Estrogen plus progestin (E+P) and breast cancer incidence and mortality.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1501-1501
Author(s):  
Rowan T. Chlebowski ◽  
Garnet L Anderson ◽  
Lewis H Kuller ◽  
Aaron K Aragaki ◽  
JoAnn E Manson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Cancer Prognosis ◽  
Breast Cancers ◽  
Incidence And Mortality ◽  
Mortality Table

1501 Background: In the WHI clinical trial, E+P increased both breast cancer incidence and breast cancer mortality (JAMA 2010;304:1684). In contrast, breast cancers associated with E+P use in most observational studies have a more favorable prognosis. To address differences, a cohort of WHI Observational Study participants with characteristics similar to the WHI clinical trial was identified to examine E+P association with invasive breast cancer incidence and outcome. Methods: 41,449 postmenopausal women with no prior hysterectomy and mammogram negative for breast cancer < 2 years before who either were not hormone users (25,328) or were using E+P (16,121) were identified. Breast cancers were verified by centralized medical record review. Adjusted Cox proportional hazard regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). Additional analyses adjusted for breast cancer screening, censoring participants for incidence analyses who had a > 2 year interval without a mammogram. Results: After a mean (SD) follow-up 11.3 (3.1) years, 2,236 breast cancers were diagnosed. Breast cancer incidence was higher in E+P users (0.60% vs 0.42%, annualized rate, respectively: HR 1.55, 95% CI 1.41-1.70, P<0.001). Screening adjusted analyses had stronger breast cancer association (0.63% vs 0.39%, HR 1.72, 95% CI 1.54-1.93; P<0.001). Survival following breast cancer, measured from diagnosis date, was similar in E+P users and non-users (HR 0.95, 95% CI 0.74-1.23). Breast cancer mortality, analyzed from cohort entry date, are shown in the table. Conclusions: E+P use is associated with increased breast cancer incidence. As breast cancer prognosis following diagnosis on E+P is similar to that of nonusers, the higher incidence with E+P leads to increased breast cancer mortality. [Table: see text]

scholarly journals Geographical and socioeconomic inequalities in female breast cancer incidence and mortality in Iran: A Bayesian spatial analysis of registry data

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248723
Author(s):  
Shadi Rahimzadeh ◽  
Beata Burczynska ◽  
Alireza Ahmadvand ◽  
Ali Sheidaei ◽  
Sara Khademioureh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mortality Rate ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
National Level ◽  
Mortality Rates ◽  
Incidence And Mortality ◽  
Over Time

Background In Iran, trends in breast cancer incidence and mortality have generally been monitored at national level. The purpose of this study is to examine province-level disparities in age-standardised breast cancer incidence versus mortality from 2000 to 2010 and their association with socioeconomic status. Methods In this study, data from Iran’s national cancer and death registry systems, and covariates from census and household expenditure surveys were used. We estimated the age-standardised incidence and mortality rates in women aged more than 30 years for all 31 provinces in the consecutive time intervals 2000–2003, 2004–2007 and 2008–2010 using a Bayesian spatial model. Results Mean age-standardised breast cancer incidence across provinces increased over time from 15.0 per 100,000 people (95% credible interval 12.0,18.3) in 2000–2003 to 39.6 (34.5,45.1) in 2008–2010. The mean breast cancer mortality rate declined from 10.9 (8.3,13.8) to 9.9 (7.5,12.5) deaths per 100,000 people in the same period. When grouped by wealth index quintiles, provinces in the highest quintile had higher levels of incidence and mortality. In the wealthiest quintile, reductions in mortality over time were larger than those observed among provinces in the poorest quintile. Relative breast cancer mortality decreased by 16.7% in the highest quintile compared to 10.8% in the lowest quintile. Conclusions Breast cancer incidence has increased over time, with lower incidence in the poorest provinces likely driven by underdiagnoses or late-stage diagnosis. Although the reported mortality rate is still higher in wealthier provinces, the larger decline over time in these provinces indicates a possible future reversal, with the most deprived provinces having higher mortality rates. Ongoing analysis of incidence and mortality at sub-national level is crucial in addressing inequalities in healthcare systems and public health both in Iran and elsewhere.

scholarly journals Comparing CISNET Breast Cancer Incidence and Mortality Predictions to Observed Clinical Trial Results of Mammography Screening from Ages 40 to 49

2018 ◽  
Vol 38 (1_suppl) ◽  
pp. 140S-150S ◽  
Author(s):  
Jeroen J. van den Broek ◽  
Nicolien T. van Ravesteyn ◽  
Jeanne S. Mandelblatt ◽  
Hui Huang ◽  
Mehmet Ali Ergun ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Mammography Screening ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Mortality Reduction ◽  
Incidence And Mortality ◽  
The Uk

Background. The UK Age trial compared annual mammography screening of women ages 40 to 49 years with no screening and found a statistically significant breast cancer mortality reduction at the 10-year follow-up but not at the 17-year follow-up. The objective of this study was to compare the observed Age trial results with the Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer model predicted results. Methods. Five established CISNET breast cancer models used data on population demographics, screening attendance, and mammography performance from the Age trial together with extant natural history parameters to project breast cancer incidence and mortality in the control and intervention arm of the trial. Results. The models closely reproduced the effect of annual screening from ages 40 to 49 years on breast cancer incidence. Restricted to breast cancer deaths originating from cancers diagnosed during the intervention phase, the models estimated an average 15% (range across models, 13% to 17%) breast cancer mortality reduction at the 10-year follow-up compared with 25% (95% CI, 3% to 42%) observed in the trial. At the 17-year follow-up, the models predicted 13% (range, 10% to 17%) reduction in breast cancer mortality compared with the non-significant 12% (95% CI, -4% to 26%) in the trial. Conclusions. The models underestimated the effect of screening on breast cancer mortality at the 10-year follow-up. Overall, the models captured the observed long-term effect of screening from age 40 to 49 years on breast cancer incidence and mortality in the UK Age trial, suggesting that the model structures, input parameters, and assumptions about breast cancer natural history are reasonable for estimating the impact of screening on mortality in this age group.

Breast cancer screening for carriers of ATM, CHEK2, and PALB2 pathogenic variants: A comparative modeling analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10500-10500
Author(s):  
Kathryn P. Lowry ◽  
H. Amarens Geuzinge ◽  
Natasha K. Stout ◽  
Oguzhan Alagoz ◽  
John M. Hampton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Simulation Models ◽  
Pathogenic Variants ◽  
Life Years ◽  
Incidence And Mortality

10500 Background: Inherited pathogenic variants in ATM, CHEK2, and PALB2 confer moderate to high risks of breast cancer. The optimal approach to screening in these women has not been established. Methods: We used two simulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) and data from the Cancer Risk Estimates Related to Susceptibility consortium (CARRIERS) to project lifetime breast cancer incidence and mortality in ATM, CHEK2, and PALB2 carriers. We simulated screening with annual mammography from ages 40-74 alone and with annual magnetic resonance imaging (MRI) starting at ages 40, 35, 30, and 25. Joint and separate mammography and MRI screening performance was based on published literature. Lifetime outcomes per 1,000 women were reported as means and ranges across both models. Results: Estimated risk of breast cancer by age 80 was 22% (21-23%) for ATM, 28% (26-30%) for CHEK2, and 40% (38-42%) for PALB2. Screening with MRI and mammography reduced breast cancer mortality by 52-60% across variants (Table). Compared to no screening, starting MRI at age 30 increased life years (LY)/1000 women by 501 (478-523) in ATM, 620 (587-652) in CHEK2, and 1,025 (998-1,051) in PALB2. Starting MRI at age 25 versus 30 gained 9-12 LY/1000 women with 517-518 additional false positive screens and 197-198 benign biopsies. Conclusions: For women with ATM, CHEK2, and PALB2 pathogenic variants, breast cancer screening with MRI and mammography halves breast cancer mortality. These mortality benefits are similar to those for MRI screening for BRCA1/2 mutation carriers and should inform practice guidelines.[Table: see text]

scholarly journals Breast cancer mortality and overdiagnosis after implementation of population-based screening in Denmark

2020 ◽  
Vol 184 (3) ◽  
pp. 891-899
Author(s):  
Elsebeth Lynge ◽  
Anna-Belle Beau ◽  
My von Euler-Chelpin ◽  
George Napolitano ◽  
Sisse Njor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Historical Control Group ◽  
Historical Control ◽  
Control Group ◽  
Study Group ◽  
Screening Programs

Abstract Introduction Service breast cancer screening is difficult to evaluate because there is no unscreened control group. Due to a natural experiment, where 20% of women were offered screening in two regions up to 17 years before other women, Denmark is in a unique position. We utilized this opportunity to assess outcome of service screening. Materials and methods Screening was offered in Copenhagen from 1991 and Funen from 1993 to women aged 50–69 years. We used difference-in-differences methodology with a study group offered screening; a historical control group; a regional control group; and a regional–historical control group, comparing breast cancer mortality and incidence, including ductal carcinoma in situ, between study and historical control group adjusted for changes in other regions, and calculating ratios of rate ratios (RRR) with 95% confidence intervals (CI). Data came from Central Population Register; mammography screening databases; Cause of Death Register; and Danish Cancer Register. Results For breast cancer mortality, the study group accumulated 1,551,465 person-years and 911 deaths. Long-term breast cancer mortality in Copenhagen was 20% below expected in absence of screening; RRR 0.80 (95% CI 0.71–0.90), and in Funen 22% below; RRR 0.78 (95% CI 0.68–0.89). Combined, cumulative breast cancer incidence in women followed 8+ years post-screening was 2.3% above expected in absence of screening; RRR 1.023 (95% CI 0.97–1.08). Discussion Benefit-to-harm ratio of the two Danish screening programs was 2.6 saved breast cancer deaths per overdiagnosed case. Screening can affect only breast cancers diagnosed in screening age. Due to high breast cancer incidence after age 70, only one-third of breast cancer deaths after age 50 could potentially be affected by screening. Increasing upper age limit could be considered, but might affect benefit-to-harm ratio negatively.

Screening mammography in old women saves lives: A simulation model

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10561-10561
Author(s):  
E. Barrajon ◽  
A. Lopez ◽  
E. Adrover
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Randomized Clinical Trials ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Reduction Rate ◽  
Mammographic Screening ◽  
Screening Mammography ◽  
Incidence And Mortality ◽  
The Impact

10561 Background: Screening mammography has shown to decrease breast cancer specific death rate by 20–25% and has been recommended in women aged 40 and above, nevertheless, some country service screen programs stop screening in women older than 69, even though the sensitivity and specificity of screening mammography is highest in older women, especially those older than 80 years. The size of the older population is growing exponentially and old women have the highest incidence of breast cancer; one third of breast cancer diagnosis and half the deaths of breast cancer in USA occurred in women aged 70 and above in the year 2000. The aim of this study is to estimate the impact of mammographic screening in women aged 70 and above on breast cancer mortality. Methods: US Census, SEER, CISNET, CDC, HMD, ULTD databases were searched to obtain population data and rates of incidence and mortality of breast cancer by age. In addition, mammography screening bibliography from randomized clinical trials, meta-analysis, and service health programs publications were reviewed to estimate the impact of screening mammography on results for different strata. Analytical and simulation methods were applied for modeling the data with the aid of Mathematica to calculate breast cancer reduction rate. Results: A reduction in breast cancer mortality was observed with a magnitude proportional to age, even after taking into account competing risks of death by other causes in the aging population. Simulation of different scenarios revealed a decrease in breast cancer mortality in the range of 5 to15% for women younger than 50 years, 15 to 25% in the group of women aged 50 to 69, and 25 to 35% in women older than 69. Factors such as population life expectancy, breast cancer incidence, attrition rate in screening or cross-over, overall specificity of mammographic detection, interval of screening, impact the estimations, explaining in part some of the negative results of prevention trials. Conclusions: Reduction of breast cancer mortality by mammographic screening is proportional to age. Women aged 70 and above benefit more from mammographic screening than younger women. No significant financial relationships to disclose.

scholarly journals Long-Term Effect of Breast Symptoms Reported at Mammography Screening Visit on Cancer Incidence and Mortality

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 210s-210s
Author(s):  
D. Singh ◽  
A. Anttila ◽  
N. Malila ◽  
J. Pitkaniemi ◽  
J. Miettinen
Keyword(s):  
Breast Cancer ◽  
Cancer Incidence ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Nipple Discharge ◽  
National Breast ◽  
Incidence And Mortality ◽  
All Cause Mortality ◽  
Risk Of Cancer

Background: Efforts to reduce mortality through early detection and diagnosis has intensified in the recent decade. An important risk factor, 'breast symptoms' reported by women during screening visit, is still overlooked. Aim: To study the association between breast symptoms reported at screening visit and the risk of cancer incidence and mortality in a prospective manner over a period of 24-years. Methods: This population based matched cohort study was based on the follow-up of the ongoing Finnish National Breast Cancer Screening Program (FNBCSP) that began in 1987. Symptomatic subjects who attended screening with symptoms (lump, 39,965 visits; retraction, 24,190 visits; nipple discharge, 7882 visits) were identified from the Finnish Cancer Registry database. For each visit with symptoms, nonsymptomatic controls were matched (1:1 for lump and retraction; 1:2 for nipple discharge) based on age at screening visit (within 2 years), year of invitation (2 years band), number of invited visits, and municipality of invitation. The primary outcomes were incidence of breast cancer and incidence-based mortality, including all-cause mortality. Results: Women who reported lump or retraction had about twofold risk of breast cancer incidence, threefold risk of breast cancer mortality and all-cause mortality respectively as compared with women without respective symptoms. We found a substantial difference in mortality rates throughout the follow-up period between symptomatic and asymptomatic group. In absolute terms, for lump, in every 1000 screening visits, 20 women died of breast cancer as compared with 7 women without lump, and 30 vs 11 all-cause deaths in women with and without lump, respectively after 24 years of follow-up. We also found difference in the number of deaths in women who reported retraction or nipple discharge. Conclusion: This study provides comprehensive evidence that women with breast symptoms remain in a higher risk of dying over a very long period. Guidelines to reduce these inequalities needs to be developed.

Protein intake and breast cancer incidence and mortality.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1569-1569
Author(s):  
Kathy Pan ◽  
Joseph C Larson ◽  
Rowan T. Chlebowski ◽  
Joanne E. Mortimer ◽  
JoAnn E Manson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Incidence ◽  
Protein Intake ◽  
Lower Risk ◽  
Vegetable Protein ◽  
Linear Trend ◽  
Breast Cancer Incidence ◽  
Animal Protein ◽  
Breast Cancers ◽  
Incidence And Mortality

1569 Background: Associations between dietary protein intake and breast cancer are unclear, in part due to limitations of dietary self-report. Women’s Health Initiative (WHI) investigators compared the accuracy of food frequency questionnaire (FFQ) data on energy and protein intake with objective measures of dietary intake using biomarkers (doubly labeled water for energy and urinary nitrogen for protein [n=544]). Subsequently, regression equations incorporating participant characteristics were developed acknowledging differential reporting dietary data errors based on participant characteristics (Neuhouser Am J Epidemiol). FFQ findings were then used to determine biomarker- adjusted animal vs vegetable protein ratios. Methods: We examined associations of energy and protein intake with breast cancer incidence and mortality in Women’s Health Initiative (WHI) participants 50-79 years of age at entry between1993-1998, with breast cancers verified by medical record review and survival enhanced by serial National Death Index (NDI) searches through 2016. Associations between sources of protein intake (animal versus vegetable) quintiles and breast cancer incidence and mortality were estimated using multivariable Cox proportional hazards regression. Results: With 100,024 eligible participants, after 14 years follow-up, women with higher total protein intake had greater body mass index, were more likely White, menopausal hormone therapy users with higher total energy intake and fat intake. With 6,340 incident breast cancers, 764 deaths from breast cancer and 2,059 deaths after breast cancer, higher vegetable protein intake was associated with significantly lower breast cancer incidence (P for linear trend = 0.01) while higher animal protein intake was associated with significantly higher breast cancer incidence (P for linear trend = 0.03). Higher vegetable protein intake was also associated with significantly lower risk of death after breast cancer (P <0.001) but not with lower risk of deaths from breast cancer (breast cancer followed by death attributed to breast cancer). Animal protein intake was not associated with deaths from breast cancer or deaths after breast cancer. Conclusions: Based on findings from biomarker-calibrated determination of protein intake by source, higher vegetable protein intake was associated with significantly lower risk of breast cancer incidence and of death after breast cancer while higher animal protein intake was associated with significantly higher risk of breast cancer incidence, but not mortality.

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