Irregular screening participation increases advanced stage breast cancer at diagnosis:A population-based study

Objective: To evaluate the effect of irregular screening behaviour on the risk of advanced stage breast cancer at diagnosis in Flanders. Methods: All women aged 50–69 who were invited to the organized breast cancer screening and diagnosed with breast cancer before age 72 from 2001 to 2018 were included. All prevalent screen and interval cancers within 2 years of a prevalent screen were excluded. Screening behaviour was categorized based on the number of invitations and performed screenings. Four groups were defined: regular, irregular, only-once, and never attenders. Advanced stage cancer was defined as a stage III + breast cancer. The association between screening regularity and breast cancer stage at diagnosis was evaluated in multivariable logistic regression models, taking age of diagnosis and socio-economic status into account. Results: In total 13.5% of the 38,005 breast cancer cases were diagnosed at the advanced stage. Compared to the regular attenders, the risk of advanced stage breast cancer for the irregular attenders, women who participated only-once, and never attenders was significantly higher with ORadjusted:1.17 (95%CI:1.06–1.29) and ORadjusted:2.18 (95%CI:1.94–2.45), and ORadjusted:5.95 (95%CI:5.33–6.65), respectively. Conclusions: In our study, never attenders were nearly six times more likely to be diagnosed with advanced stage breast cancer than regular attenders, which was much higher than the estimates published thus far. An explanation for this is that the ever screened women is a heterogeneous group regarding the participation profiles which also includes irregular and only-once attenders. The benefit of regular screening should be informed to all women invited for screening

Effectiveness of Organized Mammography Screening for Different Breast Cancer Molecular Subtypes

Background: Screening program effectiveness is generally evaluated for breast cancer (BC) as one disease and without considering the regularity of participation, while this might have an impact on detection rate. Objectives: To evaluate the short-term effectiveness of a mammography screening program for the major molecular subtypes of invasive BC. Methods: All women who participated in the screening program and were diagnosed with screen-detected or interval BC in Flanders were included in the study (2008–2018). Molecular subtypes considered were luminal and luminal-HER2-positive, human epidermal growth factor receptor 2-positive, and triple-negative BC (TNBC). The relationship between the BC stage at diagnosis (early (I–II) versus advanced (III–IV)) and the method of detection (screen-detected or interval) and the relationship between the method of detection and participation regularity (regular versus irregular) were evaluated by multi-variable logistic regression models. All models were performed for each molecular subtype and adjusted for age. Results: Among the 12,318 included women, BC of luminal and luminal-HER2-positive subtypes accounted for 70.9% and 11.3%, respectively. Screen-detected BC was more likely to be diagnosed at early stages than interval BC with varied effect sizes for luminal, luminal-HER2-positive, and TNBC with OR:2.82 (95% CI: 2.45–3.25), OR:2.39 (95% CI: 1.77–3.24), and OR:2.29 (95% CI: 1.34–4.05), respectively. Regular participation was related to a higher likelihood of screening detection than irregular participation for luminal, luminal-HER2-positive, and TNBC with OR:1.21 (95% CI: 1.09–1.34), OR: 1.79 (95% CI: 1.38–2.33), and OR: 1.62 (95% CI: 1.10–2.41), respectively. Conclusions: Regular screening as compared to irregular screening is effective for all breast cancers except for the HER2 subtype

Structural Controllability of Switching Max-Plus Linear Systems

We introduce a framework for studying controllability properties of discrete-event systems modelled as switching max-plus linear systems. In this framework, we generalise the notion of structural controllability to include the switching phenomenon. Such models provide an additional discrete input to change the synchronisation and/or ordering constraints of the system. In this paper, we solve the problem of assigning the throughput of the system by suitable controller configurations. In particular, we formulate structural conditions for the existence of controllers achieving stable stationary behaviour. We also classify the achievable throughput under different controller configurations.Team Bart De SchutterMathematical Physic

Framework for Studying Stability of Switching Max-Plus Linear Systems

We propose a framework for studying the stability of discrete-event systems modelled as switching max-plus linear systems. In this framework, we propose a set of notions of stability for generic discrete-event systems in the max-plus algebra. Then we show the loss of equivalence of these notions for switching max-plus linear systems due to the lack of global monotonicity and the accompanying difficulty in rigorous analysis. This serves as a motivation to relax the assumption on monotonicity of the dynamics to positive invariance of max-plus cones. Then we proceed to generalise the notions of stability when the dynamics is restricted to such cones. The stability analysis approach presented in this paper serves as a first step to study the stability of a general class of switching max-plus linear systems.Team DeSchutterMathematical Physic