Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer

Grace Hui Min Wu, Li Sheng Chen, King Jen Chang, Ming Feng Hou, Shin Chen Chen, Tse Jia Liu, Chiun Sheng Huang, Giu Cheng Hsu, Chih Cheng Yu, Li Li Jeng, Shou Tung Chen, Yi Hung Chou, Chang Ying Wu, Koong Shin-Lan, Tony Hsiu Hsi Chen

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Few studies have been published regarding the practice of breast cancer screening in Asian countries. Aims: The present study illustrates how the health policy for breast cancer screening has evolved in Taiwan from selective mammographic screening within a high-risk group, firstly to a programme of physical examination by public health nurses, and finally to a two-stage breast cancer screening programme, with a risk assessment followed by mammography for those at moderate to high risk. Data sources: Breast cancer screening has evolved from 1995 to 2004 in Taiwan in three stages: (1) selective screening for breast cancer with mammography, ultrasound and physical examination only in first-degree relatives of breast cancer cases (1995-1998); (2) a programme of mass screening (1999-2001) with physical examination by public health nurses; and (3) two-stage breast cancer screening with a risk factor questionnaire and mammography for those deemed at moderate-to-high risk (2002-2004). The questionnaire was based on significant risk factors in a previous epidemiological study, in conjunction with the physical examination programme, a risk score was constructed from the logistic regression coefficients from the previous study, and women with a score above the median in the previous epidemiological study were assigned to mammography. Results: Two-stage mammography screening had the most favourable results compared with the two previous screening regimes. It had a positive predictive value of recall after mammography of 14%, compared with 8% for selective screening and 2% for physical examination. Of screen-detected cancers in the two-stage programme, 71% were either ductal carcinoma in situ or stage T1, compared with 61% for selective screening and 60% for physical examination. The area under the receiver operating characteristic curve was 71% for the two-stage programme. Conclusions: For a low- to medium-risk country such as Taiwan, two-stage screening has acceptable parameters of recall and cancer detection, and compares well with other screening strategies.

Original languageEnglish
JournalJournal of Medical Screening
Volume13
Issue numberSUPPL.1
Publication statusPublished - Dec 2006
Externally publishedYes

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Early Detection of Cancer
Physical Examination
Mammography
Breast Neoplasms
Incidence
Taiwan
Public Health Nurses
Epidemiologic Studies
Mammary Ultrasonography
Mass Screening
Carcinoma, Intraductal, Noninfiltrating
Information Storage and Retrieval
Health Policy
ROC Curve
Neoplasms
Logistic Models

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy

Cite this

Wu, G. H. M., Chen, L. S., Chang, K. J., Hou, M. F., Chen, S. C., Liu, T. J., ... Chen, T. H. H. (2006). Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer. Journal of Medical Screening, 13(SUPPL.1).

Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer. / Wu, Grace Hui Min; Chen, Li Sheng; Chang, King Jen; Hou, Ming Feng; Chen, Shin Chen; Liu, Tse Jia; Huang, Chiun Sheng; Hsu, Giu Cheng; Yu, Chih Cheng; Jeng, Li Li; Chen, Shou Tung; Chou, Yi Hung; Wu, Chang Ying; Shin-Lan, Koong; Chen, Tony Hsiu Hsi.

In: Journal of Medical Screening, Vol. 13, No. SUPPL.1, 12.2006.

Research output: Contribution to journalArticle

Wu, GHM, Chen, LS, Chang, KJ, Hou, MF, Chen, SC, Liu, TJ, Huang, CS, Hsu, GC, Yu, CC, Jeng, LL, Chen, ST, Chou, YH, Wu, CY, Shin-Lan, K & Chen, THH 2006, 'Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer', Journal of Medical Screening, vol. 13, no. SUPPL.1.
Wu, Grace Hui Min ; Chen, Li Sheng ; Chang, King Jen ; Hou, Ming Feng ; Chen, Shin Chen ; Liu, Tse Jia ; Huang, Chiun Sheng ; Hsu, Giu Cheng ; Yu, Chih Cheng ; Jeng, Li Li ; Chen, Shou Tung ; Chou, Yi Hung ; Wu, Chang Ying ; Shin-Lan, Koong ; Chen, Tony Hsiu Hsi. / Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer. In: Journal of Medical Screening. 2006 ; Vol. 13, No. SUPPL.1.
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abstract = "Background: Few studies have been published regarding the practice of breast cancer screening in Asian countries. Aims: The present study illustrates how the health policy for breast cancer screening has evolved in Taiwan from selective mammographic screening within a high-risk group, firstly to a programme of physical examination by public health nurses, and finally to a two-stage breast cancer screening programme, with a risk assessment followed by mammography for those at moderate to high risk. Data sources: Breast cancer screening has evolved from 1995 to 2004 in Taiwan in three stages: (1) selective screening for breast cancer with mammography, ultrasound and physical examination only in first-degree relatives of breast cancer cases (1995-1998); (2) a programme of mass screening (1999-2001) with physical examination by public health nurses; and (3) two-stage breast cancer screening with a risk factor questionnaire and mammography for those deemed at moderate-to-high risk (2002-2004). The questionnaire was based on significant risk factors in a previous epidemiological study, in conjunction with the physical examination programme, a risk score was constructed from the logistic regression coefficients from the previous study, and women with a score above the median in the previous epidemiological study were assigned to mammography. Results: Two-stage mammography screening had the most favourable results compared with the two previous screening regimes. It had a positive predictive value of recall after mammography of 14{\%}, compared with 8{\%} for selective screening and 2{\%} for physical examination. Of screen-detected cancers in the two-stage programme, 71{\%} were either ductal carcinoma in situ or stage T1, compared with 61{\%} for selective screening and 60{\%} for physical examination. The area under the receiver operating characteristic curve was 71{\%} for the two-stage programme. Conclusions: For a low- to medium-risk country such as Taiwan, two-stage screening has acceptable parameters of recall and cancer detection, and compares well with other screening strategies.",
author = "Wu, {Grace Hui Min} and Chen, {Li Sheng} and Chang, {King Jen} and Hou, {Ming Feng} and Chen, {Shin Chen} and Liu, {Tse Jia} and Huang, {Chiun Sheng} and Hsu, {Giu Cheng} and Yu, {Chih Cheng} and Jeng, {Li Li} and Chen, {Shou Tung} and Chou, {Yi Hung} and Wu, {Chang Ying} and Koong Shin-Lan and Chen, {Tony Hsiu Hsi}",
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T1 - Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer

AU - Wu, Grace Hui Min

AU - Chen, Li Sheng

AU - Chang, King Jen

AU - Hou, Ming Feng

AU - Chen, Shin Chen

AU - Liu, Tse Jia

AU - Huang, Chiun Sheng

AU - Hsu, Giu Cheng

AU - Yu, Chih Cheng

AU - Jeng, Li Li

AU - Chen, Shou Tung

AU - Chou, Yi Hung

AU - Wu, Chang Ying

AU - Shin-Lan, Koong

AU - Chen, Tony Hsiu Hsi

PY - 2006/12

Y1 - 2006/12

N2 - Background: Few studies have been published regarding the practice of breast cancer screening in Asian countries. Aims: The present study illustrates how the health policy for breast cancer screening has evolved in Taiwan from selective mammographic screening within a high-risk group, firstly to a programme of physical examination by public health nurses, and finally to a two-stage breast cancer screening programme, with a risk assessment followed by mammography for those at moderate to high risk. Data sources: Breast cancer screening has evolved from 1995 to 2004 in Taiwan in three stages: (1) selective screening for breast cancer with mammography, ultrasound and physical examination only in first-degree relatives of breast cancer cases (1995-1998); (2) a programme of mass screening (1999-2001) with physical examination by public health nurses; and (3) two-stage breast cancer screening with a risk factor questionnaire and mammography for those deemed at moderate-to-high risk (2002-2004). The questionnaire was based on significant risk factors in a previous epidemiological study, in conjunction with the physical examination programme, a risk score was constructed from the logistic regression coefficients from the previous study, and women with a score above the median in the previous epidemiological study were assigned to mammography. Results: Two-stage mammography screening had the most favourable results compared with the two previous screening regimes. It had a positive predictive value of recall after mammography of 14%, compared with 8% for selective screening and 2% for physical examination. Of screen-detected cancers in the two-stage programme, 71% were either ductal carcinoma in situ or stage T1, compared with 61% for selective screening and 60% for physical examination. The area under the receiver operating characteristic curve was 71% for the two-stage programme. Conclusions: For a low- to medium-risk country such as Taiwan, two-stage screening has acceptable parameters of recall and cancer detection, and compares well with other screening strategies.

AB - Background: Few studies have been published regarding the practice of breast cancer screening in Asian countries. Aims: The present study illustrates how the health policy for breast cancer screening has evolved in Taiwan from selective mammographic screening within a high-risk group, firstly to a programme of physical examination by public health nurses, and finally to a two-stage breast cancer screening programme, with a risk assessment followed by mammography for those at moderate to high risk. Data sources: Breast cancer screening has evolved from 1995 to 2004 in Taiwan in three stages: (1) selective screening for breast cancer with mammography, ultrasound and physical examination only in first-degree relatives of breast cancer cases (1995-1998); (2) a programme of mass screening (1999-2001) with physical examination by public health nurses; and (3) two-stage breast cancer screening with a risk factor questionnaire and mammography for those deemed at moderate-to-high risk (2002-2004). The questionnaire was based on significant risk factors in a previous epidemiological study, in conjunction with the physical examination programme, a risk score was constructed from the logistic regression coefficients from the previous study, and women with a score above the median in the previous epidemiological study were assigned to mammography. Results: Two-stage mammography screening had the most favourable results compared with the two previous screening regimes. It had a positive predictive value of recall after mammography of 14%, compared with 8% for selective screening and 2% for physical examination. Of screen-detected cancers in the two-stage programme, 71% were either ductal carcinoma in situ or stage T1, compared with 61% for selective screening and 60% for physical examination. The area under the receiver operating characteristic curve was 71% for the two-stage programme. Conclusions: For a low- to medium-risk country such as Taiwan, two-stage screening has acceptable parameters of recall and cancer detection, and compares well with other screening strategies.

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