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Breast screening atypia and subsequent development of cancer: protocol for an observational analysis of the Sloane database in England (Sloane atypia cohort study)

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David Jenkinson, Karoline Freeman, Karen Clements, Bridget Hilton, Joanne Dulson-Cox, Olive Kearins, Nigel Stallard, Matthew G Wallis, Nisha Sharma, Cliona Kirwan, Sarah Pinder, Elena Provenzano, Abeer M Shaaban, Hilary Stobart, Samantha McDonnell, Alastair M Thompson, Sian Taylor-Phillips

Original languageEnglish
Article numbere058050
Pages (from-to)e058050
JournalBMJ Open
Issue number1
Accepted/In press9 Nov 2021
Published7 Jan 2022

Bibliographical note

Funding Information: Funding This study is funded by the NIHR Research for Patient Benefit Call (RfPB) (NIHR202220). At the time of writing, the Sloane Project work is undertaken within the Screening QA Service at NHS England and NHS Improvement. The Sloane Project has received funding since the work commenced in 2002 from the following: NHS Breast Screening Programme (via Public Health England April 2013 to September 2021, previously NHS 2002–2013), Breast Cancer Research Trust (2-year project grant 2008-2009), Pfizer (3-year unrestricted educational grant 2005–2007), Ad hoc fundraising events and private donations. The funders have not had any involvement in the study design, in the data collection, in the writing of the manuscript or in the decision to submit the manuscript for publication. Funding Information: Competing interests All authors have completed the ICMJE uniform disclosure form at ICMJE | Disclosure of Interest and declare: DJ, KF, ST-P, NSt, NSh and SP receive funding from the NIHR Research for Patient Benefit Call (RfPB) for the conduct of this study. ST-P is funded by the NIHR through a career development fellowship (NIHR-CDF-2016-09-018). EP received a speaker’s honoraria and travel costs from Roche to speak at an advisory group meeting. EP participates as a IPB advisor at advisory group meetings. KC is funded as part of the Cancer Grand Challenges PRECISION team which is funded by Cancer Research UK and the Dutch Cancer Society. HS received travel and support to attend meetings of CRUK Grand Challenge Precision. SP is a member of the PRECISION Consortium, a recipient of a Cancer Research UK Grand Challenge Award, jointly funded by Cancer Research UK and the Dutch Cancer Society (KWF). AMS has participated in Advisory Boards for Exact Sciences and Veracyte. BH, SM, MGW, OK, JD-C, CK and AMT have nothing to declare. Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.


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    Uploaded date:13 Jan 2022

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King's Authors


Introduction: The National Health Service (NHS) Breast Screening Programme aims to detect cancer earlier when treatment is more effective but can harm women by over diagnosing and overtreating cancers which would never have become symptomatic. As well as breast cancer, a spectrum of atypical epithelial proliferations (atypia) can also be detected as part of screening. This spectrum of changes, while not cancer, may mean that a woman is more likely to develop breast cancer in the future. Follow-up of atypia is not evidence based. We currently do not know which atypia should be detected to avoid future cancer. This study will explore how atypia develops into breast cancer in terms of number of women, time of cancer development, cancer type and severity, and whether this varies for different types of atypia. Methods and analysis: The Sloane cohort study began in April 2003 with ongoing data collection including atypia diagnosed through screening at screening units in the UK. The database for England has 3645 cases (24 September 2020) of epithelial atypia, with follow-up from 1 to 15 years. The outcomes include subsequent invasive breast cancer and the nature of subsequent cancer. Descriptive statistics will be produced. The observed rates of breast cancer at 1, 3 and 6 years for types of atypia will be reported with CIs, to enable comparison to women in the general population. Time to event methods will be used to describe the time to breast cancer diagnosis for the types of atypia, including flexible parametric modelling if appropriate. Patient representatives from Independent Cancer Patients’ Voice are included at every stage of the research. Ethics and dissemination: The study has received research ethics approval from the University of Warwick Biomedical and Scientific Research Ethics Committee (BSREC 10/20–21, 8 October 2020), Public Health England office for data release approvals (ODR1718_313) and approval from the English Breast Research Advisory Committee (BSPRAC_031). The findings will be disseminated to breast screening clinicians (via journal publication and conference presentation), to the NHS Breast Screening Programme to update their guidelines on how women with atypia should be followed up, and to the general public.

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