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Cheung KS. Big data approach in the field of gastric and colorectal cancer research. J Gastroenterol Hepatol 2024. [PMID: 38413187 DOI: 10.1111/jgh.16527] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
Big data is characterized by three attributes: volume, variety,, and velocity. In healthcare setting, big data refers to vast dataset that is electronically stored and managed in an automated manner and has the potential to enhance human health and healthcare system. In this review, gastric cancer (GC) and postcolonoscopy colorectal cancer (PCCRC) will be used to illustrate application of big data approach in the field of gastrointestinal cancer research. Helicobacter pylori (HP) eradication only reduces GC risk by 46% due to preexisting precancerous lesions. Apart from endoscopy surveillance, identifying medications that modify GC risk is another strategy. Population-based cohort studies showed that long-term use of proton pump inhibitors (PPIs) associated with higher GC risk after HP eradication, while aspirin and statins associated with lower risk. While diabetes mellitus conferred 73% higher GC risk, metformin use associated with 51% lower risk, effect of which was independent of glycemic control. Nonetheless, nonsteroidal anti-inflammatory drugs (NA-NSAIDs) are not associated with lower GC risk. CRC can still occur after initial colonoscopy in which no cancer was detected (i.e. PCCRC). Between 2005 and 2013, the rate of interval-type PCCRC-3y (defined as CRC diagnosed between 6 and 36 months of index colonoscopy which was negative for CRC) was 7.9% in Hong Kong, with >80% being distal cancers and higher cancer-specific mortality compared with detected CRC. Certain clinical and endoscopy-related factors were associated with PCCRC-3 risk. Medications shown to have chemopreventive effects on PCCRC include statins, NA-NSAIDs, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.
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Affiliation(s)
- Ka Shing Cheung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Moshina N, Gräwingholt A, Lång K, Mann R, Hovda T, Hoff SR, Skaane P, Lee CI, Aase HS, Aslaksen AB, Hofvind S. Digital breast tomosynthesis in mammographic screening: false negative cancer cases in the To-Be 1 trial. Insights Imaging 2024; 15:38. [PMID: 38332187 PMCID: PMC10853101 DOI: 10.1186/s13244-023-01604-5] [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: 09/07/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES The randomized controlled trial comparing digital breast tomosynthesis and synthetic 2D mammograms (DBT + SM) versus digital mammography (DM) (the To-Be 1 trial), 2016-2017, did not result in higher cancer detection for DBT + SM. We aimed to determine if negative cases prior to interval and consecutive screen-detected cancers from DBT + SM were due to interpretive error. METHODS Five external breast radiologists performed the individual blinded review of 239 screening examinations (90 true negative, 39 false positive, 19 prior to interval cancer, and 91 prior to consecutive screen-detected cancer) and the informed consensus review of examinations prior to interval and screen-detected cancers (n = 110). The reviewers marked suspicious findings with a score of 1-5 (probability of malignancy). A case was false negative if ≥ 2 radiologists assigned the cancer site with a score of ≥ 2 in the blinded review and if the case was assigned as false negative by a consensus in the informed review. RESULTS In the informed review, 5.3% of examinations prior to interval cancer and 18.7% prior to consecutive round screen-detected cancer were considered false negative. In the blinded review, 10.6% of examinations prior to interval cancer and 42.9% prior to consecutive round screen-detected cancer were scored ≥ 2. A score of ≥ 2 was assigned to 47.8% of negative and 89.7% of false positive examinations. CONCLUSIONS The false negative rates were consistent with those of prior DM reviews, indicating that the lack of higher cancer detection for DBT + SM versus DM in the To-Be 1 trial is complex and not due to interpretive error alone. CRITICAL RELEVANCE STATEMENT The randomized controlled trial on digital breast tomosynthesis and synthetic 2D mammograms (DBT) and digital mammography (DM), 2016-2017, showed no difference in cancer detection for the two techniques. The rates of false negative screening examinations prior to interval and consecutive screen-detected cancer for DBT were consistent with the rates in prior DM reviews, indicating that the non-superior DBT performance in the trial might not be due to interpretive error alone. KEY POINTS • Screening with digital breast tomosynthesis (DBT) did not result in a higher breast cancer detection rate compared to screening with digital mammography (DM) in the To-Be 1 trial. • The false negative rates for examinations prior to interval and consecutive screen-detected cancer for DBT were determined in the trial to test if the lack of differences was due to interpretive error. • The false negative rates were consistent with those of prior DM reviews, indicating that the lack of higher cancer detection for DBT versus DM was complex and not due to interpretive error alone.
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Affiliation(s)
- Nataliia Moshina
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Axel Gräwingholt
- Mammographiescreening-Zentrum Paderborn, Breast Cancer Screening, Paderborn, NRW, Germany
| | - Kristina Lång
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Ritse Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Tone Hovda
- Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Solveig Roth Hoff
- Department of Radiology, Ålesund Hospital, Møre Og Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Per Skaane
- Department of Radiology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Hildegunn S Aase
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Aslak B Aslaksen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.
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Canévet M, Pruvost-Couvreur M, Morvan M, Badic B, Brousse-Potocki J, Kermarrec T, Bouzeloc S, Nousbaum JB, Robaszkiewicz M, Reboux N, Quénéhervé L. Sensitivity of fecal immunochemical test and risk factors for interval colorectal cancer in a French population. Clin Res Hepatol Gastroenterol 2023; 47:102093. [PMID: 36764389 DOI: 10.1016/j.clinre.2023.102093] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening using fecal immunochemical testing (FIT) aims to detect pre-symptomatic colorectal lesions and reduce CRC mortality. AIMS The objectives of this study were to determine the FIT sensitivity for diagnosis of CRC, the impact of diagnostic circumstances on treatment and survival, and risk factors for interval cancer (IC). METHODS This population-based study evaluated the 2016-2017 CRC screening campaign in Finistère, France. CRCs were classified according to diagnostic circumstances: screen-detected CRC (SD-CRC), CRC with delayed diagnosis, IC after negative FIT (FIT-IC), post-colonoscopy CRC, CRC in non-responders and CRC in the excluded population. RESULTS This study included 909 CRCs: 248 SD-CRCs (6% of positive FIT) and 60 FIT-ICs (0.07% of negative FIT). The FIT sensitivity for CRC was 80.5% (CI95%: 76.1-84.9) at the threshold of 30 µg hemoglobin/g feces used in France. In multivariate analysis, proximal (OR:6.73) and rectal locations (OR:7.52) were associated with being diagnosed with FIT-IC rather than SD-CRC. The FIT positivity threshold maximizing the sum of sensitivity and specificity was found to be 17 µg/g, with 14 additional CRCs diagnosed compared to the current threshold. CONCLUSIONS Our study confirms the good sensitivity of FIT. A decrease of the FIT detection threshold could optimize sensitivity.
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Kou K, Cameron J, Youl P, Pyke C, Chambers S, Dunn J, Aitken JF, Baade PD. Severity and risk factors of interval breast cancer in Queensland, Australia: a population-based study. Breast Cancer 2023; 30:466-477. [PMID: 36809492 PMCID: PMC10119209 DOI: 10.1007/s12282-023-01439-4] [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: 10/18/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Interval breast cancers (BC) are those diagnosed within 24 months of a negative mammogram. This study estimates the odds of being diagnosed with high-severity BC among screen-detected, interval, and other symptom-detected BC (no screening history within 2 years); and explores factors associated with being diagnosed with interval BC. METHODS Telephone interviews and self-administered questionnaires were conducted among women (n = 3,326) diagnosed with BC in 2010-2013 in Queensland. Respondents were categorised into screen-detected, interval, and other symptom-detected BCs. Data were analysed using logistic regressions with multiple imputation. RESULTS Compared with screen-detected BC, interval BC had higher odds of late-stage (OR = 3.50, 2.9-4.3), high-grade (OR = 2.36, 1.9-2.9) and triple-negative cancers (OR = 2.55, 1.9-3.5). Compared with other symptom-detected BC, interval BC had lower odds of late stage (OR = 0.75, 0.6-0.9), but higher odds of triple-negative cancers (OR = 1.68, 1.2-2.3). Among women who had a negative mammogram (n = 2,145), 69.8% were diagnosed at their next mammogram, while 30.2% were diagnosed with an interval cancer. Those with an interval cancer were more likely to have healthy weight (OR = 1.37, 1.1-1.7), received hormone replacement therapy (2-10 years: OR = 1.33, 1.0-1.7; > 10 years: OR = 1.55, 1.1-2.2), conducted monthly breast self-examinations (BSE) (OR = 1.66, 1.2-2.3) and had previous mammogram in a public facility (OR = 1.52, 1.2-2.0). CONCLUSION These results highlight the benefits of screening even among those with an interval cancer. Women-conducted BSE were more likely to have interval BC which may reflect their increased ability to notice symptoms between screening intervals.
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Affiliation(s)
- Kou Kou
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia
| | - Jessica Cameron
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Philippa Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Woolloongabba, Australia
| | - Chris Pyke
- Mater Hospitals South Brisbane, Brisbane, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jeff Dunn
- Prostate Cancer Foundation of Australia, Sydney, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
| | - Peter D Baade
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia. .,Centre for Data Science, Faculty of Science, Queensland University of Technology, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia.
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Ishibashi F, Suzuki S, Nagai M, Mochida K, Kobayashi K, Morishita T. A Close Follow-Up Strategy in the Short Period of Time after Helicobacter pylori Eradication Contributes to Earlier Detection of Gastric Cancer. Digestion 2022:1-9. [PMID: 36423597 DOI: 10.1159/000527476] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to optimize the surveillance frequency and period for efficient detection of early gastric cancer (EGC) after Helicobacter pylori (HP) eradication. METHODS Data from patients with eradicated HP infection were extracted from the endoscopy databases of two institutions from January 2016 to March 2021. The patients were divided into a close follow-up group with frequent surveillance after eradication and an open follow-up group with an intermittent surveillance method, and the cases of post-eradication EGC found in the two groups were analyzed. RESULTS Thirty-six out of 9,322 patients (0.39%) in the close follow-up group and 20 out of 11,436 patients (0.17%) in the open follow-up group were found to have EGC. The cumulative incidence of EGC after eradication was significantly higher in the close follow-up group (p = 0.004). The duration between eradication and EGC detection was significantly shorter in the close follow-up group (51.7 vs. 90.5 months, p = 0.002). A logistic regression model revealed that duration after eradication was an independent predictor for detecting EGC in the close follow-up group (p = 0.045). A Cox proportional hazards model revealed that the close follow-up strategy was effective in patients with an eradication duration of less than 65 months to identify EGC (p = 0.015), but there was no difference between the two strategies in patients with an eradication duration of more than 65 months (p = 0.624). DISCUSSION/CONCLUSIONS Frequent surveillance after HP eradication is efficient for the early detection of EGC during the first 65 months.
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Affiliation(s)
- Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa-shi, Japan.,Koganei Tsurukame Clinic, Endoscopy Center, Koganei-shi, Japan.,Shinjuku Tsurukame Clinic, Digestive Disease Center, Shibuya-ku, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa-shi, Japan
| | - Mizuki Nagai
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa-shi, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa-shi, Japan
| | | | - Tetsuo Morishita
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa-shi, Japan
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Martiniussen MA, Sagstad S, Larsen M, Larsen ASF, Hovda T, Lee CI, Hofvind S. Screen-detected and interval breast cancer after concordant and discordant interpretations in a population based screening program using independent double reading. Eur Radiol 2022; 32:5974-85. [PMID: 35364710 DOI: 10.1007/s00330-022-08711-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To analyze rates, odds ratios (OR), and characteristics of screen-detected and interval cancers after concordant and discordant initial interpretations and consensus in a population-based screening program. METHODS Data were extracted from the Cancer Registry of Norway for 487,118 women who participated in BreastScreen Norway, 2006-2017, with 2 years of follow-up. All mammograms were independently interpreted by two radiologists, using a score from 1 (negative) to 5 (high suspicion of cancer). A score of 2+ by one of the two radiologists was defined as discordant and 2+ by both radiologists as concordant positive. Consensus was performed on all discordant and concordant positive, with decisions of recall for further assessment or dismiss. OR was estimated with logistic regression with 95% confidence interval (CI), and histopathological tumor characteristics were analyzed for screen-detected and interval cancer. RESULTS Among screen-detected cancers, 23.0% (697/3024) had discordant scores, while 12.8% (117/911) of the interval cancers were dismissed at index screening. Adjusted OR was 2.4 (95% CI: 1.9-2.9) for interval cancer and 2.8 (95% CI: 2.5-3.2) for subsequent screen-detected cancer for women dismissed at consensus compared to women with concordant negative scores. We found 3.4% (4/117) of the interval cancers diagnosed after being dismissed to be DCIS, compared to 20.3% (12/59) of those with false-positive result after index screening. CONCLUSION Twenty-three percent of the screen-detected cancers was scored negative by one of the two radiologists. A higher odds of interval and subsequent screen-detected cancer was observed among women dismissed at consensus compared to concordant negative scores. Our findings indicate a benefit of personalized follow-up. KEY POINTS • In this study of 487,118 women participating in a screening program using independent double reading with consensus, 23% screen-detected cancers were detected by only one of the two radiologists. • The adjusted odds ratio for interval cancer was 2.4 (95% confidence interval: 1.9, 2.9) for cases dismissed at consensus using concordant negative interpretations as the reference. • Interval cancers diagnosed after being dismissed at consensus or after concordant negative scores had clinically less favorable prognostic tumor characteristics compared to those diagnosed after false-positive results.
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Dreher N, Matthys M, Hadeler E, Shieh Y, Acerbi I, McAuley FM, Melisko M, Eklund M, Tice JA, Esserman LJ, Veer LJV. A case-case analysis of women with breast cancer: predictors of interval vs screen-detected cancer. Breast Cancer Res Treat 2021. [PMID: 34843026 DOI: 10.1007/s10549-021-06451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The Breast Cancer Surveillance Consortium (BCSC) model is a widely used risk model that predicts 5- and 10-year risk of developing invasive breast cancer for healthy women aged 35-74 years. Women with high BCSC risk may also be at elevated risk to develop interval cancers, which present symptomatically in the year following a normal screening mammogram. We examined the association between high BCSC risk (defined as the top 2.5% by age) and breast cancers presenting as interval cancers. METHODS We conducted a case-case analysis among women with breast cancer in which we compared the mode of detection and tumor characteristics of patients in the top 2.5% BCSC risk by age with age-matched (1:2) patients in the lower 97.5% risk. We constructed logistic regression models to estimate the odds ratio (OR) of presenting with interval cancers, and poor prognosis tumor features, between women from the top 2.5% and bottom 97.5% of BCSC risk. RESULTS Our analysis included 113 breast cancer patients in the top 2.5% of risk for their age and 226 breast cancer patients in the lower 97.5% of risk. High-risk patients were more likely to have presented with an interval cancer within one year of a normal screening, OR 6.62 (95% CI 3.28-13.4, p < 0.001). These interval cancers were also more likely to be larger, node positive, and higher stage than the screen-detected cancers. CONCLUSION Breast cancer patients in the top 2.5% of BCSC risk for their age were more likely to present with interval cancers. The BCSC model could be used to identify healthy women who may benefit from intensified screening.
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Sasaki A, Ichita C, Sumida C, Kimura K, Nishino T, Tasaki J, Masuda S, Kawachi J, Kudo M, Teshima S, Koizumi K, Kako M. Advanced Colon Cancer after Curative Resection of Intramucosal Adenocarcinoma with Endoscopic Submucosal Dissection. Case Rep Gastroenterol 2021; 15:603-609. [PMID: 34616263 PMCID: PMC8454252 DOI: 10.1159/000516314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022] Open
Abstract
Endoscopic resection, particularly endoscopic submucosal dissection (ESD), for colorectal cancers enables a precise pathological diagnosis and safe R0 resection. The recurrence rate after ESD is generally extremely low, with annual surveillance colonoscopy recommended. However, surveillance may not be considered for super-elderly patients owing to their condition. This is a case report of an 85-year-old man in whom curative resection was achieved for an intramucosal adenocarcinoma with ESD. The patient presented with a hypoechoic mass located in his lower right abdomen, diagnosed via surveillance abdominal ultrasound. He had undergone curative ESD for intramucosal cecal cancer 2 years prior. Colonoscopy revealed a type 2 epithelial tumor at the proximal aspect of the ESD scar. Ileocolic resection with lymph node dissection was performed. An epithelial tumor and well-differentiated adenocarcinoma but not a submucosal tumor was detected in the mucosal layer. The lesion was diagnosed not as a local recurrence after ESD but as a newly emerged original advanced cancer. After ESD for colorectal cancer, a newly developed advanced cancer may occur at the site of the ESD scar in a shorter term than usual. Surveillance colonoscopy after ESD is necessary even for super-elderly patients.
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Affiliation(s)
- Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Jun Kawachi
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Madoka Kudo
- Department of Diagnostic Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Teshima
- Department of Diagnostic Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
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Wang JZ, Zhang Y, Guo Q. Thoughts on factors related to colonoscopy quality. Shijie Huaren Xiaohua Zazhi 2021; 29:977-983. [DOI: 10.11569/wcjd.v29.i17.977] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
With the increase in health consciousness and the prevalence of early gastrointestinal cancer screening, the number of diagnosed cases of colorectal polyps and adenomas in the Chinese general population has substantially increased. However, the overall adenoma detection rate (ADR) in China remains lower than the global standard of 30%. High quality colonoscopy is pivotal for increasing the ADR and reducing the risk of interval colon cancer. A few factors are related to the quality of colonoscopy, including preoperative evaluation of examinees, bowel preparation, techniques for intubation, use of image enhancement endoscopy, withdraw time, and prevention of adverse events.
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Affiliation(s)
- Jing-Zhai Wang
- Department of Gastroenterology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan Province, China,Yunnan Provincial Clinical Medicine Center of GI Endoscopy, Kunming 650032, Yunnan Province, China
| | - Yu Zhang
- Department of Gastroenterology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan Province, China,Yunnan Provincial Clinical Medicine Center of GI Endoscopy, Kunming 650032, Yunnan Province, China
| | - Qiang Guo
- Department of Gastroenterology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan Province, China,Yunnan Provincial Clinical Medicine Center of GI Endoscopy, Kunming 650032, Yunnan Province, China
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Bucchi L, Ravaioli A, Baldacchini F, Giuliani O, Mancini S, Vattiato R, Rossi PG, Campari C, Canuti D, Di Felice E, de Bianchi PS, Ferretti S, Bertozzi N, Falcini F. Five-year annual incidence and clinico-molecular features of breast cancer after the last negative screening mammography at age 68-69. Eur Radiol 2021; 32:834-841. [PMID: 34363132 DOI: 10.1007/s00330-021-08129-9] [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: 02/19/2021] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The European Commission Initiative on Breast Cancer recommendation for triennial screening of women aged 70-74 is based on very weak evidence. A cohort of Italian women who had their last biennial screening mammography at age 68-69 was followed up for 5 years, assumed to represent the interval to another hypothetical screening mammography, in order to determine the annual proportional incidence of interval breast cancer. METHODS The cohort included 118,370 women. They had their last mammography between 1997 and 2008. Incident breast cancers were identified by record-linking the cohort with the regional breast cancer registry. The expected incidence in the age range 65-74 was estimated with an age-period-cohort model. The number of interval cancers was divided by the expected number to obtain their proportional incidence. RESULTS Overall, there were 298,658 woman-years at risk with 371 interval cancers versus 988.8 expected. In the first, second, third, fourth, and fifth interval year, the proportional incidence was 0.09 (95% confidence interval, 0.06-0.13), 0.32 (0.25-0.39), 0.60 (0.49-0.73), 0.75 (0.60-0.92), and 0.81 (0.60-1.07), respectively. Between the second and the fifth year, tumour stage and molecular subtype did not change significantly. CONCLUSION Though not supported by these findings, the proposal of triennial screening for women aged 70-74 merits further research, because the 95% confidence interval of the third-year proportional incidence of interval cancer included 0.50-the maximum limit considered acceptable for women aged 50-69. KEY POINTS • The third-year incidence of breast cancer relative to the expected one was 0.60 (95% confidence interval, 0.49-0.73). • Between the second and the fifth year, tumour stage and molecular subtype did not change significantly (p >0.10). • The proposal of a 3-year screening interval at age 70-74 merits further evaluation.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy.
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Campari
- Cancer Screening Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Debora Canuti
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Enza Di Felice
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | | | - Stefano Ferretti
- University of Ferrara and Local Health Authority, Ferrara, Italy
| | - Nicoletta Bertozzi
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
- Local Health Authority, Forlì, Italy
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11
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Lopes Cardozo JMN, Schmidt MK, van 't Veer LJ, Cardoso F, Poncet C, Rutgers EJT, Drukker CA. Combining method of detection and 70-gene signature for enhanced prognostication of breast cancer. Breast Cancer Res Treat 2021; 189:399-410. [PMID: 34191200 DOI: 10.1007/s10549-021-06315-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Studies have shown that screen detection by national screening programs is independently associated with better prognosis of breast cancer. The aim of this study is to evaluate the association between tumor biology according to the 70-gene signature (70-GS) and survival of patients with screen-detected and interval breast cancers. METHODS All Dutch breast cancer patients enrolled in the MINDACT trial (EORTC-10041/BIG3-04) accrued 2007-2011, who participated in the national screening program (biennial screening, ages 50-75) were included (n = 1102). Distant Metastasis-Free Interval (DMFI) was evaluated according to the 70-GS for patients with screen-detected (n = 754) and interval cancers (n = 348). RESULTS Patients with screen-detected cancers had 8-year DMFI rates of 98.2% for 70-GS ultralow-, 94.6% for low-, and 93.8% for high-risk tumors (p = 0.4). For interval cancers, there was a significantly lower 8-year DMFI rate for patients with 70-GS high-risk tumors (85.2%) compared to low- (92.2%) and ultralow-risk tumors (97.4%, p = 0.0023). Among patients with 70-GS high-risk tumors, a significant difference in 8-year DMFI rate was observed between interval (85.2%, n = 166) versus screen-detected cancers (93.8%, n = 238; p = 0.002) with a HR of 2.3 (95%CI 1.2-4.4, p = 0.010) adjusted for clinical-pathological characteristics and adjuvant systemic treatment. CONCLUSION Among patients with 70-GS high-risk tumors, a significant difference in DMFI was observed between screen-detected and interval cancers, suggesting that method of detection is an additional prognostic factor in this subgroup and should be taken into account when deciding on adjuvant treatment strategies.
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12
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Abi Doumeth S, Bou Daher H, El Mokahal A, Tawil A, Sharara AI. Prevalence and characteristics of post-gastroscopy gastric cancer: A retrospective study from an academic medical center. Arab J Gastroenterol 2021; 22:193-198. [PMID: 34090833 DOI: 10.1016/j.ajg.2021.02.001] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 02/01/2021] [Accepted: 02/17/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND STUDY AIMS Gastric cancer is diagnosed by endoscopy but false negative rates of up to 10% in the west and 40% in Asia have been reported. In Lebanon, little is known about the rates of post-gastroscopy gastric cancer (PGGC), defined as the proportion of patients diagnosed with gastric cancer with a negative previous examination within 2 years of diagnosis. We aimed to examine the rate of PGGC and its risk factors, clinico-pathologic and endoscopic characteristics at a University medical Center. PATIENTS AND METHODS Retrospective analysis of patients with histologically proven gastric malignancy over the last 14 years. Patients with history of upper endoscopy preceding the index diagnostic endoscopy by 6 to 24 months were included. RESULTS 18,976 patients underwent upper endoscopy and gastric cancer was diagnosed in 323 (1.7%). Of those, only 4 (1.2%) had a preceding endoscopy within 6 to 24 months of diagnosis: 3 adenocarcinoma and one MALT lymphoma. Upon review of the initial endoscopy, a mucosal abnormality had been noted in all 4 patients and biopsies taken in 3 were negative for cancer. The mean time to cancer diagnosis was 8 months (range 6-13 months). CONCLUSION A small proportion of gastric carcinomas are missed on endoscopy in this study. Patients with endoscopic evidence of mucosal abnormalities and negative biopsies should undergo repeat examination with multiple biopsies. Proper endoscopic technique, lesion recognition and adoption of performance improvement measures are important to optimize endoscopic practice.
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Affiliation(s)
- Sarah Abi Doumeth
- Department of Pathology & Laboratory Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 11072020, Beirut, Lebanon
| | - Halim Bou Daher
- Department of Pathology & Laboratory Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 11072020, Beirut, Lebanon
| | - Ali El Mokahal
- Department of Pathology & Laboratory Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 11072020, Beirut, Lebanon
| | - Ayman Tawil
- Division of Gastroenterology, American University of Beirut Medical Center, P.O. Box 11-0236/16-B, Beirut, Lebanon
| | - Ala I Sharara
- Department of Pathology & Laboratory Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 11072020, Beirut, Lebanon.
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13
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Houssami N, Hofvind S, Soerensen AL, Robledo KP, Hunter K, Bernardi D, Lång K, Johnson K, Aglen CF, Zackrisson S. Interval breast cancer rates for digital breast tomosynthesis versus digital mammography population screening: An individual participant data meta-analysis. EClinicalMedicine 2021; 34:100804. [PMID: 33997729 PMCID: PMC8102709 DOI: 10.1016/j.eclinm.2021.100804] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Digital breast tomosynthesis (DBT) improves breast cancer (BC) detection compared to mammography, however, it is unknown whether this reduces interval cancer rate (ICR) at follow-up. METHODS Using individual participant data (IPD) from DBT screening studies (identified via periodic literature searches July 2016 to November 2019) we performed an IPD meta-analysis. We estimated ICR for DBT-screened participants and the difference in pooled ICR for DBT and mammography-only screening, and compared interval BC characteristics. Two-stage meta-analysis (study-specific estimation, pooled synthesis) of ICR included random-effects, adjusting for study and age, and was estimated in age and density subgroups. Comparative screening sensitivity was calculated using screen-detected and interval BC data. FINDINGS Four prospective DBT studies, from European population-based programs, contributed IPD for 66,451 DBT-screened participants: age-adjusted pooled ICR was 13.17/10,000 (95%CI: 8.25-21.02). Pooled ICR was higher in the high-density (21.08/10,000; 95%CI: 6.71-66.27) than the low-density (8.63/10,000; 95%CI: 5.25-14.192) groups (P = 0.03) however estimates did not differ across age-groups (P = 0.32). Based on two studies that also provided data for 153,800 mammography screens (age-adjusted ICR 17.69/10,000; 95%CI: 13.22-23.66), DBT's pooled ICR was 16.83/10,000 (95%CI: 11.89-23.82). Comparative meta-analysis showed a non-significant difference in ICR (-0.44/10,000; 95%CI: -11.00-10.11) and non-significant difference in screening sensitivity (6.79%; 95%CI: -0.73-14.87%) between DBT and DM but a significant pooled difference in cancer detection rate of 33.49/10,000 (95%CI: 23.88-43.10). Distribution of interval BC prognostic characteristics did not differ between screening modalities except that those occurring in DBT-screened participants were significantly more likely to be negative for axillary-node metastases (P = 0.005). INTERPRETATION Although heterogeneity in ICR estimates and few datasets limit recommendations, there was no difference between DBT and mammography in pooled ICR despite DBT increasing cancer detection.
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Affiliation(s)
- Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Corresponding author.
| | - Solveig Hofvind
- Section of Breast Screening, Cancer Registry of Norway, Oslo, Norway
| | - Anne L. Soerensen
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Kristy P. Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Kylie Hunter
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Daniela Bernardi
- Breast Imaging and Screening Unit, Department of Radiology, Humanitas Research Hospital, Milan, Italy
| | - Kristina Lång
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skane University Hospital, Malmö, Sweden
| | - Kristin Johnson
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skane University Hospital, Malmö, Sweden
| | - Camilla F. Aglen
- Section of Breast Screening, Cancer Registry of Norway, Oslo, Norway
| | - Sophia Zackrisson
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skane University Hospital, Malmö, Sweden
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Abstract
BACKGROUND Screening for colorectal cancer (CRC) with colonoscopy has been credited for the majority of the decline in mortality over the past 40 years. However, colonoscopy is hampered by frequent interval cancers (ICs) occurring within 36 months after the last examination. Risk factors for IC imply that most misses are amenable to improved colonoscopic techniques. This study had two primary objectives: (1) to determine whether the proportion of persons with ICs has declined in association with improved approaches to the quality of colonoscopy and (2) to determine unrecognized causes for missed diagnoses. METHODS This is a retrospective, single-center study of persons with CRC having been diagnosed within 6-36 months since the most recent colonoscopy between 2006 and 2015. Participants, ages 50 and 89 years, were evaluated specifically for technical features and findings of the most recent colonoscopy. RESULTS Thirty-nine persons met the inclusion criteria for IC. Mean age was 69.3 years, range 50-86 years, women were 58%, races included 95% Caucasian, 2.5% Asian, and 2.5% African-American, and history of a first-degree relative with CRC was 26%. Symptoms led to the interval diagnosis in 83%, including iron-deficient anemia (38%), bleeding (25%), abdominal/pelvic pain (18%), and change in bowel habit (2.5%). Preexisting neoplasia was present in 72%. The CRC was located in the proximal colon in 51%. Late-stage disease was present in 45%. When compared to persons with an initial diagnosis of screen-detected late-onset CRC, differences were noted for older age, more women, more with a family history of CRC, and more with late-stage disease. The ratio of interval cancers to new cancers ranged between 6 and 11.5%. Findings indicating a "difficult examination" were observed in 14 cases (36%) compared to "easy or no difficulty" examinations in 25 (65%) cases. In a biennial analysis of IC rates between 2006 and 2015, the percentage of IC remained stable between 6 and 11.5%. CONCLUSIONS ICs have been stable constituting 6-11.5% of all CRCs. A "difficult examination" was often associated with IC, may be a risk factor for this problem, and may be an important clue warranting further study.
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15
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Braun B, Kurosinski MA, Khil L, Tio J, Krause-Bergmann B, Hense HW. The Mode of Detection Is Not Associated with Quality of Life in Women with Breast Cancer. Breast Care (Basel) 2020; 15:498-505. [PMID: 33223993 DOI: 10.1159/000504662] [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: 07/23/2019] [Accepted: 11/10/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Apart from saving lives, mammography screening programs (MSP) are expected to reduce negative side effects of treatment by detecting cancer earlier, when it is more responsive to less aggressive treatment. This study compared quality of life (QoL) among women with breast cancers that were detected either by screening mammography, as interval cancers, or clinically among women not participating in the MSP. Methods Retrospective study of first-ever invasive breast cancers detected among MSP-eligible women aged 50-69 years between 2006 and 2012 in Münster, Germany. EORTC QLQ-C30 and -BR23 questionnaires were mailed to 1,399 cases still alive in 2015 (response rate 64.1%). Results Women's responses were obtained on average 6.1 years after diagnosis. Mean crude and age-adjusted scores for overall QoL, breast and body image (BBI), and five functional scales (FS) were comparable between groups of detection mode. Clearly lower adjusted means for most scores were observed in women with interval cancers, if time since diagnosis was less than 5 years. Cases younger than 60 years showed lower values for some FS, particularly among interval and screen-detected cases. Discussion/Conclusion In summary, cases with breast cancer showed health-related score values that were similar to the general population of the same age. There was also no indication that mode of detection markedly influenced these scores. However, after adjusting for tumor stage and other influential factors, screening participants appeared more susceptible to score declines after a diagnosis of cancer than non-participants.
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Affiliation(s)
- Bettina Braun
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Marc-André Kurosinski
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Laura Khil
- State Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Joke Tio
- Breast Care Center, Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | | | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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16
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Jennings P, Seigneurin A, Delafosse P, Baysson H, Exbrayat C. A twelve-year study of the prevalence, risk factors and characteristics of interval colorectal cancers after negative colonoscopy. Clin Res Hepatol Gastroenterol 2020; 44:230-238. [PMID: 31302010 DOI: 10.1016/j.clinre.2019.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 05/12/2019] [Accepted: 06/13/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The objective of our study was to describe and analyse the Post-Colonoscopy Colorectal Cancers (PCCRCs) and endoscopist performance-related risk factors in the Isère regional screening programme. METHOD This was a population-based retrospective cohort study between 2002-2013, where Post-Colonoscopy Colorectal Cancers (PCCRCs) were defined as colorectal adenocarcinoma diagnosed between six and sixty months post-colonoscopy following a positive gFOBT. We analysed the endoscopist performance-related risk factors of the 62 gastroenterologists who had carried out at least 30 colonoscopies during this period. RESULTS During the period reviewed, there were 10,557 negative colonoscopies performed. Fifteen post-colonoscopy colorectal cancers were diagnosed from 2002-2013 with an average patient age of 67.1 years. Men comprised 73% of the cases and 53% of all the cases were found in the distal colon. These 15 cases comprised 1.1% of all Colorectal Cancers (CRCs) diagnosed in the screening programme, with an incidence rate of 0.42 (0.21-0.77) per 1,000 person-years. The aetiological breakdown was as follows: 47% related to missed cancers, 27% were new cancers, 20% were failed biopsy detection, and 6% related to incomplete removal. The Adenoma Detection Rate (ADR) among gastroenterologists was an average of 30%, but large heterogeneity was present within this number, ranging from 11% to 49%. CONCLUSION The post-colonoscopy colorectal cancer prevalence and incident rate were low relative to the literature. However, significant heterogeneity was present in the adenoma detection rate. Decreasing this heterogeneity by establishing a national benchmark, regular performance feedback and training modules should homogenise adenoma detection rates and decrease the number of interval cancers in the region.
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Affiliation(s)
- Paul Jennings
- Office de lutte contre le cancer, 38240 Meylan, France.
| | - Arnaud Seigneurin
- Registre du cancer de l'Isère, CHU de Grenoble, pavillon E, BP 217, 38043 Grenoble cedex 9, France
| | - Patricia Delafosse
- Registre du cancer de l'Isère, CHU de Grenoble, pavillon E, BP 217, 38043 Grenoble cedex 9, France
| | - Hélène Baysson
- Centre hospitalier Annecy-Genevois, 74370 Metz-Tessy, France
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17
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Nally DM, Ballester AW, Valentelyte G, Kavanagh DO. The contribution of endoscopy quality measures to the development of interval colorectal cancers in the screening population: a systematic review. Int J Colorectal Dis 2019; 34:123-140. [PMID: 30374522 DOI: 10.1007/s00384-018-3182-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colon cancer is the second most common cause of cancer-related death and an important cause of morbidity. The natural history of carcinogenesis, via the adenoma-carcinoma sequence, permits screening, which reduces the relative risk of mortality by up to 16%. The efficacy of a screening programme is limited by the growth of interval colorectal cancers between screening examinations. Quantifying the rate of interval cancers and delineating contributing endoscopic factors are crucial to maximise the benefit of a screening program. METHODS A systematic review was performed in accordance with PRISMA principles. Electronic databases were interrogated with a considered search strategy, and reference lists of retrieved papers were surveyed. For inclusion, studies included the rate of interval cancer (stated or calculated) and reported at least one of a predefined list of endoscopy characteristics. The primary outcome was to establish the rate of interval cancers. The secondary outcome was to determine the association between endoscopy quality measures and interval cancers. RESULTS The search yielded 2067 papers. Seventy-six full text papers were reviewed. Fifteen papers met the inclusion criteria. In total, there were 117,793 colon cancers, 7281 of which were interval lesions, giving an overall rate of 6.2%. The adenoma detection rate (ADR) of the endoscopist performing the index operation was the most consistent endoscopy factor associated with development of interval cancers. The impact of setting, volume and bowel preparation varied between papers. CONCLUSION Interval cancers reduce the efficacy of colorectal screening programmes. Ensuring the quality of the endoscopy process, specifically by increasing the ADR of practitioners, is crucial to the reduction of the rate of interval cancers.
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Affiliation(s)
- Deirdre M Nally
- Department of Surgical Affairs, 2nd Floor, Royal College of Surgeons of Ireland, 121 St. Stephen's Green, Dublin 2, Ireland.
| | - Athena Wright Ballester
- Department of Surgical Affairs, 2nd Floor, Royal College of Surgeons of Ireland, 121 St. Stephen's Green, Dublin 2, Ireland
| | - Gintare Valentelyte
- Department of Health Outcomes Research, Royal College of Surgeons, Beaux Lane House, Mercer Street Lower, Dublin 2, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, 2nd Floor, Royal College of Surgeons of Ireland, 121 St. Stephen's Green, Dublin 2, Ireland
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Nguyen TL, Aung YK, Li S, Trinh NH, Evans CF, Baglietto L, Krishnan K, Dite GS, Stone J, English DR, Song YM, Sung J, Jenkins MA, Southey MC, Giles GG, Hopper JL. Predicting interval and screen-detected breast cancers from mammographic density defined by different brightness thresholds. Breast Cancer Res 2018; 20:152. [PMID: 30545395 PMCID: PMC6293866 DOI: 10.1186/s13058-018-1081-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 06/13/2018] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Case-control studies show that mammographic density is a better risk factor when defined at higher than conventional pixel-brightness thresholds. We asked if this applied to interval and/or screen-detected cancers. METHOD We conducted a nested case-control study within the prospective Melbourne Collaborative Cohort Study including 168 women with interval and 422 with screen-detected breast cancers, and 498 and 1197 matched controls, respectively. We measured absolute and percent mammographic density using the Cumulus software at the conventional threshold (Cumulus) and two increasingly higher thresholds (Altocumulus and Cirrocumulus, respectively). Measures were transformed and adjusted for age and body mass index (BMI). Using conditional logistic regression and adjusting for BMI by age at mammogram, we estimated risk discrimination by the odds ratio per adjusted standard deviation (OPERA), calculated the area under the receiver operating characteristic curve (AUC) and compared nested models using the likelihood ratio criterion and models with the same number of parameters using the difference in Bayesian information criterion (ΔBIC). RESULTS For interval cancer, there was very strong evidence that the association was best predicted by Cumulus as a percentage (OPERA = 2.33 (95% confidence interval (CI) 1.85-2.92); all ΔBIC > 14), and the association with BMI was independent of age at mammogram. After adjusting for percent Cumulus, no other measure was associated with risk (all P > 0.1). For screen-detected cancer, however, the associations were strongest for the absolute and percent Cirrocumulus measures (all ΔBIC > 6), and after adjusting for Cirrocumulus, no other measure was associated with risk (all P > 0.07). CONCLUSION The amount of brighter areas is the best mammogram-based measure of screen-detected breast cancer risk, while the percentage of the breast covered by white or bright areas is the best mammogram-based measure of interval breast cancer risk, irrespective of BMI. Therefore, there are different features of mammographic images that give clinically important information about different outcomes.
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Affiliation(s)
- Tuong L Nguyen
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Ye K Aung
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Shuai Li
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Nhut Ho Trinh
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Christopher F Evans
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Laura Baglietto
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia.,Department of Clinical and Experimental Medicine, University of Pisa, ᅟPisa, Italy
| | - Kavitha Krishnan
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Jennifer Stone
- Curtin UWA Centre for Genetic Origins of Health and Disease, Curtin University and the University of Western Australia, Perth, Western WA, 6009, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnamgu, Seoul, 06351, South Korea
| | - Joohon Sung
- Department of Epidemiology School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Korea.,Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Korea
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Melissa C Southey
- Department of Pathology, University of Melbourne, Carlton, Victoria, 3053, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Level 3/207 Bouverie Street, Carlton, VIC, 3053, Australia.
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Burón A, Macià F, Andreu M, Pellisé M, Castells X, Grau J. Population-based colorectal cancer screening: Interval cancers and relationship with the quantitative faecal immunological for hemoglobin. Med Clin (Barc) 2018; 152:303-306. [PMID: 30146355 DOI: 10.1016/j.medcli.2018.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/27/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND OBJECTIVE The sensitivity of colorectal cancer screening programmes determines their effectiveness and is directly related to the interval cancer (IC). This study describes the frequency and characteristics of the IC of the Programme of Barcelona, Spain, and analyses its relationship with the quantitative value of the screening test (FIT). MATERIAL AND METHODS ICs after negative FIT of the first two rounds of the Programme (2010-2013) were included, observation period until July 2017. The information source of the ICs was their notification by professionals and patients, hospital databases and CMBD (Spanish Minimum Basic Data Set). RESULTS The sensitivity of the Programme is 82%. ICs are diagnosed more in proximal and rectal colon and in advanced stages than screening cancers, and have higher FIT values than overall people with negative FIT. CONCLUSIONS The sensitivity is acceptable and comparable to that of other programmes. The quantitative value of FIT in people with negative test should be included in the personalisation strategies of screening to reduce the risk of IC.
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Affiliation(s)
- Andrea Burón
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, España; REDISSEC (Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas), Madrid, España.
| | - Francesc Macià
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, España; REDISSEC (Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas), Madrid, España
| | - Montserrat Andreu
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, España; Servicio de Gastroenterología, Hospital del Mar, Barcelona, España
| | - Maria Pellisé
- Servicio de Gastroenterología, Hospital Clínic, Barcelona, IDIBAPS, Barcelona, España; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España; Universidad de Barcelona, Barcelona, España
| | - Xavier Castells
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, España; REDISSEC (Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas), Madrid, España
| | - Jaume Grau
- Universidad de Barcelona, Barcelona, España; Servicio de Preventiva y Epidemiología, ICMID, Hospital Clínic, Barcelona, España
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20
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Abstract
The correlation between a low adenoma detection rate (ADR) and interval cancers (ICs) has made ADR one of the most important quality indicators for colonoscopy. Data from nation-wide colorectal cancer (CRC) screening programs showed that there is room for improvement in ADR in order to reduce ICs in Taiwan. Measures with and without adjunct tools have been shown to have the potential to increase ADR, with the latter being more convenient to apply without additional cost. Optimal withdrawal techniques coupled with sufficient withdrawal time, training endoscopists with emphasis on recognition of subtle characteristics of flat lesions, dynamic position changes during the withdrawal phase, removing small polyps found during insertion, and retroflexion in the right colon have all been associated with increased ADR. In particular, water exchange (WE), which is characterized using water in lieu of air and suction removal of infused water during insertion, appears to meet the needs of colonoscopy patients in Taiwan. Analyses of both primary and secondary outcome variables of recently published studies have consistently shown that WE yields higher ADR than traditional air insufflation, even in propofol-sedated patients. Colonoscopists participating in the nationwide CRC screening program in Taiwan should consider applying one or more of the above measures to improve ADR and hopefully reduce ICs.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, CA, USA.,Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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21
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Musolino A, Falcini F, Sikokis A, Boggiani D, Rimanti A, Pellegrino B, Silini EM, Campanini N, Barbieri E, Zamagni C, Degli Esposti R, Cortesi L, Bisagni G, Cavanna L, Frassoldati A, Sgargi P, Michiara M. Prognostic impact of interval breast cancer detection in women with pT1a N0M0 breast cancer with HER2-positive status: Results from a multicentre population-based cancer registry study. Eur J Cancer 2017; 88:10-20. [PMID: 29175735 DOI: 10.1016/j.ejca.2017.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/29/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although human epidermal growth factor receptor 2 (HER2) overexpression is associated with poor prognosis, patients (pts) with pT1a N0M0 breast cancers (BCs) have an excellent outcome across all subtypes. Interval cancers (ICs) have poorer survival than screen-detected (SD) tumours, and an association has been reported between ICs and HER2 overexpression. We aimed to determine, in a general population of pT1a N0M0 BCs with known screening status, whether HER2-positive ICs have a poorer outcome than HER2-positive SD cancers. METHODS We evaluated all incident pT1a N0M0 BCs (n = 874) collected in the Emilia-Romagna region (Italy) from 2003 to 2009 and diagnosed in women aged 50-69. Pts unexposed to screening, with unknown HER2 status and/or treated with adjuvant trastuzumab were excluded from analysis. RESULTS Sixty-one percent of the BCs were SD, whereas 19% were ICs. BCs with high histologic grade, hormone receptor-negative or HER2-positive status (odds ratio=1.7; 95% confidence interval [CI]: 1.1-2.7) were more likely ICs. Median follow-up was 115 months. The 10-year invasive disease-free survival (iDFS) for HER2-positive ICs was lower than that for HER2-positive SD cancers: 75.0% (95% CI: 55.5%-94.5%) versus 93.8% (95% CI: 86.5%-100%). An interaction between ICs and HER2-positive status was found for poorer iDFS after adjusting for prognostic variables (HR = 5.3; 95% CI: 1.6-16.7). CONCLUSIONS IC detection may identify pts with HER2-positive pT1a N0M0 tumours in whom the rate of recurrence justifies consideration for conventional, anti-HER2, adjuvant treatment.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy.
| | - F Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Forlì, Italy; Azienda USL Della Romagna, Forlì, Italy
| | - A Sikokis
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - D Boggiani
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - A Rimanti
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - B Pellegrino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - E M Silini
- Section of Anatomy and Pathology, University Hospital of Parma, Italy
| | - N Campanini
- Section of Anatomy and Pathology, University Hospital of Parma, Italy
| | - E Barbieri
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Zamagni
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Degli Esposti
- Medical Oncology Unit, Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - L Cortesi
- Department of Oncology, Hematology and Respiratory Diseases, University Hospital of Modena, Italy
| | - G Bisagni
- Department of Oncology and Advanced Technologies, Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - L Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
| | - A Frassoldati
- Division of Medical Oncology, University Hospital of Ferrara, Italy
| | - P Sgargi
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - M Michiara
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
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22
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Pellisé M. [Colonoscopy in the screening, follow-up and treatment of colorectal cancer and precursor lesions]. Gastroenterol Hepatol 2015; 38 Suppl 1:71-7. [PMID: 26520199 DOI: 10.1016/S0210-5705(15)30022-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endoscopic polypectomy reduces the incidence of colorectal cancer and mortality due to this disease. Interval cancer is the marker par excellence of the effectiveness and quality of screening and surveillance programs. Interval cancer is defined as colorectal cancer appearing after a negative screening or surveillance test (whether colonoscopy or another type of test) for colorectal cancer and before the recommended date of the following screening test. It has been estimated that up to 75% of interval colorectal cancers may be due to poor endoscopic technique. Therefore, to reduce mortality from this disease, diagnostic and therapeutic colonoscopy must be carried out with high quality standards. In the latest congress of the American Gastroenterological Association, presentations were given on studies designed to analyse interval cancer and its possible causes, as well as to evaluate endoscopic techniques that could improve detection of polyps or optimize their complete resection. Likewise, strategies have begun to be evaluated that would allow rationalization of efforts and resources to achieve screening of the maximum number of individuals, with high quality standards, but without completely overloading the healthcare system. Finally, the congress also devoted substantial space to presentations on the management of post-polypectomy complications and large polyps.
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23
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Abstract
Squamous cell carcinoma (SCC) of the rectum is a rare clinical entity with an incidence rate of 0.1–0.25% per 1,000 cases. Though its etiology and pathogenesis remains unclear, it has been associated with chronic inflammation and infections. Herein, we report a case of an 82-year-old female who presented with a 2-month history of worsening abdominal pain, hematochezia, and bilateral inguinal lymphadenopathy with right-sided purulent discharge. Two years prior, she had had an unremarkable screening colonoscopy which met all quality indicators. Abdominal CT scan showed an irregular rectal mass with bulky pelvic and retroperitoneal adenopathy. Colonoscopy revealed one large circumferential nonobstructing lesion in the rectum. Endoscopic ultrasound confirmed its origin from the rectal wall with an enlarged perirectal lymph node. Cold biopsy followed by histopathology revealed SCC of the rectum.
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Affiliation(s)
- Daryl Ramai
- Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | - Kinesh Changela
- Division of Gastroenterology, The Brooklyn Hospital Center - Clinical Affiliate of Mount Sinai Hospital, Brooklyn, New York, USA
| | - Jonathan Lai
- Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | - Ghulamullah Shahzad
- Division of Gastroenterology, The Brooklyn Hospital Center - Clinical Affiliate of Mount Sinai Hospital, Brooklyn, New York, USA
| | - Madhavi Reddy
- Division of Gastroenterology, The Brooklyn Hospital Center - Clinical Affiliate of Mount Sinai Hospital, Brooklyn, New York, USA
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24
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Portillo I, Arana-Arri E, Idigoras I, Bilbao I, Martínez-Indart L, Bujanda L, Gutierrez-Ibarluzea I. Colorectal and interval cancers of the Colorectal Cancer Screening Program in the Basque Country (Spain). World J Gastroenterol 2017; 23:2731-2742. [PMID: 28487610 PMCID: PMC5403752 DOI: 10.3748/wjg.v23.i15.2731] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/23/2017] [Accepted: 03/21/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To assess proportions, related conditions and survival of interval cancer (IC). METHODS The programme has a linkage with different clinical databases and cancer registers to allow suitable evaluation. This evaluation involves the detection of ICs after a negative faecal inmunochemical test (FIT), interval cancer FIT (IC-FIT) prior to a subsequent invitation, and the detection of ICs after a positive FIT and confirmatory diagnosis without colorectal cancer (CRC) detected and before the following recommended colonoscopy, IC-colonoscopy. We conducted a retrospective observational study analyzing from January 2009 to December 2015 1193602 invited people onto the Programme (participation rate of 68.6%). RESULTS Two thousand five hundred and eighteen cancers were diagnosed through the programme, 18 cases of IC-colonoscopy were found before the recommended follow-up (43542 colonoscopies performed) and 186 IC-FIT were identified before the following invitation of the 769200 negative FITs. There was no statistically significant relation between the predictor variables of ICs with sex, age and deprivation index, but there was relation between location and stage. Additionally, it was observed that there was less risk when the location was distal rather than proximal (OR = 0.28, 95%CI: 0.20-0.40, P < 0.0001), with no statistical significance when the location was in the rectum as opposed to proximal. When comparing the screen-detected cancers (SCs) with ICs, significant differences in survival were found (P < 0.001); being the 5-years survival for SCs 91.6% and IC-FIT 77.8%. CONCLUSION These findings in a Population Based CRC Screening Programme indicate the need of population-based studies that continue analyzing related factors to improve their detection and reducing harm.
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25
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Strand F, Humphreys K, Cheddad A, Törnberg S, Azavedo E, Shepherd J, Hall P, Czene K. Novel mammographic image features differentiate between interval and screen-detected breast cancer: a case-case study. Breast Cancer Res 2016; 18:100. [PMID: 27716311 PMCID: PMC5053212 DOI: 10.1186/s13058-016-0761-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 09/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background Interval breast cancers are often diagnosed at a more advanced stage than screen-detected cancers. Our aim was to identify features in screening mammograms of the normal breast that would differentiate between future interval cancers and screen-detected cancers, and to understand how each feature affects tumor detectability. Methods From a population-based cohort of invasive breast cancer cases in Stockholm-Gotland, Sweden, diagnosed from 2001 to 2008, we analyzed the contralateral mammogram at the preceding negative screening of 394 interval cancer cases and 1009 screen-detected cancers. We examined 32 different image features in digitized film mammograms, based on three alternative dense area identification methods, by a set of logistic regression models adjusted for percent density with interval cancer versus screen-detected cancer as the outcome. Features were forward-selected into a multiple logistic regression model adjusted for mammographic percent density, age, BMI and use of hormone replacement therapy. The associations of the identified features were assessed also in a sample from an independent cohort. Results Two image features, ‘skewness of the intensity gradient’ and ‘eccentricity’, were associated with the risk of interval compared with screen-detected cancer. For the first feature, the per-standard deviation odds ratios were 1.32 (95 % CI: 1.12 to 1.56) and 1.21 (95 % CI: 1.04 to 1.41) in the primary and validation cohort respectively. For the second feature, they were 1.20 (95 % CI: 1.04 to 1.39) and 1.17 (95%CI: 0.98 to 1.39) respectively. The first feature was associated with the tumor size at screen detection, while the second feature was associated with the tumor size at interval detection. Conclusions We identified two novel mammographic features in screening mammograms of the normal breast that differentiated between future interval cancers and screen-detected cancers. We present a starting point for further research into features beyond percent density that might be relevant for interval cancer, and suggest ways to use this information to improve screening. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0761-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fredrik Strand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, Stockholm, SE-171 77, Sweden. .,Department of Diagnostic Radiology, Karolinska University Hospital, Solna, Sweden.
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, Stockholm, SE-171 77, Sweden.,Swedish eScience Research Centre (SeRC), Karolinska Institutet, Solna, Sweden
| | - Abbas Cheddad
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, Stockholm, SE-171 77, Sweden
| | - Sven Törnberg
- Department of Cancer Screening, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden
| | - Edward Azavedo
- Department of Diagnostic Radiology, Karolinska University Hospital, Solna, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - John Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, Stockholm, SE-171 77, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, Stockholm, SE-171 77, Sweden
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26
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Romero A, Torà-Rocamora I, Baré M, Barata T, Domingo L, Ferrer J, Torà N, Comas M, Merenciano C, Macià F, Castells X, Sala M. Prevalence of persistent pain after breast cancer treatment by detection mode among participants in population-based screening programs. BMC Cancer 2016; 16:735. [PMID: 27632982 PMCID: PMC5025583 DOI: 10.1186/s12885-016-2768-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/06/2016] [Indexed: 01/04/2023] Open
Abstract
Background To date, the study of the risks and benefits of breast cancer screening has not included the onset of persistent pain after breast cancer treatment within the context of population-based screening programs. Our purpose was to investigate the prevalence of persistent pain and associated factors in women diagnosed with breast cancer (screening or interval) in the context of a population-based breast cancer screening program in Spain. Methods A total of 1,057 women participating in a population-based breast cancer screening program were diagnosed with breast cancer between 2000 and 2008. The women were treated surgically and followed-up to 2013. The risk of developing persistent pain was estimated through multivariate logistic regression analysis. Results Breast cancer was detected during routine screening in 732 women (69.3 %) and emerged as an interval cancer between two screening rounds in 325 (30.7 %). Persistent pain was present in 118 women (11.3 %). Women diagnosed through routine screening reported a higher prevalence of persistent pain (12.9 %) than those with interval cancers (7.8 %)(P < 0.05). Multivariate logistic regression analysis identified two other variables associated with persistent pain: having a Charlson index > =2 (Odds Ratio [OR]: 4.5 95 % Confidence Interval [CI]: 2.1-9.5) versus no comorbidities, and having undergone an axillary lymph node dissection (OR: 2.0 95 % CI: 1.0-4.0) versus sentinel lymph node biopsy. Conclusions The prevalence of persistent pain was relatively low. The detection mode was not related to the onset of persistent pain. The factors associated with persistent pain were a Charlson index > =2 and the performance of axillary lymph node dissection. Women treated for breast cancer are at risk for developing persistent pain regardless of the detection mode, especially those with comorbidities and those who have undergone axillary lymph node dissection.
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Affiliation(s)
- Anabel Romero
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain.
| | - Isabel Torà-Rocamora
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Marisa Baré
- Clinical Epidemiology and Cancer Screening, Corporació Sanitària Parc Taulí-UAB, Research Network on Health Services in Chronic Diseases (REDISSEC), Sabadell, Spain
| | - Teresa Barata
- General Directorate of Health Care Programmes, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain.,Agency for Health Quality and Assessment of Catalonia (AQuAS), Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Joana Ferrer
- Department of Radiology, Hospital de Santa Caterina, Salt, Girona, Spain
| | - Núria Torà
- Clinical Epidemiology and Cancer Screening, Corporació Sanitària Parc Taulí-UAB, Research Network on Health Services in Chronic Diseases (REDISSEC), Sabadell, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Carmen Merenciano
- General Directorate of Health Care Programmes, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
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27
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Cadoni S, Falt P, Sanna S, Argiolas M, Fanari V, Gallittu P, Liggi M, Mura D, Porcedda ML, Smajstrla V, Erriu M, Leung FW. Impact of Colonoscopy Insertion Techniques on Adenoma Detection. Dig Dis Sci 2016; 61:2068-75. [PMID: 26846118 DOI: 10.1007/s10620-016-4053-1] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/21/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Low adenoma detection rate (ADR) predicts development of interval cancers, found mainly in the right (cecum-ascending) colon, where poor bowel preparation is an associated factor. Single-site studies reported increased detection of adenomas in the proximal colon segments by water exchange (WE). Data about colon cleansing revealed that WE had the greatest impact in the right colon. AIMS To test the hypothesis that WE had the greatest impact on ADR in colon segments with the most favorable bowel cleanliness scores, namely the right colon. METHODS We pooled right colon and overall ADR data of three similarly designed colonoscopy trials that compared WE, water immersion (WI) and insufflation of air or carbon dioxide (AICD) in a mixed gender European population. RESULTS In this study, 1200 (704 males) subjects and were included. 288 were screening cases. Demographic and procedural data were comparable. Water exchange achieved significantly higher right colon <10 mm ADR (11.9 %, vs WI 6.9 %, p = 0.016; vs AICD 7.2 %, p = 0.025). Water exchange achieved the lowest proportions of poor bowel preparation and the highest right colon and overall Boston bowel preparation scale scores (p range 0.003, <0.0005). In patients with right colon excellent bowel cleanliness, water exchange was the only method significantly associated with right colon adenoma detection. One of the limitations is unblinded colonoscopists. CONCLUSIONS In a mixed gender European population, water exchange is confirmed to be a superior insertion technique showing a significant increase in <10 mm right colon adenoma detection, achieving the cleanest colon and lowest proportions of poor bowel preparation requiring repeat procedures. CLINICALTRIALS. GOV NO NCT01781650, 01954862, 01780818.
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Affiliation(s)
- Sergio Cadoni
- Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy.
| | - Přemysl Falt
- Digestive Diseases Center, Vìtkovice Hospital, Zálužanského 1192/15, 703 84, Ostrava, Czech Republic
| | - Stefano Sanna
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy
| | - Mariangela Argiolas
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy
| | - Viviana Fanari
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy
| | - Paolo Gallittu
- Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy
| | - Mauro Liggi
- Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy
| | - Donatella Mura
- Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy
| | - Maria L Porcedda
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy
| | - Vit Smajstrla
- Digestive Diseases Center, Vìtkovice Hospital, Zálužanského 1192/15, 703 84, Ostrava, Czech Republic
| | - Matteo Erriu
- Department of Surgical Sciences, University of Cagliari, 09121, Cagliari, Italy
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, 91343, USA.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, 90024, USA
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28
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Abstract
Colorectal cancer is one of malignancies showing the greatest benefit from preventive measures, especially screening or secondary prevention. Several screening strategies are available with demonstrated efficacy and efficiency. The most widely used are the faecal occult blood test in countries with population-based screening programmes, and colonoscopy in those conducting opportunistic screening. The present article reviews the most important presentations on colorectal cancer screening at the annual congress of the American Gastroenterological Association held in Washington in 2015, with special emphasis on the medium-term results of faecal occult blood testing strategies and determining factors and on strategies to reduce the development of interval cancer after colonoscopy.
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Affiliation(s)
- Antoni Castells
- Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, España.
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29
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Domènech X, Garcia M, Benito L, Binefa G, Vidal C, Milà N, Moreno V. [ Interval cancers and episode sensitivity in population-based screening programmes for colorectal cancer: a systematic review]. Gac Sanit 2015; 29:464-71. [PMID: 26341155 DOI: 10.1016/j.gaceta.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 06/26/2015] [Accepted: 07/08/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe interval cancers (IC) and the sensitivity of colorectal cancer (CRC) screening programmes. METHODS A systematic review of the literature was conducted through a MEDLINE (PubMed) search. The search strategy combined the terms 'interval cancer', 'false negative', 'mass screening', 'screening' 'early detection of cancer', 'colorectal cancer' and 'bowel cancer'. Inclusion criteria consisted of population-based screening programmes, original articles written in English or Spanish and publication dates between 1999/01/01 and 2015/02/28. A narrative synthesis of the included articles was performed detailing the characteristics of the screening programmes, the IC rate, and the information sources used in each study. RESULTS Thirteen articles were included. The episode sensitivity of CRC screening programmes ranged from 42.2% to 65.3% in programmes using the guaiac test and between 59.1% and 87.0% with the immunochemical test. We found a higher proportion of women who were diagnosed with IC and these lesions were mainly located in the proximal colon. CONCLUSION There is wide variability in the IC rate in CRC programmes. To ensure comparability between programmes, there is a need for consensus on the working definition of IC and the methods used for their identification and quantification.
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Affiliation(s)
- Xènia Domènech
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Montse Garcia
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - Llúcia Benito
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; Departamento de Enfermería Fundamental y Médico-Quirúrgica, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Gemma Binefa
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Carmen Vidal
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Núria Milà
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Víctor Moreno
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departamento de Ciencias Clínicas, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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30
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Hoffman A, Murthy S, Pompetzki L, Rey JW, Goetz M, Tresch A, Galle PR, Kiesslich R. Intraprocedural bowel cleansing with the JetPrep cleansing system improves adenoma detection. World J Gastroenterol 2015; 21:8184-8194. [PMID: 26185393 PMCID: PMC4499364 DOI: 10.3748/wjg.v21.i26.8184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impact of JetPrep cleansing on adenoma detection rates.
METHODS: In this prospective, randomized, crossover trial, patients were blindly randomized to an intervention arm or a control arm. In accordance with the risk profile for the development of colorectal carcinoma, the study participants were divided into high-risk and low-risk groups. Individuals with just one criterion (age > 70 years, adenoma in medical history, and first-degree relative with colorectal cancer) were regarded as high-risk patients. Bowel preparation was performed in a standardized manner one day before the procedure. Participants in the intervention arm underwent an initial colonoscopy with standard bowel cleansing using a 250-mL syringe followed by a second colonoscopy that included irrigation by the use of the JetPrep cleansing system. The reverse sequence was used in the control arm. The study participants were divided into a high-risk group and a low-risk group according to their respective risk profiles for the development of colorectal carcinoma.
RESULTS: A total of 64 patients (34 men and 30 women) were included in the study; 22 were included in the high-risk group. After randomization, 30 patients were assigned to the control group (group A) and 34 to the intervention group (group B). The average Boston Bowel Preparation Scale score was 5.15 ± 2.04. The withdrawal time needed for the first step was significantly longer in group A using the JetPrep system (9.41 ± 3.34 min) compared to group B (7.5 ± 1.92 min). A total of 163 polyps were discovered in 64 study participants who underwent both investigation steps. In group A, 49.4% of the polyps were detected during the step of standard bowel cleansing while the miss rate constituted 50.7%. Group B underwent cleansing with the JetPrep system during the first examination step, and as many as 73.9% of polyps were identified during this step. Thus, the miss rate in group B was a mere 26.1% (P < 0.001). When considering only the right side of the colon, the miss rate in group A during the first examination was 60.6%, in contrast to a miss rate of 26.4% in group B (P < 0.001).
CONCLUSION: JetPrep is recommended for use during colonoscopy because a better prepared bowel enables a better adenoma detection, particularly in the proximal colon.
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Hassan C, Gralnek IM. Cost-effectiveness of "full spectrum endoscopy" colonoscopy for colorectal cancer screening. Dig Liver Dis 2015; 47:390-4. [PMID: 25704067 DOI: 10.1016/j.dld.2015.01.154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Compared to standard forward viewing colonoscopy, we aimed to assess the cost-effectiveness of full spectrum endoscopy colonoscopy in a population-based colorectal cancer screening and surveillance program. METHODS A Markov model was constructed to simulate the occurrence of colorectal neoplasia in a cohort of 100,000 subjects aged 50-100 years. The cost-effectiveness of full spectrum endoscopy was compared with that of standard forwarding viewing colonoscopy. Sensitivity for adenomatous and hyperplastic polyps <5mm, 6-9mm, and high-risk polyps were derived from the recent randomized tandem Fuse colonoscopy study. RESULTS The significantly higher sensitivity of full spectrum endoscopy in detecting additional adenomas resulted in an increase in cancer prevention from 58% to 74%, corresponding to a gain of 9 days per person. This 14% increase led to an absolute reduction in the cost of cancer care from $90 million to $57 million. This cost savings was only minimally impacted by the higher cost of more frequent post-polypectomy colonoscopy surveillance rates, leading to full spectrum endoscopy being associated with a savings of $145 per person. Thus, standard colonoscopy appeared to be "dominated" by the full spectrum endoscopy. CONCLUSIONS Compared to standard colonoscopy, full spectrum endoscopy appears to be more cost-effective for colon cancer screening and surveillance.
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Affiliation(s)
- Cesare Hassan
- Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy.
| | - Ian M Gralnek
- GI Outcomes Unit, Department of Gastroenterology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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O'Brien KM, Dwane F, Kelleher T, Sharp L, Comber H. Interval cancer rates in the Irish national breast screening programme. J Med Screen 2015; 22:136-43. [PMID: 25917389 DOI: 10.1177/0969141315580386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 11/05/2014] [Accepted: 03/11/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare interval cancer rates from the Irish breast screening programme, BreastCheck, for the period 2000-2007 with those from other European countries. METHODS Data from BreastCheck was linked to National Cancer Registry breast cancer registrations, to calculate numbers of women screened, screen-detected cancers, and interval cancers, by year of screening, in the first and second years after screening, and by initial or subsequent screen. Estimated underlying cancer incidence from the period 1996-1999 inclusive was used to calculate proportionate incidence. We calculated the interval cancer ratio as an alternative measure of the burden of interval cancers. RESULTS There were 372,658 screening records for 178,147 women in the period 2000-2007. The overall interval rate was 9.6 per 10,000 screens. In the first year after screening, the interval cancer rate was 5.8 per 10,000 screens and this increased to 13.4 in the second year after screening. The screen detection rate for the period was 53.6 per 10,000 screened for all screens combined. Initial screens produced a higher detection rate at 66.9 per 10,000 screened compared with subsequent screens with a screen-detected rate of 41.4 per 10,000 screens. CONCLUSION Interval breast cancer rates for the first years of the programme are within acceptable limits and are comparable with those in other European programmes. Nationwide roll-out together with the adoption of digital mammography may have an impact on interval cancer rates in future years.
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Affiliation(s)
- Katie M O'Brien
- National Cancer Registry, Building 6800, Airport Business Park, Kinsale Rd, Cork, Ireland
| | - Fiona Dwane
- National Cancer Registry, Building 6800, Airport Business Park, Kinsale Rd, Cork, Ireland
| | - Tracy Kelleher
- National Cancer Registry, Building 6800, Airport Business Park, Kinsale Rd, Cork, Ireland
| | - Linda Sharp
- National Cancer Registry, Building 6800, Airport Business Park, Kinsale Rd, Cork, Ireland
| | - Harry Comber
- National Cancer Registry, Building 6800, Airport Business Park, Kinsale Rd, Cork, Ireland
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Abstract
Colonoscopy for average-risk colorectal cancer screening has transformed the practice of gastrointestinal medicine in the United States. However, although the dominant screening strategy, its use is not supported by randomized controlled trials. Observational data do support a protective effect of colonoscopy and polypectomy on colorectal cancer incidence and mortality, but the level of protection in the proximal colon is variable and operator-dependent. Colonoscopy by high-level detectors remains highly effective, and ongoing quality improvement initiatives should consider regulatory factors that motivate changes in physician behavior.
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Affiliation(s)
- David G Hewett
- School of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD 4108, Australia.
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, 550 North University Boulevard, Indiana University Hospital #4100, Indianapolis, IN 46202, USA
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Walsh EM, Farrell MP, Nolan C, Gallagher F, Clarke R, McCaffrey JA, Kennedy MJ, Barry M, Kell MR, Gallagher DJ. Breast cancer detection among Irish BRCA1 & BRCA2 mutation carriers: a population-based study. Ir J Med Sci 2015; 185:189-94. [PMID: 25673166 DOI: 10.1007/s11845-015-1267-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/18/2014] [Accepted: 01/31/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-risk breast cancer screening for BRCA1/2 mutation carriers with clinical breast exam, mammography and MRI has reported sensitivity of 100 %, but BRCA1/2 mutation carriers still present with interval cancers. AIMS We investigated the presentation and screening patterns of an Irish cohort of BRCA1/2 mutation carriers with breast cancer. MATERIALS AND METHODS BRCA1/2 mutation carriers with breast cancer were identified in this retrospective cohort study. Records were reviewed for BRCA1/2 mutation status, demographics, screening regimen, screening modality, stage and histology at diagnosis. RESULTS Fifty-three cases of breast cancer were diagnosed between 1968 and 2010 among 60 Irish hereditary breast ovarian cancer (HBOC) families. In 50 of 53 women, the diagnosis of breast cancer predated the identification of BRCA1/2 mutations. Breast cancer detection method was identified in 47 % of patients (n = 25): 80 % (n = 20) by clinical breast exam (CBE), 12 % by mammography (n = 3), 8 % by MRI (n = 2). Fourteen women (26 %) developed a second breast cancer. Ten of these patients (71 %) were involved in regular screening; 50 % were detected by screening mammography, 20 % by MRI and 30 % by CBE alone. Six patients (43 %) had a change in morphology from first to second breast cancers. There was no change in hormone receptor status between first and second breast cancers. CONCLUSION In this cohort of Irish BRCA1/2 mutation carriers, compliance with screening was inconsistent. There was a 30 % incidence of interval cancers occurring in women in high-risk screening. Preventive surgery may be a more effective risk reduction strategy for certain high-risk women.
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Affiliation(s)
- E M Walsh
- Medical Oncology Department, Mater Misericordiae University Hospital, Dublin 7, Ireland.
| | - M P Farrell
- Cancer Genetics Service, Mater Misericordiae and Mater Private Hospitals, Dublin 7, Ireland
| | - C Nolan
- Cancer Genetics Service, St. James's Hospital, Dublin 8, Ireland
| | - F Gallagher
- Cancer Genetics Service, Mater Misericordiae and Mater Private Hospitals, Dublin 7, Ireland
- Cancer Genetics Service, St. James's Hospital, Dublin 8, Ireland
| | - R Clarke
- Cancer Genetics Service, St. James's Hospital, Dublin 8, Ireland
| | - J A McCaffrey
- Medical Oncology Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - M J Kennedy
- Medical Oncology Department, St James's Hospital, Dublin 8, Ireland
| | - M Barry
- Surgery Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - M R Kell
- Surgery Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - D J Gallagher
- Cancer Genetics Service, Mater Misericordiae and Mater Private Hospitals, Dublin 7, Ireland
- Cancer Genetics Service, St. James's Hospital, Dublin 8, Ireland
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Ahmed A, Marginan A, Sweeney K, Malone C, McLaughlin R, Kerin M. Medicolegal implications of accuracy of GP referral letters to specialist breast clinic. Ir J Med Sci 2016; 185:69-73. [PMID: 25422062 DOI: 10.1007/s11845-014-1223-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Referrals to symptomatic breast clinics have increased significantly in recent years with unchanged numbers of detected cancers. The general practitioner (GP) referral information relating to this increased patient volume causes anxiety and potentially creates confusion and future medicolegal issues if inaccurate. AIMS To compare GP triage category requests and clinical findings with those determined by the breast centre. METHODS 1,014 consecutive referrals to a symptomatic breast service were included. GP triage request category and clinical findings were prospectively recorded and compared to cancer centre surgeon triage category, clinical findings and cancer detection rates. RESULTS GPs requested urgent appointments for 49 % of referrals, only 22 % were considered urgent on triage at the cancer centre. The triage category request was downgraded in 56 % of referrals from urgent to routine. Thirty-three cancers were detected, representing 3 % of referrals. Eighty-eight percent of cancers were identified in the group with positive clinical findings at the breast clinic. 24 % of the new referrals were for mastalgia alone. In the 55 % of referred cases where GPs reported a clinical abnormality, only 39 % of these had a clinical finding confirmed by the breast surgeon. CONCLUSIONS There is poor correlation between GP triage category request and those assigned by the breast unit. GP referrals indicating patients with a clinical abnormality was discordant with specialist findings in 61% of cases. The frequency of overstating of clinical findings by GPs is such that subsequent cancer diagnosis does not imply failure of a preceding triple assessment process.
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Richter JM, Campbell EJ, Chung DC. Interval colorectal cancer after colonoscopy. Clin Colorectal Cancer. 2015;14:46-51. [PMID: 25510180 DOI: 10.1016/j.clcc.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/30/2014] [Accepted: 11/11/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND As more patients are screened for colorectal cancer a small but significant number of interval cancers develop after colonoscopy for colorectal cancer screening. MATERIALS AND METHODS We reviewed records of 75,314 adult patients who underwent colonoscopy for screening or diagnostic purposes between 1998 and 2006 inclusively, and identified 77 who developed interval cancers within the next 5 years. We reviewed their original endoscopic findings to determine the clinical and endoscopic factors that might predict a greater risk for future cancers. RESULTS Patients aged ≥ 60 years had a higher risk of an interval neoplasm (P < .0001). Interval cancers were more common on the right side of the colon and in the hepatic flexure (both P < .0001). We did not observe an increased rate of interval cancers in patients with poor preparation (P = .799); however, examination completion rates did affect the rate of interval cancers (P = .016). CONCLUSION Better identification of higher risk patients and assurance of follow-up examinations might increase the percentage of colon cancers discovered at an early stage. Special attention to careful examination of the right colon is key.
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Bessa Caserras X. [Colonoscopies for colorectal cancer screening]. Gastroenterol Hepatol 2014; 37 Suppl 3:85-92. [PMID: 25294270 DOI: 10.1016/s0210-5705(14)70087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Colonoscopies play a vital role in population screening programs, either for initial examinations or as a test carried out after a positive result from a fecal occult blood test or sigmoidoscopy. Colonoscopies, and ancillary techniques such as polipectomies, must comply with basic quality criteria that must be reflected in the quality standards of screening programs. A quality colonoscopy is absolutely vital to avoid the occurrence of interval cancers. It is extremely important to detect any proximal lesions during a colonoscopy, especially those which are serrated, because they are difficult to identify and due to the increased risk of colorectal cancer. Regarding follow-up programs for resected colorectal polyps, current evidence of the relationship between the risk of neoplasia and certain variables (age, sex, smoker, BMI, diabetes, etc.) must allow for individualized risk and algorithms for screening and follow-up frequency to be developed for these patients. However, initial endoscopic exploration in a screening colonoscopy is essential to establishing the optimum interval and ensuring follow-up. Despite poor adherence to follow-up programs, mostly due to their overuse, follow-up colonoscopies 3 years after resection of all polypoid lesions detect clinically significant lesions as effectively as colonoscopies at one year.
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Puig-Vives M, Osca-Gelis G, Camprubí-Font C, Vilardell ML, Izquierdo A, Marcos-Gragera R. [Proportion of breast cancer in women aged 50 to 69 years from Girona, Spain, according to detection method]. Med Clin (Barc) 2014; 143:300-2. [PMID: 24378145 DOI: 10.1016/j.medcli.2013.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/20/2013] [Revised: 08/02/2013] [Accepted: 09/05/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to determine the tumor stage, the proportion of cases and the age specific rate of breast cancer (BC) cases according to detection method. MATERIAL AND METHOD Cases of women aged 50 to 69 years diagnosed with BC in the Girona province during 1999-2006 were extracted from the population-based Girona Cancer Registry (n=1,254). BC was classified by detection method: screen-detected cancer, interval cancer and others. Proportion of cases and age-specific incidence were calculated according to detection method. RESULTS During the period 2002-2006, the proportion of screen-detected cancers, interval cancers and other cancers were 42.2%, 5.8% and 52.2%, respectively. After implementation of the early detection of breast cancer program (PDPCM), the incidence of screen-detected cases raised; thereafter, interval cancers also increased and the rate of other cancers decreased. CONCLUSIONS In the Girona province during the fully implemented PDPCM period (2002-2006), interval cancers represented a low proportion (5.8%) of women diagnosed with BC at 50 to 69 years old.
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Affiliation(s)
- Montse Puig-Vives
- Unitat d'Epidemiologia i Registre de Càncer de Girona, Pla Director d'Oncologia, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, España; Grup de Recerca en Estadística, Econometria i Salut (GRECS), Universitat de Girona, Girona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, España.
| | - Gemma Osca-Gelis
- Unitat d'Epidemiologia i Registre de Càncer de Girona, Pla Director d'Oncologia, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, España; Grup de Recerca en Estadística, Econometria i Salut (GRECS), Universitat de Girona, Girona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, España
| | - Carla Camprubí-Font
- Unitat d'Epidemiologia i Registre de Càncer de Girona, Pla Director d'Oncologia, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, España
| | - M Loreto Vilardell
- Unitat d'Epidemiologia i Registre de Càncer de Girona, Pla Director d'Oncologia, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, España
| | - Angel Izquierdo
- Unitat d'Epidemiologia i Registre de Càncer de Girona, Pla Director d'Oncologia, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, España; Institut Català d'Oncologia, Hospital Dr. Josep Trueta, Girona, España
| | - Rafael Marcos-Gragera
- Unitat d'Epidemiologia i Registre de Càncer de Girona, Pla Director d'Oncologia, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, España; Grup de Recerca en Estadística, Econometria i Salut (GRECS), Universitat de Girona, Girona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, España
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Abstract
Colonoscopy is currently regarded as the gold standard and preferred screening method for colorectal cancer (CRC). Recently, however, a limitation of colonoscopy in the prevention of CRCs has been identified, particularly in the right-sided colon, and the problem of so-called interval cancers has emerged. The prevalence of interval cancer is estimated to be between 4% and 8% of CRCs detected. Although the exact etiology of interval cancer remains unknown, factors implicated in the development of interval cancers include missed lesions at the time of colonoscopy, incomplete resection of previous neoplastic lesions, different tumor biology, and serrated pathway of carcinogenesis. However, recent evidence suggests that interval cancers are related to the training of the endoscopist and quality of the colonoscopy rather than tumor biology. Therefore, the importance of adequate training and continuous monitoring of the colonoscopy quality, which are amenable to improvement, cannot be overstated in order to prevent the risk of interval cancers. In this study, the current literature regarding the prevalence and potential factors related to interval cancers and colonoscopy quality-related issues are reviewed.
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Affiliation(s)
- Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
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40
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Abstract
Colonoscopy is currently the technique of choice for the diagnosis of colorectal cancer (CRC), as well as for the identification and resection of precursor lesions. However, its efficacy has been questioned due to evidence that some patients receive a diagnosis of CRC after a recent "negative" colonoscopy. These post-colonoscopy cancers are also known as interval cancers and, in the last few years, there has been interest in identifying their possible causes. The studies presented this year in the congress of the American Gastroenterological Association (AGA), described in the present article, provide important information for identification of the potential causes of neoplasms detected after a recent colonoscopy and propose methods to reduce this risk. Notable among such studies are those on the prevalence of interval colorectal cancer, those aiming to improve the quality of colonoscopy with a view to increasing the detection of neoplastic lesions, such as assessments of bowel cleansing and of the adenoma detection rate, and studies that propose new alternatives in endoscopy and in colon visualization, such as the colon capsule.
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Nederend J, Duijm LEM, Louwman MWJ, Coebergh JW, Roumen RMH, Lohle PN, Roukema JA, Rutten MJCM, van Steenbergen LN, Ernst MF, Jansen FH, Plaisier ML, Hooijen MJHH, Voogd AC. Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment - a population based study from the Netherlands. Eur J Cancer 2013; 50:31-9. [PMID: 24275518 DOI: 10.1016/j.ejca.2013.09.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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: 04/28/2013] [Revised: 08/17/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In most breast screening programmes screen-film mammography (SFM) has been replaced by full-field digital mammography (FFDM). We compared interval cancer characteristics at SFM and FFDM screening mammography. PATIENTS AND METHODS We included all 297 screen-detected and 104 interval cancers in 60,770 SFM examinations and 427 screen-detected and 124 interval cancers in 63,182 FFDM examinations, in women screened in the period 2008-2010. Breast imaging reports, biopsy results and surgical reports of all cancers were collected. Two radiologists reviewed prior and diagnostic mammograms of all interval cancers. They determined breast density, described mammographic abnormalities and classified interval cancers as missed, showing a minimal sign abnormality or true negative. RESULTS The referral rate and cancer detection at SFM were 1.5% and 4.9‰ respectively, compared to 3.0% (p<0.001) and 6.6‰ (p<0.001) at FFDM. Screening sensitivity was 74.1% at SFM (297/401, 95% confidence interval (CI)=69.8-78.4%) and 77.5% at FFDM (427/551, 95% CI=74.0-81.0%). Significantly more interval cancers were true negative at prior FFDM than at prior SFM screening mammography (65.3% (81/124) versus 47.1% (49/104), p=0.02). For interval cancers following SFM or FFDM screening mammography, no significant differences were observed in breast density or mammographic abnormalities at the prior screen, tumour size, lymph node status, receptor status, Nottingham tumour grade or surgical treatment (mastectomy versus breast conserving therapy). CONCLUSION FFDM resulted in a significantly higher cancer detection rate, but sensitivity was similar for SFM and FFDM. Interval cancers are more likely to be true negative at prior FFDM than at prior SFM screening mammography, whereas their tumour characteristics and type of surgical treatment are comparable.
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Affiliation(s)
- Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands.
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Marieke W J Louwman
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands
| | - Jan Willem Coebergh
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Paul N Lohle
- Department of Radiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Jan A Roukema
- Department of Surgery, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Matthieu J C M Rutten
- Department of Radiology, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands
| | - Liza N van Steenbergen
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands
| | - Miranda F Ernst
- Department of Surgery, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands
| | - Frits H Jansen
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands
| | - Menno L Plaisier
- Department of Radiology, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Marianne J H H Hooijen
- Department of Radiology, St. Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The Netherlands
| | - Adri C Voogd
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, P Debyelaan 1, 6229 HA Maastricht, The Netherlands
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Prieto García MA, Delgado Sevillano R, Baldó Sierra C, González Díaz E, López Secades A, Llavona Amor JA, Vidal Marín B. [Classification and characteristics of interval cancers in the Principality of Asturias's Breast Cancer Screening Program]. Radiologia 2013; 55:408-15. [PMID: 22520555 DOI: 10.1016/j.rx.2011.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 11/02/2011] [Accepted: 11/03/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review and classify the interval cancers found in the Principality of Asturias's Breast Cancer Screening Program (PDPCM). A secondary objective was to determine the histological characteristics, size, and stage of the interval cancers at the time of diagnosis. MATERIAL AND METHODS We included the interval cancers in the PDPCM in the period 2003-2007. Interval cancers were classified according to the breast cancer screening program protocol, with double reading without consensus, without blinding, with arbitration. Mammograms were interpreted by 10 radiologists in the PDPCM. RESULTS A total of 33.7% of the interval cancers could not be classified; of the interval cancers that could be classified, 40.67% were labeled true interval cancers, 31.4% were labeled false negatives on screening, 23.7% had minimal signs, and 4.23% were considered occult. A total of 70% of the interval cancers were diagnosed in the year of the period between screening examinations and 71.7% were diagnosed after subsequent screening. A total of 76.9% were invasive ductal carcinomas, 61.1% were stage II when detected, and 78.7% were larger than 10mm when detected. CONCLUSIONS The rate of interval cancers and the rate of false negatives in the PDPCM are higher than those recommended in the European guidelines. Interval cancers are diagnosed later than the tumors detected at screening. Studying interval cancers provides significant training for the radiologists in the PDPCM.
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