Intervallum rákok a diagnoszta szemével (avagy a szűrés ballasztja) dr. Nahm Krisztina Uzsoki utcai Kórház Magyar Szenológiai Társaság Tudományos Fóruma Inárcs 2017. április 21-22.
Definíciók Mammográfiás szűrés : területi adatbázishoz és életkorhoz kötött rendszeres időközönként végzett mammográfia kettős leolvasással. (Magyarországon 45 - 65 év közötti női populáció kétévenkénti szűrése, különböző intervallum lehet 1 évtől 3 évig) Intervallum rákok : Két szűrési időpont között diagnosztizált daganat a szűrt korcsoportban.
Evidenciák A rendszeres, területi adatbázishoz kötött mammográfiás szűrés csökkenti a mortalitást (30-50%-kal). A mammográfiás szűrés szekunder prevenció . A mortalitás csökkenés magas megjelenési arány mellett mérhető . Az összes operált emlőrákok 50% - a esik a szűréses korcsoportba, 25% fiatalabb, 25% idősebb korosztály A szűrésből kiemelt rákok kisebbek, alacsonyabb a grade, kevesebb az axilláris metastasis , jobb a prognózisuk, mint a panasszal érkező betegeké. Az emlőrák különböző szövettani csoportok együttese, különböző az egyes szövettani típusok proliferációja, növekedési üteme. Intervallum rákok mindenhol a világon vannak, arányuk 0,5- 2 ezrelék körüli.
Jelentések a szűrőprogramokról Statisztikai elemzés Meghívottak száma Megjelentek száma Kiszűrtek Műtétre ajánlottak Malignus esetek feldolgozása Intervallum rákok aránya, feldolgozása
Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study Stephen W Duff y, Amanda Dibden, Dimitrios Michalopoulos, Judith Off man, Dharmishta Parmar, Jacquie Jenkins, Beverley Collins, Tony Robson,Suzanne Scorfi eld, Kathryn Green, Clare Hall, Xiao-Hui Liao, Michael Ryan, Fiona Johnson, Guy Stevens, Olive Kearins, Sarah Sellars, Julietta Patnick Lancet Oncol 2016; 17: 109 – 14 Summary Backgroun d The value of screen detection and treatment of ductal carcinoma in situ (DCIS) is a matter of controversy. At present, the extent to which the diagnosis and treatment of DCIS could prevent the occurrence of invasive breast cancer in the future is not clear. We sought to estimate the association between detection of DCIS at screening and invasive interval cancers subsequent to the relevant screen. Methods We obtained aggregate data for screen-detected cancers from 84 local screening units within 11 regional Quality Assurance Reference Centres in England, Wales, and Northern Ireland from the National Health Service Breast Screening Programme. Data for DCIS diagnoses were obtained for women aged 50 – 64 years who were invited to and attended mammographic breast screening from April 1, 2003, to March 31, 2007 (4 screening years). Patient-level data for interval cancer arising in the 36 months after each of these were analysed by Poisson regression with invasive interval cancer screen detection rate as the outcome variable; DCIS detection frequencies were fi tted fi rst as a continuous and then as a categorical variable. We repeated this analysis after adjustment with both small size and high-grade invasive screen-detected cancers. Findings We analysed data for 5 243 658 women and on interval cancers occurring in the 36 months after the relevant screen. The average frequency of DCIS detected at screening was 1·60 per 1000 women screened (median 1·50 [unit range 0·54–3·56] per 1000 women). There was a signifi cant negative association of screen-detected DCIS cases with the rate of invasive interval cancers (Poisson regression coeffi cient –0·084 [95% CI –0·13 to –0·03]; p=0·002). 90% of units had a DCIS detection frequency within the range of 1·00 to 2·22 per 1000 women; in these units, for every three screen-detected cases of DCIS, there was one fewer invasive interval cancer in the next 3 years. This association remained after adjustment for numbers of small screen-detected invasive cancers and for numbers of grade 3 invasive screen-detected cancers. Interpretation The association between screen-detected DCIS and subsequent invasive interval cancers suggests that detection and treatment of DCIS is worthwhile in prevention of future invasive disease. Funding UK Department of Health Policy Research Programme and NHS Cancer Screening Programmes.
National collation of breast interval cancer data: Screening years 1st April 2003 - 31st March 2005 NHSBSP OCCASIONAL REPORT 12/03 December 2012
National collation of breast interval cancer data NHSBSP December 2012
COMPARING INTERVAL BREAST CANCER RATES IN NORWAY AND NORTH CAROLINA: RESULTS AND CHALLENGES. July 1, 2009 Hofvind S, Yankaskas BC, Bulliard JL, Klabunde CN, Fracheboud J. J Med Screen. 2009;16(3):131-9. doi: 10.1258/jms.2009.009012. Abstract OBJECTIVE: To compare interval breast cancer rates (ICR) between a biennial organized screening programme in Norway and annual opportunistic screening in North Carolina (NC) for different conceptualizations of interval cancer. SETTING: Two regions with different screening practices and performance. METHODS: 620,145 subsequent screens (1996-2002) performed in women aged 50-69 and 1280 interval cancers were analysed. Various definitions and quantification methods for interval cancers were compared. RESULTS: ICR for one year follow-up were lower in Norway compared with NC both when the rate was based on all screens (0.54 versus 1.29 per 1000 screens), negative final assessments (0.54 versus 1.29 per 1000 screens), and negative screening assessments (0.53 versus 1.28 per 1000 screens). The rate of ductal carcinoma in situ was significantly lower in Norway than in NC for cases diagnosed in both the first and second year after screening. The distributions of histopathological tumour size and lymph node involvement in invasive cases did not differ between the two regions for interval cancers diagnosed during the first year after screening. In contrast, in the second year after screening, tumour characteristics remained stable in Norway but became prognostically more favorable in NC. CONCLUSION: Even when applying a common set of definitions of interval cancer, the ICR was lower in Norway than in NC. Different definitions of interval cancer did not influence the ICR within Norway or NC. Organization of screening and screening performance might be major contributors to the differences in ICR between Norway and NC.
Biologic Characteristics of Interval and Screen-Detected Breast Cancers Frank D. Gilliland, Nancy Joste,Patricia M. Stauber, William C.Hunt, Robert Rosenberg, Gillian Redlich, Charles R. Key [J Natl Cancer Inst 2000;92:743 – 9] Conclusion: Rapidly growing and aggressive tumors account for a substantial proportion of mammographic failure to detect breast cancer, especially among younger women, who have a high proportion of aggressive cancers.
A study of interval breast cancer within the NHS breast screening programme W K Cowan, B Angus, J C Gray, L G Lunt, S Ramedan Al-Tamimi Conclusions — Interval cancers are more aggressive than screen detected cancers but in general less aggressive than symptomatic cancers. However, within a heterogeneous group, occasional interval cancers are exceptionally malignant. ( J Clin Pathol 2000; 53 :140 – 146)
Incidence of interval breast cancers after 650,000 negative mammographies in 13 Italian health districts Lauro Bucchi, Alessandra Ravaioli, Flavia Foca, Americo Colamartini, Fabio Falcini and Carlo Naldoni, the Emilia-Romagna Breast Screening Programme J Med Screen 2008;15:30 – 35
Mammographic features associated with interval breast cancers in screening programs Norman F Boyd1*, Ella Huszti1, Olga Melnichouk1, Lisa J Martin1, Greg Hislop2, Anna Chiarelli3, Martin J Yaffe4 and Salomon Minkin5 Boyd et al. Breast Cancer Research 2014, 16:417 http://breast-cancer-research.com/content/16/1/417 Conclusions Compared to women with screen-detected breast cancer, younger age and a greater dense area and smaller nondense areas in the baseline mammogram were independently associated with a greater frequency of interval breast cancers in screening programs. These results suggest that decreased detection of cancers caused by the area of dense tissue, and more rapid growth associated with a smaller non-dense area, may both contribute to the frequency of interval breast cancers. Toronto
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