JE, Ribeiro NV, Ferreira NC, Soares LR. Difficult Access and Poor Productivity: Mammography Screening in Brazil. Asian Pac J Cancer Prev 2019; 20:1857-1864. [PMID: 31244310 PMCID: PMC7021592 DOI: 10.31557/apjcp.2019.20.6.1857] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Factors that may hamper access to mammographic screening in any given region include socioeconomic
limitations and the geographical distribution and quality of the mammography machines. This study evaluated access
to breast cancer screening within the Brazilian National Health Service (SUS), the geographical distribution of
mammography equipment and the number of mammograms performed in Brazil. Methods: This ecological study
evaluated the availability of mammography machines within the SUS, those available for Brazil as a whole, its macroregions,
states and the Federal District in 2016. The number of mammography machines required for breast cancer
screening was calculated and compared to the number of machines available. The expected number of mammograms was
compared with the actual number performed. Machines were georeferenced based on their location and the municipal
seat, according to healthcare region, with 60 km being defined as the maximum distance for an individual to travel for
a mammogram. Results: In 2016, there were 4,628 mammography machines in Brazil. Of these, 4,492 were in use
and 2,113 (47%) were available to the SUS. Considering the number of mammograms required as a function of the
number clinically indicated, 2,068 machines would be required for breast cancer screening in Brazil. The network of
machines available would be capable of producing 14,279,654 exams; however, only 4,073,079 exams were performed,
representing 29% of the total capacity of production in the country in 2016. Regarding the maximum distance of 60
km to access a mammogram, only relatively small areas of Brazil were found not to meet this indicator. Conclusion:
These results suggest that the difficulty of the Brazilian population in accessing breast cancer screening through the
SUS is not associated with the number of machines available or with the geographical location of the equipment but
rather with the insufficient number of mammograms performed.
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Affiliation(s)
- Danielle Cristina Netto Rodrigues
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Ruffo Freitas-Junior
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Rosemar Macedo Sousa Rahal
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Rosangela da Silveira Correa
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - João Emílio Peixoto
- Brazilian Network for Breast Research, Service for Quality Control in Ionizing Radiation, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Noely Vicente Ribeiro
- Institute of Social and Environmental Studies (IESA), Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Leonardo Ribeiro Soares
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
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Veron L, Gelot A, Gusto G, Arveux P, Delaloge S, Boutron‐Ruault M. Modifiable risk factors for advanced
vs
. early breast cancer in the French E3N cohort. Int J Cancer 2019; 146:850-860. [DOI: 10.1002/ijc.32354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Lucie Veron
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
- Paris‐South Saclay University Villejuif France
| | - Amandine Gelot
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
| | - Gaelle Gusto
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
| | - Patrick Arveux
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
| | | | - Marie‐Christine Boutron‐Ruault
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
- Paris‐South Saclay University Villejuif France
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48
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Seppälä TT, Ahadova A, Dominguez-Valentin M, Macrae F, Evans DG, Therkildsen C, Sampson J, Scott R, Burn J, Möslein G, Bernstein I, Holinski-Feder E, Pylvänäinen K, Renkonen-Sinisalo L, Lepistö A, Lautrup CK, Lindblom A, Plazzer JP, Winship I, Tjandra D, Katz LH, Aretz S, Hüneburg R, Holzapfel S, Heinimann K, Valle AD, Neffa F, Gluck N, de Vos Tot Nederveen Cappel WH, Vasen H, Morak M, Steinke-Lange V, Engel C, Rahner N, Schmiegel W, Vangala D, Thomas H, Green K, Lalloo F, Crosbie EJ, Hill J, Capella G, Pineda M, Navarro M, Blanco I, Ten Broeke S, Nielsen M, Ljungmann K, Nakken S, Lindor N, Frayling I, Hovig E, Sunde L, Kloor M, Mecklin JP, Kalager M, Møller P. Lack of association between screening interval and cancer stage in Lynch syndrome may be accounted for by over-diagnosis; a prospective Lynch syndrome database report. Hered Cancer Clin Pract 2019; 17:8. [PMID: 30858900 PMCID: PMC6394091 DOI: 10.1186/s13053-019-0106-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/20/2019] [Indexed: 12/11/2022] Open
Abstract
Background Recent epidemiological evidence shows that colorectal cancer (CRC) continues to occur in carriers of pathogenic mismatch repair (path_MMR) variants despite frequent colonoscopy surveillance in expert centres. This observation conflicts with the paradigm that removal of all visible polyps should prevent the vast majority of CRC in path_MMR carriers, provided the screening interval is sufficiently short and colonoscopic practice is optimal. Methods To inform the debate, we examined, in the Prospective Lynch Syndrome Database (PLSD), whether the time since last colonoscopy was associated with the pathological stage at which CRC was diagnosed during prospective surveillance. Path_MMR carriers were recruited for prospective surveillance by colonoscopy. Only variants scored by the InSiGHT Variant Interpretation Committee as class 4 and 5 (clinically actionable) were included. CRCs detected at the first planned colonoscopy, or within one year of this, were excluded as prevalent cancers. Results Stage at diagnosis and interval between last prospective surveillance colonoscopy and diagnosis were available for 209 patients with 218 CRCs, including 162 path_MLH1, 45 path_MSH2, 10 path_MSH6 and 1 path_PMS2 carriers. The numbers of cancers detected within < 1.5, 1.5–2.5, 2.5–3.5 and at > 3.5 years since last colonoscopy were 36, 93, 56 and 33, respectively. Among these, 16.7, 19.4, 9.9 and 15.1% were stage III–IV, respectively (p = 0.34). The cancers detected more than 2.5 years after the last colonoscopy were not more advanced than those diagnosed earlier (p = 0.14). Conclusions The CRC stage and interval since last colonoscopy were not correlated, which is in conflict with the accelerated adenoma-carcinoma paradigm. We have previously reported that more frequent colonoscopy is not associated with lower incidence of CRC in path_MMR carriers as was expected. In contrast, point estimates showed a higher incidence with shorter intervals between examinations, a situation that may parallel to over-diagnosis in breast cancer screening. Our findings raise the possibility that some CRCs in path_MMR carriers may spontaneously disappear: the host immune response may not only remove CRC precursor lesions in path_MMR carriers, but may remove infiltrating cancers as well. If confirmed, our suggested interpretation will have a bearing on surveillance policy for path_MMR carriers.
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Affiliation(s)
- Toni T Seppälä
- 1Department of Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS Helsinki, Finland.,2University of Helsinki, Helsinki, Finland
| | - Aysel Ahadova
- 3Heidelberg University Hospital and DKFZ, Heidelberg, Germany
| | - Mev Dominguez-Valentin
- 4Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Olso, Norway.,5Department of Medical Genetics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Finlay Macrae
- 6The Royal Melbourne Hospital, Melbourne, Australia.,7University of Melbourne, Melbourne, Australia
| | - D Gareth Evans
- 8University of Manchester & Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Christina Therkildsen
- The Danish HNPCC Register, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Rodney Scott
- University of Newcastle and the Hunter Medical Research Institute, Callaghan, Australia
| | - John Burn
- 12University of Newcastle, Newcastle upon Tyne, UK
| | | | - Inge Bernstein
- 14Dept. of Surgical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Elke Holinski-Feder
- 15Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany.,16MGZ- Medical Genetics Center, Munich, Germany
| | - Kirsi Pylvänäinen
- 17Central Finland Central Hospital, Education and Research, Jyväskylä, Finland
| | - Laura Renkonen-Sinisalo
- 1Department of Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS Helsinki, Finland
| | - Anna Lepistö
- 1Department of Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS Helsinki, Finland
| | | | | | | | - Ingrid Winship
- 6The Royal Melbourne Hospital, Melbourne, Australia.,7University of Melbourne, Melbourne, Australia
| | | | - Lior H Katz
- 20Hadassah Medical Center, Jerusalem, and Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Stefan Aretz
- 21Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Robert Hüneburg
- 22Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.,23Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | - Stefanie Holzapfel
- 22Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.,23Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | - Karl Heinimann
- 24Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Adriana Della Valle
- Hospital Fuerzas Armadas, Grupo Colaborativo Uruguayo, Investigación de Afecciones Oncológicas Hereditarias (GCU), Montevideo, Uruguay
| | - Florencia Neffa
- Hospital Fuerzas Armadas, Grupo Colaborativo Uruguayo, Investigación de Afecciones Oncológicas Hereditarias (GCU), Montevideo, Uruguay
| | - Nathan Gluck
- Tel-Aviv Soursky Medical Center, Tel-Aviv, Israel
| | | | - Hans Vasen
- 28Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Monika Morak
- 15Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany.,16MGZ- Medical Genetics Center, Munich, Germany
| | - Verena Steinke-Lange
- 15Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany.,16MGZ- Medical Genetics Center, Munich, Germany
| | - Christoph Engel
- 29Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Nils Rahner
- 30Medical School, Institute of Human Genetics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Wolff Schmiegel
- 31Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Deepak Vangala
- 31Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Huw Thomas
- 32St Mark's Hospital, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kate Green
- 8University of Manchester & Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Fiona Lalloo
- 8University of Manchester & Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Emma J Crosbie
- 33University of Manchester and St Mary's Hospital, Manchester, UK
| | - James Hill
- 8University of Manchester & Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Gabriel Capella
- Hereditary Cancer Program, Catalan Institute of Oncology, Insititut d'Investigació Biomèdica de Bellvitge (IDIBELL), ONCOBELL Program, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain
| | - Marta Pineda
- Hereditary Cancer Program, Catalan Institute of Oncology, Insititut d'Investigació Biomèdica de Bellvitge (IDIBELL), ONCOBELL Program, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain
| | - Matilde Navarro
- Hereditary Cancer Program, Catalan Institute of Oncology, Insititut d'Investigació Biomèdica de Bellvitge (IDIBELL), ONCOBELL Program, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain
| | - Ignacio Blanco
- Hereditary Cancer Program, Catalan Institute of Oncology, Insititut d'Investigació Biomèdica de Bellvitge (IDIBELL), ONCOBELL Program, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain
| | - Sanne Ten Broeke
- 36University Medical Center Groningen, Groningen, the Netherlands
| | | | - Ken Ljungmann
- 38Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Sigve Nakken
- 4Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Olso, Norway
| | - Noralane Lindor
- 39Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ USA
| | - Ian Frayling
- 10Medical Genetics, Cardiff University, Cardiff, UK
| | - Eivind Hovig
- 4Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Olso, Norway.,40Center for Bioinformatics, Department of Informatics, University of Oslo, Oslo, Norway
| | - Lone Sunde
- 41Department of Medical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Matthias Kloor
- 3Heidelberg University Hospital and DKFZ, Heidelberg, Germany
| | - Jukka-Pekka Mecklin
- 42Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.,43Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Mette Kalager
- 4Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Olso, Norway.,44University of Oslo, Oslo, Norway.,45Harvard School of Public Health, Boston, MA USA
| | - Pål Møller
- 4Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Olso, Norway.,13University Witten-Herdecke, Wuppertal, Germany.,5Department of Medical Genetics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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49
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Voskarides K. The “cancer–cold” hypothesis and possible extensions for the Nordic populations. Scand J Public Health 2019; 47:477-481. [DOI: 10.1177/1403494819831905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Cancer incidence is inexplicably high in cold countries. This has been revealed by recent genetic and epidemiological studies. These studies used data from the GLOBOCAN-2012 database, for 186 populations and for a variety of cancer types. Cancer incidence in Nordic people is particularly high for the frequent cancer forms, like breast, prostate and colon cancer. A relationship of cancer with cold is suspected since Inuit and Alaska Indians that live in even more extreme low temperatures have the higher cancer rates in the world. In this article, possible reasons for this phenomenon are discussed. These explanations are related with: evolutionary adaptation to extreme cold, the genetic background of Nordic people, the experimentally proven fast growth and metastasis of tumors at low temperatures, high concentration of certain air pollutants at cold environments, low levels of serum Vitamin D, overdiagnosis by the medical doctors and high quality of the health system in Nordic countries. Lifestyle parameters are not discussed in detail, although these may be equally crucial for cancer risk in cold countries. In conclusion, more studies are needed to elucidate the real causes of this epidemiological pattern.
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50
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Whitworth P, Schonholz S, Phillips R, Robertson Y, Ruiz A, Winchester S, Graham C, Simpson J, Wernecke C. Minimally Invasive Intact Excision of High-Risk Breast Lesions and Small Breast Cancers: The Intact Percutaneous Excision (IPEX) Registry. Ann Surg Oncol 2019; 26:954-960. [PMID: 30756327 DOI: 10.1245/s10434-019-07212-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Aiming to minimize overtreatment of high-risk breast lesions (HRLs), including atypical ductal hyperplasia, and small breast cancers, including ductal carcinoma in situ (DCIS), we investigated a minimally invasive (MI) approach to definitive diagnosis and management of these conditions. METHODS In the prospective Intact Percutaneous Excision registry study, women aged 31-86 years had removal of small invasive cancers, DCIS, or HRLs using image-guided 12-20 mm radiofrequency basket capture (MI excision). Second-pass 20 mm basket capture obtained shaved margins in cancer patients. Standard imaging (specimen, breast) and histologic criteria were applied. Patient data were registered in an Institutional Review Board approved, Health Insurance Portability and Accountability Act-compliant registry. RESULTS Of 282 registered patients, 124 had DCIS (n = 52) or invasive cancer (n = 72) and 160 had HRLs. Among cancer patients, 101 (81%) had clear histologic margins [average lesion size was 11 mm for both invasive cancers (4-20 mm) and DCIS (1.5-20 mm)]; 29 patients had re-excision (six despite clear margins). Among 160 HRLs, two were upgraded to DCIS and had MI excision. Two other HRL patients had subsequent standard surgical excision (no cancer found). CONCLUSION For diminutive HRLs, DCIS, and invasive cancers, MI excision can achieve the same procedure goals as standard surgical excision. Because MI excision removes less tissue with small incisions, it may reduce the discomfort and expense associated with standard treatment.
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Affiliation(s)
| | | | | | | | - Antonio Ruiz
- Chesapeake Regional Medical Center, Chesapeake, VA, USA
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