Surgical Pathology–Based Outcomes Assessment of Breast Cancer Early Diagnosis

2001 ◽  
Vol 125 (3) ◽  
pp. 325-331
Author(s):  
Raouf E. Nakhleh ◽  
Richard J. Zarbo
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
The United States ◽  
Surgical Pathology ◽  
Detection Methods ◽  
Mortality Data ◽  
Breast Cancers ◽  
Improvement Program ◽  
Clinical Method

Abstract Objective.—To develop breast cancer outcomes data relating pathologic tumor variables at diagnosis with clinical method of detection. Design.—Anatomic pathologists assessed 30 consecutive breast cancers at each institution, resulting in an aggregate database of 4232 breast cancers. Setting.—Hospital-based laboratories from the United States (98%), Canada, Australia, and Belgium. Participants.—One hundred ninety-nine laboratories in the 1999 College of American Pathologists Q-Probes voluntary quality improvement program. Main Outcome Measures.—Pathologic variables indicative of favorable outcomes included percentage of carcinomas detected at the in situ stage, tumors ≤1 cm in diameter, and invasive cancers with lymph nodes negative for metastases. Results.—All outcomes measures, including percent in situ carcinomas (26.9% vs 13.8%), tumor size ≤1 cm (57.8% vs 36.5%), and lymph node–negative status (77.8% vs 64%), were more favorable when tumors were detected by screening mammography (P < .001) compared to all other detection methods. Conclusions.—This study demonstrates an opportunity for pathologists to develop outcomes information of interest to health care organizations, providers, patients, and payers by integrating routine oncologic surgical pathology and clinical breast cancer detection data. Such readily obtained interim outcomes data trended and benchmarked over time can demonstrate the relative clinical efficacy of preventive breast care provided by health care systems long before mortality data are available.

Ductal Carcinoma In Situ: Challenges, Opportunities, and Uncharted Waters

2012 ◽  
pp. 40-44 ◽  
Author(s):  
Abigail W. Hoffman ◽  
Catherine Ibarra-Drendall ◽  
Virginia Espina ◽  
Lance Liotta ◽  
Victoria Seewaldt
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
The United States ◽  
Targeted Prevention ◽  
Breast Cancers ◽  
Increased Risk

Overview: Ductal carcinoma in situ (DCIS) is a heterogeneous group of diseases that differ in biology and clinical behavior. Until 1980, DCIS represented less than 1% of all breast cancer cases. With the increased utilization of mammography, DCIS now accounts for 15% to 25% of newly diagnosed breast cancer cases in the United States. Although our ability to detect DCIS has radically improved, our understanding of the pathophysiology and factors involved in its progression to invasive carcinoma is still poorly defined. In many patients, DCIS will never progress to invasive breast cancer and these women are overtreated. In contrast, some DCIS cases are clinically aggressive and the women may be undertreated. We are able to define some of the predictors of aggressive DCIS compared with DCIS of low malignant potential. However, our ability to risk-stratify DCIS is still in its infancy. Clinical risk factors that predict aggressive disease and increased risk of local recurrence include young age at diagnosis, large lesion size, high nuclear grade, comedo necrosis, and involved margins. Treatment factors such as wider surgical margins and radiation therapy reduce the risk of local recurrence. DCIS represents a key intermediate in the stepwise progression to malignancy, but not all aggressive breast cancers appear to have a DCIS intermediate, notably within triple-negative breast cancer. Ongoing studies of the genetic and epigenetic alterations in precancerous breast lesions (atypia and DCIS) as well as the breast microenvironment are important for developing effective early detection and individualized targeted prevention.

scholarly journals Use of Mastectomy for Overdiagnosed Breast Cancer in the United States: Analysis of the SEER 9 Cancer Registries

2019 ◽  
Vol 2019 ◽  
pp. 1-14
Author(s):  
C. Harding ◽  
F. Pompei ◽  
D. Burmistrov ◽  
R. Wilson
Keyword(s):  
Breast Cancer ◽  
Cancer Registries ◽  
The United States ◽  
Breast Cancers ◽  
The Us ◽  
Study Population ◽  
Cancer Types ◽  
Surgical Treatments ◽  
Case Characteristics

Aim. We investigated use of mastectomy as treatment for early breast cancer in the US and applied the resulting information to estimate the minimum and maximum rates at which mastectomy could plausibly be undergone by patients with overdiagnosed breast cancer. Little is currently known about overtreatments undergone by overdiagnosed patients. Methods. In the US, screening is often recommended at ages ≥40. The study population was women age ≥40 diagnosed with breast cancer in the US SEER 9 cancer registries during 2013 (n=26,017). We evaluated first-course surgical treatments and their associations with case characteristics. Additionally, a model was developed to estimate probability of mastectomy conditional on observed case characteristics. The model was then applied to evaluate possible rates of mastectomy in overdiagnosed patients. To obtain minimum and maximum plausible rates of this overtreatment, we respectively assumed the cases that were least and most likely to be treated by mastectomy had been overdiagnosed. Results. Of women diagnosed with breast cancer at age ≥40 in 2013, 33.8% received mastectomy. Mastectomy was common for most investigated breast cancer types, including for the early breast cancers among which overdiagnosis is thought to be most widespread: mastectomy was undergone in 26.4% of in situ and 28.0% of AJCC stage-I cases. These rates are substantively higher than in many European nations. The probability-based model indicated that between >0% and <18% of the study population could plausibly have undergone mastectomy for overdiagnosed cancer. This range reduced depending on the overdiagnosis rate, shrinking to >0% and <7% if 10% of breast cancers were overdiagnosed and >3% and <15% if 30% were overdiagnosed. Conclusions. Screening-associated overtreatment by mastectomy is considerably less common than overdiagnosis itself but should not be assumed to be negligible. Screening can prompt or prevent mastectomy, and the balance of this harm-benefit tradeoff is currently unclear.

Necessity of Clinical Information in Surgical Pathology

1999 ◽  
Vol 123 (7) ◽  
pp. 615-619 ◽  
Author(s):  
Raouf E. Nakhleh ◽  
Gordon Gephardt ◽  
Richard J. Zarbo
Keyword(s):  
Clinical Data ◽  
Clinical Information ◽  
The United States ◽  
Surgical Pathology ◽  
Lower Percentage ◽  
Malignant Neoplasms ◽  
Anatomic Site ◽  
Improvement Program ◽  
Additional Information ◽  
Inadequate Information

Abstract Objectives.—To examine the frequency and nature of problems caused by inadequate clinical data provided on surgical pathology requisition forms. Design.—Participants in the 1996 Q-Probes voluntary quality improvement program of the College of American Pathologists were asked to document prospectively all surgical pathology cases with inadequate information. Inadequate clinical information was defined as the pathologist's need for additional clinical information before a diagnosis could be rendered, regardless of the amount of information already present on the requisition slip. Cases that had no clinical information on a requisition slip were not counted if the lack of history did not hinder diagnosis. The study concluded when 3 months had elapsed or 40 surgical pathology cases were documented. The following data were recorded for each case: anatomic site, type of procedure, nature of disease, method of obtaining additional information, importance of obtained information, and the length of delay in the final diagnosis. Participants.—Three hundred forty-one laboratories, 322 of which were from the United States. Results.—A total of 5594 cases (0.73%) required additional clinical information for diagnosis (10th through 90th percentile range, 3.01% to 0.08%). Institutions with greater average occupied bedsize, a greater number of cases accessioned per year, and a greater number of pathologists had a lower percentage of cases with inadequate clinical data (P &lt; .05). Sixty-eight percent of these cases had no delay in completion of a case, 16.2% had a delay of 1 day or less, and 15.1% of cases were delayed more than 1 day. In 59.4% of cases, the additional clinical information obtained confirmed the initial diagnostic impression. In 25.1%, the information was not relevant to the pathologic diagnosis. In 6.1% there was a substantial change in the diagnosis or a revised report was issued, and in 2.2% no additional information could be obtained. Specific anatomic sites that correlated with a higher rate of changed diagnoses or revised reports in cases with inadequate information included the small bowel, the bronchus/lung, and the ovary. Resection specimens were also significantly associated with a higher rate of changed diagnoses or revised reports when additional information was obtained, as were malignant neoplasms and therapy-induced changes. Conclusions.—This study establishes an aggregate rate of cases with inadequate clinical information for diagnosis (0.73%) and documents the extent of problems caused by inadequate clinical information. The criticality of appropriate clinical information provided to the pathologist is identified for specific anatomic sites and disease processes and is reflected in changed diagnoses or revised reports.

GIS, Spatial Analysis, and Modeling

2019 ◽  
pp. 1284-1297
Author(s):  
Khadijeh Rouzbehani ◽  
Ghazaleh Sajjadi ◽  
Mohamad Rahim Hatami
Keyword(s):  
Breast Cancer ◽  
United States ◽  
At Risk ◽  
The United States ◽  
Background Information ◽  
Health Related Research ◽  
Health Related ◽  
Physical Environmental Factors ◽  
International Strategies

Breast cancer is a major health issue in all countries affecting thousands of women. Its causes are unknown and the national and international strategies to reduce its morbidity and mortality levels are based on early detection of cancer through screening and treatment according to clinical guidelines. Thus, knowledge of which women are at risk and why they are at risk is therefore essential component of disease prevention and screening. In 2015, an estimated 231,840 new cases of invasive breast cancer are expected to be diagnosed in women in the United States, along with 60,290 new cases of non-invasive (in situ) breast cancer. The purpose of this study is to provide a more detailed analysis of the breast cancer distribution in the United States by comparing the spatial distribution of breast cancer cases against physical environmental factors using Geographic Information System (GIS). Further, it gives background information to the GIS and its applications in health-related research.

GIS, Spatial Analysis, and Modeling

2017 ◽  
pp. 16-29
Author(s):  
Khadijeh Rouzbehani ◽  
Ghazaleh Sajjadi ◽  
Mohamad Rahim Hatami
Keyword(s):  
Breast Cancer ◽  
United States ◽  
At Risk ◽  
The United States ◽  
Background Information ◽  
Health Related Research ◽  
Health Related ◽  
Physical Environmental Factors ◽  
International Strategies

Breast cancer is a major health issue in all countries affecting thousands of women. Its causes are unknown and the national and international strategies to reduce its morbidity and mortality levels are based on early detection of cancer through screening and treatment according to clinical guidelines. Thus, knowledge of which women are at risk and why they are at risk is therefore essential component of disease prevention and screening. In 2015, an estimated 231,840 new cases of invasive breast cancer are expected to be diagnosed in women in the United States, along with 60,290 new cases of non-invasive (in situ) breast cancer. The purpose of this study is to provide a more detailed analysis of the breast cancer distribution in the United States by comparing the spatial distribution of breast cancer cases against physical environmental factors using Geographic Information System (GIS). Further, it gives background information to the GIS and its applications in health-related research.

Breast Cancer in Latin America: A Map of the Disease in the Region

2018 ◽  
pp. 451-456 ◽  
Author(s):  
Eduardo Cazap
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Latin America ◽  
Urban Areas ◽  
Access To Health Care ◽  
Cancer Control ◽  
Public Health Problem ◽  
The United States ◽  
High Morbidity ◽  
Patient Organizations

In the next few decades, breast cancer will become a leading global public health problem as it increases disproportionately in low- and middle-income countries. Disparities are clear when comparisons are made with rates in Europe and the United States, but they also exist between the countries of the region or even within the same country in Latin America. Large cities or urban areas have better access and resource availability than small towns or remote zones. This article presents the status of the disease across 12 years with data obtained through three studies performed in 2006, 2010, and 2013 and based on surveys, reviews of literature, patient organizations, and public databases. The first study provided a general picture of breast cancer control in the region (Latin America); the second compared expert perceptions with medical care standards; and the third was a review of literature and public databases together with surveys of breast cancer experts and patient organizations. We conclude that breast cancer is the most frequent cancer and kills more women than any other cancer; we also suggest that aging is the principal risk factor, which will drive the incidence to epidemic levels as a result of demographic transition in Latin America. The economic burden also is large and can be clearly observed: in countries that today allocate insufficient resources, women go undiagnosed or uncared for or receive treatment with suboptimal therapies, all of which results in high morbidity and the associated societal costs. The vast inequities in access to health care in countries translates into unequal results in outcomes. National cancer control plans are the fundamental building block to an organized governance, financing, and delivery of health care for breast cancer.

scholarly journals Declining Incidence of Contralateral Breast Cancer in the United States From 1975 to 2006

2011 ◽  
Vol 29 (12) ◽  
pp. 1564-1569 ◽  
Author(s):  
Hazel B. Nichols ◽  
Amy Berrington de González ◽  
James V. Lacey ◽  
Philip S. Rosenberg ◽  
William F. Anderson
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Contralateral Breast Cancer ◽  
Temporal Trends ◽  
The United States ◽  
Incidence Rates ◽  
Contralateral Breast ◽  
Breast Cancers ◽  
Annual Percent Change ◽  
Er Positive

Purpose Contralateral breast cancer (CBC) is the most frequent new malignancy among women diagnosed with a first breast cancer. Although temporal trends for first breast cancers have been well studied, trends for CBC are not so well established. Patients and Methods We examined temporal trends in CBC incidence using US Surveillance, Epidemiology, and End Results database (1975 to 2006). Data were stratified by estrogen receptor (ER) status of the first breast cancer for the available time period (1990+). We estimated the annual percent change (EAPC) in CBC rates using Poisson regression models adjusted for the age at and time since first breast cancer diagnosis. Results Before 1985, CBC incidence rates were stable (EAPC, 0.27% per year; 95% CI, −0.4 to 0.9), after which they declined with an EAPC of −3.07% per year (95% CI, −3.5 to −2.7). From 1990 forward, the declines were restricted to CBC after an ER-positive cancer (EAPC, −3.18%; 95% CI, −4.2 to −2.2) with no clear decreases after an ER-negative cancer. Estimated current age-specific CBC rates (per 100/year) after an ER-positive first cancer were: 0.45 for first cancers diagnosed before age 30 years and 0.25 to 0.37 for age 30 years or older. Rates after an ER-negative cancer were higher: 1.26 before age 30 years, 0.85 for age 30 to 35 years, and 0.45 to 0.65 for age 40 or older. Conclusion Results show a favorable decrease of 3% per year for CBC incidence in the United States since 1985. This overall trend was driven by declining CBC rates after an ER-positive cancer, possibly because of the widespread usage of adjuvant hormone therapies, after the results of the Nolvadex Adjuvant Trial Organisation were published in 1983, and/or other adjuvant treatments.

Breast Cancer

2017 ◽  
Author(s):  
Louise A. Brinton ◽  
Mia M. Gaudet ◽  
Gretchen L. Gierach
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Risk Factors ◽  
Cellular Proliferation ◽  
Breast Cancer Incidence ◽  
Ovarian Hormones ◽  
The United States ◽  
Cumulative Exposure ◽  
Breast Cancers ◽  
Newly Diagnosed

Breast cancer is the most frequently diagnosed cancer in women worldwide, with annual estimates of 1.7 million newly diagnosed cases and 522,000 deaths. Although more breast cancers are diagnosed in economically developed than in developing countries, the reverse is true for mortality, reflecting limited screening and less effective treatments in the latter. Breast cancer incidence has been on the rise in the United States for many years, but in recent years this is restricted to certain subgroups, while internationally there have been continued generalized increases, likely reflecting adoption of more Westernized lifestyles. Breast cancer is widely recognized as being hormonally influenced, with most of the established risk factors believed to reflect the influence of cumulative exposure of the breast to stimulatory effects of ovarian hormones—leading to increased cellular proliferation, which in turn can result in genetic errors during cell division.

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