Female Breast Cancer Death Rates/100,000 Women, Age Adjuste - PowerPoint Presentation

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Female Breast Cancer Death Rates/100,000 Women, Age Adjusted, by State, 2011†

†Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2011 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2014. Available at: http://www.cdc.gov/uscs. (full site) Slide2

Breast Cancer ScreeningSlide3

Tumors detected at an early stage that are small and confined to the breast are more likely to be successfully treated98% 5-year survival for localized disease89% of tumors measuring 1 cm or less cured by primary surgery (mastectomy and axillary dissection)

90% of patients 10+year disease free survival periods after tumors measuring 1 cm or less were detected by mammographyRationale for Mammogram ScreeningSlide4

Twenty five year follow-up for breast cancer incidenceand mortality of the Canadian National Breast

Screening Study: randomized screening trialOPEN ACCESSAnthony B Miller professor emeritus

1

, Claus Wall

data manager

1

, Cornelia J Baines

professoremerita 1, Ping Sun statistician 2, Teresa To senior scientist 3, Steven A Narod professor 1 21Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada; 2Women’s College Research Institute, Women’sCollege Hospital, Toronto, Ontario M5G 1N8, Canada; 3Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Ontario, Canada

BMJ 2014;348:g366 doi: 10.1136/bmj.g366

Conclusion :

Annual mammography in women aged 40-59 does not

reduce mortality from breast cancer

beyond that of physical examination

or usual care when adjuvant therapy for breast cancer is freely available.

Overall, 22% (106/484) of screen detected invasive breast cancers were

over-diagnosed, representing one over-diagnosed breast cancer for

every 424 women who received mammography screening in the trial.Slide5

Other studies have shown decreased mortalityDid not look at differences in treatment morbidityOther StudiesSlide6

MammogramCBESBE

Best Recommendations for Breast Cancer ScreeningSlide7

National Breast and Cervical Cancer Early Detection Program752,081 clinical breast examinations in women age 40 and olderCBE aloneSensitivity 58.8%

Specificity 93.4%5 cases of cancer/1000 CBEIf mammogram normal 7.4 cancers/1000 CBEModest improvement in detectionClinical Breast ExaminationSlide8

When to Start Mammograms40Risk of cancer in next 10 years comparable to 50 (1.4 v 2.4/1000)

Mortality reduction similar to 50 (16% v. 15%)50,000 new breast cancers annually in US in women under 5050

USPSTF

Screening younger than 50 should be individualized based on “patient values regarding specific benefits and harms”Slide9

Breast

Cancer Screening Recommendations

Mammography

Clinical Breast Examination

Breast Self-Examination Instruction

Breast Self-Awareness

American College of Obstetricians and GynecologistsAge 40 years and older annuallyAge 20-39 years every 1-3 years

Consider for high-risk patients

Recommended

Age 40 years and older annually

American Cancer Society

Age 40 years and older annually

Age 20-39 years every 1-3 years

Optional for age 20 years and older

Recommended

Age 40 years and older annually

National Comprehensive Cancer Network

Age 40 years and older annually

Age 20-39 years every 1-3 years

Recommended

Recommended

Age 40 years and older annually

National Cancer Institute

Age 40 years and older every 1-2 years

Recommended

Not Recommended

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U.S. Preventative Services Task Force

Age 50-74 years biennially

Insufficient evidence

Not Recommended

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False PositiveUp to 20-30% of mammograms will require more evaluation to reach diagnosisDiagnostic mammograms with supplementary viewsUltrasound

BiopsyRadiation RisksFalse NegativeUp to 10% of breast cancers will not be found on mammogramPotential Harms of MammographySlide11

UltrasoundCan be adjunct to mammogramMRIHigh risk womenBRCA gene mutation

First degree relative with BRCA mutation and has not had testingLifetime breast cancer risk >20%Radiation therapy to the chest between ages of 10-30Other specific genetic syndromesPET, Thermography, etc.Selected clinical situations or adjunct to mammogram

Not for screening

Other ImagingSlide12

Ovarian Cancer ScreeningOvarian cancer has a low prevalence1 case per 2,500 women per year

If a screening test had 100% sensitivity and 99% specificityPositive predictive value would be 4.8% 20 of 21 women undergoing surgery would not have primary ovarian cancerSlide13

Potential Screening Tools in Low-Risk Women

Transvaginal UltrasoundTumor markersCA 125OVA 1Slide14

78,216 women randomly assigned to either annual screening with CA-125 and transvaginal ultrasound (n=39,105)or usual care (n-39,111)

From: Effect of Screening on Ovarian Cancer Mortality:  The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial

JAMA. 2011;305(22):2295-2303. doi:10.1001/jama.2011.766Slide15

From:

Effect of Screening on Ovarian Cancer Mortality:  The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial

JAMA. 2011;305(22):2295-2303. doi:10.1001/jama.2011.766Slide16
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ConclusionObstetricsDon’t induce labor unless it is warranted

GynecologyScreen appropriate women at the appropriate age with the appropriate screening testSlide19

Breast cancer specific mortality, by assignment to mammography or control arms (all participants)Slide20

Breast cancer specific mortality from cancers diagnosed in screening period, by assignment to mammography or

control armsSlide21

Lifetime risk of colposcopySlide22

25 year survival (%)