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Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation.

https://arctichealth.org/en/permalink/ahliterature104292
Source
AJR Am J Roentgenol. 2014 Jun;202(6):1389-94
Publication Type
Article
Date
Jun-2014
Author
Benoît Mesurolle
Juan Carlos Hidalgo Perez
Fahad Azzumea
Emmanuelle Lemercier
Xuanqian Xie
Ann Aldis
Atilla Omeroglu
Sarkis Meterissian
Author Affiliation
1 All authors: Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave W, Montreal, PQ, H3H 1A1 Canada.
Source
AJR Am J Roentgenol. 2014 Jun;202(6):1389-94
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Biopsy, Large-Core Needle - statistics & numerical data
Breast Neoplasms - diagnosis - epidemiology - pathology - surgery
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology - pathology - surgery
Endoscopic Ultrasound-Guided Fine Needle Aspiration - statistics & numerical data
False Negative Reactions
Female
Humans
Incidence
Middle Aged
Precancerous Conditions - diagnosis - epidemiology - pathology - surgery
Quebec - epidemiology
Reproducibility of Results
Risk factors
Sensitivity and specificity
Treatment Outcome
Abstract
The purposes of this article were to review the mammographic and sonographic features of breast masses yielding atypical ductal hyperplasia (ADH) at sonographically guided biopsy, evaluate the surgical pathology outcome of these lesions, and determine whether clinical or imaging features can be used to predict upgrade to malignancy.
Among 6325 sonographically guided biopsies (2003- 2010) (14-gauge cores), 56 yielded the diagnosis of ADH (0.9%). Six patients were excluded (lost to follow-up). Fifty lesions were surgically excised in 45 patients. Mammographic and sonographic features were analyzed in consensus by two radiologists using the BI-RADS lexicon.
Forty-five patients (mean age, 56 years; 12
PubMed ID
24848840 View in PubMed
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Benefit-to-harm ratio of the Danish breast cancer screening programme.

https://arctichealth.org/en/permalink/ahliterature286271
Source
Int J Cancer. 2017 Aug 01;141(3):512-518
Publication Type
Article
Date
Aug-01-2017
Author
Anna-Belle Beau
Elsebeth Lynge
Sisse Helle Njor
Ilse Vejborg
Søren Nymand Lophaven
Source
Int J Cancer. 2017 Aug 01;141(3):512-518
Date
Aug-01-2017
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - diagnosis - epidemiology - mortality
Carcinoma, Ductal, Breast - diagnosis - epidemiology - mortality
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology - mortality
Denmark - epidemiology
Early Detection of Cancer
Female
Follow-Up Studies
Humans
Incidence
Mammography
Medical Overuse
Middle Aged
Neoplasm Invasiveness
Prognosis
Survival Rate
Abstract
The primary aim of breast cancer screening is to reduce breast cancer mortality, but screening also has negative side-effects as overdiagnosis. To evaluate a screening programme, both benefits and harms should be considered. Published estimates of the benefit-to-harm ratio, the number of breast cancer deaths prevented divided by the number of overdiagnosed breast cancer cases, varied considerably. The objective of the study was to estimate the benefit-to-harm ratio of breast cancer screening in Denmark. The numbers of breast cancer deaths prevented and overdiagnosed cases [invasive and ductal carcinoma in situ (DCIS)] were estimated per 1,000 women aged 50-79, using national published estimates for breast cancer mortality and overdiagnosis, and national incidence and mortality rates. Estimations were made for both invited and screened women. Among 1,000 women invited to screening from age 50 to age 69 and followed until age 79, we estimated that 5.4 breast cancer deaths would be prevented and 2.1 cases overdiagnosed, under the observed scenario in Denmark of a breast cancer mortality reduction of 23.4% and 2.3% of the breast cancer cases being overdiagnosed. The estimated benefit-to-harm ratio was 2.6 for invited women and 2.5 for screened women. Hence, 2-3 women would be prevented from dying from breast cancer for every woman overdiagnosed with invasive breast cancer or DCIS. The difference between the previous published ratios and 2.6 for Denmark is probably more a reflection of the accuracy of the underlying estimates than of the actual screening programmes. Therefore, benefit-to-harm ratios should be used cautiously.
Notes
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Cites: BMJ. 2013 Feb 26;346:f106423444414
Cites: J Med Screen. 2015 Mar;22(1):20-725492943
Cites: J Med Screen. 2012;19 Suppl 1:5-1322972806
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Cites: Cancer. 2013 Sep 1;119(17 ):3106-1223720226
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Cites: J Med Screen. 2013 Jun;20(2):104-524065032
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Cites: J Med Screen. 2016 Dec;23 (4):203-20926940960
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Cites: Lancet. 2002 Mar 16;359(9310):909-1911918907
PubMed ID
28470685 View in PubMed
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Breast Cancer Screening in Denmark: A Cohort Study of Tumor Size and Overdiagnosis.

https://arctichealth.org/en/permalink/ahliterature282568
Source
Ann Intern Med. 2017 Mar 07;166(5):313-323
Publication Type
Article
Date
Mar-07-2017
Author
Karsten Juhl Jørgensen
Peter C Gøtzsche
Mette Kalager
Per-Henrik Zahl
Source
Ann Intern Med. 2017 Mar 07;166(5):313-323
Date
Mar-07-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Breast Neoplasms - diagnosis - epidemiology
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology
Cohort Studies
Denmark - epidemiology
Early Detection of Cancer
Female
Humans
Incidence
Mammography
Mass Screening
Medical Overuse - statistics & numerical data
Middle Aged
Abstract
Effective breast cancer screening should detect early-stage cancer and prevent advanced disease.
To assess the association between screening and the size of detected tumors and to estimate overdiagnosis (detection of tumors that would not become clinically relevant).
Cohort study.
Denmark from 1980 to 2010.
Women aged 35 to 84 years.
Screening programs offering biennial mammography for women aged 50 to 69 years beginning in different regions at different times.
Trends in the incidence of advanced (>20 mm) and nonadvanced (=20 mm) breast cancer tumors in screened and nonscreened women were measured. Two approaches were used to estimate the amount of overdiagnosis: comparing the incidence of advanced and nonadvanced tumors among women aged 50 to 84 years in screening and nonscreening areas; and comparing the incidence for nonadvanced tumors among women aged 35 to 49, 50 to 69, and 70 to 84 years in screening and nonscreening areas.
Screening was not associated with lower incidence of advanced tumors. The incidence of nonadvanced tumors increased in the screening versus prescreening periods (incidence rate ratio, 1.49 [95% CI, 1.43 to 1.54]). The first estimation approach found that 271 invasive breast cancer tumors and 179 ductal carcinoma in situ (DCIS) lesions were overdiagnosed in 2010 (overdiagnosis rate of 24.4% [including DCIS] and 14.7% [excluding DCIS]). The second approach, which accounted for regional differences in women younger than the screening age, found that 711 invasive tumors and 180 cases of DCIS were overdiagnosed in 2010 (overdiagnosis rate of 48.3% [including DCIS] and 38.6% [excluding DCIS]).
Regional differences complicate interpretation.
Breast cancer screening was not associated with a reduction in the incidence of advanced cancer. It is likely that 1 in every 3 invasive tumors and cases of DCIS diagnosed in women offered screening represent overdiagnosis (incidence increase of 48.3%).
None.
PubMed ID
28114661 View in PubMed
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Breast carcinoma in situ in 167 women--incidence, mode of presentation, therapy and follow-up.

https://arctichealth.org/en/permalink/ahliterature24724
Source
Eur J Surg Oncol. 1991 Oct;17(5):466-76
Publication Type
Article
Date
Oct-1991
Author
A. Ringberg
I. Andersson
K. Aspegren
F. Linell
Author Affiliation
Department of Plastic and Reconstructive Surgery, Lund University, Malmö General Hospital, Sweden.
Source
Eur J Surg Oncol. 1991 Oct;17(5):466-76
Date
Oct-1991
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Biopsy, Needle
Breast Neoplasms - diagnosis - epidemiology - surgery
Carcinoma in Situ - diagnosis - epidemiology - surgery
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology - surgery
Female
Follow-Up Studies
Humans
Incidence
Mammography
Mass Screening
Middle Aged
Retrospective Studies
Sweden - epidemiology
Abstract
In the city of Malmö, in southern Sweden, 1693 women were diagnosed as having breast carcinoma during 1976 through 1984. Of these, 167 women had pure in situ breast carcinoma (9.9%). One hundred and thirty-two had ductal carcinoma in situ (DCIS) alone or in combination with lobular carcinoma in situ (LCIS), intracystic carcinoma and/or Paget's disease of the nipple. Thirty-three had pure LCIS and two had pure intracystic carcinomas. The incidence of breast carcinoma in situ (CIS) in women 20 years of age or older was 18.7 per 10(5) woman years with high rates of DCIS for all ages above 40, whereas a decline in incidence rate was seen for LCIS in the postmenopausal age groups. The ratio of DCIS to LCIS was 4:1. Of the 132 patients with DCIS, 46% were asymptomatic and were diagnosed by mammography, 35% presented with clinical symptoms, and 19% of the cases were incidental findings in breasts operated on for benign lesions. Mammography had been performed on all patients with DCIS and contributed to diagnosis in 75%. Sixty-one per cent of all DCIS lesions had microcalcifications suspicious for carcinoma. Eighty-nine of 132 patients with DCIS underwent fine-needle aspiration biopsy (FNAB) before surgical biopsy. FNAB was suspicious or diagnostic for carcinoma in 57/89 (64%). Of 33 cases with LCIS all but one were incidental findings. In one of 28 cases with LCIS examined by mammography there was suspicion of carcinoma. Sixteen per cent of the patients with DCIS were treated by a breast-conserving operation (BCO), the remaining patients by mastectomy (ME) (52%) or subcutaneous mastectomy (SCM) (33%) with immediate reconstruction. Thirty-three per cent of the patients with LCIS were treated by BCO, the remaining patients by ME (18%) or SCM (49%) with immediate reconstruction. Only one patient had radiotherapy postoperatively. In 60% of all CIS cases where an excisional biopsy had been performed there were further foci of CIS in the final ME/SCM specimen. After a median follow-up of 7 years for the DCIS group, three patients out of 21 treated by BCO had invasive carcinoma appearing ipsilaterally. They were alive and without symptoms of recurrent disease 2.5 to 6 years following further surgery. One patient treated by SCM died from generalized ductal breast carcinoma. In the LCIS group (median follow-up 8 years) one patient out of 11 had an invasive tubular carcinoma diagnosed 4 years after BCO. Eight years later she was alive and well after bilateral SCM.
PubMed ID
1657650 View in PubMed
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[Clinical aspects and treatment of "minimal" forms of breast cancer].

https://arctichealth.org/en/permalink/ahliterature242555
Source
Vopr Onkol. 1983;29(5):28-33
Publication Type
Article
Date
1983
Author
V F Semiglazov
A A Orlov
Source
Vopr Onkol. 1983;29(5):28-33
Date
1983
Language
Russian
Publication Type
Article
Keywords
Adult
Aged
Breast Neoplasms - diagnosis - epidemiology - therapy
Carcinoma in Situ - diagnosis - epidemiology
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology
Female
Humans
Mass Screening
Middle Aged
Neoplasm Metastasis
Neoplasm Recurrence, Local - epidemiology
Precancerous Conditions - diagnosis - epidemiology - therapy
Russia
Terminology as Topic
Urban Population
Abstract
The data on 262 patients with minimal breast cancer (less than 1 cm in diameter) are presented. The long-term results of treatment of this group were good: 5- and 10-year survival rates were 91.2 and 79.5%, respectively. However, minimal breast cancer tended to produce regional (28.5%) and distant (10.3%) metastases. Organ-saving operation, viz. lumpectomy en bloc with axillary-subclavian adipose tissue was frequently (18.5%) followed by local and regional recurrence development. Adjuvant thiotepa therapy caused a 17.8% decrease in the frequency of recurrence and distant metastases development.
PubMed ID
6305033 View in PubMed
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Incidence and tumor characteristics of breast cancer diagnosed before and after implementation of a population-based screening-program.

https://arctichealth.org/en/permalink/ahliterature86551
Source
Acta Oncol. 2008;47(2):225-31
Publication Type
Article
Date
2008
Author
Hofvind Solveig
Sørum Ragnhild
Thoresen Steinar
Author Affiliation
The Cancer Registry of Norway, Oslo, Norway. solveig.hofvind@kreftregisteret.no
Source
Acta Oncol. 2008;47(2):225-31
Date
2008
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - diagnosis - epidemiology - pathology
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology - pathology
Female
Humans
Incidence
Mass Screening
Middle Aged
Norway - epidemiology
Prognosis
Program Development
Risk assessment
Risk factors
Time Factors
Treatment Outcome
Abstract
BACKGROUND: Randomized controlled trials and service screening programs have shown that breast cancer screening reduces the mortality from the disease. Several years of monitoring are needed to prove such an effect. In the meantime attention should be paid to early surrogate measures, such as histopathological tumor characteristics. The Norwegian Breast Cancer Screening Program started November 1995. This study compares incidence, prognostic tumor characteristics and surgical treatment in breast cancer cases diagnosed in the pre-screening (1987-1995, n=2 618) and screening period (1996-2004, n=5 417), in women aged 50-69 years, residing in the first four counties implementing the screening program. The screening period is divided into those invited versus those not invited to the screening program, and those exposed (participants) versus those not exposed to the program (non-participants). RESULTS: The incidence of invasive breast cancer rose from 170 per 100 000 women years (wy) in 1987 to 355 per 100 000 wy in 1997. The proportion of DCIS was 5% in the pre-screening period, and 14% in the screening period. Tumors 20 mm or less were diagnosed in 56% of the invasive cases in the pre-screening period, in 74% of the invited, and in 77% of the exposed women. The relative risk of diagnosing breast cancer with metastases was 0.85 (95% CI 0.84-0.87) for invited and 0.82 (95% CI 0.81-0.84) for exposed women, relative to those diagnosed in the pre-screening period. Ablation was performed in 85% of the invasive cases diagnosed in the pre-screening period, and in 45% of the cases in the screening period. CONCLUSION: Breast cancer diagnosed in the screening period had prognostically favorable tumor characteristics compared to breast cancer diagnosed in the pre-screening period. Implementation of organized population based screening and the time trend are considered possible reasons.
PubMed ID
17851868 View in PubMed
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Outcome of breast cancer screening in Denmark.

https://arctichealth.org/en/permalink/ahliterature294427
Source
BMC Cancer. 2017 12 28; 17(1):897
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
12-28-2017
Author
Elsebeth Lynge
Martin Bak
My von Euler-Chelpin
Niels Kroman
Anders Lernevall
Nikolaj Borg Mogensen
Walter Schwartz
Adam Jan Wronecki
Ilse Vejborg
Author Affiliation
Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark. elsebeth@sund.ku.dk.
Source
BMC Cancer. 2017 12 28; 17(1):897
Date
12-28-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Breast Neoplasms - diagnosis - epidemiology - mortality
Carcinoma, Ductal, Breast - diagnosis - epidemiology - mortality
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology - mortality
Denmark - epidemiology
Early Detection of Cancer - mortality
Female
Follow-Up Studies
Humans
Mammography - mortality
Middle Aged
Outcome Assessment (Health Care)
Prognosis
Survival Rate
Abstract
In Denmark, national roll-out of a population-based, screening mammography program took place in 2007-2010. We report on outcome of the first four biennial invitation rounds.
Data on screening outcome were retrieved from the 2015 and 2016 national screening quality reports. We calculated coverage by examination; participation after invitation; detection-, interval cancer- and false-positive rates; cancer characteristics; sensitivity and specificity, for Denmark and for the five regions.
At the national level coverage by examination remained at 75-77%; lower in the Capital Region than in the rest of Denmrk. Detection rate was slightly below 1% at first screen, 0.6% at subsequent screens, and one region had some fluctuation over time. Ductal carcinoma in situ (DCIS) constituted 13-14% of screen-detected cancers. In subsequent rounds, 80% of screen-detected invasive cancers were node negative and 40% =10 mm. False-positive rate was around 2%; higher for North Denmark Region than for the rest of Denmark. Three out of 10 breast cancers in screened women were diagnosed as interval cancers.
High coverage by examination and low interval cancer rate are required for screening to decrease breast cancer mortality. Two pioneer local screening programs starting in the 1990s were followed by a decrease in breast cancer mortality of 22-25%. Coverage by examination and interval cancer rate of the national program were on the favorable side of values from the pioneer programs. It appears that the implementation of a national screening program in Denmark has been successful, though regional variations need further evaluation to assure optimization of the program.
Notes
Cites: BMJ. 2005 Jan 29;330(7485):220 PMID 15649904
Cites: APMIS Suppl. 2003;(110):1-33 PMID 12739252
Cites: BMJ. 2013 Feb 26;346:f1064 PMID 23444414
Cites: J Med Screen. 2015 Mar;22(1):20-7 PMID 25492943
Cites: Clin Epidemiol. 2016 Oct 25;8:661-666 PMID 27822113
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Cites: Eur J Cancer Prev. 2005 Apr;14 (2):117-28 PMID 15785315
Cites: Br J Cancer. 1989 Jun;59(6):954-8 PMID 2736233
Cites: Br J Cancer. 2013 Jun 11;108(11):2205-40 PMID 23744281
Cites: Int J Cancer. 2017 Aug 1;141(3):512-518 PMID 28470685
Cites: Eur J Surg Oncol. 1998 Dec;24(6):499-507 PMID 9870724
Cites: Am J Epidemiol. 2005 Oct 1;162(7):623-32 PMID 16107566
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PubMed ID
29282034 View in PubMed
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Overdiagnosis due to breast cancer screening: updated estimates of the Helsinki service study in Finland.

https://arctichealth.org/en/permalink/ahliterature258261
Source
Br J Cancer. 2014 Sep 23;111(7):1463-8
Publication Type
Article
Date
Sep-23-2014
Author
S. Heinävaara
T. Sarkeala
A. Anttila
Author Affiliation
Finnish Cancer Registry, Mass Screening Registry, Unioninkatu 22, 00130 Helsinki, Finland.
Source
Br J Cancer. 2014 Sep 23;111(7):1463-8
Date
Sep-23-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Breast Neoplasms - diagnosis - epidemiology
Carcinoma, Ductal, Breast - diagnosis - epidemiology
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology
Early Detection of Cancer
False Positive Reactions
Female
Finland - epidemiology
Humans
Incidence
Mammography
Middle Aged
Abstract
Overdiagnosis is the most important adverse event of breast cancer screening with the estimates ranging from 0% to 40-50% depending on invitational age and methods. We updated the estimates of overdiagnosis in Helsinki service screening study in Finland by comparing the observed and expected cumulative incidence of all breast carcinomas and invasive breast carcinomas.
Women aged 50-59 years have been invited to Helsinki service screening since 1986. The incidence of breast carcinoma in the first invited birth cohorts born in 1935-1939 was compared with older, non-invited cohorts. The minimum follow-up time of the invitees after the last screening round was 14 years. Expected cumulative incidence rates were estimated with two alternative approaches.
For both any breast carcinoma and invasive breast carcinoma, the estimates of overdiagnosis varied from 5% (95% CI=-1, 11%) to 7% (95% CI=1, 13%) depending on the approach.
Our estimates of overdiagnosis are of the same magnitude than other plausible estimates in Europe. Both alternative approaches produced similar estimates for the expected cumulative incidence, which increased the confidence in the estimates of overdiagnosis.
PubMed ID
25121953 View in PubMed
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8 records – page 1 of 1.