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Vol. 34. Issue 4.
Pages 177-184 (July - August 2019)
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Vol. 34. Issue 4.
Pages 177-184 (July - August 2019)
Original Article
DOI: 10.1016/j.jhqr.2019.02.007
Dissemination of health technologies: Trends in the use of diagnostic test in breast cancer screening
Difusión de tecnologías sanitarias: tendencias en el uso de pruebas de confirmación diagnóstica en los programas de cribado poblacional de cáncer de mama
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C. Natala,
Corresponding author
carmen.natal@sespa.es

Corresponding author.
, A. Fernandez-Somoanob, I. Torá-Rocamorac, C. Vidald, X. Castellsc, A. Tardóne, on behalf of Benign Lesion Study Group
a Hospital Universitario Central de Asturias, Principality of Asturias Health Service, Spain
b Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), University of Oviedo, Spain
c Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute) and Research Network on Health Services in Chronic Diseases (REDISSEC), Spain
d Cancer Prevention and Monitoring Programme, Catalan Institute of Oncology, Spain
e Department of Preventive Medicine and Public Health, University of Oviedo, Asturias, Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
Benign Lesion Study Group
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Figures (1)
Tables (3)
Table 1. Cohort of screened women with description of diagnosis workup and detected lesions. Absolute numbers and rate per 1000 screening examinations (1996–2011).
Table 2. Age adjusted rates of diagnostic workup and lesions detected per 1000 breast screening examinations and 95% CI (1996–2011).
Table 3. Annual percent change (APC) of each diagnostic test rates and detection rates.
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Abstract
Objective

To analyse trends in the use of diagnostic test in breast cancer screening programs in Spain.

Materials and methods

Retrospective study of 542,695 women who had undergone at least one screening mammogram in any of the screening centres of three administrative regions in Spain, between 1996 and 2011. Process measures were: overall recall rate, overall invasive test rate, and rates of each type of invasive test (fine-needle aspiration biopsy, core-needle biopsy and surgical biopsy). As results measures were included detection of benign lesions rate, ductal in situ cancer rate and invasive cancer rate. Adjusted by age rates were estimated year by year for each measure and, also, the annual percent of change and its corresponding joint points.

Results

Core-needle biopsy rates decreased between 1996 and 1999 and changed trends in 1999–2011 with an increase of 4.9% per year. Overall recall rate declined by 4.6% from 1999 to 2004, invasive test rate declined between 1996 and 2004 by 24.3%. Fine-needle aspiration biopsy rate changes were: a 22.4% declined per year (1996–1998), and 13.5% declined per year (1998–2005). Benign lesions rate decreased from 1996 to 2011, 21.4% per year (1996–2001) and 6.0% (2001–2011). Ductal carcinoma in situ and invasive cancer had no-statistically significant changes.

Conclusion

The introduction of core-needle biopsy was slow and not concurrent with the reduction in the use of other diagnostic tests, but also represented a reduction in the rate of overall diagnostic tests and in the detection rate of benigns lesions without affecting the cancer detection rates.

Keywords:
Breast cancer
Cancer screening
Health services research
Diffusion of innovation
Health technology
Large-core needle biopsy
Resumen
Objetivo

Analizar tendencias en el uso de pruebas diagnósticas en los programas poblacionales de cribado del cáncer de mama en España.

Materiales y métodos

Estudio retrospectivo de 542.695 mujeres que habían sido sometidas al menos a una mamografía de cribado en tres regiones administrativas en España, entre los años 1996 y 2011. Medidas de proceso: tasa de recitación, tasa de realización de pruebas invasivas y tasas de cada tipo de prueba invasiva (punción-aspiración con aguja fina, biopsia con aguja gruesa y biopsia quirúrgica).

Medidas de resultado

tasa de detección de lesiones benignas, carcinoma ductal in situ y cáncer invasivo. Se estimaron tasas ajustadas por edad, porcentaje anual de cambio y sus correspondientes puntos de inflexión.

Resultados

La tasa de realización de biopsia con aguja gruesa disminuyó entre 1996 y 1999, y posteriormente aumentó un 4,9% por año. La tasa de recitación disminuyó un 4,6% (1999 y 2004), la tasa de realización de pruebas invasivas disminuyó un 24,3% (1996 y 2004). Las tasas de punción-aspiración con aguja fina disminuyeron un 22,4% por año (1996-1998) y un 13,5% (1998-2005). La tasa de detección de lesiones benignas disminuyó de 1996 a 2011: 21,4% por año (1996-2001) y 6,0% (2001-2011). Las tasas de detección de cáncer no se modificaron.

Conclusión

La introducción de la biopsia con aguja gruesa fue lenta y no concurrente con el uso de otras pruebas diagnósticas, aunque sí hubo una reducción en la utilización de las mismas y de la tasa de detección de lesiones benignas, sin afectar la detección de cáncer.

Palabras clave:
Cáncer de mama
Cribado de cáncer de mama
Evaluación de servicios sanitarios
Difusión de la innovación
Tecnologías sanitarias
Biopsia con aguja gruesa

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