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Roman M, Louro J, Vázquez I, Saladié F, Peñalva L, Bargalló X, Quintana M, Del Riego J, Vidal C, Castells X. Long-term breast cancer risk after benign breast disease in population-based screening. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01360-0] [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: 11/19/2022]
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Román M, Louro J, Posso M, Vidal C, Bargalló X, Vázquez I, Quintana MJ, Alcántara R, Saladié F, del Riego J, Peñalva L, Sala M, Castells X. Long-Term Risk of Breast Cancer after Diagnosis of Benign Breast Disease by Screening Mammography. Int J Environ Res Public Health 2022; 19:ijerph19052625. [PMID: 35270331 PMCID: PMC8909630 DOI: 10.3390/ijerph19052625] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/04/2022]
Abstract
Assessing the long-term risk of breast cancer after diagnosis of benign breast disease by mammography is of utmost importance to design personalised screening strategies. We analysed individual-level data from 778,306 women aged 50–69 years with at least one mammographic screening participation in any of ten breast cancer screening centers in Spain from 1996 to 2015, and followed-up until 2017. We used Poisson regression to compare the rates of incident breast cancer among women with and without benign breast disease. During a median follow-up of 7.6 years, 11,708 (1.5%) women had an incident of breast cancer and 17,827 (2.3%) had a benign breast disease. The risk of breast cancer was 1.77 times higher among women with benign breast disease than among those without (95% CI: 1.61 to 1.95). The relative risk increased to 1.99 among women followed for less than four years, and remained elevated for two decades, with relative risk 1.96 (95% CI: 1.32 to 2.92) for those followed from 12 to 20 years. Benign breast disease is a long-term risk factor for breast cancer. Women with benign breast disease could benefit from closer surveillance and personalized screening strategies.
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Affiliation(s)
- Marta Román
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
| | - Javier Louro
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Margarita Posso
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Carmen Vidal
- Cancer Prevention and Monitoring Program, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain;
| | - Xavier Bargalló
- Department of Radiology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Ivonne Vázquez
- Pathology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - María Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Rodrigo Alcántara
- Radiology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - Francina Saladié
- Epidemiology and Cancer Prevention Service, Hospital Universitari Sant Joan de Reus, IISPV, 43204 Reus, Spain;
| | - Javier del Riego
- Department of Radiology, Parc Taulí University Hospital-UAB, 08208 Sabadell, Spain;
| | - Lupe Peñalva
- Breast Cancer Screening Technical Office, Private Foundation Asil Hospital, 08402 Granollers, Spain;
| | - Maria Sala
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
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Louro J, Román M, Posso M, Vázquez I, Saladié F, Rodriguez-Arana A, Quintana MJ, Domingo L, Baré M, Marcos-Gragera R, Vernet-Tomas M, Sala M, Castells X. Developing and validating an individualized breast cancer risk prediction model for women attending breast cancer screening. PLoS One 2021; 16:e0248930. [PMID: 33755692 PMCID: PMC7987139 DOI: 10.1371/journal.pone.0248930] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several studies have proposed personalized strategies based on women's individual breast cancer risk to improve the effectiveness of breast cancer screening. We designed and internally validated an individualized risk prediction model for women eligible for mammography screening. METHODS Retrospective cohort study of 121,969 women aged 50 to 69 years, screened at the long-standing population-based screening program in Spain between 1995 and 2015 and followed up until 2017. We used partly conditional Cox proportional hazards regression to estimate the adjusted hazard ratios (aHR) and individual risks for age, family history of breast cancer, previous benign breast disease, and previous mammographic features. We internally validated our model with the expected-to-observed ratio and the area under the receiver operating characteristic curve. RESULTS During a mean follow-up of 7.5 years, 2,058 women were diagnosed with breast cancer. All three risk factors were strongly associated with breast cancer risk, with the highest risk being found among women with family history of breast cancer (aHR: 1.67), a proliferative benign breast disease (aHR: 3.02) and previous calcifications (aHR: 2.52). The model was well calibrated overall (expected-to-observed ratio ranging from 0.99 at 2 years to 1.02 at 20 years) but slightly overestimated the risk in women with proliferative benign breast disease. The area under the receiver operating characteristic curve ranged from 58.7% to 64.7%, depending of the time horizon selected. CONCLUSIONS We developed a risk prediction model to estimate the short- and long-term risk of breast cancer in women eligible for mammography screening using information routinely reported at screening participation. The model could help to guiding individualized screening strategies aimed at improving the risk-benefit balance of mammography screening programs.
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Affiliation(s)
- Javier Louro
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
- European Higher Education Area (EHEA) Doctoral Programme in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Marta Román
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
- * E-mail:
| | - Margarita Posso
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | | | - Francina Saladié
- Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | | | - M. Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laia Domingo
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | - Marisa Baré
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Clinical Epidemiology and Cancer Screening, Parc Taulí University Hospital, Sabadell, Spain
| | - Rafael Marcos-Gragera
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Department of Health, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | | | - Maria Sala
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
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Vernet-Tomás M, Louro J, Román M, Saladié F, Posso M, Prieto M, Vázquez I, Baré M, Peñalva L, Vidal C, Bargalló X, Sánchez M, Ferrer J, A Espinàs J, Quintana MJ, Rodríguez-Arana A, Castells X. Risk of breast cancer two years after a benign biopsy depends on the mammographic feature prompting recall. Maturitas 2020; 144:53-59. [PMID: 33358209 DOI: 10.1016/j.maturitas.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to explore whether the type of mammographic feature prompting a false-positive recall (FPR) during mammography screening influences the risk and timing of breast cancer diagnosis, particularly if assessed with invasive procedures. STUDY DESIGN We included information on women screened and recalled for further assessment in Spain between 1994 and 2015, with follow-up until 2017, categorizing FPRs by the assessment (noninvasive or invasive) and mammographic feature prompting the recall. MAIN OUTCOME MEASURES Breast cancer rates in the first two years after FPR (first period) and after two years (second period). RESULTS The study included 99,825 women with FPRs. In both periods, the breast cancer rate was higher in the invasive assessment group than in the noninvasive group (first period 12 ‰ vs 1.9 ‰, p < 0.001; second period 4.4‰ vs 3.1‰, p < 0.001). During the first period, the invasive assessment group showed diverse breast cancer rates for each type of mammographic feature, with a higher rate for asymmetric density (31.9‰). When the second period was compared with the first, the breast cancer rate decreased in the invasive assessment group (from 12‰ to 4.4‰, p < 0.001) and increased in the noninvasive assessment group (from 1.9‰ to 3.1‰, p < 0.001). CONCLUSION In the context of mammography screening, the risk of breast cancer diagnosis during the first two years after FPR was particularly high for women undergoing invasive assessment; importantly, the risk was modified by type of mammographic feature prompting the recall. This information could help to individualize follow-up after exclusion of malignancy.
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Affiliation(s)
- Maria Vernet-Tomás
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain.
| | - Javier Louro
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Marta Román
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Francina Saladié
- Fundació Lliga per a La Investigació i Prevenció del Càncer (FUNCA), Avinguda Josep Laporte, 2, 43204, Reus, Spain
| | - Margarita Posso
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Miguel Prieto
- Consejería de Sanidad, Gobierno de Asturias. Calle Ciriaco Miguel Vigil, 9, 33005, Oviedo, Spain
| | - Ivonne Vázquez
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Marisa Baré
- Consorci Corporació Sanitaria Parc Taulí, Parc Taulí, 1, 08208, Sabadell, Spain
| | - Lupe Peñalva
- Hospital General de Granollers, Av. Francesc Ribas, s/n, 08402, Granollers, Spain
| | - Carmen Vidal
- Programa de Prevenció i Control del Càncer de l'Institut Català d'Oncologia, Gran Via de l'Hospitalet, 199-203, 08908, L'Hospitalet de Llobregat, Spain
| | - Xavier Bargalló
- Centro de Diagnóstico por la Imagen Clínic (CDIC) del Hospital Clínic de Barcelona. Calle Villarroel 170, 08036, Barcelona, Spain
| | - Mar Sánchez
- Dirección General de Salud Pública del Gobierno de Cantabria, C/ Federico Vial 13, 39009, Santander, Spain
| | - Joana Ferrer
- Hospital de Santa Caterina, Carrer del Dr. Castany, s/n, 17190, Salt, Girona, Spain
| | - Josep A Espinàs
- Pla Director d'Oncologia del Departament de Salut de la Generalitat de Catalunya, Travessera de les Corts, 131-159, 08028, Barcelona, Spain
| | - M Jesús Quintana
- Departament d'Epidemiologia de l'Hospital de la Santa Creu i Sant Pau, c/ San Antoni M. Claret 167, 08025, Barcelona, Spain
| | - Ana Rodríguez-Arana
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Xavier Castells
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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Louro J, Román M, Posso M, Comerma L, Vidal C, Saladié F, Alcantara R, Sanchez M, Quintana MJ, Del Riego J, Ferrer J, Peñalva L, Bargalló X, Prieto M, Sala M, Castells X. Differences in breast cancer risk after benign breast disease by type of screening diagnosis. Breast 2020; 54:343-348. [PMID: 33023825 PMCID: PMC7770442 DOI: 10.1016/j.breast.2020.09.005] [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: 07/03/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction We aimed to assess differences in breast cancer risk across benign breast disease diagnosed at prevalent or incident screens. Materials and methods We conducted a retrospective cohort study with data from 629,087 women participating in a long-standing population-based breast cancer screening program in Spain. Each benign breast disease was classified as non-proliferative, proliferative without atypia, or proliferative with atypia, and whether it was diagnosed in a prevalent or incident screen. We used partly conditional Cox hazard regression to estimate the adjusted hazard ratios of the risk of breast cancer. Results Compared with women without benign breast disease, the risk of breast cancer was significantly higher (p-value = 0.005) in women with benign breast disease diagnosed in an incident screen (aHR, 2.67; 95%CI: 2.24–3.19) than in those with benign breast disease diagnosed in a prevalent screen (aHR, 1.87; 95%CI: 1.57–2.24). The highest risk was found in women with a proliferative benign breast disease with atypia (aHR, 4.35; 95%CI: 2.09–9.08, and 3.35; 95%CI: 1.51–7.40 for those diagnosed at incident and prevalent screens, respectively), while the lowest was found in women with non-proliferative benign breast disease (aHR, 2.39; 95%CI: 1.95–2.93, and 1.63; 95%CI: 1.32–2.02 for those diagnosed at incident and prevalent screens, respectively). Conclusion Our study showed that the risk of breast cancer conferred by a benign breast disease differed according to type of screen (prevalent or incident). To our knowledge, this is the first study to analyse the impact of the screening type on benign breast disease prognosis. Breast cancer risk after a benign breast disease varied with the screening type. Incident benign breast disease had a higher breast cancer risk than prevalent. The risk remained increased regardless of benign breast disease subtype.
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Affiliation(s)
- Javier Louro
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain; European Higher Education Area (EHEA) Doctoral Programme in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Marta Román
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain
| | - Margarita Posso
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain
| | - Laura Comerma
- Servei de Patologia, Hospital Del Mar, Barcelona, Spain
| | - Carmen Vidal
- Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - Francina Saladié
- Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, Institut D'Investigació Sanitària Pere Virgili, Universitat Rovira I Virgili, Reus, Spain
| | - Rodrigo Alcantara
- Servei de Diagnòstic per La Imatge, Hospital Del Mar, Barcelona, Spain
| | - Mar Sanchez
- Direction General of Public Health, Cantabria, Spain
| | - M Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de La Santa Creu I Sant Pau, IIB Sant Pau, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - Javier Del Riego
- Women's Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain
| | - Joana Ferrer
- Radiology Department, Hospital de Santa Caterina, Salt, Girona, Spain
| | - Lupe Peñalva
- Vallés Oriental Breast Cancer Early Detection Program, Spain
| | | | - Miguel Prieto
- Breast Cancer Screening Program, Principality of Asturias, Spain
| | - María Sala
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain
| | - Xavier Castells
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain.
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Louro J, Román M, Posso M, Vidal C, Prieto M, Saladié F, Baré M, Sánchez M, Quintana M, Bargalló X, Ferrer J, Peñalva L, Sala M, Castells X. Differences in breast cancer risk after a benign breast disease according to the screening type. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30552-9] [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: 11/26/2022]
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Laroussy L, Ameijide A, Saladié F, Espinàs JA, Borràs JM, Galceran J. [Participation of the immigrant population in breast cancer screening in Tarragona, Spain]. Gac Sanit 2018; 33:468-471. [PMID: 30205914 DOI: 10.1016/j.gaceta.2018.05.010] [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] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/22/2018] [Accepted: 05/25/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the differences between autochthonous and allochthonous women's participation in a breast cancer screening programme. METHOD Retrospective study based on data from the Breast Cancer Screening Programme of the province of Tarragona (2008-2015). The sample is the target population of the programme with known country of origin. RESULTS Cohort of 40,824 women. Allochthonous women participate less than autochthonous women (41.8% vs. 72.3%) although they have a similar global detection rate to the latter but with differences according to the human development index of their country of origin. Both groups present similar tumour stages on detection (p=.59). CONCLUSIONS Strategies specifically aimed at the immigrant population are required to improve their participation in breast cancer screening.
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Affiliation(s)
- Lamiaa Laroussy
- Departament de Ciències Mèdiques, Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Alberto Ameijide
- Programa de Detecció Precoç de Cáncer de Mama de Tarragona, Fundació Lliga per a la Investigació i Prevenció del Càncer, IISPV, Reus (Tarragona), España
| | - Francina Saladié
- Programa de Detecció Precoç de Cáncer de Mama de Tarragona, Fundació Lliga per a la Investigació i Prevenció del Càncer, IISPV, Reus (Tarragona), España
| | - Josep Alfons Espinàs
- Pla Director d'Oncologia, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España
| | - Josep Maria Borràs
- Pla Director d'Oncologia, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España
| | - Jaume Galceran
- Programa de Detecció Precoç de Cáncer de Mama de Tarragona, Fundació Lliga per a la Investigació i Prevenció del Càncer, IISPV, Reus (Tarragona), España.
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Román M, Caicoya M, Espinàs J, Sala M, Torá-Rocamora I, Quinta MJ, Vernet M, Saladié F, Romero A, Sánchez M, Baré M, Vidal C, Servitja S, Natal C, Corominas J, Ferrer J, Rodríguez-Arana A, Castells X. Clinical and histologic characteristics of breast cancers in women with previous pathologic diagnosis of benign breast disease in Spain. Breast J 2018. [PMID: 29517151 DOI: 10.1111/tbj.13003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/24/2023]
Abstract
Women with a benign breast disease (BBD) have an increased risk of subsequent breast carcinoma. Information is scarce regarding the characteristics of breast carcinomas diagnosed after a BBD. Our aim was to point out the differences in clinical and histologic characteristics of breast carcinomas diagnosed in women with and without a previous pathologic diagnosis of BBD in the context of population-based mammography screening. Retrospective cohort study of all women aged 50-69 years who were screened at least once in a population-based screening program in Spain, between 1994 and 2011 and followed up until December 2012. The mean follow-up was 6.1 years. We analyzed 6645 breast carcinomas, of whom 238 had a previous pathologic diagnosis of BBD. Information on clinical and histologic characteristics was collected from pathology reports. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence intervals (95%CI) of occurrence of selected histologic characteristics of breast carcinomas in women with and without a previous BBD. Women with a previous BBD had a higher proportion of ductal carcinoma in situ (DCIS) compared with women without a BBD (22.1% and 13.6%, respectively). Among those diagnosed with an invasive breast carcinoma, women with previous BBD were more likely to be diagnosed with carcinomas sized >2 cm (OR = 1.46; 95%CI = 1.03-2.08), metastatic positive (OR = 2.66; 95%CI = 1.21-5.86), and with a high Ki-67 proliferation rate (OR = 1.93; 95%CI = 1.24-2.99). No differences were found across histologic subtypes of BBD. Screening participants with a previous pathologic diagnosis of BBD had a higher proportion of DCIS. However, invasive carcinomas detected in women with a BBD were associated with clinical and histologic characteristics conferring a worst prognosis.
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Affiliation(s)
- Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Martin Caicoya
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Josep Espinàs
- Department of Health, Catalan Cancer Plan, Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Isabel Torá-Rocamora
- Preventive Medicine and Epidemiology Department, Hospital Clinic, Barcelona, Spain
| | - Maria J Quinta
- Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mar Vernet
- Department of Obstetrics and Gynecology, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Francina Saladié
- Breast Cancer Screening Program of Tarragona, The Foundation League for the Research and Prevention of Cancer, Tarragona, Spain
| | - Anabel Romero
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Mar Sánchez
- General Directorate of Public Health, Government of Cantabria, Santander, Spain
| | - Marisa Baré
- Clinical Epidemiology and Cancer Screening, Parc Taulí University Hospital, Sabadell, Spain
| | - Carmen Vidal
- Cancer Prevention and Monitoring Program, Catalan Institute of Oncology, Barcelona, Spain
| | - S Servitja
- Department of Oncology, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carmen Natal
- Breast Cancer Screening Program, Principality of Asturias, Oviedo, Spain
| | - Joosep Corominas
- Department of Pathological Anatomy, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Joana Ferrer
- Radiology Department, Hospital de Santa Caterina, Girona, Spain
| | - Ana Rodríguez-Arana
- Department of Image Diagnostics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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Posso M, Corominas JM, Serrano L, Román M, Torá‐Rocamora I, Domingo L, Romero A, Quintana MJ, Vernet‐Tomas M, Baré M, Vidal C, Sánchez M, Saladié F, Natal C, Ferrer J, Servitja S, Sala M, Castells X. Biomarkers expression in benign breast diseases and risk of subsequent breast cancer: a case-control study. Cancer Med 2017; 6:1482-1489. [PMID: 28470951 PMCID: PMC5463091 DOI: 10.1002/cam4.1080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/16/2022] Open
Abstract
Women with benign breast diseases (BBD) have a high risk of breast cancer. However, no biomarkers have been clearly established to predict cancer in these women. Our aim was to explore whether estrogen receptor (ER), progesterone receptor (PR), and Ki67 expression stratify risk of breast cancer in screened women with BBD. We conducted a nested case-control study. Women with breast cancer and prior BBDs (86 cases) were matched to women with prior BBDs who were free from breast cancer (172 controls). The matching factors were age at BBD diagnosis, type of BBD, and follow-up time since BBD diagnosis. ER, PR, and Ki67 expression were obtained from BBDs' specimens. Conditional logistic regression was used to estimate odds ratios (ORs), and 95% confidence intervals (CIs) of breast cancer risk according to ER, PR, and Ki67 expression. Women with >90% of ER expression had a higher risk of breast cancer (OR = 2.63; 95% CI: 1.26-5.51) than women with ≤70% of ER expression. Similarly, women with >80% of PR expression had a higher risk of breast cancer (OR = 2.22; 95% CI: 1.15-4.27) than women with ≤40% of PR expression. Women with proliferative disease and ≥1% of Ki67 expression had a nonsignificantly increased risk of breast cancer (OR = 1.16; 95% CI: 0.46-2.90) than women with <1% of Ki67 expression. A high expression of ER and PR in BBD is associated with an increased risk of subsequent breast cancer. In proliferative disease, high Ki67 expression may also have an increased risk. This information is helpful to better characterize BBD and is one more step toward personalizing the clinical management of these women.
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Affiliation(s)
- Margarita Posso
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Department of Clinical Epidemiology and Public HealthHospital de la Santa Creu i Sant Pau (IIB Sant Pau)BarcelonaSpain
| | - Josep M. Corominas
- Pathology DepartmentIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Laia Serrano
- Pathology DepartmentIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Marta Román
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
| | - Isabel Torá‐Rocamora
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
| | - Laia Domingo
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
- Agency for Health Quality and Assessment of Catalonia (AQuAS)BarcelonaSpain
| | - Anabel Romero
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
| | - María Jesús Quintana
- Department of Clinical Epidemiology and Public HealthHospital de la Santa Creu i Sant Pau (IIB Sant Pau)BarcelonaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)BarcelonaSpain
| | - María Vernet‐Tomas
- Obstetrics and Gynecology DepartmentIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Marisa Baré
- Clinical Epidemiology and Cancer ScreeningParc Taulí University HospitalBarcelonaSpain
| | - Carmen Vidal
- Cancer Prevention and Control ProgramCatalan Institute of OncologyBarcelonaSpain
| | - Mar Sánchez
- Direction General of Public HealthDepartment of HealthGovernment of CantabriaSantanderSpain
| | - Francina Saladié
- Breast Cancer Screening Program of TarragonaThe Foundation League for the Research and Prevention of CancerTarragonaSpain
| | - Carmen Natal
- Principality of Asturias Breast Cancer Screening ProgramPrincipality of AsturiasOviedoSpain
| | - Joana Ferrer
- Radiology DepartmentHospital de Santa CaterinaGironaSpain
| | - Sònia Servitja
- Oncology DepartmentIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - María Sala
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
| | - Xavier Castells
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
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Castells X, Torá-Rocamora I, Posso M, Román M, Vernet-Tomas M, Rodríguez-Arana A, Domingo L, Vidal C, Baré M, Ferrer J, Quintana MJ, Sánchez M, Natal C, Espinàs JA, Saladié F, Sala M. Risk of Breast Cancer in Women with False-Positive Results according to Mammographic Features. Radiology 2016; 280:379-86. [DOI: 10.1148/radiol.2016151174] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Castells X, Domingo L, Corominas JM, Torá-Rocamora I, Quintana MJ, Baré M, Vidal C, Natal C, Sánchez M, Saladié F, Ferrer J, Vernet M, Servitja S, Rodríguez-Arana A, Roman M, Espinàs JA, Sala M. Breast cancer risk after diagnosis by screening mammography of nonproliferative or proliferative benign breast disease: a study from a population-based screening program. Breast Cancer Res Treat 2015; 149:237-44. [PMID: 25503778 PMCID: PMC4298666 DOI: 10.1007/s10549-014-3208-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
Benign breast disease increases the risk of breast cancer. This association has scarcely been evaluated in the context of breast cancer screening programs although it is a prevalent finding in mammography screening. We assessed the association of distinct categories of benign breast disease and subsequent risk of breast cancer, as well as the influence of a family history of breast cancer. A retrospective cohort study was conducted in 545,171 women aged 50-69 years biennially screened for breast cancer in Spain. The median of follow-up was 6.1 years. The age-adjusted rate ratio (RR) of breast cancer for women with benign breast disease, histologically classified into nonproliferative and proliferative disease with and without atypia, compared with women without benign breast disease was estimated by Poisson regression analysis. A stratified analysis by family history of breast cancer was performed in a subsample. All tests were two-sided. The age-adjusted RR of breast cancer after diagnosis of benign breast disease was 2.51 (95 % CI: 2.14-2.93) compared with women without benign breast disease. The risk was higher in women with proliferative disease with atypia (RR = 4.56, 95 % CI: 2.06-10.07) followed by those with proliferative disease without atypia (RR = 3.58; 95 % CI = 2.61-4.91). Women with nonproliferative disease and without a family history of breast cancer remained also at increased risk of cancer (OR = 2.23, 95 % CI: 1.86-2.68). An increased risk of breast cancer was observed among screening participants with proliferative or nonproliferative benign breast disease, regardless of a family history of breast cancer. This information may be useful to explore risk-based screening strategies.
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Affiliation(s)
- Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg. Marítim 25-29, 08003, Barcelona, Catalonia, Spain,
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