Mammography Screening and Breast Cancer Mortality in New South Wales, Australia

OBJECTIVE: To investigate the relationship between utilisation of service mammography screening and breast cancer mortality in New South Wales (NSW) women. Setting : Population-based biennial mammography screening was progressively introduced in NSW from 1988, with active recruitment and re-invitation for women aged 50-69 years, and reached full geographic coverage by 1996. Biennial mammography screening participation has varied widely over time and by municipality. METHODS: Breast cancer mortality by age, period and municipality was obtained from the NSW Central Cancer Registry. Biennial mammography screening rates for the same strata were obtained from the BreastScreen NSW database. Temporal changes in breast cancer mortality for NSW were summarised as annual average declines using Poisson regression. Breast cancer mortality for 1997-2001 was examined in relation to lagged biennial screening rates by municipality, adjusted for age, area socio-economic and geographic indicators, and breast cancer incidence, also using Poisson regression. RESULTS: For the 50-69 year age group, the mean annual breast cancer mortality decline was 0.8% (not significant) for 1988-1994, and 4.4% (p < 0.0001) for 1995-2001. Statistically significant negative associations between breast cancer mortality in 1997-2001 and lagged biennial screening rates were found with the highest significance at a four-year lag for women aged 50-69 years ( p = 0.0003) and also for women aged 50-79 years (p c = 0.0002). From the regression coefficient, a 70% biennial screening rate is associated with 32% lower breast cancer mortality (compared to zero screening). CONCLUSIONS: The effect of population-based mammography screening on breast cancer mortality in NSW inferred using this method is consistent with results of trials and other service studies. This suggests that population-based mammography screening programs can achieve significant reductions in breast cancer mortality with adequate participation.     

Improved Detection Rate of Early Breast Cancer in Mass Screening Combined with Mammography

A cohort study to compare mass screening with and without mammography was conducted in Miyagi Prefecture, Japan in order to establish whether the effectiveness of breast cancer screening would be improved when mammography was combined with physical examination. A trial of mass screening combined with mammography was carried out in 9634 women aged over 50. Lateral imaging of the breast using single-view film mammography was performed at the first stage of mass screening in addition to physical examination of the breast. Results in the trial were compared with those obtained in 35511 age-matched subjects without mammography. Thirty breast cancers were found in the trial with a detection rate of 0.31%, which was much higher than that (0.08%) obtained by physical examination without mammography. In 15 of the 30 patients the breast tumor was not palpated at the first screening, but abnormal findings were detected in the mammography. A higher rate (73%) of early breast cancer was obtained in the screening trial with mammography than that (39%) obtained in the screening with physical examination alone. Mass screening combined with mammography is superior to that without mammography for breast cancer screening, especially for the detection of non-palpable, early breast cancer.     

Decline in Cervical Cancer Incidence and Mortality in New South Wales in Relation to Control Activities (Australia)

Background To examine time trends in cervical cancer incidence and mortality in NSW women aged ￥20 years in relation to important health service initiatives and programs. Methods Data on cervical cancer incidence and mortality were obtained from the NSW Central Cancer Registry for 1972–2001, and corresponding annual populations obtained from the Australian Bureau of Statistics. Direct age-standardised rates in the ￥20 year population were calculated using the 2001 NSW census population as standard. Proportional reductions in incidence and mortality since 1972–1974 were also calculated and related to key health service factors and to published NSW 5-year cervical cancer relative survival for similar periods. Results Declines in cervical cancer incidence (−10%) and mortality (−20%), and increased degree-of-spread specific survival following the introduction of universal health care in 1975 suggest effects of greater access to Pap screening, earlier access to diagnosis and treatment services, and improved effectiveness of treatment. Incidence plateaued during the 1980s, but mortality fell further (−7%) due to an increased proportion of localised cancers (without change to degree-of-spread specific survival). The 1980s mortality reduction was a consequence of earlier diagnosis and/or secondary prevention, not improved treatment effectiveness or reduced incidence. A marked and sustained incidence decline to 2001 (−35%) occurred after the introduction of the NSW Cervical Screening Program in 1992. This was followed 3 years later by a sustained mortality decline (−20%). During the 1990s survival across all degrees of spread remained unchanged and the mortality reduction was due entirely to reduction in incidence. Conclusions The substantial reduction of cervical cancer incidence and mortality in NSW over the last 3 decades is associated with important health service interventions that relate to control of cervical cancer, particularly the implementation of a population-based organised cervical screening program.     

High Detection Rate of Breast Cancer by Mass Screening Using Mammography in Japan

A trial of mass screening for breast cancer using both mammography and physical examination (independently) was carried out in women over 50 years of age in Tokushima Prefecture. Breast cancer was detected in eight of a total of 950 examinees by mammography alone, and no cases of breast cancer were detected by physical examination. The detection rate of breast cancer was 0.84%, which is very much higher than that obtained by conventional mass screening using physical examination alone. The detection rate increased especially in the sixth and seventh decades of life. All eight detected breast cancers were in the early stage. Based on these results, it is recommended to employ mammography in breast cancer screening for asymptomatic women aged over 50 years.     

A Review of Breast Density Implications and Breast Cancer Screening

Breast density is an independent risk factor for breast cancer and significantly decreases the sensitivity of mammography. Assessing a woman’s risk of developing breast cancer is becoming increasingly important for establishing individual screening recommendations and preventive strategies. This article reviews the factors influencing mammographic density (MD), the available methods of MD assessment, and its effect on breast cancer. Finally, we discuss the supplemental screening methods for women with dense breast tissue.     

Influence of Mammographic Screening on Breast Cancer Incidence Trends in South Australia

Purpose: To examine breast cancer (BC) incidence trends in relation to mammographic screening and riskfactor prevalence in South Australia (SA). Materials and Methods:Trends in annual BC incidence rates werecalculated using direct standardisation and compared with projected incidence derived from Poisson regressionanalysis of pre-screening rates. Annual percentage change and change time points were estimated using Joinpointsoftware. Biennial mammography screening participation rates were calculated using data from BreastScreenSA. Trends in overweight/obesity, alcohol use and hormone replacement therapy (HRT) use were examined using1991-2009 Health Omnibus Survey data. Trends in total fertility were examined using data from the AustralianBureau of Statistics. Results: BC incidence increased around the time BreastScreen commenced and thenstabilised in the mid-1990s. However rates have remained higher than projected, even though the proportionand age distribution of first time screening attendees stabilised around 1998. A decrease in BC incidence wasobserved among women aged 50-59yrs from the late-1990’s but not among older women. Obesity and alcoholuse have increased steadily in all age groups, while HRT use declined sharply from the late-1990s. Conclusions:BC incidence has remained higher than projected since mammography screening began. The sustained elevationis likely to be due to lead time effects, though over-diagnosis cannot be excluded. Declining HRT use has alsoimpacted incidence trends. Implications: Studies using individual level data, which can account for changes inrisk factor prevalence and lead time effects, are required to evaluate ‘over-diagnosis’ due to screening.     

Comparison of False Negative Rates among Breast Cancer Screening Modalities with or without Mammography: Miyagi Trial

False negative rates were compared in two screening modalities, physical examination with or without mammography, in an intervention study for women aged over 50 in Miyagi Prefecture. Thirty-five breast cancers were detected in 12,515 subjects who participated in the trial consisting of physical examination and mammography, whereas 44 breast cancers were detected in 50,105 subjects who received physical examination alone, so that the detection rates were 0.28% and 0.09%, respectively. Among 50,061 subjects who received physical examination alone, 8 women were diagnosed as having breast cancer within 12 months after the screening, while only one of 12,480 screenees receiving the combined modality was so diagnosed, implying false negative rates of 15.4% and 2.8%, respectively. When the screening sensitivity in the combined system was analyzed according to each single modality, the false negative rate provided by physical examination with mammography turned out to be 2.8%, significantly lower than that (33.3%) by the physical examination alone. Minimal breast cancers represented 25.7% of all screen-detected cancers in the combined modality, compared with 9.1% in the modality without mammography. The trial thus indicates that physical examination combined with mammography may be an appropriate modality for breast cancer screening in women aged over 50 on the basis of screening sensitivity.     

Detection of Breast Cancer in Asymptomatic and Symptomatic Groups Using Computer-Aided Detection with Full-Field Digital Mammography

Purpose

We aimed to determine the sensitivity of computer-aided detection (CAD) applied to digital mammography in asymptomatic and symptomatic breast cancer patients.

Methods

We retrospectively analyzed digital mammography and CAD images from 210 patients diagnosed with breast cancer. The patients were divided into symptomatic and asymptomatic groups. The sensitivity of CAD in both groups was assessed in relation to breast tissue density, histopathological type of breast cancer, and tumor size.

Results

The detection rate of the CAD system was 87.8% in the asymptomatic group. The sensitivity in different tissue densities was 100% in fatty breasts (P1), 88.9% with scattered fibroglandular densities (P2), 94.4% in heterogeneously dense breasts (P3), and 66.7% in extremely dense breasts (P4). The detection rate of the CAD system in the symptomatic group was 87.2%, and the sensitivity was 90.5%, 90%, 86.6%, and 75% in P1-P4 breasts, respectively. In the asymptomatic group, the CAD system detected 90.3% of invasive ductal carcinomas, not otherwise specified (IDC-NOS) and 88.9% of ductal carcinomas in situ (DCIS), but did not detect other types of malignancy. In the symptomatic group, the CAD system detected 88.2% of IDC-NOS, 88.9% of DCIS and 75% of other types of malignancy. When analyzed according to tumor size, the sensitivity of CAD in the asymptomatic and symptomatic groups was 82.6% and 83.3% for tumors <1 cm, 76.5% and 82.4% for tumors between 1 and 2 cm, and 91.7% and 89% in tumors >2 cm.

Conclusion

The sensitivity of CAD was low in P4 breasts and high for tumors larger than 2 cm, with no statistically significant differences between the asymptomatic and symptomatic groups for IDC-NOS and DCIS. CAD showed greater sensitivity for other neoplasms in symptomatic patients.     

乳腺肿块型癌与非肿块型癌的MRI、钼靶及超声差异分析

目的 分析乳腺肿块型癌与非肿块型癌的MRI、钼靶及超声差异.方法 选取70例乳腺癌患者,术前均进行MRI、钼靶、超声检查,术后进行病理组织检查.比较MRI、X线钼靶、超声三种检查方式的图像表现、对病灶的敏感性及与病理诊断的符合率.结果 3种检查方式对肿块、微小病灶的敏感性无显著差异(P>0.05).X线钼靶、超声检查对...     

Improved Performance of Adjunctive Ultrasonography After Mammography Screening for Breast Cancer Among Chinese Females

Introduction

Until now, no studies have investigated whether women other than those with dense breasts are suitable for adjunctive ultrasonography after negative mammography, and investigated whether all women with negative mammography are suitable for adjunctive ultrasonography.

Breast Cancer Screening Knowledge and Perceived Health Beliefs among Immigrant Women in Korea

Purpose

Recently, through international marriage, immigrant women have rapidly increased throughout Korea. This study was performed to identify health beliefs and practices related to breast cancer screening in immigrant women in Korea.

Methods

A cross-sectional survey was carried out between March and July 2012, and study population included immigrant females from six other Asian countries (Cambodia, China, Japan, Mongolia, Vietnam, and the Philippines). We surveyed 197 women and categorized them into four groups according to home countries. The questionnaire consisted of 55 items, including demographic and socioeconomic factors, breast cancer-related knowledge regarding risk factors and symptoms, beliefs and attitudes towards health and breast cancer, perceived susceptibility, barriers, and benefits of screening.

Results

Japanese participants were significantly older and had resided in Korea for more years than other country-of-origin groups (all p<0.001), and showed higher screening rates without statistical significance (p=0.392). In multivariate analysis, country of origin showed a significant correlation with knowledge (p=0.001), positive beliefs (p=0.002), and perceived benefits (p=0.025) of breast cancer screening. The group with the lowest household income showed a significantly lower score of perceived benefits (p=0.022). Through analysis to identify factors affecting participation in screening mammography, we found that education level (p=0.009), occupation status (p=0.006), and Korean language fluency (p=0.002) were independent predictors for screening behavior.

Conclusion

This study identified conditions related to breast cancer screening knowledge, perception, and behavior of immigrant women in Korea. The results reflect the need for increased social aids to remove barriers to medical services and more educational programs to facilitate higher rates of screening.     

Annual or biennial mammography screening for women at a higher risk with a family history of breast cancer: prognostic indicators of screen-detected cancers in New South Wales, Australia

Objective  This study examined whether offering annual mammography screening for women with the risk factor of a family history of breast cancer resulted in more favorable prognostic indicators of diagnosed cancers than the usual approach of biennial screening. Methods  The study involved women aged 50–69 years with a family history of breast cancer, defined as having ≥1 first-degree relative diagnosed with breast cancer, who were diagnosed with a screen-detected invasive breast cancer between 1998 and 2004 in BreastScreen New South Wales (n = 590). The women were grouped according to whether they screened in an area offering annual screening to women with a family history, or were offered the standard biennial screening. The odds of having favorable tumor size, grade, and nodal status prognosis were compared between these screening groups using logistic regression. A comparison group of women without a family history, all offered biennial screening, was also evaluated based on the same area groupings to examine whether any differences were due to the area, rather than the screening interval policy. Results  Women with a family history who were offered annual screening at BreastScreen NSW were significantly more likely than those who were offered biennial screening to be diagnosed with a tumor ≤20 mm in size (adjusted odds ratio (AOR) = 1.91, 95% CI: 1.21–3.02), and to have a node-negative tumor (AOR = 1.61, 95% CI: 1.03–2.50). There were also significantly higher odds of being diagnosed with tumors ≤15 mm (p < 0.001) and ≤10 mm in size (p = 0.011) in women offered annual screening. There was no significant difference in the odds of a Grade 1 tumor being detected (AOR = 1.26, 95% CI: 0.87–1.81), although the direction of the effect was consistent with that seen for size and nodal status. No significant differences were found in the comparison group of women without a family history. Conclusions  Offering annual screening for women aged 50–69 years with a family history of breast cancer significantly increased the odds of being diagnosed with a smaller, node-negative tumors. Further investigation is required to assess whether the improved prognostic indicators translate into significantly better mortality outcomes for women with a family history offered annually screening.     

乳腺钼靶和超声诊断乳腺原位癌伴早期浸润的对照研究

目的：探讨乳腺钼靶和超声诊断乳腺原位癌伴早期浸润的影像学特点,方法：对比40例手术后病理证实的乳腺原位癌伴早期浸润患者的钼靶与超声诊断结果。结果：40例患者在乳腺钼靶摄片上有乳腺癌征象的28例（70.0％），表现为良性肿瘤征象的7例（17．5％），无肿瘤征象5例（12.5％）；在乳腺超声诊断中有乳腺癌表现的13例（32.5％），表现为良性肿瘤征象的10例（25.0％），无占位表现的17例（42.5％）。结论：在乳腺原位癌伴早期浸润诊断方面，乳腺钼靶诊断与病理诊断的符合率高于乳腺超声检查；两种检查综合诊断可减少此类早期乳腺癌的漏诊。     

Mass Screening for Breast Cancer: Comparison of the Clinical Stages and Prognosis of Breast Cancer Detected by Mass Screening and in Out-patient Clinics

To establish the criteria for assessing the life-prolonging effect of mass screening for breast cancer, clinical stage and prognosis of breast cancer detected by mass screening in 11 regions of Japan were compared with those for matched patients in out-patient clinics. A total of 728 patients detected by mass screening and 1,450 found in the out-patient clinics were reviewed. The stage of the disease was Tis or I in 40.9% of the patients detected by mass screening, and 28.7% of those found in the out-patient clinics. In contrast, stage III was found in 9.3% and 14.6%, respectively, indicating that early stages were significantly more common in the patients detected by mass screening. The overall survival curve for the patients detected by mass screening was compared with that for those found in the out-patient clinics. The 5-year survival rate was significantly higher in the patients detected by mass screening (91.7% vs. 85.6%; P <0.01), while the 10-year survival rate was slightly higher in the same group of patients, but the difference from the other group was not significant (80.5% vs. 78.1%). Women who had conducted breast self-examination (BSE) showed a higher survival rate than those who had not conducted BSE.     

乳腺X线检查质量控制对乳腺癌的诊断影响

目的 探讨乳腺X线检查质量控制对乳腺癌的诊断价值.方法 选择行乳腺X线检查的乳腺癌患者83例作为研究对象,按照是否进行质量控制将其分为观察组45例及对照组38例.对两组患者乳腺X线检查结果与病理结果的诊断符合率进行分析与比较.结果 观察组诊断符合率为91.11％,对照组诊断符合率为73.68％,观察组诊断符合率明显高于对照组(P＜0.05).两组内各年龄段诊断符合率比较无显著差异,组间比较亦无统计学意义(P＞0.05).两组患者T3+T4期诊断符合率均显著高于T1 +T2期(P＜0.05).观察组各个病理分期诊断符合率均高于对照组,但差异无统计学意义(P＞0.05).观察组患者淋巴结转移情况诊断符合率为73.33％,显著高于对照组(50.00％)(P＜0.05).观察组非甲级片产生率为4.44％,明显低于对照组(15.79％)(P＜0.05).结论 乳腺X线检查质量控制对于提高乳腺癌诊断准确率具有积极的意义,值得临床广泛开展.     

Mammography Coverage and Tumor Stage in the Opportunistic Screening Context

IntroductionThe increment of breast cancer screening coverage should lead to an increase in the proportion of early tumors diagnosed and the decrease of the cancer-related mortality. However, the effectiveness of opportunistic mammography screening is not well documented for public health systems in middle-income countries.Patients and MethodsWe conducted an ecologic study to evaluate the association of mammography coverage with trends in breast cancer stage distribution. We used data from a total of 42,850 breast cancer patients, diagnosed between 2000 and 2016, combined with estimated mammography coverage from 3 surveys (2003, 2008, and 2013).ResultsBiannual mammography coverage increased from 62.4% in 2003 to 73.9% in 2013. From 2000 to 2016, the proportion of in situ tumors increased 6.9%, the proportion of localized tumors increased 3.9%, the proportion of regional tumors decreased 6.9% and the frequency of distant tumors decreased 4% (P < .00001).ConclusionMammography coverage in the context of opportunistic breast cancer screening was associated with the increase of in situ and localized tumors and decrease of regional and distant tumors.     

Comparison of Mammography in Combination with Breast Ultrasonography Versus Mammography Alone for Breast Cancer Screening in Asymptomatic Women

Aim: To compare the agreement of screening breast mammography plus ultrasound and reviewedmammography alone in asymptomatic women. Materials and Methods: All breast imaging data were obtained forwomen who presented for routine medical checkup at National Cancer Institute (NCI), Thailand from January2010 to June 2013. A radiologist performed masked interpretations of selected mammographic images retrievedfrom the computer imaging database. Previous mammography, ultrasound reports and clinical data were blindedbefore film re-interpretation. Kappa values were calculated to assess the agreement between BIRADS assessmentcategory and BIRADS classification of density obtained from the mammography with ultrasound in imagingdatabase and reviewed mammography alone. Results: Regarding BIRADS assessment category, concordancebetween the two interpretations were good. Observed agreement was 96.1%. There was moderate agreement inwhich the Kappa value was 0.58% (95%CI; 0.45, 0.87). The agreement of BI-RADS classification of density wassubstantial, with a Kappa value of 0.60 (95%CI; 0.54, 0.66). Different results were obtained when a subgroupof patients aged ≥60 years were analyzed. In women in this group, observed agreement was 97.6%. There wasalso substantial agreement in which the Kappa value was 0.74% (95%CI; 0.49, 0.98). Conclusions: The presentstudy revealed that concordance between mammography plus ultrasound and reviewed mammography alonein asymptomatic women is good. However, there is just moderate agreement which can be enhanced if agetargetedbreast imaging is performed. Substantial agreement can be achieved in women aged ≥60. Adjunctivebreast ultrasound is less important in women in this group.     

Type of Breast Cancer Diagnosis,Screening, and Survival

IntroductionBreast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence of breast cancers detected through screening, before and after introduction of an organized screening, and we evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected breast cancer or those with palpable breast cancers.Materials and MethodsWe collected data about all women who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and recurrences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant.ResultsAmong the 2070 cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A), 843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extrascreening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively, 99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference between the first 2 groups and the third (P < .05) and a trend between groups A and B (P = .081).ConclusionThe diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the diagnosis, but a longer follow-up is necessary to confirm this data.     

乳腺钙化在乳腺癌诊断中的意义

将１８４例乳腺疾病患者分为乳腺癌组与非癌组，观察和比较两组钙化出现的频率和形态特征，分析乳腺癌组的钙化与病理分型，钙化与乳腺肿块的关系。乳腺癌组Ｘ线摄影显示钙化者为６４％（６０／９３），非癌组为２８％（２６／９１）。有钙化者患乳腺癌的相对危险性（ＲＲ）是没有钙化的４．５倍（Ｐ＜０．０１）。在显示钙化的乳腺癌组，４７％为浸润性导管癌，没有显示钙化的乳腺癌中，浸润性导管癌为２４％（Ｐ＜０．０５）；仅显示钙化但不伴有明显肿块影的占３８％（２３／６０）。典型的恶性钙化如泥沙样，细线样钙化有助于对Ｘ线摄影未显示肿块影的乳腺癌的诊断。