Sarah’s Choice

2013 ◽  
Vol 3 (1) ◽  
pp. 33-48
Author(s):  
Amy Price

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.

2020 ◽  
Author(s):  
Henry G. Kaplan ◽  
Judith Malmgren ◽  
Mary K. Atwood

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.


2020 ◽  
Author(s):  
Henry G. Kaplan ◽  
Judith Malmgren ◽  
Mary K. Atwood

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.


2005 ◽  
Vol 15 (8) ◽  
pp. 634-634
Author(s):  
S CHUANG ◽  
W CHEN ◽  
M HASHIBE ◽  
G LI ◽  
P GANZ ◽  
...  

2021 ◽  
Author(s):  
Juliana Fernandes ◽  
Beatriz Machado ◽  
Cassio Cardoso-Filho ◽  
Juliana Nativio ◽  
Cesar Cabello ◽  
...  

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.


2019 ◽  
Author(s):  
Paddy Ssentongo ◽  
Joseph A. Lewcun ◽  
Xavier Candela ◽  
Anna E. Ssentongo ◽  
Eustina G. Kwon ◽  
...  

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