scholarly journals Mammograms and Mortality: How Has the Evidence Evolved?

2021 ◽  
Vol 35 (2) ◽  
pp. 119-140
Author(s):  
Amanda E. Kowalski
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Clinical Trials ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
All Cause Mortality ◽  
History Of

Decades of evidence reveal a complicated relationship between mammograms and mortality. Mammograms may detect deadly cancers early, but they may also lead to the diagnosis and potentially fatal treatment of cancers that would never progress to cause symptoms. I provide a brief history of the evidence on mammograms and mortality, focusing on evidence from clinical trials, and I discuss how this evidence informs mammography guidelines. I then explore the evolution of all-cause mortality relative to breast cancer mortality within an influential clinical trial. I conclude with some responses to the evolving evidence.

scholarly journals Associations of Insulin Resistance and Adiponectin With Mortality in Women With Breast Cancer

2011 ◽  
Vol 29 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Catherine Duggan ◽  
Melinda L. Irwin ◽  
Liren Xiao ◽  
Katherine D. Henderson ◽  
Ashley Wilder Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Insulin Resistance ◽  
Cancer Mortality ◽  
Cancer Survival ◽  
Breast Cancer Mortality ◽  
Breast Cancer Survival ◽  
Overweight And Obesity ◽  
Model Assessment ◽  
All Cause Mortality ◽  
Low Levels

Purpose Overweight or obese breast cancer patients have a worse prognosis compared with normal-weight patients. This may be attributed to hyperinsulinemia and dysregulation of adipokine levels associated with overweight and obesity. Here, we evaluate whether low levels of adiponectin and a greater level of insulin resistance are associated with breast cancer mortality and all-cause mortality. Patients and Methods We measured glucose, insulin, and adiponectin levels in fasting serum samples from 527 women enrolled in the Health, Eating, Activity, and Lifestyle (HEAL) Study, a multiethnic, prospective cohort study of women diagnosed with stage I-IIIA breast cancer. We evaluated the association between adiponectin and insulin and glucose levels (expressed as the Homeostatic Model Assessment [HOMA] score) represented as continuous measures and median split categories, along with breast cancer mortality and all-cause mortality, using Cox proportional hazards models. Results Increasing HOMA scores were associated with reduced breast cancer survival (hazard ratio [HR], 1.12; 95% CI, 1.05 to 1.20) and reduced all-cause survival (HR, 1.09; 95% CI, 1.02 to 1.15) after adjustment for possible confounders. Higher levels of adiponectin (above the median: 15.5 μg/mL) were associated with longer breast cancer survival (HR, 0.39; 95% CI, 0.15 to 0.95) after adjustment for covariates. A continuous measure of adiponectin was not associated with either breast cancer–specific or all-cause mortality. Conclusion Elevated HOMA scores and low levels of adiponectin, both associated with obesity, were associated with increased breast cancer mortality. To the best of our knowledge, this is the first demonstration of the association between low levels of adiponectin and increased breast cancer mortality in breast cancer survivors.

scholarly journals Ethnic and biological differences in the association between physical activity and survival after breast cancer

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Yunfeng Cao ◽  
Kathy B. Baumgartner ◽  
Kala Visvanathan ◽  
Stephanie D. Boone ◽  
Richard N. Baumgartner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Physical Activity ◽  
Cancer Mortality ◽  
Breast Cancer Survivors ◽  
Vigorous Physical Activity ◽  
Breast Cancer Mortality ◽  
Biological Data ◽  
Cancer Prognosis ◽  
Term Survival ◽  
All Cause Mortality

Abstract Physical activity is recommended for most cancer patients as a nonpharmacological therapy to improve prognosis. Few studies have investigated the association between physical activity and breast cancer prognosis by ethnicity, biological, and modifiable risk factors for mortality. We investigated the association between physical activity and long-term survival among breast cancer survivors. A total of 397 survivors (96 Hispanic and 301 non-Hispanic White (NHW)) from the New Mexico HEAL study contributed baseline and biological data approximately 6 months after diagnosis. Study outcomes included all-cause, breast cancer-specific, and non-breast cancer mortality. The exposure was self-reported physical activity within the past month. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox Proportional Hazards regression. A total of 133 deaths (53 breast cancer-specific deaths) were observed after a median follow-up time of 13 years. Engaging in >6.9 metabolic equivalent hours/week (MET-h/week) of moderate to vigorous physical activity (active) was inversely associated with all-cause mortality among all women (HR 0.66, 95% CI 0.43–0.99) and NHWs (HR 0.58, 95% CI 0.36–0.94). Active NHW women also had a reduced risk of non-breast cancer mortality (HR 0.56, 95% CI 0.31–0.99), compared to inactive women (0 MET-h/week). In subgroups, we observed the inverse associations with all-cause mortality among women >58 years old (p-interaction= 0.03) and with localized stage (p-interaction = 0.046). Our results confirm the protective association between physical activity and mortality after breast cancer diagnosis, and demonstrate that this association significantly differs by age and cancer stage. Larger studies are warranted to substantiate our findings.

scholarly journals All-cause mortality among breast cancer patients in a screening trial: support for breast cancer mortality as an end point

2002 ◽  
Vol 9 (4) ◽  
pp. 159-162 ◽  
Author(s):  
L. Tabar ◽  
S.W. Duffy ◽  
M-F. Yen ◽  
J. Warwick ◽  
B. Vitak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
End Point ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Disease Specific Mortality ◽  
Screening Trial ◽  
Disease Specific

BACKGROUND: It has recently been suggested that all-cause mortality is a more appropriate end point than disease specific mortality in cancer screening trials, and that disease specific mortality is biased in favour of screening. This suggestion is based partly on supposed inconsistencies between all-cause mortality results and disease specific results in cancer screening trials, and alleged increases in deaths from causes other than breast cancer among breast cancer cases diagnosed among women invited to screening. METHODS: We used data from the Swedish Two-County Trial of mammographic screening for breast cancer, in which 77 080 women were randomised to an invitation to screening and 55 985 to no invitation. We estimated relative risks (RRs) (invited v control) of death from breast cancer, death from other causes within the breast cancer cases, and death from all causes within the breast cancer cases. RRs were adjusted for age and took account of the longer follow up of breast cancer cases in the invited group due to lead time. RESULTS: There was a significant 31% reduction in breast cancer mortality in the invited group (RR 0.69, 95% confidence interval (CI) 0.58–0.80; p<0.001). There was no significant increase in deaths from other causes among breast cancer cases in the invited group (RR 1.12, 95% CI 0.96–1.31; p=0.14). A significant 19% reduction in deaths from all causes was observed among breast cancer cases in the group invited to screening (RR 0.81, 95% CI 0.72–0.90; p<0.001). A more conservative estimation gave a significant 13% reduction (RR 0.87, 95% CI 0.78–0.97; p=0.01). These findings are consistent with the magnitude of the reduction in breast cancer mortality. CONCLUSIONS: Invitation to screening was associated with a reduction in deaths from all causes among breast cancer cases, consistent with high participation rates in screening. There is no significant evidence of bias in cause of death classification in the Two-County Trial, and as breast cancer mortality is the targeted clinical outcome in breast cancer screening, it is the appropriate end point in a breast cancer screening trial. All-cause mortality is a poor and inefficient surrogate for breast cancer mortality.

Estrogen plus progestin (E+P) and breast cancer incidence and mortality.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1501-1501
Author(s):  
Rowan T. Chlebowski ◽  
Garnet L Anderson ◽  
Lewis H Kuller ◽  
Aaron K Aragaki ◽  
JoAnn E Manson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Cancer Prognosis ◽  
Breast Cancers ◽  
Incidence And Mortality ◽  
Mortality Table

1501 Background: In the WHI clinical trial, E+P increased both breast cancer incidence and breast cancer mortality (JAMA 2010;304:1684). In contrast, breast cancers associated with E+P use in most observational studies have a more favorable prognosis. To address differences, a cohort of WHI Observational Study participants with characteristics similar to the WHI clinical trial was identified to examine E+P association with invasive breast cancer incidence and outcome. Methods: 41,449 postmenopausal women with no prior hysterectomy and mammogram negative for breast cancer < 2 years before who either were not hormone users (25,328) or were using E+P (16,121) were identified. Breast cancers were verified by centralized medical record review. Adjusted Cox proportional hazard regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). Additional analyses adjusted for breast cancer screening, censoring participants for incidence analyses who had a > 2 year interval without a mammogram. Results: After a mean (SD) follow-up 11.3 (3.1) years, 2,236 breast cancers were diagnosed. Breast cancer incidence was higher in E+P users (0.60% vs 0.42%, annualized rate, respectively: HR 1.55, 95% CI 1.41-1.70, P<0.001). Screening adjusted analyses had stronger breast cancer association (0.63% vs 0.39%, HR 1.72, 95% CI 1.54-1.93; P<0.001). Survival following breast cancer, measured from diagnosis date, was similar in E+P users and non-users (HR 0.95, 95% CI 0.74-1.23). Breast cancer mortality, analyzed from cohort entry date, are shown in the table. Conclusions: E+P use is associated with increased breast cancer incidence. As breast cancer prognosis following diagnosis on E+P is similar to that of nonusers, the higher incidence with E+P leads to increased breast cancer mortality. [Table: see text]

scholarly journals Breastfeeding Duration and the Risk of All-Cause and Breast Cancer Mortality Among Parous Women From the Mexican Teachers’ Cohort

2018 ◽  
Vol 4 (Supplement 1) ◽  
pp. 27s-27s
Author(s):  
Mishel Unar Munguía ◽  
Susana Lozano Esparza ◽  
Dalia Stern ◽  
Mónica Mazariegos Posadas ◽  
Ruy López Ridaura ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cause Of Death ◽  
Cancer Mortality ◽  
Conflicts Of Interest ◽  
Breast Cancer Mortality ◽  
Breastfeeding Duration ◽  
Age At First Birth ◽  
Mexican Women ◽  
All Cause Mortality ◽  
The Impact

Abstract 79 Purpose Women who have breastfed have a lower risk of breast and ovarian cancer and other chronic diseases. Currently, breast cancer has become the leading cause of death from cancer in Mexican women. In Mexico, exclusive breastfeeding rates have declined one third in the last decade, and only 35% of women breastfed at least 1 year, which provides a unique scenario in which to analyze breastfeeding and mortality. The aim of the current study was to estimate the impact of lifetime breastfeeding duration on the risk of all-cause and breast cancer mortality in Mexican women. Methods We analyzed parous women who were enrolled in a Mexican Teachers’ Cohort since 2006 and observed over 10 years. Months of breastfeeding per pregnancy were self-reported at baseline. We categorized participants according to the accumulated duration of any mode of breastfeeding (never, < 6 months, 6 to 11 months, 12 to 23 months, and ≥ 24 months). Deaths were identified using the employer’s database and next of kin reports, and the date and cause of death were obtained from national mortality databases. We used Cox proportional hazards regression models adjusted for baseline age, parity (one, two, three, and four or more children), age at first birth (< 20, 20 to 24, 25 to 29, and ≥ 30 years), BMI at age 18 years (≤ 25 or > 25), socioeconomic level (tertiles), and smoking (current, past, and never) to estimate hazard ratios (HRs). Results Mean age at baseline was 43 ± 7 years. Over 767,600 person-years of follow-up, 952 all-cause deaths and 92 breast cancer deaths occurred among 92,794 parous women. Mean age at death was 57 ± 7 years. The incidence rate per 1,000 person-years of all-cause mortality was 1.8 for women who did not breastfeed, 1.18 (< 6 months), 1.21 (6 to 11 months), 1.01 (12 to 23 months), and 1.26 (≥ 24 months). HRs for all-cause mortality among parous women with lifetime breastfeeding of < 6 months was 0.79 (95% CI, 0.63 to 0.97), 0.85 (95% CI, 0.70 to 1.05) for 6 to 11 months, 0.78 (95% CI, 0.64 to 0.94) for 12-23 months, and 0.88 (95% CI, 0.69 to 1.10) for > 24 months compared with parous women who never breastfed. No dose-response relationship was found when comparing HRs of the different categories of breastfeeding. HR for breast cancer mortality for women who ever breastfed compared with parous women who never breastfed was 0.75 (95% CI, 0.45 to 1.33). Conclusion Breastfeeding among parous Mexican women was associated with lower all-cause mortality. Breastfeeding could potentially reduce premature deaths in women. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Efficacy of Prophylactic Mastectomy in Women With Unilateral Breast Cancer: A Cancer Research Network Project

2005 ◽  
Vol 23 (19) ◽  
pp. 4275-4286 ◽  
Author(s):  
Lisa J. Herrinton ◽  
William E. Barlow ◽  
Onchee Yu ◽  
Ann M. Geiger ◽  
Joann G. Elmore ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Contralateral Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Contralateral Breast ◽  
Research Network ◽  
Unilateral Breast Cancer ◽  
All Cause Mortality

Purpose We investigated the efficacy of contralateral prophylactic mastectomy (CPM) in reducing contralateral breast cancer incidence and breast cancer mortality among women who have already been diagnosed with breast cancer. Methods This retrospective cohort study comprised approximately 50,000 women who were diagnosed with unilateral breast cancer during 1979 to 1999. Using computerized data confirmed by chart review, we identified 1,072 women (1.9%) who had CPM. We obtained covariate information for these women and for a sample of 317 women who did not undergo CPM. Results The median time from initial breast cancer diagnosis to the end of follow-up was 5.7 years. Contralateral breast cancer developed in 0.5% of women with CPM, metastatic disease developed in 10.5%, and subsequent breast cancer developed in 12.4%; 8.1% died from breast cancer. Contralateral breast cancer developed in 2.7% of women without CPM, and 11.7% died of breast cancer. After adjustment for initial breast cancer characteristics, treatment, and breast cancer risk factors, the hazard ratio (HR) for the occurrence of contralateral breast cancer after CPM was 0.03 (95% CI, 0.006 to 0.13). After adjustment for breast cancer characteristics and treatment, the HRs for the relationship of CPM with death from breast cancer, with death from other causes, and with all-cause mortality were 0.57 (95% CI, 0.45 to 0.72), 0.78 (95% CI, 0.57 to 1.06), and 0.60 (95% CI, 0.50 to 0.72), respectively. Conclusion CPM seems to protect against the development of contralateral breast cancer, and although women who underwent CPM had relatively low all-cause mortality, CPM also was associated with decreased breast cancer mortality.

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