Population-Based Breast Cancer Screening With Risk-Based and Universal Mammography Screening Compared With Clinical Breast Examination: A Propensity Score Analysis of 1 429 890 Taiwanese Women.

IMPORTANCE: Different screening strategies for breast cancer are available but have not been researched in quantitative detail. OBJECTIVE: To assess the benefits and the harms of risk-based and universal mammography screening in comparison with annual clinical breast examination (CBE). DESIGN: Population-based cohort study comparing incidences of stage II+ disease and death from breast cancer across 3 breast cancer screening strategies, with adjustment for a propensity score for participation based on risk factors for breast cancer and comparing the 3 strategies for overdetection between January 1999 and December 2009. Asymptomatic women attending outreach screening in the community or undergoing mammography in hospitals were enrolled in the 3 screening programs. INTERVENTIONS: Risk-based biennial mammography, universal biennial mammography, and annual CBE. MAIN OUTCOMES AND MEASURES: Detection rates, stage II+ disease incidence, mortality from breast cancer, and overdiagnosis were compared using a time-dependent Cox proportional hazards regression model. RESULTS: A total of 1 429 890 asymptomatic women attending outreach screening in the community or undergoing mammography in hospitals were enrolled in the 3 screening programs. Detection rates (prevalent screen and subsequent screens per 1000) were the highest for universal biennial mammography (4.86 and 2.98, respectively), followed by risk-based mammography (2.80 and 2.77, respectively), and lowest for annual CBE (0.97 and 0.70, respectively). Universal biennial mammography screening, compared with annual CBE, was associated with a 41% mortality reduction (risk ratio, 0.59; 95% CI, 0.48-0.73) and a 30% reduction of stage II+ breast cancer (RR, 0.70; 95% CI, 0.66-0.74). Risk-based mammography screening was associated with an 8% reduction of stage II+ breast cancer (RR, 0.92; 95% CI, 0.86-0.99) but was not associated with a statistically significant mortality reduction (risk ratio [RR], 0.86; 95% CI, 0.73-1.02). Estimates of overdiagnosis were no different from CBE for risk-based screening and 13% higher than CBE for universal mammography. CONCLUSIONS AND RELEVANCE: Compared with population-based screening for breast cancer with annual CBE, universal biennial mammography resulted in a substantial reduction in breast cancer deaths, whereas risk-based biennial mammography resulted in only a modest benefit. Compared with annual CBE, risk-based and universal mammography screening did not result in significant overdiagnosis of breast cancer.

Mammographic tumour appearance and triple-negative breast cancer associated with long-term prognosis of breast cancer death: a Swedish Cohort Study.

BACKGROUND: Numerous studies have paid attention to the role of the triple-negative marker in the prognosis of breast cancer, but very few studies have combined mammographic phenotypes with the triple-negative marker to assess their relevance to the long-term prognosis of breast cancer. The current study aims to assess the respective contributions of both mammographic tumour appearance and the triple-negative marker, and their possible interactions, on the long-term survival of breast cancer, taking into account the prognostic factors already established. METHODS: A retrospective cohort of 498 breast cancer patients was enrolled at Falun Central Hospital, Sweden, between 1996 and 1998, and information on immunohistochemical markers and histological tumour distribution in these patients was collected. This cohort - together with prior information on conventional tumour attributes and mammographic tumour features from 1968 to 1995 - was formed by the Bayesian method and was followed over time until the end of 2011. RESULTS: After considering tumour attributes, histological tumour distribution, and triple-negative cancer, two mammographic tumour features - casting type (adjusted hazard ratio, aHR=3.47, 2.21-5.53) and architectural distortion (aHR=4.43, 2.02-9.50) - had poorer survival compared to other types (stellate, circular, crushed-stone-like, and powdery mass). Triple-negative status conferred an independent 1.95-fold (1.06-3.52) higher risk for death from breast cancer than non-triple-negative status. Stratified by mammographic tumour features, the impact of triple-negative status on the prognosis of breast cancer was statistically significantly greater for the casting and architecturally distorted types (aHR=5.40, 1.40-20.59) but was not statistically significant for other types of mammographic appearance (aHR=1.75, 0.75-4.21). Stratified by the triple-negative feature, the effect of casting type and architectural distortion versus other tumour types on the risk of breast cancer death was statistically significant not only among triple-negative breast cancers (aHR=9.67, 2.74-29.54) but also among non-triple-negative cancers (aHR=4.11, 1.88-8.68). CONCLUSION: In addition to demonstrating mammographic appearance and the triple-negative feature as two independent prognostic factors, the most novel finding of this study is that the triple-negative feature played a more important role among breast tumours with the mammographic appearance of casting and architectural distortion than among tumours with other types of mammographic appearance. The risk stratification of long-term prognosis of breast cancer in the light of multi-attribute information in chronological order (mammographic tumour appearance first and then the triple-negative test) may aid clinicians in developing a customised schedule of surveillance and in optimising treatment and adjuvant therapy.

Association of angiotensin-converting enzyme insertion/deletion polymorphism with serum level and development of pulmonary complications following esophagectomy.

BACKGROUND: Pulmonary complications remain the major cause of postoperative mortality in patients with esophageal cancer undergoing esophagectomy. It was unclear whether this dismal complication has a genetic predisposition. We therefore investigated the role of an angiotensin-converting enzyme (ACE) insertion/deletion polymorphism in developing these complications. METHODS: We conducted a prospective study including 152 patients with esophageal cancer who underwent esophagectomy in National Taiwan University Hospital between 1996 and 2002. The ACE genotype was determined by polymerase chain reaction amplification of leukocyte DNA obtained before surgery. The serum ACE concentration was determined by enzyme-linked immunosorbent assay. RESULTS: Thirty-five patients (23%) developed pulmonary complications following esophagectomy. As compared with patients with the I/I and I/D genotypes, those with the D/D genotype had a higher risk for pulmonary complications (adjusted odds ratio [OR], 3.12; 95% confidence interval [CI], 1.01-9.65). The risk was additively enhanced by combination of the ACE D/D genotype with other clinical risk factors (old age, hypoalbuminemia, and poor pulmonary function). The circulating ACE level was also dose-dependently with the presence of ACE D allele. As compared with the patients with circulating ACE less than 200 ng/mL, the patients with circulating ACE of 200 to 400 ng/mL and over 400 ng/mL had ORs (95% CI) of 2.75 (1.12-6.67) and 15.00 (4.3-52.34) to present with ACE D allele, respectively. CONCLUSIONS: An ACE insertion/deletion polymorphism might modulate the function of ACE gene and play a role in affecting individual susceptibility to pulmonary injury following esophagectomy in patients of esophageal cancer.