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Couto HL, Gargano LP, de Oliveira VM, Coelho BA, Pessoa EC, Hassan AT, Silva AL, Urban LABD, Fernandes LC, Sharma N, Mann R, McIntosh SA, Zanghelini F. Cost-Effectiveness Analysis of Digital Breast Tomosynthesis Added to Synthetic Mammography in Breast Cancer Screening in Brazil. Pharmacoecon Open 2024; 8:403-416. [PMID: 38233699 PMCID: PMC11058155 DOI: 10.1007/s41669-023-00470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Literature meta-analysis results show that digital breast tomosynthesis (DBT) combined with synthesized two-dimensional (s2D) mammograms can reduce recalls and improve breast cancer detection. Uncertainty regarding the screening of patients with breast cancer presents a health economic challenge, both in terms of healthcare resource use and quality of life impact on patients. OBJECTIVE This study aims to estimate the cost effectiveness of DBT + s2D versus digital mammography (DM) used in a biennial breast cancer screening setting of women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts in the Brazilian supplementary health system. METHODS A cost-effectiveness analysis was performed on the basis of clinical data obtained from a systematic review with meta-analysis performed to evaluate the analytical validity and clinical utility of DBT + s2D compared with DM. The search was conducted in the PubMed, Cochrane Library and Embase databases, with the main descriptors of the technology, a comparator, and the clinical condition in question, on 9 June 2022. The hybrid economic model (decision tree plus Markov model) simulated costs and outcomes over a lifetime for women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts. We analyzed incremental cost-effectiveness ratio (ICER) to measure the incremental cost difference per quality-adjusted life year (QALY) of adding DBT + s2D to breast cancer screening. RESULTS DBT + s2D incurred a cost saving of € 954.02 per patient, in the time horizon of 30 years, compared with DM, and gained 5.1989 QALYs, which would be considered a dominant intervention. These results were confirmed in sensitivity analyses. CONCLUSION Switching from DM to biennial DBT + s2D was cost effective. Furthermore, reductions in false-positive recall rates should also be considered in decision making.
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Affiliation(s)
- Henrique Lima Couto
- Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil.
- Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil.
- Redimama-Redimasto, Belo Horizonte, Minas Gerais, Brazil.
- Brazilian Society of Mastology, Av. João Pinheiro, 161-Centro, Belo Horizonte, MG, 30130-180, Brazil.
| | - Ludmila Peres Gargano
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- MAPESolutions, São Paulo, São Paulo, Brazil
| | - Vilmar Marques de Oliveira
- Brazilian Society of Mastology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil
| | - Bertha Andrade Coelho
- Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- UNIFIMOC University Center, Montes Claros, Minas Gerais, Brazil
| | - Eduardo Carvalho Pessoa
- Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
| | - Augusto Tufi Hassan
- Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Oncoclinicas-CAM, Salvador, BA, Brazil
| | - Agnaldo Lopes Silva
- Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Nisha Sharma
- Breast Screening Unit, Seacroft Hospital, Leeds Teaching Hospital NHS Trust, York Road, Leeds, West Yorkshire, LS146UH, UK
| | - Ritse Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Fernando Zanghelini
- MAPESolutions, São Paulo, São Paulo, Brazil
- Health Economics Consultant, Norwich Medical School, University of East Anglia, Norwich, UK
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Uematsu T. Rethinking screening mammography in Japan: next-generation breast cancer screening through breast awareness and supplemental ultrasonography. Breast Cancer 2024; 31:24-30. [PMID: 37823977 PMCID: PMC10764506 DOI: 10.1007/s12282-023-01506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023]
Abstract
Breast cancer mortality has not been reduced in Japan despite more than 20 years of population-based screening mammography. Screening mammography might not be suitable for Japanese women who often have dense breasts, thus decreasing mammography sensitivity because of masking. The J-START study showed that breast ultrasonography increases the sensitivity and the detection rate for early invasive cancers and lowers the rate of interval cancers for Japanese women in their 40 s. Breast awareness and breast cancer survival are directly correlated; however, breast awareness is not widely known in Japan. Next-generation breast cancer screening in Japan should consist of breast awareness campaigns for improving breast cancer literacy and supplemental breast ultrasonography to address the problem of false-negative mammograms attributable to dense breasts.
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Affiliation(s)
- Takayoshi Uematsu
- Department of Breast Imaging and Breast Intervention Radiology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Shizuoka, 411-8777, Japan.
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Wang T, Dossett LA. Incorporating Value-Based Decisions in Breast Cancer Treatment Algorithms. Surg Oncol Clin N Am 2023; 32:777-797. [PMID: 37714643 DOI: 10.1016/j.soc.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Given the excellent prognosis and availability of evidence-based treatment, patients with early-stage breast cancer are at risk of overtreatment. In this review, we summarize key opportunities to incorporate value-based decisions to optimize the delivery of high-value treatment across the breast cancer care continuum.
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Affiliation(s)
- Ton Wang
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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4
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Zielonke N, Senore C, Ponti A, Csanadi M, de Koning HJ, Heijnsdijk EAM, van Ravesteyn NT. Overcoming barriers: Modelling the effect of potential future changes of organized breast cancer screening in Italy. J Med Screen 2023; 30:134-141. [PMID: 36762395 PMCID: PMC10399099 DOI: 10.1177/09691413231153568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Organized breast cancer screening may not achieve its full potential due to organizational and cultural barriers. In Italy, two identified barriers were low attendance in Southern Italy and, in Italy as a whole, underscreening and overscreening in parts of the eligible population. The objective of this study was to identify potential changes to overcome these barriers and to quantify their costs and effects. METHODS To assess the impact of potential measures to improve breast cancer screening in Italy, we performed an evaluation of costs and effects for increasing adherence for Southern Italy and harmonizing screening intervals (biennial screening) for the whole of Italy, using an online tool (EU-TOPIA evaluation tool) based on the MIcrosimulation SCreening ANalysis (MISCAN) model. RESULTS Increasing adherence in Southern Italy through investing in mobile screening units has an acceptable cost-effectiveness ratio of €9531 per quality-adjusted life year gained. Harmonizing the screening interval by investing in measures to reduce opportunistic screening and simultaneously investing in mobile screening units to reduce underscreening is predicted to gain 1% fewer life-years, while saving 19% of total screening costs compared to the current situation. CONCLUSIONS Increasing adherence in Southern Italy and harmonizing the screening interval could result in substantial improvements at acceptable costs, or in the same benefits at lower costs. This example illustrates a systematic approach that can be easily applied to other European countries, as the online tools can be used by stakeholders to quantify effects and costs of a broad range of specific barriers, and ways to overcome them.
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Affiliation(s)
- Nadine Zielonke
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carlo Senore
- Epidemiology and screening Unit – CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Antonio Ponti
- Epidemiology and screening Unit – CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | | | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Narcisse MR, Shah SK, Hallgren E, Felix HC, Schootman M, McElfish PA. Factors associated with breast cancer screening services use among women in the United States: An application of the Andersen's Behavioral Model of Health Services Use. Prev Med 2023; 173:107545. [PMID: 37201597 PMCID: PMC10773561 DOI: 10.1016/j.ypmed.2023.107545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/12/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
This study applied Andersen's Behavioral Model of Health Services Use to examine predisposing, enabling, and need factors associated with adherence to the United States Preventive Services Task Force (USPSTF) guidelines for breast cancer screening (BCS). Multivariable logistic regression was used to determine factors of BCS services utilization among 5484 women aged 50-74 from the 2019 National Health Interview Survey. Predisposing factors significantly associated with use of BCS services were: being a Black (odds-ratios [OR]:1.49; 95% confidence interval [CI]:1.14-1.95) or a Hispanic woman (OR:2.25; CI:1.62-3.12); being married/partnered (OR:1.32, CI:1.12-1.55); having more than a bachelor's degree (OR: 1.62; CI:1.14-2.30); and living in rural areas (OR:0.72; CI:0.59-0.92). Enabling factors were: poverty level [≤138% federal poverty level (FPL) (OR:0.74; CI:0.56-0.97), >138-250% FPL (OR:0.77; CI:0.61-0.97), and > 250-400% FPL (OR:0.77; CI:0.63-0.94)]; being uninsured (OR:0.29; CI:0.21-0.40); having a usual source of care at a physician office (OR:7.27; CI:4.99-10.57) or other healthcare facilities (OR:4.12; CI:2.68-6.33); and previous breast examination by a healthcare professional (OR:2.10; CI:1.68-2.64). Need factors were: having fair/poor health (OR:0.76; CI:0.59-0.97) and being underweight (OR:0.46; CI:0.30-0.71). Disparities in BCS services utilization by Black and Hispanic women have been reduced. Disparities still exist for uninsured and financially restrained women living in rural areas. Addressing disparities in BCS uptake and improving adherence to USPSTF guidelines may require revamping policies that address disparities in enabling resources, such as health insurance, income, and health care access.
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Affiliation(s)
- Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72764, USA.
| | - Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72764, USA
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72764, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Mario Schootman
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72764, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72764, USA
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Sánchez-Bayuela DÁ, Ghavami N, Tiberi G, Sani L, Vispa A, Bigotti A, Raspa G, Badia M, Papini L, Ghavami M, Castellano CR, Bernardi D, Calabrese M, Tagliafico AS. A multicentric, single arm, prospective, stratified clinical investigation to evaluate MammoWave's ability in breast lesions detection. PLoS One 2023; 18:e0288312. [PMID: 37450545 PMCID: PMC10348515 DOI: 10.1371/journal.pone.0288312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
Microwave imaging is a safe and promising new technology in breast radiology, avoiding discomfort of breast compression and usage of ionizing radiation. This paper presents the first prospective microwave breast imaging study during which both symptomatic and asymptomatic subjects were recruited. Specifically, a prospective multicentre international clinical trial was performed in 2020-2021, to investigate the capability of a microwave imaging device (MammoWave) in allowing distinction between breasts with no radiological finding (NF) and breasts with radiological findings (WF), i.e., with benign or malignant lesions. Each breast scan was performed with the volunteers lying on a dedicated examination table in a comfortable prone position. MammoWave output was compared to reference standard (i.e., radiologic study obtained within the last month and integrated with histological one if available and deemed necessary by responsible investigator) to classify breasts into NF/WF categories. MammoWave output consists of a selection of microwave images' features (determined prior to trials' start), which allow distinction between NF and WF breasts (using statistical significance p<0.05). 353 women were enrolled in the study (mean age 51 years ± 12 [SD], minimum age 19, maximum age 78); MammoWave data from the first 15 women of each site, all with NF breasts, were used for calibration. Following central assessor evaluation, 111 NF (48 dense) and 272 WF (136 dense) breasts were used for comparison with MammoWave output. 272 WF comprised 182 benign findings and 90 malignant histology-confirmed cancer. A sensitivity of 82.3% was achieved (95%CI: 0.78-0.87); sensitivity is maintained when limiting the investigation to histology-confirmed breasts cancer only (90 histology-confirmed breasts cancer have been included in this analysis, having sizes ranging from 3 mm to 60 mm). Specificity value of approximately 50% was achieved as expected, since thresholds were calculated (for each feature) using median value obtained after recruiting the first 15 women (of each site), all NF. This prospective trial may represent another step for introducing microwave imaging into clinical practice, for helping in breast lesion identification in asymptomatic women.
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Affiliation(s)
- Daniel Álvarez Sánchez-Bayuela
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
- Breast Imaging Department, Radiology Service, Complejo Hospitalario Universitario de Toledo, Spain
- Faculty of Chemical Science and Technology, Instituto Regional de Investigación Científica Aplicada, University of Castilla, La Mancha, Spain
| | - Navid Ghavami
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
| | - Gianluigi Tiberi
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
- School of Engineering, London South Bank University, London, United Kingdom
| | - Lorenzo Sani
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
| | | | | | | | - Mario Badia
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
| | | | - Mohammad Ghavami
- School of Engineering, London South Bank University, London, United Kingdom
| | | | - Daniela Bernardi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Humanitas University, Milan, Italy
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Álvarez Sánchez-Bayuela D, Ghavami N, Romero Castellano C, Bigotti A, Badia M, Papini L, Raspa G, Palomba G, Ghavami M, Loretoni R, Calabrese M, Tagliafico A, Tiberi G. A Multicentric, Single Arm, Prospective, Stratified Clinical Investigation to Confirm MammoWave's Ability in Breast Lesions Detection. Diagnostics (Basel) 2023; 13:2100. [PMID: 37370995 DOI: 10.3390/diagnostics13122100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Novel techniques, such as microwave imaging, have been implemented in different prototypes and are under clinical validation, especially for breast cancer detection, due to their harmless technology and possible clinical advantages over conventional imaging techniques. In the prospective study presented in this work, we aim to investigate through a multicentric European clinical trial (ClinicalTrials.gov Identifier NCT05300464) the effectiveness of the MammoWave microwave imaging device, which uses a Huygens-principle-based radar algorithm for image reconstruction and comprises dedicated image analysis software. A detailed clinical protocol has been prepared outlining all aspects of this study, which will involve adult females having a radiologist study output obtained using conventional exams (mammography and/or ultrasound and/or magnetic resonance imaging) within the previous month. A maximum number of 600 volunteers will be recruited at three centres in Italy and Spain, where they will be asked to sign an informed consent form prior to the MammoWave scan. Conductivity weighted microwave images, representing the homogeneity of the tissues' dielectric properties, will be created for each breast, using a conductivity = 0.3 S/m. Subsequently, several microwave image parameters (features) will be used to quantify the images' non-homogenous behaviour. A selection of these features is expected to allow for distinction between breasts with lesions (either benign or malignant) and those without radiological findings. For all the selected features, we will use Welch's t-test to verify the statistical significance, using the gold standard output of the radiological study review.
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Affiliation(s)
- Daniel Álvarez Sánchez-Bayuela
- Breast Imaging Department, Radiology Service, Complejo Hospitalario Universitario de Toledo, 45007 Toledo, Spain
- Faculty of Chemical Science and Technology, Instituto Regional de Investigación Científica Aplicada, University of Castilla-La Mancha, 13001 Ciudad Real, Spain
| | - Navid Ghavami
- UBT-Umbria Bioengineering Technologies, 06081 Perugia, Italy
| | - Cristina Romero Castellano
- Breast Imaging Department, Radiology Service, Complejo Hospitalario Universitario de Toledo, 45007 Toledo, Spain
| | | | - Mario Badia
- UBT-Umbria Bioengineering Technologies, 06081 Perugia, Italy
| | - Lorenzo Papini
- UBT-Umbria Bioengineering Technologies, 06081 Perugia, Italy
| | - Giovanni Raspa
- UBT-Umbria Bioengineering Technologies, 06081 Perugia, Italy
| | | | - Mohammad Ghavami
- School of Engineering, London South Bank University, London SE1 0AA, UK
| | | | | | - Alberto Tagliafico
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Health Sciences, University of Genoa, 16126 Genoa, Italy
| | - Gianluigi Tiberi
- UBT-Umbria Bioengineering Technologies, 06081 Perugia, Italy
- School of Engineering, London South Bank University, London SE1 0AA, UK
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Jiang J, Jiang S, Ahumada-Canale A, Chen Z, Si L, Jiang Y, Yang L, Gu Y. Breast Cancer Screening Should Embrace Precision Medicine: Evidence by Reviewing Economic Evaluations in China. Adv Ther 2023; 40:1393-1417. [PMID: 36800077 PMCID: PMC10070309 DOI: 10.1007/s12325-023-02450-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
The cost-effectiveness of conventional population-based breast cancer screening strategies (e.g. mammography) has been found controversial, while evidence shows that genetic testing for early detection of pathogenic variants is cost-effective. We aimed to review the economic evaluations of breast cancer screening in China to provide an information summary for future research on this topic. We searched the literature to identify the economic evaluations that examined breast cancer screening and testing in China, supplemented by hand-searching the reference lists of the included studies. We finally included five studies satisfying our inclusion criteria. Four articles examined mammography while the rest investigated multigene testing. The existing breast cancer screening programmes were found to be cost-effective among urban Chinese women, but one study concluded that they might cause harm to women in rural areas. Contextual factors, such as data absence, urban-rural disparity, willingness-to-pay threshold, and model design, imposed barriers to cost-effectiveness analysis. Multigene testing was found to be cost-effective and has a promising population impact among all women with breast cancer in China. Future research should investigate the cost-effectiveness of screening and identifying breast cancer through precision medicine technologies, including genetic testing, genome sequencing, cascade testing, and the return of secondary findings.
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Affiliation(s)
- Jingjing Jiang
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Shan Jiang
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Antonio Ahumada-Canale
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
- Faculty of Humanities and Social Sciences, School of Economics, University of Nottingham Ningbo China, Ningbo, Zhejiang, China
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Li Yang
- School of Public Health, Peking University, Beijing, China.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
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9
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Su CW, Su WWY, Chen SLS, Chen THH, Hsu TH, Chen MK, Yen AMF. The Effectiveness of Population Mass Screening to Oral Cancer: A Simulation Study. Technol Cancer Res Treat 2022; 21:15330338221147771. [PMID: 36567633 PMCID: PMC9806397 DOI: 10.1177/15330338221147771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Mass screening of high-risk populations for oral cancer has proven to be effective in reducing oral cancer mortality. However, the magnitude of the effectiveness of the various screening scenarios has rarely been addressed. Methods: We developed a simulation algorithm for a prospective cohort under various oral cancer screening scenarios. A hypothetical cohort of 8 million participants aged ≥30 years with cigaret smoking and/or betel quid chewing habits was constructed based on parameters extracted from studies on oral cancer screening. The results of a population-based screening program in Taiwan and a randomized controlled trial in India were used to validate the fitness; then, the effectiveness of the model was determined by changing the screening parameters. Results: There was a reduction in the risk of advanced oral cancer by 40% (relative risk [RR] = 0.60, 95% confidence interval [CI]:0.59-0.62) and oral cancer mortality by 29% (RR = 0.71, 95% CI: 0.69-0.73) at the 6-year follow-up in a screening scenario similar to the biennial screening in Taiwan, with a 55.1% attendance rate and 92.6% referral rate. The incremental effect in reducing advanced oral cancer was approximately 5% with a short 1-year screening frequency, and the corresponding reduction in mortality was, on average, 6.5%. The incremental reduction in advanced oral cancer per 10% increase in the compliance rate was 3% to 4%, while only 1% to 2% reduction was noted per 10% increase in the referral rate. The effectiveness of screening in reducing advanced oral cancer was 5% to 6% less when both betel quid chewing and alcohol drinking habits were present. Conclusion: Our computer simulation model demonstrated the effect of screening on the reduction in oral cancer mortality under various scenarios. The results provide screening policymakers with the necessary guidance to implement screening programs to save lives.
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Affiliation(s)
- Chiu-Wen Su
- National Taiwan University
Hospital, Taipei, Taiwan
| | - William Wang-Yu Su
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City,
Taiwan,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive
Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tsui-Hsia Hsu
- Health Promotion Administration, Ministry of Health and
Welfare, Taipei, Taiwan
| | | | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan,Institute of Epidemiology and Preventive
Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan,Amy Ming-Fang Yen, School of Oral Hygiene,
College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
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10
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Abstract
Cancer screening is recommended for select cancers worldwide. Cancer screening has become increasingly effective and accessible and often increases overall survival. However, the mental health effects of cancer screening, such as its impact on depression, anxiety, and post-traumatic stress disorder, are largely unknown. Conflicting available literature indicates the negative, neutral, and positive mental health effects of cancer screening across cancer types. There are a limited number of randomized controlled trials measuring the mental health effects of cancer screening. Overall, the more negative and life-threatening the screening results, the greater the mental health effects. Screening for cancer without a known precursor, for example, due to family history, can have positive impacts such as decreased worry and increased quality of life. However, receiving a cancer diagnosis often has negative mental effects that increase with the life-threatening potential of malignancy. In this study, we review the existing literature and provide recommendations for future research to determine if and when cancer screening is the best practice.
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Affiliation(s)
- Lauren P. Wadsworth
- University of Iceland, Reykjavik, Iceland
- * Correspondence: Lauren P. Wadsworth, PhD, Genesee Valley Psychology 200 White Spruce Blvd, Suite 220, Rochester, NY 14623 (e-mail: )
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11
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Wang J, Greuter MJ, Zheng S, van Veldhuizen DW, Vermeulen KM, Wang Y, Lu W, de Bock GH. Assessment of the Benefits and Cost-Effectiveness of Population-Based Breast Cancer Screening in Urban China: A Model-Based Analysis. Int J Health Policy Manag 2022; 11:1658-1667. [PMID: 34273933 PMCID: PMC9808213 DOI: 10.34172/ijhpm.2021.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To decrease the burden of breast cancer (BC), the Chinese government recently introduced biennial mammography screening for women aged 45-70 years. In this study, we assess the effectiveness and cost-effectiveness of implementing this programme in urban China using a micro-simulation model. METHODS The 'Simulation Model on radiation Risk and breast cancer Screening' (SiMRiSc) was applied, with parameters updated based on available data for the Chinese population. The base scenario was biennial mammography screening for women aged 45-70 years, and this was compared to a reference population with no screening. Seven alternative scenarios were then simulated by varying the screening intervals and participant ages. This analysis was conducted from a societal perspective. The discounted incremental cost-effectiveness ratio (ICER) was compared to a threshold of triple the gross domestic product (GDP) per life years gained (LYG), which was 30 785 USD/LYG. Univariate sensitivity analyses were conducted to evaluate model robustness. In addition, a budget impact analysis was performed by comparing biennial screening with no screening at a time horizon of 10 years. RESULTS Compared with no screening, the base scenario was cost-effective in urban China, giving a discounted average cost-effectiveness ratio (ACER) of 17 309 USD/LYG. The model was most sensitive to the cost of mammography per screen, followed by mean size of self-detected tumours, mammographic breast density and the cumulative lifetime risk of BC. The efficient frontier showed that at a threshold of 30 785 USD/LYG, the base scenario was the optimal scenario with a discounted ICER of 25 261 USD/LYG. Over 10 years, screening would incur a net cost of almost 38.1 million USD for a city with 1 million citizens. CONCLUSION Compared to no screening, biennial mammography screening for women aged from 45-70 is cost-effective in urban China.
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Affiliation(s)
- Jing Wang
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcel J.W. Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Senshuang Zheng
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daniëlle W.A. van Veldhuizen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M. Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Collaborative Innovation Center of Chronic Disease Prevention and Control, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Collaborative Innovation Center of Chronic Disease Prevention and Control, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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12
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Shimonovich M, Pearce A, Thomson H, Katikireddi SV. Causal assessment in evidence synthesis: A methodological review of reviews. Res Synth Methods 2022; 13:405-423. [PMID: 35560730 PMCID: PMC9543433 DOI: 10.1002/jrsm.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 03/11/2022] [Accepted: 05/07/2022] [Indexed: 11/10/2022]
Abstract
In fields (such as population health) where randomised trials are often lacking, systematic reviews (SRs) can harness diversity in study design, settings and populations to assess the evidence for a putative causal relationship. SRs may incorporate causal assessment approaches (CAAs), sometimes called 'causal reviews', but there is currently no consensus on how these should be conducted. We conducted a methodological review of self-identifying 'causal reviews' within the field of population health to establish: (1) which CAAs are used; (2) differences in how CAAs are implemented; (3) how methods were modified to incorporate causal assessment in SRs. Three databases were searched and two independent reviewers selected reviews for inclusion. Data were extracted using a standardised form and summarised using tabulation and narratively. Fifty-three reviews incorporated CAAs: 46/53 applied Bradford Hill (BH) viewpoints/criteria, with the remainder taking alternative approaches: Medical Research Council guidance on natural experiments (2/53, 3.8%); realist reviews (2/53, 3.8%); horizontal SRs (1/53, 1.9%); 'sign test' of causal mechanisms (1/53, 1.9%); and a causal cascade model (1/53, 1.9%). Though most SRs incorporated BH, there was variation in application and transparency. There was considerable overlap across the CAAs, with a trade-off between breadth (BH viewpoints considered a greater range of causal characteristics) and depth (many alternative CAAs focused on one viewpoint). Improved transparency in the implementation of CAA in SRs in needed to ensure their validity and allow robust assessments of causality within evidence synthesis.
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Affiliation(s)
- Michal Shimonovich
- MRC/CSO Social & Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Anna Pearce
- MRC/CSO Social & Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Hilary Thomson
- MRC/CSO Social & Public Health Sciences UnitUniversity of GlasgowGlasgowUK
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13
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Chang RWJ, Jen GHH, Lin KC, Cheng TC, Chuang SY, Pan SL, Chen THH, Yen AMF. Evaluating the effectiveness of population-based breast cancer service screening: an analysis of parsimonious patient survival information with the time-varying Cox model. Int J Epidemiol 2022; 51:1910-1919. [PMID: 35560162 PMCID: PMC9749717 DOI: 10.1093/ije/dyac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 04/24/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This study is aimed at estimating the unbiased effectiveness of population-based breast cancer service screening based on case survival information alone rather than large-scale individual screening data pursuant to the intention-to-treat principle of a randomized-controlled trial. METHODS A novel time-dependent switched design with two modalities of cancer detection (screen-detected vs clinically detected) was proposed to evaluate the effectiveness of breast cancer screening. We used data on 767 patients from Kopparberg in the Swedish Two-County trial and on 78 587 patients in the Taiwan population-based service screening. We estimated the relative rate of the screen-detected vs the clinically detected with adjustment for both truncation and lead-time biases. The absolute effectiveness in terms of the number needed to screen (NNS) for averting one death from breast cancer was estimated. RESULTS The relative rate of effectiveness was estimated as 33%, which was consistent with the 37% reported from the original Swedish randomized-controlled trial. The corresponding estimate for the Taiwan screening programme was 42%, which was also very close to that estimated using individual screening history data (41%). Both relative estimates were further applied to yield 446 and 806 of NNS for averting one death from breast cancer for the corresponding two data sets. CONCLUSION The proposed time-dependent switched design and analysis with two modalities of case survival information provides a very efficient means for estimating the unbiased estimates of relative and absolute effectiveness of population-based breast cancer service screening dispensing with a large amount of individual screening history data.
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Affiliation(s)
- Rene Wei-Jung Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Grace Hsiao-Hsuan Jen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Chi Cheng
- Department of Statistics, National Chengchi University, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - Shin-Liang Pan
- Departments of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- Corresponding author. School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City 110, Taiwan. E-mail:
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14
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Shah SM, Khan RA, Arif S, Sajid U. Artificial intelligence for breast cancer analysis: Trends & directions. Comput Biol Med 2022; 142:105221. [PMID: 35016100 DOI: 10.1016/j.compbiomed.2022.105221] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 12/18/2022]
Abstract
Breast cancer is one of the leading causes of death among women. Early detection of breast cancer can significantly improve the lives of millions of women across the globe. Given importance of finding solution/framework for early detection and diagnosis, recently many AI researchers are focusing to automate this task. The other reasons for surge in research activities in this direction are advent of robust AI algorithms (deep learning), availability of hardware that can run/train those robust and complex AI algorithms and accessibility of large enough dataset required for training AI algorithms. Different imaging modalities that have been exploited by researchers to automate the task of breast cancer detection are mammograms, ultrasound, magnetic resonance imaging, histopathological images or any combination of them. This article analyzes these imaging modalities and presents their strengths and limitations. It also enlists resources from where their datasets can be accessed for research purpose. This article then summarizes AI and computer vision based state-of-the-art methods proposed in the last decade to detect breast cancer using various imaging modalities. Primarily, in this article we have focused on reviewing frameworks that have reported results using mammograms as it is the most widely used breast imaging modality that serves as the first test that medical practitioners usually prescribe for the detection of breast cancer. Another reason for focusing on mammogram imaging modalities is the availability of its labelled datasets. Datasets availability is one of the most important aspects for the development of AI based frameworks as such algorithms are data hungry and generally quality of dataset affects performance of AI based algorithms. In a nutshell, this research article will act as a primary resource for the research community working in the field of automated breast imaging analysis.
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Affiliation(s)
- Shahid Munir Shah
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan
| | - Rizwan Ahmed Khan
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan.
| | - Sheeraz Arif
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan
| | - Unaiza Sajid
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan
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15
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Rana SP, Dey M, Loretoni R, Duranti M, Sani L, Vispa A, Ghavami M, Dudley S, Tiberi G. Radial Basis Function for Breast Lesion Detection from MammoWave Clinical Data. Diagnostics (Basel) 2021; 11:1930. [PMID: 34679628 DOI: 10.3390/diagnostics11101930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 11/22/2022] Open
Abstract
Recently, a novel microwave apparatus for breast lesion detection (MammoWave), uniquely able to function in air with 2 antennas rotating in the azimuth plane and operating within the band 1–9 GHz has been developed. Machine learning (ML) has been implemented to understand information from the frequency spectrum collected through MammoWave in response to the stimulus, segregating breasts with and without lesions. The study comprises 61 breasts (from 35 patients), each one with the correspondent output of the radiologist’s conclusion (i.e., gold standard) obtained from echography and/or mammography and/or MRI, plus pathology or 1-year clinical follow-up when required. The MammoWave examinations are performed, recording the frequency spectrum, where the magnitudes show substantial discrepancy and reveals dissimilar behaviours when reflected from tissues with/without lesions. Principal component analysis is implemented to extract the unique quantitative response from the frequency response for automated breast lesion identification, engaging the support vector machine (SVM) with a radial basis function kernel. In-vivo feasibility validation (now ended) of MammoWave was approved in 2015 by the Ethical Committee of Umbria, Italy (N. 6845/15/AV/DM of 14 October 2015, N. 10352/17/NCAV of 16 March 2017, N 13203/18/NCAV of 17 April 2018). Here, we used a set of 35 patients. According to the radiologists conclusions, 25 breasts without lesions and 36 breasts with lesions underwent a MammoWave examination. The proposed SVM model achieved the accuracy, sensitivity, and specificity of 91%, 84.40%, and 97.20%. The proposed ML augmented MammoWave can identify breast lesions with high accuracy.
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16
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Philipo GS, Vuhahula E, Kimambo A, Mmbaga EJ, Van Loon K, Ng DL. Feasibility of Fine-Needle Aspiration Biopsy and Rapid On-Site Evaluation for Immediate Triage in Breast Cancer Screening in Tanzania. JCO Glob Oncol 2021; 7:146-152. [PMID: 33493018 PMCID: PMC8081537 DOI: 10.1200/go.20.00279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Clinical breast examination (CBE) is one of the most common methods used for early detection of breast cancer in low- and middle-income countries. CBE alone is limited by lack of specificity and may result in unnecessary diagnostic procedures. We evaluated the feasibility of integrating CBE, fine-needle aspiration biopsy (FNAB), and rapid on-site evaluation (ROSE) in triaging palpable breast masses for specialized cancer care. MATERIALS AND METHODS An intensive breast cancer screening event was conducted at a national trade fair by a multidisciplinary team of care providers targeting a healthy population in Dar es Salaam, Tanzania. All adults age ≥ 18 years were invited to participate. CBE was performed by oncologists and/or pathologists. FNAB was performed by a pathologist on palpable masses that were then categorized as benign, indeterminate, or suspicious for malignancy or definitively malignant based on ROSE. RESULTS A total of 208 individuals (207 females, one male; median age, 36 years; range, 18-68 years) were screened. Most (90.8%, 189 of 208) had normal findings, whereas 7.2% (15 of 208), 1% (2 of 208), and 1% (2 of 208) had a palpable mass, breast pain, and nipple discharge, respectively. Two participants had lesions too small for palpation-guided biopsy and clinically consistent with fibroadenomas; the participants were counseled, and observation was recommended. FNAB was performed on 13 breast masses, with 9 of 13 (69%) categorized as benign and 4 of 13 (31%) suspicious for malignancy. Final cytopathologic review of referred patients confirmed one case to be breast adenocarcinoma, one was suggestive of fibroadenoma, and two showed inflammations. CONCLUSION Integration of CBE with ROSE and FNAB was feasible in a breast cancer screening program in Tanzania. In settings with constrained resources for cancer care, this may be an effective method for triaging patients with breast masses.
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Affiliation(s)
- Godfrey S Philipo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Edda Vuhahula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Asteria Kimambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Department of Pathology, University of California San Francisco, San Francisco, CA
| | - Dianna L Ng
- Department of Pathology, University of California San Francisco, San Francisco, CA
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17
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Mandrik O, Tolma E, Zielonke N, Meheus F, Ordóñez-Reyes C, Severens JL, Murillo R. Systematic reviews as a "lens of evidence": Determinants of participation in breast cancer screening. J Med Screen 2021; 28:70-79. [PMID: 32517538 PMCID: PMC8167916 DOI: 10.1177/0969141320930743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/25/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the determinants of the participation rate in breast cancer screening programs by conducting a systematic review of reviews. METHODS We conducted a systematic search in PubMed via Medline, Scopus, Embase, and Cochrane identifying the literature up to April 2019. Out of 2258 revealed unique abstracts, we included 31 reviews, from which 25 were considered as systematic. We applied the Walsh & McPhee Systems Model of Clinical Preventive Care to systematize the determinants of screening participation. RESULTS The reviews, mainly in high-income settings, reported a wide range for breast cancer screening participation rate: 16-90%. The determinants of breast cancer screening participation were simple low-cost interventions such as invitation letters, basic information on screening, multiple reminders, fixed appointments, prompts from healthcare professionals, and healthcare organizational factors (e.g. close proximity to screening facility). More complex interventions (such as face-to-face counselling or home visits), mass media or improved access to transport should not be encouraged by policy makers unless other information appears. The repeated participation in mammography screening was consistently high, above 62%. Previous positive experience with screening influenced the repeated participation in screening programs. The reviews were inconsistent in the use of terminology related to breast cancer screening participation, which may have contributed to the heterogeneity in the reported outcomes. CONCLUSIONS This study shows that consistent findings of systematic reviews bring more certainty into the conclusions on the effects of simple invitation techniques, fixed appointments and prompts, as well as healthcare organizational factors on promoting participation rate in screening mammography.
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Affiliation(s)
- O Mandrik
- School of Health and Related Research, Health Economic and Decision Science (HEDS), The University of Sheffield, Sheffield, UK
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - E Tolma
- Faculty of Public Health, Kuwait University, Jabriya, Kuwait
| | - N Zielonke
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F Meheus
- Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - C Ordóñez-Reyes
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - JL Severens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - R Murillo
- Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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Sani L, Vispa A, Loretoni R, Duranti M, Ghavami N, Alvarez Sánchez-Bayuela D, Caschera S, Paoli M, Bigotti A, Badia M, Scorsipa M, Raspa G, Ghavami M, Tiberi G. Breast lesion detection through MammoWave device: Empirical detection capability assessment of microwave images' parameters. PLoS One 2021; 16:e0250005. [PMID: 33848318 PMCID: PMC8043413 DOI: 10.1371/journal.pone.0250005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/29/2021] [Indexed: 01/21/2023] Open
Abstract
MammoWave is a microwave imaging device for breast lesions detection, which operates using two (azimuthally rotating) antennas without any matching liquid. Images, subsequently obtained by resorting to Huygens Principle, are intensity maps, representing the homogeneity of tissues' dielectric properties. In this paper, we propose to generate, for each breast, a set of conductivity weighted microwave images by using different values of conductivity in the Huygens Principle imaging algorithm. Next, microwave images' parameters, i.e. features, are introduced to quantify the non-homogenous behaviour of the image. We empirically verify on 103 breasts that a selection of these features may allow distinction between breasts with no radiological finding (NF) and breasts with radiological findings (WF), i.e. with lesions which may be benign or malignant. Statistical significance was set at p<0.05. We obtained single features Area Under the receiver operating characteristic Curves (AUCs) spanning from 0.65 to 0.69. In addition, an empirical rule-of-thumb allowing breast assessment is introduced using a binary score S operating on an appropriate combination of features. Performances of such rule-of-thumb are evaluated empirically, obtaining a sensitivity of 74%, which increases to 82% when considering dense breasts only.
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Affiliation(s)
- Lorenzo Sani
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
| | | | - Riccardo Loretoni
- Breast Screening and Diagnostic Breast Cancer Unit, AUSL Umbria 2, Foligno, Italy
| | - Michele Duranti
- Department of Diagnostic Imaging, Perugia Hospital, Perugia, Italy
| | - Navid Ghavami
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
| | | | | | - Martina Paoli
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
| | | | - Mario Badia
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
| | | | | | - Mohammad Ghavami
- School of Engineering, London South Bank University, London, United Kingdom
| | - Gianluigi Tiberi
- UBT—Umbria Bioengineering Technologies, Perugia, Italy
- School of Engineering, London South Bank University, London, United Kingdom
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Salmani H, Ahmadi M, Shahrokhi N. The Impact of Mobile Health on Cancer Screening: A Systematic Review. Cancer Inform 2020; 19:1176935120954191. [PMID: 33116352 PMCID: PMC7573752 DOI: 10.1177/1176935120954191] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/11/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction: Mobile health is an emerging technology around the world that can be effective in cancer screening. This study aimed to examine the effectiveness of mobile health applications on cancer screening. Methods: We conducted a systematic literature review of studies related to the use of mobile health applications in cancer screening. We also conducted a comprehensive search of articles on cancer screening related to the use of mobile health applications in journals published between January 1, 2008, and January 31, 2019, using 5 databases: IEEE, Scopus, Web of Science, Science Direct and PubMed. Results: A total of 23 articles met the inclusion criteria and were included in the present review. All studies have identified positive effects of applications on cancer screening and clinical health outcomes. Furthermore, more than half of mobile applications had multiple functions such as providing information, planning and education. Moreover, most of the studies, which examined the satisfaction of patients and quality improvement, showed healthcare application users have significantly higher satisfaction of living and it leads to improving quality. Conclusion: This study found that the use of mobile health applications has a positive impact on health-related behaviours and outcomes. Application users were more satisfied with applying mobile health applications to manage their health condition in comparison with users who received conventional care.
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Affiliation(s)
- Hosna Salmani
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ahmadi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Shahrokhi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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20
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Muratov S, Canelo-Aybar C, Tarride JE, Alonso-Coello P, Dimitrova N, Borisch B, Castells X, Duffy SW, Fitzpatrick P, Follmann M, Giordano L, Hofvind S, Lebeau A, Quinn C, Torresin A, Vialli C, Siesling S, Ponti A, Giorgi Rossi P, Schünemann H, Nyström L, Broeders M. Monitoring and evaluation of breast cancer screening programmes: selecting candidate performance indicators. BMC Cancer 2020; 20:795. [PMID: 32831048 PMCID: PMC7444070 DOI: 10.1186/s12885-020-07289-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection. METHODS The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries. RESULTS A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate. CONCLUSION This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality.
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Affiliation(s)
- Sergei Muratov
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Center, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Nadya Dimitrova
- European Commission, Joint Research Centre, Via E. Fermi 2749 - TP 127, I-21027, Ispra, VA, Italy.
| | - Bettina Borisch
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Patricia Fitzpatrick
- National Screening Service, Dublin, Ireland
- UCD School of Public Health, Physiotherapy & Sports Science, Dublin, Ireland
| | | | - Livia Giordano
- CPO-Piedmont - AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Annette Lebeau
- University Medical Center Hamburg-Eppendorf and Private Group Practice for Pathology, Hamburg, Germany
| | - Cecily Quinn
- St. Vincent's University Hospital, Dublin, Ireland
| | | | - Claudia Vialli
- European Commission, Joint Research Centre, Via E. Fermi 2749 - TP 127, I-21027, Ispra, VA, Italy
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- University of Twente, Enschede, Netherlands
| | - Antonio Ponti
- CPO-Piedmont - AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Mireille Broeders
- Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
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Zielonke N, Kregting LM, Heijnsdijk EAM, Veerus P, Heinävaara S, McKee M, de Kok IMCM, de Koning HJ, van Ravesteyn NT. The potential of breast cancer screening in Europe. Int J Cancer 2020; 148:406-418. [PMID: 32683673 PMCID: PMC7754503 DOI: 10.1002/ijc.33204] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/18/2020] [Accepted: 06/17/2020] [Indexed: 01/01/2023]
Abstract
Currently, all European countries offer some form of breast cancer screening. Nevertheless, disparities exist in the status of implementation, attendance and the extent of opportunistic screening. As a result, breast cancer screening has not yet reached its full potential. We examined how many breast cancer deaths could be prevented if all European countries would biennially screen all women aged 50 to 69 for breast cancer. We calculated the number of breast cancer deaths already prevented due to screening as well as the number of breast cancer deaths which could be additionally prevented if the total examination coverage (organised plus opportunistic) would reach 100%. The calculations are based on total examination coverage in women aged 50 to 69, the annual number of breast cancer deaths for women aged 50 to 74 and the maximal possible mortality reduction from breast cancer, assuming similar effectiveness of organised and opportunistic screening. The total examination coverage ranged from 49% (East), 62% (West), 64% (North) to 69% (South). Yearly 21 680 breast cancer deaths have already been prevented due to mammography screening. If all countries would reach 100% examination coverage, 12 434 additional breast cancer deaths could be prevented annually, with the biggest potential in Eastern Europe. With maximum coverage, 23% of their breast cancer deaths could be additionally prevented, while in Western Europe it could be 21%, in Southern Europe 15% and in Northern Europe 9%. Our study illustrates that by further optimising screening coverage, the number of breast cancer deaths in Europe can be lowered substantially.
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Affiliation(s)
- Nadine Zielonke
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lindy M Kregting
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Piret Veerus
- National Institute for Health Development, Tallinn, Estonia
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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- The EU-TOPIA collaborators are listed in the Appendix
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22
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Chang RWJ, Chuang SL, Hsu CY, Yen AMF, Wu WYY, Chen SLS, Fann JCY, Tabar L, Smith RA, Duffy SW, Chiu SYH, Chen HH. Precision Science on Incidence and Progression of Early-Detected Small Breast Invasive Cancers by Mammographic Features. Cancers (Basel) 2020; 12:cancers12071855. [PMID: 32664200 PMCID: PMC7408735 DOI: 10.3390/cancers12071855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/21/2022] Open
Abstract
The aim was to evaluate how the inter-screening interval affected the performance of screening by mammographic appearances. This was a Swedish retrospective screening cohort study with information on screening history and mammography features in two periods (1977–1985 and 1996–2010). The pre-clinical incidence and the mean sojourn time (MST) for small breast cancer allowing for sensitivity by mammographic appearances were estimated. The percentage of interval cancer against background incidence (I/E ratio) was used to assess the performance of mammography screening by different inter-screening intervals. The sensitivity-adjusted MSTs (in years) were heterogeneous with mammographic features, being longer for powdery and crushed stone-like calcifications (4.26, (95% CI, 3.50–5.26)) and stellate masses (3.76, (95% CI, 3.15–4.53)) but shorter for circular masses (2.65, (95% CI, 2.06–3.55)) in 1996–2010. The similar trends, albeit longer MSTs, were also noted in 1977–1985. The I/E ratios for the stellate type were 23% and 32% for biennial and triennial screening, respectively. The corresponding figures were 32% and 43% for the circular type and 21% and 29% for powdery and crushed stone-like calcifications, respectively. Mammography-featured progressions of small invasive breast cancer provides a new insight into personalized quality assurance, surveillance, treatment and therapy of early-detected breast cancer.
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Affiliation(s)
- Rene Wei-Jung Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City 100, Taiwan; (R.W.-J.C.); (C.-Y.H.)
| | - Shu-Lin Chuang
- Department of Medical Research, National Taiwan University Hospital, Taipei City 100, Taiwan;
| | - Chen-Yang Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City 100, Taiwan; (R.W.-J.C.); (C.-Y.H.)
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City 110, Taiwan; (A.M.-F.Y.); (S.L.-S.C.)
| | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, 90187 Umeå, Sweden;
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City 110, Taiwan; (A.M.-F.Y.); (S.L.-S.C.)
| | - Jean Ching-Yuan Fann
- Department of Health Industry Management, College of Healthcare Management, Kainan University, Taoyuan City 338, Taiwan;
| | - Laszlo Tabar
- Department of Mammography, Falun Central Hospital, 791823 Falun, Sweden;
| | - Robert A. Smith
- Center for Cancer Screening, American Cancer Society, Atlanta, GA 30303, USA;
| | - Stephen W. Duffy
- Centre for Cancer Prevention, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK;
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan City 333, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
- Correspondence: (S.Y.-H.C.); (H.-H.C.); Tel.: +886-3-2118800 (ext. 5250) (S.Y.-H.C.); +886-2-33668033 (H.-H.C.)
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City 100, Taiwan; (R.W.-J.C.); (C.-Y.H.)
- Correspondence: (S.Y.-H.C.); (H.-H.C.); Tel.: +886-3-2118800 (ext. 5250) (S.Y.-H.C.); +886-2-33668033 (H.-H.C.)
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23
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Zhu Q, Poplack S. A review of optical breast imaging: Multi-modality systems for breast cancer diagnosis. Eur J Radiol 2020; 129:109067. [PMID: 32497943 DOI: 10.1016/j.ejrad.2020.109067] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/04/2020] [Accepted: 05/09/2020] [Indexed: 11/24/2022]
Abstract
This review of optical breast imaging describes basic physical and system principles and summarizes technological evolution with a focus on multi-modality platforms and recent clinical trial results. Ultrasound-guided diffuse optical tomography and co-registered ultrasound and photoacoustic imaging systems are emphasized as models of state of the art optical technology that are most conducive to clinical translation.
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24
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Wang J, Phi XA, Greuter MJW, Daszczuk AM, Feenstra TL, Pijnappel RM, Vermeulen KM, Buls N, Houssami N, Lu W, de Bock GH. The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program. Eur Radiol 2020; 30:5437-5445. [PMID: 32382844 PMCID: PMC7476964 DOI: 10.1007/s00330-020-06812-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/17/2020] [Accepted: 03/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate at which sensitivity digital breast tomosynthesis (DBT) would become cost-effective compared to digital mammography (DM) in a population breast cancer screening program, given a constant estimate of specificity. METHODS In a microsimulation model, the cost-effectiveness of biennial screening for women aged 50-75 was simulated for three scenarios: DBT for women with dense breasts and DM for women with fatty breasts (scenario 1), DBT for the whole population (scenario 2) or maintaining DM screening (reference). For DM, sensitivity was varied depending on breast density from 65 to 87%, and for DBT from 65 to 100%. The specificity was set at 96.5% for both DM and DBT. Direct medical costs were considered, including screening, biopsy and treatment costs. Scenarios were considered to be cost-effective if the incremental cost-effectiveness ratio (ICER) was below €20,000 per life year gain (LYG). RESULTS For both scenarios, the ICER was more favourable at increasing DBT sensitivity. Compared with DM screening, 0.8-10.2% more LYGs were found when DBT sensitivity was at least 75% for scenario 1, and 4.7-18.7% when DBT sensitivity was at least 80% for scenario 2. At €96 per DBT, scenario 1 was cost-effective at a DBT sensitivity of at least 90%, and at least 95% for scenario 2. At €80 per DBT, these values decreased to 80% and 90%, respectively. CONCLUSION DBT is more likely to be a cost-effective alternative to mammography in women with dense breasts. Whether DBT could be cost-effective in a general population highly depends on DBT costs. KEY POINTS • DBT could be a cost-effective screening modality for women with dense breasts when its sensitivity is at least 90% at a maximum cost per screen of €96. • DBT has the potential to be cost-effective for screening all women when sensitivity is at least 90% at a maximum cost per screen of €80. • Whether DBT could be used as an alternative to mammography for screening all women is highly dependent on the cost of DBT per screen.
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Affiliation(s)
- Jing Wang
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Xuan-Anh Phi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alicja M Daszczuk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Talitha L Feenstra
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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Yen AM, Chen H. Modeling the overdetection of screen‐identified cancers in population‐based cancer screening with the Coxian phase‐type Markov process. Stat Med 2019; 39:660-673. [DOI: 10.1002/sim.8437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Amy Ming‐Fang Yen
- School of Oral Hygiene, College of Oral MedicineTaipei Medical University Taipei Taiwan
| | - Hsiu‐Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan University Taipei Taiwan
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26
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Mandrik O, Zielonke N, Meheus F, Severens J(H, Guha N, Herrero Acosta R, Murillo R. Systematic reviews as a 'lens of evidence': Determinants of benefits and harms of breast cancer screening. Int J Cancer 2019; 145:994-1006. [PMID: 30762235 PMCID: PMC6619055 DOI: 10.1002/ijc.32211] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022]
Abstract
This systematic review, stimulated by inconsistency in secondary evidence, reports the benefits and harms of breast cancer (BC) screening and their determinants according to systematic reviews. A systematic search, which identified 9,976 abstracts, led to the inclusion of 58 reviews. BC mortality reduction with screening mammography was 15-25% in trials and 28-56% in observational studies in all age groups, and the risk of stage III+ cancers was reduced for women older than 49 years. Overdiagnosis due to mammography was 1-60% in trials and 1-12% in studies with a low risk of bias, and cumulative false-positive rates were lower with biennial than annual screening (3-17% vs 0.01-41%). There is no consistency in the reviews' conclusions about the magnitude of BC mortality reduction among women younger than 50 years or older than 69 years, or determinants of benefits and harms of mammography, including the type of mammography (digital vs screen-film), the number of views and the screening interval. Similarly, there was no solid evidence on determinants of benefits and harms or BC mortality reduction with screening by ultrasonography or clinical breast examination (sensitivity ranges, 54-84% and 47-69%, respectively), and strong evidence of unfavourable benefit-to-harm ratio with breast self-examination. The reviews' conclusions were not dependent on the quality of the reviews or publication date. Systematic reviews on mammography screening, mainly from high-income countries, systematically disagree on the interpretation of the benefit-to-harm ratio. Future reviews are unlikely to clarify the discrepancies unless new original studies are published.
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Affiliation(s)
- Olena Mandrik
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
- Erasmus School of Health Policy & Management, Erasmus University RotterdamRotterdamThe Netherlands
- Health Economic and Decision Science (HEDS), School of Health and Related Research (ScHARR)The University of SheffieldSheffieldUnited Kingdom
| | - Nadine Zielonke
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Filip Meheus
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
| | - J.L. (Hans) Severens
- Erasmus School of Health Policy & Management, Erasmus University RotterdamRotterdamThe Netherlands
- Institute for Medical Technology Assessment (iMTA)Erasmus University RotterdamRotterdamThe Netherlands
| | - Neela Guha
- Section of Evidence Synthesis and ClassificationInternational Agency for Research on CancerLyonFrance
| | - Rolando Herrero Acosta
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
| | - Raul Murillo
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
- Centro Javeriano de Oncología – Hospital Universitario San IgnacioBogotáColombia
- Faculty of Medicine – Pontificia Universidad JaverianaBogotáColombia
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27
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Young RP, Hopkins R. The potential impact of chronic obstructive pulmonary disease in lung cancer screening: implications for the screening clinic. Expert Rev Respir Med 2019; 13:699-707. [PMID: 31274043 DOI: 10.1080/17476348.2019.1638766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Following the findings of the National Lung Screening Trial (NLST), lung cancer screening is now recommended in the United States. However, post-hoc analyses of the NLST suggest that reducing lung cancer mortality through screening is highly dependent on the underlying characteristics of the screening participants, in particular, the presence of chronic obstructive pulmonary disease (COPD). Areas covered: In this review, we outline how outcomes in lung cancer screening are significantly affected by the presence of airflow limitation, as caused by COPD, and how this might impact the assessment of eligible smokers in a lung cancer screening clinic. Expert opinion: There is growing evidence showing that CT-based screening for lung cancer reduces lung cancer mortality. The benefits of screening exceed those seen in the NLST when screening is carried out in lower risk populations, for a longer duration, and when outcomes are compared with usual care control cohorts. In this article, we review data from a post-hoc analysis of the NLST. We suggest that whilst worsened airflow limitation is associated with greater lung cancer risk, there is also more aggressive lung cancer, reduced lung cancer operability, and for advanced COPD, reduced benefits from screening. We advocate an 'outcomes-based' approach to screening over a 'risk-based' approach.
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Affiliation(s)
- Robert P Young
- a School of Biological Sciences, University of Auckland , Auckland , New Zealand.,b Faculty of Medical and Health Sciences, University of Auckland , Auckland , New Zealand
| | - Raewyn Hopkins
- b Faculty of Medical and Health Sciences, University of Auckland , Auckland , New Zealand
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28
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Johnson A, Baeten J, Patel K, Killian M, Sunny S, Suresh A, Uma K, Birur P, Kuriakose M, Kademani D. Evaluation of a Lectin-Based Imaging System for the Chairside Detection of Oral Dysplasia and Malignancy. J Oral Maxillofac Surg 2019; 77:1941-1951. [PMID: 31004587 DOI: 10.1016/j.joms.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Currently available oral cancer screening adjuncts have not enhanced clinical screening methods because of high false positives and negatives, highlighting the need for a molecularly specific technique for accurate screening of suspicious oral lesions. The purpose of this study was to evaluate the in vivo screening accuracy of an oral lesion identification system that evaluates aberrant glycosylation patterns using a fluorescently labeled lectin (wheat germ agglutinin and fluorescein isothiocyanate [WGA-FITC]). MATERIALS AND METHODS The authors designed and implemented a prospective cohort study at 3 institutions composed of patients with and without suspicious oral lesions. Oral cavities were screened by clinical examination and with the oral lesion identification system according to a stepwise procedure that included the topical application and fluorescence visualization of a fluorescent nuclear stain and WGA-FITC. Tissue samples were obtained from all enrolled patients for histopathological diagnosis and were used to calculate sensitivity and specificity metrics (primary outcome variable) irrespective of the oral lesion identification system result. RESULTS The sample was composed of 97 patients; 86 had 100 clinically suspicious lesions and 11 without such lesions were included as a control group. Use of the oral lesion identification system resulted in 100, 100, and 74% sensitivity for cancer, high-grade dysplasia, and low-grade dysplasia, respectively, and a specificity of 80%. Clinical diagnosis yielded similar sensitivity values of 84, 100, and 88% for cancer, high-grade dysplasia, and low-grade dysplasia, respectively, and a specificity of 76%. Use of the oral lesion identification system enhanced the visualization of lesion dimensionality and borders. CONCLUSIONS The results of this study suggest the oral lesion identification system was a beneficial adjunct to standard clinical examination, because the system provided sensitivity and specificity values similar to or greater than clinical diagnosis.
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Affiliation(s)
| | - John Baeten
- Director of Engineering/Research and Development, Inter-Med, Inc, Racine, WI
| | - Ketan Patel
- Attending Surgeon, North Memorial Health Care, Robbinsdale, MN
| | - Molly Killian
- Clinical Research Coordinator, North Memorial Health Care, Robbinsdale, MN
| | - Sumsum Sunny
- Fellow, Mazumdar Shaw Cancer Center, Bangalore, India
| | - Amritha Suresh
- Research Scientist, Mazumdar Shaw Cancer Center, Bangalore, India
| | - K Uma
- Oral Pathologist, KLES Dental College, Bangalore, India
| | - Praveen Birur
- Professor and Department Head, Oral Medicine and Radiology, KLES Dental College, Bangalore, India
| | - Moni Kuriakose
- Professor and Director, Department of Surgical Oncology, Narayana Hrudayalaya Hospital, Bangalore, India; Professor of Oncology and Director of Head and Neck Oncology Research Program, Roswell Park Cancer Institute, Buffalo, NY
| | - Deepak Kademani
- Chief of Surgery, Chief and Fellowship Director, Oral and Maxillofacial Surgery, North Memorial Medical Center, Robbinsdale, MN.
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29
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Fann JC, Chang KJ, Hsu CY, Yen AM, Yu CP, Chen SL, Kuo WH, Tabár L, Chen HH. Impact of Overdiagnosis on Long-Term Breast Cancer Survival. Cancers (Basel) 2019; 11:E325. [PMID: 30866499 DOI: 10.3390/cancers11030325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 02/24/2019] [Accepted: 03/04/2019] [Indexed: 12/31/2022] Open
Abstract
Elucidating whether and how long-term survival of breast cancer is mainly due to cure after early detection and effective treatment and therapy or overdiagnosis resulting from the widespread use of mammography provides a new insight into the role mammography plays in screening, surveillance, and treatment of breast cancer. Given information on detection modes, the impact of overdiagnosis due to mammography screening on long-term breast cancer survival was quantitatively assessed by applying a zero (cured or overdiagnosis)-inflated model design and analysis to a 15-year follow-up breast cancer cohort in Dalarna, Sweden. The probability for non-progressive breast cancer (the zero part) was 56.14% including the 44.34% complete cure after early detection and initial treatment and a small 11.80% overdiagnosis resulting from mammography screening program (8.94%) and high awareness (2.86%). The 15-year adjusted cumulative survival of breast cancer was dropped from 88.25% to 74.80% after correcting for the zero-inflated part of overdiagnosis. The present findings reveal that the majority of survivors among women diagnosed with breast cancer could be attributed to the cure resulting from mammography screening and accompanying effective treatment and therapy and only a small fraction of those were due to overdiagnosis.
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30
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Wender RC, Brawley OW, Fedewa SA, Gansler T, Smith RA. A blueprint for cancer screening and early detection: Advancing screening's contribution to cancer control. CA Cancer J Clin 2019; 69:50-79. [PMID: 30452086 DOI: 10.3322/caac.21550] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
From the mid-20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The opportunity to detect and treat precursor lesions and invasive disease at a more favorable stage has contributed substantially to reduced incidence, morbidity, and mortality. However, as new discoveries portend advancements in technology and risk-based screening, we fail to fulfill the greatest potential of the existing technology, in terms of both full access among the target population and the delivery of state-of-the art care at each crucial step in the cascade of events that characterize successful cancer screening. There also is insufficient commitment to invest in the development of new technologies, incentivize the development of new ideas, and rapidly evaluate promising new technology. In this report, the authors summarize the status of cancer screening and propose a blueprint for the nation to further advance the contribution of screening to cancer control.
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Affiliation(s)
- Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Department of Surveillance Research, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Strategic Director of Pathology Research, American Cancer Society, Atlanta, GA
| | - Robert A Smith
- Vice-President, Cancer Screening, Cancer Control Department, and Director, Center for Quality Cancer Screening and Research, American Cancer Society Atlanta, GA
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31
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Tabár L, Dean PB, Chen THH, Yen AMF, Chen SLS, Fann JCY, Chiu SYH, Ku MMS, Wu WYY, Hsu CY, Chen YC, Beckmann K, Smith RA, Duffy SW. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer 2018; 125:515-523. [PMID: 30411328 PMCID: PMC6588008 DOI: 10.1002/cncr.31840] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 11/16/2022]
Abstract
Background Women and their health care providers need a reliable answer to this important question: If a woman chooses to participate in regular mammography screening, then how much will this choice improve her chances of avoiding a death from breast cancer compared with women who choose not to participate? Methods To answer this question, we used comprehensive registries for population, screening history, breast cancer incidence, and disease‐specific death data in a defined population in Dalarna County, Sweden. The annual incidence of breast cancer was calculated along with the annual incidence of breast cancers that were fatal within 10 and within 11 to 20 years of diagnosis among women aged 40 to 69 years who either did or did not participate in mammography screening during a 39‐year period (1977‐2015). For an additional comparison, corresponding data are presented from 19 years of the prescreening period (1958‐1976). All patients received stage‐specific therapy according to the latest national guidelines, irrespective of the mode of detection. Results The benefit for women who chose to participate in an organized breast cancer screening program was a 60% lower risk of dying from breast cancer within 10 years after diagnosis (relative risk, 0.40; 95% confidence interval, 0.34‐0.48) and a 47% lower risk of dying from breast cancer within 20 years after diagnosis (relative risk, 0.53; 95% confidence interval, 0.44‐0.63) compared with the corresponding risks for nonparticipants. Conclusions Although all patients with breast cancer stand to benefit from advances in breast cancer therapy, the current results demonstrate that women who have participated in mammography screening obtain a significantly greater benefit from the therapy available at the time of diagnosis than do those who have not participated. After 20 years of follow‐up, women who participate in mammography screening have a 47% lower risk of dying from breast cancer. Although all patients with breast cancer potentially can benefit from advances in breast cancer therapy, women who participate in mammography screening obtain a significantly greater benefit from the therapy available at the time of diagnosis than those who do not participate.
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Affiliation(s)
- László Tabár
- Department of Mammography, Falun Central Hospital, Falun, Sweden
| | - Peter B Dean
- Department of Radiology, University of Turku, Turku, Finland
| | - Tony Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, Collage of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, Collage of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | | | | | - May Mei-Sheng Ku
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Chen-Yang Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ching Chen
- Department of Biostatistics, Taipei City Hospital, Taipei, Taiwan
| | - Kerri Beckmann
- Center for Population Health Research, University of South Australia, Adelaide, Australia
| | - Robert A Smith
- Cancer Control Department, and Center for Quality Cancer Screening and Research, American Cancer Society, Atlanta, Georgia
| | - Stephen W Duffy
- Center for Cancer Prevention, Queen Mary University of London, London, United Kingdom
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Alba LH, Díaz S, Gamboa O, Poveda C, Henao A, Perry F, Duggan C, Gil F, Murillo R. Accuracy of mammography and clinical breast examination in the implementation of breast cancer screening programs in Colombia. Prev Med 2018; 115:19-25. [PMID: 30092313 DOI: 10.1016/j.ypmed.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/30/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
Most evidence on breast cancer screening accuracy derives from high income countries. We evaluated screening accuracy and factors related to program implementation in Bogota, Colombia. Between 2008 and 2012 participants underwent clinical breast examination (CBE) and mammography. Positive results underwent histological verification. Adherence to screening protocols was analyzed. Sensitivity, specificity, and predictive values were estimated and adjusted by overdiagnosis. Impact of alternative screening algorithms on follow-up was explored, including combined screening tests and modified coding systems for mammography. In total, 7436 women aged 50-69 were enrolled; 400 discontinued and 1003 non-compliant with screening protocols. 23 cancer cases were diagnosed. Mammography sensitivity and specificity were 78.3% (95%CI 77.3-99.3) and 99.4% (95%CI 99.2-99.6). CBE sensitivity was 39.1% (95%CI 37.9-40.3) and specificity 83.4% (95%CI 82.6-84.3). Parallel mammography and CBE showed the highest sensitivity (95.6%) and combined as serial tests the lowest (positive CBE followed by mammography 13.0%). A simplified coding system for mammography (recall/no-recall) had 6.3% of positive results and a minor reduction in specificity compared with standard mammography, but reported the best balance between recall rates and screening protocol compliance. Call-backs had high rates of loss-to-follow-up; thus, alternative screening algorithms might help increase screening compliance and follow-up in low and middle income countries, particularly in populations with poor screening history and low access to health services.
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Affiliation(s)
- Luz Helena Alba
- Department of Preventive and Social Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sandra Díaz
- Clínica de seno, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Oscar Gamboa
- Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - César Poveda
- Servicio de Imaginología, Instituto Nacional de Cancerología, Bogotá, Colombia; Facultad de Medicina, Universidad Nacional, Bogotá, Colombia
| | - Andrés Henao
- Radiología, Centro de Enfermedades Mamarias, Bogotá, Colombia
| | - Fernando Perry
- Clínica de seno, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Fabián Gil
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Raúl Murillo
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France; Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, Colombia.
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Al-Shamsi HO, Alrawi S. Breast cancer screening in the United Arab Emirates: is it time to call for a screening at an earlier age? ACTA ACUST UNITED AC 2018. [DOI: 10.15406/jcpcr.2018.09.00334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Williams LB, McCall A, Looney SW, Joshua T, Tingen MS. Demographic, psychosocial, and behavioral associations with cancer screening among a homeless population. Public Health Nurs 2018; 35:281-290. [PMID: 29473212 DOI: 10.1111/phn.12391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although cancer incidence and mortality is declining, cancer remains among the leading causes of death in the United States. Research shows that cancer morbidity and mortality can be reduced by early detection. Yet, both cancer risks and screening behavior remain understudied in the homeless population. METHODS Researchers conducted a cross-sectional survey of homeless individuals (n = 201). The analysis describes the demographic, psychosocial, and behavioral associations with cancer screenings and knowledge of the lung cancer screening recommendation. RESULTS Participants' mean age was 51.7 years (SD 13.6); the group was largely African American (77.3%) and male (67.9%). Among women, the breast and cervical cancer screening rates were 46.5% and 85.1%. Among men the prostate cancer screening rate was 34.2%. Among all participants, the colon cancer screening rate was 44%. Cancer risk behaviors were high. Lung cancer screening knowledge was low (23.0%). Some cancer screening behaviors were associated with age, income, health status, obesity, tobacco use, and physical activity. DISCUSSION Despite higher cancer risk behaviors, knowledge and general participation rates for cancer screenings were below national benchmarks. CONCLUSION To improve cancer survival among disparate populations, sustained community outreach is necessary to increase awareness of screening recommendations, identify high-risk individuals, and navigate them to resources.
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Affiliation(s)
- Lovoria B Williams
- Biobehavioral Department, College of Nursing, Augusta University, Augusta, GA, USA
| | - Amber McCall
- Department of Physiological & Technological Nursing, College of Nursing, Augusta University, Augusta, GA, USA
| | - Stephen W Looney
- Department of Biostatistics and Epidemiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Thomas Joshua
- Biobehavioral Department, College of Nursing, Augusta University, Augusta, GA, USA
| | - Martha S Tingen
- Department of Pediatrics and the Georgia Prevention Institute, Medical College of Georgia, Population Health Sciences, Augusta University, Augusta, GA, USA
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Carlson NS. Current Resources for Evidence-Based Practice, July/August 2017. J Obstet Gynecol Neonatal Nurs 2017; 46:e138-43. [PMID: 28576658 DOI: 10.1016/j.jogn.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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