Stage distribution at first and repeat examinations in breast cancer screening

Boer, R. de; Koning, Harry J. de; Oortmarssen, Gerrit van; Warmerdam, Peter G.; Maas, P. van der

doi:10.1136/jms.6.3.132

Cited by 16 publications

(12 citation statements)

References 36 publications

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“…Independent, blinded reading and options for referral were the subject of our study, which was occasioned by the less favourable stage distribution of screen-detected cancers in subsequent screening rounds than was expected [5]. This raised the question whether the performance of the Dutch screening programme could be optimised.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands

Groenewoud

Otten

Fracheboud

et al. 2006

Breast Cancer Res Treat

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In mammography screening with double reading, different strategies can be used when the readers give discordant recommendations for referral. We investigated whether the results of the Dutch breast cancer screening programme can be optimised by replacing the standard referral strategy by consensus. Twenty-six screening radiologists independently and blinded to outcome read a test set consisting of previous screening mammograms of 250 cases (screen-detected and interval cancers) and 250 controls. Their referral recommendations were paired and, in case of discrepancy, re-read according to three referral strategies: (1) decision by one of the readers; (2) arbitration by a third reader; (3) referral if both readers agree (consensus). Data allowed studying other referral strategies, including referral if any reader suggests, as well. Double reading with referral if any reader suggests resulted in a 1.03 times higher sensitivity (76.6%) and a 1.31 times higher referral rate (1.26%) than double reading with consensus. To estimate the cost-effectiveness, the outcomes were used in a microsimulation model. Even if double reading with referral if any reader suggests results in four times as high referral rates and an accompanying increase of biopsies or other invasive procedures, the cost-effectiveness of 4,190 Euros per life-year gained may well be in the range of acceptable cost-effectiveness for Dutch health care programmes.

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Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands

Groenewoud

Otten

Fracheboud

et al. 2006

Breast Cancer Res Treat

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“…However, there have also been less favourable results. For the period of 1990-1995, the detection rate for subsequent screening examinations was lower than expected (observed rate 3.4%; expected rate 4.3%), the interval cancer rate was higher than expected (observed rate 0.99%; expected rate 0.96%), and the stage distribution of screen-detected cancers was less favourable than expected [8,9]. These results were suggested to be attributable to the very low recall rate (< 1%) in the subsequent screening examinations of the Dutch programme in comparison with that of screening programmes in other countries, which have recall rates of 2-5% [10].…”

Section: Screening Results 1990-1999mentioning

confidence: 75%

The Dutch Population-Based Mammography Screening: 30-Year Experience

Holland¹,

Rijken²,

Hendriks³

2007

Breast Care

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Based on the results of the 2 pilot mammographic screening projects in Nijmegen and Utrecht, a population- based programme was set up in the Netherlands in 1989. The main characteristics of the programme are the centralised organisation including centralised technical and medical quality control and audit, the 2-year interval between examinations, and the eligible age of 50-74. The National Expert and Training Centre in Nijmegen is responsible for the technical and medical quality control and the National Evaluation Team in Rotterdam for the data collection evaluation and annual reporting of the performance results. After 15 years, the Dutch breast cancer screening programme can be regarded as an effective health care intervention at reasonable costs. A new challenge for the Dutch screening programme is the planed transformation of analogue to digital screening within the next 2 years. It will be a major logistic operation with many, at this moment still unforeseen obstacles.

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“…The Mean Sojourn Ttimes (MST1, MST2) and the sensitivity of CBE screening (Scbe) were based on the international literature. 16,18,[23][24][25][26][27][28] Other unobserved parameters, such as the sensitivity of mammography (Sm) in age groups that were not included in the Nijmegen Screening Program, were derived from an assumed parameter distribution (Table 1). More detailed information on these parameters can be found in Appendix A.…”

Section: Equationmentioning

confidence: 99%

“…**< age 35 S-curve: e 1:207 þ À101:43 age /> age 35 Inverse: 1:398 þ À44:622 age (R square: 0.947). Estimates of age-specific mean sojourn times (MST1, MST2) and the age-specific sensitivity of CBE (Scbe) were base on the literature, 16,18,23,[26][27][28][29][30] and can be best explained by the formulas below. R squares in these formulas represent explained variance of age-specific estimates from literature vs. age-specific values estimated by formula.…”

Section: Equationmentioning

confidence: 99%

“…Although the amount of stage shift cannot be straightforwardly linked to breast cancer mortality, it can be regarded as an important proxy for the performance of early detection programmes. 8,[10][11][12][13][14][15][16] Particularly in LMICs where the stage distribution of newly diagnosed breast cancer cases is often poor, the amount of stage shift is an essential performance indicator that could help LIMCs to decide on which breast cancer control programmes to implement.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predicting the stage shift as a result of breast cancer screening in low- and middle-income countries: a proof of concept

et al. 2014

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Objective: To provide proof of concept for a simple model to estimate the stage shift as a result of breast cancer screening in low-and middle-income countries (LMICs). Stage shift is an essential early detection indicator and an important proxy for the performance and possible further impact of screening programmes. Our model could help LIMCs to choose appropriate control strategies. Methods: We assessed our model concept in three steps. First, we calculated the proportional performance rates (i.e. index number Z) based on 16 screening rounds of the Nijmegen Screening Program (384,884 screened women). Second, we used linear regression to assess the association between Z and the amount of stage shift observed in the programme. Third, we hypothesized how Z could be used to estimate the stage shift as a result of breast cancer screening in LMICs. Results: Stage shifts can be estimated by the proportional performance rates (Zs) using linear regression. Zs calculated for each screening round are highly associated with the observed stage shifts in the Nijmegen Screening Program (Pearson's R: 0.798, R square: 0.637). Conclusions: Our model can predict the stage shifts in the Nijmegen Screening Program, and could be applied to settings with different characteristics, although it should not be straightforwardly used to estimate the impact on mortality. Further research should investigate the extrapolation of our model to other settings. As stage shift is an essential screening performance indicator, our model could provide important information on the performance of breast cancer screening programmes that LMICs consider implementing.

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Stage distribution at first and repeat examinations in breast cancer screening

Cited by 16 publications

References 36 publications

Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands

Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands

The Dutch Population-Based Mammography Screening: 30-Year Experience

Predicting the stage shift as a result of breast cancer screening in low- and middle-income countries: a proof of concept

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