Article

Scheduling mammography screening for the early detection of breast cancer in Korean women

Department of Preventive Medicine and Public Health, School of Medicine, Ajou University, Suwon, Republic of Korea.
Journal of Medical Screening (Impact Factor: 2.72). 12/2007; 14(4):205-9. DOI: 10.1258/096914107782912103
Source: PubMed

ABSTRACT To propose an efficient screening schedule for breast cancer among Korean women using the stochastic model in which the age-specific incidence rate was considered.
Female breast cancer data in the Korea Central Cancer Registry 2002.
The stochastic model was based on the threshold method, in which the schedule is determined by a pre-specified threshold value. The threshold value was defined as the probability of being in a preclinical state of breast cancer at age 40 years. The sensitivity of the mammography was specified as 0.7. Two models for mean sojourn time (MST) in the preclinical state were considered; MSTs for Model I were 2 (ages < 50 years), 3 (ages 50-59 years), and 4 years (ages > or = 60 years), and MSTs for Model II were 3, 4, and 5 years for the corresponding age groups.
The threshold method for Model I generated 19 examinations within the screening ages of 40-69 years. Each screening time was determined at ages 40.0, 41.6, 43.2, 44.8, 46.0, 47.2, 48.4, 49.6, 50.7, 51.7, 52.7, 53.7, 54.7, 56.2, 57.8, 59.4, 61.3, 63.1, and 64.9 years. The schedule sensitivity of Model I was 64.2%, which was higher than that (57.5%) of the biennial periodic schedule. Model II included 11 screenings between the ages of 40 and 69 years and also showed a higher schedule sensitivity, especially for women aged 40 years as compared with the biennial screening.
This finding suggests that the threshold screening schedule for breast cancer increase the schedule sensitivity by reflecting the age-specific incidence rate of a population.

0 Followers
 · 
98 Views
  • Source
    • "Screening mammography and use of ultrasonography play an important role in detection of breast cancers in earlier stages (17). Since 1996, it was recommended that all Korean women over 40 yr old underwent a mammography every 1 or 2 yr (18). From 1996 to 2004, the incidence of stage 0 and I breast cancers increased remarkably by 128.6% and 81.6%, respectively (16). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinicopathological characteristics and prognostic factors of mucinous carcinoma (MC) were compared with invasive ductal carcinoma-not otherwise specified (IDC-NOS). Clinicopathological characteristics and survivals of 104 MC patients were retrospectively reviewed and compared with those of 3,936 IDC-NOS. The median age at diagnosis was 45 yr in MC and 47 yr in IDC-NOS, respectively. The sensitivity of mammography and sonography for pure MC were 76.5% and 94.7%, respectively. MC showed favorable characteristics including less involvement of lymph node, lower stage, more expression of estrogen receptors, less HER-2 overexpression and differentiated grade, and better 10-yr disease-free survival (DFS) and overall survival (OS) (86.1% and 86.3%, respectively) than IDC-NOS (74.7% and 74.9%, respectively). Ten-year DFS of pure and mixed type was 90.2% and 68.8%, respectively. Nodal status and stage were statistically significant factors for survival. MC in Koreans showed similar features to Western populations except for a younger age of onset than in IDC-NOS. Since only pure MC showed better prognosis than IDC-NOS, it is important to differentiate mixed MC from pure MC. Middle-aged Korean women presenting breast symptoms should be examined carefully and evaluated with an appropriate diagnostic work-up because some patients present radiologically benign-like lesions.
    Journal of Korean medical science 03/2010; 25(3):361-8. DOI:10.3346/jkms.2010.25.3.361 · 1.25 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Because the Asia–Pacific region contains approximately 25% of the world's population, the rapidly rising incidence of breast cancer in this area represents a serious global health problem. Epidemiologic and biologic profiles of breast cancer in the Asia–Pacific region differ from those in Western countries. Compared with the West, breast cancer occurs more frequently among young premenopausal women and women in urban areas. Breast cancer is also more frequently diagnosed in advanced stages than in Western countries, and tumors are more likely to be estrogen receptor- and progesterone receptor-negative. These differences can impact treatment selection, response to treatment, and outcomes, including morbidity and mortality. Breast cancer mortality in some countries of the Asia–Pacific region is two-fold higher than in Western countries. The screening, diagnosis, and management of patients with breast cancer in the Asia–Pacific region are associated with a number of unique challenges. These include patient misperceptions about the disease and its treatment, a lack of access to imaging equipment and diagnostic testing, inconsistencies in the implementation of breast cancer screening programs and limited access to expensive treatments. Whereas some of the more Westernized countries within this region have established screening programs, many areas are still lacking in adequate breast cancer screening facilities. Various cultural and economic barriers must be addressed to improve treatment and outcomes for Asian-Pacific patients with breast cancer.
    Asia-Pacific Journal of Clinical Oncology 12/2008; 4(s3):S5 - S13. DOI:10.1111/j.1743-7563.2008.00191.x · 1.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The epidemiological characteristics of breast cancer in Korean women are different from the characteristics reported in Western women. The highest incidence rate occurs in Korean women in their 40s. The purpose of this study was to determine the most cost-effective screening interval and target age range for Korean women from the perspective of the national healthcare system. A stochastic model was used to simulate breast cancer screenings by varying both the screening intervals and the age ranges. The effectiveness of mammography screening was defined as the probability of detecting breast cancer in the preclinical state and the cost was based on the direct cost of mammography screening and the confirmative tests. The age-specific mean sojourn times and the sensitivity of the mammography were applied in the stochastic model. An optimal cost-effectiveness was determined by the incremental cost-effectiveness ratio and lifetime schedule sensitivity. Sensitivity analyses were undertaken to assess parameter uncertainty. The selected cost-effective strategies were: (1) the current biennial mammography screenings for women who are at least 40 years old; (2) biennial screening for women between the ages of 35 and 75 years; and (3) a combination strategy consisting of biennial screening for women aged between 45 and 54 years, and 3-year interval screening for women aged between 40 and 44 years and 55 and 65 years. Further studies should follow to investigate the effectiveness of mammography screening in women younger than 40 years in Asia as well as in Korea.
    Cancer Science 04/2009; 100(6):1105-11. DOI:10.1111/j.1349-7006.2009.01147.x · 3.53 Impact Factor
Show more

Preview

Download
0 Downloads
Available from