Breast screening programme

Breast Screening Programme, England 2018-19 | NHS Digital |  30 January 2020

Women between the ages of 50 and 70 are invited for regular breast screening (every three years) under a national programme. Screening is intended to reduce mortality by detecting breast cancer at an early stage when there is a better chance of successful treatment.

This report presents information about the NHS Breast Screening Programme in England in 2018-19 and includes data on women invited for breast screening, coverage, uptake of invitations, outcomes of screening and cancers detected.

The publication also features an online interactive dashboard to complement the existing publication resources.

Full report: Breast Screening Programme England, 2018-19 | NHS Digital

Further detail at NHS Digital

International evaluation of an AI system for breast cancer screening

McKinney, S. M., et al. |2020| International evaluation of an AI system for breast cancer screening| Nature| 577|(7788)| P. 89-94.

An international team of researchers including experts from Imperial College London trained and tested an artificial intelligence (AI) system screening using a simulation of the double-reading process that is used in the UK.  29000 mammography images were used to demonstrate that the AI system was able to correctly identify cancers from the images with a similar degree of accuracy to expert radiologists, and holds the potential to assist clinical staff in practice. 

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The authors of the paper found that the computer algorithm (AI system) maintained non-inferior performance and reduced the workload of the second reader by 88%. This robust assessment of the AI system paves the way for clinical trials to improve the accuracy and efficiency of breast cancer screening (Source: Imperial College London). 

Full press release from Imperial College London Artificial intelligence could help to spot breast cancer

Screening mammography aims to identify breast cancer at earlier stages of the disease, when treatment can be more successful1. Despite the existence of screening programmes worldwide, the interpretation of mammograms is affected by high rates of false positives and false negatives2. Here we present an artificial intelligence (AI) system that is capable of surpassing human experts in breast cancer prediction. To assess its performance in the clinical setting, we curated a large representative dataset from the UK and a large enriched dataset from the USA. We show an absolute reduction of 5.7%and 1.2% (USA and UK) in false positives and 9.4% and 2.7% in false negatives. We provide evidence of the ability of the system to generalize from the UK to the USA. In an independent study of six radiologists, the AI system outperformed all of the human readers: the area under the receiver operating characteristic curve (AUC-ROC) for the AI system was greater than the AUC-ROC for the average radiologist by an absolute margin of 11.5%. We ran a simulation in which the AI system participated in the double-reading process that is used in the UK, and found that the AI system maintained non-inferior performance and reduced the workload of the second reader by 88%. This robust assessment of the AI system paves the way for clinical trials to improve the accuracy and efficiency of breast cancer screening.

Paper: International evaluation of an AI system for breast cancer screening

In the news:

BBC |  AI ‘outperforms’ doctors diagnosing breast cancer

BMJ |  AI system outperforms radiologists in first reading of breast cancer screening, study claims

 

Blood test for breast cancer may be a step closer

NCRI Cancer Research Institute |nd | Clinical Utility of Autoantibodies in Early Detection of Breast Cancer

A team of researchers including experts from the University of Nottingham have developed a blood test which could detect breast cancer up to five years earlier before its clinical presentation. white-plastic-syringe-1164531.jpg

Abstract

Background

Autoantibodies against numbers of tumour-associated antigens (TAAs) were shown to be relevant tumor biomarkers and can be detected up to 5 years before the tumour is overt clinically. Early diagnosis of cancer is paramount to improved survival by enabling treatment prior to cancer spreading, when tumours should be both surgically removable and curable. The NHS in Scotland is currently carrying out a RCT (ECLS) involving 12,000 individuals at high risk of developing lung cancer being randomised to having (or not) an autoantibody ELISA blood test (EarlyCDT-Lung®) – followed by CT scans over 2 years follow-up in those individuals with a positive test – for early lung cancer detection.

We are aiming to develop a blood test enabling the early detection of breast cancer to significantly improve clinical outcome.

Method

In this pilot study, 180 breast cancer matched control samples were screened for the presence of autoantibodies against 67 TAAs which have already been shown to involve in breast cancer pathology. Optimised Protein microarray technology was applied for this study.

Results

The results confirmed our hypothesis that BC induce autoantibodies (AAbs) against different panels of specific tumour associated antigens (TAAs) used in the pilot study. The assay provided cancer/control discrimination through detection of AAbs against TAAs.

Conclusion

We identified antigen panels of sufficient sensitivity and specificity for early detection of BC based upon serum profiling of autoantibody response. This opens the possibility of a blood test for screening and detection of breast cancer.

The research has been recently presented at NCRI Cancer Conference, in Glasgow, Scotland on Sunday 3 November.

Read the story at Science Daily 

OnMedica Blood test for breast cancer may be a step closer

See also:

Nottingham Post Nottingham researchers develop blood test which could detect breast cancer much earlier

The Telegraph Simple blood test could spot breast cancer five years before any symptom

Record numbers beating breast cancer in the UK

More than 130,000 UK breast cancer deaths have been avoided in the last 30 years, according to new Cancer Research UK analysis to mark breast cancer awareness month

Breast cancer deaths in the UK hit a record high in 1989, when around 15,600 women lost their lives to the disease – but thanks to research developing new tests and better treatments, the death rate for women has since fallen by 44%.

This considerable drop is due to major advances in diagnosis and treatment. In the last three decades, we have seen improvements in surgical techniques and use of radiotherapy, new drugs being made available, and the impact of the national breast screening programme.

Full story at Cancer Research UK

See also: Breast cancer deaths almost halved since 1989, UK figures show | The Guardian

Breast cancer: Call for genetic screening for all

Study, published in JAMA Oncology looked at data on 11,800 women diagnosed with breast cancer in the UK, US and Australia, with findings suggesting that breast cancer genetic screening would save hundreds of lives each year | story via BBC News

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Offering every woman diagnosed with breast cancer genetic screening would save hundreds of lives each year, according to a new study published in JAMA Oncology.  Currently, only those with risk factors such as a close family history of breast cancer are offered the check. The analysis suggests one year’s testing could save 2,102 cases of breast and ovarian cancer and 633 lives in the UK.

The research says screening everyone would enable women to make informed treatment choices and allow family members to take preventative action. It would also be cost-effective for the NHS, they say.

Full story at BBC News

Full research paper: Sun L, Brentnall A, Patel S, et al. | A Cost-effectiveness Analysis of Multigene Testing for All Patients With Breast Cancer |  JAMA Oncology | Published online October 03, 2019

BMJ: Cancer screening uptake- only a third of women take up offers

Torjesen, I. | 2019| Cancer screening: only a third of women in England take up all offers | BMJ| 366 | l5588 | doi: https://doi.org/10.1136/bmj.l5588

A new study published in the BMJ indicates that of the screening services offered to women in their 60s, which include cervical, breast and bowel screening only a third attend these screening sessions.  

The study included over 3000 women aged between 60-65 who had responded to their last invitations from each of these three screening programmes.

Results showed that:

  • 35% took part in all three screening programmes;
  • 37% participated in two programmes;
  • 17% accessed one type of screening; and
  • 10% were not screened at all.

They found that in the last screening round, 2525 (83%) had taken up mammography, 1908 (62%) cervical screening, and 1635 (53%) bowel cancer screening, which is consistent with the proportions reported in the official statistics for England (78%, 58-59%, and 57-59%, respectively).

The researchers also explored area level correlations between participation in the three screening programmes and various population characteristics for all English general practices with complete data in the Fingertips database curated by Public Health England. This database reports health related data for England aggregated by administrative area.

General practices with higher proportions of unemployed patients and smokers had a lower rate of take-up of all three screening programmes. Conversely, general practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes (Source:  Torjesen, 2019).

To determine how many women participate in all three recommended cancer screening programmes (breast, cervical, and bowel). During their early 60s, English women receive an invitation from all the three programmes.

For 3060 women aged 60–65 included in an England-wide breast screening case–control study, we investigated the number of screening programmes they participated in during the last invitation round. Additionally, using the Fingertips database curated by Public Health England, we explored area-level correlations between participation in the three cancer screening programmes and various population characteristics for all 7014 English general practices with complete data.
Results

Of the 3060 women, 1086 (35%) participated in all three programmes, 1142 (37%) in two, 526 (17%) in one, and 306 (10%) in none. Participation in all three did not appear to be a random event (p  less than 0.001). General practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes.

Only a minority of English women is concurrently protected through all recommended cancer screening programmes. Future studies should consider why most women participate in some but not all recommended screening.

 

See also: King’s College London Only a third of women take up all offered cancer screenings, new research finds

BMJ Cancer screening: only a third of women in England take up all offers

[NICE Appraisal consultation] Approval for treatment option for early breast cancer after adjuvant trastuzumab [ID981]

NICE | August 2019| Approval for treatment option for early breast cancer after adjuvant trastuzumab [ID981]

Today (7 August 2019) The National Institute for Health and Care Excellence (NICE) has published draft guidance recommending neratinib as an additional treatment for some people with early hormone- receptor-positive human epidermal growth factor receptor 2 (HER2)- positive breast cancer. 

In a press release, NICE recommends Neratinib (also called Nerlynx and marketed by Pierre Fabre), under the terms of a commercial arrangement, for people with this type of breast cancer who are less than 1 year from completing trastuzumab (Herceptin)-based treatment following surgery (called adjuvant treatment).

The clinical trial evidence showed that people who had treatment with neratinib have less risk of disease recurrence than people who had treatment with a placebo. Despite there being no available data about how this might translate into increasing the overall length of time people live, the committee concluded that the cost-effectiveness estimates for neratinib made it an acceptable use of NHS resources.

Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said: “Breast cancer remains the most common form of cancer in the UK, accounting for around 30% of all cancers in women. And although there have been advances in the treatment of early stage HER2-positive breast cancer, around a quarter of people treated with trastuzumab following surgery will have a recurrence of their cancer.

“We are therefore pleased to be able to recommend neratinib as a further treatment option for people with this type of breast cancer, based on the benefits it provides in extending the time before the disease gets worse and on its important potential to reduce the risk of the cancer returning.”

Neratinib, which is taken as 6 x 40 mg tablets daily for 1 year, is recommended provided trastuzumab is the only HER2-directed adjuvant treatment people have had (Source: NICE).

The guidance is in development, comments can be made via the  Appraisal consultation

The closing date for comments is Wednesday 28 August 2019

Related:

NICE [press release] NICE recommends additional treatment option for people with early breast cancer   NICE

See also:

OnMedica Approval for treatment option for early breast cancer