Assessment of a tumour growth model for virtual clinical trials of breast cancer screening

Study Design of Randomized Controlled Clinical Trials of Breast Cancer Screening,

JNCI Monographs ◽

10.1093/jncimono/1997.22.21 ◽

1997 ◽

Vol 1997 (22) ◽

pp. 21-25 ◽

Cited By ~ 9

Author(s):

Eugenio Paci ◽

Freda E. Alexander

Keyword(s):

Breast Cancer ◽

Clinical Trials ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Study Design ◽

Controlled Clinical Trials ◽

Randomized Controlled Clinical Trials ◽

Randomized Controlled

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Random effects tumour growth models for identifying image markers of mammography screening sensitivity

Epidemiologic Methods ◽

10.1515/em-2019-0022 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Linda Abrahamsson ◽

Maya Alsheh Ali ◽

Kamila Czene ◽

Gabriel Isheden ◽

Per Hall ◽

...

Keyword(s):

Breast Cancer ◽

Mammographic Density ◽

Growth Model ◽

Statistical Power ◽

Large Scale ◽

Tumour Growth ◽

Percentage Mammographic Density ◽

Dense Tissue ◽

Screening Sensitivity ◽

Tumour Growth Model

AbstractIntroductionPercentage mammographic density has long been recognised as a marker of breast cancer risk and of mammography sensitivity. There may be other image markers of screening sensitivity and efficient statistical approaches would be helpful for establishing them from large scale epidemiological and screening data.MethodsWe compare a novel random effects continuous tumour growth model (which includes a screening sensitivity submodel) to logistic regression (with interval vs. screen-detected cancer as the dependent variable) in terms of statistical power to detect image markers of screening sensitivity. We do this by carrying out a simulation study. We also use continuous tumour growth modelling to quantify the roles of dense tissue scatter (measured as skewness of the intensity gradient) and percentage mammographic density in screening sensitivity. This is done by using mammograms and information on tumour size, mode of detection and screening history from 1,845 postmenopausal women diagnosed with invasive breast cancer, in Sweden between 1993 and 1995.ResultsThe statistical power to detect a marker of screening sensitivity was larger for our continuous tumour growth model than it was for logistic regression. For the settings considered in this paper, the percentage increase in power ranged from 34 to 56%. In our analysis of data from Swedish breast cancer patients, using our continuous growth model, when including both percentage mammographic density and dense tissue scatter in the screening sensitivity submodel, only the latter variable was significantly associated with sensitivity. When included one at a time, both markers were significantly associated (p-values of 5.7 × 10−3 and 1.0 × 10−5 for percentage mammographic density and dense tissue scatter, respectively).ConclusionsOur continuous tumour growth model is useful for finding image markers of screening sensitivity and for quantifying their role, using large scale epidemiological and screening data. Clustered dense tissue is associated with low mammography screening sensitivity.

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Screening Sensitivity and Sojourn Time From Breast Cancer Early Detection Clinical Trials: Mammograms and Physical Examinations

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.15.3490 ◽

2001 ◽

Vol 19 (15) ◽

pp. 3490-3499 ◽

Cited By ~ 85

Author(s):

Yu Shen ◽

Marvin Zelen

Keyword(s):

Breast Cancer ◽

Clinical Trials ◽

Cancer Screening ◽

Early Detection ◽

Physical Examination ◽

Breast Cancer Screening ◽

Sojourn Time ◽

Screening Programs ◽

Screening Sensitivity ◽

Screening Trials

PURPOSE: To estimate sensitivities of breast cancer screening modalities and preclinical duration of the disease from eight breast cancer screening clinical trials. PATIENTS AND METHODS: Screening programs invariably lead to diagnosis of disease before signs or symptoms are present. Two key quantities of screening programs are the sensitivity of the disease detection modality and the mean sojourn time (MST). The observed screening histories in a periodically screened cohort make it possible to estimate these quantities of interest. We applied recently developed statistical methods to data from eight randomized breast cancer screening trials to estimate the sensitivities of early detection modalities and MST. Moreover, when a screening trial involved two screening modalities, our methods enabled the estimation of the individual sensitivity of each screening modality. RESULTS: We analyzed breast cancer data from several screening trials and have relatively complete data from the Health Insurance Plan (HIP), Edinburgh, and two Canadian studies. The screening sensitivity for mammography, physical examination, and MST were, respectively, HIP: 0.39, 0.47, and 2.5 years; Edinburgh: 0.63, 0.40, and 4.3 years; Canadian (age 40 to 49 at entry): 0.61, 0.59, and 1.9 years; Canadian (age 50 to 59 at entry): 0.66, 0.39, and 3.1 years. CONCLUSION: The public debate on early breast cancer detection is mainly centered on mammograms. However, the current study indicates that a physical examination is of comparable importance. Cautious interpretation of trial differences is required as a result of various experimental designs and the age dependency of screening sensitivity and MST.

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Evaluation of the Regular Practice of Breast Cancer Screening in a Health Area

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300009715 ◽

1996 ◽

Vol 12 (2) ◽

pp. 388-394 ◽

Cited By ~ 2

Author(s):

Xavier Bonfill Cosp ◽

Mercé Marzo Castillejo ◽

Melcior Sentís Crivillé ◽

Ramon Rossell Mir ◽

Xavier Gallardo Cistaré ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trials ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Program ◽

Sources Of Information ◽

Insufficient Information ◽

Health Area ◽

Regular Practice

AbstractBreast cancer screening has proved to be efficacious only in clinical trials or structured programs. However, little is known of its effectiveness as a regular practice. This study is an assessment of breast cancer screening in regular practice in a Spanish area of 350,000 inhabitants through analysis of existing sources of information. It is evident that this screening is insufficient, inefficient, very variable, nonspecific, and probably ineffective, although there is insufficient information to prove it. The immediate implementation of a well structured and accredited screening program is essential to overcome the current limitations.

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