Impact Of Breast Cancer Screening Research Articles

Impact of Breast Cancer Screening on 10-Year Net Survival in Canadian Women Age 40-49 Years.

In Canada, some provincial/territorial mammography screening programs include women age 40-49 years, whereas others do not. This study examines the impact of this dichotomy on the 10-year breast cancer (BC) net survival (NS) among women age 40-49 years and 50-59 years at diagnosis. Using the Canadian Cancer Registry data record linked to death information, we evaluated the cohort of Canadian women age 40-49 years and 50-59 years diagnosed with BC from 2002 to 2007. We compared 10-year NS estimates in the jurisdictions with organized screening programs that included women age 40-49 years, designated as screeners (Northwest Territories, British Columbia, Alberta, Nova Scotia, and Prince Edward Island), with comparator programs that did not (Yukon, Manitoba, Saskatchewan, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador). BC was the primary cause of 10-year mortality in women age 40-49 years diagnosed with BC (90.7% of deaths). Among these women, the 10-year NS for screeners (84.8%; 95% CI, 83.8 to 85.8) was 1.9 percentage points (pp) higher than that for comparators (82.9%; 95% CI, 82.3 to 83.5; P = .001). The difference in favor of screeners was significant among women age 45-49 years (2.6 pp; P = .001) but not among women age 40-44 years (0.9 pp; P = .328). Similarly, the incidence-based BC mortality rate was significantly lower in screener jurisdictions among women age 40-49 years and 45-49 years, but not for 40-44 years. Provincial/territorial NS increased significantly with higher mammography screening participation (P = .003). The BC incidence rate was virtually identical in screener and comparator jurisdictions among women age 40-49 years (P = .976) but was significantly higher for comparators among women age 50-59 years (P < .001). Screening programs that included women in their 40s were associated with a significantly higher BC 10-year NS in women age 40-49 years, but not an increased rate of BC diagnosis. These results may inform screening guidelines for women age 40-49 years.

142P Multidimensional impact of breast cancer screening: Results from a real-world French cohort

Organized breast cancer (BC) screening in France by mammography every 2 years in women aged 50–74 years is regularly criticized, over hypothetical adverse effects, overdiagnosis or overtreatment. We assessed the screening impact on initial tumor features, treatments and outcomes.

Breast Cancer Stage Migration in Saudi Arabia: Examining the Influence of Screening.

Breast Cancer Stage Migration in Saudi Arabia: Examining the Influence of Screening.

The psychological impact and experience of breast cancer screening in young women with an increased risk of breast cancer due to neurofibromatosis type 1.

Women with neurofibromatosis type 1 (NF1) have an increased risk of developing early breast cancer with a poorer prognosis compared to the general population. Therefore, international management guidelines recommend regular screening in women with NF1 starting from 30 to 35 years. As the psychological impacts of breast cancer screening in other high-risk populations cannot be extended to women with NF1, due to increased incidence of cognitive and mental health issues, the psychological harms of breast screening in women with NF1 are unknown. Consequently, the aim of this study was to assess the psychological impact of breast cancer screening in women with NF1 attending an established risk management clinic. Twenty-eight women with NF1 (30–50 years) completed psychological well-being and patient experience questionnaires, administered across five time points, before and after their initial and second round annual breast screening visits. Preliminary findings demonstrated the screening regimen was well-tolerated, with most participants reporting high satisfaction with the screening process. Overall, no significant increase in psychological distress related to the breast screening process was identified, with mean cancer worry and anxiety scores decreasing over time. However, some women did experience negative aspects of screening and barriers to re-attendance at annual breast screening appointments. As some women with NF1 exhibited clinical levels of psychological distress prior to screening, efforts to identify those at risk and additional support to address concerns and expectations throughout the breast screening process may be beneficial.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10689-021-00259-9.

ASO Author Reflections: Impact of Breast Cancer Screening Beyond Mortality Reductions.

ASO Author Reflections: Impact of Breast Cancer Screening Beyond Mortality Reductions.

Impact of breast cancer screening in a population with high spontaneous coverage with mammography.

The impact of organized screening programs on breast cancer (BC) mortality is unclear in an era of high spontaneous referral of women to mammography. The aim of this study was to analyze if the introduction of mammographic screening programs reduced BC mortality in the Veneto region, Italy, despite already widespread spontaneous access to mammography. In Veneto, screening was introduced in different years between 1999 and 2009 across 21 local health units (LHUs), inviting asymptomatic women aged 50-69 years to undergo mammography biennially. We compared BC mortality for the 1995-2014 period of women aged 40-49 and 50-74 years who were resident in LHUs where screening programs started in 2003 (early LHUs) with women resident in LHUs where screening was introduced later (late LHUs). Poisson regression models were applied to incidence-based mortality (IBM), including only deaths from BC arising within the screening period. In the prescreening period and until 2010, BC mortality rates in early and late LHUs were similar in both age groups. In the last study period (2010-2014), we observed a 10% decrease in overall BC mortality in early compared to late LHU, limited to women aged 50-74 years. IBM was reduced by 8% (95% CI 1%-16%) in the overall study period and by 16% (6%-25%) in 2010-2014. In the Veneto region, screening programs were associated with a significant impact on BC-specific mortality; such effect appeared at least 8 years after screening implementation.

Psychological impact of breast cancer screening in Japan.

The purpose of this study was to evaluate the psychological impact of breast cancer screening by use of mammography and/or ultrasound, and to reveal factors related to psychological distress. Three hundred and twenty women were recalled to our hospital because of suspicious malignant findings from breast cancer screening between March and November 2012. They were asked to complete three questionnaires: the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression, the Brief Coping Orientations to Problems Experienced scale (Brief COPE) for coping styles, and an original questionnaire for personal information. Complete data were available for 312 of 320 women (97.5 %). The median age was 45 years (range 23-73). The HADS revealed borderline or clinically significant anxiety for 70 % of the women. Family history of breast cancer, area of residence, number of times screened, number of recalls, and the period before the first visit were significantly related to psychological distress (p < 0.05). Brief COPE scores showed that self-blame, behavioral disengagement, self-distraction, use of emotional support, venting, denial, and less acceptance were related to increased anxiety. Seventy percent of women who were recalled after breast cancer screening experienced psychological distress. Thus, negative psychological impact should be regarded as an adverse effect of breast cancer screening.

Ductal carcinoma in situ in Chinese women undergoing opportunistic breast cancer screening

AimBefore the introduction of breast cancer screening in 1990, ductal carcinoma in situ (DCIS) was a rare disease, representing less than 2 per cent of all breast cancers in Chinese. With the availability of screening mammography, DCIS, which is believed to be the precursor of invasive breast cancers, is diagnosed with increasing frequency. In the present study, we evaluated the impact of breast cancer screening by comparing the clinicopathological differences between screen‐detected and symptomatic DCIS in the largest cohort of Chinese women.Patients and MethodsBetween March 2003 and March 2008, 206 Chinese women with DCIS were treated in the Hong Kong Sanatorium and Hospital Breast Care Centre. They were divided into two groups according to the mode of discovery: 87 (42 per cent) women were allocated to the screen‐detected DCIS group, and 119 (58 per cent) women were allocated to the symptomatic DCIS group. Clinical records and pathological reports were recorded prospectively in our multidisciplinary breast conference and reviewed retrospectively. Differences in demographic information, clinical data and breast cancer prognostic markers between the two groups were evaluated.ResultsOnly 8.2 per cent of women with screen‐detected DCIS were under the age of 40, but it was not uncommon in women with symptomatic DCIS (23.7 per cent, P = 0.002). Women with screen‐detected DCIS also had a stronger family history of breast cancer (21.8 per cent), while only 8.4 per cent of women with symptomatic DCIS had a family history (P = 0.006). The tumour size of the screen‐detected DCIS was smaller (mean and median: 21.9 mm and 15 mm, respectively) than the symptomatic DCIS (28.8 mm and 26 mm, respectively; P = 0.004). The tumour grade showed no difference (P = 0.639) between the two groups. Women with screen‐detected DCIS were more likely to undergo breast‐conserving surgery (odds ratio = 2.185, 95 per cent confidence interval: 1.225–3.900, P = 0.008). There was no difference demonstrated in terms of oestrogen receptor (ER) (P = 0.929) expression, progesterone receptor (PR) (P = 0.578) expression, C‐erb B‐2 score (P = 0.089), Ki‐67 index (P = 0.312) and triple negative for the ER/PR/C‐erb B‐2 score (P = 0.201).ConclusionBreast cancer screening allows for the early detection of high‐grade DCIS, which are considered more prone to develop into invasive cancer. Further studies are needed to review if mass screening will be translated into cost‐effectiveness and reduced mortality of breast cancer in Hong Kong.

Abstract P2-04-05: Pros and cons of breast cancer screening: Knowledge in lay women

Abstract Background: It has been more than 20 years since local initiatives were proposed and 8 years since national organized breast cancer screening (BCS) (nationwide coverage) was implemented in France. It was associated with mass media and professional information for women with the aim of increasing the participation rate. The current reported coverage rate for women aged 50-74 every other year is about 80%. However the fairness of the process had not yet been assessed. It appears that having information about the pros and cons of BCS is thus a critical issue for targeted women. Methodology: A nationwide observational study, recorded in the EDIFICE iterative surveys, with a representative sample of 451 women living in France aged 40-75 years old, was carried out in January 2013, using the quota method. The survey questionnaire was conducted using a computer-assisted telephone interviewing technique (CATI) 3 months after the beginning of a worldwide controversy spread by the mass media on BCS. Results: The vast majority of women are reassured by BCS (74% vs. 13%). However 39% reported that they were stressed by BCS, with the main reason being fear of the results (30%) rather than the examination itself (9%). The main-reported benefits consisted of early detection of BC (38%), increased cure rate (22%) and preventing breast cancer (10%). The main reported limitations are a long period between two examinations (21%), starting too late (19%) and not being reliable enough (14%). A few people spontaneously reported screening-related risks (14%); the main risk being radiation-induced cancer (6%) false positives, over diagnosis and over treatment (5%). 18% have already heard about over diagnosis. With early detection of BC, 79% of women think that they will have only loco regional treatment, 3% think they will avoid major surgery, and only 10% of them think they will still have systemic treatment. Conclusion: Overall women have a fair level of knowledge about the pros and cons of BCS. They are generally confident in BCS, but they underestimate its limitations and adverse effects, and have a lack of knowledge about the impact of BCS on therapeutic management. This appears to be a target for the next step in women: delivering honest and relevant information about BCS. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-04-05.

Measuring the Mortality Impact of Breast Cancer Screening

To i) estimate how large the mortality reductions would be if women were offered screening from age 50 until age 69; ii) to do so using the same trials and participation rates considered by the Canadian Task Force; iii) but to be guided in our analyses by the critical differences between cancer screening and therapeutics, by the time-pattern that characterizes the mortality reductions produced by a limited number of screens, and by the year-by-year mortality data in the appropriate segment of follow-up within each trial; and thereby iv) to avoid the serious underestimates that stem from including inappropriate segments of follow-up, i.e., too soon after study entry and too late after discontinuation of screening. We focused on yearly mortality rate ratios in the follow-up years where, based on the screening regimen employed, mortality deficits would be expected. Because the regimens differed from trial to trial, we did not aggregate the yearly data across trials. To avoid statistical extremes arising from the small numbers of yearly deaths in each trial, we calculated rate ratios for 3-year moving windows. We were able to extract year-specific data from the reports of five of the trials. The data are limited for the most part by the few rounds of screening. Nevertheless, they suggest that screening from age 50 until age 69 would, at each age from 55 to 74, result in breast cancer mortality reductions much larger than the estimate of 21% that the Canadian Task Force report is based on. By ignoring key features of cancer screening, several of the contemporary analyses have seriously underestimated the impact to be expected from such a program of breast cancer screening.

Measuring the psychological consequences of breast cancer screening: a confirmatory factor analysis of the Psychological Consequences Questionnaire

To use confirmatory factor analysis (CFA) to test the proposed factor structure of the Psychological Consequences Questionnaire (PCQ), a measure of the psychological impact of breast cancer screening. A further aim was to examine the robustness of the proposed factor structure across key demographic and clinical variables. Following visits to breast cancer screening clinics, women who received a false-positive diagnosis and a matched sample of women who had received all-clear diagnoses were sent a questionnaire package containing the PCQ and a demographics measure. A total of 220 women returned completed questionnaires. CFA was used to test the factor structure and multiple indicator-multiple cause (MIMIC) models were used to test the robustness of the factor structure across the test result group, age, and family history of breast cancer diagnosis. The CFA results suggested support for both a three- and a one-factor model; a one-factor model was preferred, however, due to the very high covariance between the three latent factors in the three-factor model. A CFA MIMIC model suggested that the test result impacted on the latent factor: women who initially received a false-positive diagnosis showed significantly higher levels of psychological dysfunction after screening. The PCQ appears to be a promising tool for assessing psychological dysfunction after breast cancer screening; however, a one-factor model received more support than the initially proposed three-factor model. There was little evidence of differential item functioning across key demographic and clinical variables for the PCQ.

Evaluation of the impact of breast cancer screening in South Australia

In 1989 BreastScreen SA started screening for breast cancer in South Australia. The programme concentrated on women between the ages of 50 and 69, using a 24-month screening interval and a joint method of mammography, clinical examination and self-detection. This paper is a summary of our efforts to provide an assessment of the impact of the screening programme in terms of additional survival time past the age of first detection of the disease. The concept of benchmarks is introduced, and the survival advantages for screened women is measured from these benchmarks. The women in the BreastScreen SA service, who had primary breast tumours, had an estimated additional survival advantage of 2.6 years. Some statistical modelling allowed us to extrapolate to other screening designs.

Measuring Psychological Consequences of Screening: Adaptation of the Psychological Consequences Questionnaire into Dutch

To assess the psychometric properties of a Dutch adaptation of an originally Australian instrument measuring the psychological impact of breast cancer screening. The three subscales (emotional, physical, social) of the Psychological Consequences Questionnaire (PCQ) underwent formal linguistic and cultural translation. A total of 524 women under intensive surveillance because of increased breast cancer risk were asked to complete the questionnaire at 2 months prior to screening, at the day of the screening visit preceding the screening, and 1-4 weeks after screening. Acceptability, score distribution, internal consistency, scale structure, responsiveness to change and construct validity were analysed. Response rates were high (98-94%) and there were very few missing answers and non-unique answers. All scales had Cronbach's alphas > 0.70. The physical and social subscale showed ceiling effects. The item-own scale correlations were only slightly higher than the corresponding item-other scale correlations. Factor analysis showed that the assumed three separate subscales were replicated in our study. Pre- and post-screening effect sizes for the emotional scale were larger than for the other two scales. All PCQ scales correlated with the scales of two other psychological measures (p <or= 0.01). The emotional scale and the total PCQ score were able to differentiate between subgroups varying in affective risk perception (p <or= 0.01). The Dutch PCQ is useful in measuring psychological impact among women under intensive surveillance because of high breast cancer risk.

Participation secondaire des femmes au dépistage organisé du cancer du sein: Revue de la littérature

In France, breast cancer is the most frequently occurring cancer and the leading cause of cancer deaths in women. Breast cancer screening has been shown to reduce breast cancer mortality by 30% provided attendance rate is 70% and re-screening interval is two to three years. Maintaining a high rate of reattendance is also important. The decline with time of completion rates of re-screening will lessen the benefits of a breast cancer screening program.A review of published studies examining factors associated with attendance and reattendance to breast cancer screening.Positive views about initial screening are determining factors in reattendance: mammography should not be painful and embarrassing, appointments should be punctual and clinic staff courteous and supportive. Psychological factors influencing attendance also influence reattendance as does intention to participate, a major predictor of repeat participation and as do perceived susceptibility of breast cancer, perceived benefits of mammography, absence of emotional barriers. These factors can be modified by experience of previous screening. Other predicting factors of attendance continue to influence reattendance: practice of other preventive health behaviors, outside support from physicians, knowledge of breast cancer and screening.A better understanding of factors influencing attendance is necessary to increase the impact of breast cancer screening. Field studies are necessary to support the elaboration of publicity campaigns aimed at increasing participation.

Building a model to determine the cost-effectiveness of breast cancer screening in France.

This paper describes the methods and initial validation of a cost-effectiveness model developed to simulate the breast cancer screening situation in France. The first screening pilot programmes were set up in France in 1989 to test the feasibility of a decentralized screening model based in a large number of existing non-dedicated radiology centres. The present cost-effectiveness model was built as a tool to help guide current policy discussions on the future of screening in France. This Markov model compares the costs and effects expected when a screening programme is offered to a given cohort of women to those expected in the absence of screening. The model was initially validated using current results from the Bas-Rhin screening programme and local cancer registry epidemiological data. Over a 20-year period, 315 274 women would attend for screening, of whom 12 491 would be recalled for further assessment. 4423 cancers would be detected, resulting in 637 deaths. Screening allows the detection of 106 additional cancer cases, thereby preventing 92 deaths, and saves 1522 life-years compared with a situation without screening. Breast cancer mortality is reduced by 12.6%, yielding a cost-effectiveness ratio of 137 000 FF per life-year saved. The results of initial analyses suggest that the model is capable of suitably assessing the impact of breast cancer screening in terms of costs and effects. Further scenario analyses are needed to understand the impact of screening policy changes on the costs and effectiveness of future screening programmes.

Accuracy of the “Triple Test” in the Diagnosis of Palpable Breast Masses in Saudi Females

For patients who present to clinicians with palpable breast lesions, the triple test: (physical examination, mammography and fine-needle aspiration cytology) can be employed to provide accurate diagnosis. In this study, the sensitivity, specificity and predictive values of triple test components were studied separately and in combination. During the study period (from January 1998 to December 1999), 140 patients with palpable breast masses were subjected to all components of the triple test followed by confirmatory open biopsy. Physical examination showed 82.6% sensitivity, 97.3% specificity and 86.4% positive predictive value. Mammography showed 87.5% sensitivity, 97.3% specificity and 87.5% positive predictive value and fine-needle aspiration cytology (FNAC) showed 91.7% sensitivity, 100% specificity and 100% positive predictive value in concordant cases (elements had either all malignant or all benign results). The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Based on these results, we recommend elimination of the confirmatory open biopsy, which will result in reduced expenses and morbidity compared with open biopsy.

The impact of breast cancer screening on survival. A 5- to 10-year follow-up study.

The Missouri Breast Cancer Detection Demonstration Project (BCDDP) at the Cancer Research Center in Columbia, Missouri, detected 136 malignant lesions among 10,187 asymptomatic participants between 1974 and 1980. Mammography was the sole detection modality in 76 or 56% of cases (Group 1). Mammography combined with physical examination revealed 41 (30%) additional cases (Group 2). Physical examination alone detected 19 (14%) cases (Group 3). Follow-up was complete in all cases. There were 26 (19%) noninvasive and 110 (81%) invasive lesions. Positive axillary nodes were found in 34 (25%) cases, and 102 (75%) patients had negative nodes. The overall 5-year survival was 84.5%. After a minimum follow-up of 5 years and a median follow-up of 8.5 years, 108 patients are alive, 5 of whom have recurrences. Among 28 deceased patients, 9 died of causes unrelated to breast cancer. The 5-year survival of Group 1 was 95% (72/76). Among this group of patients, 84% (64/76) had negative lymph nodes. At 5 to 10 years follow-up, there have been no breast cancer-related deaths among this group, and only one patient has recurrent disease 91 months after mastectomy. Furthermore, 85% (22/26) of all noninvasive lesions were found in this group. Of the remaining 12 patients diagnosed by mammography alone but who had positive nodes, the 5-year survival was 75% (9/12). By contrast, patients diagnosed by mammography plus physical examination (Group 2) experienced a survival of 71% (29/41) at 5 years. Sixty-three percent of patients diagnosed by physical examination had negative lymph nodes. Their 5-year survival was 84%, which contrasts with a 50% 5-year survival for patients with positive nodes. In Group 3, 79% (15/19) had negative nodes. The 5-year survival rate of this group was 74% (14/19), and the 5-year survival rate of the node-negative patients with invasive disease in this group was 29% and 21% lower than that of the node-negative patients with invasive disease of Groups 1 and 2, respectively (P less than 0.01). This study suggests that improved survival in breast cancer screening program is in large measure dependent on the ability to detect lesions before they become palpable. The authors conclude that mammography is a determining factor in early diagnosis, and at 5 to 10 years contributes significantly to improved 5- and 10-year survival rates.