scholarly journals Lead Time Bias as a Factor in Mammography Detected Invasive Breast Cancer Survival in an Institutional Cohort

2020 ◽  
Author(s):  
Henry G. Kaplan ◽  
Judith Malmgren ◽  
Mary K. Atwood
Keyword(s):  
Breast Cancer ◽  
Lead Time ◽  
Cancer Survival ◽  
Detection Method ◽  
Distant Recurrence ◽  
Breast Cancer Survival ◽  
Stage I ◽  
Time Interval ◽  
Distant Disease ◽  
Lead Time Bias

Abstract Background: Lead time, the interval between screen detection and when a disease would have become clinically evident, has been cited to explain longer survival times in mammography detected breast cancer cases (BC). Methods: An institutional retrospective cohort study of BC outcomes related to detection method (mammography (MamD) vs. patient (PtD)). Cases were first primary invasive stage I-III BC, age 40-74 years (n = 6603), 1999-2016. Survival time was divided into 1) distant disease-free interval (DDFI) and 2) distant disease-specific survival (DDSS) as two separate time interval outcomes. We measured statistical association between detection method and diagnostic, treatment and outcome variables using bivariate comparisons, Cox proportional hazards analyses and mean comparisons. Outcomes were distant recurrence (n=422), DDFI and DDSS. Results: 39% of cases were PtD (n = 2566) and 61% were MamD (n = 4037). MamD cases had a higher percentage of Stage I tumors [MamD 69% stage I vs. PtD 31%, p<.001]. Rate of distant recurrence was 11% among PtD BC cases (n=289) vs. 3% of MamD (n=133) (p<.001). Order of factor entry into the distant recurrence time interval (DDFI) model was 1) TNM stage (p<.001), 2) HR/HER2 status (p<.001), 3) histologic grade (p=.005) and 4) detection method (p<.001). Unadjusted PtD DDFI mean time was 4.34 years and MamD 5.52 years (p<.001) however when stratified by stage, the most significant factor relative to distant recurrence, there was no significant difference between PtD and MamD BC. Distant disease specific survival time did not differ by detection method.Conclusion: We observed breast cancer survival differential lead time to be a function of stage at diagnosis and tumor characteristics with marginal contribution of detection method. Patient and mammography detected breast cancer time to distant recurrence did not differ stratified by stage indicating survival difference is more likely related to early diagnosis than lead time bias. Lead time bias associated with breast cancer detection method appears to have marginal influence on survival in the current diagnostic and treatment era.

scholarly journals Lead Time Bias as a Factor in Mammography Detected Invasive Breast Cancer Survival in an Institutional Cohort

2020 ◽  
Author(s):  
Henry G. Kaplan ◽  
Judith Malmgren ◽  
Mary K. Atwood
Keyword(s):  
Breast Cancer ◽  
Lead Time ◽  
Cancer Survival ◽  
Detection Method ◽  
Distant Recurrence ◽  
Breast Cancer Survival ◽  
Stage I ◽  
Time Interval ◽  
Distant Disease ◽  
Lead Time Bias

Abstract Background: Lead time, the interval between screen detection and when a disease would have become clinically evident, is commonly cited to explain longer survival times in mammography detected breast cancer cases (BC). Methods: An institutional retrospective cohort study of BC outcomes related to detection method (mammography (MamD) vs. patient (PtD)). Cases were first primary invasive stage I-III BC, age 40-74 years (n = 6603), 1999-2016. Survival time was divided into 1) distant disease-free interval (DDFI) and 2) distant disease-specific survival (DDSS) as two separate time interval outcomes. We measured statistical association between detection method and diagnostic, treatment and outcome variables using bivariate comparisons, Cox proportional hazards analyses and mean comparisons. Outcomes were distant recurrence (n=422), DDFI and DDSS. Results: 39% of cases were PtD (n = 2566) and 61% were MamD (n = 4037). MamD cases had a higher percentage of Stage I tumors [MamD 69% stage I vs. PtD 31%, p<.001]. Rate of distant recurrence was 11% among PtD BC cases (n=289) vs. 3% of MamD (n=133) (p<.001). Order of factor entry into the distant recurrence time interval (DDFI) model was 1) TNM stage (p<.001), 2) HR/HER2 status (p<.001), 3) histologic grade (p=.005) and 4) detection method (p<.001). Unadjusted PtD DDFI mean time was 4.34 years and MamD 5.52 years (p<.001) however when stratified by stage, the most significant factor relative to distant recurrence, there was no significant difference between PtD and MamD BC. Distant disease specific survival time did not differ by detection method.Conclusion: We observed breast cancer survival differential lead time to be a function of stage at diagnosis and tumor characteristics with marginal contribution of detection method. Patient and mammography detected breast cancer time to distant recurrence did not differ stratified by stage indicating survival difference is more likely related to early diagnosis than lead time bias. Lead time bias associated with breast cancer detection method appears to have marginal influence on survival in the current diagnostic and treatment era.

scholarly journals Breast Cancer Distant Recurrence Lead Time Interval by Detection Method in an Institutional Cohort

2020 ◽  
Author(s):  
Henry G. Kaplan ◽  
Judith Malmgren ◽  
Mary K. Atwood
Keyword(s):  
Breast Cancer ◽  
Lead Time ◽  
Detection Method ◽  
Distant Recurrence ◽  
Stage I ◽  
Time Interval ◽  
Disease Specific Survival ◽  
Distant Disease ◽  
Disease Free ◽  
Disease Specific

Abstract Background: Lead time, the interval between screen detection and when a disease would have become clinically evident, has been cited to explain longer survival times in mammography detected breast cancer cases (BC). Methods: An institutional retrospective cohort study of BC outcomes related to detection method (mammography (MamD) vs. patient (PtD)). Cases were first primary invasive stage I-III BC, age 40-74 years (n = 6603), 1999-2016. Survival time was divided into 1) distant disease-free interval (DDFI) and 2) distant disease-specific survival (DDSS) as two separate time interval outcomes. We measured statistical association between detection method and diagnostic, treatment and outcome variables using bivariate comparisons, Cox proportional hazards analyses and mean comparisons. Outcomes were distant recurrence (n=422), DDFI and DDSS.Results: 39% of cases were PtD (n = 2566) and 61% were MamD (n = 4037). MamD cases had a higher percentage of Stage I tumors [MamD 69% stage I vs. PtD 31%, p<.001]. Rate of distant recurrence was 11% among PtD BC cases (n=289) vs. 3% of MamD (n=133) (p<.001). Order of factor entry into the distant recurrence time interval (DDFI) model was 1) TNM stage (p<.001), 2) HR/HER2 status (p<.001), 3) histologic grade (p=.005) and 4) detection method (p<.001). Unadjusted PtD DDFI mean time was 4.34 years and MamD 5.52 years (p<.001), however when stratified by stage, the most significant factor relative to distant recurrence, there was no significant difference between PtD and MamD BC. Distant disease specific survival time did not differ by detection method.Conclusion: We observed breast cancer distant disease-free interval to be primarily associated with stage at diagnosis and tumor characteristics with less contribution of detection method to the full model. Patient and mammography detected breast cancer mean lead time to distant recurrence differed significantly by detection method for all stages but not significantly within stage with no difference in time from distant recurrence to death. Lead time difference related to detection method appears to be present but may be less influential than other factors in distant disease-free and disease specific survival.

scholarly journals Breast cancer distant recurrence lead time interval by detection method in an institutional cohort

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Henry G. Kaplan ◽  
Judith A. Malmgren ◽  
Mary K. Atwood
Keyword(s):  
Breast Cancer ◽  
Lead Time ◽  
Detection Method ◽  
Distant Recurrence ◽  
Stage I ◽  
Time Interval ◽  
Disease Specific Survival ◽  
Distant Disease ◽  
Disease Free ◽  
Disease Specific

Abstract Background Lead time, the interval between screen detection and when a disease would have become clinically evident, has been cited to explain longer survival times in mammography detected breast cancer cases (BC). Methods An institutional retrospective cohort study of BC outcomes related to detection method (mammography (MamD) vs. patient (PtD)). Cases were first primary invasive stage I-III BC, age 40–74 years (n = 6603), 1999–2016. Survival time was divided into 1) distant disease-free interval (DDFI) and 2) distant disease-specific survival (DDSS) as two separate time interval outcomes. We measured statistical association between detection method and diagnostic, treatment and outcome variables using bivariate comparisons, Cox proportional hazards analyses and mean comparisons. Outcomes were distant recurrence (n = 422), DDFI and DDSS. Results 39% of cases were PtD (n = 2566) and 61% were MamD (n = 4037). MamD cases had a higher percentage of Stage I tumors [MamD 69% stage I vs. PtD 31%, p < .001]. Rate of distant recurrence was 11% among PtD BC cases (n = 289) vs. 3% of MamD (n = 133) (p < .001). Order of factor entry into the distant recurrence time interval (DDFI) model was 1) TNM stage (p < .001), 2) HR/HER2 status (p < .001), 3) histologic grade (p = .005) and 4) detection method (p < .001). Unadjusted PtD DDFI mean time was 4.34 years and MamD 5.52 years (p < .001), however when stratified by stage, the most significant factor relative to distant recurrence, there was no significant difference between PtD and MamD BC. Distant disease specific survival time did not differ by detection method. Conclusion We observed breast cancer distant disease-free interval to be primarily associated with stage at diagnosis and tumor characteristics with less contribution of detection method to the full model. Patient and mammography detected breast cancer mean lead time to distant recurrence differed significantly by detection method for all stages but not significantly within stage with no difference in time from distant recurrence to death. Lead time difference related to detection method appears to be present but may be less influential than other factors in distant disease-free and disease specific survival.

Sarah’s Choice

2013 ◽  
Vol 3 (1) ◽  
pp. 33-48
Author(s):  
Amy Price
Keyword(s):  
Breast Cancer ◽  
False Positive ◽  
Lead Time ◽  
Cancer Survival ◽  
Survival Rates ◽  
Breast Cancer Survival ◽  
Lead Time Bias ◽  
Screening Mammograms

The utility of screening mammograms is debated amidst reviews of lead-time bias and high false positive rates. Medical communities are highly invested with equipment and labor to fulfill screening mandates. It is an emotive topic, as 1 in 12 women will be diagnosed with breast cancer. Survival rates are rising but still death from breast cancer is tragic and painful. It is against this backdrop the author assists Sarah (pseudo-name), who is a 39 year old woman make a choice about mammogram screening.

scholarly journals Breast Cancer Survival in the Mammography Era in Brazil: A Population-Based Analysis of 2,715 Cases

2021 ◽  
Author(s):  
Juliana Fernandes ◽  
Beatriz Machado ◽  
Cassio Cardoso-Filho ◽  
Juliana Nativio ◽  
Cesar Cabello ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survival ◽  
Survival Rates ◽  
Population Based ◽  
Breast Cancer Survival ◽  
Stage I ◽  
Current Status ◽  
Breast Cancers ◽  
Risk Of Death ◽  
Significant Difference

Abstract Background This study aims to assess breast cancer survival rates after one decade of mammography in a large urban area of Brazil. Methods It is a population-based retrospective cohort of women with breast cancer in Campinas, São Paulo, from 2010 to 2014. Age, vital status and stage were accessed through the cancer and mortality registry, and patients records. Statistics used Kaplan-Meier, log-rank and Cox's regression. Results Out of the 2,715 cases, 665 deaths (24.5%) were confirmed until early 2020. The mean age at diagnosis was 58.6 years. Women 50-69 years were 48.0%, and stage I the most frequent (25.0%). The overall mean survival was 8.4 years (8.2-8.5). The 5-year survival (5yOS) for overall, 40-49, 50-59, 60-69, 70-79 years was respectively 80.5%, 87.7%, 83.7%, 83.8% and 75.5%. The 5yOS for stages 0, I, II, III and IV was 95.2%, 92.6%, 89.4%, 71.1% and 47.1%. There was no significant difference in survival in stage I or II (p=0.058). Compared to women 50-59 years, death's risk was 2.3 times higher for women 70-79 years and 26% lower for women 40-49 years. Concerning stage I, the risk of death was 1.5, 4.1 and 8.6 times higher, and 34% lower, respectively, for stage II, III, IV and 0. Conclusions In Brazil, breast cancers are currently diagnosed in the early stages, although advanced cases persist. Survival rates may reflect improvements in screening, early detection and treatment. The results can reflect the current status of other regions or countries with similar health care conditions.

S-phase fraction is a prognostic factor in stage I breast carcinoma.

1993 ◽  
Vol 11 (9) ◽  
pp. 1717-1722 ◽  
Author(s):  
O Stål ◽  
M Dufmats ◽  
T Hatschek ◽  
J Carstensen ◽  
C Klintenberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Carcinoma ◽  
Dna Content ◽  
Cancer Survival ◽  
Prognostic Significance ◽  
Breast Cancer Survival ◽  
S Phase ◽  
Stage I ◽  
Phase Fraction ◽  
Breast Cancer Patients

PURPOSE AND METHODS The prognostic significance of cell proliferation, estimated as cytometric S-phase fraction (SPF), was investigated in node-negative breast cancer patients with small tumors (T1, NO). The 219 stage I patients originated from two series and were diagnosed either from 1978 to 1981 or from 1981 to 1985. The tumors were analyzed for estrogen receptors (ERs) by isoelectric focusing and for cellular DNA content by static cytofluorometry or flow cytometry. RESULTS A high SPF correlated with the absence of ERs and abnormal DNA content, and was less often found in tumors smaller than 11 mm compared with those with a diameter between 11 and 20 mm. Among the variables age, tumor size, DNA ploidy, ER status, and SPF, only SPF showed a significant association with distant recurrence and breast cancer survival in systemically untreated patients. The relative recurrence rate for patients with an SPF of 10% or greater was three times that for patients with lower SPFs. Estimated 8-year breast cancer survival rates for the same groups were 72% and 91%, respectively. CONCLUSION This study suggests that cytometric SPF has prognostic significance in stage I breast carcinoma.

Mortgage discrimination and breast cancer survival among older women in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13615-e13615
Author(s):  
Kirsten M. M. Beyer ◽  
Yuhong M. Zhou ◽  
Purushottam W. Laud ◽  
Emily McGinley ◽  
Tina W.F. Yen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Cancer Survival ◽  
The United States ◽  
Breast Cancer Survival ◽  
Stage I ◽  
Outcome Variable ◽  
Home Mortgage Disclosure Act ◽  
All Cause Mortality ◽  
Mortgage Discrimination

e13615 Background: Although racism and racial residential segregation are widely considered to contribute to health disparities, including in breast cancer, studies examining the impact of mortgage discrimination, a factor contributing to residential racial segregation, and breast cancer survival are limited. The objective of this study is to examine the relationship between redlining (mortgage discrimination based on property location) and survival among older women with breast cancer. Methods: Using the Home Mortgage Disclosure Act (HMDA) database, we estimated redlining for all census tracts in the Metropolitan Statistical Areas (MSAs) within 15 Surveillance Epidemiology and End Results (SEER) areas. This measure was linked by tract with a SEER-Medicare cohort of 27,516 women aged 66-90 years with an incident stage I-IV breast cancer in 2007-2009 and claims information through 2014. We used cox proportional hazards regression models with survival time as the outcome variable and a 4-level categorical logged redlining variable as the key predictor. We also modeled the hazard ratio using redlining as a continuous variable. Models were stratified by stage, ER/PR status, and age group and adjusted for comorbidity and MSA-level standard error. Results: At a median follow-up of 72 months, one-third of the cohort was deceased. The majority of the cohort had no comorbidities and had hormone receptor-positive, early stage (I/II) cancers. Redlining was associated with poorer survival. When redlining is discretized into four groups with approximate equal-sized intervals, the first and second highest redlining groups are significantly associated with all-cause mortality (HR = 1.226 [1.108, 1.355] for the highest group; HR = 1.159 [1.095, 1.228] for the second highest group). When redlining and its quadratic terms are included in the model, the original and square terms are significantly associated with all-cause mortality (HR = 1.177 [1.111, 1.248] for redlining; HR = 0.982 [0.973, 0.991] for squared redlining). Conclusions: The study suggests that redlining could negatively contribute to breast cancer survival. Persistent place-based mortgage discrimination, as a manifestation of institutional racism, could have long-term effects on people’s health, possibly by impacting health care access or exposing residents to harmful neighborhood conditions. Housing policies that seek to reduce or eliminate place-based mortgage discrimination could contribute to reducing breast cancer survival disparities.

scholarly journals Role of Detection Method in Predicting Breast Cancer Survival: Analysis of Randomized Screening Trials

2005 ◽  
Vol 97 (16) ◽  
pp. 1195-1203 ◽  
Author(s):  
Yu Shen ◽  
Ying Yang ◽  
Lurdes Y. T. Inoue ◽  
Mark F. Munsell ◽  
Anthony B. Miller ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Survival Analysis ◽  
Cancer Survival ◽  
Detection Method ◽  
Breast Cancer Survival ◽  
Screening Trials

Evaluation of the Overall 5-Year Survival of Breast Cancer at INO: Data from the 5-Year Prospective Database

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 23-23
Author(s):  
NA Kaddi ◽  
NA Berrada ◽  
HA Errihani
Keyword(s):  
Breast Cancer ◽  
Cancer Survival ◽  
Metastatic Cancer ◽  
Stage Iv ◽  
Breast Cancer Survival ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Rank Test ◽  
Her2 Positive

Background: Breast cancer is both the most common and deadliest cancer among women in the world. The objective of this study was to assess breast cancer survival rates. Material and Methods: Prospective study conducted at the National Institute of oncology (INO) Sidi Mohamed Ben Abdellah Rabat .diagnosed patients with cancer from 2013 to 2015. The date of inclusion in the study is the date of histological confirmation of cancer. The survival assessment performed by the Kaplan Meier method, and the comparison between the different classes of a variable was performed by the Log Rank test. Results: 931 cases were collected during this study. According to molecular classification 59% of luminal patients, 25% positive human epidermal growth factor receptors (her2 positive) and 16% basal. The percentage of survival at 5 years, for luminal stage I 93%, stage II 92%, stage III 74% and stage IV 25% ;as well as for basal stage I 92%, stage II 80%, stage III 53% and stage IV 10% ; then the her2 positive stage I 100%, stage II 75% and stage III 70%. Conclusion: The discovery of metastatic cancer decreased breast cancer survival rate, hence the importance of Early Detection Awareness.

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