Incidence Of Early Breast Cancer Research Articles

PELATIHAN SADARI MENINGKATKAN PENGETAHUAN WANITA MENOPAUSE TENTANG SADARI SEBAGAI CARA DETEKSI DINI KANKER PAYUDARA

Menopause is a normal change that occurs in a woman's life when her menstrual period stops. Menopause causes women to be susceptible to cancer, one of which is breast cancer. One way that can be done to detect early incidence of breast cancer is by doing Breast Self-Examination (BSE) routinely, and this requires a woman's knowledge of how to detect breast cancer with the breast self-examination method (BSE). This study used a quasi-experimental study with a pre test - post test design with a control group. The population in this study were all menopausa women (45 - 55 years) in Wates Village, Wonotunggal Subdistrict, Batang Regency. The sampling technique was simple random (simple ramdom). In this study, the sample used was 60 respondents, with a sample size of 30 for the intervention group and 30 samples for the control group. The data analysis used the Wilcoxon test to determine the effect of BSE training, while to determine the difference in knowledge between the intervention group and the control group, the Friedman test was used to test the normality of the data using the Kolmogorov-Smirnov non-parametric statistical test. The results showed that there was an effect of providing BSE training in the intervention group on knowledge with a value of p 0.05.Suggestions are given to increase public awareness, especially menopausal women about breast self-examination (BSE), through health training activities. Keywords: BSE training, menopausal age women, knowledge

Impact of COVID-19 pandemic on clinical and surgical breast cancer management.

Impact of COVID-19 pandemic on clinical and surgical breast cancer management.

Overcalling low-risk findings: grouped amorphous calcifications found at screening mammography associated with minimal cancer risk.

Because of the increasing availability of screening mammography and spread of information about its benefits, the incidence of early breast cancer has been increasing in Japan. However, screening mammography can result in overdiagnoses or false positives, causing in some subjects undergoing unnecessary invasive procedures. The current mammography guidelines recommend further investigation of subjects with grouped amorphous calcifications; this recommendation may have resulted in overdiagnoses or false positives. We retrospectively reviewed the charts of patients who had undergone screening mammography in the screening unit of our institution from January 2011 to December 2012 and been found to have grouped amorphous calcifications. Of the 233 such cases, 17 had been lost to follow-up, whereas whether the lesions were actually benign or malignant had been determined in the remaining 216 (92.7%). Six (2.8%) of 216 subjects with grouped amorphous calcifications were diagnosed as having malignancy and the remaining 210 (97.2%) as having benign lesions. Four of the six cases (1.9%) with malignancy had ductal carcinoma in situ and two (0.9%) 3 and 4mm diameter invasive cancers of luminal type and nuclear grade 1. Grouped amorphous calcifications identified on screening mammography contribute minimally to detection of breast cancer and are not thought to be associated with any identifiable improvement in prognosis; present recommendations concerning this finding may result in false positives and overdiagnoses.

Radiologic findings of screen-detected cancers in an organized population-based screening mammography program in Turkey.

Bahçeşehir Breast Cancer Screening Program is a population based organized screening program in Turkey, where asymptomatic women aged 40-69 years are screened biannually. In this prospective study, we aimed to determine the mammographic findings of screen-detected cancers and discuss the efficacy of breast cancer screening in a developing country. A total of 6912 women were screened in three rounds. The radiologic findings were grouped as mass, focal asymmetry, calcification, and architectural distortion. Masses were classified according to shape, border, and density. Calcifications were grouped according to morphology and distribution. Cancers were grouped according to the clinical stage. Seventy cancers were detected with an incidence of 4.8/1000. Two cancers were detected in other centers and three were not visualized mammographically. Mammographic presentations of the remaining 65 cancers were mass (47.7%, n=31), calcification (30.8%, n=20), focal asymmetry (16.9%, n=11), architectural distortion (3.1%, n=2), and skin thickening (1.5%, n=1). The numbers of stage 0, 1, 2, 3, and 4 cancers were 13 (20.0%), 34 (52.3%), 14 (21.5%), 3 (4.6%), and 1 (1.5%), respectively. The numbers of interval and missed cancers were 5 (7.4%) and 7 (10.3%), respectively. A high incidence of early breast cancer has been detected. The incidence of missed and interval cancers did not show major differences from western screening trials. We believe that this study will pioneer implementation of efficient population-based mammographic screenings in developing countries.

Débats autour du cancer du sein : « contre » la radiothérapie peropératoire

Early breast cancer incidence increases owing to mammography screening. Hypofractionated radiotherapy is more and more proposed in women with low local relapse risk breast cancer, especially accelerated partial breast irradiation. Various irradiation modalities have been reported: brachytherapy, intraoperative irradiation, 3D-conformal accelerated partial breast irradiation. We describe limitations of intraoperative irradiation and the advantages of alternative techniques.

Abstract P1-09-06: Imaging Tests in Staging and Surveillance of Early Breast Cancer (EBC) — Changes in Routine Clinical Practice and Cost Implications

Abstract Background. New imaging tests such as computed tomography [CT], [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning and magnetic resonance imaging (MRI) are not recommended for staging or follow up of asymptomatic patients with EBC according to current guidelines. However, frequently these tests are requested even in the absence of a clinical indication. Variations in practice patterns have significant cost implications and no clear impact on cancer outcomes. Aim. In the present study we analyzed how the availability of novel and more expensive imaging technique has changed staging and follow-up modalities in EBC patients and if these changes affect costs. Methods. Two thousand and five patients with EBC diagnosed between January 2005 and December 2008 were identified using clinical computerized medical records from 639 general practitioners assisting 915,689 inhabitants of the Campania, a southern region of Italy. For each year EBC incidence, the mean number of diagnostic tests per patient (N/Pt) done during the first year after the initial diagnosis and the mean costs per each year were evaluated and compared by Anova test. Results. We identified 576, 489, 474 and 497 newly diagnosed cases of EBC in 2005, 2006, 2007 and 2008 respectively. Table 1 Table 1 describes changes in the mean number of different imaging tests requested per patient in these years. Overall, there was a significant increase of the mean number of imaging tests done per patient from 2005 to 2008 (P<0.0001). No change of the mean number of mammograms, bone scan and chest X ray requested per patient was observed. However, importantly, the mean number of TC scan, PET scan and MRI requested per patient almost doubled from 2005 to 2008. Accordingly, the mean costs for staging and surveillance per patient also significantly increased (355 € in 2005, 378 € in 2006, 391 € in 2007 and 547 € in 2008; <0.0001). Conclusions. TC scan, PET scan and MRI employment for patient with EBC in daily clinical practice has been steadily growing over the past four years. However, there are no data to support their role in routine breast cancer staging or surveillance in asymptomatic patients. More studies are needed to characterize which subset of patients deserve more intensive staging and follow up procedures as costs related to these imaging test prescriptions are relevant. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-09-06.

Role of hormonal and environmental factors on early incidence of breast cancer in Iran

Although the probability of having breast cancer increases with the age in general, this malignancy affects Iranian women at least one decade younger than their counterparts in other countries. However the underlying risk factors for the discrepancy have not been identified. The aryl hydrocarbon receptor (AhR) mediates the effects of many environmental endocrine disruptors and contributes to the loss of normal ovarian function in polluted environments. This study was aimed to compare the interactions between AhR and other fundamental genes (p53, K-Ras, ER, PgR) in a clinical setting. To conduct the immunohistochemical studies using appropriate monoclonal antibodies, 25 premenopausal invasive ductal carcinoma, 29 postmenopausal invasive ductal carcinoma and 30 breast fibroadenoma were selected retrospectively from 2004 to 2007 in the pathology department of Imam Khomeini hospital complex of Tehran University of Medical Sciences . Higher levels of AhR in epithelial cells of premenopausal patients and breast fibroadenoma emphasized the susceptibility of these cells to environmental-induced tumors. AhR overexpression contributed to ER-/PgR-immunophenotype in young/premenopausal patients but the same pattern was not observed in benign and postmenopausal malignant tumors. It seems that early incidence of breast cancer in Iran is the result of interactions between hormonal and environmental factors.

Estimating the potential economic value of trastuzumab in breast cancer from 2000–2020 in five European countries

6611 Background: Most economic evaluations of new oncology drugs are based on a single specific indication. Typically, they are first tested in metastatic disease and, if efficacy is demonstrated, drugs then tested in earlier stages of disease. A new approach for assessing the overall value of an oncology product requires analysis of both clinical and economic outcomes over the entire life cycle of the product, as approvals for new indications are gained and more patients are treated. Trastuzumab (T) is approved for the treatment of HER2- positive early breast cancer (EBC) as well as metastatic breast cancer (MBC). As a case study, we estimated the overall (life cycle) cost- effectiveness (CE) and potential value of T over a 21-year period in five large Western European countries. Methods: Based on epidemiologic projections, a dynamic life cycle CE model was used to estimate both the overall CE of T in treating 75% of patients with HER2-positive breast cancer, who are expected to receive T between 2000 and 2020 in the five countries, and the potential value of T to society over this period. Published CE analyses were used to project the average additional costs and benefits (quality-adjusted life-years; QALYs) gained with T. Cost per QALY values used as model inputs were: MBC - €42,931; EBC - €14,858. The mean costs and QALYs gained in both EBC and MBC were weighted by the estimated number of patients. Sensitivity analyses were performed for cost per QALY and number of patients treated. Results: From 2000 to 2020, the incidence of EBC is predicted to increase and that of MBC to decrease, in part due to earlier use of T. We project that by 2020 approximately 9,000 women in the five countries will be receiving T for MBC and 33,000 for EBC. In our model, the mean life cycle cost of T per QALY (overall CE) would be €17,950, with a total of 884,600 QALYs gained over the 21-year period. Conclusions: We have shown that the economic value of new products can be considered over the entire life cycle of clinical development. In our case study, the CE of T improves over time due to the higher benefit of T in EBC and the increasing number of EBC patients; the value to society in terms of QALYs gained is substantial. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration F. Hoffmann-La Roche Ltd Genentech, Roche Roche Genentech, Roche

Correlations between access to mammography and breast cancer stage at diagnosis

There is a lack of data on the access to mammography and its relation to the incidence of early breast cancer. In this study, the authors evaluated access by correlating geographically the number of U.S. Food and Drug Administration (FDA)-certified mammography facilities and the AJCC stage of breast cancer at diagnosis by county. Breast cancer incidence rates and stage at diagnosis were compared with the number of FDA-certified mammography facilities by county in the Surveillance, Epidemiology, and End Results reporting areas. The objective was to determine whether the number of certified facilities was associated with the percent of breast cancers diagnosed at the in situ stage. This was a multiple-group ecologic study, and counties were used as the units of analysis. There was a strong correlation between the number of mammography facilities and the population of a county, whereas there was no correlation between the number of mammography facilities and the land area of a county. A correlation existed between the percent of incident breast cancers that were diagnosed as in situ disease and the number of mammography facilities per 10,000 women among both whites and African Americans. There was an association between the number of mammography facilities and population. In counties with >/= 30,000 black and white females, 1) the percent of in situ breast cancers in black women and white women was correlated with the number of facilities per 10,000 women, indicating that population density is a factor in access for both racial groups; 2) except for 2 counties with >/= 30,000 black women, the percent of incident in situ cases was similar in both black women and white women, indicating equal access in both groups; and 3) there was a correlation between the percent in situ incidence and number of facilities per 1000 square miles in white women, but not in black women. There was a direct correlation of statewide mammography rates with the number of facilities per 1000 square miles, indicating that the rate of screening depends on availability. Maximum rates of statewide screening were achieved when there were > 15 mammography facilities per 1000 square miles.

Anti-oestrogenic prevention of breast cancer--the make or break point.

Clinical trials have shown that giving anti-oestrogens to healthy women can reduce the early incidence of breast cancer by approximately 40%. However, the large numbers of women treated, compared with the few who get breast cancer, together with the not insignificant toxicity and the unknown long-term clinical benefits and risks, makes this strategy of prevention versus treatment precarious. So how can we improve the odds for the successful use of endocrine chemoprevention?

Breast cancer prevention.

Epidemiological, experimental, and clinical data strongly support the possibility that breast cancer will be prevented by using anti-estrogenic interventions in healthy women. Three trials involving over 20,000 women have so far been reported using tamoxifen 20 mg/day or placebo in healthy women to chemoprevent breast cancer. The American National Surgical Adjuvant Breast and Bowel P-1 Project randomized over 13,000 women to take tamoxifen or placebo and showed a 49% reduction in the early incidence of breast cancer. This was associated with a reduction in osteoporotic fractures but increases in the risks of endometrial cancer, cataract, and thromboembolism. The Royal Marsden tamoxifen trial randomized 2,500 women, and the Italian national trial randomized 5,000 women. Interim analyses from these two trials showed no effect on the early incidence of breast cancer. These results, therefore, have not been able to clearly show an overall clinical benefit of giving tamoxifen to healthy women, nor have they shown which women are likely to benefit. Another selective anti-estrogen (SERM), raloxifene, has been used in a clinical trial to prevent osteoporotic fractures in women with low bone mineral density. Annual mammography in this trial has shown an approximate 80% reduction in the early incidence of breast cancer, and further follow-up of this trial continues. New trials in chemoprevention of breast cancer being started or being proposed use luteinizing-hormone-releasing hormone analogues, aromatase inhibitors, and other SERMs.

The Royal Marsden Hospital (RMH) trial: key points and remaining questions.

The reported interim analysis of the Royal Marsden chemoprevention trial, giving tamoxifen (20 mg/day) for up to 8 years to healthy women at increased risk of breast cancer because of a family history, has failed to confirm the 49% reduction in overall early incidence of breast cancer reported from the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 trial. Although statistically compatible, this discrepancy in results raises the possibility that the sensitivity to tamoxifen chemoprevention may depend on the population characteristics of the participants in the two trials. Younger women who do not have lobular carcinoma in situ or atypical ductal hyperplasia, or who may be at high risk of carrying a breast cancer predisposing gene, may be relatively resistant to tamoxifen chemoprevention. Furthermore, the clinical benefit of a reduction in the early incidence of breast cancer by using tamoxifen in healthy women has not been clearly established by the P-1 trial because of the lack of mortality data. Use of tamoxifen for risk reduction in healthy women needs to take into account these factors, and more information needs to be gained from the continuing placebo-controlled trials that are under way.

Breast cancer chemoprevention – Quo vadis?

SUMMARY The interim results of three placebo-controlled randomized chemoprevention of breast cancer trials of tamoxifen 20 mg/day in healthy women have been published. The National Surgical Adjuvant Breast Project P-1 trial showed a 49% reduction in the early incidence of breast cancer, whereas the Royal Marsden trial and the Italian national trial showed no effect. These differences in results in the three trials could be accounted for by differences in the risk characteristics of the population of healthy women. Because of the short follow-up in the P-1 trial: clinical benefit, particularly survival, has not been established and further follow-up of the other trials including the UK/Australasian IBIS trial are required. Another selective antioestrogen (SERM), raloxifene, has been used in a clinical trial to prevent osteoporotic fractures in women with low bone mineral density. Annual mammography has shown an approximate 80% reduction in the early incidence of breast cancer and further follow-up of this trial continues. New initiatives for chemoprevention, including LHRH analogues, aromatase inhibitors, and other selective antioestrogens (SERMs) are proposed and have been reviewed in this paper.

Recent trends in the incidence of in situ and invasive breast cancer in the Detroit metropolitan area (1975–1988)

Over the past two decades, breast cancer incidence rates have increased dramatically for women in all age groups. Breast cancer incidence trends were evaluated in a population-based study of data from the Metropolitan Detroit Cancer Surveillance System, a participant in the Surveillance Epidemiology and End Results Program of the National Cancer Institute. Incidence rates from 1975 through 1988 were evaluated, based on tumor size, age at diagnosis, and race. Age-adjusted rates for all breast cancers have increased since 1975, with the largest change occurring since 1983. Age-adjusted incidence rates for ductal carcinoma in situ (DCIS) and cancers smaller than 2.0 cm were higher in white women than black women, whereas age-adjusted incidence rates for larger tumors (> or = 2.0 cm) have been higher in black women since 1985. The rate of increase in incidence as measured by the average interval percentage change was highest for DCIS and small invasive tumors (< 1.0 cm) for all age groups of women. The more rapid increase in incidence of early breast cancer in the population suggests that the observed increase in breast cancer incidence over the last 2 decades may have resulted, at least in part, from a screening effect.