Nationwide Breast Cancer Screening Program Research Articles

Sociodemographic factors, health indicators and lifestyle factors among participants in BreastScreen Norway 2006-2016 – a cohort profile

Purpose: To collect information on sociodemographic factors, health indicators, and lifestyle factors in women who attended the nationwide breast cancer-screening program, BreastScreen Norway, with the aim of investigating how these factors influence the risk of breast cancer, other cancer types, and cancer-related outcomes. Participants: The cohort data includes self-reported responses to questionnaires from 554,149 women aged 50-69 years, who attended BreastScreen Norway during the data collection period, 2006-2016. Findings to date: Information about sociodemographic factors, health indicators, and lifestyle factors was collected for the current time and retrospectively back to birth. For the cohort, we have complete mammographic screening data, including information about 24,000 breast cancer cases and other cancer types from the Cancer Registry of Norway. These outcomes are aggregating continuously. Data from the cohort have been utilized in studies related to breast cancer and menopausal status. Future projects: Data will be utilized in studies related to tumour growth and risk of breast cancer as well as other cancer types, in addition to overall and cancer-specific death. Registration: The cohort profile is not registered in Clinical Trials.

Mammographic Breast Density, Benign Breast Disease, and Subsequent Breast Cancer Risk in 3.9 Million Korean Women.

Background Mammographic breast density and benign breast disease are strong risk factors for breast cancer. Accordingly, women with both risk factors may have a markedly high risk for developing breast cancer. Purpose To investigate the risk of breast cancer associated with the combination of mammographic density and benign breast disease in Korean women, where population-based mammographic breast cancer screening is provided for all women aged at least 40 years. Materials and Methods This is a retrospective analysis of data from a nationwide breast cancer screening program linked with the national cancer registry. The study included Korean women between 40-74 years of age screened for breast cancer between January 2009 and December 2010 and observed up to December 2020 (median follow-up of 10.6 years). Benign breast disease and breast density were extracted from mammography screening results. Cox proportional hazard regression analysis was used to calculate adjusted hazard ratios (HRs) for breast cancer risk. Results In this study, 3 911 348 women (mean age, 53 years ± 9 [SD]) were analyzed. During follow-up (median, 10.6 years), 58 321 women developed breast cancer. At screening, 10 729 (18.4%) cases of benign breast disease were detected among women who developed breast cancer. Women with extremely dense breasts (Breast Imaging Reporting and Data System [BI-RADS] density category D) and benign breast disease had a greater risk of breast cancer when compared with women presenting with fatty breast (BI-RADS density category A) and those without benign breast disease (HR, 2.75; 95% CI: 2.63, 2.88; P < .001). Women with benign breast disease and fatty breasts (HR, 1.49; 95% CI: 1.40, 1.58; P < .001) and women with extremely dense breasts and without benign breast disease (HR, 2.28; 95% CI: 2.20, 2.35; P < .001) also had an elevated breast cancer risk compared with women with fatty breast tissue. Conclusion Women with dense breasts and benign breast disease at screening mammography had an elevated risk of future breast cancer. © RSNA, 2022 Online supplemental material is available for this article.

Predictors and Trend in Attendance for Breast Cancer Screening in Lithuania, 2006-2014.

In Lithuania, a Nationwide Breast Cancer (BC) Screening Program was launched in 2005, offering mammography for women aged 50 to 69 years, every other year. This study aimed to determine the trend in the attendance for mammography screening during 2006–2014 and to identify the factors that are predictive for participation in it. The study sample consisted of 1941 women aged 50–64 years, who participated in five cross-sectional biennial postal surveys of Lithuanian Health Behavior Monitoring, carried out in independent national random samples. The attendance for screening was identified if women reported having had a mammogram within the last two years. The proportion of women attending the screening was continuously increasing from 20.0% in 2006 up to 65.8% in 2014. The attendance for BC screening was associated with the participation in cervical cancer screening. A higher level of education, living in a city, frequent contact with a doctor, and healthy behaviors (fresh-vegetable consumption, physical activity, and absence of alcohol abuse) were associated with higher participation rates in BC screening. To increase BC screening uptake and to reduce inequalities in attendance, new strategies of organized BC screening program using systematic personal invitations are required in Lithuania.

Saliva samples as a source of DNA for high throughput genotyping: an acceptable and sufficient means in improvement of risk estimation throughout mammographic diagnostics

BackgroundBreast cancer screening programs seem to be an insufficient tool for women at high genetic risk for breast cancer. These women are not adequately monitored yet. Genetic testing may improve clearly the quality of breast cancer prevention programs. At present, blood samples are favored for obtaining high-quality DNA; however, DNA can also be obtained by collecting saliva. The aim of this study was, on the one hand, to determine whether saliva sampling is a practicable means to obtain sufficient quantity and quality of DNA and, on the other hand, whether it is accepted by patients throughout mammographic diagnostics.Methods67 consecutive women with diagnostic need for mammography with or without a family history for breast cancer were asked for their basic willingness to undergo a genetic testing by saliva sample in addition to standard diagnostics. Saliva samples were analyzed in terms of DNA quantity and quality.Results64 (95.6%) women agreed to provide a saliva sample; 3 of them denied participation. And even 63 out of 64 (98.4%) were interested in their specific results. 45 out of 64 samples contained a DNA concentration above 50 ng/µl, 12 samples were between 25 and 50 ng/µl and only 7 of them were under 25 ng/µl with the standard extraction procedure.ConclusionA high number of patients seem to accept salvia samples as a risk assessment tool in breast diagnostics and are interested in their specific risk situation. At the same time, it could be demonstrated that it is an effective way to provide high-quality DNA for breast cancer gene analysis. However, it remains to be shown whether it would be possible to integrate it with the same acceptance in a nationwide breast cancer screening program.

Stortingsdebattene om mammografiscreening i 1998

In 1998, the Storting unanimously adopted the introduction of nationwide mammography screening in Norway. Mammography screening has been the subject of scientific debate, but there has been little research on the political arguments for a public screening programme. In this article I analyse the arguments put forward at that time for nationwide mammography screening. A document analysis of proposals to the Storting was performed, and recommendations and minutes of debates in the Storting that dealt with nationwide mammography screening. The documents are from the period February-June 1998. The Storting was unanimously in favour of introducing a nationwide breast cancer screening programme. The debate consisted of four main lines of argument: 'breast cancer mortality and the effect of mammography screening', 'women's health', 'justice and equality of healthcare services', and that 'private service providers offer the solution for insufficient equipment and personnel'. The effect of mammography screening on breast cancer mortality permeated the debate. Problematic aspects of screening were not discussed. The fact that early detection affects breast cancer mortality was an underlying premise in the debate on nationwide mammography screening in the Storting in 1998. Since its introduction, mammography screening has been the subject of scientific debate. This has not undermined the political will to maintain the mammography programme, and the introduction of a new screening programme for colon cancer has now been adopted.

Breast cancer screening.

Cass R. Sunstein's 2016 book The Ethics of Influence: Government in the Age of Behavioral Science provides an extremely informative introduction to the science and ethics of the exercise of "influence" over others. As a longtime physician employed in both the public and private sectors, I now recognize that most of my formal training has been in the hard sciences, with little, if any, training in the appropriate influence of the decision-making processes of my patients and/or other health care professionals in institutional settings. Breast cancer screening is an excellent example of the conflicts of modern medicine, highlighting our collective inability to effectively "nudge" others in the pursuit of health and/or organizational effectiveness and efficiency. Using the framework of Sunstein's ethical values of welfare, autonomy, dignity, and self-government, I discuss many of the conflicting issues in a nationwide breast cancer screening program and the effects of these issues on client nudging to determine whether mammography screening is ethical.

PINK RIBBON AND PINKTOBER

The month of October comes with a familiar sight of ‘pink ribbon’ display and events organized in this context, globally. While this is an integral part of the international calendar in the developed world, developing countries like Pakistan attach little importance to promotion of this concept brand. One of the reasons for this apathy is a lack understanding amongst the social circles and general population about what the pink ribbon advocates. This editorial is meant to highlight the true spirit and importance of this symbol.&#x0D; A ‘pink ribbon’ is an international symbol of breast cancer awareness with the month of October referred to as ‘pinktober’ chosen as the breast cancer awareness month in many countries over the world. Breast cancer is the most common cancer amongst the female gender with more than one million women worldwide diagnosed with the disease every year. The WHO in its global health estimate reported 508000 deaths in women worldwide from this disease in the year 20111.More than 58% of deaths from breast cancer are known to occur in less developed countries2, which sets aside the misconception that the disease is a problem of the more affluent class. Early detection of breast cancer with its favorable impact on morbidity and mortality associated with the disease is now established as the cornerstone of management3.&#x0D; Against the backdrop of the magnitude and impact of this condition there is a dire need for creating awareness about the symptoms and treatment of the disease as well as promoting research and facilities leading to early detection, multimodality treatment and support for those suffering from the disease. Pink ribbon as a concept brand allows a platform to achieve these goals by raising money and encouraging scientific progress. The first known use of Pink Ribbon dates back to 1991 when it was handed out by the Susan G Koman foundation to participants of a New York city race for breast cancer survivors and adopted as an official symbol in 19924. Buying, wearing, displaying or sponsoring pink ribbon is a sign of support for women health. Thousands of pink ribbon products are advertised and sold each year with part of the earnings spent in promoting breast cancer awareness and funding research.&#x0D; The month of October as the national breast cancer awareness month (NBCAM) was started in 1985 by the American Cancer Society and pharmaceutical company Astra Zeneca. The organization behind NBCAM is keen on promoting mammography as a screening tool for early detection of breast cancer. Running, walking and riding besides observing pink dress day and pink hijab day form the essence of events organized globally as fundraisers under this banner.&#x0D; The campaign for helping breast cancer patients is not limited to diagnosis and treatment only. Addressing the burden of physical, social and psychological stigma associated with the disease is as important as the initial steps in management. The term She-ro, derived from hero is sometimes used to refer to those suffering from the disease. After treatment, the she-ro regains her femininity by using breast reconstruction, prosthetic devices, wigs, cosmetics, and clothing to present an aesthetically appealingappearance5.Breast cancer culture, or pink ribbon culture, refers to steps taken in public to effectively address different aspects of the disease. It supports the efforts of the doctors, promotes diagnostic modalities such as mammograms and various treatment options on offer for breast cancer patients.&#x0D; Pakistan has the highest rate of breast cancer in Asia. One out of every nine women is at the risk of breast cancer making the Pakistani women most susceptible to the disease after the non Arab Israeli women6. Studies have shown that a significant number of young women make the afore-mentioned list. Therefore, Pink Ribbon has reading-prc-Iterature been running Youth Awareness Program in collaboration with Higher Education Commission (HEC) since 2012. This program not only educates the young women about the importance of self-examination and screening modalities like ultrasound scan and mammograms but also through their interaction with members of their family and society makes them conscious of the disease and advocating regular check-ups. Benefit is also derived from established women groups and Lady Health workers who are in contact with the population in far-flung areas of the country, in spreading awareness to the grass root level. In collaboration with Pakistan Atomic Energy Commission hospitals, Pink ribbon has launched a free nationwide Breast Cancer screening program and is working on building a dedicated Breast Cancer Hospital in Lahore, Pakistan.&#x0D; Realizing the disease burden and the health, social and financial implications of breast cancer it is imperative that Pink Ribbon as a source of Breast Cancer awareness is propagated in the society and an all out moral and material support be extended to the organizations working under this banner.

Urban-rural disparity of breast cancer and socioeconomic risk factors in China.

Breast cancer is one of the most commonly diagnosed cancers worldwide. The primary aim of this work is the study of breast cancer disparity among Chinese women in urban vs. rural regions and its associations with socioeconomic factors. Data on breast cancer incidence were obtained from the Chinese cancer registry annual report (2005–2009). The ten socioeconomic factors considered in this study were obtained from the national population 2000 census and the Chinese city/county statistical yearbooks. Student’s T test was used to assess disparities of female breast cancer and socioeconomic factors in urban vs. rural regions. Pearson correlation and ordinary least squares (OLS) models were employed to analyze the relationships between socioeconomic factors and cancer incidence. It was found that the breast cancer incidence was significantly higher in urban than in rural regions. Moreover, in urban regions, breast cancer incidence remained relatively stable, whereas in rural regions it displayed an annual percentage change (APC) of 8.55. Among the various socioeconomic factors considered, breast cancer incidence exhibited higher positive correlations with population density, percentage of non-agriculture population, and second industry output. On the other hand, the incidence was negatively correlated with the percentage of population employed in primary industry. Overall, it was observed that higher socioeconomic status would lead to a higher breast cancer incidence in China. When studying breast cancer etiology, special attention should be paid to environmental pollutants, especially endocrine disruptors produced during industrial activities. Lastly, the present work’s findings strongly recommend giving high priority to the development of a systematic nationwide breast cancer screening program for women in China; with sufficient participation, mammography screening can considerably reduce mortality among women.

Results of the Czech National Breast Cancer Screening Programme

Breast cancer screening based on mammography is an effective tool for lowering mortality rates from this disease. The organised and nationwide Breast Cancer Screening Programme has been underway in the Czech Republic since 2002. Monitoring of the programme is based on data from the Czech National Cancer Registry (CNCR), Breast Cancer Screening Registry, and the Czech National Reference Centre (CNRC). These data sources make it possible to evaluate early performance indicators according to international standards, and to monitor the cancer burden in the Czech population. The CNRC data allow us to document the high validity of the available data as well as to map non-organised mammography examinations (so-called opportunistic screening). Until the mid-1990s, breast cancer incidence and mortality rates saw a slight but continuous increase. In the last 15 years, however, incidence rates have grown more substantially; by contrast, mortality rates have stalled and even started to decline since the 2000s. In the mid-1990s, the proportion of cancers diagnosed at stage I was below 20%; this situation has dramatically improved since then, as more than 40% cases of breast cancer were diagnosed at stage I in 2011. Breast cancer screening coverage currently amounts to 50%; this value reached a plateau in the period 2007-2008, and unfortunately has not shown any further significant increase. Over the last few decades, the breast cancer burden among the Czech population has been significantly reduced - despite the growing incidence rates, mortality rates have decreased, which can be largely attributed to earlier detection of breast cancer based on the screening programme. Further improvements in the programmes effectiveness can only be achieved if the population coverage becomes higher; the programme of personalised invitations to mammography examinations, which was introduced in early 2014, should contribute to the accomplishment of this goal.

Attendance of the fourth (2008–2009) screening round of the Hungarian organized, nationwide breast cancer screening program

Organised, nationwide screening for breast cancer with mammography in the age group between 45 and 65 years with 2 years screening interval started in Hungary in January 2002. The aim of this study is to analyze the attendance rate of nationwide breast screening programme for the 2008-2009 years. The data derive from the database of the National Health Insurance Fund Administration. The ratio of women in the age group 45-65 years was calculated having either a screening mammography or a diagnostic mammography in the 4th screening round of the programme. In the years 2000-2001, 7.6% of the women had an opportunistic screening mammography while in 2008-2009 31.2% of the target population had screening mammography within the organized programme. During the same periods 20.2% (2000-2001) and 20.4% (2008-2009) of women had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 26.6% (2000-2001) to 50.1% (2008-2009). The attendance rate failed to change between 2002 and 2009. In order to decrease the mortality due to breast cancer, the attendance rate of mammography screening programme should be increased. Orv. Hetil., 154(50), 1975-1983.

PCN25 - Quality Indicators of the Fourth Screening Round (2008-2009) of the Hungarian Organized, Nationwide Breast Cancer Screening Programme

PCN25 - Quality Indicators of the Fourth Screening Round (2008-2009) of the Hungarian Organized, Nationwide Breast Cancer Screening Programme

PCN26 - The Attendance of the Fourth Screening Round (2008-2009) of the Hungarian Organized, Nationwide Breast Cancer Screening Program

PCN26 - The Attendance of the Fourth Screening Round (2008-2009) of the Hungarian Organized, Nationwide Breast Cancer Screening Program

Cost-Effectiveness of Screening Women With Familial Risk for Breast Cancer With Magnetic Resonance Imaging

To reduce mortality, women with a family history of breast cancer are often screened with mammography before age 50 years. Additional magnetic resonance imaging (MRI) improves sensitivity and is cost-effective for BRCA1/2 mutation carriers. However, for women with a family history without a proven mutation, cost-effectiveness is unclear. We evaluated data of the largest prospective MRI screening study (MRISC). Between 1999 and 2007, 1597 women (8370 woman-years at risk) aged 25 to 70 years with an estimated cumulative lifetime risk of 15% to 50% for breast cancer were screened with clinical breast examination every 6 months and with annual mammography and MRI. We calculated the cost per detected and treated breast cancer. After incorporating MRISC data into a microsimulation screening analysis model (MISCAN), different schemes were evaluated, and cost per life-year gained (LYG) was estimated in comparison with the Dutch nationwide breast cancer screening program (biennial mammography from age 50 to 75 years). All statistical tests were two-sided. Forty-seven breast cancers (9 ductal carcinoma in situ) were detected. Screening with additional MRI costs $123 672 (€93 639) per detected breast cancer. In increasing age-cohorts, costs per detected and treated breast cancer decreased, but, unexpectedly, the percentage of MRI-only detected cancers increased. Screening under the MRISC-scheme from age 35 to 50 years was estimated to reduce breast cancer mortality by 25% at $134 932 (€102 164) per LYG (3.5% discounting) compared with 17% mortality reduction at $54 665 (€41 390) per LYG with mammography only. Screening with MRI may improve survival for women with familial risk for breast cancer but is expensive, especially in the youngest age categories.

PCN10 - The Attendance Of The Third Screening Round (2006-2007) Of The Hungarian Organized, Nationwide Breast Cancer Screening Program

PCN10 - The Attendance Of The Third Screening Round (2006-2007) Of The Hungarian Organized, Nationwide Breast Cancer Screening Program

PCN9 - Quality Indicators Of The Third Screening Round (2006-2007) Of The Hungarian Organized, Nationwide Breast Cancer Screening Program

PCN9 - Quality Indicators Of The Third Screening Round (2006-2007) Of The Hungarian Organized, Nationwide Breast Cancer Screening Program

Abstract P3-02-08: Is repetition of the contralateral mammogram of patients referred from breast cancer screening for unilateral findings necessary?

Abstract Introduction - The Netherlands started a nationwide breast cancer screening program in 1989, including women from the age of 50 until 75. Screening mammograms are performed two yearly in a mobile unit and consist of a bilateral two-view mammogram of the breast (mediolateral oblique and craniocaudal views). If indicated, patients are referred to a breast clinic for diagnostic analysis. This work-up consist of among others repeating the bilateral two-view mammogram. Since the screening is digitalized, repeating of at least the mammogram of the non suspicious side might be unnecessary. The aim of this study is to determine the additional value of repeating the contralateral mammogram in patients referred for a suspicious unilateral lesion. Material and methods – 395 patients were referred from breast screening program to our institution for unilateral findings between October 2009 and August 2011. In all patients a bilateral mammogram was repeated and analyzed by an experienced breast radiologist. In the case of breast cancer a breast magnetic resonance imaging (MRI) was performed for preoperative staging. Anonymised data concerning the date of registration of the screening mammogram, the referred side (left/right or bilateral), age, screening's BI-RADS classification, breast density, biopsy results and breast MRI results were collected. Results - Of the 395 patients referred for a suspicious unilateral finding, a malignancy on the referred side was observed in 144 patients (36.5%). In five patients bilateral breast cancer was detected. In one patient no malignancy was detected on the referred side, though on the contralateral side. Three of these six contralateral malignancies were directly mammographically detected. All six malignancies were detected with preoperative breast MRI. Conclusion - Repetition of the two-view mammogram of the contralateral side in patients referred with a unilateral suspicious finding seems unnecessary, since all contralateral malignancies were depicted on the preoperative staging breast MRI recommended according to the EUSOBI-guidelines. Omission of the contralateral mammogram could lead to reduction of associated health care costs, radiation exposure, and patient discomfort caused by the exam. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-08.

Abstract P4-16-12: Outcomes of low- risk Ductal Carcinoma in situ in South East Asian women treated with breast conservation surgery.

Abstract Background: Singapore is the first South East Asian country to establish a nationwide breast cancer screening programme in 2002. Since then, the incidence of breast cancer and pre-invasive disease, in particular, has increased tremendously. Ductal carcinoma in situ (DCIS) constitutes over a quarter of all screen-detected cancers. In Singapore, most patients with DCIS are managed with breast conserving surgery (BCS). In almost all cases, this is followed by adjuvant radiotherapy (RT) to the whole breast. However, the optimum management of low-risk DCIS remains contentious. Non-randomized data in Caucasian women suggests benefits in the reduction of local recurrence despite already low recurrence rates. Similar information in Asian women is lacking. We examined the outcomes of South East Asian women with low-risk DCIS treated with BCS. Methods: Retrospective chart reviews of patients treated with BCS for DCIS from 1995 to 2011 was performed. Patients meeting the pathological criteria from ECOG 5194 were included: Low-Intermediate grade (LG) DCIS ≥0.3cm but ≤2.5cm excised with final margins ≥3mm and High grade (HG) DCIS ≥3mm but ≤1.0cm. Most patients received adjuvant RT consisting of whole breast RT to 50Gy followed by a 10Gy boost to the tumour bed. Patients deemed to have especially low recurrence risks did not receive RT and some patient declined adjuvant RT. Patients who are oestrogen receptor positive were offered 5 years of tamoxifen. Results: A total of 744 patients with pathological diagnosis of pure DCIS were identified, of which 273 meets the selection criteria: LG (N = 219); HG (N = 54). Median follow-up for these patients is 60 months. Median age at diagnosis is 50 years old. About 70% of patients were screen detected; only 21 of which (7.7%) were diagnosed before the introduction of breast screening. There were 8 ipsilateral breast tumour recurrences (IBTR) in total; 7 of which were DCIS. The estimated actuarial IBTR rates at 5- and 10-year for the entire cohort are 1.8% and 4.3% respectively. In comparison, 10 contralateral new breast primaries were diagnosed in this cohort, giving 5- and 10-year contralateral relapse rates of 1.9% and 7.2% respectively. All patients with LG DCIS received RT except for 9. There were 7 recurrences in this group, two among the 9 patients who did not receive RT. The estimated IBTR rates at 5- and 10-year are 2.3% and 4.2% respectively. All patients with HG DCIS received RT. There was only 1 IBTR occurring beyond 5 years giving an estimated IBTR rate of 4.5% at 10-year. These results compare favourably with the 5-year IBTR rates of 6.1% and 15.3% in the LG and HG patients respectively in the ECOG 5194 study where patients were managed with BCS alone. One patient died of metastatic breast cancer from the contralateral breast giving a 10-year overall survival of 98.5%. Conclusions: South East Asian women with screen detected DCIS have exceedingly low rates of IBTR after breast conservation therapy. The addition of adjuvant RT approximately halved the IBTR rates in our study patients. The high proportion of recurrence in the small group of patients who did not receive RT warns of the potential hazards of managing even these low-risk patients without radiation. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-12.

Image quality of mammography in Croatian nationwide screening program: Comparison between various types of facilities

The study was aimed to provide objective evidence about the mammographic image quality in Croatia, to compare it between different types of MG facilities and to identify the most common deficiencies and possible reasons as well as the steps needed to improve image quality. A total of 420 mammographic examinations collected from 84 mammographic units participating in the Croatian nationwide breast cancer screening program were reviewed in terms of four image quality categories: identification of patient and examination, breast positioning and compression, exposure and contrast, and artifacts. Those were rated using image evaluating system based on American College of Radiology and European Commission proposals. The results were compared among different types of mammographic units, and common image quality deficiencies were identified. Total image quality scores of 12.8, 16.1, 13.0 and 13.7 were found for general hospitals, university hospitals, private clinics and public healthcare centres, respectively. Average score for all mammographic units was 13.5 (out of 25 points). University hospitals were significantly better than all other mammography units in overall image quality, which was mostly contributed by better breast positioning practices. Private clinics showed the worst results in identification, exposure, contrast and artifacts. Serious deficiencies in identification and breast positioning, which might compromise breast cancer screening outcome, were detected in our material. They occur mainly due to subjective reasons and could be corrected through additional staff training and improvement of working discipline.

A model to optimize health care assistance for women with breast cancer: The Núcleo Mama Porto Alegre Project

e17526 Background: The promptness of breast cancer (BC) diagnosis and treatment is cornerstone in reducing the disease's mortality. In Brazil, the main problem to achieve this is lack of access to the insufficient referral centers, which in turn are not used to perform early diagnosis and treatment. To address this problem in our city, we created the Núcleo Mama Porto Alegre (NMPOA) model, through a partnership among the private, public and third sectors. The cohort is composed by 9,218 women, of which 4,500 are in the 40–69 age group and have annual clinical examination and mammography (MMG) at NMPOA, and the remainder (&lt;40 and &gt;=70) have clinical follow-up at primary care facilities. All clinical visits, exams and treatment are conducted in the NMPOA center. Our aim is to demonstrate the effectiveness of a model for underserved population to shorten the time between 1st medical appointment and the start of BC treatment. Methods: We analyzed all BC cases diagnosed up to now. We evaluated 3 time periods of the patient's care: median time (MT) between the medical appointment and MMG, MT between MMG and biopsy, and MT between biopsy and the first treatment as indicated: definitive surgery, neoadjuvant chemo- or hormone therapy. Results: 48 cases were evaluated. Clinical staging were the following: stage 0: 16.6%; I: 37.5%; IIA: 18.8%; IIB: 12.5%; IIIA: 10.4%; and IV: 4.1%. MT between the first visit and MMG was 0 days; between MMG and biopsy, 3 days; and between biopsy and first treatment, 23 days. Conclusions: Our model shows much faster results than the usual delay time in Brazil (4–6 months between first visit and treatment). A nationwide BC screening program in Brazil must be implemented with efficient infrastructure and well trained personnel in order to rapid investigate breast lesions, assuring quick access to treatment and therefore diminishing BC mortality. No significant financial relationships to disclose.

Brustkrebs: Mortalitätsreduktion durch Früherkennung und adjuvante Therapie

Die auch in Deutschland zu beobachtende Mortalitätsreduktion des Mammakarzinoms ist im Wesentlichen auf die Erfolge der adjuvanten Therapie zurückzuführen, da in dem entsprechenden Beobachtungszeitraum (1990–2004) kein flächendeckendes Mammografie-Früherkennungsprogramm existent war. Somit ist mit der Einführung des Screeningprogramms ein weiterer Fortschritt zu erwarten. Insbesondere die Einführung von Brustzentren mit der Definition entsprechender struktureller und qualitativer Vorgaben sowie die Implementierung und konsequente Anwendung von Leitlinien hat die Therapie auf eine evidenzbasierte Grundlage gestellt. Der Paradigmenwandel in der Systemtherapie des Mammakarzinoms ist gekennzeichnet von den molekularbiologischen Erkenntnissen und der Entwicklung entsprechend zielgerichtet einzusetzender neuer Substanzen. Voraussetzung für den optimalen Einsatz dieser Substanzen ist jedoch die qualitätsgesicherte, pathohistologische Bestimmung des entsprechenden Targets sowie die Identifikation neuer prognostischer und prädiktiver Marker. Dieser Entwicklung müssen auch die Studienkonzepte Rechnung tragen, da die empirische Herangehensweise den modernen Ansprüchen in der Onkologie nicht länger gerecht wird.