Breast cancer screening: a 35-year perspective.
ABSTRACT Screening for breast cancer has been evaluated by 9 randomized trials over 5 decades and recommended by major guideline groups for more than 3 decades. Successes and lessons for cancer screening from this history include development of scientific methods to evaluate screening, by the Canadian Task Force on the Periodic Health Examination and the U.S. Preventive Services Task Force; the importance of randomized trials in the past, and the increasing need to develop new methods to evaluate cancer screening in the future; the challenge of assessing new technologies that are replacing originally evaluated screening tests; the need to measure false-positive screening test results and the difficulty in reducing their frequency; the unexpected emergence of overdiagnosis due to cancer screening; the difficulty in stratifying individuals according to breast cancer risk; women's fear of breast cancer and the public outrage over changing guidelines for breast cancer screening; the need for population scientists to better communicate with the public if evidence-based recommendations are to be heeded by clinicians, patients, and insurers; new developments in the primary prevention of cancers; and the interaction between improved treatment and screening, which, over time, and together with primary prevention, may decrease the need for cancer screening.
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ABSTRACT: Background: Although the United States Preventive Services Task Force (USPSTF) downgraded their recommendation for breast cancer screening for women aged 40-49 years in 2009, Japanese women in their 40s have been encouraged to attend breast cancer screenings since 2004. The aim of this study is to examine whether these different mass-screening strategies are justifiable by the different situations of these countries and to provide evidence for suitable judgment.Methods: Performance of screening strategies (annual/biennial intervals; initiating/terminating ages) was evaluated using a mathematical model based on the natural history of breast cancer and the transition between its stages. Benefits (reduced number of deaths and extended average life expectancy) and harm (false-positives) associated with these strategies were calculated.Results: Additional average life expectancy by including women in their 40s as participants were 13 days (26%) and 25 days (22%) in Japan and the United States, respectively, under the biennial screening condition; however, the respective increases in numbers of false-positive cases were 65% and 53% in Japan and the United States. Moreover, the number of screenings needed to detect one diagnosis or to avert one death was smaller when participants were limited to women of age 50 or over than when women in their 40s were included. The validity of including women in their 40s in Japan could not be determined without specifying the weight of harms compared to benefits.Conclusions: Whether screening of women in their 40s in Japan is justifiable must be carefully determined based the quantitative balance of benefits and harms.Journal of Epidemiology 12/2014; 25(2). DOI:10.2188/jea.JE20140047 · 2.86 Impact Factor
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ABSTRACT: Entre el 5 al 10 % de los cánceres de ovario y mama son atribuidos a una transmisiónautosómica dominante de mutaciones heredadas en los genes BRCA 1 y BRCA 2. Estosexplican el 90 % y el 50 % de los cánceres hereditarios de ovario y mama, respectivamente. Lasmujeres que heredan la mutación en el gen BRCA tienen mayor riesgo de cáncer de mama, de ovarioy los varones poseedores de dicho gen tienen un riesgo de cáncer de próstata. Las mujeres con lamutación en el gen BRCA 2 también tienen riesgo (aunque menor) de presentar cáncer de mamay de ovario, y en varones hay un riesgo de cáncer de mama. Sin embargo, hay otros síndromes queexplican el cáncer hereditario de mama y ovario y otros genes que aún están por descubrirse. Entreestos están el Lynch II, el síndrome Li-Fraumeni, el síndrome de ataxia - telangiectasia, el síndromede Cowden y el síndrome de Bloom. En la actualidad es posible ofrecer la identificación de estas mutacionescon base en el DNA y en una historia familiar completa, pero la utilidad de la predicciónde las pruebas genéticas requiere de una adecuada asesoría para la interpretación de sus resultados.07/2012; 26(2):185-199.
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ABSTRACT: Cancer vaccines are an effective way to prevent the occurrence of cancer. Epidermal growth factor receptor pathway substrate 8 (Eps8) is a novel tumor-associated antigen, which is overexpressed in the majority of tumor types. In the present study, the Eps8 protein was cloned and characterized, and its feasibility as an antitumor agent in murine breast carcinoma was investigated. The results revealed that the Eps8 protein increased the secretion of interleukin (IL)-12 in the culture supernatant of dendritic cells (DCs). The Eps8 protein‑pulsed DCs induced significant cytotoxic T lymphocyte (CTL) responses, T-cell proliferation and a higher level of interferon (IFN)-γ in the culture supernatant of the splenocytes ex vivo. Additionally, when the mice were immunized with the Eps8 vaccine, this resulted in a regression of 4T1 breast tumors and significantly prolonged survival time in the tumor‑bearing mice compared with that in the phosphate-buffered saline (PBS) control group. The Eps8 vaccine induced higher CTL responses in the splenocytes of mice vaccinated against the 4T1 cells; the ratio of CD4+/CD8+ T cells was increased in the Eps8 group; and the percentage of CD4+CD25+ FoxP3+ regulatory T (Treg) cells in the Eps8 group was significantly lower compared with that of the PBS group. The results suggested that the Eps8 vaccine was able to stimulate antitumor effects against 4T1 breast cancer cells in vitro and in vivo, and it may provide a potential immunotherapeutic agent for the treatment of breast cancer.Molecular Medicine Reports 06/2013; 8(2). DOI:10.3892/mmr.2013.1514 · 1.48 Impact Factor