| Objectives:In order to give a perspective of breast image screening in urban area of China, we start this article with 3 objectives. The first part is to review all the subclinical breast cancer cases detected by opportunistic mammography screening during 2000 to 2007 in Shanghai Cancer Center, Fudan University. The second part is to evaluate the sensitivity and clinical value of a new breast image screening strategy: combination of ultrasound and mammography. The third part is to report the preliminary data of a community-based mass screening project:Qi-bao Town breast screening programme.Methods:Part one:A Review of Subclinical Breast Cancers Detected by Opportunistic Mammography ScreeningBreast cancers detected by means of opportunistic mammography screening in Shanghai Cancer Center, Fudan University (FUSCC) between Jan 1st 2000 and Dec 31th 2007 were enrolled in the study. Various clinical-pathological features including histological type, stage at diagnosis, as well as treatment modalities and reasons to participate the screening were described by manual telephone follow-up. Kaplan-Meier life table analysis was also done for disease free survival (DFS) and overall survival (OS). Part two:The Clinical Value of Breast X-ray Combined with Ultrasound in Breast Imaging Screening.Including criteria:(1) breast cancers detected by the breast image screening projects in FDSCC;(2) female over 40 years old;(3) both mammogram and ultrasound was done at the screening time, and (4) the mammographic and sonographic images were read separately by different radiologists. Sensitivity of mammography in combination with ultrasound and mammography alone were compared in all, and by different age groups and by different breast density.Part three:The Preliminary Results of a Qi-bao Town Breast Imaging Screening Project.In Qi-bao Town (a small Shanghainese community with about 80,000 population), female residents aged between 35 and 74 years had been organized to participate in breast screening project since May 2008. At baseline, all participants were required to receive clinical breast examination (CBE) and breast health education, complete an epidemiological questionnaire, and a blood test for FBG and AFP. Among them, women aged between 45 and 69 years in 2008 (born between Jan 1st 1939 and Dec 31st 1963) were organized to receive both breast mammography and ultrasonography in FUSCC. These image screening activities will be repeated in the following 5 years for another 2 rounds. At the same time, we found communities where organized breast screening were conducted by CBE alone as a study control. In the current study, we evaluate the breast cancer incidence, stage at diagnosis and therapy modality and screening sensitivity within 1st round screening in Qi-bao and control communities.Results:Part one:181 breast cancer cases were enrolled. The number of ductal carcinoma in situ (DCIS), ductal carcinoma in situ with microinvasion (DCIS-Mi) and invasive ductal carcinoma (IDC) was 69,41, and 71, respectively. Early stage (0+I) rate was 82.9%. Reasons of breast screening can be roughly separated into two parts:one is without symptom and require by patients themselves; another one is with non-typical symptoms and recommended by doctors. There is statistically difference in histological type and breast surgery modalities between non-symptom ones and symptom ones (P<0.05). At median follow-up time of 42.9 months, 5-year disease free survival (DFS) and overall survival (OS) in this cohort of patients is 97.0% and 100% respectively.Part two:42 breast cancers detected by screening meet the enrolling criteria. Respectively, the screening sensitivity of Mammography alone, ultrasound alone and Mammography combined with ultrasound 81.0%,64.3%,95.2%, the difference was statistically significant (P<0.05). The benefit of adding ultrasound to mammography as a new breast image screening strategy was found statistically significant in patients with dense breast on mammogram, while was not found in younger (<50 years old) women. Part three:There are 9431 women participate in this community-based mass screening project till the end of Dec 2009.5615 women took part in the first-round breast image screening.27 breast cancers were finally diagnosed in these participants. The cancer detection rate was 286.3/100,000 which was much higher than the control communities, 79.3/100,000. The proportion of early stage (0+I) stage was 48.1%(13/27). The cases with negative lymph nodes and breast-conserving surgery were 88.9%(24/27) and 40.7%(11/27). The sensitivity of X-ray, B-us and CBE was 85.2%(23/27),70.4%(19/27) and 25.9%(7/27), respectively. The recall rate in the study community was 1.98%, and the biopsy rate was 0.98%. One case was reported as an interval cancer (10.6/100,000). The cost of the first round was aboutï¿¥2087348.35. In addition,18 non-participants of Qi-bao screening project were reported as breast cancers in 2009 according to SCR. The proportion of 0+I stage disease in patients not participate in the screening project was 22.2%(2/18).Conclusion:Part one:The subclinical breast cancers, which detected by opportunistic mammography screening, are more likely to be early stages and have perfect prognosis.Part two:Mammography combined with ultrasound could increase the diagnostic sensitivity of breast screening. The combination image screening strategy could be recommended for women with dense breast on mammography.Part three:Breast imaging screening including mammography could increase the detection rate of early breast cancers in Shanghai community population. In the result, prognosis and treatment of breast cancer could be improved. The sensitivity of imaging screening was higher than that of CBE screening. Organized community screening was costly. A risk-factor predictive model was expected.Final conclusion:Community hospital, academic hospital and Municipal Health Bureau/CDC collaborate with each other and each performs its own functions. Systemically carry out both hospital-based opportunistic screening and community-based mass screening so as to achieve early diagnosis of breast cancer in urban of China. |
PDF Full Text Request