The Impact of Organised Screening Programs on Breast Cancer Stage at Diagnosis for Canadian Women Aged 40–49 and 50–59

Wilkinson, Anna N.; Billette, J.; Ellison, Larry F.; Killip, Michael A.; Islam, Nasir; Seely, Jean M.

doi:10.3390/curroncol29080444

Cited by 15 publications

(21 citation statements)

References 53 publications

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“…While some testosterone inhibitors such as finasteride are used for curing baldness in men which also tend to lower PCa and its mortality rate 37 , this is unlikely to be commonly used within a less affluent study cohort. Age is usually the predictor of advanced-grade cancer where there is a national screening program for a specific age group 38 , 39 , hence associations between age and the advanced disease was not expected in this study.…”

Section: Discussionmentioning

confidence: 64%

Linking African ancestral substructure to prostate cancer health disparities

Gheybi,

Mmekwa,

Lebelo

et al. 2023

Sci Rep

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Prostate cancer (PCa) is a significant health burden in Sub-Saharan Africa, with mortality rates loosely linked to African ancestry. Yet studies aimed at identifying contributing risk factors are lacking within the continent and as such exclude for significant ancestral diversity. Here, we investigate a series of epidemiological demographic and lifestyle risk factors for 1387 men recruited as part of the multi-ethnic Southern African Prostate Cancer Study (SAPCS). We found poverty to be a decisive factor for disease grade and age at diagnosis, with other notably significant PCa associated risk factors including sexually transmitted diseases, erectile dysfunction, gynaecomastia, and vertex or complete pattern balding. Aligned with African American data, Black ethnicity showed significant risk for PCa diagnosis (OR = 1.44, 95% CI 1.05–2.00), and aggressive disease presentation (ISUP ≥ 4: OR = 2.25, 95% CI 1.49–3.40). New to this study, we demonstrate African ancestral population substructure associated PCa disparity, observing increased risk for advanced disease for the southern African Tsonga people (ISUP ≥ 4: OR = 3.43, 95% CI 1.62–7.27). Conversely, South African Coloured were less likely to be diagnosed with aggressive disease overall (ISUP ≥ 3: OR = 0.38, 95% 0.17–0.85). Understanding the basis for PCa health disparities calls for African inclusion, however, lack of available data has limited the power to begin discussions. Here, focusing on arguably the largest study of its kind for the African continent, we draw attention to the contribution of within African ancestral diversity as a contributing factor to PCa health disparities within the genetically diverse region of southern Africa.

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Section: Discussionmentioning

confidence: 64%

Linking African ancestral substructure to prostate cancer health disparities

Gheybi,

Mmekwa,

Lebelo

et al. 2023

Sci Rep

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“…Firstly, we observed different tumor characteristics of women depending on MSP participation. For instance, a more favorable tumor stage distribution is a well-recognized prognostic factor [ 27 ] and an acknowledged advantage of screening [ 28 ], and might explain the survival differences. While we showed that the detection of BC at an earlier stage had a significant effect on survival, it only partially explained the observed effects.…”

Section: Discussionmentioning

confidence: 99%

Breast cancer patients enrolled in the Swiss mammography screening program “donna” demonstrate prolonged survival

Kuklinski,

Blum,

Subelack

et al. 2024

Breast Cancer Res

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Study goal We compared the survival rates of women with breast cancer (BC) detected within versus outside the mammography screening program (MSP) “donna”. Methods We merged data from the MSP with the data from corresponding cancer registries to categorize BC cases as within MSP (screen-detected and interval carcinomas) and outside the MSP. We analyzed the tumor stage distribution, tumor characteristics and the survival of the women. We further estimated hazard ratios using Cox-regressions to account for different characteristics between groups and corrected the survival rates for lead-time bias. Results We identified 1057 invasive (ICD-10: C50) and in-situ (D05) BC cases within the MSP and 1501 outside the MSP between 2010 and 2019 in the Swiss cantons of St. Gallen and Grisons. BC within the MSP had a higher share of stage I carcinoma (46.5% vs. 33.0%; p < 0.01), a smaller (mean) tumor size (19.1 mm vs. 24.9 mm, p < 0.01), and fewer recurrences and metastases in the follow-up period (6.7% vs. 15.6%, p < 0.01). The 10-year survival rates were 91.4% for women within and 72.1% for women outside the MSP (p < 0.05). Survival difference persisted but decreased when women within the same tumor stage were compared. Lead-time corrected hazard ratios for the MSP accounted for age, tumor size and Ki-67 proliferation index were 0.550 (95% CI 0.389, 0.778; p < 0.01) for overall survival and 0.469 (95% CI 0.294, 0.749; p < 0.01) for BC related survival. Conclusion Women participating in the “donna” MSP had a significantly higher overall and BC related survival rate than women outside the program. Detection of BC at an earlier tumor stage only partially explains the observed differences.

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“…Screening programs in Canada were established between 1989 and 1992 and vary according to each provincial or territorial health authority. 16 Ten-year NS estimates were calculated for the cohort of eligible cases diagnosed from 2002 to 2007. Ten-year NS was selected as the longest period possible to observe the recognized benefits of BC mortality reduction within the context of available data and established screening programs in Canada.…”

Section: Methodsmentioning

confidence: 99%

“…Jurisdictions with no organized screening programs for women age 40-49 years had a significantly lower proportion of BCs diagnosed at stage I and significantly higher proportions of stage II, III, and IV BCs at diagnosis compared with those jurisdictions that had organized screening. 16 Treatments for early-stage BC (stage 0 and I) 17 involve less invasive surgical techniques and less need for chemotherapy. 18 Beyond the decreased morbidity of treatments in early-stage BC, there are also clear survival benefits.…”

Section: Introductionmentioning

confidence: 99%

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

Wilkinson

Ellison

Billette

et al. 2023

JCO

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PURPOSE 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. METHODS 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). RESULTS 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). CONCLUSION 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.

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The Impact of Organised Screening Programs on Breast Cancer Stage at Diagnosis for Canadian Women Aged 40–49 and 50–59

Cited by 15 publications

References 53 publications

Linking African ancestral substructure to prostate cancer health disparities

Linking African ancestral substructure to prostate cancer health disparities

Breast cancer patients enrolled in the Swiss mammography screening program “donna” demonstrate prolonged survival

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

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