The Importance of Mammographic Screening Relative to the Treatment of Women With Carcinoma of the Breast

Solin, Lawrence J.; Legorreta, Antonio P.; Schultz, Delray; Zatz, Steven; Goodman, Robert L.

doi:10.1001/archinte.1994.00420070055007

Cited by 22 publications

(4 citation statements)

References 31 publications

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“…This decrease may be attributable to any of several factors, such as the growing number of studies in which age has been shown to be an independent risk factor for local recurrence and the characterization of the BRCA1 and BRCA2 genes, which has made surgeons and patients, and especially younger patients, increasingly aware of familial breast carcinoma. Only a limited number of other studies have described the effects of breast carcinoma screening on breast‐conserving therapy, and those studies have reported conflicting results 30–32…”

Section: Discussionmentioning

confidence: 99%

Breast carcinoma diagnosis, treatment, and prognosis before and after the introduction of mass mammographic screening

Ernst

Voogd

Coebergh

et al. 2004

Cancer

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BACKGROUND The introduction of breast carcinoma screening leads to early detection and is believed to reduce mortality and increase the proportion of patients for whom breast‐conserving surgery is possible. METHODS In 1992, a population‐based mammographic screening program was introduced in the Dutch city of Tilburg and its surroundings; the program achieved total coverage in 1996. The authors examined the effects of this screening program by investigating disease stage, treatment, and survival among women diagnosed with breast carcinoma at a teaching hospital in Tilburg during the periods 1985–1991 and 1992–1999. RESULTS Between January 1, 1985, and December 31, 1999, 1400 patients were diagnosed with breast carcinoma. Among patients ages 50–69 years, the proportion of TNM Stage I breast carcinoma increased from 24% in 1985–1991 to 45% in 1992–1999 (P < 0.001). The proportion of patients age < 50 years with invasive breast carcinoma who underwent breast‐conserving surgery decreased from 45% to 33% (P = 0.011). Among patients ages 50–69 years, the overall survival rate during the period from 1992 to 1999 was significantly greater than the corresponding rate during the period from 1985 to 1991 (P = 0.0009). Even after adjustments were made for tumor stage and patient age, a slight reduction in mortality risk was observed in this age group. No difference in stage distribution or prognosis was found among patients age < 50 years or among patients age ≥ 70 years. Of the 168 invasive malignancies found in patients ages 50–69 years between 1997 and 1999, 68 (40%) were detected by the screening program, 47 (28%) were interval malignancies, and 53 (32%) were detected in nonparticipants or in women who did not participate in 1 or more screening rounds. Patients with screen‐detected tumors had a much more favorable prognosis than did patients with interval malignancies (P = 0.0018) or patients with clinically detected breast carcinoma (P < 0.0001). CONCLUSIONS Between 1992 and 1999, after the introduction of breast carcinoma screening, improved prognosis and more favorable tumor stage were observed among patients ages 50–69 years. Even after the screening program was fully implemented in 1996, the majority of invasive malignancies still were detected between screening rounds or in patients who did not participate in the program. Cancer 2004;100:1337–44. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Breast carcinoma diagnosis, treatment, and prognosis before and after the introduction of mass mammographic screening

Ernst

Voogd

Coebergh

et al. 2004

Cancer

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“…26 This variability reflects several factors, including the years during which the study was conducted, the age of the study patients, the geographic location of the study, and the socioeconomic status of the patients. [27][28][29] In contrast, eligibility for BCT approaches 90% in women who have mammographically detected breast cancer. 29 The rate of positive margins following the initial surgical procedure was estimated at 10%, reflecting our institutional experience.…”

Section: Methodsmentioning

confidence: 99%

“…[27][28][29] In contrast, eligibility for BCT approaches 90% in women who have mammographically detected breast cancer. 29 The rate of positive margins following the initial surgical procedure was estimated at 10%, reflecting our institutional experience. The frequency of margin positivity following NLB varies in the literature from 5% to 90%.…”

Section: Methodsmentioning

confidence: 99%

Cost-Benefit Analysis of Biopsy Methods for Suspicious Mammographic Lesions

Fahy¹

2001

Arch Surg

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Hypothesis: Stereotactic core biopsy (SCB) is more costeffective than needle-localized biopsy (NLB) for evaluation and treatment of mammographic lesions. Design: A computer-generated mathematical model was developed based on clinical outcome modeling to estimate costs accrued during evaluation and treatment of suspicious mammographic lesions. Total costs were determined for evaluation and subsequent treatment of cancer when either SCB or NLB was used as the initial biopsy method. Cost was estimated by the cumulative work relative value units accrued. The risk of malignancy based on the Breast Imaging Reporting Data System (BIRADS) score and mammographic suspicion of ductal carcinoma in situ were varied to simulate common clinical scenarios. Main Outcome Measures: Total cost accumulated during evaluation and subsequent surgical therapy (if required). Results: Evaluation of BIRADS 5 lesions (highly suggestive, risk of malignancy = 90%) resulted in equivalent relative value units for both techniques (SCB, 15.54; NLB, 15.47). Evaluation of lesions highly suspicious for ductal carcinoma in situ yielded similar total treatment relative value units (SCB, 11.49; NLB, 10.17). Only for evaluation of BIRADS 4 lesions (suspicious abnormality, risk of malignancy = 34%) was SCB more costeffective than NLB (SCB, 7.65 vs NLB, 15.66).

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“…11 Numerous uncontrolled trials and retrospective studies have documented the importance of mammographic screening in diagnosing small, early-stage breast cancers. [12][13][14][15][16] Early diagnosis leads to identification of breast cancer at an earlier stage and grade and therefore allows more women to be eligible for breast-conserving treatment (BCT), the standard of care for women with early-stage breast cancer. 12 Therefore, in the interest of examining BCT eligibility, this study will also look at the staging of breast tumors.…”

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confidence: 99%

Diagnosis, Clinical Staging, and Treatment of Breast Cancer

Legorreta

Chernicoff²,

Trinh³

et al. 2004

American Journal of Clinical Oncology

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This study compares diagnosis, staging, and treatment of newly diagnosed breast cancer cases over a several-year period. The study design was a retrospective, multiyear comparison between new breast cancer cases diagnosed in 1995 (n = 827) and 1997 (n = 815). Cases were identified through claims data, and medical record abstraction was used to verify each case and to identify clinical staging and type of treatment. All medical records were reviewed by one physician to maximize internal reliability. Both cohorts were predominantly 40 and older, white, married, and postmenopausal. The latter cohort (1997) had a higher proportion of women aged 70 to 79 and a lower proportion of women aged 40 to 49. In both cohorts, women age 40 and older were likely to be diagnosed with breast cancer at the time of mammographic screening, while women younger than 40 were more likely to be diagnosed by clinical breast examination. In logistic regression analyses, controlling for confounding factors such as age, undergoing mammographic screening increased the likelihood of having a low cancer stage at diagnosis by more than three and a half times. Mammographic screening was statistically significantly positively associated with having eligibility for breast-conserving treatment (BCT); however, although an increase in BCT eligibility was observed, actual use of BCT did not change. Mammography leads to a lower clinical stage as well as a greater likelihood of BCT eligibility at time of breast cancer diagnosis, but may not have a substantial effect on treatment choice (lumpectomy vs. mastectomy). Between 1995 and 1997, a trend was observed toward downstaging of disease at diagnosis; further research is warranted to observe whether this trend continues over time.

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The Importance of Mammographic Screening Relative to the Treatment of Women With Carcinoma of the Breast

Cited by 22 publications

References 31 publications

Breast carcinoma diagnosis, treatment, and prognosis before and after the introduction of mass mammographic screening

Breast carcinoma diagnosis, treatment, and prognosis before and after the introduction of mass mammographic screening

Cost-Benefit Analysis of Biopsy Methods for Suspicious Mammographic Lesions

Diagnosis, Clinical Staging, and Treatment of Breast Cancer

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