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11. International variation in management of screen-detected ductal carcinoma in situ of the breast

Author

Ponti, Antonio, Lynge, Elsebeth, James, Ted, Májek, Ondřej, von Euler-Chelpin, My, Anttila, Ahti, Fitzpatrick, Patricia, Mano, Maria Piera, Kawai, Masaaki, Scharpantgen, Astrid, Fracheboud, Jacques, Hofvind, Solveig, Vidal, Carmen, Ascunce, Nieves, Salas, Dolores, Bulliard, Jean-Luc, Segnan, Nereo, Kerlikowske, Karla, Taplin, Stephen, and group, ICSN DCIS Working

Subjects
Cancer, Clinical Research, Breast Cancer, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Aged, Breast Neoplasms, Carcinoma, Intraductal, Noninfiltrating, Early Detection of Cancer, Europe, Female, Humans, International Agencies, Japan, Lymph Node Excision, Mastectomy, Segmental, Middle Aged, Outcome Assessment, Health Care, Radiotherapy, United States, Breast cancer, Ductal carcinoma in situ, Screening mammography, Overtreatment, Axillary staging, Cancer registration, ICSN DCIS Working group, Oncology and Carcinogenesis, Public Health and Health Services, Oncology & Carcinogenesis
Abstract

BackgroundDuctal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity.MethodsWe sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy.ResultsTwelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions.ConclusionsVariation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.

Published
2014

12. Variation in detection of ductal carcinoma in situ during screening mammography: A survey within the International Cancer Screening Network

Author

Lynge, Elsebeth, Ponti, Antonio, James, Ted, Májek, Ondřej, von Euler-Chelpin, My, Anttila, Ahti, Fitzpatrick, Patricia, Frigerio, Alfonso, Kawai, Masaaki, Scharpantgen, Astrid, Broeders, Mireille, Hofvind, Solveig, Vidal, Carmen, Ederra, Maria, Salas, Dolores, Bulliard, Jean-Luc, Tomatis, Mariano, Kerlikowske, Karla, Taplin, Stephen, and group, the ICSN DCIS Working

Subjects
Prevention, Cancer, Clinical Research, Breast Cancer, Good Health and Well Being, Aged, Breast Neoplasms, Carcinoma, Ductal, Breast, Carcinoma, Intraductal, Noninfiltrating, Data Collection, Early Detection of Cancer, Europe, Female, Humans, Mammography, Middle Aged, United States, Breast cancer, Ductal carcinoma in situ, Screening mammography, Cancer registration, ICSN DCIS Working group, Oncology and Carcinogenesis, Public Health and Health Services, Oncology & Carcinogenesis
Abstract

BackgroundThere is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection.Patients and methodsData were collected during 2004-2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS.ResultsData were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76-3.00); 2.97 (95% CI 2.51-3.51) for detection of breast cancer; and 3.49 (95% CI 2.70-4.51) for detection of DCIS.ConclusionsConsiderable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.

Published
2014

28. European Code against Cancer, 4th Edition: Cancer screening

Author

Armaroli, Paola, Villain, Patricia, Suonio, Eero, Almonte, Maribel, Anttila, Ahti, Atkin, Wendy S., Dean, Peter B., de Koning, Harry J., Dillner, Lena, Herrero, Rolando, Kuipers, Ernst J., Lansdorp-Vogelaar, Iris, Minozzi, Silvia, Paci, Eugenio, Regula, Jaroslaw, Törnberg, Sven, and Segnan, Nereo

Published
2015
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30. European Code against Cancer 4th Edition: 12 ways to reduce your cancer risk

Author

Guha, Neela, Kralikova, Eva, McNeill, Anne, Peruga, Armando, Anderson, Annie, Berrino, Franco, Boutron-Ruault, Marie-Christine, Cecchini, Michele, Key, Tim J., Leitzmann, Michael, Norat, Teresa, Powers, Hilary J, Scoccianti, Chiara, Auvinen, Anssi, de Vries, Esther, Erdmann, Friederike, Greinert, Rüdiger, Harrison, John, Kesminiene, Ausrele, McColl, Neil, Friis, Søren, Kogevinas, Manolis, Saracci, Rodolfo, Straif, Kurt, Vainio, Harri, Almonte, Maribel, Anttila, Ahti, De Vuyst, Hugo, Dillner, Joakim, Franceschi, Silvia, Gonzalez, Paula, Hall, Andrew, Park, Jin Young, Armaroli, Paola, Atkin, Wendy, Dean, Peter B., de Koning, Harry, Dillner, Lena, Kuipers, Ernst, Lansdorp-Vogelaar, Iris, Paci, Eugenio, Regula, Jaroslaw, Suonio, Eero, Törnberg, Sven, Wood, Lynn Faulds, Gaudin, Nicolas, Frie, Kirstin Grosse, Terrasse, Veronique, Winstanley, Kelly, Bellisario, Cristina, Biagioli, Elena, Cinquini, Michela, Gianola, Silvia, Gonzalez Lorenzo, Marien, von Karsa, Lawrence, Lignini, Tracy, Schüz, Joachim, Espina, Carolina, Villain, Patricia, Herrero, Rolando, Leon, Maria E., Minozzi, Silvia, Romieu, Isabelle, Segnan, Nereo, Wardle, Jane, Wiseman, Martin, Belardelli, Filippo, Bettcher, Douglas, Cavalli, Franco, Galea, Gauden, Lenoir, Gilbert, Martin-Moreno, Jose M., Nicula, Florian Alexandru, Olsen, Jørgen H., Patnick, Julietta, Primic-Zakelj, Maja, Puska, Pekka, van Leeuwen, Flora E., Wiestler, Otmar, and Zatonski, Witold

Published
2015
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33. CanScreen5, a global repository for breast, cervical and colorectal cancer screening programs

Author

Zhang, Li, Mosquera, Isabel, Lucas, Eric, Rol, Mary Luz, Carvalho, Andre L., Basu, Partha, Sadowski, Daniel, Natasha, Bartlett, Budd, Alison, Nessa, Ashrafun, De Brabander, Isabel, Haelens, Annemie, Pringels, Sarah, Tairo, Jonas, Hofvind, Solveig, Burrion, J. B., Valerianova, Zdravka, Tinmouth, Jill, Law, Cindy, Ebenuwah, Simbi, McCurdy, Bronwen, Janik, Beata, Pupwe, George, Groeneveld, Linn Fenna, Skare, Gry Baadstrand, Layne, Penelope, Sarkeala, Tytti, Chaila, Mwate Joseph, Kaminski, Michal, Kinel, Beata, Lissowska, Jolanta, Mumukunde, Inga, Rodrigues, Vitor, Rodriguez, Robinson, Perez Sanz, Elena, Zubizarreta Alberdi, Raquel, Ronco, Guglielmo, Antoljak, Natasa, Nakic, Dinka, Plazanin, Davor, Parun, Andrea Supe, Goossens, Mat, Nowakowski, Andrzej, de Koning, Harry, Dams, Els, Martin, Asha, Epermane, Mara, Jankovska, Natalja, Antle, Scott, Fracheboud, Jacques, Toes-Zoutendijk, Esther, van Agt, Heleen M. E., Budewig, Karen, Stomper, Barbara, Anttila, Ahti, McLeish, Sorana, Ramssl-Sauer, Alexandra, Ziniel, Georg, Kyprianou, Theopisti, Pavlou, Pavlos, Kaliva, Fofo, Tsantidou, Maria, Zhang, Shaokai, Xu, Huifang, Mushtaq, Wali, Paredes Barragan, Biviana, Montalvo, Alexandra, de la Torre Santos, Ana Victoria, Guertin, Marie-Helene, Fournier, Sarah, Duport, Nicolas, Majek, Ondrej, Ngo, Ondrej, Ivanus, Urska, Jarm, Katja, Primic-Zakelj, Maja, de Correa, Flavia Miranda, Migowski, Arn, Cancela, Marianna, Gallardo, Patricia, Fattore, Gisel, Puello, Adrian, Polanco, Victor, Ascunce Elizaga, Nieves, Fabri, Valerie, Mantellini, Paola, Zappa, Marco, Kellen, Eliane, Lynge, Elsebeth, Kaab-Sanyal, Vanessa, Malek, Daniela, Chami, Youssef, Ivanauskiene, Rugile, Bandhoe, Nensy, Dillenbourg, Claire, Heckters, Karin, Scharpantgen, Astrid, Mariela Ruiz, Oris, Mireya Gonzalez, Geneva, Arenas, Elsa, Palacios Cacacho, Eduardo Alberto, Pomata, Alicia, Navarro, Eliza, Mencia, Milva, Abreu Ruiz, Gisela, Campoverde, Ruth, Camel, Claudia, Donis, Rocio, Ines Sandoval, Yolanda, Garcia, Heidy, Isabel Roldan, Omaira, del Carmen Moreno, Teresa, Morales Velado, Mario, Merino, Gina, Rios, Juvenal A., Marte, Sabrina, Oliva Hernandez, Reina, Anea Chacon, Marina, Isabel Ruiz, Xiomara, Hernandez Vivas, Xiomara del Carmen, Ivan Gonzalez, Roger, Medal Ruiz, Damaris Isabel, Ortega, Lourdes, Matos Orbegozo, Andrea, Chuquiyauri Haro, Carlos Adolfo, Dalmas, Miriam, Unlu, Fahriye, Abousselham, Loubna, De Waldt, Rose-Marie, Buys, Charlotte, Hanna, Yasine, Williams, Cathi-Ann, Ottey, Londi-Ann, Philbert-Cyr, Shana, Emmanuel, Crissah, Jemmott, Alexandra, Alberto de Miranda, Nuno Augusto, Kioupi, Stala, Asnake, Takelech Moges, Attia, Adel A., Tshisimogo, Gontse, Seema, Lame, Banda, Jonathan Chiwanda, Mustapha, Feisul Idzwan, Mugolo, Rosita Paulo, de Miguel Juliao, Reginaldo Alice, Nyangasi, Mary, Mwenda, Valerian, Ferreira, Sonia Tavares, Barbosa, Carla, Makua, Manala, Bakare, Yacubu Herve Julius, Charles, Myanna, Charles, Leandra, Edwards-France, Vera, Sewtahal, Cheshta, Kebirungi, Bridget, Rwabinumi, Mugabe Frank, Williams, Valarie, Zachariah, Oritta, Scott, Arlitha, Deleveaux, Camille, Campbell, Martin, Ferreira, Cesaltina, Perera, Suraj, Silva, Padmaka, Kumarapeli, Vindya, Grant-Tate, Merisa, Tulloch, Cherie, Saika, Kumiko, Lee, Kyeongmin, Jun, Jae Kwan, Mukete, Sona Franklin, Dimitrov, Plamen, Momkuviene, Vaida, Zaksas, Viaceslavas, Veerus, Piret, Bric, Tatjana Kofol, Mlakar, Dominika Novak, Skrjanec, Ana Lucija, Zakotnik, Jozica Maucec, Skhirtladze, Tamar, Xuereb, Stephanie, Colquhoun, Carol, Sangrajrang, Suleeporn, Eshwar, Kumar, Stanners, Greig, Black, Roger, Andreassen, Trude, Budai, Andras, Dobrossy, Lajos, Kovacs, Attila, Nicula, Florian, Portillo, Isabel, Miren Altzibar, Jone, Arenaza, Edurne, Simango, Ndabaningi, Espinas, Josep A., Glinton-Rolle, Constance, Anews-Barr, Jeanette, Capote, Mariana, Fazzino, Marisa, Armstrong, Claire, Gamble, Andrew, Mc Innes, Kenneth, Wright, Suzanne, Clayton, Helen, Latinovic, Radoslav, Mackie, Anne, Rimmer, Janet, Hall, Clare, Elfstrom, Klara Miriam, Tornberg, Sven, Zorzi, Manuel, Leja, Marcis, Rezeberga, Dace, Hagenimana, Marc, Hamers, Francoise, Rogel, Agnes, Assogba, Frank, Fitzpatrick, Patricia, Arbyn, Marc, Figueroa, Jacqueline, Rovelo, Alex, Salinas, Erosloa, Yused Arguello, Elias, Milano Castillo, Adriana, Rosas, Velia, Spanik, Stanislav, Houmann, Merete Ronmos, Johansen, Dorte, Dillner, Joakim, Oswal, Kunal, Huang, Yubei, Siala, Ismail M., Candeur, Michel, Hoeck, Sarah, Borras, Josep M., Bleyen, Luc, Guzha, Bothwell Takaingofa, Mesmin Olivier, Adie Yao, Fasching, Elisabeth, Gesundheit, Alexander Gollmer, Taohid, Tonoy, Bencomo, Walkiria Bermejo, Tejada, Darbelis, Valletta, Joseph Psaila, Nisbett, Judy, Baptiste, Damaris, Layne, Melanie Ann, and CanScreen5 Collaborators

Subjects
Chemistry, Human medicine, Biology
Abstract

In the first results from an ongoing global cancer screening data repository, screening program organization was better overall in Europe compared to other continents; however, there were substantial gaps in implementation across both high- and low-resource settings. The CanScreen5 project is a global cancer screening data repository that aims to report the status and performance of breast, cervical and colorectal cancer screening programs using a harmonized set of criteria and indicators. Data collected mainly from the Ministry of Health in each country underwent quality validation and ultimately became publicly available through a Web-based portal. Until September 2022, 84 participating countries reported data for breast (n = 57), cervical (n = 75) or colorectal (n = 51) cancer screening programs in the repository. Substantial heterogeneity was observed regarding program organization and performance. Reported screening coverage ranged from 1.7% (Bangladesh) to 85.5% (England, United Kingdom) for breast cancer, from 2.1% (Cote d'Ivoire) to 86.3% (Sweden) for cervical cancer, and from 0.6% (Hungary) to 64.5% (the Netherlands) for colorectal cancer screening programs. Large variability was observed regarding compliance to further assessment of screening programs and detection rates reported for precancers and cancers. A concern is lack of data to estimate performance indicators across the screening continuum. This underscores the need for programs to incorporate quality assurance protocols supported by robust information systems. Program organization requires improvement in resource-limited settings, where screening is likely to be resource-stratified and tailored to country-specific situations.

Published
2023

47. HPV-testaamisen vaikutukset kohdunkaulasyövän seulonnan lähete- ja löydösmääriin

Author

Hakkila, Aino, Heinävaara, Sirpa, Sarkeala, Tytti, Anttila, Ahti, Pankakoski, Maiju, Lääketieteellinen tiedekunta, and Helsingin yliopisto

Subjects
Vaginal Smears, Overdiagnosis, 3111 Biolääketieteet, +diagnosis, Uterine Cervical Neoplasms, Unnecessary Procedures, Uterine Cervical Dysplasia, Risk Assessment, Human Papillomavirus DNA Tests, Colposcopy, Mass Screening, Female, +prevention & control, Referral and Consultation, Standing Orders
Abstract

Vertaisarvioitu. JOHDANTO : Kohdunkaulasyövän seulontamenetelmänä käytetyn papakokeen rinnalle on yleistynyt HPV-testi, joka otettiin Suomessa ensimmäistä kertaa käyttöön jo 2000-luvun alussa. Tarkastelimme HPV-testin käytön laajenemista, ja arvioimme sen vaikutusta seulonnan lähete- ja löydösmääriin. Aineisto sisälsi kohdunkaulasyövän seulontaohjelmaan vuosina 2003-2015 osallistuneiden 30-69-vuotiaiden naisten testitulokset sekä niitä seuranneet kolposkopialähetteet ja diagnoosit seulontaohjelmassa ja sen ulkopuolella. Lähete- ja esiasteriskien eroja tarkasteltiin HPV- ja papaseulottujen välillä. TULOKSET : HPV-testattujen henkilöiden todennäköisyys saada kolposkopialähete ja esiastediagnoosi oli noin kaksinkertainen verrattuna papakokeella testattuihin. Esiastediagnooseja tehtiin HPV-testatuille henkilöille etenkin riskiryhmäseulonnassa. Lähetteitä ja löydöksiä tehtiin testimenetelmästä riippumatta melko paljon myös seulontaohjelman ulkopuolella. PÄÄTELMÄT : HPV-seulonnassa löytyy paljon itsestään paranevia esiastemuutoksia, joten pitkittyneeseen HPV-infektioon pohjautuvat lähetekriteerit aiheuttavat runsaasti ylidiagnostiikkaa. Terveydenhuollon resursseja voitaisiin säästää kehittämällä HPV-seulonnan lähetekriteereitä ja vähentämällä seulontaohjelman ulkopuolisia näytteitä.

Published
2022

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