Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis

Abstract

Background: Although well established, population based screening and family risk assessment for breast cancer have come under increasing scrutiny. The concept of over diagnosis is increasingly cited in cancer publications. This study assessed the impact of failure to screen or risk assess patients attending with a new diagnosis of breast cancer. Methods: A retrospective review was undertaken of 200 consecutive patients diagnosed with breast cancer between January 2010 and September 2012 at Letterkenny Hospital. Appropriate screening was defined as biennial in those aged 50 - 66 and in those 40 - 49 with moderate/high family history risk (NICE criteria or IBIS criteria). Patient demographics, screening history, diagnosis date and stage (TNM) were documented. Patients with previous breast cancer were not included (n = 17). Results: 200 consecutive patients, whose mean age was 61 (range 28 - 99), were studied. 112/200 (56%) met no criteria for screening or family history assessment, and 88/200 (44%) met criteria for either screening (in 56) or family history assessment (in 32). 61/88 (69.3%) meeting criteria did not have a mammogram or risk assessment. The stage of breast cancer was significantly earlier in those screened appropriately, with early stage cancer in n = 111/139 (79.9 %) and late in n = 28/139 (20.1%), compared with 38/61 (62.3%) and 23/61 (37.7%) in those failing to be screened appropriately (p = 0.01 χ2 df1). Conclusion: Failure to engage in breast screening and risk assessment resulted in more advanced stage at diagnosis.

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Johnston, A. , Curran, S. and Sugrue, M. (2015) Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis. Advances in Breast Cancer Research, 4, 53-62. doi: 10.4236/abcr.2015.42006.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] De Angelis, R., Sant, M., Coleman, M.P., et al. (2014) Cancer Survival in Europe 1999-2007 by Country and Age: Results of EUROCARE-5—A Population-Based Study. The Lancet Oncology, 15, 23-34.
http://dx.doi.org/10.1016/S1470-2045(13)70546-1
[2] Barburin, A., Aareleid, T., Padrik, P., et al. (2014) Time Trends in Population-Based Cancer Survival in Estonia: Analysis by Age and Stage. Acta Oncologica, 53, 226-234.
http://dx.doi.org/10.3109/0284186X.2013.806992
[3] Richards, M.A. (2009) The Size of the Prize for Earlier Diagnosis of Cancer in England. British Journal of Cancer, 101, S125-S129.
http://dx.doi.org/10.1038/sj.bjc.6605402
[4] Devi, B.C., Tang, T.S. and Corbex, M. (2007) Reducing by Half the Percentage of Late-Stage Presentation for Breast and Cervix Cancer over 4 Years: A Pilot Study of Clinical Downstaging in Sarawak, Malaysia. Annals of Oncology, 18, 1172-1176.
http://dx.doi.org/10.1093/annonc/mdm105
[5] Friedman, L.C., Kalidas, M., Elledge, R., et al. (2006) Medical and Psychosocial Predictors of Delay in Seeking Medical Consultation for Breast Symptoms in Women in a Public Sector Setting. Journal of Behavioral Medicine, 29, 327-334.
http://dx.doi.org/10.1007/s10865-006-9059-2
[6] Mathis, K., Hoskin, T., Boughey, J., et al. (2010) Palpable Presentation of Breast Cancer Persists in the Era of Screening Mammography. Journal of American College of Surgeons, 210, 314-318.
http://dx.doi.org/10.1016/j.jamcollsurg.2009.12.003
[7] Miller, A., Wall, C., Baines, C., et al. (2014) Twenty Five Year Follow-Up for Breast Cancer Incidence and Mortality of the Canadian National Breast Screening Study: Randomised Screening Trial. British Medical Journal, 348, g366-g366.
[8] Bleyer, A. and Welch, H.G. (2012) Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence. The New England Journal of Medicine, 367, 1998-2005.
http://dx.doi.org/10.1056/NEJMoa1206809
[9] Tabár, L., Vitak, B., Chen, T.H., et al. (2011) Swedish Two-County Trial: Impact of Mammographic Screening on Breast Cancer Mortality during 3 Decades. Radiology, 260, 658-663.
http://dx.doi.org/10.1148/radiol.11110469
[10] Biller-Andorno, N. and Juni, P. (2014) Abolishing Mammography Screening Programs? A View from the Swiss Medical Board. The New England Journal of Medicine, 370, 1965-1967.
http://dx.doi.org/10.1056/NEJMp1401875
[11] Marmot, M. (2013) Sorting through the Arguments on Breast Screening. JAMA, 309, 2553-2554.
http://dx.doi.org/10.1001/jama.2013.6822
[12] McCartney, M. (2014) A Trial to Extend Breast Cancer Screening May Be Unethical. British Medical Journal, 349, g5105.
http://dx.doi.org/10.1136/bmj.g5105
[13] National Cancer Screening Service (NCSS) (2000) Breast Check—The National Breast Screening Programme.
http://www.breastcheck.ie/
[14] Armstrong, A. and Evans, G. (2014) Management of Women at High Risk of Breast Cancer. British Medical Journal, 348, g2756.
http://dx.doi.org/10.1136/bmj.g2756
[15] National Institute for Health and Clinical Excellence (2006) Quick Reference Guide. Clinical Guideline 41. Familial Breast Cancer: The Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care. NICE, London.
[16] Madlensky, L., Vierkant, R., Vachon, C.M., Pankratz, V.S., Cerhan, J.R., Vadaparampil, S.T. and Sellers, T.A. (2005) Preventive Health Behaviors and Familial Breast Cancer. Cancer Epidemiology, Biomarkers & Prevention, 14, 2340-2345.
http://dx.doi.org/10.1158/1055-9965.EPI-05-0254
[17] Price, M.A., Butow, P.N., Charles, M., Bullen, T., Meiser, B., McKinley, J.M., et al. (2010) Predictors of Breast Cancer Screening Behavior in Women with a Strong Family History of the Disease. Breast Cancer Research and Treatment, 124, 509-519.
http://dx.doi.org/10.1007/s10549-010-0868-1
[18] Samphao, S., Wheeler, A.J., Rafferty, E., Michaelson, J.S., Specht, M.C., Gadd, M.A., et al. (2009) Diagnosis of Breast Cancer in Women Age 40 and Younger: Delays in Diagnosis Result from Underuse of Genetic Testing and Breast Imaging. American Journal of Surgery, 198, 538-543.
http://dx.doi.org/10.1016/j.amjsurg.2009.06.010
[19] Narod, S., Valentini, A., Nofech-Mozes, S., Sun, P. and Hanna, W. (2012) Tumour Characteristics among Women with Very Low-Risk Breast Cancer. Breast Cancer Research and Treatment, 134, 1241-1246.
http://dx.doi.org/10.1007/s10549-012-2065-x
[20] Health Service Executive. Galway University Hospitals Cancer Centre—Annual Report 2012.
http://www.wnwhg.ie/sites/default/files/publications/cancer-centre-annual-report-2012.pdf
[21] IBIS Breast Cancer Risk Evaluation Tool. V6 2004.
http://www.ems-trials.org/riskevaluator/
[22] AJCC (American Joint Committee on Cancer) (2010) Cancer Staging Manual. 7th Edition, Edge, S.B., Byrd, D.R., Compton, C.C., et al., Eds., Springer-Verlag, New York.
[23] National Cancer Screening Service (2014) Breast Check—Programme Report 2012-2013. Health Service Executive, Dublin.
http://www.breastcheck.ie/sites/default/files/bcheck/documents/bc_pr_2013.pdf
[24] Smith, R. (2014) Counterpoint: Overdiagnosis in Breast Cancer Screening. Journal of the American College of Radiology, 11, 648-652.
http://dx.doi.org/10.1016/j.jacr.2014.03.011
[25] Hersch, J., Barratt, A., Jansen, J., Irwig, L., McGeechan, K., Jacklyn, G., et al. (2015) Use of a Decision Aid Including Information on Overdetection to Support Informed Choice about Breast Cancer Screening: A Randomised Controlled Trial. The Lancet, Published Online18 February 2015.
[26] Pace, L. and Keating, N. (2014) A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions. JAMA, 311, 1327-1335.
http://dx.doi.org/10.1001/jama.2014.1398
[27] National Institute for Health and Clinical Excellence (2013) Familial Breast Cancer: Classification and Care of People at Risk of Familial Breast Cancer and Management of Breast Cancer and Related Risks in People with a Family History of Breast Cancer. CG164.
http://guidance.nice.org.uk/CG164/Guidance
[28] Moller, H., Sandin, F., Bray, F., Klint, A., Linklater, K.M., Purushotham, A., et al. (2010) Breast Cancer Survival in England, Norway and Sweden: A Population-Based Comparison. International Journal of Cancer, 127, 2630-2638.
http://dx.doi.org/10.1002/ijc.25264
[29] Anderson, E., Berg, J., Black, R., Bradshaw, N., Campbell, J., Carnaghan, H., et al. (2008) Prospective Surveillance of Women with a Family History of Breast Cancer: Auditing the Risk Threshold. British Journal of Cancer, 98, 840-844.
http://dx.doi.org/10.1038/sj.bjc.6604155
[30] Gui, G., Hogben, R., Walsh, G., A’Hern, R. and Eeles, R. (2001) The Incidence of Breast Cancer from Screening Women According to Predicted Family History Risk: Does Annual Clinical Examination Add to Mammography? European Journal of Cancer, 37, 1668-1673.
http://dx.doi.org/10.1016/S0959-8049(01)00207-6
[31] Taib, N., Yip, C. and Low, W. (2014) A Grounded Explanation of Why Women Present with Advanced Breast Cancer. World Journal of Surgery, 38, 1676-1684.
http://dx.doi.org/10.1007/s00268-013-2339-4
[32] Schwartz, M., Taylor, K., Wilard, K., Siegel, J.E., Lamdan, R.M. and Moran, K. (1999) Distress, Personality and Mammography Utilization among Women with a Family History of Breast Cancer. Health Psychology, 18, 327-332.
http://dx.doi.org/10.1037/0278-6133.18.4.327
[33] Chang, G., Chan, C. and Hartman, M. (2011) A Commentary on Delayed Presentation of Breast Cancer in Singapore. Asian Pacific Journal of Cancer Prevention, 12, 1635-1639.
[34] Tabár, L., Vitak, B., Chen, H., Yen, M.F., Duffy, S.W. and Smith, R.A. (2001) Beyond Randomized Controlled Trials. Cancer, 91, 1724-1731.
http://dx.doi.org/10.1002/1097-0142(20010501)91:9<1724::AID-CNCR1190>3.0.CO;2-V
[35] Paap, E., Verbeek, A., Botterweck, A., et al. (2014) Breast Cancer Screening Halves the Risk of Breast Cancer Deaths: A Case-Referent Study. The Breast, 23, 439-444.
http://dx.doi.org/10.1016/j.breast.2014.03.002
[36] Gunsoy, N., Garcia-Closas, M. and Moss, S. (2012) Modelling the Overdiagnosis of Breast Cancer Due to Mammography Screening in Women Aged 40 to 49 in the United Kingdom. Breast Cancer Research, 14, R152.
http://dx.doi.org/10.1186/bcr3365
[37] HSE, NCCP Symptomatic Breast Disease. Key Performance Indicators: 3 Year Report 2010-2012.
http://www.hse.ie/eng/services/list/5/cancer/pubs/intelligence/NCCP%20KPI%20report%20symptomatic%20breast%20disease%202010%20-%202013.pdf
[38] Love, R., Duc, N., Baumann, L., Thi Hoang Anh, P., Van To, T., Qian, Z. and Havighurst, T.C. (2004) Duration of Signs and Survival in Premenopausal Women with Breast Cancer. Breast Cancer Research and Treatment, 86, 117-124.
http://dx.doi.org/10.1023/B:BREA.0000032980.55245.c3
[39] Brazda, A., Estroff, J., Euhus, D., Leitch, A.M., Huth, J., Andrews, V., et al. (2010) Delays in Time to Treatment and Survival Impact in Breast Cancer. Annals of Surgical Oncology, 17, S291-S296.
http://dx.doi.org/10.1245/s10434-010-1250-6
[40] Bright, K., Barghash, M., Donach, M., de la Barrera, M.G., Schneider, R.J. and Formenti, S.C. (2011) The Role of Health System Factors in Delaying Final Diagnosis and Treatment of Breast Cancer in Mexico City, Mexico. The Breast, 20, S54-S59.
http://dx.doi.org/10.1016/j.breast.2011.02.012
[41] Gorman, A., Sugrue, M., Ahmed, Z. and Johnston, A. (2014) An Evaluation of FaHRAS Computer Programmes’ Utility in Family History Triage of Breast Cancer. Advances in Breast Cancer Research, 3, 17-21.
http://dx.doi.org/10.4236/abcr.2014.32004
[42] Thomas, J., Sugrue, M., Curran, S., Furey, M. and Sugrue, R. (2013) Are Family Doctors Compliant with Breast Family History Guidelines? Advances in Breast Cancer Research, 2, 149-153.
http://dx.doi.org/10.4236/abcr.2013.24024
[43] Olesen, F., Hansen, R. and Vedsted, P. (2009) Delay in Diagnosis: The Experience in Denmark. British Journal of Cancer, 101, S5-S8.
http://dx.doi.org/10.1038/sj.bjc.6605383
[44] Woods, L., Rachet, B., O’Connell, D., Lawrence, G., Tracey, E., Willmore, A. and Coleman, M.P. (2009) Large Difference in Patterns of Breast Cancer Survival between Australia and England: A Comparative Study Using Cancer Registry Data. International Journal of Cancer, 124, 2391-2399.
http://dx.doi.org/10.1002/ijc.24233
[45] Sant, M., Allemani, C., Capocaccia, R., Hakulinen, T., Aareleid, T., Coebergh, J.W., et al. (2003) Stage at Diagnosis Is a Key Explanation of Differences in Breast Cancer Survival across Europe. International Journal of Cancer, 106, 416-422.
http://dx.doi.org/10.1002/ijc.11226
[46] Kopans, D. (2014) A New Era in Mammography Screening. Radiology, 271, 629-631.
http://dx.doi.org/10.1148/radiol.14140177
[47] Skaane, P., Bandos, A., Eben, E., Jebsen, I.N., Krager, M., Haakenaasen, U., et al. (2014) Two-View Digital Breast Tomosynthesis Screening with Synthetically Reconstructed Projection Images: Comparison with Digital Breast Tomosynthesis with Full-Field Digital Mammographic Images. Radiology, 271, 655-663.
http://dx.doi.org/10.1148/radiol.13131391

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