Trends in advanced breast cancer incidence rates after implementation of a mammography screening program in a German population

Simbrich, Alexandra; Wellmann, Ina; Heidrich, Jan; Heidinger, Oliver; Hense, Hans Werner

doi:10.1016/j.canep.2016.07.006

Cited by 39 publications

(34 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The screening interval was 24 months except in the West Midlands (36 months) [13]. The start of screening programmes ranged from the early/mid 1970s in Florence, Utrecht, and Nijmegen [14, 29] to 2005 in the Münster district (Germany) [40]. The time period of observation of breast cancer incidence was between the second half of 1980s and the first half of the current decade in most studies.…”

Section: Resultsmentioning

confidence: 99%

“…We assigned the design of the studies that evaluated the magnitude of effect to four broad categories:comparison of ABCR before and after the introduction of screening using different endpoints, i.e., annual percent change (APC), percent reduction in ABCR, absolute reduction in ABCR, incidence rate ratio (IRR), relative risk (RR), excess RR, slope value calculated from a log-linear Poisson regression model, and observed:expected ratio, or simply by juxtaposition of rates [8, 12, 15, 19, 29, 30, 32–40, 43, 44];comparison of ABCR between each year after the introduction of screening and the prescreening years using the estimated annual percent change (EAPC) [14, 31];calculation of the EAPC after the introduction of screening without information on prescreening years [13, 41]; andcomparison of ABCR in an invited population vs. a neighbouring uninvited one using the percent reduction in ABCR. This is the case for a single study [42], although the inclusion of neighbouring nonscreening areas is a secondary part of the design of other investigations [8, 36].…”

Section: Resultsmentioning

confidence: 99%

“…comparison of ABCR before and after the introduction of screening using different endpoints, i.e., annual percent change (APC), percent reduction in ABCR, absolute reduction in ABCR, incidence rate ratio (IRR), relative risk (RR), excess RR, slope value calculated from a log-linear Poisson regression model, and observed:expected ratio, or simply by juxtaposition of rates [8, 12, 15, 19, 29, 30, 32–40, 43, 44];…”

Section: Resultsmentioning

confidence: 99%

“…Methods like the joinpoint analysis are useful for assessing the points in time when ABCR begins to decrease and when it stabilizes, but may be misleading when used to assess the significance of the trend. Also, the important issue is arguably what happened to ABCR following the screening rather than at what point a change occurred in the direction of a trend, which is affected by both confounding and analytic assumptions.[8, 12, 13, 19, 29, 35, 40–43]…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review

et al. 2018

View full text Add to dashboard Cite

BackgroundObservational studies have reported conflicting results on the impact of mammography service screening programmes on the advanced breast cancer rate (ABCR), a correlation that was firmly established in randomized controlled trials. We reviewed and summarized studies of the effect of service screening programmes in the European Union on ABCR and discussed their limitations.MethodsThe PubMed database was searched for English language studies published between 01-01-2000 and 01–06-2018. After inspection of titles and abstracts, 220 of the 8644 potentially eligible papers were considered relevant. Their abstracts were reviewed by groups of two authors using predefined criteria. Fifty studies were selected for full paper review, and 22 of these were eligible. A theoretical framework for their review was developed. Review was performed using a ten-point checklist of the methodological caveats in the analysis of studies of ABCR and a standardised assessment form designed to extract quantitative and qualitative information.ResultsMost of the evaluable studies support a reduction in ABCR following the introduction of screening. However, all studies were challenged by issues of design and analysis which could at least potentially cause bias, and showed considerable variation in the estimated effect. Problems were observed in duration of follow-up time, availability of reliable reference ABCR, definition of advanced stage, temporal variation in the proportion of unknown-stage cancers, and statistical approach.ConclusionsWe conclude that much of the current controversy on the impact of service screening programmes on ABCR is due to observational data that were gathered and/or analysed with methodological approaches which could not capture stage effects in full. Future research on this important early indicator of screening effectiveness should focus on establishing consensus in the correct methodology.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4666-1) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The malignant breast tumors that were overlooked in primary reporting affected patients in advanced tumor stages and were not therapeutically and prognostically relevant. The prevalence of malignant breast lesions (940 per 100 000 patients examined with CT) was approximately twice as high as in mammography screening [20,21]. The results of the study highlight the importance of targeted consideration of incidental senological findings in CT examinations of the chest also in other clinical settings than that of the included patients in a clinic with a main focus on oncology.…”

Section: Discussionmentioning

confidence: 77%

Focal Breast Lesions in Clinical CT Examinations of the Chest: A Retrospective Analysis

Krug

Houbois

Grinstein

et al. 2017

Fortschr Röntgenstr

View full text Add to dashboard Cite

ABSTR AC TPurpose Based on radiological reports, the percentage of breast cancers visualized as incidental findings in routine CT examinations is estimated at ≤ 2 %. In view of the rising number of CT examinations and the high prevalence of breast cancer, it was the goal of the present study to verify the frequency and image morphology of false-negative senological CT findings. Materials and MethodsAll first contrast-enhanced CT examinations of the chest in adult female patients carried out in 2012 were retrospectively included. A senior radiologist systematically assessed the presence of breast lesions on all CT images using the BI-RADS system. All BI-RADS ≥ 3 notations were evaluated by a second senior radiologist. A consensus was obtained in case of differing BI-RADS assessments.Reference diagnoses were elaborated based on all available clinical, radiological and pathological data. The findings of the CT reports were classified according to the BI-RADS system and were compared with the retrospective consensus findings as well as with the reference diagnoses. ResultsThe range of indications comprised a broad spectrum including staging and follow-up examinations of solid tumors/lymphoma (N = 701, 59.9 %) and vascular (190,16.2 %), inflammatory (48, 4.1 %) and pulmonologic (22, 1.9 %) issues. BI-RADS 1/2 classifications were present in 92.5 % and BI-RADS 6 classifications were assessed in 1.7 % of the 1170 included examinations. 68 patients (5.8 %) had at least one lesion retrospectively classified as BI-RADS 3 -5. The histological potential was known in 57 of these lesions as benign (46, 3.9 %) or malignant (11, 0.9 %). 13 BI-RADS 4/5 consensus assessments (1.1 %) were false-positive. 2 of the 10 lesions classified as being malignant based on the further clinical and radiological course were not mentioned in the written CT reports (0.2 %). Both false-negative CT reports were therapeutically and prognostically irrelevant. ConclusionThe relative frequency of BI-RADS 3 -5 findings was 5.8 %. It reflects the situation encountered in clinical imaging for primarily non-senologic questions and therefore differs from what would be expected in a dedicated screening program. The rates of known false-positive BI-RADS 4/5 findings in the retrospective evaluations (1.1 %) and of false-negative findings in the written CT reports (0.2 %) reflect the different diagnostic approaches of image-based senological screening and radiological examinations indicated in order to solve clinical problems not primarily concerning the breast region. Statements regarding the prevalence of clinically occult breast cancers can only be made with caution in the presented, highly selective group of patients due to the often incomplete visualization of breast tissue and the retrospective approach. Key points▪ Intramammary mass and non-mass lesions needing clarification may be present in up to 5.8 % of all contrast enhanced CT-examinations of the female chest. ▪ Irregular forms, unscharp/spiculated margins, inhomogeneous matrices and a pronounced c...

show abstract

Modifiable risk factors for advanced vs. early breast cancer in the French E3N cohort

Veron

Gélot

Gusto

et al. 2019

Intl Journal of Cancer

View full text Add to dashboard Cite

Advanced breast cancer (BC) is associated with heavier treatments and poorer prognosis than early BC. Despite mammographic screening, advanced BC incidence remains stable. Little is known about risk factors differentially associated with advanced BC. We analyzed factors predicting for postmenopausal advanced vs. early BC in the E3N cohort. E3N has been prospectively following 98,995 French women aged 50–65 years at baseline since 1990. Hazard ratios (HRs) and 95% confidence intervals (CIs) for advanced and early invasive BC were estimated with multivariate Cox competing risk hazard models. With a median follow‐up of 15.7 years, 4,941 postmenopausal BC were diagnosed, including 1,878 (38%) advanced BC. Compared to early BC, advanced BC was differentially associated with excess weight (HR 1.39 [95% CI = 1.26–1.53] vs. 1.08 [95% CI = 1.00–1.17], phomogeneity < 0.0001) and living in a rural area (HR 1.14 [95% CI = 1.00–1.31] vs. 0.93 [95% CI = 0.82–1.04], phomogeneity 0.02). Excess weight was the only differential risk factor for advanced BC for hormone‐dependent BC and for women compliant with screening recommendations. Previous mammography was associated with reduced advanced BC risk (HR 0.86 [95% CI = 0.73–1.00]) and increased early BC risk (HR 1.36 [95% CI = 1.18–1.56], phomogeneity < 0.0001), but only for hormone‐dependent BC. Excess weight appears to be mostly associated with advanced BC, especially hormone‐dependent BC. These results add to the evidence for maintaining weight within the recommended limits.

show abstract

Trends in advanced breast cancer incidence rates after implementation of a mammography screening program in a German population

Cited by 39 publications

References 25 publications

The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review

The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review

Focal Breast Lesions in Clinical CT Examinations of the Chest: A Retrospective Analysis

Modifiable risk factors for advanced vs. early breast cancer in the French E3N cohort

Contact Info

Product

Resources

About