Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project

Objective: We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (20092019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. Materials and Methods: Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. Results: A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of$ 2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($ 10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. Conclusion: Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.Roche Turkey; Breast Health Society of Turkey (MEMEDER); Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Advancing Translational Sciences (NCATS) [UL1TR000427]; NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCESUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Advancing Translational Sciences (NCATS) [UL1TR000427] Funding Source: NIH RePORTERThe study was funded by Roche Turkey and in part by the Breast Health Society of Turkey (MEMEDER). Also, it was partially supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH

Bahcesehir mammography screening project (BMSP) is cost-effective in a developing country

38th Annual CTRC-AACR San Antonio Breast Cancer Symposium -- DEC 08-12, 2015 -- San Antonio, TX[No Abstract Available]Canc Therapy Res Ctr, Amer Assoc Canc Re

First Round Results of A Long Term Population- Based Breast Cancer Screening Program From Bahcesehir

Introduction: The Bahcesehir Breast Cancer Screening Project is the first organized population based breast cancer screening project in Turkey. The objectives of this prospective observational study are to determine implementation of a population-based organized breast cancer screening program in Turkish women and to find out the effect of screening on stage shift. Materials and Methods: A total of 3758 women within 40-69 years of age were recruited in this prospective study. The screening was done biannually and five rounds were planned. After completing a clinical breast examination (CBE), two-view mammograms were obtained and classified according to Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology (ACR). True positivity, false positivity, positive predictive values (PPV) according to ACR, cancer detection rate, minimal cancer detection rate, axillary node positivity and recall rate were calculated. Results: Seventeen cancers were detected in the first round. The overall cancer detection rate was 4.5 per 1000 women. Minimal cancer detection rate and axillary node positivity were 52.9 % and 11.7 %, respectively. A positive prediction for biopsy was 32%. The overall recall rate was 18.4 %. Discussion: These are the first round results of the screening project. Our results showed that screening can be done effectively in a population based organization

First round results of a long term populatin-based breast cancer screening program from Bahcesehir

Giriş: Bahçeşehir Meme Kanseri Tarama Projesi, Türkiye'nin 10 yıl sürecek olan toplum tabanlı organize meme kanseri tarama projesidir. Bu prospektif gözlemsel çalışmanın amacı Türk kadınlarında toplum tabanlı meme kanseri tarama programının uygulanabilirliğini belirlemek ve taramanın evre değişikliklerindeki etkisini ortaya koymaktır. Materyal-Metod: Bu prospektif çalışmaya 40-69 yaş arasında toplam 3758 kadın dahil edildi. Tarama, iki yıllık dönemlerle toplam beş dönem uygulanmak üzere planlandı. Mamogramlar, klinik meme muayenesi sonrasında, Amerikan Radyoloji Koleji'nin (ARK) Meme Görüntüleme Raporlama ve Veri Sistemi'ne (BI-RADS) göre iki ayrı radyolog tarafından değerlendirildi. Gerçek pozitiflik, yalancı pozitiflik, ARK'ye göre pozitif prediktif değerler (PPD), kanser saptama oranı, minimal kanser saptama oranı, aksiller lenf nodu pozitifliği ve geri çağırma oranı hesaplandı. Sonuç: Birinci dönemde 17 kanser saptandı. Bunların %23.4'ü duktal karsinoma in situ, %64.7'si ise evre I meme kanseri idi. Kanser yakalama oranı 4.5/1000 idi. Minimal kanser saptama oranı %52,9, aksiller lenf nodu pozitifliği %11,7, biyopsi için pozitif prediktivite değeri %32, tüm geri çağırma oranı %18,4 idi. Tartışma: Bu bulgular, tarama projesinin ilk turunun verileri olup, toplum tabanlı organize bir çalışmada taramanın etkin olarak yapılabileceğini ve hastaların önemli bir kısmında çok erken tanı konulabileceğini göstermiştir.Introduction: The Bahcesehir Breast Cancer Screening Project is the first organized population based breast cancer screening project in Turkey. The objectives of this prospective observational study are to determine implementation of a population-based organized breast cancer screening program in Turkish women and to find out the effect of screening on stage shift. Materials and Methods: A total of 3758 women within 40–69 years of age were recruited in this prospective study. The screening was done biannually and five rounds were planned. After completing a clinical breast examination (CBE), two-view mammograms were obtained and classified according to Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology (ACR). True positivity, false positivity, positive predictive values (PPV) according to ACR, cancer detection rate, minimal cancer detection rate, axillary node positivity and recall rate were calculated. Results: Seventeen cancers were detected in the first round. The overall cancer detection rate was 4.5 per 1000 women. Minimal cancer detection rate and axillary node positivity were 52.9 % and 11.7 %, respectively. A positive prediction for biopsy was 32%. The overall recall rate was 18.4 %. Discussion: These are the first round results of the screening project. Our results showed that screening can be done effectively in a population based organization

Screen detected breast cancers exhibit good clinicopathological characteristics: Updated results of Turkish Bahcesehir Breast Cancer Screening Project

10th European Breast Cancer Conference (EBCC) -- MAR 09-11, 2016 -- Amsterdam, NETHERLANDS[No Abstract Available

Molecular profiles of screen detected breast cancers: Final results of Turkish Bahcesehir breast cancer screening project

[No Abstract Available

Successful First Round Results of a Turkish Breast Cancer Screening Program with Mammography in Bahcesehir, Istanbul

Background: The Bahcesehir Breast Cancer Screening Project is the first organized population based breast cancer mammographic screening project in Turkey. The objective of this prospective observational study was to demonstrate the feasibility of a screening program in a developing country and to determine the appropriate age (40 or 50 years old) to start with screening in Turkish women. Materials and Methods: Between January 2009 to December 2010, a total of 3,758 women aged 40-69 years were recruited in this prospective study. Screening was conducted biannually, and five rounds were planned. After clinical breast examination (CBE), two-view mammograms were obtained. True positivity, false positivity, positive predictive values (PPV) according to ACR, cancer detection rate, minimal cancer detection rate, axillary node positivity and recall rate were calculated. Breast ultrasound and biopsy were performed in suspicious cases. Results: Breast biopsy was performed in 55 patients, and 18 cancers were detected in the first round. The overall cancer detection rate was 4.8 per 1,000 women. Most of the screened women (54%) and detected cancers (56%) were in women aged 40-49. Ductal carcinoma in situ (DCIS) and stage I cancer and axillary node positivity rates were 22%, 61%, and 16.6%, respectively. The positive predictivity for biopsy was 32.7%, whereas the overall recall rate was 18.4 %. Conclusions: Preliminary results of the study suggest that population based organized screening are feasible and age of onset of mammographic screening should be 40 years in Turkey

Bahcesehir long-term population-based screening compared to National Breast Cancer Registry Data: effectiveness of screening in an emerging country

PURPOSE We aimed to show the effects of long-term screening on clinical, pathologic, and survival outcomes in patients with screen-detected breast cancer and compare these findings with breast cancer patients registered in the National Breast Cancer Registry Data (NBCRD). METHODS Women aged 40-69 years, living in Bahcesehir county, Istanbul, Turkey, were screened every 2 years using bilateral mammography. The Bahcesehir National Breast Cancer Registry Data (BMSP) data were collected during a 10-year screening period (five rounds of screening). BMSP data were compared with the NBCRD regarding age, cancer stage, types of surgery, tumor size, lymph node status, molecular subtypes, and survival rates. RESULTS During the 10-year screening period, 8758 women were screened with 22621 mammograms. Breast cancer was detected in 130 patients; 51 (39.2%) were aged 40-49 years. The comparison of breast cancer patients in the two programs revealed that BMSP patients had earlier stages, higher breast-conserving surgery rates, smaller tumor size, more frequent negative axillary nodal status, lower histologic grade, and higher ductal carcinoma in situ rates than NBCRD patients (p = 0.001, for all). CONCLUSION These results indicate the feasibility of successful population-based screening in middle-income countries.Breast Health Society of Turkey (MEMEDER); Roche Turkey; General ElectricGeneral ElectricBMSP was funded mainly by the Breast Health Society of Turkey (MEMEDER) and partly by Roche Turkey. The Breast Health Center was rented by Bahcesehir Municipality. General Electric supported the periodic routine maintenance of the digital mammography device

Comparison of Qualitative and Volumetric Assessments of Breast Density and Analyses of Breast Compression Parameters and Breast Volume of Women in Bahcesehir Mammography Screening Project

Objective: We aimed to compare visual and quantitative measurements of breast density and to reveal the density profile with compression characteristics. Materials and Methods: Screening mammograms of 1399 women between May 2014 and May 2015 were evaluated by using Volpara 4th and 5th version. First 379 mammograms were assessed according to ACR BI-RODS 4th- edition and compared to Volpara. We categorized the breast density in two subgroups as dens or non-dens. Two radiologists reviewed the images in consensus. Agreement level between visual and volumetric methods and volumetric methods between themselves assessed using weighted kappa statistics. Volpara data such as fibroglandular volume (FGV), breast volume (BV), compression thickness (CT), compression force (CF), compression pressure (CP) were also analyzed with relation to the age. Results: 1399 mammograms were distributed as follows: 12.7% VDG1, 39.3% VDG2, 34.1% VDG3, 13.9% VDG4 according to the 4th edition of Volpara; 1.2% VDC1, 46% VDG2, 36.8% VDG3, 15.9% VDG4 according to the 5 -5 edition of Volpara. The difference between two editions was 4.7% increase in dense cat. -gory. 379 mammograms, according to ACR BI-BADS 4th edition, were distributed as follows: 25.9% category A, 50.9% category B, 19.8% category C, 3.4% category D. The strength of agreement between the Volpara 4th and 5th editions was found substantial (k= 0.726). The agreements between visual assessment and both Volpara editions were poor (k=- 0.413, k-0.399 respectively). There was a 142% increase in dense group with the VDG 4th edition and 162% with the VDG 5th edition when compared to visual assessment. Compression force decreased while compression pressure increased with incasing Volpara Density Grade (VDG) (p for trend <0.001 for both). Compression thickness and breast volume decreased with increasing VDG (p for trend <0.001 for both).The FGV decreases with age and the breast volume increases with increasing age (p<0.001). Conclusion: Visual assessment of breast density doesn't correlate well with volumetric assessments. Obtaining additional information about physical parameters and breast profile by the results of quantified methods is important for breast cancer risk assessments and prevention strategies