Adiposity changes after a 1-year aerobic exercise intervention among postmenopausal women: a randomized controlled trial

Objective:

We examined the effects of an aerobic exercise intervention on adiposity outcomes that may be involved in the association between physical activity and breast cancer risk.

Design:

This study was a two-centre, two-armed, randomized controlled trial. The 1-year-long exercise intervention included 45 min of moderate-to-vigorous aerobic exercise five times per week, with at least three of the sessions being facility based. The control group was asked not to change their activity and both groups were asked not to change their diet.

Subjects:

A total of 320 postmenopausal, sedentary, normal weight-to-obese women aged 50–74 years who were cancer-free, nondiabetic and nonhormone replacement therapy users were included in this study.

Measurements:

Anthropometric measurements of height, weight and waist and hip circumferences; dual energy X-ray absorptiometry measurements of total body fat; and computerized tomography measurements of abdominal adiposity were carried out.

Results:

Women in the exercise group exercised a mean of 3.6 days (s.d.=1.3) per week and 178.5 min (s.d.=76.1) per week. Changes in all measures of adiposity favored exercisers relative to controls (P<0.001). The mean difference between groups was: −1.8 kg for body weight; −2.0 kg for total body fat; −14.9 cm² for intra-abdominal fat area; and −24.1 cm² for subcutaneous abdominal fat area. A linear trend of greater body fat loss with increasing volume of exercise was also observed.

Conclusion:

A 1-year aerobic exercise program consistent with current public health guidelines resulted in reduced adiposity levels in previously sedentary postmenopausal women at higher risk of breast cancer.

A comparative study of the effective radiation doses from cone beam computed tomography and plain radiography for sialography

OBJECTIVES

As a first step in developing a protocol for multidimensional sialography using cone beam CT (CBCT), the objective of this study was to compare the effective radiation doses from sialography of the parotid and submandibular glands using plain radiography and CBCT.

METHODS

The effective doses were calculated from dose measurements made at 25 selected locations in the head and neck of a radiation analogue dosimeter (RANDO) phantom, using International Commission on Radiological Protection 2007 tissue weighting factors.

RESULTS

The effective dose (E) changed in relationship to changes in CBCT field of view (FOV), peak kilovoltage (kVp) and milliamperage (mA). Specifically, E decreased from a maximum of 932 microSv (30 cm FOV, 120 kVp, 15 mA) to 60 microSv (15 cm FOV, 80 kVp, 10 mA) for a parotid gland study and to 148 microSv (15 cm FOV, 80 kVp, 10 mA) for a submandibular study. The collective series of plain radiographs made during sialography of the parotid and submandibular glands yielded effective doses of 65 microSv and 156 microSv, respectively. The plain parotid gland series included one panoramic, two anterior-posterior skull and four lateral skull radiographs, whereas the submandibular gland series included one panoramic, one standard mandibular occlusal and four lateral skull radiographs.

CONCLUSION

The effective doses from CBCT examinations centred on the parotid and submandibular glands were similar to those calculated for plain radiograph sialography when a 15 cm FOV was chosen in combination with exposure conditions of 80 kVp and 10 mA.

Validation of a method for measuring the volumetric breast density from digital mammograms

The purpose of this study was to evaluate the performance of an algorithm used to measure the volumetric breast density (VBD) from digital mammograms. The algorithm is based on the calibration of the detector signal versus the thickness and composition of breast-equivalent phantoms. The baseline error in the density from the algorithm was found to be 1.25 +/- 2.3% VBD units (PVBD) when tested against a set of calibration phantoms, of thicknesses 3-8 cm, with compositions equivalent to fibroglandular content (breast density) between 0% and 100% and under x-ray beams between 26 kVp and 32 kVp with a Rh/Rh anode/filter. The algorithm was also tested against images from a dedicated breast computed tomography (CT) scanner acquired on 26 volunteers. The CT images were segmented into regions representing adipose, fibroglandular and skin tissues, and then deformed using a finite-element algorithm to simulate the effects of compression in mammography. The mean volume, VBD and thickness of the compressed breast for these deformed images were respectively 558 cm(3), 23.6% and 62 mm. The displaced CT images were then used to generate simulated digital mammograms, considering the effects of the polychromatic x-ray spectrum, the primary and scattered energy transmitted through the breast, the anti-scatter grid and the detector efficiency. The simulated mammograms were analyzed with the VBD algorithm and compared with the deformed CT volumes. With the Rh/Rh anode filter, the root mean square difference between the VBD from CT and from the algorithm was 2.6 PVBD, and a linear regression between the two gave a slope of 0.992 with an intercept of -1.4 PVBD and a correlation with R(2) = 0.963. The results with the Mo/Mo and Mo/Rh anode/filter were similar.

The myth of the 50-50 breast

PURPOSE

For dosimetry and for work in optimization of x-ray imaging of the breast, it is commonly assumed that the breast is composed of 50% fibroglandular tissue and 50% fat. The purpose of this study was to assess whether this assumption was realistic.

METHODS

First, data obtained from an experimental breast CT scanner were used to validate an algorithm that measures breast density from digitized film mammograms. Density results obtained from a total of 2831 women, including 191 women receiving CT and from mammograms of 2640 women from three other groups, were then used to estimate breast compositions.

RESULTS

Mean compositions, expressed as percent fibroglandular tissue (including the skin), varied from 13.7% to 25.6% among the groups with an overall mean of 19.3%. The mean compressed breast thickness for the mammograms was 5.9 cm (sigma = 1.6 cm). 80% of the women in our study had volumetric breast density less than 27% and 95% were below 45%.

CONCLUSIONS

Based on the results obtained from the four groups of women in our study, the "50-50" breast is not a representative model of the breast composition.

Professions show different enquiry strategies for elder abuse detection: implications for training and interprofessional care

In a project to develop and validate a tool to assist family physicians' identification of elder abuse, nine prospective questions underwent critique and ranking in focus groups comprised of 31 social workers, doctors, and nurses working with elder abuse. Differing attitudes to the questions were discernible amongst the three professions. The social workers' approach appeared based on need to advocate for clients. Nurses' viewpoints seemed influenced by utilitarian concerns for practicality and directness, desire to respect doctors' time constraints, and discomfort that some physicians' questioning might impose on nursing fields of interest. Physicians' concerns tended to be holistic, tempered by practicality and time management issues. However despite such differences expressed during lengthy group discussions, members of all three professions, when asked to independently rank the top five questions, favorably ranked the same five (though not necessarily in the same order). Since there are known barriers to successful elder abuse enquiry the differences and concerns seen in this study may represent another potential obstacle. Programs that address elder abuse might therefore consider sensitizing trainees to the potential predispositions within their own and their colleagues' professions. This proactive strategy might facilitate interprofessional approaches to elder abuse detection.

Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI)

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.

Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI)

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.

Family physicians' perspectives on care of dementia patients and family caregivers

OBJECTIVE

To identify factors that facilitate or impede family physicians in ambulatory care of patients with dementia and the family caregivers of such patients.

DESIGN

Explanatory qualitative analyses of focus group discussions.

SETTING

Large, medium, and small urban; suburban; and rural family practices from various regions of the province of Quebec.

PARTICIPANTS

Twenty-five family doctors whose practices had at least 75% ambulatory patients; of these patients, an estimated minimum of 20% were 65 years old or older and at least 2% suffered from dementia.

METHOD

Physicians were recruited by telephone to be paid participants in their regions in focus groups studying aspects of dementia care in ambulatory settings. Grounded theory and constant comparative methods were used to explore data from 3 French-speaking focus groups and 1 English-speaking focus group.

MAIN FINDINGS

Physicians were 72% male, had a mean of 21.3 years in practice, and spent about 87% of their professional time in office practice. An estimated 38.7% of their patients were 65 years old or older, and 5.6% of these patients had Alzheimer disease or related dementias. Physicians were comfortable caring for these patients and their family caregivers but thought much of this care should come from support services offered elsewhere. Physicians admitted they had little knowledge of these services and had little interest in acquiring information about them. Government-run, community-based health and social service centres were the "black boxes" to which they referred patients and their caregivers for any form of help. Inconsistencies in the services offered by these centres were noted. CONCLUSION; While family doctors are seeking a more seamless form of interdisciplinary dementia care, a large amount of that care comes from support services about which physicians are not well informed and are not interested in learning.

Bridging the gap: the effectiveness of teaming a stroke coordinator with patient's personal physician on the outcome of stroke

OBJECTIVES

to test the hypothesis as to whether persons newly discharged into the community following an acute stroke and assigned a stroke case manager would experience, compared to usual post-hospital care, better health-related quality of life (HRQL), fewer emergency room visits and less non-elective hospitalisations.

DESIGN

a stratified, balanced, evaluator-blinded, randomised clinical trial.

SETTING

five university-affiliated acute-care hospitals in Montreal, Quebec, Canada.

PARTICIPANTS

persons (n = 190) returning home directly from the acute-care hospital following a first or recurrent stroke with a need for health care supervision post-discharge because of low function, co-morbidity, or isolation.

INTERVENTION

for 6 weeks following hospital discharge a nurse stroke care manager maintained contact with patients through home visits and telephone calls designed to coordinate care with the person's personal physician and link the stroke survivor into community-based stroke services.

MEASUREMENTS

the primary outcome was the Physical Component Summary (PCS) of the Short-Form (SF)-36 survey. A secondary outcome was utilisation of health services. Also measured was the impact of stroke on functioning. Measurements were made at hospital discharge (baseline), following the 6-week intervention and at 6-months post-stroke.

RESULTS

the average age of the participants was 70 years. Discharge was achieved on average 12 days post-stroke and most participants had had a stroke of moderate severity. There were no differences between groups on the primary outcome measure, health services utilisation, or any of the secondary outcome measures.

CONCLUSION

for this population, there was no evidence that this type of passive case management inferred any added benefit in terms of improvement in health-related quality of life or reduction in health services utilisation and stroke impact, than usual post-discharge management.

Whole-specimen histopathology: a method to produce whole-mount breast serial sections for 3-D digital histopathology imaging

AIMS

To develop a method for preparing diagnostic-quality, whole-mount serial sections of breast specimens while preserving 3-D conformation. This required supporting the fresh specimen prior to breadloafing and refining the conventional tissue processing method. The overall goal is to use digital images of whole-specimen histopathology to improve the estimation of extent of disease.

METHODS AND RESULTS

To maintain a 3-D conformation, the specimen is suspended in 3.5% agar at 55 degrees C. The block is sliced at 5-mm intervals. Sectioning is performed after extended fixation in 4% formaldehyde from paraformaldehyde in 0.1 m Millonig's buffer, followed by paraffin processing using a non-routine schedule and extended paraffin infiltration. Whole-mount serial breast sections are produced with features of equal or superior quality to that which can be achieved using conventional methods. The method is compatible with some immunohistochemical stains but requires further optimization for others.

CONCLUSIONS

The technique is currently suitable for research applications. With the reduction in processing time achievable with microwave-assisted processing, there is the potential for its use as a routine clinical method. This tool may improve the accuracy of margin estimates and identification of multifocality in breast cancer; further evaluation is necessary.

Helping family doctors detect vulnerable caregivers after an emergency department visit for an elderly relative: results of a longitudinal study

BACKGROUND

Family doctors have been ascribed a role in monitoring patients and their informal caregivers. Little is known about the factors that might alert physicians to changing circumstances or needs of the caregivers. The study objective was to examine changes in family caregivers' quality of life following an emergency department (ED) visit by an older community-dwelling relative that might cue doctors to subsequent caregiver distress.

METHODS

A longitudinal study with follow-up at 1- and 4-months was conducted in the EDs of 4 hospitals in Montreal, Canada. Caregivers reported on demographics and quality of life (SF-36). Patients reported on demographics and functional disability. Multiple linear regression for repeated measures was used to evaluate changes in caregiver quality of life and factors related to these changes.

RESULTS

159 caregivers (60.5 yrs +/- 15.8%; 73.0% female), including 68 (42.8%) spouses, 60 (37.7%) adult children, and 31 (19.5%) other relatives participated. Following an initial ED visit by older relatives, caregiver general health and physical functioning declined over time, while mental health status improved. Compared to the other relative caregiver group, spouses were at increased risk for decline in general health, mental health, and physical functioning at 1 month, while adult children were at increased risk for decline in physical health at 1 month.

CONCLUSION

Spouses were most at risk for decline in quality of life. Primary care physicians who become aware of an ED visit by an elderly person may be alerted to possible subsequent deterioration in family caregivers, especially spouses.

Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients/family: a descriptive study

BACKGROUND

Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants.

METHODS

An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared.

RESULTS

101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined.

CONCLUSION

Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.

Morbidity and mortality audits: "How to"for family practice

PROBLEM BEING ADDRESSED

While professions hold their members responsible for self-regulation, many physicians have insufficient information about outcome measures in their practices to judge performance and are inexperienced in performing audits to gather the information they need to judge performance.

OBJECTIVE OF PROGRAM

To develop a structure and process to support family doctors with little experience in doing quality improvement studies to conduct morbidity and mortality (M&M) audits.

PROGRAM DESCRIPTION

A family medicine teaching group provides members on a rotating basis to an M&M review committee. The committee meets eight times a year and has done four audits, the most comprehensive on the topic of preventable hospital admissions. Both implicit and explicit criteria were incorporated into decision making. Strengths and limitations of the audit process and practice changes that resulted from the audit are discussed.

CONCLUSION

Morbidity and mortality audits can vary in rigour. To promote physicians' interest in and commitment to audits, factors considered should reflect the goals, needs, skills, and time available of the physicians involved. Practical learning often results from simple projects.

Depression in frail elders: impact on family caregivers

OBJECTIVES

To examine the relationship between depression among medically ill, frail elders and family caregivers' hours of care, health status, and quality of life.

DESIGN AND METHODS

A cross-sectional study of 193 family caregivers of seniors treated in the emergency department (ED) was conducted. Measures included patient depression (Geriatric Depression Scale-15), and caregivers' hours of care, mental health and physical functioning (SF-36), and quality of life (EQ-5D).

RESULTS

Mean caregiver age was 60.0 +/- 16.1 years and 70.5% were female. More caregivers of depressed seniors provided more care in the previous month (37.3% vs 22.4%, p = 0.03), had poor mental health (63.5% vs 47.0%, p = 0.03), and poor perceived quality of life (63.5% vs 50.4%, p = 0.04) compared to caregivers of non-depressed seniors. Multiple logistic regression analyses indicated that patient depression was associated with poor caregiver quality of life (OR = 3.15, 95% CI 1.48, 6.73), and poor mental health in spousal and adult child caregivers (OR = 2.72, 95% CI = 0.88, 8.39, and OR = 3.29, 95% CI = 1.10, 9.86, respectively).

CONCLUSIONS

Psychosocial support may be needed for caregivers of depressed seniors.

Toward a model of quality of life for family caregivers of stroke survivors

The important role of family caregivers in maintaining their disabled and elderly members in the community is becoming increasingly recognized. Caregiver research, for the most part, has explored burden and emotional distress as outcomes of the caregiving experience. Although there is a growing consensus among health-care researchers concerning the importance of quality of life (QoL) as an outcome, there is little research examining QoL of family caregivers. The purpose of this paper, therefore, was to construct a conceptual framework from which to study the QoL of family caregivers of stroke survivors. Findings from a review of studies addressing the QoL of these caregivers guided the development of the model. The components of the model include the caregiving situation, characteristics of the caregiver, and environmental factors, and their proposed relationships with QoL. This model provides a framework for investigating how the caregiving experience impacts on the caregiver's QoL.

Physician perspectives on the elderly patient-family caregiver-physician encounter

BACKGROUND

Eldercare often necessitates the presence of a family caregiver at the senior's visit to a doctor's office. Studies indicate that some caregivers are not satisfied with these encounters or with their outcomes. An understanding of the dynamics of these complex interactions is required.

OBJECTIVES

To explore family physicians' attitudes to interfacing with family caregivers of the elderly, to identify factors within the family doctor-elderly patient-caregiver encounters in the office setting that might be problematic for physicians, to ascertain factors that might contribute to doctors' behaviors and concerns, and to propose possible solutions for optimizing the outcomes of these visits.

METHOD

A questionnaire for self-administration was mailed to 200 family physicians in Montreal, Canada who are affiliated with two community secondary care and one tertiary care hospital and involved in geriatric office practice. The survey focused on family physician attitudes, concerns and observations on the interactions among themselves, elderly patients and their family caregivers during office visits.

RESULTS

A total of 142 completed questionnaires were returned with a 71% response rate. Most family doctors felt that it was their responsibility to respond to caregiver concerns (90.6%) and that they were generally meeting their needs (94.2%). In contrast, 81% found this activity stressful and that as few as three such encounters per day were sufficient to generate stress. Causes of stress included: a) concern regarding misdiagnosis, b) different agendas or conflicting responses of patient and caregiver to doctors' suggestions, and c) reluctance of the elderly or the caregiver to use community resources. A common physician strategy was reliance on acquired professional experience to solving problems of the elderly or of their caregivers.

CONCLUSIONS

Despite the stress involved, physicians are interested in assisting caregivers in the management of the elderly. Many doctors lack adequate knowledge about or confidence in community resources. Clinicians may require enhanced skills in conflict resolution necessary to achieve optimal outcomes.

Comparison of image quality indicators among mammography facilities in Ontario

OBJECTIVE

To compare the technical aspects of image quality of mammography machines in facilities across Ontario.

METHODS

Eight mammographic physics consultants took measurements and calculated accreditation phantom scores, mean glandular dose, entrance exposure, average optical density, half value layer and the limiting resolution of the imaging chain for 100 mammography machines across Ontario.

RESULTS

Of the 100 machines, 39 were affiliated with the Ontario Breast Screening Program (OBSP), and the remaining 61 were applying to become OBSP affiliates. All of the OBSP facilities and 32 of the applicants were accredited with the Mammography Accreditation Program (MAP) of the Canadian Association of Radiologists (CAR). All OBSP facilities had passing phantom scores, and 84% of the applicants with CAR accreditation and 79% of those without had passing phantom scores. The mean glandular dose was 1.5 (range 1.0-1.9, standard deviation [SD] 0.22) mGy for OBSP facilities, 1.3 (0.8-1.8, SD 0.29) mGy for CAR accredited and 1.4 (0.9-1.9, SD 0.24) mGy for nonaccredited applicants. Mean entrance exposures were 798 (540-1280, SD 135) mR, 717 (430-980, SD 153) mR and 770 (520-930, SD 116) mR for the OBSP, accredited and nonaccredited facilities respectively. There were no appreciable differences in the mean optical densities (approx. 1.62 OD), mean half-value layers (approx. 0.34 mm Al) or mean resolutions measured with the large focal spot (nominal size of 0.3 mm) either parallel (approx. 16 line pairs/mm) or perpendicular (approx. 14 line pairs/mm) to the cathode-anode axis of the x-ray tube, among the 3 types of facilities.

CONCLUSION

Image quality is increased and variability is decreased in facilities participating in a province-wide screening program.

Relationship between phantom failure rates and radiation dose in mammography accreditation

The American College of Radiology Mammography Accreditation Program (ACR MAP) reviews both clinical mammograms and a phantom image to assess clinical and technical quality from each mammography unit. The phantom contains details representing fibers (speculations), speck groups (microcalcifications), and masses. The depiction of these structures by the mammographic system is scored by medical physicists. The phantom image is taken using the facility's exposure technique for a 4.2-cm thick breast of average composition. The mean glandular dose (MGD) is determined from a set of thermoluminescent dosimeters placed on top of the chest wall edge of the phantom. Phantom scores and MGD data collected from 1993 to 1999 based on 31 535 unit evaluations are presented in this paper. The relationship between the failure rate for phantom image quality and MGD has been analyzed. While over all doses the phantom failure rate was 11%, for doses of 0.26 to 0.50 mGy the failure rate was 43%. The phantom failure rate fell continuously to about 6% for MGDs in the range of 1.51-2.0 mGy. With further increases in dose, failure rates began to rise. Factors that may account for these results are presented and discussed.

Better care and better teaching. New model of postpartum care for early discharge programs

PROBLEM BEING ADDRESSED

Rapid postpartum discharge has reduced opportunities to detect early newborn or parenting problems and to teach neonatal assessment and maternal postpartum care to medical trainees.

OBJECTIVE OF PROGRAM

Development of a program to not only ensure adequate care of mothers and newborns after early hospital discharge, but also to teach outpatient assessment skills to family medicine residents.

MAIN COMPONENTS OF PROGRAM

In an urban, secondary care, university-affiliated teaching hospital predominantly training family medicine residents, an interdisciplinary committee created and supervised a neonatal and maternal postpartum assessment program. Newborn infants and their mothers are seen by a family physician, a family medicine resident, and a nurse within 48 hours of discharge, after which care is assumed in the community by the child's primary care physician. An assessment protocol developed by the interdisciplinary group promotes standardized mother and child care and a structured learning experience for trainees.

CONCLUSION

Rapid follow up of early discharged infants and their mothers can be facilitated by a program of standardized assessment by a roster of pooled, interacting family physicians and nurses. When this assessment occurs in a teaching milieu, a comprehensive learning experience can be combined with defined objectives that emphasize and encourage newborn and maternal assessment for ambulatory patients.

Comparison of breast magnetic resonance imaging, mammography, and ultrasound for surveillance of women at high risk for hereditary breast cancer

PURPOSE

Recommended surveillance for BRCA1 and BRCA2 mutation carriers includes regular mammography and clinical breast examination, although the effectiveness of these screening techniques in mutation carriers has not been established. The purpose of the present study was to compare breast magnetic resonance imaging (MRI) with ultrasound, mammography, and physical examination in women at high risk for hereditary breast cancer.

PATIENTS AND METHODS

A total of 196 women, aged 26 to 59 years, with proven BRCA1 or BRCA2 mutations or strong family histories of breast or ovarian cancer underwent mammography, ultrasound, MRI, and clinical breast examination on a single day. A biopsy was performed when any of the four investigations was judged to be suspicious for malignancy.

RESULTS

Six invasive breast cancers and one noninvasive breast cancer were detected among the 196 high-risk women. Five of the invasive cancers occurred in mutation carriers, and the sixth occurred in a woman with a previous history of breast cancer. The prevalence of invasive or noninvasive breast cancer in the 96 mutation carriers was 6.2%. All six invasive cancers were detected by MRI, all were 1.0 cm or less in diameter, and all were node-negative. In contrast, only three invasive cancers were detected by ultrasound, two by mammography, and two by physical examination. The addition of MRI to the more commonly available triad of mammography, ultrasound, and breast examination identified two additional invasive breast cancers that would otherwise have been missed.

CONCLUSION

Breast MRI may be superior to mammography and ultrasound for the screening of women at high risk for hereditary breast cancer.