DOCSLIB.ORG

Meta-Analysis on the Diagnostics Accuracy of Different Breast Cancer Screening Modalities in Low and High Risk of Breast Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Meta-Analysis on the Diagnostics Accuracy of Different Breast Cancer Screening Modalities in Low and High Risk of Breast Cancer META-ANALYSIS ON THE DIAGNOSTICS ACCURACY OF DIFFERENT BREAST CANCER SCREENING MODALITIES IN LOW AND HIGH RISK OF BREAST CANCER Akriti Chahar, Mohammad Zoheb, Shashwat Sharma, Mohammad Ameel, Ajai Basil, Anjaney, Vigneshwaran, SB Sinha Division of Healthcare Technology National Health Systems Resource Centre (NHSRC), New Delhi BACKGROUND ¨ Breast cancer is the most commonly occurring cancer among females in the world (American Cancer Society). ¨ Estimated 627,000 women died from breast cancer in 2018 (WHO, 2018). ¨ Annual incidence of breast cancer is approximately 1,44,000 making it most commonly occurring cancer in females in India (WHO, 2012). Screening Modality: ¨ Mammography - X ray technique that captures the image of the breast on an x – ray film. ¨ Clinical Breast Examination – Clinical Examination of breast by a trained Healthcare professional to detect any lumps or warning signs of breast cancer. ¨ Breast Ultrasound – Uses sound waves to produce images of the breast. ¨ Magnetic Resonance Imaging – An imaging technique in radiology. Used to visualize internal structures in detail by using magnetic radiation. ¨ Piezoelectric finger – Works on the technique of piezoelectric palpitation to enhance the Clinical Breast Examination Objective To assess diagnostic accuracy of different screening modalities in women at low and high risk of breast cancer. PICO • Population: Women • Intervention: CBE, Mammography, MRI, Piezoelectric finger, Ultrasonography • Comparator: No screening • Outcome: Diagnostic Accuracy PRISMA Flowchart Summary of characterstics of the included studies S.N Author, Year Country, No. Women Mean Study Population of o of sites (completed Age, Design Interest screening) Years (Range) 1. Broach, 2016 USA 78 42 (21-79) Prospective Adult patients cohort study presenting for diagnostic work up 2. Kuhl, 2005 Germany 529 41.7 (27 – 59) Prospective Lifetime risk> 20 % observational based on family history cohort study 3. Ozulker, 2010 Turkey 46 46.1 ± 13.31 Prospective Women with suspicious (22 – 82) cohort study lesions detected in their breasts by palpitation, imaging modalities or clinically 4. Pediconi, Italy 238 47.5 ± 9.3 (16 – Retrospective Women with dense 2009 77) cohort study breast parenchyma who were suspicious for breast cancer Summary of characterstics of the included studies S.No Author, Year Country, Women Mean Age, Study Population of No. of sites (complete Years (Range) Design Interest d screens) 5. Riedl, 2016 Austria 559 Median 44 (22 Prospective * BRCA1 or BRCA2 – 83) non – mutation *Lifetime randomized risk>20 % comparison study 6. Schwarz, Germany 99 Median 50 (30 Prospective Patients underwent 2010 – 66) multicentre one or more breast trial imaging modalities before surgery in addition to clinical examination 7. Somashekhar, India 916 Women above Prospective Asymptomatic 2016 40 and under three arm women 40 triple blinded comparative study Summary of characterstics of the included studies S.No Author, Country, No. Women Mean Age, Study design Population of interest Year of sites (complete Years d screens) (Range) 8. Vassiou, Greece 69 53 (39 – 68) Prospective Women with focal breast 2008 comparative lesions study 9. Warner, Canada 236 46.6 (26.4 – Prospective Women with BRCA 1 or 2004 64.8) observational BRCA 2 mutations who study underwent 1 to 3 annual screening examination 10. Weinstei USA 609 Median 49 Prospective multi Asymptomatic high –risk n, 2009 – modality cohort women study 11. Malur, Germany 413 58 (19 – 85) Prospective Abnormal breast findings 2000 cohort study Summary of characterstics of the included studies S.No Author, Year Country, No of Women Mean Study Population of sites (completed Age, designs interest screens) Years (Range) 12. Huang, 2012 China 3028 25 years or Randomize Females seeking older d organized and controlled opportunistic trials screening women with existing untreated malignancies, known metastatic disease or psychiatric condition 13. Sankarnaraya India 50366 30 – 69 years Cluster Healthy women n, 2011 randomize aged 30 – 69 d years with no controlled history of breast trial cancer Methodological quality of the included studies – Risk bias and applicability concerns graph Fig: Risk of bias and applicability CLINICAL EFFECTIVENESS REVIEW Table: Diagnostic accuracy of single and combined screening modalities obtained from the results of systematic review and meta – analysis. Screening Positives Negatives Sensitivity Specificity Predictive value modalities (95 % CI) (95 % CI) True False True False Positive Negative (95 (95 % CI) % CI) Ultrasonography 379 357 6320 136 0.730 (0.657 – 0.946 (0.948 0.51 0.97 0.794) – 0.9444) Mammography 361 273 6356 144 0.715 (0.673 – 0.959 (0.954 0.56 0.97 0.754) – 0.963) MRI 438 346 3313 52 0.894 (0.863 - 0.905 (0.895 0.55 0.98 0.920) – 0.915) CBE 127 2881 5043 47 0.730 (0.657 – 0.946 (0.948 0.04 0.99 8 0.794) – 0.944) Piezoelectric 183 119 933 35 0.839 (0.784 – 0.887 (0.866 0.62 0.96 finger 0.886) – 0.905) MMG paralleled 130 226 2533 6 0.956 (0.906 – 0.918 (0.907 0.36 0.99 with MRI 0.984) – 0.928) MMG paralleled 119 285 5465 50 0.704 (0.629 – 0.950 (0.945 0.29 0.99 with USG 0.772) – 0.956) MRI paralleled 36 162 1163 4 0.90 (0.76 – 0.88 (0.86 – 0.18 0.99 with USG 0.97) 0.89) CLINICAL EFFECTIVENESS REVIEW Screening Positives Negatives Sensitivity Specificity Predictive value modalities (95 % CI) (95 % CI) True False True False Positive (95 Negative % CI) (95 % CI) CBE paralled 30 36 2959 3 0.91 0.99 0.90 0.99 by USG (0.76-0.98) (0.98 – 0.99) CBE followed 20 10 2985 13 0.61 (0.42 – 1.00 (0.99 – 0.66 0.99 by USG 0.77) 1.00) CBE followed 23 17 2978 10 0.70 (0.51 – 0.99 (0.99 – 0.57 1.03 by MMG 0.84) 1.00) USG paralleled 30 36 2959 3 0.91 (0.76 – 0.99 (0.98 – 0.90 0.99 with CBE 0.98) 0.99) MMG 28 60 5 2935 0.85 (0.68 – 0.98 (0.97 – 0.84 0.99 paralleled with 0.95) 0.98) CBE Sources: 1. WHO, Radhakrishnan et al, 2018 (Role of MRI in breast cancer management) & Broach RB 2016, (A cost effective handheld device breast scanner for use in low – resource environments). 2. Broach RB, Geha R, Englander BS, Delacruz L, Thrash H and Books AD (2016), A cost-effective handheld breast scanner for use in low – resource environments: a validation study, World Journal of Surgical Oncology 14:277, DOI 10.1186/s12957-016-1022-2 Health Technology Assessment of medical devices, WHO Medical Device Technical series 3. Kuhl CK, Schrading S, Leutner CC, Spitz NM, Wardelmann E, Fimmers R, Kuhn W and Schild HH (2005), Mammography, Breast Ultrasound, and Magnetic Resonance Imaging for Surveillance of Women at High Familial Risk for Breast Cancer, Journal of Clinical Oncology, DOI: 10.1200/JCO.2004.00.4960 4. Ozulker T, Ozulker F, Ozpacaci T, Bender O, Degirmenci H (2010), The efficacy of 99m Tc – MIBI scintimmammography in the evaluation of breast lesions and axillary involvement: a comparison with X – rays mammography, ultrasonography and magnetic resonance imaging, Hell J Nucl Med; 13 (2): 144 – 149 5. Pediconi F, Catalano C, Roselli A, Dominelli V, Cagioli S, Karatasiou A, Pronio AM, Kirchin MA and Passariello R (2009), The Challenge of Imaging Dense Breast Parenchyma, Is Magnetic Resonance Mammography the Technique of Choice? A Comparative study with X-Ray Mammography and Whole – Breast Ultrasound, Invest Radiol; 44: 412 – 421. 6. Riedl CC, Luft Nikolaus, Bernhart C, Weber M, Bernathova M, Tea M-K M, Rudas M, Singer CF and Helbich TH, Triple – Modality Screening Trial for Familial Breast Cancer Underlines the importance of Magnetic Resonance Imaging and Questions the Role of Mammography and Ultrasound Regardless of Patient Mutation Status, Age, and Breast Density, Journal of Clinical Oncology, Vol 33, No. 10, DOI: 10.1200/JCO.2014.56.8626 7. Schwarz JD, Tiling R, Sassen SA, Mahner S, Lebeau A, Weber C, (2010) Schwaiger M, Janicke F, Untch M and Avril N, Assessment of residual tumour by FDG- PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced breast cancer, British Journal of Cancer, 102, 35 -41.8. 8. Somashekhar SP, Vijay R, Ananthasivan R, Prasanna G (2016), Non-invasive and low – cost technique for early detection of clinically relevant breast lesions using a handheld point of care medical device (iBreast Exam): Prospective three – arm triple – blinded comparative study, Indian Journal of Gynecol Oncolog 14:26. 9. Vassiou K, Kanavou T, Vlychou M, Poultsidi A, Athanasiou E, Arvanitis DL and Fezoulidis IV (2009), Characterization of breast lesions with CE – MR multimodal morphological and kinetic analysis: Comparison with conventional mammography and high – resolution ultrasound, European Journal of Radiology 70, 69 – 76 Warner E, Plewes D.B, Hill K.A, Causer P.A, Zubovits J.T, Jong R.A, Cuturara M.R, Deboer G, Yaffe M.J, Messner SJ, Meschina WS, Piron CA and Narod SA (2004), Surveillance of BRCA1 and BRCA2 mutation carriers with Magnetic Resonance Imaging, Ultrasound, Mammography, and Clinical Breast Examination, JAMA, Vol 292, No. 11 10. Weinstein SP, Localto R, Conant EF, Rosen M, Thomas KM and Schnall M.D, (2009), Multimodality screening of high – risk women: A prospective cohort study, Vol 27. No. 36 11. Malur S, Wurdinger S, Moritz A, Michels W and Schneider A (2000), Comparison of written reports of mammography, sonography and magnetic resonance mammography for preoperative evaluation of breast lesions, with special emphasis on magnetic resonance mammography, Breast Cancer Res, 3:55 – 60 12. Huang Y, Kang M, Li H, Li J.Y, Zhang J.Y, Liu L.H, Liu X.T, Zhao Y, Wang Q, Li C.C and Lee H (2012), Combined performance of physical examination, mammography, and ultrasonography for breast cancer screening among Chinese women: a follow – up study, Curr Oncol, Vol 19, pp eS22-30.
Load more

Recommended publications
  • Breast Cancer: Management and Follow-Up
    Breast Cancer: Management and Follow-Up Effective Date: October 1, 2013 Scope This guideline provides recommendations for management and follow-up of biopsy-proven breast cancer in women aged ≥ 19 years. For diagnostic recommendations, please refer to BCGuidelines.ca - Breast Disease & Cancer: Diagnosis. Refer to Appendix A for the algorithms associated with these guidelines. Key Recommendations • Immediately refer patient to the appropriate specialist by telephone, as soon as a tissue diagnosis of cancer is made. • Surveillance for an asymptomatic patient is recommended with a physical examination and annual diagnostic mammography. • A patient should report any symptoms of concern (e.g., new lumps, bone pain, chest pain, persistent headaches, dyspnea, or abdominal pain) immediately to their family physician and/or oncologist. • No routine laboratory tests are indicated in an asymptomatic patient for surveillance. Management Indications for Referral to Specialist Surgeon: As soon as a patient has a confirmed tissue diagnosis of a malignant or atypical proliferative breast lesion, immediately refer the patient to surgeon by telephone. Where possible, refer to a surgeon with experience or special interest in the breast. If a mastectomy is planned, the surgeon may refer the patient to a plastic surgeon to discuss reconstructive options pre-surgery. Oncologist*: Referral to an oncologist is typically done by the surgeon post-surgery unless the patient wants a discussion with an oncologist prior to making a decision about surgery. GP can also help facilitate this referral process if indicated. Additional Considerations for Referral Fertility Specialist: A discussion about fertility preservation with women who have invasive cancer that may require chemotherapy and would like to have children should occur soon after diagnosis.
    [Show full text]
  • (NCCN Guidelines®) Breast Cancer
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Breast Cancer Version 4.2017 — February 7, 2018 NCCN.org NCCN Guidelines for Patients® available at www.nccn.org/patients Continue Version 4.2017, 02/07/18 National Comprehensive Cancer Network, Inc. 2018, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Anton Kabakov on 3/5/2018 6:44:49 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 4.2017 Panel Members NCCN Guidelines Index Table of Contents Breast Cancer Discussion * William J. Gradishar, MD/Chair ‡ † Sharon H. Giordano, MD, MPH † Lori J. Pierce, MD § Robert H. Lurie Comprehensive Cancer The University of Texas University of Michigan Center of Northwestern University MD Anderson Cancer Center Comprehensive Cancer Center * Benjamin O. Anderson, MD/Vice-Chair ¶ Matthew P. Goetz, MD ‡ † Elizabeth C. Reed, MD † ξ Fred Hutchinson Cancer Research Mayo Clinic Cancer Center Fred & Pamela Buffett Cancer Center Center/Seattle Cancer Care Alliance Lori J. Goldstein, MD † Kilian E. Salerno, MD § Ron Balassanian, MD ≠ Fox Chase Cancer Center Roswell Park Cancer Institute UCSF Helen Diller Family Comprehensive Cancer Center Steven J. Isakoff, MD, PhD † Lee S. Schwartzberg, MD ‡ † Massachusetts General Hospital St. Jude Children’s Research Hospital/ Sarah L. Blair, MD ¶ Cancer Center The University of Tennessee UC San Diego Moores Cancer Center Health Science Center Janice Lyons, MD § Harold J. Burstein, MD, PhD † Case Comprehensive Cancer Center/ Amy Sitapati, MD Þ Dana-Farber/Brigham and Women’s University Hospitals Seidman Cancer Center and UC San Diego Moores Cancer Center Cancer Center Cleveland Clinic Taussig Cancer Institute Karen Lisa Smith, MD, MPH † Amy Cyr, MD ¶ P.
    [Show full text]
  • Biomarkers Tests of Cancer Tissue
    This coverage guidance has been partially superseded by the coverage guidance “Gene Expression Profiling for Prostate Cancer" approved January, 2018. HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: BIOMARKER TESTS OF CANCER TISSUE FOR PROGNOSIS AND POTENTIAL RESPONSE TO TREATMENT Approved 8/13/2015 HERC Coverage Guidance Oncotype DX is recommended for coverage in early stage breast cancer when used to guide adjuvant chemotherapy treatment decisions for women who are lymph node negative (strong recommendation). The following genetic tests of cancer tissue are recommended for coverage (strong recommendation): BRAF gene mutation testing for melanoma Epidermal growth factor receptor (EGFR) gene mutation testing for non-small-cell lung cancer KRAS gene mutation testing for colorectal cancer The following genetic tests of cancer tissue are not recommended for coverage (weak recommendation): Mammaprint, ImmunoHistoChemistry 4 (IHC4), and Mammostrat for breast cancer Prolaris and Oncotype DX for prostate cancer BRAF, microsatellite instability (MSI), and Oncotype DX for colorectal cancer KRAS for lung cancer Urovysion for bladder cancer Oncotype DX for lymph node-positive breast cancer The use of multiple molecular testing to select targeted cancer therapy is not recommended for coverage (weak recommendation). Note: Definitions for strength of recommendation are provided in Appendix A GRADE Element Description RATIONALE FOR GUIDANCE DEVELOPMENT The HERC selects topics for guideline development or technology assessment based on the following principles: Represents a significant burden of disease Represents important uncertainty with regard to efficacy or harms Represents important variation or controversy in clinical care Represents high costs, significant economic impact Topic is of high public interest Coverage guidance development follows to translate the evidence review to a policy decision.
    [Show full text]
  • (NCCN) Breast Cancer Clinical Practice Guidelines
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Breast Cancer Version 5.2020 — July 15, 2020 NCCN.org NCCN Guidelines for Patients® available at www.nccn.org/patients Continue Version 5.2020, 07/15/20 © 2020 National Comprehensive Cancer Network® (NCCN®), All rights reserved. NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN. NCCN Guidelines Index NCCN Guidelines Version 5.2020 Table of Contents Breast Cancer Discussion *William J. Gradishar, MD/Chair ‡ † Sharon H. Giordano, MD, MPH † Sameer A. Patel, MD Ÿ Robert H. Lurie Comprehensive Cancer The University of Texas Fox Chase Cancer Center Center of Northwestern University MD Anderson Cancer Center Lori J. Pierce, MD § *Benjamin O. Anderson, MD/Vice-Chair ¶ Matthew P. Goetz, MD ‡ † University of Michigan Fred Hutchinson Cancer Research Mayo Clinic Cancer Center Rogel Cancer Center Center/Seattle Cancer Care Alliance Lori J. Goldstein, MD † Hope S. Rugo, MD † Jame Abraham, MD ‡ † Fox Chase Cancer Center UCSF Helen Diller Family Case Comprehensive Cancer Center/ Comprehensive Cancer Center Steven J. Isakoff, MD, PhD † University Hospitals Seidman Cancer Center Massachusetts General Hospital Amy Sitapati, MD Þ and Cleveland Clinic Taussig Cancer Institute Cancer Center UC San Diego Moores Cancer Center Rebecca Aft, MD, PhD ¶ Jairam Krishnamurthy, MD † Karen Lisa Smith, MD, MPH † Siteman Cancer Center at Barnes- Fred & Pamela Buffet Cancer Center The Sidney Kimmel Comprehensive Jewish Hospital and Washington Cancer Center at Johns Hopkins University School of Medicine Janice Lyons, MD § Case Comprehensive Cancer Center/ Mary Lou Smith, JD, MBA ¥ Doreen Agnese, MD ¶ University Hospitals Seidman Cancer Center Research Advocacy Network The Ohio State University Comprehensive and Cleveland Clinic Taussig Cancer Institute Cancer Center - James Cancer Hospital Hatem Soliman, MD † and Solove Research Institute P.
    [Show full text]
  • Guidelines for Management of Breast Cancer WHO Library Cataloguing in Publication Data
    EMRO Technical Publications Series 31 Guidelines for management of breast cancer WHO Library Cataloguing in Publication Data Guidelines for management of breast cancer/by WHO Regional Office for the Eastern Mediterranean p. (EMRO Technical Publications Series ; 31) 1. Breast neoplasms – Diagnosis 2. Breast neoplasms – Therapy 3. Breast – Cancer 4. Breast – Cancer – Guidelines I. Title II. WHO Regional Office for the Eastern Mediterranean III. Series ISBN : 978-92-9021-405-2 (NLM Classification: WP 870) ISSN : 1020-0428 © World Health Organization 2006 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt (tel: +202 670 2535, fax: +202 670 2492; email: [email protected]).
    [Show full text]
  • Male Breast Cancer: Management and Followup Recommendations
    ORIGINAL ARTICLE Male Breast Cancer: Management and Follow-up Recommendations John V. Kiluk, MD,* Marie Catherine Lee, MD,* Catherine K. Park, MD, MPH,* Tammi Meade, BS, BA,* Susan Minton, DO,* Eleanor Harris, MD,* Jongphil Kim, PhD, and Christine Laronga, MD* *Comprehensive Breast Program, Department of Women’s Oncology and Department of Biostatistics, H. Lee Moffitt Cancer Center, Tampa, Florida 33612 n Abstract: National Comprehensive Cancer Network (NCCN) guidelines for female breast cancer treatment and surveillance are well established, but similar guidelines on male breast cancers are less recognized. As an NCCN institu- tion, our objective was to examine practice patterns and follow-up for male breast cancer compared to established guide- lines for female patients. After Institutional Review Board approval, a prospective breast database from 1990 to 2009 was queried for male patients. Medical records were examined for clinico-pathological factors and follow-up. The 5-year survival rates with 95% confidence intervals were estimated using Kaplan–Meier method and Greenwood formula. Of the 19,084 patients in the database, 73 (0.4%) were male patients; 62 had complete data. One patient had bilateral synchronous breast cancer. The median age was 68.8 years (range 29–85 years). The mean ⁄ median invasive tumor size was 2.2 ⁄ 1.6 cm (range 0.0–10.0 cm). All cases had mastectomy (29 with axillary node dissection, 23 with sentinel lymph node biopsy only, 11 with sentinel node biopsy followed by completion axillary dissection). Lymph node involvement occurred in 25 ⁄ 63 (39.7%). Based on NCCN guidelines, chemotherapy, hormonal therapy, and radiation are indicated in 34 cases, 62 cases, and 14 cases, respectively.
    [Show full text]
  • Healthcare Professional Guide
    Healthcare Professional Guide Brachytherapy: The precise answer for tackling breast cancer Because life is for living Radiotherapy: a cornerstone of Brachytherapy: treating breast early breast cancer care cancer ‘from the inside, out’ Breast cancer is the most commonly diagnosed Radiotherapy can be divided into radiation ‘from the malignancy in women worldwide and the global outside, in’, i.e. external beam radiotherapy (EBRT), incidence is rising.1 Rates are especially high in and ‘from the inside, out’, frequently referred to as developed countries (approximately 80–90 per brachytherapy. Unlike EBRT, brachytherapy involves 100,000).1 Although the incidence of breast cancer placing a radiation source internally, into the breast. has increased over recent decades, mortality has This precise, targeted approach allows radiation to declined in developed countries. The high survival be delivered direct to the target area, while sparing rates are largely due to early diagnosis through surrounding tissues and structures.2,3 effective screening programs.1 However, significantly, improvements in treatment mean many women This guide provides an overview of the benefits of can now achieve excellent cancer control and brachytherapy that make it an important treatment preservation of their breast. option for many women with early breast cancer as part of their treatment plan. In recent years, breast cancer treatment goals have moved from life preservation to cure with breast conservation. Benefits of brachytherapy in early breast cancer; Radiotherapy plays an important role in early delivering radiation from the ‘inside, out’: breast cancer management and has achieved • Demonstrated efficacy: Cancer control and remarkable progress during the last two decades.
    [Show full text]
  • Clinical Guidelines for Breast Cancer Control and Management
    CLINICAL GUIDELINES FOR BREAST CANCER CONTROL AND MANAGEMENT 1 National Department of Health Switchboard: 012 395 8000 Physical Address: Civitas Building Corner of Thabo Sehume and Struben Streets Pretoria Postal address: Private Bag X828 Pretoria 0001 Published by the Department of Health, Private Bag X828, Pretoria, 0001, South Africa Copyright: © Department of Health, Republic of South Africa April 2018 www.doh.gov.za 2 Table of Contents Foreword ...................................................................................................................................................... 4 Acknowledgements ...................................................................................................................................... 5 Abbreviations and Acronyms ........................................................................................................................ 6 Definition of terms ......................................................................................................................................... 8 List of tables ............................................................................................................................................... 10 List of figures .............................................................................................................................................. 10 1. Introduction.......................................................................................................................................... 12 2. Key area
    [Show full text]
  • The Evolution of Paradigms for the Management of Breast Cancer: a Personal Perspective1
    (CANCER RESEARCH 52, 2371-2383, May I, 1992] Perspectivesin CancerResearch The Evolution of Paradigms for the Management of Breast Cancer: A Personal Perspective1 Bernard Fisher2 National Surgical Adjuvant Breast and Bowel Project Headquarters, Pittsburgh, Pennsylvania 15261 Introduction will develop the disease in her lifetime (1). Surveillance, Epi demiology, and End Results program (SEER) data indicate Although female breast cancer remains a major public health that, as age increases, so does the incidence of breast cancer problem, notable improvements have occurred in its treatment. (2). Whereas, for women 50-54 years of age the incidence is For most of this century, women with primary breast cancer 212 per 100,000, it increases progressively over the next 25 have been treated by radical mastectomy or some variation of years to 435 per 100,000 for women 80 to 84 years old. As that procedure. In recent years lumpectomy has become the ominous as they may seem, these statistics do not begin to recommended operation for most patients. Before the mid- portray the magnitude of the problem. The 75,000 or more 1970s, postoperative adjuvant systemic therapy was not used; women with invasive breast cancer clinically and/or mammo- now it is a major component of treatment strategies. How have graphically diagnosed each year represent only the tip of an these drastic changes come about? Are they the result of anec iceberg. Those women comprise only one cohort of the female dotal recitations of personal experiences or the outcome of population whose breasts contain a spectrum of aberrations, more abstruse circumstances? How are future changes apt to among which are the detected cancers (Fig.
    [Show full text]
  • The Effect of Reduced RDI of Chemotherapy on the Outcome Of
    www.nature.com/scientificreports OPEN The efect of reduced RDI of chemotherapy on the outcome of breast cancer patients Wanwan Qi1, Xiaoyi Wang1, Lu Gan2, Yunhai Li1, Hongyuan Li1 & Qiao Cheng1* The aims of this study were to investigate the impact of the relative dose intensity (RDI) of chemotherapy on disease-free survival (DFS) and overall survival (OS), to identify the optimal RDI cut- of points with the docetaxel, epirubicin and cyclophosphamide (TEC) regimen for stage I–III breast cancer patients and to explore the adverse events in these patients. To achieve this, we performed a retrospective analysis of breast cancer patients treated at the First Afliated Hospital of Chongqing Medical University in 2011. The results showed that among 293 patients with the TEC regimen, 85% and 80% were the cut-of points at which a high RDI was associated with better overall survival (HR = 2.04; 95% CI 1.13, 3.70; p = 0.02) and disease-free survival (HR = 1.97; 95% CI 1.14–3.42; p = 0.02), respectively. Among 169 HR(+) patients, 80% was the cut-of point for DFS (HR = 2.33; 95% CI 1.07–5.08; p = 0.03), and 85% was the cut-of point for OS (HR = 3.00; 95% CI 1.24–7.26; p = 0.02). Among 105 HR(−) patients, 80% was the cut-of point for OS (HR = 2.86; 95% CI 1.05–7.80; p = 0.04). Of 293 patients, neutropenia, nausea, and vomiting were found to be correlated with the level of RDI. In conclusion, a higher RDI of chemotherapy is associated with better survival but with a higher probability of causing adverse events.
    [Show full text]
  • Breast Cancer This Brief Summarizes the Contributions of Kaiser Permanente Research Since 2007 on the Topic of Breast Cancer
    Kaiser Permanente Research Brief Breast Cancer This brief summarizes the contributions of Kaiser Permanente Research since 2007 on the topic of breast cancer. Breast cancer is a common disease. Kaiser Permanente Publications Approximately 1 in 8 American women Related to Breast Cancer and 1 in 1,000 American men will Since 2007 develop breast cancer during their lifetimes. Although the incidence of breast cancer has decreased since 2000, more than 330,000 new cases 556 18,900 of breast cancer are expected to be Journal Articles Citationsa diagnosed in 2019, including over 270,000 cases of invasive breast cancer and nearly 63,000 cases of non-invasive “in situ” tumors. Improvements in detection and 90 42 treatment have led to higher survival Practice Clinical Guideline Decision Aid rates, but breast cancer still accounts b c for about 41,000 deaths every year in References References the United States.1 In situ tumors — that is, those still confined to the breast Source: Kaiser Permanente Publications Library ducts or lobules — are less dangerous and PLUM metrics, as of 24 July 2019. than those that progress into other a Number of citing journal articles, according to Scopus. parts of the breast tissue, and some b Number of references in PubMed guidelines. types of invasive breast cancer are c Citations in DynaMed Plus, a point-of-care more aggressive than others. clinical reference tool. Breast cancer is an active area of study for Kaiser Permanente Research. Scientists across the organization have used our rich, comprehensive, longitudinal data to advance knowledge in the areas of understanding risk, improving patient outcomes, and translating research findings into policy and practice.
    [Show full text]
  • National Cancer Grid Breast Cancer Management Guidelines – Sept 2019
    National Cancer Grid Breast Cancer management guidelines – Sept 2019 Disclaimer: These are general guidelines and must be considered with value judgements for individual patients. Essential: mandatory Preferred /Desirable / Optimal: cost effective with evidence of efficacy Optional: can be considered, minimal evidence, cost is an issue Page 1 of 18 National Cancer Grid Breast Cancer management guidelines – Sept 2019 Formatted: Indent: Left: 0 cm, First line: 0 cm Evaluation of a breast Lump All women with a breast lump should undergo a TRIPLE TEST which comprising of 1. Clinical Examination by an experienced clinician preferably a breast surgeon 2. Bilateral imaging: a bilateral mammogram and/or Ultrasound/ MRI as appropriate## 3. Histopathology** (Core biopsy preferred or FNAC) # Incisional biopsy may be considered in exceptional cases Type of lesion Suspicious looking solid mass (includes Benign looking Cyst* Benign looking (confirmed on Breast complex cystic and solid mass) solid mass Ultrasound) Biopsy Biopsy for Histopathology confirmation *** hemorrhagic contents / rapid filling or refilling/ residual solid component Aspirate Malignant Benign Biopsy *** (image-guided if needed) Watery, Observe/ Excise yellow, green Benign Malignant Follow relevant algorithm Discharge patient (follow up if clinical concern) *Solitary and multiple simple cysts can be observed and do not need to be aspirated. ***Core Biopsy is preferred in cases where neo-adjuvant therapy is planned (for grading and receptor status) and for guided non palpable-lesions and if MRM considered. FNAC is acceptable if patient cannot afford Core Biopsy. IHC evaluation is mandatory prior to neo adjuvant therapy. Histo/cyto pathology confirmation is a MUST before initiating cancer directed treatment (surgery/ chemotherapy/ other systemic treatment).
    [Show full text]