Long term absence of invasive breast cancer diagnosis in 2,402,672 pre and postmenopausal women:
A systematic review and meta-analysis
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https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237925
Published September 10, 2020, Public Library of Science
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Abstract
Background
Invasive Breast Cancer (IBC) risk estimates continue to be based on data collated from cancer registries, i.e., retrospective research that excludes disease-free women. For women without a prior diagnosis, these estimates inflate both risk and screening frequency recommendations and inadvertently increase recently recognized harms from overdiagnosis and overtreatment.
Objective
To estimate the likelihood that pre or postmenopausal women with no prior diagnosis will remain free of IBC in order to enable evidence-based screening recommendations.
Methods
Prospective data from 21 studies of 2,402,672 women were analyzed, updating our previously published systematic search of 19 studies. This second systematic search included PubMed and The Cochrane Library from 2012 through April 2019. Inclusion criteria: only studies reporting the number of women enrolled, length of follow-up, and number of women diagnosed with IBC. Linear regression was used to estimate the percentage of women expected to remain free from an IBC diagnosis based on follow-up duration. To minimize non-response bias and selective outcome bias, only studies reporting outcomes for all enrolled women followed for similar, specific lengths of time were included. Sensitivity analyses confirm that the overall findings were unchanged by age at enrollment, menopausal status, screened women, variation in sample size, duration of follow-up, and heteroskedasticity.
Results
The calculated percentage of women remaining IBC-free after follow-ups of 5, 10, 15, 20 and 25 years decreases uniformly by about one-fourth of one percent per year, i.e., 0.255% (95% CI: -0.29, -0.22; p < .0001). At 25 years, the expected percentage of women with no invasive breast cancer is 93.41% (95% CI: 92.75, 94.07).
Conclusions
Over 99.7% of pre/postmenopausal women with no prior diagnosis continued with no IBC each year, with 93.41% still free after 25 years. Our study supports the medical justification for reducing the frequency of mammograms for menopausal women with no prior IBC diagnosis.
Reaction from Isaac Schiff, C.M., M. D. Distinguished Professor of Gynecology, Harvard Medical School Sept 12, 2020
Winnifred: "I am thrilled for you and of course for the readers of your article. It will change what I tell my patients. CONGRATULATIONS!!! I am so proud of you and what you have done.
THANK YOU----Isaac"
Isaac Schiff, C.M., M. D.
Joe Vincent Meigs Distinguished Professor of Gynecology
Harvard Medical School
Chief, Vincent Department of Obstetrics and Gynecology, Emeritus
Massachusetts General Hospital, 55 Fruit Street, Founders 5, Boston MA 02114
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" My research has consistently focussed on what behavior a woman can engage in to increase her power, well-being, and vitality."
--Winnifred B. Cutler, Ph.D.