Incidence Of Late-stage Breast Cancer Research Articles

Development of Sub-County Cancer Reporting Zones in Delaware and Example Use Case for Targeted Interventions.

To describe the Delaware Cancer Registry (DCR)'s participation in the National Cancer Institute (NCI)/North American Association of Central Cancer Registries (NAACCR) Zone Design Project to create sub-county geographic areas ("zones") for use in cancer reporting and geospatial analysis. DCR and other stakeholders reviewed up to ten unique zone configurations for each of Delaware's three counties. The zone configurations were created using AZTool and were set to optimize three objectives: create zones that have a minimum and target population of 50,000; are homogenous based on the variables of percent minority, percent below poverty, and percent urban; and are as compact as possible. The DCR sent a survey to stakeholders to provide input on their preferred zone configuration for each county. Following the final selection of zones, the DCR utilized the geographies for calculating overall and late-stage breast cancer incidence statistics and created choropleth maps to visualize the rates by quintiles. The final selections resulted in a total of 15 zones for Delaware, with three in Kent County, nine in New Castle County, and three in Sussex County. The zones ranged in population size from 54,013 to 67,693 people. Zones with higher late-stage breast cancer incidence rates included those near the areas of Wilmington, Middletown, and between Milford and Georgetown. Comparing results of overall breast cancer incidence rates by zone with late-stage rates by zone, there were areas that had lower relative overall breast cancer incidence rates but were relatively higher for late-stage rates by zones or vice versa. Aggregating census tracts into zones allows for reporting reliable cancer rates at sub-county levels, which is instrumental in conveying meaningful information about regional cancer trends to stakeholders and the public. Delaware will be able to utilize zone-level cancer information to provide targeted interventions and outreach initiatives.

Is mammography screening an effective public health intervention? Evidence from a natural experiment

Population-based breast screening programmes aim to improve clinical outcomes, alleviate health inequalities, and reduce healthcare costs. However, while screening can bring about immediate changes in mode of presentation and stage at diagnosis of breast cancer cases, the benefits and harms of these programmes can only be observed at a population level, and only over a long enough timeframe for the cascade of events triggered by screening to culminate in disease-specific mortality reductions. In this paper we exploit a natural experiment resulting from the phased geographic rollout of a national mammography screening programme to examine the impact of screening on breast cancer outcomes from both a patient cohort and a population perspective. Using data on 33,722 breast cancer cases over the period 1994–2011, we employ a difference-in-differences research design using ten-year follow-up data for cases diagnosed before and after the introduction of the programme in screened and unscreened regions. We conclude that although the programme produced the intended intermediate effects on breast cancer presentation and incidence, these failed to translate into significant decreases in overall population-level mortality, though screening may have helped to reduce socioeconomic disparities in late stage breast cancer incidence.

Trends in female breast cancer incidence, mortality, and survival in Austria, with focus on age, stage, and birth cohorts (1983–2017)

Breast cancer (BC) is the most commonly diagnosed malignant disease and the leading cause of cancer death in women in Austria. We investigated overall and subgroup-specific female breast cancer rates to provide a comprehensive analysis of trends over several decades. Incidence, mortality, and survival, as well as age-, stage-, and birth cohort-specific incidence were analysed using nationwide cancer registry data on 163,694 cases of female breast cancer in Austria (1983–2017). Annual percentage changes were estimated using joinpoint regression. BC incidence underwent linear increases until 1997 and reversed with statistically non-significant declines until 2017. After initial increases in BC-specific mortality, rates were stable from 1989 through 1995 and started declining thereafter, although statistically non-significantly after 2011. Overall BC-specific survivals, as well as survivals according to the calendar period of diagnosis, increased throughout the observation period. Incidence in younger women (aged 44 and lower) showed linear increases, whereas for women aged 45 and higher mostly stable or decreasing rates were observed. Localised BC incidence increased markedly and started declining only in 2012. Distant disease-BC incidence decreased through the whole observation period and incidence of regionalised BC started declining in 2000. Birth cohort-specific incidence peaked in women born between 1935 and 1949 (ages 45–74). In conclusion, the incidence of BC in younger women is increasing, while overall female BC incidence and mortality are stable with non-significant declines. Further, increases in the incidence of early-stage BC (localised) seem disproportionately high in comparison to more modest decreases in late-stage BC incidence (regionalised and distant disease).

Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy

BackgroundThe objective of this study was to evaluate if mammography screening attendance is associated with a reduction in late-stage breast cancer incidence. MethodsThe cohort included over 400,000 Italian women who were first invited to participate in regional screening programmes during the 1990s and were followed for breast cancer incidence for 13 years. We obtained individual data on their exposure to screening and correlated this with total and stage-specific breast cancer incidence. Socio-economic status and pre-screening incidence data were used to assess the presence of self-selection bias. ResultsOverall, screening attendance was associated with a 10% excess risk of in situ and invasive breast cancer (IRR = 1.10; 95% confidence interval (CI): 1.06–1.14), which dropped to 5% for invasive cancers only (IRR = 1.05; 95% CI: 1.01–1.09). There were significant reductions among attenders for specific cancer stages; we observed a 39% reduction for T2 or larger (IRR = 0.61; 95% CI: 0.57–0.66), 19% for node positives (IRR = 0.81; 95% CI: 0.76–0.86) and 28% for stage II and higher (IRR = 0.72; 95% CI: 0.68–0.76). Our data suggest that the presence of self-selection bias is limited and, overall, invited women experienced a 17% reduction of advanced cancers compared with pre-screening rates. ConclusionsComparing attenders' and non-attenders' stage-specific breast cancer incidence, we have estimated that screening attendance is associated with a reduction of nearly 30% for stages II+.

Geographic disparities in late stage breast cancer incidence: results from eight states in the United States.

BackgroundLate stage of cancer at diagnosis is an important predictor of cancer mortality. In many areas worldwide, cancer registry systems, available data and mapping technologies can provide information about late stage cancer by geographical regions, offering valuable opportunities to identify areas where further investigation and interventions are needed. The current study examined geographical variation in late stage breast cancer incidence across eight states in the United States with the objective to identify areas that might benefit from targeted interventions.MethodsData from the Surveillance Epidemiology and End Results Program on late stage breast cancer incidence was used as dependent variable in regression analysis and certain factors known to contribute to high rates of late stage cancer (socioeconomic characteristics, health insurance characteristics, and the availability and utilization of cancer screening) as covariates. Geographic information systems were used to map and highlight areas that have any combination of high late stage breast cancer incidence and significantly associated risk factors.ResultsThe differences in mean rates of late stage breast cancer between eight states considered in this analysis are statistically significant. Factors that have statistically negative association with late stage breast cancer incidence across the eight states include: density of mammography facilities, percent population with Bachelor’s degree and English literacy while percent black population has statistically significant positive association with late stage breast cancer incidence.ConclusionsThis study describes geographic disparities in late stage breast cancer incidence and identifies areas that might benefit from targeted interventions. The results suggest that in the eight US states examined, higher rates of late stage breast cancer are more common in areas with predominantly black population, where English literacy, percentage of population with college degree and screening availability are low. The approach described in this work may be utilized both within and outside US, wherever cancer registry systems and technologies offer the same opportunity to identify places where further investigation and interventions for reducing cancer burden are needed.

Abstract P1-17-03: Impact of a culturally syntonic door-to-door breast cancer early detection intervention

Abstract Introduction. Disparities in the detection of breast cancer persist despite efforts to reach underserved populations and increase mammography utilization. Black and Hispanic women are more likely to be diagnosed at a later stage compared to White women. Lack of health insurance and limited awareness of breast cancer are significant predictors of screening behaviors; other reasons remain poorly understood and warrant further research. Our study presents highlights of the Women’s Breast Health Initiative Florida Affiliate (WBHI) intervention and key findings related to its impact. Methods. The intervention targeted single-family home neighborhoods with high incidence of late-stage breast cancer, median income at 200% of the poverty level, and access to affordable health clinics. Neighborhood mobile mammography or transportation to local facilities was provided, followed by navigation to assure proper follow up. Eligible women were uninsured, ≥40 years of age and were qualified for an annual screening mammogram. During 2011-2012Intervention Days45Educational Materials21,079Volunteers*2,025Women Interviewed5,441Eligible Women643Appointments Scheduled581Screening Days15Screening Mammograms Completed409*culturally relevant & trained Descriptive and inferential statistical methods were used to analyze participant data divided into 3 groups based on neighborhood racial demographics: "Black" or "Hispanic" data groups had ≥75% Black or Hispanic residents respectively, while the "Other" did not have a predominant race. Post-visit phone surveys of 1,871 participants were conducted within 30 days. Results. The intervention significantly increased screening rates amongst eligible women from 22% to 64%, had a 0.24% breast cancer diagnosis rate and motivated 59% of the women to propagate awareness. Health insurance coverage rates did not differ significantly between the 3 groups. Notably, amongst the insured, those from "Hispanic" neighborhoods had the highest recent mammogram rate while, amongst the uninsured, those from "Black" neighborhoods had the highest. Neighborhood culture and prior mammogram history impacted the efficacy of the intervention. Among the "Hispanic" and "Other" groups, women with no prior mammograms were less receptive to receiving one compared to those who had prior mammograms. This phenomenon was not observed in the "Black" group. Women’s responses and perceived benefit to the educational package differed according to the neighborhood race and ethnicity: "Black""Hispanic""Other"Benefited70%85%88%Spread the Word54%57%65% Discussion. WBHI reached the goal of increasing screening rates in this underserved population, thus showing that this type of intervention can be effective. Educational packages presented in a face-to-face format within a door-to-door context were found useful by most women. Our findings highlight disparities beyond a woman’s access to breast healthcare and education by showing that neighborhood culture impacts response to outreach intervention and breast healthcare. This generates the hypothesis that given equal access to care, disparities in using screening mammography will remain. Educational methods further tailored to racial and ethnic characteristics may play a significant role in closing disparity gaps. Citation Format: Carmen J Calfa, Julie G Wilkinson, Mindy M Williams, James M Pann, Angela Yehl, Stephanie E Hoogenbergen, Andrea D Ivory. Impact of a culturally syntonic door-to-door breast cancer early detection intervention [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-17-03.

Reduction in late-stage breast cancer incidence in the mammography era: Implications for overdiagnosis of invasive cancer.

Mammographic screening is expected to decrease the incidence of late-stage breast cancer. In the current study, the authors determined the decrease in late-stage cancer incidence and the changes in invasive cancer incidence that occurred in the mammographic era after adjusting for prescreening temporal trends. Breast cancer incidence and stage data were obtained from the Surveillance, Epidemiology, and End Results program. The premammography period (1977-1979) was compared with the mammographic screening period (2007-2009) for women aged ≥ 40 years. The authors estimated prescreening temporal trends using 5 measures of annual percentage change (APC). Stage-specific incidence values from 1977 through 1979 (baseline) were adjusted using APC values of 0.5%, 1.0%, 1.3%, and 2.0% and then compared with observed stage-specific incidence in 2007 through 2009. Prescreening APC temporal trend estimates ranged from 0.8% to 2.3%. The joinpoint estimate of 1.3% for women aged ≥ 40 years approximated the 4-decade long APC trend of 1.2% noted in the Connecticut Tumor Registry. At an APC of 1.3%, late-stage breast cancer incidence decreased by 37% (56 cases per 100,000 women) with a reciprocal increase in early-stage rates noted from 1977 through 1979 to 2007 through 2009. Resulting late-stage cancer incidence decreased from 21% at an APC of 0.5% to 48% at an APC of 2.0%. Total invasive breast cancer incidence decreased by 9% (27 cases per 100,000 women) at an APC of 1.3%. There is evidence that a substantial reduction in late-stage breast cancer has occurred in the mammography era when appropriate adjustments are made for prescreening temporal trends. At background APC estimates of ≥ 1%, the total invasive breast cancer incidence also decreased.

English

Objective: To determine if screening mammography produced the expected increase in the incidence of early-stage breast cancer and reduced the expected incidence of late-stage breast cancer in women 40 years of age or older. Design: Population-based observation study using a before and after cohort time series design. Data Sources: 1) National Health Interview Survey; 2) Surveillance, Epidemiology and End Results (SEER) data; 3) United States Census. 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 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 from 102 to 94 cases per 100 000 women — an absolute decrease of 8 cases per 100 000 women. With the assumption of a constant underlying disease burden, it was estimated that only 8 of the 122 additional early-stage cancers diagnosed would progress to advanced disease. After excluding the transient excess incidence associated with hormone replacement therapy and adjusting for trends in the incidence of breast cancer among women younger than 40 years old, it was estimated that breast cancer was overdiagnosed (i.e., tumours were detected on screening that would never have led to clinical symptoms) in 70 000 women in 2008 and 1.3 million women in the past 30 years. Conclusion: Despite substantial increases in the number of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with late-stage cancer.

Invasive Cancer Incidence—United States, 2009

Cancer has many causes, some of which can, at least in part, be avoided through interventions known to reduce cancer risk. Healthy People 2020 objectives call for reducing colorectal cancer incidence to 38.6 per 100,000 persons, reducing late-stage breast cancer incidence to 41.0 per 100,000 women, and reducing cervical cancer incidence to 7.1 per 100,000 women. To assess progress toward reaching these Healthy People 2020 targets, CDC analyzed data from U.S. Cancer Statistics (USCS) for 2010. USCS includes incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System. In 2010, a total of 1,456,496 invasive cancers were reported to cancer registries in the United States (excluding Arkansas and Minnesota), an annual incidence rate of 446 cases per 100,000 persons, compared with 459 in 2009. Cancer incidence rates were higher among men (503) than women (405), highest among blacks (455), and ranged by state from 380 to 511 per 100,000 persons. Many factors, including tobacco use, obesity, insufficient physical activity, and human papilloma virus (HPV) infection, contribute to the risk for developing cancer, and differences in cancer incidence indicate differences in the prevalence of these risk factors. These differences can be reduced through policy approaches such as the Affordable Care Act, which could increase access for millions of persons to appropriate and timely cancer preventive services, including help with smoking cessation, cancer screening, and vaccination against HPV.

Decreasing incidence of late‐stage breast cancer after the introduction of organized mammography screening in Italy

After the introduction of a mammography screening program, the incidence of late-stage breast cancer is expected to decrease. The objective of the current study was to evaluate variations in the total incidence of breast cancer and in the incidence of breast cancers with a pathologic tumor (pT) classification of pT2 through pT4 after the introduction of mammography screening in 6 Italian administrative regions. The study area included 700 municipalities, with a total population of 692,824 women ages 55 to 74 years, that were targeted by organized mammography screening between 1991 and 2005. The year screening started at the municipal level (year 1) was identified. The years of screening were numbered from 1 to 8. The ratio of the observed 2-year, age-standardized (Europe) incidence rate to the expected rate (the incidence rate ratio [IRR]) was calculated. Expected rates were estimated assuming that the incidence of breast cancer was stable and was equivalent to that in the last 3 years before year 1. The study was based on a total of 14,447 incident breast cancers, including 4036 pT2 through pT4 breast cancers. The total IRR was 1.35 (95% confidence interval, 1.03-1.41) in years 1 and 2, 1.16 (95% confidence interval, 1.10-1.21) in years 3 and 4, 1.14 (95% confidence interval, 1.08-1.20) in years 5 and 6, and 1.14 (95% confidence interval, 1.08-1.21) in years 7 and 8. The IRR for pT2 through pT4 breast cancers was 0.97 (95% confidence interval, 0.90-1.04) in years 1 and 2, 0.81 (95% confidence interval, 0.75-0.88) in years 3 and 4, 0.79 (95% confidence interval, 0.73-0.87) in years 5 and 6, and 0.71 (95% confidence interval, 0.64-0.79) in years 7 and 8. A significant and stable decrease in the incidence of late-stage breast cancer was observed from the third year of screening onward, when the IRR varied between 0.81 and 0.71.

Trends in incidence of late-stage breast cancer following introduction of organised mammography screening in Italy by Impact Working Group

Trends in incidence of late-stage breast cancer following introduction of organised mammography screening in Italy by Impact Working Group

Visualizing and testing the impact of place on late-stage breast cancer incidence: A non-parametric geostatistical approach

This paper describes the combination of three-way contingency tables and geostatistics to visualize the non-linear impact of two putative covariates on individual-level health outcomes and test the significance of this impact, accounting for the pattern of spatial correlation and correcting for multiple testing. The methodology is used to explore the influence of distance to mammography clinics and census-tract poverty level on the rate of late-stage breast cancer diagnosis in three Michigan counties. Incidence rates are significantly lower than the area-wide mean (18.04%) mainly in affluent neighbourhoods [0–5% poverty], while higher incidences are mainly controlled by distance to clinics. The new simulation-based multiple testing correction is very flexible and less conservative than the traditional false discovery rate approach that results in a majority of tests becoming non-significant. Classes with significantly higher frequency of late-stage diagnosis often translate into geographic clusters that are not detected by the spatial scan statistic.