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Breast. 2018 Jun 18;41:25-33. doi: 10.1016/j.breast.2018.06.007. [Epub ahead of print]

The impact of organized breast assessment on survival by stage for screened women diagnosed with invasive breast cancer.

Author information

1
Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue Toronto, Ontario M5G 2L7, Canada.
2
Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue Toronto, Ontario M5G 2L7, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor Toronto, Ontario M5T 3M7, Canada. Electronic address: anna.chiarelli@cancercare.on.ca.
3
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, Ontario M5T 1P5, Canada.
4
Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor Toronto, Ontario M5T 3M7, Canada; Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, United States.
5
Department of Laboratory Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
6
Prevention and Screening Services, Northwestern Ontario, 980 Oliver Road, Thunder Bay, ON, Canada P7B 6V4.
7
South East Regional Cancer Program, 25 King Street West Kingston, Ontario K7L 5P9, Canada.
8
North East Regional Cancer Program, 41 Ramsey Lake Road, Sudbury, ON P3E 5J1, Canada.
9
South West Regional Cancer Program, 790 Commissioners Road East London, Ontario N6A 4L6, Canada.
10
North Simcoe Muskoka Regional Cancer Program, 201 Georgian Drive Barrie, ON L4M 6M2, Canada.
11
Waterloo Wellington Regional Cancer Program, 835 King Street West Kitchener, Ontario N2G 1G3, Canada.
12
Central East Regional Cancer Program, 1 Hospital Court Oshawa, ON L1G 2B9, Canada.
13
Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, Ontario M5T 1P5, Canada; Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
14
Hamilton Niagara Haldimand Brant Regional Cancer Program, 699 Concession Street Hamilton, Ontario L8V 5C2, Canada.
15
North York General Hospital, 4001 Leslie St, North York, ON, M2K 1E1, Canada.
16
Champlain Regional Cancer Program, 501 Smyth Road Ottawa, Ontario K1H 8L6, Canada.
17
Erie St. Clair Regional Cancer Program, 2220 Kildare Road Windsor, Ontario N8W 2X3, Canada.
18
Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue Toronto, Ontario M5G 2L7, Canada; St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor Toronto, Ontario M5T 1W7, Canada.

Abstract

PURPOSE:

Since 1998, the Ontario Breast Screening Program (OBSP) has offered organized assessment through Breast Assessment Centres (BAC). This study compares survival between screened women diagnosed with breast cancer who have undergone assessment through a BAC and usual care (UC).

METHODS:

A retrospective design identified two concurrent cohorts of women aged 50 to 69 within the OBSP diagnosed with screen-detected invasive breast cancer at a BAC (n = 2010) and UC (n = 1844) between 2002 and 2010 and followed until 2016. Demographic and assessment characteristics were obtained from the OBSP. Abstraction of medical charts provided prognostic and treatment data. Death data were assessed from the Registered Person's Database and the Ontario Registrar General All-Cause Mortality File. Multivariable Cox proportional hazards models compared overall survival by assessment type (BAC/UC), stratified by stage.

RESULTS:

There were 505 deaths during the study (BAC = 239; UC = 266). Among women with stage I screen-detected breast cancer, those diagnosed through a BAC had 31% reduced risk of all-cause mortality (HR = 0.69, 95% CI = 0.53-0.90) compared to UC. Diagnosis within 7 weeks of an abnormal mammogram reduced the hazard of death from all causes by 34% among all women with stage I breast cancers (HR = 0.66, 95% CI = 0.47-0.91), and was more likely in BAC (79.7%) than UC (66.9%).

CONCLUSION:

The significant improvement in overall survival for women with stage I screen-detected invasive breast cancer assessed through BACs further supports the recommendation that women with abnormal mammograms should be managed through organized assessment.

KEYWORDS:

Breast cancer; Organized assessment; Survival; Time to diagnosis

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