Sojourn Time, Sensitivity and Positive Predictive Value of Mammography Screening for Breast Cancer in Women Aged 40-49

Duffy, Stephen W.; Chen, Chien-Jen; Tabár, Làszló; Fagerberg, G; Paci, Euǵenio

doi:10.1093/ije/25.6.1139

Cited by 55 publications

(39 citation statements)

References 7 publications

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“…The biological timing of the malignant transformation of the cells within the sick lobe may be very variable [4,6,7]. Simultaneous involvement of most of the epithelial cells within the sick lobe leads to rapid development of extensive, diffuse, usually high-grade, DCIS.…”

Section: Theory Of the Sick Lobementioning

confidence: 99%

DCIS, cytokeratins, and the theory of the sick lobe

Tot

2005

Virchows Arch

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We postulate that ductal carcinoma in situ (DCIS), and consequently breast carcinoma in general, is a lobar disease, as the simultaneously or asynchronously appearing, often multiple, in situ tumor foci are localized within a single lobe. Although the whole lobe is sick, carrying some form of genetic instability, the malignant transformation of the epithelial cells may appear localized to a part or different parts of the sick lobe at the same time or with varying time difference. It may be confined to terminal ductal lobular units (TDLUs), to ducts or both. The malignant transformation is often associated with aberrant branching and/or aberrant lobularization within the sick lobe. Involvement of a single individual TDLU or of a group of adjacent TDLUs generates a unifocal lesion. Multifocal lesions appear if distant TDLUs are involved. Diffuse growth pattern in DCIS indicates involvement of the larger ducts. The extent of the involved area in multifocal or diffuse cases varies considerably. Diffuse growth pattern with or without evidence of aberrant arborisation within the sick lobe seems to characterize a subgroup of DCIS with unfavourable prognosis. In this paper, we discuss the anatomical, embryological and pathological background of the theory of the sick lobe and present supporting evidence from modern radiological breast imaging, long-term follow-up studies and from our own series of 108 DCIS cases.

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Section: Theory Of the Sick Lobementioning

confidence: 99%

DCIS, cytokeratins, and the theory of the sick lobe

Tot

2005

Virchows Arch

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“…There is limited evidence for the efficacy of mammography for pre-menopausal women. Recent evidence shows a benefit in women over 40 years (Duffy et al, 1996). Magnetic resonance imaging screening may be more sensitive in pre-menopausal women than mammography (Stoutjesdijk et al, 2001).…”

Section: Risk Managementmentioning

confidence: 99%

Predictive testing for BRCA1/2: attributes, risk perception and management in a multi-centre clinical cohort

et al. 2002

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The aim of this multi-centre UK study is to examine the attributes of a cohort offered predictive genetic testing for breast/ ovarian cancer predisposition. Participants are adults unaffected with cancer from families with a known BRCA1/2 mutation. This is the first large multi-centre study of this population in the UK. The study evaluates mental health, perceived risk of developing cancer, preferred risk management options, and motivation for genetic testing. Participants were assessed when coming forward for genetic counselling prior to proceeding to genetic testing. Three hundred and twelve individuals, 76% of whom are female, from nine UK centres participated in the study. There are no gender differences in rates of psychiatric morbidity. Younger women (550 years) are more worried about developing cancer than older women. Few women provide accurate figures for the population risk of breast (37%) or ovarian (6%) cancer but most think that they are at higher risk of developing breast (88%) and ovarian (69%) cancer than the average woman. Cancer related worry is not associated with perceived risk or uptake of risk management options except breast self-examination. The findings indicate that younger women may be particularly vulnerable at the time of the offer of a predictive genetic test.

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“…For women aged 55 or older at diagnosis, the predicted reduction is greater (19%), whereas for women aged under 55, it is small (7%) and not significant, as noted previously in other screened populations and attributed to the reduced sensitivity of screening and faster rate of tumour progression in these younger women (Tabar et al, 1995;Duffy et al, 1996). These predictions may underestimate the true impact of screening, since the 3 years' lead time allowed to adjust for the earlier diagnosis of screen detected cancers in the invited group may be an overestimate.…”

Section: Discussionmentioning

confidence: 54%

Predicted long-term mortality reduction associated with the second round of breast screening in East Anglia

McCann

Duffy²,

Day³

2001

Br J Cancer

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Summary Randomized trials have demonstrated that mammographic screening can reduce breast cancer mortality. Our aim was to estimate the reduction in mortality expected from the East Anglian breast screening programme. Breast screening achieves benefit by improving cancer prognosis (reducing tumour size, nodal involvement and possibly grade) through earlier diagnosis. We compared cancer prognosis between women invited for screening and those not yet invited in East Anglia, UK, in order to predict the mortality reduction achievable by screening, independently of any reduction due to changes in treatment and underlying disease. Participants (both invited and not-yet invited) were women eligible for invitation to first and second screens and diagnosed with invasive breast cancer in 1989-96. Death rates were predicted based on the observed distribution of tumour grade, size and node status amongst 950 cancers diagnosed following first invitation, up to and including at second screen (excluding those detected at first screening), and 451 cancers presenting symptomatically in women awaiting first invitation during the staggered introduction of screening, after adjustment for lead time amongst screen detected cases. For all ages, the ratio of predicted breast cancer mortality in the invited compared with the uninvited group was 0.85 (95% CI 0.78, 0.93). It was 0.93 (0.80, 1.08) for women aged 50-54 at diagnosis and 0.81 (0.72, 0.91) for those aged 55-64. We conclude that, by 2004, the second round of screening in East Anglia should reduce mortality by around 7% in women below age 55 at diagnosis, and by around 19% in those aged 55-64.

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Sojourn Time, Sensitivity and Positive Predictive Value of Mammography Screening for Breast Cancer in Women Aged 40-49

Abstract: The methods involving more explicit modelling of the disease process and fewer assumptions tended to find higher estimates of predictive value in the Two-County study. The results suggest that previously poor sensitivity and predictive value estimates may have been overpessimistic.

Cited by 55 publications

References 7 publications

DCIS, cytokeratins, and the theory of the sick lobe

DCIS, cytokeratins, and the theory of the sick lobe

Predictive testing for BRCA1/2: attributes, risk perception and management in a multi-centre clinical cohort

Predicted long-term mortality reduction associated with the second round of breast screening in East Anglia

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