Effects of Screening and Systemic Adjuvant Therapy on ER-Specific US Breast Cancer Mortality

Muñoz, David F.; Near, Aimee M.; Ravesteyn, Nicolien T. van; Lee, Sandra J.; Schechter, Clyde B.; Alagöz, Oğuzhan; Berry, Donald A.; Burnside, Elizabeth S.; Chang, Yao-Jen; Chisholm, Gary B.; Koning, Harry J. de; Ergün, Meltem; Heijnsdijk, Eveline A.M.; Huang, Hui; Stout, Natasha K.; Sprague, Brian L.; Trentham‐Dietz, Amy; Mandelblatt, Jeanne S.; Plevritis, Sylvia K.

doi:10.1093/jnci/dju289

Cited by 131 publications

(129 citation statements)

References 50 publications

Supporting

Mentioning

128

Contrasting

Unclassified

Order By: Relevance

“…Since our earlier analysis,(1) the models have undergone substantial revision to reflect advances in breast cancer control, including: portrayal of four distinct molecular subtypes based on estrogen receptor (ER) and human epidermal growth factor-2 receptor (HER2) status;(24) current population incidence (32) and competing non-breast cancer mortality; digital screening; and the most current therapies. (33) All models (except Model S) include DCIS.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies

et al. 2016

Self Cite

View full text Add to dashboard Cite

Background Controversy persists about optimal mammography screening strategies. Objective To evaluate mammography strategies considering screening and treatment advances. Design Collaboration of six simulation models. Data Sources National data on incidence, risk, breast density, digital mammography performance, treatment effects, and other-cause mortality. Target Population An average-risk cohort. Time Horizon Lifetime. Perspective Societal. Interventions Mammograms from age 40, 45 or 50 to 74 at annual or biennial intervals, or annually from 40 or 45 to 49 then biennially to 74, assuming 100% screening and treatment adherence. Outcome Measures Screening benefits (vs. no screening) include percent breast cancer mortality reduction, deaths averted, and life-years gained. Harms include number of mammograms, false-positives, benign biopsies, and overdiagnosis. Results for Average-Risk Women Biennial strategies maintain 79.8%-81.3% (range across strategies and models: 68.3–98.9%) of annual screening benefits with almost half the false-positives and fewer overdiagnoses. Screening biennially from ages 50–74 achieves a median 25.8% (range: 24.1%-31.8%) breast cancer mortality reduction; annual screening from ages 40–74 years reduces mortality an additional 12.0% (range: 5.7%-17.2%) vs. no screening, but yields 1988 more false-positives and 7 more overdiagnoses per 1000 women screened. Annual screening from ages 50–74 had similar benefits as other strategies but more harms, so would not be recommended. Sub-population Results Annual screening starting at age 40 for women who have a two- to four-fold increase in risk has a similar balance of harms and benefits as biennial screening of average-risk women from 50–74. Limitations We do not consider other imaging technologies, polygenic risk, or non-adherence. Conclusion These results suggest that biennial screening is efficient for average-risk groups, but decisions on strategies depend on the weight given to the balance of harms and benefits. Primary Funding Source National Institutes of Health

show abstract

Section: Methodsmentioning

confidence: 99%

“…(22,23) Collaboration of several models provides a range of plausible effects and illustrates the impact of differences in model assumptions. (1,7,24)…”

Section: Introductionmentioning

confidence: 99%

Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…[16][17][18][19][20] Elaborate models that incorporated data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute on breast cancer incidence, survival, and many other factors indicated that both screening and adjuvant treatment contributed to improvements in mortality, but estimates were uncertain. [21][22][23] Elkin et al 24 studied secular trends in relative breast cancer survival in SEER from 1975 to 1999. By standardizing on tumor size, they showed that a substantial proportion of the improvement was attributable to decreases in tumor size within local and regional stage.…”

Section: Introductionmentioning

confidence: 99%

“…An update that also used ER status attributed 38% to 52% to screening. 23 It is difficult to compare our findings with these estimates of the proportion of improvements in overall US breast cancer mortality attributable to screening, because these models also incorporated information on the changing stage distribution. It is striking, however, how little of the stage-and age-specific improvements in women younger than age 70 years could be explained by changes in tumor size over time (Figs 2 and 3).…”

mentioning

confidence: 97%

Improvements in US Breast Cancer Survival and Proportion Explained by Tumor Size and Estrogen-Receptor Status

Park

Anderson

Gail

2015

JCO

View full text Add to dashboard Cite

A B S T R A C T PurposeBreast cancer mortality began declining in many Western countries during the late 1980s. We estimated the proportion of improvements in stage-and age-specific breast cancer survival in the United States explained by tumor size or estrogen receptor (ER) status. MethodsWe estimated hazard ratios for breast cancer-specific death from time of invasive breast cancer diagnosis in the National Cancer Institute's Surveillance, Epidemiology, and End Results 9 Registries Database from 1973 to 2010, with and without stratification by tumor size and ER status. ResultsHazards from breast cancer-specific death declined from 1973 to 2010, not only in the first 5 years after diagnosis, but also thereafter. Stratification by tumor size explained less than 17% of the improvements comparing 2005 to 2010 versus 1973 to 1979, except for women age Ն 70 years with local (49%) or regional (38%) disease. Tumor size usually accounted for more of the improvement in the first 5 years after diagnosis than later. Additional adjustment for ER status (positive, negative, or unknown) from 1990 to 2010 did not explain much more of the improvement, except for women age Ն 70 years within 5 years after diagnosis. ConclusionMost stage-specific survival improvement in women younger than age 70 years old is unexplained by tumor size and ER status, suggesting a key role for treatment. In the first 5 years after diagnosis, tumor size contributed importantly for women Ն 70 years old with local and regional stage, and stratification by tumor size and ER status explained even more of the survival improvement among women age Ն 70 years.

show abstract

“…Although the prognosis of BC has improved in the last 40 years, this progress has not been equally distributed amongst age groups [5][6] [7]. Prognosis is worse especially in the oldest old (above 80) [8] [9], an age group that has seemingly not profited from improvements in treatment standards [10].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant chemotherapy in elderly patients with breast cancer: key challenges

Pondé

Lago

Azim

2016

Expert Review of Anticancer Therapy

View full text Add to dashboard Cite

Elderly women with early breast cancer (BC) form a heterogeneous and large subgroup (41.8% of women with BC are over 65). Decision making in this subgroup is made more difficult by lack of familiarity with their physical, cognitive and social issues. Adequate management depends on biological factors and accurate clinical evaluation through comprehensive geriatric assessment (CGA). CGA can help to better select and determine potential risks factors for patients who are candidates for adjuvant chemotherapy. It is still recently introduced in geriatric oncology and there is a lack of awareness of its importance. Available data on adjuvant chemotherapy for BC is limited but suggests it can be of benefit for well selected patients, though the risk of short and long-term toxicity is significant. Here we provide a discussion of the key practical issues in decision making in the setting of adjuvant chemotherapy for elderly BC patients.

show abstract

Effects of Screening and Systemic Adjuvant Therapy on ER-Specific US Breast Cancer Mortality

Abstract: As advances in risk assessment facilitate identification of women with increased risk of ER-negative breast cancer, additional mortality reductions could be realized through more frequent targeted screening, provided these benefits are balanced against screening harms.

Cited by 131 publications

References 50 publications

Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies

Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies

Improvements in US Breast Cancer Survival and Proportion Explained by Tumor Size and Estrogen-Receptor Status

Adjuvant chemotherapy in elderly patients with breast cancer: key challenges

Contact Info

Product

Resources

About