scholarly journals Estimating the frequency of indolent breast cancer in screening trials

2018 ◽  
Vol 28 (4) ◽  
pp. 1261-1271
Author(s):  
Yu Shen ◽  
Wenli Dong ◽  
Roman Gulati ◽  
Marc D Ryser ◽  
Ruth Etzioni
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Screening Test ◽  
Accurate Estimation ◽  
Model Parameters ◽  
Interval Cancers ◽  
Standard Methods ◽  
Test Sensitivity ◽  
Satisfactory Performance ◽  
Screening Trials

Cancer screening can detect cancer that would not have been detected in a patient’s lifetime without screening. Standard methods for analyzing screening data do not explicitly account for the possibility that a fraction of tumors may remain latent indefinitely. We extend these methods by representing cancers as a mixture of those that progress to symptoms (progressive) and those that remain latent (indolent). Given sensitivity of the screening test, we derive likelihood expressions to simultaneously estimate (1) the rate of onset of preclinical cancer, (2) the average preclinical duration of progressive cancers, and (3) the fraction of preclinical cancers that are indolent. Simulations demonstrate satisfactory performance of the estimation approach to identify model parameters subject to precise specifications of input parameters and adequate numbers of interval cancers. In application to four breast cancer screening trials, the estimated indolent fraction among preclinical cancers varies between 2% and 35% when assuming 80% test sensitivity and varying specifications for the earliest time that participants could plausibly have developed cancer. We conclude that standard methods for analyzing screening data can be extended to allow some indolent cancers, but accurate estimation depends on correctly specifying key inputs that may be difficult to determine precisely in practice.

scholarly journals Interval cancers after negative immunochemical test compared to screen and non-responders’ detected cancers in Slovenian colorectal cancer screening programme

2018 ◽  
Vol 52 (4) ◽  
pp. 413-421 ◽  
Author(s):  
Dominika Novak Mlakar ◽  
Tatjana Kofol Bric ◽  
Ana Lucija Škrjanec ◽  
Mateja Krajc
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Screening Test ◽  
Screening Programme ◽  
Interval Cancers ◽  
Faecal Immunochemical Test ◽  
Test Sensitivity ◽  
Cancer Screening Programme ◽  
Immunochemical Test

Abstract Background We assessed the incidence and characteristics of interval cancers after faecal immunochemical occult blood test and calculated the test sensitivity in Slovenian colorectal cancer screening programme. Patients and methods The analysis included the population aged between 50 to 69 years, which was invited for screening between April 2011 and December 2012. The persons were followed-up until the next foreseen invitation, in average for 2 years. The data on interval cancers and cancers in non-responders were obtained from cancer registry. Gender, age, years of schooling, the cancer site and stage were compared among three observed groups. We used the proportional incidence method to calculate the screening test sensitivity. Results Among 502,488 persons invited for screening, 493 cancers were detected after positive screening test, 79 interval cancers after negative faecal immunochemical test and 395 in non-responders. The proportion of interval cancers was 13.8%. Among the three observed groups cancers were more frequent in men (p = 0.009) and in persons aged 60+ years (p < 0.001). Comparing screen detected and cancers in non-responders with interval cancers more interval cancers were detected in persons with 10 years of schooling or more (p = 0.029 and p = 0.001), in stage III (p = 0.027) and IV (p < 0.001), and in right hemicolon (p < 0.001). Interval cancers were more frequently in stage I than non-responders cancers (p = 0.004). Test sensitivity of faecal immunochemical test was 88.45%. Conclusions Interval cancers in Slovenian screening programme were detected in expected proportions as in similar programmes. Test sensitivity was among the highest when compared to similar programmes and was accomplished using test kit for two stool samples.

Estimating mean sojourn time and screening test sensitivity in breast cancer mammography screening: new results

2005 ◽  
Vol 12 (4) ◽  
pp. 172-178 ◽  
Author(s):  
Harald Weedon-Fekjær ◽  
Lars J Vatten ◽  
Odd O Aalen ◽  
Bo Lindqvist ◽  
Steinar Tretli
Keyword(s):  
Breast Cancer ◽  
Hormone Replacement Therapy ◽  
Cancer Screening ◽  
Replacement Therapy ◽  
Breast Cancer Screening ◽  
Sojourn Time ◽  
Screening Test ◽  
Hormone Replacement ◽  
Opportunistic Screening ◽  
Test Sensitivity

Objective: To assess if new screening techniques, increased use of hormone replacement therapy, or the transition from breast cancer screening trials to large scale screening programmes may influence the average time in preclinical screening detectable phase (mean sojourn time [MST]) or screening test sensitivity (STS). Setting: Screening and interval data for 395,188 women participating in the Norwegian Breast Cancer Screening Programme (NBCSP). Methods: Weighted non-linear least-square regression estimates using a tree step Markov chain model, and a sensitivity analysis of the possible impact by opportunistic screening between ordinary breast cancer screening rounds. Results: MST was estimated to 6.1 (95% confidence interval [CI] 5.1–7.0) years for women aged 50–59 years, and 7.9 (95% CI 6.0–7.9) years for those aged 60–69 years. Correspondingly, STS was estimated to 58% (95% CI 52–64 %) and 73 % (67–78 %), respectively. Simulations revealed that opportunistic screening may give a moderate estimation bias towards higher MST and lower STS. Assuming a probable 21% higher background incidence, due to increased hormone replacement therapy use, MST estimates decreased to 3.9 and 5.0 years for the two age groups, and STS increased to 75 and 85%. Conclusions: The new estimates indicate that screening detectable phase is longer than that found in previous mammography trials/programmes, but also that the sensitivity of the screening test is lower. Overall, the NBCSP detects more cancer cases than most previous trials/programmes.

scholarly journals 965The estimated impact of improved breast screening tests targeted at women with dense breasts

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Pietro Procopio ◽  
Louiza Velentzis ◽  
A Dennis Petrie ◽  
G Bruce Mann ◽  
Anne M Kavanagh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Breast Density ◽  
Screening Test ◽  
Tumour Size ◽  
Screening Tests ◽  
Masking Effect ◽  
Interval Cancers ◽  
Dense Breasts

Abstract Background There is increasing interest in risk-based breast cancer screening, including interventions to improve outcomes for women with mammographically dense breasts. Methods Policy1-Breast is a continuous-time, multiple-cohort micro-simulation whole-population model which incorporates breast cancer risk, life-course breast density, menopause, hormone therapy use and screening participation. Outcomes include cancer diagnoses and characteristics (invasive/DCIS, tumour size, grade), mode of detection (screen-detected/interval/other) and mortality (breast cancer and other cause). Policy1-Breast validates well against key observed clinical outcomes in Australia. We estimate changes in outcomes within and outside the BreastScreen program upon the introduction of a hypothetical screening test with improved sensitivity for women with dense breasts. Results We estimate that introducing in year 2020 a screening test for women in the highest quintile of breast density at age 50 that halves the masking effect of their breast density would, by 2026-2030, increase diagnosis rates of population-level invasive cancers ( 10%) and screen-detected cancers (20%) and decrease rates of interval cancers (17%) and community-detected cancers (6%). Conclusions Targeted screening tests with improved sensitivity for women with dense breasts are expected to markedly reduce interval cancers and other cancers diagnosed outside the BreastScreen program, while increasing all cancer diagnoses due to increased rates of screen-detected cancers. Key messages Specialised breast cancer screening tests directed at women with very high breast density are expected to reduce interval cancers and increase overall cancer diagnoses. Population simulation models such as Policy1-Breast can complement trial evidence by evaluating a range of scenarios and estimating short and long-term implications.

Basic Principles of Epidemiology and Biostatistics

2014 ◽  
pp. 1005-1012
Author(s):  
Julie E. Buring ◽  
I-Min Lee
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Predictive Value ◽  
Screening Test ◽  
Basic Principles ◽  
Screening Unit

One hundred women over the age of 50 received mammograms at a mobile breast cancer screening unit. Twenty-seven women had findings suspicious for malignancy on the mammogram; 19 of these women were confirmed as having breast cancer by biopsy. One woman had a negative mammogram but in the subsequent year developed breast cancer and is assumed to have had the disease at the time of screening. What is the sensitivity of the mammogram? The specificity? And the predictive value of a positive screening test?

scholarly journals Breast Cancer Screening Trials: Endpoints and Overdiagnosis

2020 ◽  
Author(s):  
Ismail Jatoi ◽  
Paul F Pinsky
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Cancer Detection ◽  
Primary Endpoint ◽  
Tumor Detection ◽  
Breast Cancer Detection ◽  
Detection Rates ◽  
Screening Strategies ◽  
Screening Trials

Abstract Screening mammography was assessed in 9 randomized trials initiated between 1963 and 1990, with breast cancer-specific mortality as the primary endpoint. In contrast, breast cancer detection has been the primary endpoint in most screening trials initiated during the past decade. These trials have evaluated digital breast tomosynthesis, magnetic resonance imaging, and ultrasound, and novel screening strategies have been recommended solely on the basis of improvements in breast cancer detection rates. Yet, the assumption that increases in tumor detection produce reductions in cancer mortality has not been validated, and tumor-detection endpoints may exacerbate the problem of overdiagnosis. Indeed, the detection of greater numbers of early stage breast cancers in the absence of a subsequent decline in rates of metastatic cancers and cancer-related mortality is the hallmark of overdiagnosis. There is now evidence to suggest that both ductal carcinoma in situ and invasive cancers are overdiagnosed as a consequence of screening. For each patient who is overdiagnosed with breast cancer, the adverse consequences include unnecessary anxiety, financial hardships, and a small risk of morbidity and mortality from unnecessary treatments. Moreover, the overtreatment of breast cancer, as a consequence of overdiagnosis, is costly and contributes to waste in health-care spending. In this article, we argue that there is a need to establish better endpoints in breast cancer screening trials, including quality of life and composite endpoints. Tumor-detection endpoints should be abandoned, because they may lead to the implementation of screening strategies that increase the risk of overdiagnosis.

scholarly journals A simple way to measure the burden of interval cancers in breast cancer screening

BMC Cancer ◽  
2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Sune Bangsbøll Andersen ◽  
Sven Törnberg ◽  
Elsebeth Lynge ◽  
My Von Euler-Chelpin ◽  
Sisse Helle Njor
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Interval Cancers

scholarly journals Feasibility Study of a Randomised Trial of Ovarian Cancer Screening among the General Population

1994 ◽  
Vol 1 (4) ◽  
pp. 209-214 ◽  
Author(s):  
C A Parkes ◽  
D Smith ◽  
N J Wald ◽  
T H Bourne
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Screening Test ◽  
False Positive Rate ◽  
Randomised Trial ◽  
Doppler Imaging ◽  
Colour Doppler ◽  
Ovarian Cancer Screening

To determine the feasibility of a randomised trial of ovarian cancer screening among women attending a breast cancer screening centre. Randomised controlled trial of ovarian cancer screening using transvaginal ultrasonography as a primary screening test and colour Doppler imaging as a secondary screening test in the screened group and no intervention in the control group. Reading breast cancer screening centre (United Kingdom). 8678 women, without a bilateral oophorectomy or hysterectomy, aged between SO and 64 attending for NHS breast cancer screening between September 1989 and February 1993. Uptake of ovarian cancer screening among eligible women and the screening false positive rate (considered as the referral rate to a gynaecologist for surgical intervention). −82% (7124/8678) of eligible women agreed to join the trial and were randomly allocated in equal numbers to each arm of the trial. 3280 women had an initial scan. The false positive rate after ultrasonography alone was 2·9% (86/2952), but this dropped to 0·5% after colour Doppler as a secondary screening test. One stage I primary ovarian cancer was detected at screening in a 58 year old women. A randomised trial of ovarian cancer screening using ultrasonography and colour Doppler imaging is feasible and acceptable among women attending a breast cancer screening centre. The results indicate that the expected odds of being affected given a positive result in the general population would be about 1:12. A full randomised trial of ovarian cancer screening with mortality as the end point is needed to assess whether screening reduces mortality from this disease. A multicentre European trial is currently in progress.

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