Evidence of breast cancer mortality reduction: aggressive screening in women under age 50

Moskowitz, Myron; Ps, Gartside

doi:10.2214/ajr.138.5.911

Cited by 41 publications

(8 citation statements)

References 12 publications

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“…These results are identical to those reported by others (Holmberg et al, 1986;Shapiro et al, 1982). It is often argued that shortening the screening interval would reduce the number of interval cancers (Tab'ar et al, 1987;Moskowitz & Gartside, 1982). Especially the high proportion of interval cancers occurring in women under age 50 is reported to cause the absence of a clear reduction in mortality in women from this age-group, after participating in a screening programme.…”

Section: Discussionmentioning

confidence: 99%

The occurrence of interval cancers in the Nijmegen screening programme

Peeters

Verbeek²,

Hendriks³

et al. 1989

Br J Cancer

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Summary Since January 1975 a population-based screening programme for the early detection of breast cancer has been carried out in the city of Nijmegen. During five interscreening periods of 2 years each a total of 158 so-called interval cancers were diagnosed. Careful revision of all screening and diagnostic mammograms was executed. Of all interval cancers 26% were 'missed' at the previous screening examination (due to technical or observer error), 16% were radiographically occult at the time of diagnosis and 58% were 'true' interval cancers. Interval cancers were regarded as 'true' when an obvious lesion was observed on the diagnostic mammogram while no suspect signs were seen on the previous screening mammogram. The prevalence of 'missed' cancers did not decline in the course of the screening programme. Radiographically occult tumours were localised, mostly in Wolfe's P2/DY breast parenchyma (83%), 33% were lobular invasive and 25% ductal non-invasive. 'True' interval cancer cases (58%) showed the same overall survival as control breast cancer patients, diagnosed in a non-screening situation. Shortening the screening interval would reduce interval cancer rates and probably further decrease breast cancer mortality in a screened population. However, from the present series of interval cancers 63% would not have been prevented by an annual screening examination. As regards women under age 50 annual screening would still leave 66% of all interval cancers in this age group undetected. Probably more benefit will be gained by searching for new imaging techniques to reduce numbers of 'missed' cancers and to detect lobular invasive and ductal non-invasive cancers in dense breast parenchyma.Within any screening programme for the early detection of breast cancer, women are diagnosed as having so-called interval cancer. These cancers surface among negative screenees before the next scheduled examination would have taken place. Of all breast cancers in a screened population about 20-35% are diagnosed within 2 years after the last screening examination (Verbeek, 1985;Tabar et al., 1987;Moskowitz, 1986;de Waard et al., 1984;Lundgren, 1979). The survival of patients with interval cancers turned out to be just as bad as the survival of patients diagnosed outside screening programmes (Holmberg et al., 1986;Shapiro et al., 1982). This finding would seem to suggest that shortening the screening interval to, say, one year might further decrease breast cancer mortality in a population offered a screening programme. The aim of the present study was to search for more evidence validating such recommendations. It was evaluated whether the number of 'missed' cancers decreased during the 12-year observation period. Interval cancers were compared with breast cancers, detected at one of the five screening rounds, in terms of such radiological and prognostic aspects as Wolfe classification, mammographical tumour size, age at the previous examination, quetelet index, oestrogen receptor positivity and axillary lymph node involvement. To eva...

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Section: Discussionmentioning

confidence: 99%

The occurrence of interval cancers in the Nijmegen screening programme

Peeters

Verbeek²,

Hendriks³

et al. 1989

Br J Cancer

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“…, 1984 ;Fagerberg et al, 1985;Lundgren, 19796;Palli el al., 1986;Seidman et al, 1987;Shapiro et al, 1982;Tabhr et al, 1985;Thomas, 1975; UK Trial of Early Detection of Breast Cancer Group, 1988;Verbeek et al, 1984). Although many questions remain to be answered, such as which agegroups benefit most (Verbeek et al., 1985;Moskowitz and Gartside, 1982;Seidman, 1977), or which screening interval is the optimum (Tabhr et al, 1987), or how to maintain the quality of the project (Peeters et al, 1988;Schnitt et al, 1988;Witcombe, 1988), it is likely that many projects will be set up in the near future. The aim of this study is to give an indication of figures to be expected after several years of screening, such as compliance rates, referral rates, breast cancer detection rates and number of interval cancers, based upon the Nijmegen experience.…”

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confidence: 99%

Screening for breast cancer in nijmegen. report of 6 screening rounds, 1975–1986

Peeters

Verbeek

Hendriks

et al. 1989

Intl Journal of Cancer

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A population-based screening programme for breast cancer was initiated in Nijmegen in 1975 with mammography as the only screening procedure. Up to January 1987, 6 screening rounds were carried out with a 2-year screening interval. Rates of attendance, referral, biopsy and detection were calculated and numbers of interval cancers are presented in order to give a clear view of what repeated screening can accomplish in a population. At the first screening round the attendance rate was 87% for women under age 50 and 83% for women aged 50-64. For women aged 65 or over the initial attendance rate was 40%. Rates of attendance declined in subsequent years. Detection rates were highest for elderly women at their first examination: 9.5 per 1,000 screened women. Corresponding rates were 5.6 and 2.3 per 1,000 for women aged 50-64 and below 50 respectively. The positive predictive value for referral was, on average, 20% for women under age 50 and 50% for elderly women, although a sharp increase was seen in the last 2 screening examinations for all age-groups. Predictive values for biopsy were higher: 30% on average for women aged under 50 and 60%-70% for elderly women, again with a sharp increase in the last 2 screening rounds. Interval cancer rates, calculated as the number of cancers occurring within 2 years among negatively screened women at risk, showed no particular trend and varied between 0.9-1.3 per 1,000 woman-years after each screening round. Compared to screen-detected cancers, interval cancers occurred more frequently in younger women. In women under age 50, the ratio between screen-detected and interval cancer was about 1:1, while it was about 2:1 for elderly women.

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“…Breast cancer mortality can only be reduced by detecting the tumor at the earlier stage. For example, self-palpation breast examination, a screening procedure used in an attempt to detect early breast cancer, has proved to be effective in discovering 80% of all carcinomas treated surgically [18]. Serum markers in breast cancer are helpful for clinicians in providing more effective management of the disease.…”

Section: Discussionmentioning

confidence: 99%

Clinical Usefulness of Cancer Antigen 15-3 in Breast Cancer Patients Before and After Surgery

Daniele

Divella

Trerotoli

et al. 2013

TOBCANJ

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Abstract:Background: Cancer Antigen 15-3 (CA 15-3) is a tumor-associated antigen used as serum marker for breast cancer surveillance in patients and for monitoring the response to treatment. Aim of this study was to retrospectively evaluate CA 15-3 as a prognostic factor in early detection of breast cancer relapse as well as to analyze the statistical correlation between CA 15-3 levels and clinical-pathological parameters including staging, grading, estrogen and progesterone receptors.Methods: Sera of 726 women with breast carcinoma obtained preoperatively and postoperatively were assayed for CA 15-3 by chemoluminescent immunometric assay.Results: We found that the mean serum CA 15-3 levels in patients before surgery were significantly higher (36.59 U/ml) compared with those of CA 15-3 after surgery (27.11 U/ml). We also found that elevated preoperative serum levels of CA 15-3 were significantly correlated with the presence of metastatic disease. In particular, among 305/700 patients (43,6%) that displayed over cut-off (>40U/ml) preoperative levels of CA 15-3, 94 patients (30,8%) developed advanced disease (metastases to distant sites). By contrast, in a subgroup of 395/700 patients (56.4%) with CA 15.3 serum levels < 40U/ml, only 32/305 patients (8%) showed signs of advanced disease during follow-up. Cox regression analysis revealed that only the presence of metastasis and the increased serum levels of CA 15-3 after surgery are significant risk factors for relapse of disease.Conclusion: Elevated preoperative concentrations of CA 15-3 may be a useful predictive factor for cancer progression in postoperative patients.

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Evidence of breast cancer mortality reduction: aggressive screening in women under age 50

Cited by 41 publications

References 12 publications

The occurrence of interval cancers in the Nijmegen screening programme

The occurrence of interval cancers in the Nijmegen screening programme

Screening for breast cancer in nijmegen. report of 6 screening rounds, 1975–1986

Clinical Usefulness of Cancer Antigen 15-3 in Breast Cancer Patients Before and After Surgery

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