Analysis and classification of interval cancers in a French breast cancer screening programme (départment of Isère)

Exbrayat, C.; Garnier, Anne; Colonna, Maria Antonietta; Assouline, David; Salicru, B.; Winckel, P; Ménegoz, F; Bolla, M.

doi:10.1097/00008469-199906000-00014

Cited by 23 publications

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“…5 This results in a shift in time of part of first-year cancers to the second interval year. This temporal bias might explain why, in the present and many other service studies, 16,17,20,21,23,31 the increase in proportional incidence from the first to the second interval year has been sharper than in the Two-County trial. 32 In non-research settings, and especially during the initial round, the increased length of surgical waiting lists may delay the registration of interval cancers.…”

Section: Table1 Total Proportional Incidence Of Interval Breast Cancersmentioning

confidence: 51%

Incidence of interval breast cancers after 650,000 negative mammographics in 13 Italian health districts

Bucchi¹,

Ravaioli²,

Foca³

et al. 2008

J Med Screen

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Objectives To estimate the total proportional incidence of interval breast cancers in a two-yearly mammography screening programme, and to perform subgroup analyses by woman's age, screening centre-specific recall rate and screening round. Methods Using unconverted electronic data-sets from the 13 screening centres in the EmiliaRomagna Region of northern Italy (540,450 women aged 50 -69 years), a database of 919,538 mammography records was created. Of these, 655,175 eligible single-mammography records (1997 -2002) from 379,318 women were record-linked with the regional Breast Cancer Registry. In the two-year inter-screening interval, a total of 1,022,694.3 woman-years at risk were accumulated, with 695 interval cancers observed and 2428.3 expected. The observed number of interval cancers was divided by the expected number to obtain the proportional incidence. Results The total proportional incidence of first-and second-year interval cancers was 0.18 (95% CI 0.15 -0.20) and 0.43 (0.39-0.47), respectively. Woman's age was inversely associated with proportional incidence in both interval years, with a cut-off point at age 60. A screening centrespecific recall rate greater than the regional average of 5% was associated with a proportional incidence of 0.14 (0.11 -0.17) versus 0.20 (0.17 -0.24) in the first interval year, and of 0.36 (0.31 -0.41) versus 0.50 (0.44 -0.56) in the second. The proportional incidence remained unchanged between the first and subsequent screening rounds. Conclusions The results were in line with the previous Italian data and with the recommended European standards. The inverse effect of woman's age and of recall rate was expected.

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Section: Table1 Total Proportional Incidence Of Interval Breast Cancersmentioning

confidence: 51%

Incidence of interval breast cancers after 650,000 negative mammographics in 13 Italian health districts

Bucchi¹,

Ravaioli²,

Foca³

et al. 2008

J Med Screen

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“…Further, discarding DCIS should enhance international comparability of IC by excluding an entity whose classification may differ across pathologists and which is the main contributor to over-diagnosis in screening programmes. On the other hand, inclusion of the DCIS diagnosed in the interscreening interval, which contribute between 2 and 8% of all IC, 7,10,29 implicitly considers opportunistic screening activity as a contributory factor for international differences in IC frequency.…”

Section: Discussionmentioning

confidence: 99%

Methodological issues in international comparison of interval breast cancers

Bulliard

Sasieni

Klabunde

et al. 2006

Intl Journal of Cancer

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International comparisons of interval cancers (IC) are important to better understand the relationship between programmes' performance and screening practices. In this respect, differences in (i) definition, (ii) identification and (iii) quantification of IC have received little attention. To examine these 3 comparability issues and activities involving IC, an assessment was conducted among member countries of the International Breast Cancer Screening Network, and the impact of accuracy of identification and quantification practices was estimated using 1996-98 data from the Dutch breast cancer screening programme. Information was obtained from 19 screening programmes in 18 countries, 16 of which acknowledged the coexistence of opportunistic screening. IC data were collected to evaluate performance of the screening programme (100% of programmes) and the radiologists (89%); 53% of programmes had a designated review process for IC. Most programmes (84%) agreed with the European Guidelines definition of IC, but a case situation exercise evidenced substantial discrepancy in classification of cancers that occurred after a positive screen. Completeness of identification of IC appears to contribute most to international variation, and cannot be easily controlled for in methodologically rigorous comparisons. Statistically significant differences of about 4% were measured between quantification methods for IC. An operational definition of IC is proposed to enhance international comparability. Valid comparisons of IC are possible with careful attention to the definition but true differences in IC frequency across screening programmes should exceed 10% to be possibly indicative of real differences between programmes. ' 2006 Wiley-Liss, Inc.Key words: mammography; mass screening; interval cancer; international collaboration; comparative study Although mammography is currently the only proven screening method for reducing mortality from breast cancer, 1-3 some breast cancers will inevitably elude screening detection. Interval cancers (IC) are those tumours that are diagnosed in the time period between 2 screening rounds. They occur because of the following: rapid tumour growth leads to cancers that truly develop in the interval after screening, cancers that are present are masked by characteristics of the breast or the cancer, readers miss subtle or minimal signs on the screening mammogram, or further assessment procedures fail to diagnose the cancer radiologically detected. 4,5 From a population-based perspective, IC are a key measure of the quality of the radiology performed and of the early impact of screening programmes. 6 A high incidence of IC adversely affects the ability of a screening programme to reduce mortality from breast cancer. Knowledge of IC is also necessary to determine the sensitivity of the programme and of the radiologists' performance.The frequency of IC has been assessed in randomised studies and in established programmes that provide mammography to a defined target group (service screening), and compa...

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“…Several papers have been published on IC rates from national or local screening programmes (Frisell et al, 1987;Tabar et al, 1987;Day et al, 1995;Johnson and Shekhdar, 1995;Asbury et al, 1996;Blanks and Moss, 1996;Faux et al, 1997;Sylvester et al, 1997aSylvester et al, , 1997bFracheboud et al, 1998Fracheboud et al, , 1999Lynge, 1998;Moss and Blanks, 1998;Rickard et al, 1998;Everington et al, 1999;Exbrayat et al, 1999;Kavanagh et al, 1999;Warren and Duffy, 2000;Brown et al, 2001;Taylor et al, 2002;Zappa et al, 2002;Gorini et al, 2004;Törnberg et al, 2005;Bulliard et al, 2006;Hofvind et al, 2006;Bucchi et al, 2008a). To the best of our knowledge, no data have been published yet on pooled analysis from several BC screening programmes in different European Countries sharing the same screening guidelines (Perry et al, 2006) and data collection protocols, and providing detailed information including histological characteristics which allow for a better understanding of the complexity of IC (Brekelmans et al, 1996;Goel et al, 2007;Bucchi et al, 2008b).…”

Section: Introductionmentioning

confidence: 99%

A pooled analysis of interval cancer rates in six European countries

Törnberg

Kemetli

Ascunce

et al. 2010

European Journal of Cancer Prevention

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The objective of this study was to assess detection rates and interval breast cancer (IC) rates from eight programmes in the European Breast Cancer Screening Network. A common data collection protocol was used to explore differences in IC rates among programmes and discuss their potential determinants. Pooled analysis was used to describe IC rates by age, compliance in screening, recall rate, screening detection (SD) rate and expected breast cancer incidence. Participation in screening averaged 77.9% (range 42.6-88.7%), recall rate 5.4% (range 3.3-17.7%) in the initial and 3.4% (range 1.8-8.9%) in the subsequent screening rounds, and SD rate was 60.4 (range 41.6-91) per 10 000 women in initial and 38.5 (range 31.3-62.6) in subsequent screens. IC rate during first 12 months after screening was 5.9 (range 2.1-7.3) per 10 000 women screened negative and 12.6 (range 6.3-15) in the second year of the interval. IC comprised 28% of the IC and SD cancers. The ratio between IC rate and expected incidence was 0.29 for the first 12 months and 0.63 for the 13-24 months period. Sensitivity was higher for the ages 60-69 years and for initial tests than subsequent tests. There were distinct differences in the IC rates between programmes. The results of this study reveal large variations in screening sensitivity and performance. Pooled evaluation of some process indicators within the European breast cancer screening programmes proved to be feasible and is likely to be useful for the future, particularly if it is performed regularly and extensively.

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Analysis and classification of interval cancers in a French breast cancer screening programme (départment of Isère)

Cited by 23 publications

References 0 publications

Incidence of interval breast cancers after 650,000 negative mammographics in 13 Italian health districts

Incidence of interval breast cancers after 650,000 negative mammographics in 13 Italian health districts

Methodological issues in international comparison of interval breast cancers

A pooled analysis of interval cancer rates in six European countries

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