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Showing content from https://pubmed.ncbi.nlm.nih.gov/31172693/ below:

Breast cancer screening: Impact on care pathways

Affiliations

• ¹ Health Data and Assessment Department, Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ² Screening Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ³ Presidency, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ⁴ Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ⁵ Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ⁶ Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France.

• PMID: 31172693
• PMCID: PMC6639186
• DOI: 10.1002/cam4.2283

Item in Clipboard

Delphine Lefeuvre et al. Cancer Med. 2019 Jul.

• ¹ Health Data and Assessment Department, Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ² Screening Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ³ Presidency, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ⁴ Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ⁵ Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.
• ⁶ Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France.

• PMID: 31172693
• PMCID: PMC6639186
• DOI: 10.1002/cam4.2283

Item in Clipboard

Background: Controversy persists concerning screening programs (SPs), related to a potential risk of overdiagnosis or the impact on survival. One of the main questions to be addressed concerns the aggressiveness of the related treatments.

Methods: Using the "Cancer Cohort," a national-based cohort (medico-administrative database), all women between the ages of 50 and 74 years and treated in 2014 for incident breast cancer were compared, according to whether their diagnosis was made following a mammogram performed within the framework of the SP (SP group) or outside it (NSP group).

Results: A total of 23 788 women were identified: 13 530 (57%) in the SP group and 10 258 (43%) in the NSP group. The women in the SP group had a higher rate of in situ or localized invasive breast cancer. They had a higher rate of breast-conserving surgery (82% vs 70%), and a lower rate of chemotherapy (34% vs 53%). These findings were observed irrespective of the stage. They had a higher rate of pathways involving breast-conserving surgery followed by radiotherapy. Among women with metastatic cancer, those in the SP group had a lower proportion of liver, lung, brain, and bone metastases, and a higher proportion of lymph node metastases (other than axillary), irrespective of the time to onset of the metastases.

Conclusion: The women in whom cancer was diagnosed following a mammogram performed in the context of the SP had less advanced cancer and less aggressive treatments. This observational study helps illustrate the benefit of the SP in France using a different approach.

Keywords: French cancer cohort; breast cancer; care pathways; screening.

© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

PubMed Disclaimer

The authors declare that they have no conflict of interest.

Flowchart. ICD10, The international classification…

Flowchart. ICD10, The international classification of diseases—tenth version; LTD, long‐term disease; SP, screening…

Flowchart. ICD10, The international classification of diseases—tenth version; LTD, long‐term disease; SP, screening program mammogram; NSP, mammogram outside screening program, as part of opportunistic screening or in the event of clinical symptoms. *Breast cancer‐related care, biopsy, breast surgery, chemotherapy, radiotherapy, palliative care

Care pathways by cancer stage…

Care pathways by cancer stage and group. A color is attributed to each…

Care pathways by cancer stage and group. A color is attributed to each treatment: light blue for partial mastectomy, dark blue for total mastectomy, red for chemotherapy, etc Each care pathway is represented by a sequence of colored lines corresponding to the sequence of treatments received. For example, the care pathway of a woman treated by partial mastectomy followed by radiotherapy is represented by a strip of 2 colors: light blue and green. Alternating colors represented women having both radiotherapy or hormone therapy and chemotherapy during the same period of time. Strips of colors representing care pathways have a size proportional to the number of women following concerned pathways

• Aggressive primary treatments with favourable 5-year survival for screen-interval breast cancers.

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