1
|
Duffy SW, Yen AMF, Tabar L, Lin ATY, Chen SLS, Hsu CY, Dean PB, Smith RA, Chen THH. Beneficial effect of repeated participation in breast cancer screening upon survival. J Med Screen 2024; 31:3-7. [PMID: 37437178 PMCID: PMC10878004 DOI: 10.1177/09691413231186686] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES The benefit of mammography screening in reducing population mortality from breast cancer is well established. In this paper, we estimate the effect of repeated participation at scheduled screens on case survival. METHODS We analysed incidence and survival data on 37,079 women from nine Swedish counties who had at least one to five invitation(s) to screening prior to diagnosis, and were diagnosed with breast cancer between 1992 and 2016. Of these, 4564 subsequently died of breast cancer. We estimated the association of survival with participation in up to the most recent five screens before diagnosis. We used proportional hazards regression to estimate the effect on survival of the number of scheduled screens in which subjects participated prior to the diagnosis of breast cancer. RESULTS There was successively better survival with an increasing number of screens in which the subject participated. For a woman with five previous screening invitations who participated in all five, the hazard ratio was 0.28 (95% confidence interval (CI) 0.25-0.33, p < 0.0001) compared to a woman attending none (86.9% vs 68.9% 20-year survival). Following a conservative adjustment for potential self-selection factors, the hazard ratio was 0.34 (95% CI 0.26-0.43, p < 0.0001), an approximate three-fold reduction in the hazard of dying from breast cancer. CONCLUSION For those women who develop breast cancer, regular prior participation in mammography screening confers significantly better survival.
Collapse
Affiliation(s)
- Stephen W Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Abbie Ting-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Yang Hsu
- Master of Public Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | | | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
2
|
Tabár L, Dean PB, Ming-Fang Yen A, Yi-Ying Wu W, Tarján M, Lee Tucker F, Hsiu-Hsi Chen T, Vörös A. The term "classic invasive lobular carcinoma" of the breast defines breast malignancies of vastly different nature. Eur J Radiol 2023; 168:111119. [PMID: 37813006 DOI: 10.1016/j.ejrad.2023.111119] [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: 07/23/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To describe in detail the special features of a previously unappreciated "classic invasive lobular carcinoma" which is confined to the terminal ductal lobular units (TDLUs) and differs considerably from the extensive classic invasive lobular carcinoma, and to suggest specific terminology. METHOD All invasive breast cancer cases without associated microcalcifications diagnosed in our Institution with the histopathologic diagnosis of classic invasive lobular carcinoma during the years 1996-2019 (n = 560) formed the basis of this study. The cases were prospectively classified according to their imaging biomarkers (mammographic features) and followed up to Dec 31, 2021, to determine long-term patient outcome. An additional 2600 invasive breast cancer cases (diagnosed other than invasive lobular carcinoma) without associated microcalcifications served as a reference group. Detailed histopathologic analysis used large format (10x8 cm) thin section technique and staining methods including hematoxylin-eosin (H&E), E-cadherin, cytokeratin CK 5/6, a transmembrane glycoprotein (CD44) and anti-actin or anti-smooth muscle myosin heavy chain. RESULTS The imaging biomarkers differentiated two separate disease subgroups, having the same histopathologic diagnosis, classic invasive lobular carcinoma. One of these has the imaging biomarker of extensive architectural distortion with no central tumour mass, occupies the extralobular mesenchyme and has a long-term survival of 56%. The other subgroup forms stellate or circular non-calcified tumour masses usually smaller than 20 mm, which appear to arise in the intralobular mesenchyme, and has a significantly better long-term survival of 84%. CONCLUSIONS There is a striking difference between the subgross histopathology and the mammographic appearance (imaging biomarkers) of two breast malignancies having the same histopathologic diagnosis, "classic invasive lobular carcinoma". The large difference in the long-term outcome of these two tumour types is even more striking. Using the same specific term, "classic invasive lobular carcinoma", to describe these two separate entities can adversely affect management decisions.
Collapse
Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden.
| | - Peter B Dean
- University of Turku, FI-20014 Turun Yliopisto, Finland
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - Miklós Tarján
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden
| | - F Lee Tucker
- Virginia Biomedical Laboratories, Wirtz, VA, USA
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Hsuchow Road, Taipei 100, Taiwan
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás út 1, H-6720 Szeged, Hungary
| |
Collapse
|
3
|
Duffy SW, Tabar L, Chen TH, Yen AM, Dean PB, Smith RA. A plea for more careful scholarship in reviewing evidence: the case of mammographic screening. BJR Open 2023; 5:20230041. [PMID: 37942497 PMCID: PMC10630970 DOI: 10.1259/bjro.20230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 11/10/2023] Open
Abstract
Objectives To identify issues of principle and practice giving rise to misunderstandings in reviewing evidence, to illustrate these by reference to the Nordic Cochrane Review (NCR) and its interpretation of two trials of mammographic screening, and to draw lessons for future reviewing of published results. Methods A narrative review of the publications of the Nordic Cochrane Review of mammographic screening (NCR), the Swedish Two-County Trial (S2C) and the Canadian National Breast Screening Study 1 and 2 (CNBSS-1 and CNBSS-2). Results The NCR concluded that the S2C was unreliable, despite the review's complaints being shown to be mistaken, by direct reference to the original primary publications of the S2C. Repeated concerns were expressed by others about potential subversion of randomisation in CNBSS-1 and CNBSS-2; however, the NCR continued to rely heavily on the results of these trials. Since 2022, however, eyewitness evidence of such subversion has been in the public domain. Conclusions An over-reliance on nominal satisfaction of checklists of criteria in systematic reviewing can lead to erroneous conclusions. This occurred in the case of the NCR, which concluded that mammographic screening was ineffective or minimally effective. Broader and more even-handed reviews of the evidence show that screening confers a substantial reduction in breast cancer mortality. Advances in knowledge Those carrying out systematic reviews should be aware of the dangers of over-reliance on checklists and guidelines. Readers of systematic reviews should be aware that a systematic review is just another study, with the capability that all studies have of coming to incorrect conclusions. When a review seems to overturn the current position, it is essential to revisit the publications of the primary research.
Collapse
Affiliation(s)
- Stephen W. Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, UK
| | | | - Tony H.H. Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amy M.F. Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | | | | |
Collapse
|
4
|
Tabár L, Dean PB, Tucker FL, Yen AMF, Chen SLS, Lin ATY, Hsu CY, Munpolsri P, Wu WYY, Smith RA, Duffy SW, Chen THH, Tarján M, Vörös A. Imaging biomarkers are underutilised but highly predictive prognostic factors for the more fatal breast cancer subtypes. Eur J Radiol 2023; 166:111021. [PMID: 37542814 DOI: 10.1016/j.ejrad.2023.111021] [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: 04/23/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE The development and refinement of breast imaging modalities offer a wealth of diagnostic information such as imaging biomarkers, which are primarily the mammographic appearance of the various breast cancer subtypes. These are readily available preoperatively at the time of diagnosis and can enhance the prognostic value of currently used molecular biomarkers. In this study, we investigated the relative utility of the molecular and imaging biomarkers, both jointly and independently, when predicting long-term patient outcome according to the site of tumour origin. METHODS We evaluated the association of imaging biomarkers and conventional molecular biomarkers, (ER, PR, HER-2, Ki67), separately and combined, with long-term patient outcome in all breast cancer cases having complete data on both imaging and molecular biomarkers (n = 2236) diagnosed in our Institute during the period 2008-2019. Large format histopathology technique was used to document intra- and intertumoural heterogeneity and select the appropriate foci for evaluating molecular biomarkers. RESULTS The breast cancer imaging biomarkers were strongly predictive of long-term patient outcome. The molecular biomarkers were predictive of outcome only for unifocal acinar adenocarcinoma of the breast (AAB), but less reliable in the multifocal AAB cases due to variability of molecular biomarkers in the individual tumour foci. In breast cancer of mesenchymal origin (BCMO), conventionally termed classic invasive lobular carcinoma, and in cancers originating from the major lactiferous ducts (ductal adenocarcinoma of the breast, DAB), the molecular biomarkers misleadingly indicated favourable prognosis, whereas the imaging biomarkers in BCMO and DAB reliably indicated the high risk of breast cancer death. Among the 2236 breast cancer cases, BCMO and DAB comprised 21% of the breast cancer cases, but accounted for 45% of the breast cancer deaths. CONCLUSIONS Integration of imaging biomarkers into the diagnostic workup of breast cancer yields a more precise, comprehensive and prognostically accurate diagnostic report. This is particularly necessary in multifocal AAB cases having intertumoural heterogeneity, in diffuse carcinomas (DAB and BCMO), and in cases with combined DAB and AAB. In such cases, the imaging biomarkers should be prioritised over molecular biomarkers in planning treatment because the latter fail to predict the severity of the disease. In combination with the use of the large section histopathology technique, imaging biomarkers help alleviate some of the current problems in breast cancer management, such as over- and under-assessment of disease extent, which carry the risk of overtreatment and undertreatment.
Collapse
Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden.
| | - Peter B Dean
- University of Turku, FI-20014 Turun Yliopisto, Finland
| | | | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, 250 Wuxing Street, Taipei 110, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, 250 Wuxing Street, Taipei 110, Taiwan
| | - Abbie Ting-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Hsuchow Road, Taipei 100, Taiwan
| | - Chen-Yang Hsu
- Daichung Hospital, No. 304, Guangfu Rd, Zhunan Township, Miaoli 350, Taiwan
| | - Pattaranan Munpolsri
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, 250 Wuxing Street, Taipei 110, Taiwan
| | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, GA 30303, USA
| | - Stephen W Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square London EC1M 6BQ, UK
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Hsuchow Road, Taipei 100, Taiwan
| | - Miklós Tarján
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás street 1, H-6720 Szeged, Hungary
| |
Collapse
|
5
|
Tabár L, Bozó R, Dean PB, Ormándi K, Puchkova O, Oláh-Németh O, Németh IB, Veréb Z, Yen MF, Chen LS, Chen HH, Vörös A. Does Diffusely Infiltrating Lobular Carcinoma of the Breast Arise from Epithelial-Mesenchymal Hybrid Cells? Int J Mol Sci 2023; 24:10752. [PMID: 37445938 DOI: 10.3390/ijms241310752] [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: 05/31/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Classic diffusely infiltrating lobular carcinoma has imaging features divergent from the breast cancers originating from the terminal ductal lobular units and from the major lactiferous ducts. Although the term "invasive lobular carcinoma" implies a site of origin within the breast lobular epithelium, we were unable to find evidence supporting this assumption. Exceptional excess of fibrous connective tissue and the unique cell architecture combined with the aberrant features at breast imaging suggest that this breast malignancy has not originated from cells lining the breast ducts and lobules. The only remaining relevant component of the fibroglandular tissue is the mesenchyme. The cells freshly isolated and cultured from diffusely infiltrating lobular carcinoma cases contained epithelial-mesenchymal hybrid cells with both epithelial and mesenchymal properties. The radiologic and histopathologic features of the tumours and expression of the mesenchymal stem cell positive markers CD73, CD90, and CD105 all suggest development in the direction of mesenchymal transition. These hybrid cells have tumour-initiating potential and have been shown to have poor prognosis and resistance to therapy targeted for malignancies of breast epithelial origin. Our work emphasizes the need for new approaches to the diagnosis and therapy of this highly fatal breast cancer subtype.
Collapse
Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden
| | - Renáta Bozó
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Korányi Street 6, H-6720 Szeged, Hungary
| | - Peter B Dean
- Department of Diagnostic Radiology, Faculty of Medicine, University of Turku, FI-20014 Turun, Finland
| | - Katalin Ormándi
- Department of Radiology, University of Szeged, Semmelweis Street 6, H-6725 Szeged, Hungary
| | - Olga Puchkova
- Department of Breast Imaging, Il'inskaya Hospital, Novorizhskoye Highway 9 km, 101000 Moscow, Russia
| | - Orsolya Oláh-Németh
- Department of Pathology, University of Szeged, Állomás Street 2, H-6725 Szeged, Hungary
| | - István Balázs Németh
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Korányi Street 6, H-6720 Szeged, Hungary
| | - Zoltán Veréb
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Korányi Street 6, H-6720 Szeged, Hungary
| | - Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Hsuchow Road, Taipei 100, Taiwan
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás Street 2, H-6725 Szeged, Hungary
| |
Collapse
|
6
|
Tabár L, Dean PB, Tucker FL, Yen AMF, Chen THH, Wu WYY, Vörös A. Multifocal and diffusely infiltrating breast cancers are highly fatal subgroups needing further improvement in diagnostic and therapeutic strategies. Eur J Radiol 2023; 164:110854. [PMID: 37163829 DOI: 10.1016/j.ejrad.2023.110854] [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: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
Physicians treating breast cancer patients often wonder why this dreaded disease is still fatal in some women despite our best diagnostic and therapeutic efforts. Our own studies on prospectively documented cases spanning several decades have given us new insights for approaching this problem. By using imaging biomarkers to classify breast cancer subtypes according to their apparent site of origin, we found that a majority of breast cancer deaths (71%) occur in a minority of breast cancers (45%). Breast cancer deaths are significantly more likely to occur in women with multifocal acinar adenocarcinoma of the breast, AAB (13.1%), diffusely invasive breast cancers of ductal origin, DAB (24 %) and breast malignancies of mesenchymal hybrid cell origin, BCMO (33.7%) compared with women having unifocal invasive breast cancers (6.1%). Preventing more of these fatal events will require a re-evaluation of the current imperfect histopathologic terminology of breast cancer with special attention to the diffuse breast cancer subtypes, intensification of multimodality imaging and multidisciplinary management, as well as application of image guided large format histopathology.
Collapse
Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen, 10, 791 82 Falun, Sweden.
| | - Peter B Dean
- University of Turku, FI-20014 Turun Yliopisto, Finland
| | - F Lee Tucker
- Virginia Biomedical Laboratories, Wirtz, VA, USA
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17, Hsuchow Road, Taipei 100, Taiwan
| | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás út 1, H-6720 Szeged, Hungary
| |
Collapse
|
7
|
Tabár L, Dean PB, Lee Tucker F, Vörös A. Can we improve breast cancer management using an image-guided histopathology workup supported by larger histopathology sections? Eur J Radiol 2023; 161:110750. [PMID: 36821956 DOI: 10.1016/j.ejrad.2023.110750] [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: 12/10/2022] [Accepted: 02/14/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE Breast radiologists examine the entire breast in full-size images, while breast pathologists examine small tissue samples at high magnification. The diagnostic information from these complementary imaging approaches can be difficult to integrate for a more clinically relevant evaluation of malignancies spanning several centimetres. We have explored the advantages and disadvantages of imaging guided larger section pathology techniques compared with the standard 2 × 2.5 cm. small section technique. METHODS We compared the ability of conventional small section histopathology with larger section histopathology techniques to examine surgical resection margins and full disease extent. We evaluated the pre-surgical imaging workup and use of microfocus magnification radiography of sliced surgical specimens in the histopathologic evaluation of disease extent and status of surgical margins. RESULTS Image assisted large section histopathology of excised breast tissue enables comprehensive examination of an approximately tenfold larger contiguous tissue area than is provided by conventional small section technology. Attempting to cover the full area of each consecutive slice of resected tissue is more labour-intensive and expensive with the small section approach and poses challenges in reconstituting three-dimensional tumour architecture after morcellation and sectioning. Restricting histopathologic examination to a limited number of samples provides an incomplete evaluation of surgical margins. CONCLUSIONS A considerably improved documentation of breast cancer and a more reliable assessment of tissue margins is provided by using larger sized histopathology samples to correlate with breast imaging findings. These in turn can enable more appropriate treatment planning, improved surgical performance, fewer recurrences, and better patient outcome. Uncertainty of surgical margin evaluation inherent to the standard small section technique can lead to inappropriate decisions in surgical management and adjunctive therapy. Progress in breast diagnosis and treatment will largely depend on whether histopathology terminology and technique will undergo a revolution similar to the one that has already occurred in breast imaging.
Collapse
Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden.
| | - Peter B Dean
- University of Turku, FI-20014 Turun Yliopisto, Finland
| | - F Lee Tucker
- Virginia Biomedical Laboratories, Wirtz, Virginia, USA
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás street 1, H-6720 Szeged, Hungary
| |
Collapse
|
8
|
Tabár L, Dean PB, Lee Tucker F, Yen AMF, Chang RWJ, Hsu CY, Smith RA, Duffy SW, Chen THH. Breast cancers originating from the major lactiferous ducts and the process of neoductgenesis: Ductal Adenocarcinoma of the Breast, DAB. Eur J Radiol 2022; 153:110363. [DOI: 10.1016/j.ejrad.2022.110363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/30/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
|
9
|
Tabár L, Dean PB, Tucker FL, Yen AMF, Fann JCY, Lin ATY, Smith RA, Duffy SW, Chen THH. Breast cancers originating from the terminal ductal lobular units: In situ and invasive acinar adenocarcinoma of the breast, AAB. Eur J Radiol 2022; 152:110323. [DOI: 10.1016/j.ejrad.2022.110323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/15/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
|
10
|
Tabár L, Dean PB, Lee Tucker F, Hsiu-Hsi Chen T, Smith RA, Duffy SW, Yueh-Hsia Chiu S, Mei-Sheng Ku M, Fan CY, Ming-Fang Yen A. Imaging Biomarkers of Breast Cancers Originating from the Major Lactiferous Ducts: Ductal Adenocarcinoma of the Breast, DAB. Eur J Radiol 2022; 154:110394. [DOI: 10.1016/j.ejrad.2022.110394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
|
11
|
Jarm K, Kadivec M, Šval C, Hertl K, Primic Žakelj M, Dean PB, von Karsa L, Žgajnar J, Gazić B, Kutnar V, Zdešar U, Kurir Borovčić M, Zadnik V, Josipović I, Krajc M. Quality assured implementation of the Slovenian breast cancer screening programme. PLoS One 2021; 16:e0258343. [PMID: 34624045 PMCID: PMC8500434 DOI: 10.1371/journal.pone.0258343] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/26/2021] [Indexed: 12/01/2022] Open
Abstract
SETTING The organised, population-based breast cancer screening programme in Slovenia began providing biennial mammography screening for women aged 50-69 in 2008. The programme has taken a comprehensive approach to quality assurance as recommended by the European guidelines for quality assurance in breast cancer screening and diagnosis (4th edition), including centralized assessment, training and supervision, and proactive monitoring of performance indicators. This report describes the progress of implementation and rollout from 2003 through 2019. METHODS The screening protocol and key quality assurance procedures initiated during the planning from 2003 and rollout from 2008 of the screening programme, including training of the professional staff, are described. The organisational structure, gradual geographical rollout, and coverage by invitation and examination are presented. RESULTS The nationwide programme was up and running in all screening regions by the end of 2017, at which time the nationwide coverage by invitation and examination had reached 70% and 50%, respectively. Nationwide rollout of the population-based programme was complete by the end of 2019. By this time, coverage by invitation and examination had reached 98% and 76%, respectively. The participation rates consistently exceeded 70% from 2014 to 2019. CONCLUSIONS The successful implementation of the screening programme can be attributed to an independent central management, external guidance, and strict adherence to quality assurance procedures, all of which contributed to increasing governmental and popular support. The benefits of quality assurance have influenced all aspects of breast care and have provided a successful model for multidisciplinary management of other diseases.
Collapse
Affiliation(s)
- Katja Jarm
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Ljubljana, Slovenia
| | | | - Cveto Šval
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | - Peter B. Dean
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Formerly at the International Agency for Research on Cancer, Lyon, France
| | - Lawrence von Karsa
- Formerly at the International Agency for Research on Cancer, Lyon, France
| | - Janez Žgajnar
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Barbara Gazić
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Urban Zdešar
- Institute of Occupational Safety, Ljubljana, Slovenia
| | | | - Vesna Zadnik
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Mateja Krajc
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
12
|
Malaspina S, Anttinen M, Taimen P, Jambor I, Sandell M, Rinta-Kiikka I, Kajander S, Schildt J, Saukko E, Noponen T, Saunavaara J, Dean PB, Sequeiros RB, Aronen HJ, Kemppainen J, Seppänen M, Boström PJ, Ettala O. Prospective comparison of 18F-PSMA-1007 PET/CT, whole-body MRI and CT in primary nodal staging of unfavourable intermediate- and high-risk prostate cancer. Eur J Nucl Med Mol Imaging 2021; 48:2951-2959. [PMID: 33715033 PMCID: PMC8263440 DOI: 10.1007/s00259-021-05296-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 12/03/2020] [Accepted: 02/28/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively compare 18F-prostate-specific membrane antigen (PSMA)-1007 positron emission tomography (PET)/CT, whole-body magnetic resonance imaging (WBMRI) including diffusion-weighted imaging (DWI) and standard computed tomography (CT), in primary nodal staging of prostate cancer (PCa). METHODS Men with newly diagnosed unfavourable intermediate- or high-risk PCa prospectively underwent 18F-PSMA-1007 PET/CT, WBMRI with DWI and contrast-enhanced CT within a median of 8 days. Six readers (two for each modality) independently reported pelvic lymph nodes as malignant, equivocal or benign while blinded to the other imaging modalities. Sensitivity, specificity and accuracy were reported according to optimistic (equivocal lesions interpreted as benign) and pessimistic (equivocal lesions interpreted as malignant) analyses. The reference standard diagnosis was based on multidisciplinary consensus meetings where available histopathology, clinical and follow-up data were used. RESULTS Seventy-nine patients completed all the imaging modalities, except for one case of interrupted WBMRI. Thirty-one (39%) patients had pelvic lymph node metastases, which were detected in 27/31 (87%), 14/31 (45%) and 8/31 (26%) patients by 18F-PSMA-1007 PET/CT, WBMRI with DWI and CT, respectively (optimistic analysis). In 8/31 (26%) patients, only 18F-PSMA-1007 PET/CT detected malignant lymph nodes, while the other two imaging modalities were reported as negative. At the patient level, sensitivity and specificity values for 18F-PSMA-1007 PET/CT, WBMRI with DWI and CT in optimistic analysis were 0.87 (95%CI 0.71-0.95) and 0.98 (95%CI 0.89-1.00), 0.37 (95%CI 0.22-0.55) and 0.98 (95%CI 0.89-1.00) and 0.26 (95%CI 0.14-0.43) and 1.00 (95%CI 0.93-1.00), respectively. CONCLUSION 18F-PSMA-1007 PET/CT showed significantly greater sensitivity in nodal staging of primary PCa than did WBMRI with DWI or CT, while maintaining high specificity. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov ID: NCT03537391.
Collapse
Affiliation(s)
- Simona Malaspina
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
| | - Mikael Anttinen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine and Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Sandell
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Sami Kajander
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Jukka Schildt
- Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Ekaterina Saukko
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tommi Noponen
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter B Dean
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Marko Seppänen
- Department of Clinical Physiology, Nuclear Medicine and Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
13
|
Duffy SW, Tabár L, Yen AMF, Dean PB, Smith RA, Jonsson H, Törnberg S, Chiu SYH, Chen SLS, Jen GHH, Ku MMS, Hsu CY, Ahlgren J, Maroni R, Holmberg L, Chen THH. Beneficial Effect of Consecutive Screening Mammography Examinations on Mortality from Breast Cancer: A Prospective Study. Radiology 2021; 299:541-547. [PMID: 33650900 DOI: 10.1148/radiol.2021203935] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Previously, the risk of death from breast cancer was analyzed for women participating versus those not participating in the last screening examination before breast cancer diagnosis. Consecutive attendance patterns may further refine estimates. Purpose To estimate the effect of participation in successive mammographic screening examinations on breast cancer mortality. Materials and Methods Participation data for Swedish women eligible for screening mammography in nine counties from 1992 to 2016 were linked with data from registries and regional cancer centers for breast cancer diagnosis, cause, and date of death (Uppsala University ethics committee registration number: 2017/147). Incidence-based breast cancer mortality was calculated by whether the women had participated in the most recent screening examination prior to diagnosis only (intermittent participants), the penultimate screening examination only (lapsed participants), both examinations (serial participants), or neither examination (serial nonparticipants). Rates were analyzed with Poisson regression. We also analyzed incidence of breast cancers proving fatal within 10 years. Results Data were available for a total average population of 549 091 women (average age, 58.9 years ± 6.7 [standard deviation]). The numbers of participants in the four groups were as follows: serial participants, 392 135; intermittent participants, 41 746; lapsed participants, 30 945; and serial nonparticipants, 84 265. Serial participants had a 49% lower risk of breast cancer mortality (relative risk [RR], 0.51; 95% CI: 0.48, 0.55; P < .001) and a 50% lower risk of death from breast cancer within 10 years of diagnosis (RR, 0.50; 95% CI: 0.46, 0.55; P < .001) than serial nonparticipants. Lapsed and intermittent participants had a smaller reduction. Serial participants had significantly lower risk of both outcomes than lapsed or intermittent participants. Analyses correcting for potential biases made little difference to the results. Conclusion Women participating in the last two breast cancer screening examinations prior to breast cancer diagnosis had the largest reduction in breast cancer death. Missing either one of the last two examinations conferred a significantly higher risk. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Stephen A. Feig in this issue.
Collapse
Affiliation(s)
- Stephen W Duffy
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - László Tabár
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Amy Ming-Fang Yen
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Peter B Dean
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Robert A Smith
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Håkan Jonsson
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Sven Törnberg
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Sherry Yueh-Hsia Chiu
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Sam Li-Sheng Chen
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Grace Hsiao-Hsuan Jen
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - May Mei-Sheng Ku
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Chen-Yang Hsu
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Johan Ahlgren
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Roberta Maroni
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Lars Holmberg
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| | - Tony Hsiu-Hsi Chen
- From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.)
| |
Collapse
|
14
|
Tabár L, Dean PB. Recommendations for breast cancer screening. Lancet Oncol 2020; 21:e511. [DOI: 10.1016/s1470-2045(20)30495-2] [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] [Received: 08/13/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
|
15
|
Anttinen M, Ettala O, Malaspina S, Jambor I, Sandell M, Kajander S, Rinta-Kiikka I, Schildt J, Saukko E, Rautio P, Timonen KL, Matikainen T, Noponen T, Saunavaara J, Löyttyniemi E, Taimen P, Kemppainen J, Dean PB, Blanco Sequeiros R, Aronen HJ, Seppänen M, Boström PJ. A Prospective Comparison of 18F-prostate-specific Membrane Antigen-1007 Positron Emission Tomography Computed Tomography, Whole-body 1.5 T Magnetic Resonance Imaging with Diffusion-weighted Imaging, and Single-photon Emission Computed Tomography/Computed Tomography with Traditional Imaging in Primary Distant Metastasis Staging of Prostate Cancer (PROSTAGE). Eur Urol Oncol 2020; 4:635-644. [PMID: 32675047 DOI: 10.1016/j.euo.2020.06.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [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: 05/06/2020] [Revised: 06/08/2020] [Accepted: 06/29/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Computed tomography (CT) and bone scintigraphy (BS) are the imaging modalities currently used for distant metastasis staging of prostate cancer (PCa). OBJECTIVE To compare standard staging modalities with newer and potentially more accurate imaging modalities. DESIGN, SETTING, AND PARTICIPANTS This prospective, single-centre trial (NCT03537391) enrolled 80 patients with newly diagnosed high-risk PCa (International Society of Urological Pathology grade group ≥3 and/or prostate-specific antigen [PSA] ≥20 and/or cT ≥ T3; March 2018-June 2019) to undergo primary metastasis staging with two standard and three advanced imaging modalities. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The participants underwent the following five imaging examinations within 2 wk of enrolment and without a prespecified sequence: BS, CT, 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) single-photon emission computed tomography (SPECT)-CT, 1.5 T whole-body magnetic resonance imaging (WBMRI) using diffusion-weighted imaging, and 18F-prostate-specific membrane antigen-1007 (18F-PSMA-1007) positron emission tomography(PET)-CT. Each modality was reviewed by two independent experts blinded to the results of the prior studies, who classified lesions as benign, equivocal, or malignant. Pessimistic and optimistic analyses were performed to resolve each equivocal diagnosis. The reference standard diagnosis was defined using all available information accrued during at least 12 mo of clinical follow-up. Patients with equivocal reference standard diagnoses underwent MRI and/or CT to search for the development of anatomical correspondence. PSMA PET-avid lesions without histopathological verification were rated to be malignant only if there was a corresponding anatomical finding suspicious for malignancy at the primary or follow-up imaging. RESULTS AND LIMITATIONS Seventy-nine men underwent all imaging modalities except for one case of interrupted MRI. The median interval per patient between the first and the last imaging study was 8 d (interquartile range [IQR]: 6-9). The mean age was 70 yr (standard deviation: 7) and median PSA 12 ng/mL (IQR:7-23). The median follow-up was 435 d (IQR: 378-557). Metastatic disease was detected in 20 (25%) patients. The imaging modality 18F-PSMA-1007 PET-CT had superior sensitivity and highest inter-reader agreement. The area under the receiver-operating characteristic curve (AUC) values for bone metastasis detection with PSMA PET-CT were 0.90 (95% confidence interval [CI]: 0.85-0.95) and 0.91 (95% CI: 0.87-0.96) for readers 1 and 2, respectively, while the AUC values for BS, CT, SPECT-CT, and WBMRI were 0.71 (95% CI: 0.58-0.84) and 0.8 (95% CI: 0.67-0.92), 0.53 (95% CI: 0.39-0.67) and 0.66 (95% CI: 0.54-0.77), 0.77 (95% CI: 0.65-0.89) and 0.75 (95% CI: 0.62-0.88), and 0.85 (95% CI: 0.74-0.96) and 0.67 (95% CI: 0.54-0.80), respectively, for the other four pairs of readers. The imaging method 18F-PSMA-1007 PET-CT detected metastatic disease in 11/20 patients in whom standard imaging was negative and influenced clinical decision making in 14/79 (18%) patients. In 12/79 cases, false positive bone disease was reported only by PSMA PET-CT. Limitations included a nonrandomised study setting and few histopathologically validated suspicious lesions. CONCLUSIONS Despite the risk of false positive bone lesions, 18F-PSMA-1007 PET-CT outperformed all other imaging methods studied for the detection of primary distant metastasis in high-risk PCa. PATIENT SUMMARY In this report, we compared the diagnostic performance of conventional and advanced imaging. It was found that 18F-prostate-specific membrane antigen-1007 positron emission tomography/computed tomography (18F-PSMA-1007 PET-CT) was superior to the other imaging modalities studied for the detection of distant metastasis at the time of initial diagnosis of high-risk prostate cancer. PSMA PET-CT also appears to detect some nonmetastatic bone lesions.
Collapse
Affiliation(s)
- Mikael Anttinen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Simona Malaspina
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Minna Sandell
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Sami Kajander
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Irina Rinta-Kiikka
- Department of Radiology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Jukka Schildt
- Department of Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ekaterina Saukko
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pentti Rautio
- Department of Clinical Physiology, North Karelia Central Hospital, Joensuu, Finland
| | - Kirsi L Timonen
- Department of Clinical Physiology and Nuclear Medicine, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Tuomas Matikainen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tommi Noponen
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Pekka Taimen
- Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter B Dean
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Marko Seppänen
- Department of Clinical Physiology, Nuclear Medicine and Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
16
|
Duffy SW, Tabár L, Yen AMF, Dean PB, Smith RA, Jonsson H, Törnberg S, Chen SLS, Chiu SYH, Fann JCY, Ku MMS, Wu WYY, Hsu CY, Chen YC, Svane G, Azavedo E, Grundström H, Sundén P, Leifland K, Frodis E, Ramos J, Epstein B, Åkerlund A, Sundbom A, Bordás P, Wallin H, Starck L, Björkgren A, Carlson S, Fredriksson I, Ahlgren J, Öhman D, Holmberg L, Chen THH. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer 2020; 126:2971-2979. [PMID: 32390151 PMCID: PMC7318598 DOI: 10.1002/cncr.32859] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [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: 10/23/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death. METHODS Among 549,091 women, covering approximately 30% of the Swedish screening-eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression. RESULTS Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51-0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66-0.84 [P < .001]). CONCLUSIONS Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens.
Collapse
Affiliation(s)
- Stephen W Duffy
- Centre for Cancer Prevention, Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - László Tabár
- Department of Mammography, Falun Central Hospital, Falun, Sweden
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Peter B Dean
- Diagnostic Radiology, University of Turku, Turku, Finland
| | - Robert A Smith
- Cancer Control Sciences, American Cancer Society, Atlanta, Georgia
| | - Håkan Jonsson
- Regional Cancer Center, Umeå University, Umeå, Sweden
| | - Sven Törnberg
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Division of Biostatistics, Institute of Preventive Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jean Ching-Yuan Fann
- Department of Nutrition and Health Sciences, Kainan University, Taoyuan City, Taiwan
| | - May Mei-Sheng Ku
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | | | - Chen-Yang Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | | | - Gunilla Svane
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Edward Azavedo
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Ewa Frodis
- Västerås Central Hospital, Västerås, Sweden
| | | | | | | | | | | | | | | | | | | | - Irma Fredriksson
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Ahlgren
- Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden
| | - Daniel Öhman
- Regional Cancer Center, Stockholm-Gotland, Stockholm, Sweden
| | | | - Tony Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| |
Collapse
|
17
|
Tabár L, Chen THH, Yen AMF, Dean PB, Smith RA, Jonsson H, Törnberg S, Chen SLS, Chiu SYH, Fann JCY, Ku MMS, Wu WYY, Hsu CY, Chen YC, Svane G, Azavedo E, Grundström H, Sundén P, Leifland K, Frodis E, Ramos J, Epstein B, Åkerlund A, Sundbom A, Bordás P, Wallin H, Starck L, Björkgren A, Carlson S, Fredriksson I, Ahlgren J, Öhman D, Holmberg L, Duffy SW. Early detection of breast cancer rectifies inequality of breast cancer outcomes. J Med Screen 2020; 28:34-38. [PMID: 32370610 PMCID: PMC7905745 DOI: 10.1177/0969141320921210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/30/2022]
Abstract
Objectives To explain apparent differences among mammography screening services in Sweden using individual data on participation in screening and with breast cancer–specific survival as an outcome. Methods We analysed breast cancer survival data from the Swedish Cancer Register on breast cancer cases from nine Swedish counties diagnosed in women eligible for screening. Data were available on 38,278 breast cancers diagnosed and 4312 breast cancer deaths. Survival to death from breast cancer was estimated using the Kaplan–Meier estimate, for all cases in each county, and separately for cases of women participating and not participating in their last invitation to screening. Formal statistical comparisons of survival were made using proportional hazards regression. Results All counties showed a reduction in the hazard of breast cancer death with participation in screening, but the reductions for individual counties varied substantially, ranging from 51% (95% confidence interval 46–55%) to 81% (95% confidence interval 74–85%). Survival rates in nonparticipating women ranged from 53% (95% confidence interval 40–65%) to 74% (95% confidence interval 72–77%), while the corresponding survival in women participating in screening varied from 80% (95% confidence interval 77–84%) to 86% (95% confidence interval 83–88%), a considerably narrower range. Conclusions Differences among counties in the effect of screening on breast cancer outcomes were mainly due to variation in survival in women not participating in screening. Screening conferred similarly high survival rates in all counties. This indicates that the performance of screening services was similar across counties and that detection and treatment of breast cancer in early-stage reduces inequalities in breast cancer outcome.
Collapse
Affiliation(s)
| | | | | | - Peter B Dean
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | | | - Håkan Jonsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Sven Törnberg
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden
| | | | | | | | | | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | | | - Gunilla Svane
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden
| | - Edward Azavedo
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden
| | | | | | | | - Ewa Frodis
- Västerås Central Hospital, Västerås, Sweden
| | | | | | | | | | - Pál Bordás
- Sunderby Hospital, Department of Radiology, Norrbotten County, Sweden
| | | | | | | | | | | | - Johan Ahlgren
- Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden
| | - Daniel Öhman
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden
| | - Lars Holmberg
- Uppsala University, Uppsala, Sweden and Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| |
Collapse
|
18
|
Duffy SW, Smith RA, Tabár L, Dean PB, Chen THH. Reply to The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer 2019; 125:2130-2131. [PMID: 30747993 DOI: 10.1002/cncr.32007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - László Tabár
- Department of Mammography, Falun Central Hospital, Falun, Sweden
| | - Peter B Dean
- Department of Radiology, University of Turku, Turku, Finland
| | | |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Duffy SW, Tabar L, Chen THH, Yen AMF, Dean PB, Smith RA. What Information Should be Given to Women Invited for Mammographic Screening for Breast Cancer? Womens Health (Lond Engl) 2016; 2:829-33. [DOI: 10.2217/17455057.2.6.829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mammography is the only proven frontline screening method for breast cancer. Following the demonstration of a reduction in breast cancer mortality with mammography, population mammographic screening services have been instituted, and there has been discussion in the medical literature of how to convey the pros and cons of screening to invited women. Much of the discussion has focused on the negative aspects of screening, such as false-positive and negative screens, overdiagnosis and anxiety. Also, some commentators have advocated rather cumbersome amounts of quantitative information. In this article we review the original evidence on the positive and negative aspects of screening, and show that the latter may have been exaggerated in the past. We suggest a few simple and clear points that should be made to the invited women, summarizing the positive and negative aspects without a mass of confusing statistics.
Collapse
Affiliation(s)
- Stephen W Duffy
- Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, London, UK, Tel.: +44 (0)20 7014 0252; Fax: +44 (0)20 7014 0258
| | | | | | - Amy MF Yen
- National Taiwan University, Taipei, Taiwan
| | | | | |
Collapse
|
21
|
Dean PB. Book Review: An Atlas and Text of the Breast. Acta Radiol 2016. [DOI: 10.1177/028418518802900131] [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: 11/17/2022]
|
22
|
Armaroli P, Villain P, Suonio E, Almonte M, Anttila A, Atkin WS, Dean PB, de Koning HJ, Dillner L, Herrero R, Kuipers EJ, Lansdorp-Vogelaar I, Minozzi S, Paci E, Regula J, Törnberg S, Segnan N. European Code against Cancer, 4th Edition: Cancer screening. Cancer Epidemiol 2015; 39 Suppl 1:S139-52. [PMID: 26596722 DOI: 10.1016/j.canep.2015.10.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [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: 07/29/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 12/23/2022]
Abstract
In order to update the previous version of the European Code against Cancer and formulate evidence-based recommendations, a systematic search of the literature was performed according to the methodology agreed by the Code Working Groups. Based on the review, the 4th edition of the European Code against Cancer recommends: "Take part in organized cancer screening programmes for: Bowel cancer (men and women); Breast cancer (women); Cervical cancer (women)." Organized screening programs are preferable because they provide better conditions to ensure that the Guidelines for Quality Assurance in Screening are followed in order to achieve the greatest benefit with the least harm. Screening is recommended only for those cancers where a demonstrated life-saving effect substantially outweighs the potential harm of examining very large numbers of people who may otherwise never have, or suffer from, these cancers, and when an adequate quality of the screening is achieved. EU citizens are recommended to participate in cancer screening each time an invitation from the national or regional screening program is received and after having read the information materials provided and carefully considered the potential benefits and harms of screening. Screening programs in the European Union vary with respect to the age groups invited and to the interval between invitations, depending on each country's cancer burden, local resources, and the type of screening test used For colorectal cancer, most programs in the EU invite men and women starting at the age of 50-60 years, and from then on every 2 years if the screening test is the guaiac-based fecal occult blood test or fecal immunochemical test, or every 10 years or more if the screening test is flexible sigmoidoscopy or total colonoscopy. Most programs continue sending invitations to screening up to the age of 70-75 years. For breast cancer, most programs in the EU invite women starting at the age of 50 years, and not before the age of 40 years, and from then on every 2 years until the age of 70-75 years. For cervical cancer, if cytology (Pap) testing is used for screening, most programs in the EU invite women starting at the age of 25-30 years and from then on every 3 or 5 years. If human papillomavirus testing is used for screening, most women are invited starting at the age of 35 years (usually not before age 30 years) and from then on every 5 years or more. Irrespective of the test used, women continue participating in screening until the age of 60 or 65 years, and continue beyond this age unless the most recent test results are normal.
Collapse
Affiliation(s)
- Paola Armaroli
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Patricia Villain
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Eero Suonio
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Maribel Almonte
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1NY, United Kingdom
| | - Peter B Dean
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Harry J de Koning
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Lena Dillner
- Department of Infectious Disease, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Eugenio Paci
- ISPO-Cancer Prevention and Research Institute, Occupational and Environmental Epidemiology Unit, Ponte Nuovo - Padiglione Mario Fiori, Via delle Oblate 2, 50141 Florence, Italy
| | - Jaroslaw Regula
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Gastroenterology, 02-781 Warsaw, Poland
| | - Sven Törnberg
- Department of Cancer Screening, Stockholm Regional Cancer Centre, PO Box 6909, S-102 39 Stockholm, Sweden
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy.
| |
Collapse
|
23
|
Tabár L, Dean PB, Yen AMF, Tarján M, Chiu SYH, Chen SLS, Fann JCY, Chen THH. A Proposal to Unify the Classification of Breast and Prostate Cancers Based on the Anatomic Site of Cancer Origin and on Long-term Patient Outcome. Breast Cancer (Auckl) 2014; 8:15-38. [PMID: 24653647 PMCID: PMC3948717 DOI: 10.4137/bcbcr.s13833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 01/08/2023]
Abstract
The similarity between the structure and function of the breast and prostate has been known for a long time, but there are serious discrepancies in the terminology describing breast and prostate cancers. The use of the large, thick-section (3D) histology technique for both organs exposes the irrationality of the breast cancer terminology. Pathologists with expertise in diagnosing prostate cancer take the anatomic site of cancer origin into account when using the terms AAP (acinar adenocarcinoma of the prostate) and DAP (ductal adenocarcinoma of the prostate) to distinguish between the prostate cancers originating primarily from the fluid-producing acinar portion of the organ (AAP) and the tumors originating either purely from the larger ducts (DAP) or from both the acini and the main ducts combined (DAP and AAP). Long-term patient outcome is closely correlated with the terminology, because patients with DAP have a significantly poorer prognosis than patients with AAP. The current breast cancer terminology could be improved by modeling it after the method of classifying prostate cancer to reflect the anatomic site of breast cancer origin and the patient outcome. The long-term survival curves of our consecutive breast cancer cases collected since 1977 clearly show that the non-palpable, screen-detected breast cancers originating from the milk-producing acini have excellent prognosis, irrespective of their histologic malignancy grade or biomarkers. Correspondingly, the breast cancer subtypes of truly ductal origin have a significantly poorer outcome, despite recent improvements in diagnosis and therapy. The mammographic appearance of breast cancers reflects the underlying tissue structure. Addition of these "mammographic tumor features" to the currently used histologic phenotypes makes it possible to distinguish the breast cancer cases of ductal origin with a poor outcome, termed DAB (ductal adenocarcinoma of the breast), from the more easily managed breast cancers of acinar origin, termed AAB (acinar adenocarcinoma of the breast), which have a significantly better outcome. This simple and easily communicable terminology could lead to better communication between the diagnostic and therapeutic team members and result in more rational treatment planning for the benefit of their patients.
Collapse
Affiliation(s)
- László Tabár
- Department of Mammography, Falun Central Hospital, Falun, Sweden
| | - Peter B Dean
- Department of Diagnostic Radiology, University of Turku, Finland
| | - Amy M-F Yen
- School of Oral Hygiene, Taipei Medical University, Taiwan
| | - Miklós Tarján
- Department of Clinical Pathology, Falun Central Hospital, Falun, Sweden
| | - Sherry Y-H Chiu
- Department and Graduate Institute of Health Care Management, Chang Gung, Taiwan
| | - Sam L-S Chen
- School of Oral Hygiene, Taipei Medical University, Taiwan
| | - Jean C-Y Fann
- Department of Nutrition and Health Sciences, Kainan University, Taoyuan, Taiwan
| | - Tony H-H Chen
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
24
|
Tarján M, Chen HH, Tot T, Wu W, Lenngren A, Dean PB, Tabár L. Improved differentiation between ductal and acinar prostate cancer using three-dimensional histology and biomarkers. ACTA ACUST UNITED AC 2012; 46:258-66. [PMID: 22519924 DOI: 10.3109/00365599.2012.675586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the study was to refine the methodology for discriminating the ductal (DAP) and acinar adenocarcinomas (AAP) of the prostate and confirm that prostate carcinoma of ductal origin is a more aggressive subtype. MATERIAL AND METHODS A retrospective analysis of 110 consecutive radical prostatectomy cases operated on between 2000 and 2006 and worked up using large-format "two-dimensional" (2D; 4 μm thick) and "three-dimensional" (3D; 1500 μm thick) histology sections was carried out, with an average follow-up of 5.1 years. The same material was also analysed for selected biomarkers in tissue microarray blocks. The most discriminatory biomarkers were then tested on preoperative core biopsy specimens from 24 of these patients. RESULTS 3D histology classified 97/110 (88%) cases of AAP and 13/110 (12%) DAP, which was then confirmed in 2D specimens. The DAP cases had a significantly greater frequency of pT3a and more advanced cancers, > 20 mm tumour focus, high-grade prostatic intraepithelial neoplasia, Gleason score ≥ 7, positive margin, extracapsular extension, vascular invasion, seminal vesicle infiltration, biochemical/local recurrence, regional lymph-node metastases and distant metastases. Three biomarkers in combination (chromogranin A, epidermal growth factor receptor and p53] distinguished DAP from AAP with an accuracy of 94% (area under the curve 0.94, 95% confidence interval 0.88-0.99). The same high accuracy was achieved using these three biomarkers on the preoperative specimens. CONCLUSIONS Both 3D histology and the three selected biomarkers can help in accurately distinguishing DAP from AAP. The clear-cut distinction of two forms of prostate cancers by the approach advocated in this paper would allow AAP patients to undergo less radical treatment and would segregate DAP patients into a subset requiring more effective treatment regimens.
Collapse
Affiliation(s)
- Miklós Tarján
- Department of Pathology and Clinical Cytology, Central Hospital, Falun, Sweden.
| | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Randomized controlled mammography screening trials and the evaluation of service screening have unequivocally proven that regular mammography screening significantly reduces mortality from breast cancer. This evidence contradicts the theory of Fisher, claiming that breast cancer is a systemic disease from its inception and undermines the justification for systemic therapy in most screen-detected cancers, because they are still localized to the breast and can be cured by local treatment alone. When high quality mammographic screening is offered at regular intervals to 40- to 74- year-old women, over 50% of the invasive cancers will be detected in the size range of 1-14 mm, fewer than 20% will be axillary node positive, and only about 20% will be poorly differentiated. This predominance of early-stage disease has created a revolutionary new era for those involved in the diagnosis and treatment of patients with breast cancer.
Collapse
Affiliation(s)
- László Tabár
- Department of Mammography, Falun Central Hospital, Falun, Sweden.
| | | |
Collapse
|
26
|
|
27
|
Pfleiderer SOR, Brunzlow H, Schulz-Wendtland R, Pamilo M, Vag T, Camara O, Facius M, Runnebaum IB, Dean PB, Kaiser WA. Two-year follow-up of stereotactically guided 9-G breast biopsy: a multicenter evaluation of a self-contained vacuum-assisted device. Clin Imaging 2009; 33:343-7. [PMID: 19712812 DOI: 10.1016/j.clinimag.2008.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 12/16/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the performance of a self-contained, battery-driven, vacuum-assisted breast biopsy (VABB) system for the sampling of clustered breast microcalcifications and masses under stereotactic guidance. METHODS AND MATERIALS A total of 144 patients (median age: 56 years; range: 21-87 years) in four European breast centers underwent percutaneous 9-gauge (G), stereotactic-guided VABB. The median lesion size was 11 mm (range 2-60 mm). Patients were biopsied in the prone (n=125) or upright position (n=19). All patients were followed up for at least 24 months. RESULTS The stereotactic procedure was successful in 142 (98.6%) of 144 cases, with two cases cancelled due to either severe patient motion (one case) or failure to detect faint calcifications (one case). A median of 12 specimens per procedure was obtained. In 39 cases (27.5%), the suspicious lesion could no longer be detected mammographically after the biopsy procedure. The histological diagnosis was malignancy in 45 (31.7%) cases. One case of atypical ductal hyperplasia diagnosed preoperatively was upgraded to ductal carcinoma in situ (DCIS) at operation, giving an overall sensitivity of 97.7% for the vacuum-assisted biopsy procedure. In two cases where DCIS was diagnosed at vacuum-assisted biopsy, the malignant tissue was apparently completely removed and could no longer be found at operation. No serious complications occurred. During the follow-up period, no breast cancers appeared at the location of biopsy. Six patients dropped out during the follow-up period. CONCLUSION The self-contained, vacuum-assisted biopsy device is well suited for stereotactically guided breast biopsies, having demonstrated excellent sensitivity and specificity in the preoperative workup of mammographically detected breast lesions after 2 years of follow-up.
Collapse
Affiliation(s)
- Stefan O R Pfleiderer
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Erlanger Allee 101, D-07740 Jena, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Tabar L, Dean PB. Thirty years of experience with mammography screening: a new approach to the diagnosis and treatment of breast cancer. Breast Cancer Res 2008; 10 Suppl 4:S3. [PMID: 19128441 PMCID: PMC2614855 DOI: 10.1186/bcr2163] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- László Tabar
- University of Uppsala School of Medicine, 75105 Uppsala, Sweden
| | | |
Collapse
|
29
|
Tabár L, Tot T, Dean PB. Early Detection of Breast Cancer: Large-section and Subgross Thick-section Histologic Correlation with Mammographic Appearances. Radiographics 2007. [DOI: 10.1148/radiographics.27.suppl_1.0270005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
|
31
|
Tabár L, Chen THH, Yen AMF, Dean PB. Detection, Diagnosis, and Treatment of Early Breast Cancer Requires Creative Interdisciplinary Teamwork. ACTA ACUST UNITED AC 2005. [DOI: 10.1053/j.sembd.2006.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
32
|
Abstract
OBJECTIVES To review the evidence demonstrating that early detection of breast cancer substantially decreases death from the disease, and to demonstrate that the significant change in the outcome of breast cancer patients results from a combination of early detection and surgical removal of breast cancer, as treatment of the late stage disease provides little impact on ultimate outcome. METHOD Review results of the randomized controlled trials of mammographic screening and the published results of service screening. RESULTS Both randomized controlled trials and service screening, when performed properly, provide unequivocal evidence demonstrating that arresting the disease in its preclinically detectable phase has significant impact on outcome. Primary emphasis should be upon preventing breast cancer from developing to metastatic disease. CONCLUSIONS Numerous scientific trials have repeatedly and convincingly confirmed that breast cancer is progressive rather than a systemic disease from its inception. Progression of breast cancer can be arrested through detection and treatment at an early phase. The time at which disease progression is arrested has significant impact on clinical outcome, making mammographic screening a key factor in the control of breast cancer.
Collapse
Affiliation(s)
- L Tabár
- University of Uppsala Faculty of Medicine, Department of Mammography, Falun Central Hospital, Falun, Sweden.
| | | |
Collapse
|
33
|
Affiliation(s)
- Peter B Dean
- Turku University Central Hospital, Turku, Finland.
| |
Collapse
|
34
|
Dean PB. "References are needed--not unsubstantiated opinions". Lakartidningen 2003; 100:2469; author reply 2469. [PMID: 12914151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
|
35
|
Abstract
The impact of mammography screening upon the chances of a woman dying from breast cancer has been studied for four decades. Until this century the results have always been presented in terms of benefit to populations, and have erroneously been assumed to be directly transferable to individual women. A multitude of factors combine to reduce the effect of screening upon a population as measurable in a randomized controlled trial. The most serious problem has been the misunderstanding that an invitation to mammography screening would be equivalent to actually getting a mammogram. Additionally, the control population also benefits from the screening program, and these benefits reduce the measurable effect of screening. Recent long-term trials, which have been able to fully document participation in mammography screening on an individual basis, have demonstrated an even more substantial reduction in breast cancer mortality attributable to mammography screening, with a much more limited impact of therapeutic advances against advanced breast cancer.
Collapse
|
36
|
Dean PB. The proven reliability of mammography screening. Breast 2002; 11:211-4. [PMID: 14965669 DOI: 10.1054/brst.2002.0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Peter B Dean
- Radiological Society of Finland, University Central Hospital, Turku, Finland.
| |
Collapse
|
37
|
Dean PB. [Mammographic screening should not be affected by unfounded arguments]. Lakartidningen 2002; 99:944-5. [PMID: 11962019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Peter B Dean
- Abo universitet, Central för diagnostisk avbildning, Universitetssjukhuset, Abo.
| |
Collapse
|
38
|
Dean PB. [Mammographic screening is a reliable examination method]. Lakartidningen 2001; 98:5924-6. [PMID: 11806274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- P B Dean
- Abo universitet, Center för diagnostisk utbildning, Universitetssjukhuset, Abo.
| |
Collapse
|
39
|
Paajanen H, Pulliainen L, Hendolin N, Hermunen H, Helle M, Dean PB. The demands of screening mammography on surgical inpatient services of breast cancer. Am Surg 2001; 67:648-53. [PMID: 11450781] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A nationwide mammographic screening of women ages 50 to 59 years commenced in Finland in January 1987. We studied the demands of screening on surgical inpatient services by comparing the treatment strategy, volume of breast biopsies, and hospital stay before and after implementation of mass screening of women age 50 to 59. Approximately 20 patients per 100,000 inhabitants were referred annually from mass screening for surgical biopsies, in half of which cancer was detected. In 1985 through 1986 (before screening) we operated on 134 patients suspected of having breast cancer. After the first (in 1990) and the second (in 1995) round of mammographic screening we operated on 161 patients in 2 years suspected of having breast cancer. Concurrently 25 of 92 cancers (27%) were found only because of the screening. Before the screening period clinical symptoms and palpable tumors were cause for referral to surgery in 84 per cent of the cases and abnormal mammography in only 16 per cent. During screening these ratios were 34 and 61 per cent, respectively. The number of T(is)-1 cancers (<2 cm) increased from 44 per cent before screening to 70 per cent during screening. In contrast the number of T2 cancers (2-4 cm) decreased from 40 to 20 per cent. The mammographic screening did not increase the hospital stay of patients. We conclude that the mammographic screening program of all women age 50 to 59 years increased the number of surgical biopsies in our hospital by only 30 per cent. Breast cancer was found at an earlier stage during screening. More than one-fourth of breast cancers are currently found through the mass screening program in Finland.
Collapse
Affiliation(s)
- H Paajanen
- Department of Surgery, Mikkeli Central Hospital, Finland
| | | | | | | | | | | |
Collapse
|
40
|
Abstract
The twentieth century saw the introduction of mammography as a diagnostic tool and its refinement as a screening method. It appears guaranteed that women who are well informed will seek mammography screening with high expectations of technical quality and accurate interpretation. More refined knowledge of breast anatomy and pathology will assist radiologists to interpret with high specificity. We will learn how to recognized more accurately normal structures and doubtful findings. We will gain experience in interpretation through faithful review of interval cancers and subtle screen-detected cancers, and will use educational tools that have the potential to improve the efficiency of education by directing attention to specific deficiencies. Mammographic screening has been advanced through the efforts of dedicated teams of physicians, scientists, and other professionals throughout the world. The international communication of ideas and discoveries will continue to challenge the boundaries of what can be accomplished in early detection as well as noninvasive therapy, and this body of knowledge will continue to be enriched by these diverse contributions.
Collapse
Affiliation(s)
- L J Burhenne
- Department of Radiology, University of British Columbia, #505-750 W Broadway, Vancouver, BC V5Z 1H4, Canada
| | | | | | | | | | | |
Collapse
|
41
|
Näppi J, Dean PB, Nevalainen O, Toikkanen S. Algorithmic 3D simulation of breast calcifications for digital mammography. Comput Methods Programs Biomed 2001; 66:115-124. [PMID: 11378233 DOI: 10.1016/s0169-2607(01)00145-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We present a framework for algorithmic three-dimensional simulation of breast calcifications. The simulated calcifications can be viewed from any angle at a higher spatial resolution than currently available for digital mammography, and they can be placed onto a simulated or real mammographic background to provide example cases for computers and radiologists. In order to simulate calcification clusters, we also show how to simulate duct networks and terminal ductal lobular units. We evaluated the model with a double-blind evaluation of 60 cases with four experienced radiologists by mixing 30 cases of simulated calcification clusters on a real or simulated mammographic background with 30 cases of real breast calcification clusters digitized at a spatial resolution of 15 microm from high-resolution radiographs of 5 mm slices of breast specimens. The results indicate that the majority of the 2D projections of the 3D simulated calcifications compare favorably with the radiographic images of real breast calcifications.
Collapse
Affiliation(s)
- J Näppi
- Department of Computer Science, University of Turku, Turku Centre for Computer Science (TUCS), Lemmink aisenkatu 14 A FIN-20520, Turku, Finland.
| | | | | | | |
Collapse
|
42
|
Paajanen H, Pulliainen L, Hendolin N, Hermunen H, Helle M, Dean PB. The Demands of Screening Mammography on Surgical Inpatient Services of Breast Cancer. Am Surg 2001. [DOI: 10.1177/000313480106700712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A nationwide mammographic screening of women ages 50 to 59 years commenced in Finland in January 1987. We studied the demands of screening on surgical inpatient services by comparing the treatment strategy, volume of breast biopsies, and hospital stay before and after implementation of mass screening of women age 50 to 59. Approximately 20 patients per 100,000 inhabitants were referred annually from mass screening for surgical biopsies, in half of which cancer was detected. In 1985 through 1986 (before screening) we operated on 134 patients suspected of having breast cancer. After the first (in 1990) and the second (in 1995) round of mammographic screening we operated on 161 patients in 2 years suspected of having breast cancer. Concurrently 25 of 92 cancers (27%) were found only because of the screening. Before the screening period clinical symptoms and palpable tumors were cause for referral to surgery in 84 per cent of the cases and abnormal mammography in only 16 per cent. During screening these ratios were 34 and 61 per cent, respectively. The number of Tis-1 cancers (<2 cm) increased from 44 per cent before screening to 70 per cent during screening. In contrast the number of T2 cancers (2–4 cm) decreased from 40 to 20 per cent. The mammographic screening did not increase the hospital stay of patients. We conclude that the mammographic screening program of all women age 50 to 59 years increased the number of surgical biopsies in our hospital by only 30 per cent. Breast cancer was found at an earlier stage during screening. More than one-fourth of breast cancers are currently found through the mass screening program in Finland.
Collapse
Affiliation(s)
- Hannu Paajanen
- Departments of Surgery, Mikkeli Central Hospital, Mikkeli
| | - Lea Pulliainen
- Departments of Surgery, Mikkeli Central Hospital, Mikkeli
| | - Niilo Hendolin
- Departments of Surgery, Mikkeli Central Hospital, Mikkeli
| | - Heikki Hermunen
- Departments of Diagnostic Radiology, Mikkeli Central Hospital, Mikkeli
| | - Markku Helle
- Departments of Pathology, Mikkeli Central Hospital, Mikkeli
| | - Peter B. Dean
- Department of Diagnostic Radiology, University of Turku, Finland
| |
Collapse
|
43
|
Abstract
Mammography screening calls for a reevaluation of the working relationship between physicians dealing with the diagnosis and treatment of breast diseases. In this new era, histologic-mammographic correlation needs to be extended to correctly describe the deceptive mammographic findings that correspond to variations in normal breast tissue. Progress in histologic-mammographic correlation can only be made by overcoming the limitations inherent to the traditional histologic technique by examining a histologic specimen of greater length, width, and depth. There are several distinct advantages to using the large-section histology technique in the diagnosis of breast diseases. The subgross (three-dimensional) histology technique serves to bridge the gap that separates the pathologist and radiologist, bringing them to a common ground for a better understanding of breast morphology. These improvements in communication between the members of the diagnostic team will serve to optimize the sensitivity and specificity of breast cancer diagnosis.
Collapse
Affiliation(s)
- T Tot
- Department of Pathology, Falun Central Hospital, Sweden.
| | | | | |
Collapse
|
44
|
Säämänen AK, Salminen HJ, Dean PB, De Crombrugghe B, Vuorio EI, Metsäranta MP. Osteoarthritis-like lesions in transgenic mice harboring a small deletion mutation in type II collagen gene. Osteoarthritis Cartilage 2000; 8:248-57. [PMID: 10903878 DOI: 10.1053/joca.2000.0298] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The present study was conducted on transgenic Del1 (+/-) mice harboring six copies of a transgene with small deletion mutation engineered into mouse type II collagen gene. Incorporation of transgene into mouse genome was predicted to cause reduced mechanical strength of articular cartilage with deposition of structurally inferior collagen network and consequently to predispose the animal to early-onset joint degeneration. DESIGN Progression of degenerative chances in the knee joints of Del1 (+/-) and control mice was followed by macroscopic and histologic analyses at 3-5 month intervals between 3 and 22 months of age. Expression and distribution of type II collagen was studied with Northern hybridization, RNase protection assay and immunohistochemistry. RESULTS Articular cartilage degeneration began with superficial fibrillation at the age of 3 months in Del1 (+/-) mice. These changes coincided with a significant reduction in the expression of both endogenous and transgene-derived type II collagen mRNA. The defects gradually progressed into erosions penetrating the articular cartilage, bony sclerosis, degeneration of menisci, mineralization of various joint structures, cyst formation and exposure of subchondral bone. Nontransgenic controls also developed osteoarthritic lesions, but these appeared significantly later and were less severe. Increased transcription of type IIA procollagen mRNA, typical for chondroprogenitor cells and cartilage repair was also observed at six months in Del1 (+/-) mice. CONCLUSION These findings suggest that the impact of truncated type II collagen transgene, together with maturation-related reduction in type II collagen production significantly contribute to the early-onset degeneration of knee joints in Del1 (+/-) mice. These mice with osteoarthritis-like phenotype should provide a useful model for studies on the early pathogenic mechanisms involved in articular cartilage degeneration.
Collapse
Affiliation(s)
- A K Säämänen
- Department of Medical Biochemistry and Molecular Biology, University of Turku, Turku, Finland
| | | | | | | | | | | |
Collapse
|
45
|
Dean PB. Final comment. The articles by Gøtzsche and Olsen are not official Cochrane reviews and lack scientific merit. Lakartidningen 2000; 97:3106. [PMID: 10911710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- P B Dean
- Radiological Society of Finland, University of Turku
| |
Collapse
|
46
|
Dean PB. The Swedish mammography screening trials. Check up on your sources. Lakartidningen 2000; 97:3105-6. [PMID: 10911709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- P B Dean
- Radiological Society of Finland, University of Turku
| |
Collapse
|
47
|
Abstract
We have developed a multiscale algorithm for segmenting breast calcifications from high-resolution specimen radiographs. The algorithm was evaluated using 152 mammographic regions of interest digitized at a 15-microm spatial resolution. The true-positive detection rate was approximately 97.4% with 0.67 false-positives per image, and the segmentation error of individual calcification particles was approximately 5%. The performance of the algorithm is highly satisfactory.
Collapse
Affiliation(s)
- J Näppi
- Turku Centre for Computer Science, University of Turku, Finland.
| | | |
Collapse
|
48
|
Tabár L, Dean PB, Kaufman CS, Duffy SW, Chen HH. A new era in the diagnosis of breast cancer. Surg Oncol Clin N Am 2000; 9:233-77. [PMID: 10757844] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The regular use of high-quality mammography on asymptomatic women enables most breast cancers to be detected in the preclinical phase. Earlier detection dramatically rearranges the spectrum of breast cancer outcomes, resulting in better control of breast cancer. The new era requires a shift in thinking and a re-evaluation of the traditional diagnostic and therapeutic approaches to breast diseases. Tumors are smaller, less often node-positive, and have a more favorable malignancy grade. The challenge for diagnosticians is to find as many breast cancers as possible in the preclinical phase. The challenge for therapists is to adapt the treatment guidelines accordingly, in order to avoid over-treatment.
Collapse
Affiliation(s)
- L Tabár
- Department of Diagnostic Radiology, University of Turku Faculty of Medicine, Turku, Finland
| | | | | | | | | |
Collapse
|
49
|
Tabár L, Chen HH, Duffy SW, Yen MF, Chiang CF, Dean PB, Smith RA. A novel method for prediction of long-term outcome of women with T1a, T1b, and 10-14 mm invasive breast cancers: a prospective study. Lancet 2000; 355:429-33. [PMID: 10841122 DOI: 10.1016/s0140-6736(00)82008-5] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women with small mammographically detected breast cancers generally have good long-term outcomes, but a few with T1a (1-5 mm) and T1b (6-10 mm) tumours will eventually die from breast cancer. We investigated whether women at high risk of breast-cancer death could be identified with mammographic criteria and differentiated from women with small cancers of the breast and good outcomes. METHODS We prospectively applied mammographic classifications of tumour type to a consecutive series of 343 mammograms of invasive breast cancers of size 1-14 mm. Classifications were: stellate (spiculated) mass with no calcifications; circular or oval lesions with no calcifications; spiculated or circular lesions with non-casting-type calcifications; and casting-type calcifications. FINDINGS 20-year survival for women with 1-14 mm invasive tumours with casting-type calcifications was 55%. 14% of 138 women with 1-9 mm tumours had casting-type calcifications on mammography, which accounted for 73% of all breast-cancer deaths (p<0.001). T1a, T1b, and 10-14 mm tumours with casting-type calcifications behaved as if they were larger lesions, since the rate of death was similar to that for women with advanced high-grade tumours. Most women who died were node-negative. The long-term survival of women who had tumours of 1-9 mm with no casting-type calcifications was about 95%. INTERPRETATION Mammographic classification seemed to reliably predict good and bad long-term outcomes for survival in tumours of 14 mm or smaller, and especially for those smaller than 10 mm. The implications for therapy are substantial.
Collapse
Affiliation(s)
- L Tabár
- Department of Mammography, Falun Central Hospital, Sweden.
| | | | | | | | | | | | | |
Collapse
|
50
|
Dean PB, Pamilo M. Screening mammography in Finland--1.5 million examinations with 97 percent specificity. Mammography Working Group, Radiological Society of Finland. Acta Oncol 1999; 38 Suppl 13:47-54. [PMID: 10612496 DOI: 10.1080/028418699432761] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A nationwide mammography screening program including women aged 50 59 years at the time of the first invitation and involving more than 100 radiologists was started in Finland in January, 1987. From 1987 through 1997, a total of 1690496 invitations to biennial two-view mammography screening was sent out. The compliance for screening was 88.5% with 1 495744 screening examinations performed during this 11-year period. There were 49020 recalls (3.28% of those attending) for further work-up studies and 9689 women (0.65% of those attending) were referred for surgery. The total number of screening-detected breast cancers was 5595, giving a detection rate of 3.7 cancers per 1000 screening studies. More than half (57.7%) of all surgical biopsies revealed breast cancer and 67.8% of the invasive cancers were at Stage I. The positive predictive value of referral to surgical biopsy increased from 33.2% in 1987 to 65.5% in 1997. and the ratio of malignant to benign biopsies more than tripled from the first to the fifth year of screening. The observed/expected ratio of invasive cancer detection was 2.44. Only 0.27% (1 out of every 372) of all screening mammograms were followed by a benign biopsy, and 2.90% (1 out of every 34) of all screening mammograms were followed by the women being recalled for further studies and not found to have breast cancer. This gave a specificity of recall after screening mammography greater than 97.0% and a specificity of referral to surgical biopsy greater than 99.7%. Measures of specificity improved considerably during the first three years of the screening program. The high specificity of screening mammography can be attributed to the nature of the screening process as well as to the opportunity for individual radiologists to attain a greater level of experience and competence. The decision to recall appears to have been crucial in determining the specificity.
Collapse
Affiliation(s)
- P B Dean
- Department of Diagnostic Radiology, University of Turku, Finland
| | | |
Collapse
|