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BMJ Open Nov 2021Attendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Attendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance.
DESIGN
CINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987-June 2019, and reporting attendance in relation to at least one patient-level factor.
DATA SYNTHESIS
Independent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible.
RESULTS
Of 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence.
CONCLUSIONS
Attendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated.
TRIAL REGISTRATION NUMBER
CRD42016051597.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Text Messaging
PubMed: 34848507
DOI: 10.1136/bmjopen-2020-046660 -
British Journal of Cancer Mar 2022Although mammography screening is recommended in most European countries, the balance between the benefits and harms of different screening intervals is still a matter...
Benefits and harms of annual, biennial, or triennial breast cancer mammography screening for women at average risk of breast cancer: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC).
BACKGROUND
Although mammography screening is recommended in most European countries, the balance between the benefits and harms of different screening intervals is still a matter of debate. This review informed the European Commission Initiative on Breast Cancer (BC) recommendations.
METHODS
We searched PubMed, EMBASE, and the Cochrane Library to identify RCTs, observational or modelling studies, comparing desirable (BC deaths averted, QALYs, BC stage, interval cancer) and undesirable (overdiagnosis, false positive related, radiation related) effects from annual, biennial, or triennial mammography screening in women of average risk for BC. We assessed the certainty of the evidence using the GRADE approach.
RESULTS
We included one RCT, 13 observational, and 11 modelling studies. In women 50-69, annual compared to biennial screening may have small additional benefits but an important increase in false positive results; triennial compared to biennial screening may have smaller benefits while avoiding some harms. In younger women (aged 45-49), annual compared to biennial screening had a smaller gain in benefits and larger harms, showing a less favourable balance in this age group than in women 50-69. In women 70-74, there were fewer additional harms and similar benefits with shorter screening intervals. The overall certainty of the evidence for each of these comparisons was very low.
CONCLUSIONS
In women of average BC risk, screening intervals have different trade-offs for each age group. The balance probably favours biennial screening in women 50-69. In younger women, annual screening may have a less favourable balance, while in women aged 70-74 years longer screening intervals may be more favourable.
Topics: Adult; Age Factors; Aged; Breast Neoplasms; Early Detection of Cancer; Europe; False Positive Reactions; Female; Humans; Mammography; Middle Aged; Observational Studies as Topic; Practice Guidelines as Topic; Risk Assessment
PubMed: 34837076
DOI: 10.1038/s41416-021-01521-8 -
European Journal of Cancer (Oxford,... Dec 2021Over 1 billion doses of COVID-19 vaccines have been already administered across the United States, the United Kingdom and the European Union at the time of writing....
PURPOSE
Over 1 billion doses of COVID-19 vaccines have been already administered across the United States, the United Kingdom and the European Union at the time of writing. Furthermore, 1.82 million booster doses have been administered in the US since 13th August, and similar booster programmes are currently planned or under consideration in the UK and the EU beginning in the autumn of 2021. Early reports showed an association between vaccine administration and the development of ipsilateral axillary and supraclavicular lymphadenopathy, which could interfere with the diagnosis, treatment and follow-up of breast cancer patients. In this paper, we review the available evidence on vaccine-related lymphadenopathy, and we discuss the clinical implications of the same on breast cancer diagnosis and management.
METHODS
A literature search was performed - PubMed, Ovid Medline, Scopus, CINHAL, Springer Nature, ScienceDirect, Academic Search Premier and the Directory of Open Access Journals were searched for articles reporting on regional palpable or image-detected lymphadenopathy following COVID-19 vaccination. Separately, we compiled a series of case studies from the University Hospitals of Derby and Burton, United Kingdom and the Mayo Clinic in Minnesota, United States of America, to illustrate the impact that regional lymphadenopathy post-COVID-19 vaccination can have on the diagnosis and management of patients being seen in diagnostic and therapeutic breast clinics.
RESULTS
From the literature search, 15 studies met the inclusion criteria (n = 2057 patients, 737 with lymphadenopathy). The incidence of lymphadenopathy ranged between 14.5% and 53% and persisted for >6 weeks in 29% of patients.
CONCLUSIONS
Clinicians managing breast cancer patients should be aware that the COVID-19 vaccination may result in regional lymphadenopathy in a significant number of patients, which can result in unnecessary investigations, treatment and increased patient anxiety. An accurate COVID-19 vaccination history should be collected from all patients where regional lymphadenopathy is a clinical and/or an imaging finding and then combined with clinical judgement when managing individual cases.
Topics: Breast Neoplasms; COVID-19 Vaccines; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Incidence; Lymphadenopathy; Mammography; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Time Factors; Vaccination
PubMed: 34731748
DOI: 10.1016/j.ejca.2021.09.033 -
JAMA Network Open Nov 2021The use of magnetic resonance imaging (MRI) in pretreatment planning of ductal carcinoma in situ (DCIS) remains controversial. Understanding changes in short-term...
Patient-Reported Testing Burden of Breast Magnetic Resonance Imaging Among Women With Ductal Carcinoma In Situ: An Ancillary Study of the ECOG-ACRIN Cancer Research Group (E4112).
IMPORTANCE
The use of magnetic resonance imaging (MRI) in pretreatment planning of ductal carcinoma in situ (DCIS) remains controversial. Understanding changes in short-term health-related quality of life associated with breast MRI would allow for a more complete comparative effectiveness assessment.
OBJECTIVE
To assess whether there are changes in patient-reported quality of life associated with breast MRI among women diagnosed with DCIS.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was a substudy of a nonrandomized clinical trial conducted at 75 participating US institutions from March 2015 to April 2016. Women recently diagnosed with unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. A total of 355 women met the eligibility criteria and underwent the study MRI. Data analysis was performed from June 3, 2020, to July 1, 2021.
EXPOSURES
Participants underwent bilateral breast MRI within 30 days of study registration and before surgery. Information on patient-reported testing burden for breast MRI was collected after MRI and before surgery.
MAIN OUTCOMES AND MEASURES
The primary outcome of this substudy was the patient-reported testing burden of breast MRI, measured by the Testing Morbidities Index (TMI) summated scale score. The TMI is a 7-item instrument that evaluates the temporary changes in quality of life associated with imaging before, during, and after the test (0 represents the worst possible, 100 the hypothetical ideal test experience).
RESULTS
Of the 355 women who met the eligibility criteria, 244 (69%) completed both questionnaires and were included in this analysis. The median age was 59 years (range, 34-85 years). The mean MRI TMI summated scale score was 85.9 (95% CI, 84.6-87.3). Of the 244 women, 142 (58%) experienced at least some fear and anxiety before the examination, and 120 women (49%) experienced fear and anxiety during the examination. A total of 156 women (64%) experienced pain or discomfort during the examination. In multivariable analyses, greater test-related burden was associated with higher levels of cancer worry (regression coefficient, -2.75; SE, 0.94; P = .004).
CONCLUSIONS AND RELEVANCE
In this cohort study, a clinically meaningful breast MRI testing burden among women with DCIS was revealed that was significantly associated with cancer worry. Understanding the potential quality-of-life reduction associated with MRI, especially when used in combination with mammography, may allow development of targeted interventions to improve the patient experience.
Topics: Adult; Aged; Aged, 80 and over; Anxiety; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Intraductal, Noninfiltrating; Clinical Trials as Topic; Fear; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Quality of Life
PubMed: 34726748
DOI: 10.1001/jamanetworkopen.2021.29697 -
European Radiology Apr 2022Digital breast tomosynthesis (DBT) plus digital mammography (DM) in screening is problematic due to increased radiation by the double exposure. Synthesised... (Meta-Analysis)
Meta-Analysis
Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis.
OBJECTIVES
Digital breast tomosynthesis (DBT) plus digital mammography (DM) in screening is problematic due to increased radiation by the double exposure. Synthesised two-dimensional mammography (s2D) calculated from DBT datasets at no additional dose appears a sensible alternative compared to adding DM. This systematic review and meta-analysis focuses on screening performance outcomes in women screened with DBT plus s2D compared to DM alone.
METHODS
PubMed was searched from January 1, 2010, to September 2, 2020. Studies comparing DBT plus s2D to DM alone in breast cancer screening were included. Pooled risk ratios (RR) were estimated for cancer detection rates (CDR), recall rates, interval cancer rates (ICR), biopsy rates, and positive predictive values for recalls (PPV-1), for biopsies recommended (PPV-2), and for biopsies performed (PPV-3). Sensitivity analyses were performed using the leave-one-out approach. Risk of bias (RoB) was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool.
RESULTS
Twelve papers covering 414,281 women were included from 766 records identified. CDR is increased ([RR, 95% CI] 1.35, 1.20-1.52), recall rates are decreased (0.79, 0.64-0.98), and PPV-1 is increased (1.69, 1.45-1.96) when using DBT plus s2D compared to DM alone. ICR and biopsy rates did not differ, but PPV-2 respectively PPV-3 increased with DBT plus s2D (1.57, 1.08-2.28 respectively 1.36, 1.17-1.58). Overall RoB of studies was assessed to be low.
CONCLUSION
Results show improved diagnostic outcomes with DBT plus s2D compared to DM alone and underline the value of DBT in combination with s2D in breast cancer screening.
KEY POINTS
• DBT plus s2D is associated with higher CDR, lower recall rates, and a higher PPV-1 compared to DM alone in breast cancer screening. • No differences in biopsy rates were found between screening modalities, but PPV-2 and PPV-3 were higher in women screened with DBT plus s2D compared to DM alone. • We identified inconsistent results of ICR in two studies comparing DBT plus s2D to DM alone-resulting in no differences when pooling ICR in meta-analysis.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Predictive Value of Tests
PubMed: 34694451
DOI: 10.1007/s00330-021-08308-8 -
Mayo Clinic Proceedings. Innovations,... Dec 2021The purpose of this study was to assess the impact of measures designed to mitigate the spread of coronavirus disease 2019 (COVID-19) on worldwide cancer screening. We... (Review)
Review
The purpose of this study was to assess the impact of measures designed to mitigate the spread of coronavirus disease 2019 (COVID-19) on worldwide cancer screening. We systematically searched PubMed, Ovid MEDLINE, the Cochrane COVID-19 Study Register, ClinicalTrials.gov, and EMBASE without language restrictions for studies published between January 1, 2021, and February 10, 2021. Studies selected for full-text review contained data on patients screened for any type of cancer during the COVID-19 pandemic and comparison data from a time interval just prior to the pandemic. Data were obtained through dual extraction. All the included studies were assessed for quality and risk of bias. A meta-analysis was performed on 13 studies: 7 on screening mammography, 5 on colon cancer screening, and 3 on cervical cancer screening. Two of our studies reported on more than one type of cancer screening. The screening outcomes were reported as pooled incidence rate ratios using the inverse variance method and random effects models. All studies included in our meta-analysis reported the number of patients screened for cancer in defined time intervals before and during the COVID-19 pandemic. We found that the pooled incidence rate ratios were significantly lower for screening during the COVID-19 pandemic for breast cancer (0.63; 95% CI, 0.53 to 0.77; <.001), colon cancer (0.11; 95% CI, 0.05 to 0.24; <.001), and cervical cancer (0.10; 95% CI, 0.04 to 0.24; <.001). These findings may add further morbidity and mortality to this public health crisis.
PubMed: 34693211
DOI: 10.1016/j.mayocpiqo.2021.10.003 -
Radiology Jan 2022Background Advances in computer processing and improvements in data availability have led to the development of machine learning (ML) techniques for mammographic... (Meta-Analysis)
Meta-Analysis
Background Advances in computer processing and improvements in data availability have led to the development of machine learning (ML) techniques for mammographic imaging. Purpose To evaluate the reported performance of stand-alone ML applications for screening mammography workflow. Materials and Methods Ovid Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science literature databases were searched for relevant studies published from January 2012 to September 2020. The study was registered with the PROSPERO International Prospective Register of Systematic Reviews (protocol no. CRD42019156016). Stand-alone technology was defined as a ML algorithm that can be used independently of a human reader. Studies were quality assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 and the Prediction Model Risk of Bias Assessment Tool, and reporting was evaluated using the Checklist for Artificial Intelligence in Medical Imaging. A primary meta-analysis included the top-performing algorithm and corresponding reader performance from which pooled summary estimates for the area under the receiver operating characteristic curve (AUC) were calculated using a bivariate model. Results Fourteen articles were included, which detailed 15 studies for stand-alone detection ( = 8) and triage ( = 7). Triage studies reported that 17%-91% of normal mammograms identified could be read by adapted screening, while "missing" an estimated 0%-7% of cancers. In total, an estimated 185 252 cases from three countries with more than 39 readers were included in the primary meta-analysis. The pooled sensitivity, specificity, and AUC was 75.4% (95% CI: 65.6, 83.2; = .11), 90.6% (95% CI: 82.9, 95.0; = .40), and 0.89 (95% CI: 0.84, 0.98), respectively, for algorithms, and 73.0% (95% CI: 60.7, 82.6), 88.6% (95% CI: 72.4, 95.8), and 0.85 (95% CI: 0.78, 0.97), respectively, for readers. Conclusion Machine learning (ML) algorithms that demonstrate a stand-alone application in mammographic screening workflows achieve or even exceed human reader detection performance and improve efficiency. However, this evidence is from a small number of retrospective studies. Therefore, further rigorous independent external prospective testing of ML algorithms to assess performance at preassigned thresholds is required to support these claims. ©RSNA, 2021 See also the editorial by Whitman and Moseley in this issue.
Topics: Breast Neoplasms; Female; Humans; Machine Learning; Mammography; Radiographic Image Interpretation, Computer-Assisted; Sensitivity and Specificity; Workflow
PubMed: 34665034
DOI: 10.1148/radiol.2021210391 -
Journal of Family Medicine and Primary... Aug 2021Due to the contradictory results of previous research and the lack of a specific study to address the effective nursing interventions in the early diagnosis of cancer,...
BACKGROUND AND AIMS
Due to the contradictory results of previous research and the lack of a specific study to address the effective nursing interventions in the early diagnosis of cancer, the purpose of this study was to determine the effect of nursing interventions on early diagnosis of cancer.
METHODS
This systematic review and meta-analysis were conducted during the last 5 years from 2015 to September 30, 2020. The articles related to the nursing interventions to early diagnosis of cancer were achieved from PubMed, Cochrane Library, Embase, ISI, Scopus databases, and Google and Google Scholar search engines. Risk-ratio with a 95% confidence interval (CI) between the intervention and control groups was determined using the fixed-effect model, and the Mantel-Haenszel method and I2 showed the heterogeneity of studies. Stata V16 software was used for meta-analysis.
RESULTS
The effect of an intervention on early diagnosis of breast cancer was evaluated using mammography, clinical breast examination, and breast self-exam. A total of 300 individuals participated in the study. RR results in the intervention group showed the effectiveness of nursing interventions on breast cancer detected early in both the mammography and colonoscopy (RR, 1.18 95% CI 0.57, 1.79. =0.00 and RR, 0.58, 95% CI 0.42, 0.75, = 0.00, respectively).
CONCLUSION
A variety of nursing interventions including education, consultation, patient guidance, and reminders can have a positive impact on the early detection of cancers.
PubMed: 34660432
DOI: 10.4103/jfmpc.jfmpc_2148_20 -
Cancers Sep 2021The aim of this meta-analysis was to evaluate the association between mammographic density changes over time and the risk of breast cancer. We performed a systematic... (Review)
Review
The aim of this meta-analysis was to evaluate the association between mammographic density changes over time and the risk of breast cancer. We performed a systematic literature review based on the PubMed and ISI Web of Knowledge databases. A meta-analysis was conducted by computing extracted hazard ratios (HRs) and 95% confidence intervals (CIs) for cohort studies or odds ratios (ORs) and 95% confidence interval using inverse variance method. Of the nine studies included, five were cohort studies that used HR as a measurement type for their statistical analysis and four were case-control or cohort studies that used OR as a measurement type. Increased breast density over time in cohort studies was associated with higher breast cancer risk (HR: 1.61; 95% CI: 1.33-1.96) whereas decreased breast density over time was associated with lower breast cancer risk (HR: 0.78; 95% CI: 0.71-0.87). Similarly, increased breast density over time was associated with higher breast cancer risk in studies presented ORs (pooled OR: 1.85; 95% CI: 1.29-2.65). Our findings imply that an increase in breast density over time seems to be linked to an increased risk of breast cancer, whereas a decrease in breast density over time seems to be linked to a lower risk of breast cancer.
PubMed: 34638289
DOI: 10.3390/cancers13194805 -
European Journal of Radiology Nov 2021Breast cancer has four distinct molecular subtypes which are discriminated using gene expression profiling following biopsy. Radiogenomics is an emerging field which... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Breast cancer has four distinct molecular subtypes which are discriminated using gene expression profiling following biopsy. Radiogenomics is an emerging field which utilises diagnostic imaging to reveal genomic properties of disease. We aimed to perform a systematic review of the current literature to evaluate the value radiomics in differentiating breast cancers into their molecular subtypes using diagnostic imaging.
METHODS
A systematic review was performed as per PRISMA guidelines. Studies assessing radiomictumour analysis in differentiatingbreast cancer molecular subtypeswere included. Quality was assessed using the radiomics quality score (RQS). Diagnostic sensitivity and specificity of radiomic analyses were included for meta-analysis; Study specific sensitivity and specificity were retrieved and summary ROC analysis were performed to compile pooled sensitivities and specificities.
RESULTS
Forty-one studies were included. Overall, there were 10,090 female patients (mean age of 47.6 ± 11.7 years, range: 21-93) and molecular subtypewas reported in 7,693 of cases, with Luminal A (LABC), Luminal B (LBBC), Human Epidermal Growth Factor Receptor-2 overexpressing (HER2+), and Triple Negative (TNBC) breast cancers representing 51.3%, 19.9%, 12.3% and 16.3% of tumour respectively. Seven studies provided radiomic analysis to determine molecular subtypes using mammography to differentiateTNBCvs.others (sensitivity: 0.82,specificity:0.79). Thirty-five studies reported on radiomic analysis of magnetic resonance imaging (MRI); LABC versus others(sensitivity:0.78,specificity:0.83),HER2+versusothers(sensitivity:0.87,specificity:0.88), andLBBCversusTNBC (sensitivity: 0.79,specificity:0.88) respectively.
CONCLUSION
Radiomic tumour assessment of contemporary breast imaging provide a novel option in determining breast cancer molecular subtypes. However, amelioration of such techniques are required and genetic expression assessment will remain the gold standard.
Topics: Adult; Breast; Breast Neoplasms; Female; Humans; Magnetic Resonance Imaging; Mammography; Middle Aged; ROC Curve
PubMed: 34624649
DOI: 10.1016/j.ejrad.2021.109996