Overdiagnosis in the population-based service screening programme with mammography for women aged 40 to 49 years in Sweden

Hellquist, Barbro Numan; Duffy, Stephen W.; Nyström, Lennarth; Jonsson, Håkan

doi:10.1258/jms.2012.011104

Cited by 30 publications

(15 citation statements)

References 16 publications

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“…Also, we had no information on breastfeeding or whether tumors were detected by invitational screening mammography. During the study period about half of Sweden's counties invited women to screening from 40 years …”

Section: Discussionmentioning

confidence: 99%

Tumor characteristics and prognosis in women with pregnancy‐associated breast cancer

Johansson

Andersson

Hsieh

et al. 2017

Intl Journal of Cancer

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There is evidence of poor prognosis in women with pregnancy-associated breast cancer (PABC) diagnosed during pregnancy or within 2 years of delivery. Using a large, population-based cohort, we examined clinicopathologic features and survival in women with PABC. A cohort of women diagnosed with invasive breast cancer between 1992 and 2009 at ages 15-44 years was identified in the Swedish Cancer Register and the Breast Cancer Quality Registers. Dates of childbirths for each woman were retrieved from the Swedish Multi-Generation Register. Age-standardized distributions of tumor stage (tumor size, nodal status, metastasis), Elston grade and ER/PR/HER2 status were compared between nulliparous women and women with breast cancer during pregnancy and up to 10 years postdelivery. Adjusted hazard ratios for all-cause mortality rates among patients were estimated using Cox regression. We identified 1,661 nulliparous women with breast cancer, 778 women with PABC (97 during pregnancy, 270 within first and 411 within second year postdelivery) and 3,598 during 2-10 years postdelivery. Compared to nulliparous women, women with PABC, and especially women diagnosed 0-12 months after delivery, had more advanced T and N stage, and higher proportions of ER/PR negative, HER2 positive and triple-negative tumors. Increased hazard ratios were observed in women diagnosed within 5 years of delivery after adjustment for age, year, education and region. Following additional adjustment for tumor characteristics, the hazard ratios were attenuated and nonsignificant. The poorer prognosis observed in women with PABC appears to be largely explained by more adverse tumor characteristics at diagnosis.

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Section: Discussionmentioning

confidence: 99%

Tumor characteristics and prognosis in women with pregnancy‐associated breast cancer

Johansson

Andersson

Hsieh

et al. 2017

Intl Journal of Cancer

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“…Hellquist et al . [21] estimated that 1% (-6 to 8) of all breast cancers were overdiagnosed in a screening programme for women aged 40 to 49 screened every 18 months in Sweden. In a systematic review, the range of overdiagnosis for women aged 40 to 49 years was -4% to 7.1% [22].…”

Section: Discussionmentioning

confidence: 99%

Modelling the overdiagnosis of breast cancer due to mammography screening in womenaged 40 to 49 in the United Kingdom

2012

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IntroductionOverdiagnosis of breast cancer due to mammography screening, defined as the diagnosis of screen-detected cancers that would not have presented clinically in a women's lifetime in the absence of screening, has emerged as a highly contentious issue, as harm caused may question the benefit of mammographic screening. Most studies included women over 50 years old and little information is available for younger women.MethodsWe estimated the overdiagnosis of breast cancer due to screening in women aged 40 to 49 years using data from a randomised trial of annual mammographic screening starting at age 40 conducted in the UK. A six-state Markov model was constructed to estimate the sensitivity of mammography for invasive and in situ breast cancer and the screen-detectable mean sojourn time for non-progressive in situ, progressive in situ, and invasive breast cancer. Then, a 10-state simulation model of cancer progression, screening, and death, was developed to estimate overdiagnosis attributable to screening.ResultsThe sensitivity of mammography for invasive and in situ breast cancers was 90% (95% CI, 72 to 99) and 82% (43 to 99), respectively. The screen-detectable mean sojourn time of preclinical non-progressive and progressive in situ cancers was 1.3 (0.4 to 3.4) and 0.11 (0.05 to 0.19) years, respectively, and 0.8 years (0.6 to 1.2) for preclinical invasive breast cancer. The proportion of screen-detected in situ cancers that were non-progressive was 55% (25 to 77) for the first and 40% (22 to 60) for subsequent screens. In our main analysis, overdiagnosis was estimated as 0.7% of screen-detected cancers. A sensitivity analysis, covering a wide range of alternative scenarios, yielded a range of 0.5% to 2.9%.ConclusionAlthough a high proportion of screen-detected in situ cancers were non-progressive, a majority of these would have presented clinically in the absence of screening. The extent of overdiagnosis due to screening in women aged 40 to 49 was small. Results also suggest annual screening is most suitable for women aged 40 to 49 in the United Kingdom due to short cancer sojourn times.

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“…Recent studies indicate that there is a need to reduce overdiagnosis and overtreatment of non-lethal breast cancers [7,[10][11][12][13][14][15][16][17][18][19][20]. The breast imaging community has been challenged with the responsibility of identifying lesions that are suspicious for malignancy, and have a potential to lead to dissemination and recurrences that lead to incurable stages of breast cancer as these lesions will most likely benefit from systemic treatment.…”

Section: Introductionmentioning

confidence: 99%

Can mammographic and sonographic imaging features predict the Oncotype DX™ recurrence score in T1 and T2, hormone receptor positive, HER2 negative and axillary lymph node negative breast cancers?

Yepes

Romilly

Collado-Mesa

et al. 2014

Breast Cancer Res Treat

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To determine whether mammographic or sonographic features can predict the Oncotype DX™ recurrence scores (RS) in patients with TI-II, hormone receptor (HR) positive, HER2/neu negative and node negative breast cancers. Institutional board review was obtained and informed consent was waived for this retrospective study. Seventy-eight patients with stage I-II invasive breast cancer that was HR positive, HER2 negative, and lymph node negative for whom mammographic and or sonographic imaging and Oncotype DX™ assay scores were available were included in the study Four breast dedicated radiologists blinded to the RS retrospectively described the lesions according to BI-RADS lexicon descriptors. Multivariable logistic regression was used to test for significant independent predictors of low (<18) versus intermediate to high range (≥18). Two imaging features reached statistical significance in predicting low from intermediate or high risk RS: pleomorphic microcalcifications within a mass (P = 0.017); OR 8.37, 95 % CI (1.47-47.79) on mammography and posterior acoustic enhancement in a mass on ultrasound (P = 0.048); OR 4.35, 95 % CI (1.01-18.73) on multivariable logistic regression. A mass with pleomorphic microcalcifications on mammography or the presence of posterior acoustic enhancement on ultrasound may predict an intermediate to high RS as determined by the Oncotype DX(TM) assay in patients with stage I-II HR positive, HER2 negative, and lymph node negative invasive breast cancer.

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Overdiagnosis in the population-based service screening programme with mammography for women aged 40 to 49 years in Sweden

Abstract: We found no significant overdiagnosis for women aged 40-49 in the Swedish service screening programme with mammography.

Cited by 30 publications

References 16 publications

Tumor characteristics and prognosis in women with pregnancy‐associated breast cancer

Tumor characteristics and prognosis in women with pregnancy‐associated breast cancer

Modelling the overdiagnosis of breast cancer due to mammography screening in womenaged 40 to 49 in the United Kingdom

Can mammographic and sonographic imaging features predict the Oncotype DX™ recurrence score in T1 and T2, hormone receptor positive, HER2 negative and axillary lymph node negative breast cancers?

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