Cancer Res Treat.  2023 Jan;55(1):136-144. 10.4143/crt.2021.962.

Estimating Age-Specific Mean Sojourn Time of Breast Cancer and Sensitivity of Mammographic Screening by Breast Density among Korean Women

Affiliations
  • 1Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
  • 2National Cancer Control Institute, National Cancer Center, Goyang, Korea
  • 3Center for Breast Cancer, National Cancer Center, Goyang, Korea
  • 4Graduate School of Public Health, Yonsei University, Seoul, Korea

Abstract

Purpose
High breast cancer incidence and dense breast prevalence among women in forties are specific to Asian. This study examined the natural history of breast cancer among Korean women.
Materials and Methods
We applied a three-state Markov model (i.e., healthy, preclinical, and clinical state) to fit the natural history of breast cancer to data in the Korean National Cancer Screening Program. Breast cancer was ascertained by linkage to the Korean Central Cancer Registry. Disease-progression rates (i.e., transition rates between three states), mean sojourn time (MST) and mammographic sensitivity were estimated across 10-year age groups and levels of breast density determined by the Breast Imaging, Reporting and Data System.
Results
Overall prevalence of dense breast was 53.9%. Transition rate from healthy to preclinical state, indicating the preclinical incidence of breast cancer, was higher among women in forties (0.0019; 95% confidence interval [CI], 0.0017 to 0.0021) and fifties (0.0020; 95% CI, 0.0017 to 0.0022), than women in sixties (0.0014; 95% CI, 0.0012 to 0.0017). The MSTs, in which the tumor is asymptomatic but detectable by screening, were also fastest among younger age groups, estimated as 1.98 years (95% CI, 1.67 to 2.33), 2.49 years (95% CI, 1.92 to 3.22), and 3.07 years (95% CI, 2.11 to 4.46) for women in forties, fifties, and sixties, respectively. Having dense breasts increased the likelihood of the preclinical cancer risk (1.96 to 2.35 times) and decreased the duration of MST (1.53 to 2.02 times).
Conclusion
This study estimated Korean-specific natural history parameters of breast cancer that would be utilized for establishing optimal screening strategies in countries with higher dense breast prevalence.

Keyword

Breast density; Mammography; Natural history; Mean sojourn time; Screening sensitivity

Figure

  • Fig. 1 A three-state Markov model of natural history of breast cancer and effects of breast density.

  • Fig. 2 Cumulative incidence of breast cancer by breast density levels. Cumulative incidence of invasive breast cancer (A) and in situ breast cancer (B) from the time of cohort enrollment.


Reference

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