Archives

  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2020-03
  • 2020-07
  • 2020-08
  • 2021-03
  • br RESULTS br The number

    2020-08-18


    RESULTS
    The number of cases of breast cancer in 2006−2009 and 2011−2014 among women aged 40−74 years is pre-sented in Appendix Table 1 (available online). The 4-year average annual incidence of breast cancer remained
    Table 2 showed the composition of breast cancer by stage between 2006−2009 and 2011−2014. The distribu-tion of cancer stages remained stable between the two time periods among both women aged 40−49 and 50−74 years. There were also no differences in stage dis-tribution between 2006−2009 and 2011−2014 in His-panics, non-Hispanic whites, non-Hispanic blacks, and Asian/Pacific Islanders.
    DISCUSSION
    Using data from the NPCR and SEER Incidence−USCS database, this study evaluated the impact of screening 
    guideline changes for breast cancer on trends in the inci-dence of breast cancer by stage. The 2001−2014 USCS database includes high-quality population-based cancer incidence data on the entire U.S. population. This study found no differences in the stage distribution of breast cancer before and after the guideline change in 2009 among women aged 40−49 years or 50−74 years. Some minor differences in breast cancer incidence by stage were observed, such as a slightly higher incidence in localized and distant cancer and a lower incidence in regional cancer in 2011−2014 compared with that in 2006−2009 among both the age groups (40−49 years and 50−74 years). However, the APC in distant-stage cancer was lower after the 2009 guideline change. Over-all, this study found no immediate adverse effects of the USPSTF screening guideline change on breast cancer incidence, though calling for long-term active surveil-lance of the incidence of breast cancer by stage.
    Although USPSTF revised their breast cancer screen-ing guidelines in 2009 in terms of screening Adenosine deaminase age and screening interval,10 the American Cancer Soci-ety27 and other consensus guidelines28−30 did not endorse these recommendations during this study period. As early as 2007, the American College of Physi-cians started to recommend screening in women aged 40
    −59 years based on risk profile and personal choice rather than universal screening every 1−2 years.31,32 Dif-
    ferent guidelines vary because of different interpretations of evidence and judgment about the benefits, such as reduced mortality, and the harms, such as false positives and unnecessary workups. Comparative modeling analy-ses indicate that biennial screening in women aged 50−74 years retained 78.2% of breast cancer mortality reduction of annual screening (25.8% reduction in bien-nial screening vs 33.0% reduction in annual screening compared with no screening); 84.5% of years of life gained of annual screening (122.4 years of life gained per 1,000 women screened by biennial screening vs 144.8 years by annual screening compared with no screening); and 86.4% of quality-adjusted life years (QALYs) gained of annual screening (86.0 QALYs gained per 1,000 women screened by biennial screening vs 99.5 QALYs by annual screening compared with no screening).18,20 Multiple factors including trust in con-sensus guidelines, previously established screening pat-terns, physician financial incentives, and willingness to change preventive care patterns have prevented the full adoption of biennial screening recommendations.11 Nevertheless, since the USPSTF screening guideline
    changes in 2009, annual mammography rates have declined significantly among U.S. adult women,11,13,14
    indicating at least some level of responsiveness to this guideline change.11
    www.ajpmonline.org
    Variable
    All cases by race/ethnicity
    Invasive breast cancer by race/ethnicity
    All cases by race/ethnicity
    Invasive breast cancer by race/ethnicity
    Note: Data were from U.S. Cancer Statistics (USCS), the combined data from the Centers for Disease Control and Prevention’s (CDC’s) National Pro-gram for Cancer Registries (NPCR) and the National Cancer Institute’s (NCI’s) Surveillance, Epidemiology, and End Results (SEER) Program. Boldface indicates statistical significance (p<0.05). Rates are per 1,000,000 and age-adjusted to the 2000 U.S. Standard Population. CIs are 95% for rates (Tiwari method). Differences in age-adjusted 4-year average annual rates between 2011−2014 and 2006−2009 were evaluated using rate ratio (RR) and the corresponding 95% CI. Each RR was derived from a stratified model in a specified population (different age groups, races, or stages).
    Annual screening has 67% more false-positive screen-ing results than biennial screening (1,570 false-positive results per 1,000 women by annual screening vs 940 by biennial screening).19 Longer screening intervals and a late screening initiation age as endorsed by USPSTF would reduce false-positive results and consequent workups. This study found a slightly higher incidence in localized and distant cancer and a lower incidence in