Screening prior to Breast Cancer Diagnosis: The More Things Change, the More They Stay the Same (original) (raw)
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Mammographic screening: Patterns of use and estimated impact on breast carcinoma survival
Cancer, 2004
BACKGROUND. Although many studies support the life-saving potential of screening mammography, the actual utilization of screening and the impact of the actual pattern of screening use on the breast carcinoma death rate, remain incompletely understood. In the current report, the authors describe patterns of screening use among women who were examined at a large screening and diagnostic service and estimate the added mortality associated with missed screening mammograms.
Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence
2014
To reduce mortality, screening must detect life-threatening disease at an earlier, more curable stage. Effective cancer-screening programs therefore both increase the incidence of cancer detected at an early stage and decrease the incidence of cancer presenting at a late stage. Methods We used Surveillance, Epidemiology, and End Results data to examine trends from 1976 through 2008 in the incidence of early-stage breast cancer (ductal carcinoma in situ and localized disease) and late-stage breast cancer (regional and distant disease) among women 40 years of age or older. Results The introduction of screening mammography in the United States has been associated with a doubling in the number of cases of early-stage breast cancer that are detected each year, from 112 to 234 cases per 100,000 women — an absolute increase of 122 cases per 100,000 women. Concomitantly, the rate at which women present with late-stage cancer has decreased by 8%, from 102 to 94 cases per
Reason for Late-Stage Breast Cancer: Absence of Screening or Detection, or Breakdown in Follow-up?
JNCI Journal of the National Cancer Institute, 2004
Background: Mammography screening increases the detection of early-stage breast cancers. Therefore, implementing screening should reduce the percentage of women who are diagnosed with late-stage disease. However, despite high national mammography screening rates, late-stage breast cancers still occur, possibly because of failures in screening implementation. Methods: Using data from seven health care plans that included 1.5 million women aged 50 years or older, we conducted retrospective reviews of chart and automated data for 3 years before 1995-1999 diagnoses of late-stage (metastatic and/or tumor size >3 cm; case subjects, n ؍ 1347) and early-stage breast cancers (control subjects, n ؍ 1347). We categorized the earliest screening mammogram during the period 13-36 months before diagnosis as none (absence of screening), negative (absence of detection), or positive (potential breakdown in follow-up). We compared the proportion of case and control subjects in each category of screening implementation and estimated the likelihood (odds ratio [OR] with 95% confidence intervals [CIs]) of late-stage breast cancer. We also evaluated demographic characteristics associated with absence of screening in women with late-stage disease. All statistical tests were two-sided. Results: Absence of screening, absence of detection, and potential breakdown in follow-up were distributed differently among case (52.1%, 39.5%, and 8.4%, respectively) and control subjects (34.4%, 56.9%, and 8.8%, respectively) (P ؍ .03). Among all women, the odds of having late-stage cancer were higher among women with an absence of screening (OR ؍ 2.17, 95% CI ؍ 1.84 to 2.56; P<.001). Among case patients, women were more likely to be in the absence-of-screening group if they were aged 75 years or older (OR ؍ 2.77, 95% CI ؍ 2.10 to 3.65), unmarried (OR ؍ 1.78, 95% CI ؍ 1.41 to 2.24), or without a family history of breast cancer (OR ؍ 1.84, 95% CI ؍ 1.45 to 2.34). A higher proportion of women from census blocks with less education (58.5% versus 49.4%; P ؍ .003) or lower median annual income (54.4% versus 42.9%; P ؍ .004) were in the absence-of-screening category compared with the proportion for the other two categories combined. Conclusions: To reduce late-stage breast cancer occurrence, reaching unscreened women, including elderly, unmarried, low-income, and less educated women, should be made a top priority for screening implementation. [J Natl Cancer Inst 2004;96: 1518 -27]
Potential Impact of USPSTF Recommendations on Early Diagnosis of Breast Cancer
2011
Objective. Current US Preventive Services Task Force (USPSTF) guidelines recommend against routine screening mammography in women aged 40-49 years. However, diagnosis of early-stage breast cancer relies on mammographic screening for detection. We hypothesized that screening at younger age may be important for detecting earlier and more treatable cancers for women in different demographic groups. Methods. All women with ductal carcinoma in situ (DCIS) or T1N0 breast cancer between 2004 and 2008 in the California Cancer Registry were evaluated. Patients were divided into: (1) women aged 40-49 years, who would be excluded from USPSTF recommendations for screening, and (2) women aged 50-74 years, who are recommended for screening. Patients in the two age groups were compared by race/ethnicity, socioeconomic status (SES), and hormone receptor (HR), human epidermal growth factor receptor 2 (HER-2), and triple-negative (TN) status. Results. Of 46,691 patients identified, 22.6% were aged 40-49 years, and 77.4% were aged 50-74 years. Younger women with DCIS had statistically higher odds of being HR positive and having higher SES, and Hispanic and Asian/Pacific Islander (PI) race/ethnicity, while younger women diagnosed with T1N0 breast cancer had higher odds of being HR positive, HER-2 positive, and triple negative and of having higher SES and non-white race/ ethnicity.
Breast Cancer Screening for Women at Average Risk
JAMA, 2015
IMPORTANCE Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. OBJECTIVE To update the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer. PROCESS The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. EVIDENCE SYNTHESIS Screening mammography in women aged 40 to 69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening for women 70 years and older who are in good health. Estimates of the cumulative lifetime risk of false-positive examination results are greater if screening begins at younger ages because of the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs biennially. Evidence does not support routine clinical breast examination as a screening method for women at average risk. RECOMMENDATIONS The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually (qualified recommendation). Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation). CONCLUSIONS AND RELEVANCE These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. These recommendations should be considered by physicians and women in discussions about breast cancer screening.
Journal of medical screening, 1997
To determine the pathological and biological characteristics of breast cancers diagnosed by screening and examined at the Edinburgh University pathology department. These cancers were classified by screening status: never screened (n = 111), prevalence screen detected (n = 105), and previously screened (n = 74). The last category arose in women who had been regularly screened during the trial; the cancers were diagnosed as interval cases before the first invitation to service screening (n = 33) or were incidence screen detected at that time (n = 41). Association (for operable invasive cancers, n = 250) of cancer characteristics with screening status reflects influences of biology (aggressiveness) or chronology (time of diagnosis), or both. The prognostic indicators tumour grade, histological type, and oestrogen receptor status were found in a smaller percentage of the patients with poor prognosis among the prevalence screen detected cases (9%, 77%, 18%) than among those previously s...
Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer
Annals of Internal Medicine, 2010
TO THE EDITOR: The recent changes to the U.S. Preventive Services Task Force (USPSTF) breast cancer screening recommendations are welcome and reflect the best available current evidence (1). The updated systematic review by Nelson and colleagues (2), which is the basis for the changes, concurs substantially with the relevant Cochrane review on mammography and, indeed, the Cochrane review of breast self-examination or clinical examination (3, 4).
Medical Bulletin of Haseki, 2022
Breast cancer is the most prevalent cancer diagnosed in women. Screening programs to diagnose breast anomalies increase the likelihood of early diagnosis and survival. This study describes the most extensive breast cancer screening program in Istanbul/Turkey between 2018 and 2019 and offers recommendations for nationwide programs. Methods: We collected data from the Istanbul Health Directorate's cancer surveillance database from May 2018 to December 2019. We analyzed data on patients referred for further investigation due to suspicion of possible tumors in their screening radiography. The database included socio-demographic information and further examination details (tests, outcomes, and planned treatment). Results: The mean age of the 3,577 women who were invited for further examination was 52.3 [standard deviation (SD): 7.5]. The age group with the highest percentage of further investigation invitations was between 50 and 54. The mean time between the results of screening mammography was 16.2 days (SD: 15.3). 5.1% of the women referred were diagnosed with some sort of cancer. Women who went to the place of scheduled appointments, instead of getting an appointment in another place of their choosing, were diagnosed and treated earlier. Conclusion: For a breast screening program to reach the entirety of the target population, a comprehensive approach to every step of the process (screening, diagnosis, treatment) needs to be considered together.