Publications by authors named "Solveig Hofvind"

152 Publications

The relation of number of childbirths with age at natural menopause: a population study of 310 147 women in Norway.

Hum Reprod 2021 Nov 13. Epub 2021 Nov 13.

Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.

Study Question: Does age at natural menopause increase with increasing of number of childbirths?

Summary Answer: Age at menopause increased with increasing number of childbirths up to three childbirths; however, we found no further increase in age at menopause beyond three childbirths.

What Is Known Already: Pregnancies interrupt ovulation, and a high number of pregnancies have therefore been assumed to delay menopause. Previous studies have had insufficient statistical power to study women with a high number of childbirths. Thus, the shape of the association of number of childbirths with age at menopause remains unknown.

Study Design, Size, Duration: A retrospective population study of 310 147 women in Norway who were 50-69 years old at data collection.

Participants/materials, Setting, Methods: The data were obtained by two self-administered questionnaires completed by women attending BreastScreen Norway, a population-based screening program for breast cancer. The associations of number of childbirths with age at menopause were estimated as hazard ratios by applying Cox proportional hazard models, adjusting for the woman's year of birth, cigarette smoking, educational level, country of birth, oral contraceptive use and body mass index.

Main Results And The Role Of Chance: Women with three childbirths had the highest mean age at menopause (51.36 years; 95% CI: 51.33-51.40 years), and women with no childbirths had the lowest (50.55 years; 95% CI: 50.48-50.62 years). Thus, women with no childbirths had higher hazard ratio of reaching menopause compared to women with three childbirths (reference group) (adjusted hazard ratio, 1.24; 95% CI: 1.22-1.27). Beyond three childbirths, we estimated no further increase in age at menopause. These findings were confirmed in sub-analyses among (i) women who had never used hormonal intrauterine device and/or systemic menopausal hormonal therapy; (ii) women who were born before 1950 and (iii) women who were born in 1950 or after.

Limitations, Reasons For Caution: Information about age at menopause was based on self-reports.

Wider Implications Of The Findings: If pregnancies truly delay menopause, one would expect that women with the highest number of childbirths had the highest age at menopause. Our results question the assumption that interrupted ovulation during pregnancy delays menopause.

Study Funding/competing Interest(s): This work was supported by the South-Eastern Norway Regional Health Authority [2016112 to M.S.G.] and by the Norwegian Cancer Society [6863294-2015 to E.K.B.]. The authors declare no conflicts of interest.

Trial Registration Number: N/A.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/humrep/deab246DOI Listing
November 2021

A Warning about Warning Signals for Interpreting Mammograms.

Radiology 2021 Nov 9:212092. Epub 2021 Nov 9.

From the Section for Mammographic Screening, Cancer Registry of Norway, PO Box 5313, Majorstuen, Oslo 0304, Norway (S.H.); Department of Health and Care Sciences, UiT-The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); and Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2021212092DOI Listing
November 2021

Quality of life among women with symptomatic, screen-detected, and interval breast cancer, and for women without breast cancer: a retrospective cross-sectional study from Norway.

Qual Life Res 2021 Oct 26. Epub 2021 Oct 26.

Cancer Registry of Norway, Majorstuen, P.O. 5313, 0304, Oslo, Norway.

Purpose: Breast cancers detected at screening need less aggressive treatment compared to breast cancers detected due to symptoms. The evidence on the quality of life associated with screen-detected versus symptomatic breast cancer is sparse. This study aimed to compare quality of life among Norwegian women with symptomatic, screen-detected and interval breast cancer, and women without breast cancer and investigate quality adjusted life years (QALYs) for women with breast cancer from the third to 14th year since diagnosis.

Methods: This retrospective cross-sectional study was focused on women aged 50 and older. A self-reported questionnaire including EQ-5D-5L was sent to 11,500 women. Multivariable median regression was used to analyze the association between quality of life score (visual analogue scale 0-100) and detection mode. Health utility values representing women's health status were extracted from EQ-5D-5L. QALYs were estimated by summing up the health utility values for women stratified by detection mode for each year between the third and the 14th year since breast cancer diagnosis, assuming that all women would survive.

Results: Adjusted regression analyses showed that women with screen-detected (n = 1206), interval cancer (n = 1005) and those without breast cancer (n = 1255) reported a higher median quality of life score using women with symptomatic cancer (n = 1021) as reference; 3.7 (95%CI 2.2-5.2), 2.3 (95%CI 0.7-3.8) and 4.8 (95%CI 3.3-6.4), respectively. Women with symptomatic, screen-detected and interval cancer would experience 9.5, 9.6 and 9.5 QALYs, respectively, between the third and the 14th year since diagnosis.

Conclusion: Women with screen-detected or interval breast cancer reported better quality of life compared to women with symptomatic cancer. The findings add benefits of organized mammographic screening.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11136-021-03017-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547129PMC
October 2021

Impact of Artificial Intelligence Decision Support Using Deep Learning on Breast Cancer Screening Interpretation with Single-View Wide-Angle Digital Breast Tomosynthesis.

Radiology 2021 09 6;300(3):529-536. Epub 2021 Jul 6.

From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.).

Background The high volume of data in digital breast tomosynthesis (DBT) and the lack of agreement on how to best implement it in screening programs makes its use challenging. Purpose To compare radiologist performance when reading single-view wide-angle DBT images with and without an artificial intelligence (AI) system for decision and navigation support. Materials and Methods A retrospective observer study was performed with bilateral mediolateral oblique examinations and corresponding synthetic two-dimensional images acquired between June 2016 and February 2018 with a wide-angle DBT system. Fourteen breast screening radiologists interpreted 190 DBT examinations (90 normal, 26 with benign findings, and 74 with malignant findings), with the reference standard being verified by using histopathologic analysis or at least 1 year of follow-up. Reading was performed in two sessions, separated by at least 4 weeks, with a random mix of examinations being read with and without AI decision and navigation support. Forced Breast Imaging Reporting and Data System (categories 1-5) and level of suspicion (1-100) scores were given per breast by each reader. The area under the receiver operating characteristic curve (AUC) and the sensitivity and specificity were compared between conditions by using the public-domain iMRMC software. The average reading times were compared by using the Wilcoxon signed rank test. Results The 190 women had a median age of 54 years (range, 48-63 years). The examination-based reader-averaged AUC was higher when interpreting results with AI support than when reading unaided (0.88 [95% CI: 0.84, 0.92] vs 0.85 [95% CI: 0.80, 0.89], respectively; = .01). The average sensitivity increased with AI support (64 of 74, 86% [95% CI: 80%, 92%] vs 60 of 74, 81% [95% CI: 74%, 88%]; = .006), whereas no differences in the specificity (85 of 116, 73.3% [95% CI: 65%, 81%] vs 83 of 116, 71.6% [95% CI: 65%, 78%]; = .48) or reading time (48 seconds vs 45 seconds; = .35) were detected. Conclusion Using a single-view digital breast tomosynthesis (DBT) and artificial intelligence setup could allow for a more effective screening program with higher performance, especially in terms of an increase in cancers detected, than using single-view DBT alone. © RSNA, 2021 See also the editorial by Chan and Helvie in this issue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2021204432DOI Listing
September 2021

Detection and significance of small and low proliferation breast cancer.

J Med Screen 2021 Jun 22:9691413211023970. Epub 2021 Jun 22.

Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.

Objectives: To determine the frequency and discuss possible implications of early breast cancer with particularly good prognosis and defined by tumor diameter and cell proliferation.

Setting: Detection of small and slowly growing tumors presents a challenge in breast cancer management, due to the risk of over-treatment. Here, we attempted to define a group of such tumors by combining small diameter (≤10 mm, T1ab tumors) with low tumor cell proliferation (≤10% Ki67 expression rate). These tumors were termed small low proliferation cancers (SLPC).

Methods: Two population-based cohorts were studied: a small research series ( = 534), and a nation-wide registry-based series of prospectively collected routine data ( = 8433). In the latter, we stratified by detection mode; screen-detected, interval, and breast cancers detected outside of screening. Patients were treated according to national guidelines at time of their diagnosis. For both cohorts, we compared tumor histopathology and risk of breast cancer death using a log-rank test for cases with SLPC versus non-SLPC.

Results: In the research series (median follow-up 151 months), the frequency of SLPC was 10% (54/534), with one breast cancer death compared with 78 among the remaining 480 cases of non-SLPC ( = 0.008). In the registry series (median follow-up 42 months), the frequency of SLPC was 10% (854/8433), with five deaths compared to 187 among the remaining 7579 cases ( = 0.0004).

Conclusions: SLPC was associated with very low risk of breast cancer death. Prospective randomized trials are needed to clarify whether less aggressive treatment could be a safe option for women with such early breast cancers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/09691413211023970DOI Listing
June 2021

Does it matter for the radiologists' performance whether they read short or long batches in organized mammographic screening?

Eur Radiol 2021 Dec 10;31(12):9548-9555. Epub 2021 Jun 10.

Section for Breast Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Oslo, Norway.

Objective: To analyze the association between radiologists' performance and image position within a batch in screen reading of mammograms in Norway.

Method: We described true and false positives and true and false negatives by groups of image positions and batch sizes for 2,937,312 screen readings performed from 2012 to 2018. Mixed-effects models were used to obtain adjusted proportions of true and false positive, true and false negative, sensitivity, and specificity for different image positions. We adjusted for time of day and weekday and included the individual variation between the radiologists as random effects. Time spent reading was included in an additional model to explore a possible mediation effect.

Result: True and false positives were negatively associated with image position within the batch, while the rates of true and false negatives were positively associated. In the adjusted analyses, the rate of true positives was 4.0 per 1000 (95% CI: 3.8-4.2) readings for image position 10 and 3.9 (95% CI: 3.7-4.1) for image position 60. The rate of true negatives was 94.4% (95% CI: 94.0-94.8) for image position 10 and 94.8% (95% CI: 94.4-95.2) for image position 60. Per 1000 readings, the rate of false negative was 0.60 (95% CI: 0.53-0.67) for image position 10 and 0.62 (95% CI: 0.55-0.69) for image position 60.

Conclusion: There was a decrease in the radiologists' sensitivity throughout the batch, and although this effect was small, our results may be clinically relevant at a population level or when multiplying the differences with the number of screen readings for the individual radiologists.

Key Points: • True and false positive reading scores were negatively associated with image position within a batch. • A decreasing trend of positive scores indicated a beneficial effect of a certain number of screen readings within a batch. • False negative scores increased throughout the batch but the association was not statistically significant.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-021-08010-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589803PMC
December 2021

Factors associated with attendance and attendance patterns in a population-based mammographic screening program.

J Med Screen 2021 06 17;28(2):169-176. Epub 2020 Jun 17.

Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.

Objective: To explore the factors associated with attendance and attendance pattern in BreastScreen Norway.

Methods: We evaluated the number of invitations (n = 1,253,995) and attendances, 2015-2019, stratified by age, invitation method, screening unit and time of appointment. Attendance pattern was analysed for women invited 10 times (n = 47,979), 1996-2019. The association of education level, body mass index, physical activity and smoking status with attendance was analysed for a sub-sample of women (n = 37,930). Descriptive statistics were used to analyse attendance, and negative binomial regression was used to analyse the association between the total number of attendances and education level and lifestyle factors.

Results: The attendance rate was 76.0%, 2015-2019. The rate was 78.0% for women aged >64 and 73.9% for those <55 . We found a rate of 82.0% for women who received a digital invitation, while it was 73.7% for those invited by post. The rate was 78.1% for invitations in the late afternoon, 3-6 p.m., while later appointments reached a rate of 73.7%. Half of the women invited 10 times attended all times. The predicted total number of attendances was 9 out of 10 for the factors investigated.

Conclusion: The highest attendance rates were shown for women aged >64, those who received digital invitations and those having appointments in late afternoon. The differences in predicted number of attendances between the investigated factors were minor. Overall, BreastScreen Norway has a high attendance rate. However, efforts aimed at increasing the attendance in specific groups should be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0969141320932945DOI Listing
June 2021

Interval breast cancer rates for digital breast tomosynthesis versus digital mammography population screening: An meta-analysis.

EClinicalMedicine 2021 Apr 20;34:100804. Epub 2021 Mar 20.

Department of Translational Medicine, Diagnostic Radiology, Lund University, Skane University Hospital, Malmö, Sweden.

Background: Digital breast tomosynthesis (DBT) improves breast cancer (BC) detection compared to mammography, however, it is unknown whether this reduces (ICR) at follow-up.

Methods: Using (IPD) from DBT screening studies (identified via periodic literature searches July 2016 to November 2019) we performed an IPD meta-analysis. We estimated ICR for DBT-screened participants and the difference in pooled ICR for DBT and mammography-only screening, and compared interval BC characteristics. Two-stage meta-analysis (study-specific estimation, pooled synthesis) of ICR included random-effects, adjusting for study and age, and was estimated in age and density subgroups. Comparative screening sensitivity was calculated using screen-detected and interval BC data.

Findings: Four prospective DBT studies, from European population-based programs, contributed IPD for 66,451 DBT-screened participants: age-adjusted pooled ICR was 13.17/10,000 (95%CI: 8.25-21.02). Pooled ICR was higher in the high-density (21.08/10,000; 95%CI: 6.71-66.27) than the low-density (8.63/10,000; 95%CI: 5.25-14.192) groups ( = 0.03) however estimates did not differ across age-groups ( = 0.32). Based on two studies that also provided data for 153,800 mammography screens (age-adjusted ICR 17.69/10,000; 95%CI: 13.22-23.66), DBT's pooled ICR was 16.83/10,000 (95%CI: 11.89-23.82). Comparative meta-analysis showed a non-significant difference in ICR (-0.44/10,000; 95%CI: -11.00-10.11) and non-significant difference in screening sensitivity (6.79%; 95%CI: -0.73-14.87%) between DBT and DM but a significant pooled in cancer detection rate of 33.49/10,000 (95%CI: 23.88-43.10). Distribution of interval BC prognostic characteristics did not differ between screening modalities except that those occurring in DBT-screened participants were significantly more likely to be negative for axillary-node metastases ( = 0.005).

Interpretation: Although heterogeneity in ICR estimates and few datasets limit recommendations, there was no difference between DBT and mammography in pooled ICR despite DBT increasing cancer detection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eclinm.2021.100804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102709PMC
April 2021

Can breast cancer be stopped? Modifiable risk factors of breast cancer among women with a prior benign or premalignant lesion.

Int J Cancer 2021 09 22;149(6):1247-1256. Epub 2021 May 22.

Cancer Registry of Norway, Oslo, Norway.

Physical inactivity, high postmenopausal body mass index, alcohol consumption and use of menopausal hormone therapy are established risk factors for breast cancer. Less is known about whether these factors influence the risk of progression of benign and premalignant breast lesions to invasive breast cancer. This registry-based cohort study was based on women with a precancerous lesion who were followed for breast cancer. The cohort consisted of 11 270 women with a benign lesion, 972 women with hyperplasia with atypia and 2379 women with carcinoma in situ diagnosed and treated after participation in BreastScreen Norway, 2006-2016. Information on breast cancer risk factors was collected by a questionnaire administered with the invitation letter. Cox regression analysis was used to estimate the association between breast cancer and physical activity, body mass index, alcohol consumption, tobacco smoking and menopausal hormone therapy, adjusted for age. During follow-up, 274 women with a benign lesion, 34 women with hyperplasia with atypia and 118 women with carcinoma in situ were diagnosed with invasive breast cancer. We observed an increased risk of breast cancer associated with use of menopausal hormone therapy for women with a benign or premalignant lesion. Alcohol consumption and tobacco smoking showed suggestive increased risk of breast cancer among women with a benign lesion. We were only to a limited degree able to identify associations between modifiable risk factors of breast cancer and the disease among women with a precancerous lesion, and a larger study is needed to confirm or refute associations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijc.33680DOI Listing
September 2021

Interval and Subsequent Round Breast Cancer in a Randomized Controlled Trial Comparing Digital Breast Tomosynthesis and Digital Mammography Screening.

Radiology 2021 07 11;300(1):66-76. Epub 2021 May 11.

From the Cancer Registry of Norway, PO 5313, Maiorstuen, 0304 Oslo, Norway (S.H., N.M., Å.S.H., A.S.D.); Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Services, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (N.H.); Department of Radiology (H.S.A., I.S.H.), Department of Pathology (L.A.A.), and Mohn Medical Imaging and Visualization Centre (I.S.H.), Haukeland University Hospital, Bergen, Norway; and Department of Clinical Medicine (H.S.A., I.S.H.), Section for Pathology (L.A.A.), and Centre for Cancer Biomarkers CCBIO (L.A.A.), University of Bergen, Bergen, Norway.

Background Prevalent digital breast tomosynthesis (DBT) has shown higher cancer detection rates and lower recall rates compared with those of digital mammography (DM). However, data are limited on rates and histopathologic tumor characteristics of interval and subsequent round screen-detected cancers for DBT. Purpose To follow women randomized to screening with DBT or DM and to investigate rates and tumor characteristics of interval and subsequent round screen-detected cancers. Materials and Methods To-Be is a randomized controlled trial comparing the outcome of DBT and DM in organized breast cancer screening. The trial included 28 749 women, with 22 306 women returning for subsequent DBT screening 2 years later (11 201 and 11 105 originally screened with DBT and DM, respectively). Differences in rates, means, and distribution of histopathologic tumor characteristics between women prevalently screened with DBT versus DM were evaluated with Z tests, tests, and χ tests. Relative risk (RR) with 95% CIs was calculated for the cancer rates. Results Interval cancer rates were 1.4 per 1000 screens (20 of 14 380; 95% CI: 0.9, 2.1) for DBT versus 2.0 per 1000 screens (29 of 14 369; 95% CI: 1.4, 2.9; = .20) for DM. The rates of subsequent round screen-detected cancer were 8.1 per 1000 (95% CI: 6.6, 10.0) for women originally screened with DBT and 9.1 per 1000 (95% CI: 7.4, 11.0; = .43) for women screened with DM. The distribution of tumor characteristics did not differ between groups for either interval or subsequent screen-detected cancer. The RR of interval cancer was 0.69 (95% CI: 0.39, 1.22; = .20) for DBT versus DM, whereas RR of subsequent screen-detected cancer for women prevalently screened with DBT versus DM was 0.89 (95% CI: 0.67, 1.19; = .43). Conclusion Rates of interval or subsequent round screen-detected cancers and their tumor characteristics did not differ between women originally screened with digital breast tomosynthesis (DBT) versus digital mammography. The analysis suggests that the benefits of prevalent DBT screening did not come at the expense of worse downstream screening performance measures in a population-based screening program. © RSNA, 2021 See also the editorial by Taourel in this issue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2021203936DOI Listing
July 2021

True and Missed Interval Cancer in Organized Mammographic Screening: A Retrospective Review Study of Diagnostic and Prior Screening Mammograms.

Acad Radiol 2021 Apr 26. Epub 2021 Apr 26.

Faculty of Health Science, Oslo Metropolitan University, PO Box 4 St. Olavs plass, 0130 Oslo, Norway. Electronic address:

Rationale And Objectives: To explore radiological aspects of interval breast cancer in a population-based screening program.

Materials And Methods: We performed a consensus-based informed review of mammograms from diagnosis and prior screening from women diagnosed with interval cancer 2004-2016 in BreastScreen Norway. Cases were classified as true (no findings on prior screening mammograms), occult (no findings at screening or diagnosis), minimal signs (minor/non-specific findings) and missed (obvious findings). We analyzed mammographic findings, density, time since prior screening, and histopathological characteristics between the classification groups.

Results: The study included 1010 interval cancer cases. Mean age at diagnosis was 61 years (SD = 6), mean time between screening and diagnosis 14 months (SD = 7). A total of 48% (479/1010) were classified as true or occult, 28% (285/1010) as minimal signs and 24% (246/1010) as missed. We observed no differences in mammographic density between the groups, except from a higher percentage of dense breasts in women with occult cancer. Among cancers classified as missed, about 1/3 were masses and 1/3 asymmetries at prior screening. True interval cancers were diagnosed later in the screening interval than the other classification categories. No differences in histopathological characteristics were observed between true, minimal signs and missed cases.

Conclusion: In an informed review, 24% of the interval cancers were classified as missed based on visibility and mammographic findings on prior screening mammograms. Three out of four true interval cancers were diagnosed in the second year of the screening interval. We observed no statistical differences in histopathological characteristics between true and missed interval cancers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acra.2021.03.022DOI Listing
April 2021

Patterns of aggressiveness: risk of progression to invasive breast cancer by mammographic features of calcifications in screen-detected ductal carcinoma in situ.

Acta Radiol 2021 Apr 22:2841851211006319. Epub 2021 Apr 22.

Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway.

Background: Mammographic features of calcifications on mammograms showing invasive breast cancer are associated with survival. Less is known about mammographic features and progression to invasive breast cancer among women treated for ductal carcinoma in situ (DCIS).

Purpose: To investigate mammographic features of calcifications in screen-detected DCIS in women who later did and did not get diagnosed with invasive breast cancer.

Material And Methods: This registry-based nested case-control study analyzed data from women with screen-detected DCIS in BreastScreen Norway, 1995-2016. Within this cohort of women with DCIS, those who were later diagnosed with invasive breast cancer (cases) were matched (1:2) to women who were not diagnosed with invasive breast cancer (controls) after their DCIS and by the end of 2016. Information on mammographic features were collected by a national radiological review, where screening mammograms were reviewed locally at each of the 16 breast centers in Norway. We used conditional logistic regression analysis to estimate associations between mammographic features of calcifications in the DCIS mammogram and the risk of subsequent invasive breast cancer.

Results: We found a higher risk of invasive breast cancer associated with fine linear branching (casting) morphology (odds ratio 20.0; 95% confidence interval [CI] 2.5-158.9) compared to fine linear or fine pleomorphic morphology. Regional or diffuse distribution showed an odds ratio of 2.8 (95% CI 1.0-8.2) compared to segmental or linear distribution.

Conclusion: Mammographic features of calcifications in screen-detected DCIS were of influence on the risk of invasive breast cancer. Unfavorable characteristics of DCIS were fine linear branching morphology, and regional or diffuse distribution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/02841851211006319DOI Listing
April 2021

Digital breast tomosynthesis in a population based mammographic screening program: Breast compression and early performance measures.

Eur J Radiol 2021 Jun 19;139:109665. Epub 2021 Mar 19.

Cancer Registry of Norway, Oslo, Norway; Faculty of Health Sciences Oslo Metropolitan University, Oslo, Norway. Electronic address:

Purpose: We aimed to determine if compression force or pressure could be associated with early performance measures for women screened with digital breast tomosynthesis (DBT) in BreastScreen Norway. Early performance measures included rates of consensus, recall, and screen-detected breast cancer.

Method: Data on compression force and pressure, compressed breast thickness and breast characteristics were extracted from an automated software for density assessment of DBT screening examinations for 25,286 women. For descriptive analyses, force (Newton, N) and pressure (kilopascal, kPa) were categorized into quartiles. Analyses were stratified by mammographic view, craniocaudal (CC) and mediolateral oblique (MLO). Logistic regression with restricted cubic splines was used to investigate the association between force and pressure as continuous exposures and early performance measures adjusted for age, compressed breast thickness and fibroglandular volume.

Results: Mean age of the screened women was 60.7 (SD = 5.2) years. Mean compression force was 90.8 (SD = 14.2) N for CC and 106.3 (SD = 20.6) N for MLO, and pressure was 11.3 (SD = 3.6) kPa for CC and 8.7 (SD = 2.0) kPa for MLO. The highest rates of screen-detected cancer were observed for low force (1.04 % for <82.5 N for CC and 1.07 % for <92.0 N for MLO) and low pressure (1.07 % for <7.2 kPa for MLO). No association was found between force or pressure as continuous exposures and early performance measures in adjusted regression analyses.

Conclusions: We found the highest rates of screen-detected cancer for low force and pressure, but no significant association between continuous values of force or pressure and early performance measures in DBT. The findings might indicate that the levels of force and pressure in DBT are of lower significance for screening performance than reported in standard digital mammography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2021.109665DOI Listing
June 2021

Assessment of breast positioning criteria in mammographic screening: Agreement between artificial intelligence software and radiographers.

J Med Screen 2021 12 9;28(4):448-455. Epub 2021 Mar 9.

Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.

Objectives: To determine the agreement between artificial intelligence software (AI) and radiographers in assessing breast positioning criteria for mammograms from standard digital mammography and digital breast tomosynthesis.

Methods: Assessment of breast positioning was performed by AI and by four radiographers in pairs of two on 156 examinations of women screened in Bergen, April to September 2019, as part of BreastScreen Norway. Ten criteria were used; three for craniocaudal and seven for mediolateral-oblique view. The criteria evaluated the appearance of the nipple, breast rotation, pectoral muscle, inframammary fold and pectoral nipple line. Intraclass correlation and Cohen's kappa coefficient (κ) were used to investigate the correlation and agreement between the radiographer's assessments and AI.

Results: The intraclass correlation for the pectoral nipple line between the radiographers and AI was >0.92. A substantial to almost perfect agreement (κ > 0.69) was observed between the radiographers and AI on the nipple in profile criterion. We observed a slight to moderate agreement for the other criteria (κ = 0.06-0.52) and generally a higher agreement between the two pairs of radiographers (mean κ = 0.70) than between the radiographers and AI (mean κ = 0.41).

Conclusions: AI has great potential in evaluating breast position criteria in mammography by reducing subjectivity. However, varying agreement between radiographers and AI was observed. Standardized and evidence-based criteria for definitions, understandings and assessment methods are needed to reach optimal image quality in mammography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0969141321998718DOI Listing
December 2021

Meta-analysis of prospective studies evaluating breast cancer detection and interval cancer rates for digital breast tomosynthesis versus mammography population screening.

Eur J Cancer 2021 05 9;148:14-23. Epub 2021 Mar 9.

Section of Breast Screening, Cancer Registry of Norway, Oslo, Norway.

Introduction: Breast cancer (BC) screening using digital breast tomosynthesis (DBT) has been shown to increase cancer detection compared with mammography; however, it is unknown whether DBT impacts interval cancer rate (ICR).

Methods: We systematically identified prospective DBT studies reporting data on screen-detected and interval BCs to perform a study-level meta-analysis of the comparative effect of DBT on ICR in population screening. Meta-analysis of cancer detection rate (CDR), ICR, and the differences between DBT and mammography in CDR and ICR pooled estimates, included random-effects. Sensitivity analysis examined whether study methods (imaging used, comparison group design, interval BC ascertainment) affected pooled estimates.

Results: Five eligible prospective (non-randomised) studies of DBT population screening reported on 129,969 DBT-screened participants and 227,882 mammography-only screens, including follow-up publications reporting interval BC data. Pooled CDR was 9.03/1000 (95% confidence interval [CI] 8.53-9.56) for DBT, and 5.95/1000 (95% CI 5.65-6.28) for mammography: the pooled difference in CDR was 3.15/1000 (95% CI 2.53-3.77), and was evident for the detection of invasive and in-situ malignancy. Pooled ICR was 1.56/1000 DBT screens (95% CI 1.22-2.00), and 1.75/1000 mammography screens (95% CI 1.46-2.11): the estimated pooled difference in ICR was -0.15/1000 (95% CI -0.59 to 0.29) and was not substantially altered in several sensitivity analyses.

Conclusions: Meta-analysis shows consistent evidence that DBT significantly increased CDR compared with mammography screening; however, there was little difference between DBT and mammography in pooled ICR. This could suggest, but does not demonstrate, some over-detection. Meta-analysis using individual participant data, randomised trials and comparative studies quantifying cumulative detection and ICR over repeat DBT screen-rounds would provide valuable evidence to inform screening programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejca.2021.01.035DOI Listing
May 2021

Attendance in BreastScreen Norway among immigrant and Norwegian-born women.

Tidsskr Nor Laegeforen 2021 02 1;141(2). Epub 2021 Feb 1.

Background: Women residing in Oslo have had lower attendance in BreastScreen Norway than the national average. We explored attendance in BreastScreen Norway among immigrant versus Norwegian-born women in Oslo, compared to other counties in Norway.

Material And Method: We linked attendance data from BreastScreen Norway to sociodemographic data from Statistics Norway for 885 979 women offered mammographic screening in the period 1996-2015. We undertook descriptive analyses of attendance in the different counties for the group of invitees as a whole, and for Norwegian-born and immigrants by country of birth ('Western Europe, Northern America, Australia and New Zealand' and 'other countries'). Furthermore, we estimated the predicted likelihood of attendance with the aid of logistic regression, using attendance (yes/no) as the outcome variable. Independent variables in the model included place of residence (Oslo/other counties), country of birth and interaction between these variables. In addition, we adjusted for age at the time of the invitation, education and marital status.

Results: Among women residing in Oslo, attendance was 67 % among Norwegian-born women, 61 % among women born in Western Europe, Northern America, Australia and New Zealand, and 39 % among women born in 'other countries'. Among women residing outside Oslo, the corresponding attendance was 79 %, 71 % and 50 % respectively.

Interpretation: Oslo as place of residence was associated with lower attendance in BreastScreen Norway, especially among immigrant women from 'other countries', and independently of adjustment for possible confounding variables.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4045/tidsskr.20.0134DOI Listing
February 2021

Can artificial intelligence reduce the interval cancer rate in mammography screening?

Eur Radiol 2021 Aug 23;31(8):5940-5947. Epub 2021 Jan 23.

Diagnostic Radiology, Department of Translational Medicine, Lund University, Inga Maria Nilssons gata 47, SE-20502, Malmö, Sweden.

Objectives: To investigate whether artificial intelligence (AI) can reduce interval cancer in mammography screening.

Materials And Methods: Preceding screening mammograms of 429 consecutive women diagnosed with interval cancer in Southern Sweden between 2013 and 2017 were analysed with a deep learning-based AI system. The system assigns a risk score from 1 to 10. Two experienced breast radiologists reviewed and classified the cases in consensus as true negative, minimal signs or false negative and assessed whether the AI system correctly localised the cancer. The potential reduction of interval cancer was calculated at different risk score thresholds corresponding to approximately 10%, 4% and 1% recall rates.

Results: A statistically significant correlation between interval cancer classification groups and AI risk score was observed (p < .0001). AI scored one in three (143/429) interval cancer with risk score 10, of which 67% (96/143) were either classified as minimal signs or false negative. Of these, 58% (83/143) were correctly located by AI, and could therefore potentially be detected at screening with the aid of AI, resulting in a 19.3% (95% CI 15.9-23.4) reduction of interval cancer. At 4% and 1% recall thresholds, the reduction of interval cancer was 11.2% (95% CI 8.5-14.5) and 4.7% (95% CI 3.0-7.1). The corresponding reduction of interval cancer with grave outcome (women who died or with stage IV disease) at risk score 10 was 23% (8/35; 95% CI 12-39).

Conclusion: The use of AI in screen reading has the potential to reduce the rate of interval cancer without supplementary screening modalities.

Key Points: • Retrospective study showed that AI detected 19% of interval cancer at the preceding screening exam that in addition showed at least minimal signs of malignancy. Importantly, these were correctly localised by AI, thus obviating supplementary screening modalities. • AI could potentially reduce a proportion of particularly aggressive interval cancers. • There was a correlation between AI risk score and interval cancer classified as true negative, minimal signs or false negative.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-021-07686-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270858PMC
August 2021

Survival among women diagnosed with screen-detected or interval breast cancer classified as true, minimal signs, or missed through an informed radiological review.

Eur Radiol 2021 May 12;31(5):2677-2686. Epub 2020 Nov 12.

Section for Breast Cancer Screening, Cancer Registry of Norway, PO Box 5313, Majorstuen, 0304, Oslo, Norway.

Objectives: "True" breast cancers, defined as not being visible on prior screening mammograms, are expected to be more aggressive than "missed" cancers, which are visible in retrospect. However, the evidence to support this hypothesis is limited. We compared the risk of death from any cause for women with true, minimal signs, and missed invasive screen-detected (SDC) and interval breast cancers (IC).

Methods: This nation-wide study included 1022 SDC and 788 IC diagnosed through BreastScreen Norway during 2005-2016. Cancers were classified as true, minimal signs, or missed by five breast radiologists in a consensus-based informed review of prior screening and diagnostic images. We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of death from any cause associated with true, minimal signs, and missed breast cancers, adjusting for age at diagnosis, histopathologic tumour diameter and grade, and subtype. Separate models were created for SDC and IC.

Results: Among SDC, 463 (44%) were classified as true and 242 (23%) as missed; among IC, 325 (39%) were classified as true and 235 (32%) missed. Missed SDC were associated with a similar risk of death as true SDC (HR = 1.20, 95% CI (0.49, 2.46)). Similar results were observed for missed versus true IC (HR = 1.31, 95% CI (0.77, 2.23)).

Conclusions: We did not observe a statistical difference in the risk of death for women diagnosed with true or missed SDC or IC; however, the number of cases reviewed and follow-up time limited the precision of our estimates.

Key Points: • An informed radiological review classified screen-detected and interval cancers as true, minimal signs, or missed based on prior screening and diagnostic mammograms. • It has been hypothesised that true cancers, not visible on the prior screening examination, may be more aggressive than missed cancers. • We did not observe a statistical difference in the risk of death from any cause for women with missed versus true screen-detected or interval breast cancers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-020-07340-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043922PMC
May 2021

Surgical treatment of breast cancer in Norway 2003-2018.

Tidsskr Nor Laegeforen 2020 10 26;140(15). Epub 2020 Oct 26.

Background: Breast-conserving surgery is recommended in Norway and internationally in cases of early-stage breast cancer. We analysed the surgical methods used for breast-cancer patients by hospital providing treatment, age at the time of diagnosis, detection method and histopathological characteristics of the tumours in the period 2003 to 2018.

Material And Method: Data on women of all ages diagnosed with invasive breast cancer (n = 47 004) were retrieved from the Cancer Registry of Norway's databases. We excluded women with distant metastases at the time of diagnosis (n = 1 773) and those for whom no surgical method was recorded (n = 2 638). The detection method was defined as breast cancer detected by screening, in inter-screening intervals, or outside BreastScreen Norway. The surgical methods chosen were compared by means of descriptive analyses.

Results: Slightly over half (23 661 of 42 593, i.e. 55.6 %) of the women in whom breast cancer was detected in the study period underwent breast-conserving surgery. The percentage increased from 1 189/2 423 (49.1 %) in 2003 to 2 070/2 958 (70.0 %) in 2018. There were large differences across hospitals. In the period 2015-2018 we found the highest proportion of breast-conserving surgery, 175/187 (93.6 %) for breast cancer detected by screening to be performed at Ålesund Hospital, and the lowest proportion, 121/351 (34.5 %) among women with breast cancer detected outside BreastScreen Norway, to be performed at Radiumhospitalet. Breast-conserving surgery was used most frequently on women with small tumours without spreading to axillary lymph nodes.

Interpretation: We found considerable differences in the surgical methods used across hospitals and for different detection methods.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4045/tidsskr.20.0090DOI Listing
October 2020

Radiological review of prior screening mammograms of screen-detected breast cancer.

Eur Radiol 2021 Apr 1;31(4):2568-2579. Epub 2020 Oct 1.

Section for Breast Cancer Screening, Cancer Registry of Norway, PO Box 5313, Majorstuen, 0304, Oslo, Norway.

Objective: To perform a radiological review of mammograms from prior screening and diagnosis of screen-detected breast cancer in BreastScreen Norway, a population-based screening program.

Methods: We performed a consensus-based informed review of mammograms from prior screening and diagnosis for screen-detected breast cancers. Mammographic density and findings on screening and diagnostic mammograms were classified according to the Breast Imaging-Reporting and Data System®. Cases were classified based on visible findings on prior screening mammograms as true (no findings), missed (obvious findings), minimal signs (minor/non-specific findings), or occult (no findings at diagnosis). Histopathologic tumor characteristics were extracted from the Cancer Registry of Norway. The Bonferroni correction was used to adjust for multiple testing; p < 0.001 was considered statistically significant.

Results: The study included mammograms for 1225 women with screen-detected breast cancer. Mean age was 62 years ± 5 (SD); 46% (567/1225) were classified as true, 22% (266/1225) as missed, and 32% (392/1225) as minimal signs. No difference in mammographic density was observed between the classification categories. At diagnosis, 59% (336/567) of true and 70% (185/266) of missed cancers were classified as masses (p = 0.004). The percentage of histological grade 3 cancers was higher for true (30% (138/469)) than for missed (14% (33/234)) cancers (p < 0.001). Estrogen receptor positivity was observed in 86% (387/469) of true and 95% (215/234) of missed (p < 0.001) cancers.

Conclusions: We classified 22% of the screen-detected cancers as missed based on a review of prior screening mammograms with diagnostic images available. One main goal of the study was quality improvement of radiologists' performance and the program. Visible findings on prior screening mammograms were not necessarily indicative of screening failure.

Key Points: • After a consensus-based informed review, 46% of screen-detected breast cancers were classified as true, 22% as missed, and 32% as minimal signs. • Less favorable prognostic and predictive tumor characteristics were observed in true screen-detected breast cancer compared with missed. • The most frequent mammographic finding for all classification categories at the time of diagnosis was mass, while the most frequent mammographic finding on prior screening mammograms was a mass for missed cancers and asymmetry for minimal signs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-020-07130-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979605PMC
April 2021

Response to Zahl.

J Natl Cancer Inst 2020 11;112(11):1175

Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jnci/djaa130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669222PMC
November 2020

Comparing Screening Outcomes for Digital Breast Tomosynthesis and Digital Mammography by Automated Breast Density in a Randomized Controlled Trial: Results from the To-Be Trial.

Radiology 2020 12 15;297(3):522-531. Epub 2020 Sep 15.

From the Cancer Registry of Norway, PO Box 5313, Majorstuen, 0304 Oslo, Norway (N.M., A.S.D., S.H.); Department of Radiology, Haukeland University Hospital, Bergen, Norway (H.S.A., I.S.H.); Department of Clinical Medicine, University of Bergen, Bergen, Norway (H.S.A., I.S.H.); Department of Radiology, Seattle Cancer Care Alliance, University of Washington, Seattle, Wash (C.I.L.); Department of Translational Medicine, Diagnostic Radiology, Lund University Cancer Center, Malmö, Sweden (S.Z.); and Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway (S.H.).

Background Digital breast tomosynthesis (DBT) is considered superior to digital mammography (DM) for women with dense breasts. Purpose To identify differences in screening outcomes, including rates of recall, false-positive (FP) findings, biopsy, cancer detection rate, positive predictive value of recalls and biopsies, and histopathologic tumor characteristics by density using DBT combined with two-dimensional synthetic mammography (SM) (hereafter, DBT+SM) versus DM. Materials and Methods This randomized controlled trial comparing DBT+SM and DM was performed in Bergen as part of BreastScreen Norway, 2016-2017. Automated software measured density (Volpara Density Grade [VDG], 1-4). The outcomes were compared for DBT+SM versus DM by VDG in descriptive analyses. A stratified log-binomial regression model was used to estimate relative risk of outcomes in subgroups by screening technique. Results Data included 28 749 women, 14 380 of whom were screened with DBT+SM and 14 369 of whom were screened with DM (both groups: median age, 59 years; interquartile range [IQR], 54-64 years). The recall rate was lower for women screened with DBT+SM versus those screened with DM for VDG 1 (2.1% [81 of 3929] vs 3.3% [106 of 3212]; = .001) and VDG 2 (3.2% [200 of 6216] vs 4.3% [267 of 6280]; = .002). For DBT+SM, adjusted relative risk of recall (VDG 2: 1.8; < .001; VDG 3: 2.4; < .001; VDG 4: 1.8; = .02) and screen-detected breast cancer (VDG 2: 2.4; = .004; VDG 3: 2.8; = .01; VDG 4: 2.8; = .05) increased with VDG, whereas no differences were observed for DM (relative risk of recall for VDG 2: 1.3; = .06; VDG 3: 1.1; = .41; VDG 4: 1.1; = .71; and relative risk of screen-detected breast cancer for VDG 2: 1.7; = .13; VDG 3: 2.1; = .06; VDG 4: 2.2; = .15). Conclusion Screening with digital breast tomosynthesis combined with synthetic two-dimensional mammograms (DBT+SM) versus digital mammography (DM) yielded lower recall rates for women with Volpara Density Grade (VDG) 1 and VDG 2. Adjusted relative risk of recall and screen-detected breast cancer increased with denser breasts for DBT+SM but not for DM. © RSNA, 2020 See also the editorial by Sechopoulos and Athanasiou in this issue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2020201150DOI Listing
December 2020

Self-reported symptoms among participants in a population-based screening program.

Breast 2020 Dec 31;54:56-61. Epub 2020 Aug 31.

Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway. Electronic address:

Background: A limited number of studies have explored the association between self-reported symptoms and the risk of breast cancer among participants of population based screening programs.

Methods: We performed descriptive statistics on recall, screen-detected and interval cancer, positive predictive value and histopathological tumour characteristics by symptom group (asymptomatic, lump, and skin or nipple changes) as reported from 785,642 women aged 50-69 when they attended BreastScreen Norway 1996-2016. Uni- and multivariable mixed effects logistic regression models were used to analyze the association between symptom group and screen-detected or interval cancer. Results were presented as odds ratios and 95% confidence intervals (CI).

Results: A lump or skin/nipple change was reported in 6.2% of the 3,307,697 examinations. The rate of screen-detected cancers per 1000 examinations was 45.2 among women with a self-reported lump and 5.1 among asymptomatic women. Adjusted odds ratio of screen-detected cancer was 10.1 (95% CI: 9.3-11.1) and 2.0 (95% CI: 1.6-2.5) for interval cancer among women with a self-reported lump versus asymptomatic women. Tumour diameter, histologic grade and lymph node involvement of screen-detected and interval cancer were less prognostically favourable for women with a self-reported lump versus asymptomatic women.

Conclusion: Despite targeting asymptomatic women, 6.2% of the screening examinations in BreastScreen Norway was performed among women who reported a lump or skin/nipple change when they attended screening. The odds ratio of screen-detected cancer was higher for women with versus without symptoms. Standardized follow-up guidelines might be beneficial for screening programs in order to take care of women reporting signs or symptoms of breast cancer when they attend screening.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.breast.2020.08.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495098PMC
December 2020

Time of day and mammographic reader performance in a population-based breast cancer screening programme.

J Med Screen 2020 Aug 30:969141320953206. Epub 2020 Aug 30.

Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.

Objectives: To analyse how reader performance varied by time during the day in a population-based breast cancer screening programme.

Methods: A total of 2,937,312 readings from 148 radiologists and 1,468,656 women were included in this study from Norway. Number and percentages of mammographic readings, positive scores, true and false positive readings, true and false negative readings, sensitivity and specificity were presented for categories of time of day and for each day of the week. Multilevel mixed effect logistic regression models with restricted cubic splines were fitted to the data, and used to predict the odds ratio of the different performance measures.

Results: The following distribution was found for the performance measures during the study period: true positive: 12,463 (0.4%); false positive: 128,419 (4.4%); true negative: 2,794,636 (95.1%); and false negative: 1794 (0.06%). The percentage of positive readings (true positive and false positive) was highest before lunch and in the early afternoon (4.9%): false positive was highest in both periods (4.5%) and true positive was highest in the early afternoon (0.5%). The percentage of true negative was highest in the evening (95.6%), and of false negative was highest at lunchtime (0.07%). This corresponds to a gradually decreasing predicted sensitivity throughout the day. The opposite was observed for specificity.

Conclusions: Screen-reading early versus late during the day resulted in higher sensitivity, although at the cost of specificity. Despite small differences in the performance measures during the day, the results may be important in the discussion of optimal management of screening programmes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0969141320953206DOI Listing
August 2020

Monitoring and evaluation of breast cancer screening programmes: selecting candidate performance indicators.

BMC Cancer 2020 Aug 24;20(1):795. Epub 2020 Aug 24.

Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.

Background: In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection.

Methods: The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries.

Results: A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate.

Conclusion: This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12885-020-07289-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444070PMC
August 2020

Development and use of health outcome descriptors: a guideline development case study.

Health Qual Life Outcomes 2020 Jun 5;18(1):167. Epub 2020 Jun 5.

Department of Health Research Methodology, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.

Background: During healthcare guideline development, panel members often have implicit, different definitions of health outcomes that can lead to misunderstandings about how important these outcomes are and how to balance benefits and harms. McMaster GRADE Centre researchers developed 'health outcome descriptors' for standardizing descriptions of health outcomes and overcoming these problems to support the European Commission Initiative on Breast Cancer (ECIBC) Guideline Development Group (GDG). We aimed to determine which aspects of the development, content, and use of health outcome descriptors were valuable to guideline developers.

Methods: We developed 24 health outcome descriptors related to breast cancer screening and diagnosis for the European Commission Breast Guideline Development Group (GDG). Eighteen GDG members provided feedback in written format or in interviews. We then evaluated the process and conducted two health utility rating surveys.

Results: Feedback from GDG members revealed that health outcome descriptors are probably useful for developing recommendations and improving transparency of guideline methods. Time commitment, methodology training, and need for multidisciplinary expertise throughout development were considered important determinants of the process. Comparison of the two health utility surveys showed a decrease in standard deviation in the second survey across 21 (88%) of the outcomes.

Conclusions: Health outcome descriptors are feasible and should be developed prior to the outcome prioritization step in the guideline development process. Guideline developers should involve a subgroup of multidisciplinary experts in all stages of development and ensure all guideline panel members are trained in guideline methodology that includes understanding the importance of defining and understanding the outcomes of interest.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12955-020-01338-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275587PMC
June 2020

S. Hofvind and colleagues respond.

Tidsskr Nor Laegeforen 2020 05 25;140(8). Epub 2020 May 25.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4045/tidsskr.20.0379DOI Listing
May 2020

Number of prior negative screening outcomes does not influence future risk of breast cancer.

Eur J Epidemiol 2020 Jun 19;35(6):549-556. Epub 2020 May 19.

Section for Breast Cancer Screening, Cancer Registry of Norway, Postbox 5313, Majorstuen, 0304, Oslo, Norway.

We questioned whether a history of negative screening outcomes could be used to predict breast cancer risk, and thus be used as a potential factor for stratification of mammographic screening. Data from the Norwegian population based breast cancer screening program, BreastScreen Norway, was used to estimate cumulative hazard rates for breast cancer by number of prior negative screening outcomes among participants from 1995 through 2016. We followed three age cohorts of women, who started screening at age 50-54, 55-59, and 60-64 years. Further, we estimated the absolute and relative risk of breast cancer by number of prior negative screening outcomes. The cumulative hazard curves were parallel for all numbers of negative screening outcomes for all age cohorts. The absolute risk of breast cancer increased with number of negative screening outcomes for the youngest age cohort. For the oldest age cohorts, the absolute risk was stable during the screening period and decreased thereafter. The number of negative screening outcomes was not associated with risk of breast cancer, adjusted for age, percent screening attendance and calendar years (HR 1.00, 95% CI 0.98-1.02). Our results suggest that the number of negative screening outcomes does not predict breast cancer risk among participants in BreastScreen Norway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10654-020-00645-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320949PMC
June 2020

Screening with 3D mammography – more accurate, but more costly.

Authors:
Solveig Hofvind

Tidsskr Nor Laegeforen 2020 03 30;140(5). Epub 2020 Mar 30.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4045/tidsskr.20.0046DOI Listing
March 2020
-->