Interval cancer in the Córdoba Breast Tomosynthesis Screening Trial (CBTST): comparison of digital breast tomosynthesis plus digital mammography to digital mammography alone

PURPOSE

This work aims to compare the interval cancer rate and interval cancer characteristics between women screened with digital breast tomosynthesis (DBT) + digital mammography (DM) and those screened with DM alone.

METHODS

The interval cancer rate and interval cancer characteristics of the study population included in the Córdoba Breast Tomosynthesis Screening Trial (CBTST) were compared to a contemporary control population screened with DM. The tumour characteristics of screen-detected and interval cancers were also compared. Contingency tables were used to compare interval cancer rates. The chi-square test and Fisher's exact test were used to compare the qualitative characteristics of the cancers whereas Student's t test and the Mann-Whitney U test were used to analyse quantitative features.

RESULTS

A total of 16,068 screening exams with DBT + DM were conducted within the CBTST (mean age 57.59 ± 5.9 [SD]) between January 2015 and December 2016 (study population). In parallel, 23,787 women (mean age 58.89 ± 5.9 standard deviation [SD]) were screened with DM (control population). The interval cancer rate was lower in the study population than in the control population (15 [0.93‰; 95% confidence interval (CI): 0.73, 1.14] vs 43 [1.8‰; 95% CI: 1.58, 2.04] respectively; p = 0.045). The difference in rate was more marked in women with dense breasts (0.95‰ in the study population vs 3.17‰ in the control population; p = 0.031). Interval cancers were smaller in the study population than in the control population (p = 0.031).

CONCLUSIONS

The interval cancer rate was lower in women screened with DBT + DM compared to those screened with DM alone. These differences were more pronounced in women with dense breasts.

CLINICAL RELEVANCE STATEMENT

Women screened using tomosynthesis and digital mammography had a lower rate of interval cancer than women screened with digital mammography, with the greatest difference in the interval cancer rate observed in women with dense breasts.

KEY POINTS

• The interval cancer rate was lower in the study population (digital breast tomosynthesis [DBT] + digital mammography [DM]) than in the control population (DM). • The difference in interval cancer rates was more pronounced in women with dense breasts. • Interval cancers were smaller in the study population (DBT + DM) than in the control population (DM).

Breast cancer is associated to impaired glucose/insulin homeostasis in premenopausal obese/overweight patients

The association between breast cancer (BCa) presence and altered glucose/insulin metabolism is controversial likely due to an inaccurate insulin resistance (IR) assessment and inappropriate stratification of patients by body-mass index (BMI) and menopausal state. 148 women with suspect of sporadic BCa were stratified by BMI and menopause. Fasting levels of glucose, insulin, glycohemoglobin and selected IR-related and tumor-derived markers were measured. Glucose/insulin levels during OGTT were used to calculate insulin resistance/sensitivity indexes. Analysis of 77 BCa-bearing patients and 71 controls showed an association between BCa and IR as demonstrated by impaired glucose/insulin homeostasis (increased fasting- and OGTT-induced glucose levels) and deteriorated IR indexes, which was especially patent in premenopausal women. The association between BCa presence and IR was markedly influenced by BMI, being obese BCa patients significantly more insulin resistant than controls. BCa presence was associated to elevated levels of IR (glucose, triglycerides) and tumor-derived (VEGF) markers, especially in overweight/obese patients. BCa presence is associated to IR in overweight/obese premenopausal but not in premenopausal normal weight or postmenopausal women. Our data support a bidirectional relationship between dysregulated/imbalanced glucose/insulin metabolism and BCa, as tumor- and IR-markers are correlated with the impairment of glucose/insulin metabolism in overweight/obese premenopausal BCa patients.

[Acute cerebrovascular disease in the Northern Cordoba Health Area]

INTRODUCTION

Its high rates of prevalence, mortality and disability make acute cerebrovascular disease (ACVD) a priority health problem. It is as the second most common cause of admission to internal medicine services.

AIMS

To examine inpatient care for ACVD during 2004 in the Valle de los Pedroches health area in the province of Cordoba, as well as survival at six months, so as to be able to carry out the changes needed to improve the attention offered for this condition.

PATIENTS AND METHODS

A longitudinal study of the acute phase of the illness and survival at six months was conducted by means of face-to-face interviews.

RESULTS

The prevalence of arterial hypertension (75.5%) stands out as a risk factor. The mean age was higher than in other series. There is no characteristic profile of clinical symptoms. The proportion of ischaemic to haemorrhagic strokes falls within the normal range. All 110 patients were submitted to a cranial computerised axial tomography scan in less than three hours. A compromised level of consciousness, senility, haemorrhagic stroke, poorer scoring on the Canadian Neurological Scale and complications all affected mortality rates. The study showed that 20% died while in hospital and 19.1% at six months. At discharge, 30.9% were undergoing rehabilitation. The spouse was the main caregiver in 55.5% of cases. A total of 79% had sequelae at six months.

CONCLUSIONS

Instruments that allow fast effective diagnoses and treatments and guarantee proper clinical practice while reducing brain damage and its dependence should be made generally available. Improving primary and secondary prevention is essential in order to halt the progression of ACVD.