programas cribado cancer

Nota bibliográfica cribado c mama 2013-04

Carney P, O'Neill S, O'Neill C. Determinants of breast cancer screening uptake in women, evidence from the British Household Panel Survey. Soc Sci Med 2013 Apr;82:108-114. DOI:10.1016/j.socscimed.2012.12.018; 10.1016/j.socscimed.2012.12.018. PMID:23415458.

Breast cancer screening is an integral part of the cancer control strategies of many developed economies. In Britain individuals screened in a given year are re-called every three years unless results indicate a need for more immediate investigation. This pattern may create a legacy arising from past decisions, a legacy that should be considered when examining current decisions. In this paper we use a balanced panel drawn from the British Household Panel Survey of 1997 women over an 18 year period to examine variations in uptake. A dynamic random effects probit model is used to control for unobserved heterogeneity and the legacy of previous decisions. As might be expected women to whom universal screening is offered are more likely to screen than others. Changes during the study period in the eligible age range saw an increase in uptake among the age group to whom the programme was extended but not among other groups. Past screening behaviour was found to be a significant predictor of current behaviour. Failure to account for past choices may result in model mis-specification and a failure to develop policies aimed at promoting initial engagement that may compromise the screening programme. Income was not found to be a significant determinant of uptake.

Amaro J, Severo M, Vilela S, Fonseca S, Fontes F, La Vecchia C, et al. Patterns of breast cancer mortality trends in Europe. The Breast 2013 6;22(3):244-253.
Conclusion This study provides a general model for the description and interpretation of the variation in breast cancer mortality in Europe, based in three main patterns.

Eric Lavigne, Eric J Holowaty, Sai Yi Pan, Paul J Villeneuve, Kenneth C Johnson, Dean A Fergusson, et al. Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ 2013 BMJ Publishing Group Ltd;346 DOI:10.1136/bmj.f2399.
Conclusions The research published to date suggests that cosmetic breast augmentation adversely affects the survival of women who are subsequently diagnosed as having breast cancer. These findings should be interpreted with caution, as some studies included in the meta-analysis on survival did not adjust for potential confounders. Further investigations are warranted regarding diagnosis and prognosis of breast cancer among women with breast implants.

Houssami N, Abraham LA, Kerlikowske K, Buist DSM, Irwig L, Lee J, et al. Risk Factors for Second Screen-Detected or Interval Breast Cancers in Women with a Personal History of Breast Cancer Participating in Mammography Screening. Cancer Epidemiology Biomarkers & Prevention 2013 March 19 DOI:10.1158/1055-9965.EPI-12-1208-T.
Conclusion: Although the risk of a second breast cancer is modest, our models identify risk factors for interval second breast cancer in PHBC women.Impact: Our findings may guide discussion and evaluations of tailored breast screening in PHBC women, and incorporating this information into clinical decision-making warrants further research. Cancer Epidemiol Biomarkers Prev; 1–16. ©2013 AACR.

Mandelblatt J, van Ravesteyn N, Schechter C, Chang Y, Huang A, Near AM, et al. Which strategies reduce breast cancer mortality most? Cancer 2013:n/a-n/a. DOI:10.1002/cncr.28087.

Foca F, Mancini S, Bucchi L, Puliti D, Zappa M, Naldoni C, et al. Decreasing incidence of late-stage breast cancer after the introduction of organized mammography screening in Italy. Cancer 2013:n/a-n/a. DOI:10.1002/cncr.28014.
CONCLUSIONS: A significant and stable decrease in the incidence of late-stage breast cancer was observed from the third year of screening onward, when the IRR varied between 0.81 and 0.71. Cancer 2013. © 2013 American Cancer Society.

Yaghjyan L, Colditz G, Rosner BA, Tamimi RM. Mammographic Breast Density and Subsequent Risk of Breast Cancer in Postmenopausal Women according to the Time Since the Mammogram. Cancer Epidemiology Biomarkers & Prevention 2013 April 19 DOI:10.1158/1055-9965.EPI-13-0169.

Conclusions. Patterns of the associations between percent density, absolute dense and non-dense area with breast cancer risk persist for up to 10 years after the mammogram. Impact. A one-time density measure can be used for long-term breast cancer risk prediction.

Nelson HD, Fu R, Goodard K, Mitchell Priest J, Okinaka-Hu L, Pappas M, et al. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 101. AHRQ Publication No. 12-05164-EF-1. 2013.

Whelehan P, Evans A, Wells M, MacGillivray S. The effect of mammography pain on repeat participation in breast cancer screening: A systematic review. The Breast (0) DOI:10.1016/j.breast.2013.03.003.

Toriola AT, Colditz GA. Trends in breast cancer incidence and mortality in the United States: implications for prevention. Breast Cancer Res Treat 2013 Apr 2 DOI:10.1007/s10549-013-2500-7. PMID:23546552
While debate continues regarding short-term changes in breast cancer incidence and the impact of screening on mortality, a long-term view of trends in incidence and mortality may better inform our understanding of the changing patterns of disease and ultimately guide in population-based prevention. Although many factors have influenced breast cancer incidence over the past seven decades, some have played more prominent roles at various times. Changing reproductive patterns, greater longevity, and post-menopausal hormone (estrogen + progesterone) were important in the steady increase before 1980, while mammographic screening, probably in conjunction with escalating combined estrogen + progesterone use, played dominant roles in the post-1980 surge. Accruing evidence also indicates that the rapid drop in 2003 was mostly due to a sharp decline in estrogen + progesterone use. The most paradoxical observation relates to the divergence in incidence and mortality trends most noticeable when mortality rates started to decline shortly after the surge in incidence rates started in 1980. In addition to the dynamic changes in risk factor profiles, the divergence reflects wider uptake of screening mammography, better characterization of tumor biology, and improvements in treatment. The rise in incidence rates over the past three decades is due to an increase in estrogen receptor positive (ER+) tumors, which respond favorably to treatment. On the other hand, the incidence of estrogen receptor negative (ER-) tumors, which respond poorly to hormonal therapy, has been decreasing for almost three decades. Furthermore, widespread adoption of screening mammography has led to tumors being diagnosed at earlier stages when treatment is effective and advances in treatment have ensured adoption of targeted and better tolerated therapies. To achieve long-term success in the primary prevention of breast cancer, a greater understanding of factors responsible for the decrease in ER- tumors is essential. In addition, improving the sensitivity of breast cancer screening to facilitate earlier detection of tumors with very aggressive phenotypes would go a long way in bridging the divergence between incidence and mortality.

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