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Tumor Size and Breast Cancer Detection: What Might Be the Effect of a Less Sensitive Screening Tool Than Mammography?
- Source :
- The Breast Journal. 12:S91-S95
- Publication Year :
- 2006
- Publisher :
- Hindawi Limited, 2006.
-
Abstract
- In some limited-resource areas, a state-of-the-art mammography program is not affordable. In such circumstances, one might consider a less resource-intensive, but also less sensitive screening tool such as clinical breast examination (CBE). We used data from the Swedish Two-County Trial to estimate the shift in tumor size resulting from invitation to mammographic screening. By postulating a lesser benefit of a less sensitive screening tool (CBE), particularly in terms of detecting very small tumors, we predicted its likely effect on tumor size distribution. In addition, using the observed association between tumor size and nodal status, and between tumor size and fatality, we predicted the likely benefit in terms of reductions in node-positive disease and in breast cancer mortality. An invitation to mammographic screening was associated with a 27% reduction in the number of node-positive tumors and a 31% reduction in the number of breast cancer deaths. We estimate that in the trial population, screening with CBE alone would have led to an 11% reduction in node-positive tumors and an 11% reduction in breast cancer deaths (approximately 42 deaths prevented per 1,000 cases). Assuming instead a tumor size distribution typical of a limited-resource setting (70% of tumors are 30 mm at presentation), we estimate that screening with CBE alone would lead to a 13% reduction in node-positive tumors and a 12% reduction in breast cancer deaths (approximately 72 deaths prevented per 1,000 cases). Thus, although the relative benefit of CBE is only slightly greater in the limited-resource setting, the absolute reduction in deaths per case is about 70% higher. Our findings suggest that a less sensitive tool might be expected to confer a breast cancer mortality reduction about half of that observed with mammography.
- Subjects :
- Oncology
medicine.medical_specialty
Population
Medically Underserved Area
Breast Neoplasms
Disease
Sensitivity and Specificity
Palpation
Breast cancer
Predictive Value of Tests
Internal medicine
Internal Medicine
Humans
Medicine
Mammography
Screening tool
education
Developing Countries
Randomized Controlled Trials as Topic
education.field_of_study
medicine.diagnostic_test
Tumor size
business.industry
medicine.disease
Predictive value of tests
Female
Surgery
business
Subjects
Details
- ISSN :
- 15244741 and 1075122X
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- The Breast Journal
- Accession number :
- edsair.doi.dedup.....eaa296ac5cc691299e3d045344fd4b4f