Digital vs screen-film mammography in population-based breast cancer screening:performance indicators and tumour characteristics of screen-detected and interval cancers

Background: Full-field digital mammography (FFDM) has replaced screen-film mammography (SFM) in most breast cancer screening programs due to technological advantages such as possibilities to adjust contrast, better image quality and transfer capabilities. This study describes the performance indicators during the transition from SFM to FFDM and the characteristics of screen-detected and interval cancers. Methods: Data of the Dutch breast cancer screening program, region North from 2004 to 2010 were linked to The Netherlands Cancer Registry (N = 902 868). Performance indicators and tumour characteristics of screen-detected and interval cancers were compared between FFDM and SFM. Results: After initial screens, recall rates were 2.1% (SFM) and 3.0% (FFDM; P <0.001). The positive predictive values (PPV) were 25.6% (SFM) and 19.9% (FFDM; P = 0.002). Detection rates were similar, as were all performance indicators after subsequent screens. Similar percentages of low-grade ductal carcinoma in situ (DCIS) were found for SFM and FFDM. Invasive cancers diagnosed after subsequent screens with FFDM were more often of high-grade (P = 0.024) and ductal type (P = 0.030). The incidence rates of interval cancers were similar for SFM and FFDM after initial (2.69/1000 vs 2.51/1000; P = 0.787) and subsequent screens (2.30 vs 2.41; P = 0.652), with similar tumour characteristics. Conclusions: FFDM resulted in similar rates of screen-detected and interval cancers, indicating that FFDM performs as well as SFM in a breast cancer screening program. No signs of an increase in low-grade DCIS (which might connote possible overdiagnosis) were seen. Nonetheless, after initial screening, which accounts for 12% of all screens, FFDM resulted in higher recall rate and lower PPV that requires attention

Quantifying the duration of the preclinical detectable phase in cancer screening: a systematic review

Objectives: To provide an overview of published mathematical estimation approaches to quantify the duration of the preclinical detectable phase using data from cancer screening programs. Methods: A systematic search in PubMed and Embase for original studies presenting mathematical approaches using screening data. The studies were categorized by mathematical approach, data source and assumptions made. Furthermore, estimates of the duration of the preclinical detectable phase of breast and colorectal cancer were reported per study population. Results: From 689 publications, 34 estimation methods were included. Five distinct types of mathematical estimation approaches were identified: prevalence to incidence ratio (n=8), maximum likelihood estimation (n=16), expectation-maximization algorithm (n=1), regression of observed on expected (n=6) and Bayesian Markov Chain Monte Carlo estimation (n=5). Fourteen studies used data of a screened and an unscreened population whereas nineteen studies included only information from a screened population. Estimates of the duration of the preclinical detectable phase varied between two and seven years for breast cancer within the HIP study (annual mammography and clinical breast examination in women aged 40-64 years) and two and five years for colorectal cancer within the Calvados study (one guaiac fecal occult blood test in men and women aged 45-74 years). Conclusion: Different types of mathematical approaches lead to different estimates of the duration of preclinical detectable phase. We advise researchers to use the method that matches the data available, and use multiple methods for estimation when possible as no method is perfect

Dutch, UK and US professionals' perceptions of screening for Barrett's esophagus and esophageal adenocarcinoma: a concept mapping study.

Acknowledgements: The authors thank Henk Schers, Breg Braak, Irene Debiram, and Nicola Grehan for their assistance with the data collection process. The authors also thank Izhar Bagwan, Corinne Bakker, Bertine Bast, Ian Beales, Dorien van der Biessen-van Beek, Duncan Blake, Truuske de Bock, Jan Bornschein, Geert Bulte, David Chan, Parakrama Chandrasoma, Marion Claes, Helen Coleman, Scott Corbett, Tom Crosby, Katherine Dickerman, Jason Dunn, Gary Falk, Kieran Foley, Vicky Goh, James Gossage, John Haydek, Yasmijn van Herwaarden, Remco Huiszoon, Madhu Iyengar, Marnix Jansen, Blake Jones, Jeffrey Kaplan, David Katzka, Sunnie Kim, Bastiaan Klarenbeek, Iris Lansdorp-Vogelaar, Alexis Leal, Christopher Lieu, Arjan Lock, Mirjam van Loon, Martin McCarter, Elizabeth Montgomery, Iris Nagtegaal, Grard Nieuwenhuizen, Gert Olthuis, Ariadne Ooms, Frank Oort, Claire Palles, Christopher Peters, Frans Peters, Massimiliano Di Pietro, Chella van der Post, Leo van Rossum, Heidi Rutten, Maartje Schermers, Erik Schoon, Pim Schout, Ruud Schrauwen, Iris Seriese, Siddharth Singh, Jo Skinner, Richard Skipworth, Marije van Slingerland, Manon Spaander, Adriaan Tan, Danielle Timmermans, Jamie Weaver, David Weinberg, Ravy Vajravelu, Rena Yadlapati, Yeng Ang, and anonymous participants for their thoughtful and diligent participation throughout the study period. All respondents participated independently from their affiliation.BACKGROUND: Novel, less-invasive technologies to screen for Barrett's esophagus (BE) may enable a paradigm shift in early detection strategies for esophageal adenocarcinoma (EAC). Understanding professionals' perspectives on screening is important to determine how to proceed. We aimed to explore and compare professionals' perceptions of screening for BE and EAC screening in three countries. METHODS: In this study, 29 Dutch, 20 British and 18 American health care professionals (clinicians, researchers and policy makers) participated in concept mapping: a mixed-methods consensus building methodology. Statements on perceived barriers, facilitators, advantages, disadvantages, implications or worries associated with screening for BE and EAC were collected in asynchronous digital brainstorm sessions. Subsequently, participants sorted the statements into groups according to thematic similarity and assessed the relevance of each statement in evaluating the acceptability of BE and EAC screening. Multidimensional scaling and cluster analysis were used to map the associations between generated statements. RESULTS: Professionals across three countries identified eight consistent themes that relate to their perceptions of screening for BE and EAC: (1) Benefits, (2) Harms, (3) Clinical effectiveness concerns, (4) Screening population, (5) Screening modality, (6) Resources, (7) Ownership, and (8) Public communication. Dutch and American professionals prioritized the potential health benefits of screening but also questioned clinical impact. In contrast, British participants prioritized identification of the screening population and suitable test. CONCLUSIONS: Most professionals see potential in less-invasive screening tests for BE and EAC but underline the need to define the target screening population and determine benefits and harms before widely employing them. Successful implementation will require thoughtful consideration of the involvement of general practitioners, readiness of endoscopy and pathology services, balanced public communication, and country-specific regulations

Breast magnetic resonance imaging as a problem solving tool in women recalled at biennial screening mammography:A population-based study in the Netherlands

PURPOSE: Problem solving magnetic resonance imaging (MRI) is used to exclude malignancy in women with equivocal findings on conventional imaging. However, recommendations on its use for women recalled after screening are lacking. This study evaluates the impact of problem solving MRI on diagnostic workup among women recalled from the Dutch screening program, as well as time trends and inter-hospital variation in its use. METHODS: Women who were recalled at screening mammography in the South of the Netherlands (2008–2017) were included. Two-year follow-up data were collected. Diagnostic-workup and accuracy of problem solving MRI were evaluated and time trends and inter-hospital variation in its use were examined. RESULTS: In the study period 16,175 women were recalled, of whom 906 underwent problem solving MRI. Almost half of the women (45.4%) who underwent problem solving MRI were referred back to the screening program without further workup. The sensitivity, specificity, and positive and negative predictive values of problem solving MRI were 98.2%, 70.0%, 31.1%, and 99.6%, respectively. The percentage of recalled women receiving problem solving MRI fluctuated over time (4.7%–7.2%) and significantly varied among hospitals (2.2%–7.0%). CONCLUSION: The use of problem solving MRI may exclude malignancy in recalled women. The use of problem solving MRI varied over time and among hospitals, which indicates the need for guidelines on problem solving MRI

Scan-based competing death risk model for reevaluating lung cancer computed tomography screening eligibility

Purpose: A baseline CT scan for lung cancer (LC) screening may reveal information indicating that certain LC screening participants can be screened less, and instead require dedicated early cardiac and respiratory clinical input. We aimed to develop and validate competing death (CD) risk models using CT information to identify participants with a low LC and a high CD risk. Methods: Participant demographics and quantitative CT measures of LC, cardiovascular disease, and chronic obstructive pulmonary disease were considered for deriving a logistic regression model for predicting five-year CD risk using a sample from the National Lung Screening Trial (n=15 000). Multicentric Italian Lung Detection data was used to perform external validation (n=2287). Results: Our final CD model outperformed an external pre-scan model (CDRAT) in both the derivation (Area under the curve=0.744 [95% confidence interval=0.727 to 0.761] and 0.677 [0.658 to 0.695], respectively) and validation cohorts (0.744 [0.652 to 0.835] and 0.725 [0.633 to 0.816], respectively). By also taking LC incidence risk into consideration, we suggested a risk threshold where a subgroup (6258/23 096, 27%) was identified with a number needed to screen to detect one LC of 216 (versus 23 in the remainder of the cohort) and ratio of 5.41 CDs per LC case (versus 0.88). The respective values in the validation cohort subgroup (774/2287, 34%) were 129 (versus 29) and 1.67 (versus 0.43). Conclusions: Evaluating both LC and CD risks post-scan may improve the efficiency of LC screening and facilitate the initiation of multidisciplinary trajectories among certain participants