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Niroshani HS, Jeyasugiththan J, Senanayake G, Negishi T. Establishment of regional diagnostic reference levels for digital mammography in Western Province of Sri Lanka. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:79-96. [PMID: 33271512 DOI: 10.1088/1361-6498/abd075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
The radiation dose to the breasts should be kept to a minimum as breast tissues are highly sensitive to radiation. In mammography, the mean glandular dose (MGD) is used to specify the patient dose. In this study, data on the MGD during diagnostic mammographic examinations was collected using the database from six digital mammography facilities available in the Western Province in Sri Lanka. Examinations involving breast pathology, breast implants, or compressed breast thicknesses (CBT) outside the range of 20-110 mm were excluded in this study. The mean MGD per breast was 3.50 mGy, with a mean CBT of 57 mm. The mean MGD per facility varies from 1.58 to 2.27 mGy, with overall 75th and 95th percentiles of 2.15 and 2.82 mGy, respectively. The 75th and 95th percentile MGD per image, for the average CBT of 57 ± 12 mm, were 2.00 and 2.65 mGy respectively. The 75th percentile value of the MGD is suggested for the Western Province and it depends on the specific CBT.
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Affiliation(s)
- H S Niroshani
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
- Department of Radiography & Radiotherapy, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
- Department of Radiological Sciences, Graduate school of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | | | - G Senanayake
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
| | - Toru Negishi
- Department of Radiological Sciences, Graduate school of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Silver EH, Shulman SD, Rehani MM. Innovative monochromatic x-ray source for high-quality and low-dose medical imaging. Med Phys 2021; 48:1064-1078. [PMID: 33368354 DOI: 10.1002/mp.14677] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE An estimated 377 million diagnostic and interventional radiological exams are performed annually in the United States and approximately 4 to 5 billion globally. All use x-ray tubes that emit x-rays over a broad energy band, a technology that is more than a century old. Only a small fraction of the radiation is useful for imaging while the remaining fraction either increases the radiation dose received by the patient or degrades the image. Monochromatic x-rays can provide lower dose images in many of these radiological applications while maintaining or improving image quality. We report the development of the first monochromatic x-ray source suitable for low-dose, high-quality imaging in the clinic and demonstrate its first application and performance with mammography phantoms. METHODS X-ray fluorescence was used to generate monochromatic x-rays with selectable energies from 18 to 60 keV. This patented technology was incorporated into a laboratory prototype of a monochromatic x-ray mammography system. Image quality was evaluated as a function of radiation dose in standard breast phantoms using the signal-to-noise ratio (SNR) measured for high and low contrast masses and microcalcifications. Spatial imaging properties were assessed from these images as well as from modulation transfer function (MTF) analysis. Measurements using an iodine contrast agent were also performed. The results were compared to those obtained using a commercially available, conventional x-ray mammography system. RESULTS Our prototype system reduced radiation dose by factors of five to ten times for the same SNRs as obtained from the conventional system. This performance was demonstrated in phantoms simulating a wide range of lesion sizes and microcalcifications in a variety of breast thicknesses. The high SNRs for very thick breast phantoms provide evidence that screening with less breast compression is possible while maintaining image quality. Contrast-enhanced digital mammography (CEDM) with monochromatic x-rays was shown to provide a simpler and more effective technique at substantially lower radiation dose. The MTF value at 20% was 9 lp/mm. CONCLUSIONS The monochromatic x-ray system is more sensitive for imaging a wide range of breast sizes and compositions than conventional broadband mammography. High image quality and lower dose are its hallmarks. It also makes CEDM much more effective than current methods developed for use with conventional broadband mammography systems.
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Affiliation(s)
- Eric H Silver
- Imagine Scientific, Inc., 90 Kerry Place, Norwood, MA, 02062, USA
| | - Seth D Shulman
- Imagine Scientific, Inc., 90 Kerry Place, Norwood, MA, 02062, USA
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Aglan SA, Elsammak M, Elsammak O, El-Bakoury EA, Elsheredy HG, Ahmed YS, Sultan MH, Awad AM. Evaluation of serum Nestin and HOTAIR rs12826786 C>T polymorphism as screening tools for breast cancer in Egyptian women. J Med Biochem 2021; 40:17-25. [PMID: 33584136 PMCID: PMC7857851 DOI: 10.5937/jomb0-25295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nestin is a neural stem cell protein that plays an important role in cancer stem cells (CSC) development and proliferation. It has been identified as a marker for newly formed endothelial cells and was shown to be preferentially expressed in basal and myoepithelial cells of the mammary gland. HOTAIR is long intergenic non-coding (linRNA) associated with tumorigenesis through promotion of epithelial-mesenchymal transition (EMT) and stemness as well. HOTAIR gene contains a functioning single nucleotide polymorphic site rs12826786 C>T that has been associated with several cancer types. METHODS We evaluated serum Nestin and the HOTAIR rs12826786 C>T polymorphism in healthy Egyptian women and those with breast cancer as a possible screening tool to identify patients with breast cancer. Also, we tested the possible association of the two markers with each other and the aggressiveness of the disease. RESULTS Patients with breast cancer had a median (Min-Max) of serum Nestin 31.3 (6.7-167.3 pg/mL), while control subjects had a median (Min-Max) of serum Nestin 42.3 (25.7-315.95) pg/mL. The best cut-off value for serum Nestin to differentiate normal subjects and patients with breast cancer was 39.9 pg/mL. This cut-off value had a diagnostic sensitivity of 84.8% and specificity of 65.1%. There was a significant difference in the distribution of different alleles in patients with breast cancer than normal subjects (P=0.039 Exact Fisher test). The breast cancer patients group had 23.9% CC, 52.1% CT, and 23.9% TT genotypes, respectively, while the control group had 46.9% CC, 42.8% CT, and 10.2% TT, respectively. CONCLUSIONS A significantly low serum Nestin below 39.9 pg/mL and a higher percentage of the T/T homozygous variant allele of HOTAIR rs12826786 C>T were found in Egyptian patients with breast cancer. We suggest that the reported cut-off value of serum Nestin and the presence of C/T polymorphism can be used to assess the risk of females for developing breast cancer and might be of potential benefit in screening the disease. Larger studies in different ethnic groups are needed to confirm our findings.
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Affiliation(s)
- Sarah A. Aglan
- Alexandria University, Medical Research Institute, Department of Chemical Pathology, Egypt
| | - Mohamed Elsammak
- Alexandria University, Medical Research Institute, Department of Chemical Pathology, Egypt
| | | | - Eman A. El-Bakoury
- Alexandria University, Medical Research Institute, Department of Radio-diagnosis, Egypt
| | - Heba G. Elsheredy
- Alexandria University, Medical Research Institute, Department of Cancer Management and Research, Alexandria, Egypt
| | - Yasser S. Ahmed
- Alexandria University, Medical Research Institute, Department of Experimental and Clinical Surgery, Alexandria, Egypt
| | - Mohamed H. Sultan
- Alexandria University, Medical Research Institute, Department of Experimental and Clinical Surgery, Alexandria, Egypt
| | - Ahmed M. Awad
- Alexandria University, Medical Research Institute, Department of Chemical Pathology, Egypt
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Hooshmand S, Reed WM, Suleiman ME, Brennan PC. Breast-iRRISC: a novel model for predicting the individualised lifetime risk of radiation-induced breast cancer from a single screening event. Br J Radiol 2021; 94:20200734. [PMID: 33031706 DOI: 10.1259/bjr.20200734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This work establishes the prototype of a new innovative risk model that aims to evaluate the total risk involved with screening mammography for each individual female. This has been specifically designed to accommodate any combination of lifetime screening regimes, using only the information gathered from a single mammographic examination. METHODS This model prototype was developed with the aid of a large dataset of images from the Cancer Institute New South Wales (CINSW) with over 30,000 images from over 7000 examinations. Each examination is derived from a separate female. RESULTS This prototype which we have called Breast Individualised Risk of Radiation-Induced Screening Cancer (Breast-iRRISC) is a novel tool for the assessment of the lifetime risk involved with screening mammography. The results demonstrate the applicability of this approach to the various screening regimes utilised around the globe, in addition to the personalised screening frequency patterns females have undergone and are likely to receive in the future. CONCLUSIONS This unique tailored approach to risk assessment will further empower females and clinicians towards a more informed clinical decision process regarding future imaging pathways. It will also inform health policy decisions regarding alternate screening durations and intervals. ADVANCES IN KNOWLEDGE Breast-iRRISC is a novel tool that provides females, clinicians and health policymakers around the globe with the ability to quantify the lifetime risk of radiation-induced breast cancer from screening mammography on an individual level from a single exposure.
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Affiliation(s)
- Sahand Hooshmand
- Faculty of Medicine and Health, The University of Sydney, Cumberland Campus, 75 East St, Lidcombe, Sydney, NSW 2141, Australia
| | - Warren M Reed
- Faculty of Medicine and Health, The University of Sydney, Cumberland Campus, 75 East St, Lidcombe, Sydney, NSW 2141, Australia
| | - Mo'ayyad E Suleiman
- Faculty of Medicine and Health, The University of Sydney, Cumberland Campus, 75 East St, Lidcombe, Sydney, NSW 2141, Australia
| | - Patrick C Brennan
- Faculty of Medicine and Health, The University of Sydney, Cumberland Campus, 75 East St, Lidcombe, Sydney, NSW 2141, Australia
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Abstract
Since its widespread introduction 30 years ago, screening mammography has contributed to substantial reduction in breast cancer-associated mortality, ranging from 15% to 50% in observational trials. It is currently the best examination available for the early diagnosis of breast cancer, when survival and treatment options are most favorable. However, like all medical tests and procedures, screening mammography has associated risks, including overdiagnosis and overtreatment, false-positive examinations, false-positive biopsies, and radiation exposure. Women should be aware of the benefits and risks of screening mammography in order to make the most appropriate care decisions for themselves.
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Affiliation(s)
- Colleen H Neal
- Department of Radiology, Breast Imaging Division, University of Michigan, Ann Arbor, MI, USA.
| | - Mark A Helvie
- Department of Radiology, Breast Imaging Division, University of Michigan, Ann Arbor, MI, USA
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S VS, Royea R, Buckman KJ, Benardis M, Holmes J, Fletcher RL, Eyk N, Rajendra Acharya U, Ellenhorn JDI. An introduction to the Cyrcadia Breast Monitor: A wearable breast health monitoring device. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 197:105758. [PMID: 33007593 DOI: 10.1016/j.cmpb.2020.105758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/10/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND The most common breast cancer detection modalities are generally limited by radiation exposure, discomfort, high costs, inter-observer variabilities in image interpretation, and low sensitivity in detecting cancer in dense breast tissue. Therefore, there is a clear need for an affordable and effective adjunct modality that can address these limitations. The Cyrcadia Breast Monitor (CBM) is a non-invasive, non-compressive, and non-radiogenic wearable device developed as an adjunct to current modalities to assist in the detection of breast tissue abnormalities in any type of breast tissue. METHODS The CBM records thermodynamic metabolic data from the breast skin surface over a period of time using two wearable biometric patches consisting of eight sensors each and a data recording device. The acquired multi-dimensional temperature time series data are analyzed to determine the presence of breast tissue abnormalities. The objective of this paper is to present the scientific background of CBM and also to describe the history around the design and development of the technology. RESULTS The results of using the CBM device in the initial clinical studies are also presented. Twenty four-hour long breast skin temperature circadian rhythm data was collected from 93 benign and 108 malignant female study subjects in the initial clinical studies. The predictive model developed using these datasets could differentiate benign and malignant lesions with 78% accuracy, 83.6% sensitivity and 71.5% specificity. A pilot study of 173 female study subjects is underway, in order to validate this predictive model in an independent test population. CONCLUSIONS The results from the initial studies indicate that the CBM may be valuable for breast health monitoring under physician supervision for confirmation of any abnormal changes, potentially prior to other methods, such as, biopsies. Studies are being conducted and planned to validate the technology and also to evaluate its ability as an adjunct breast health monitoring device for identifying abnormalities in difficult-to-diagnose dense breast tissue.
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Affiliation(s)
- Vinitha Sree S
- Cyrcadia Health, 1325 Airmotive Way, Ste. 175-L, Reno, NV 89502, United States; Cyrcadia Asia, Ltd., Hong Kong.
| | | | - Kevin J Buckman
- Cyrcadia Health, 1325 Airmotive Way, Ste. 175-L, Reno, NV 89502, United States; Adventist Health Lodi Memorial Hospital, Lodi, CA 95240, United States
| | - Matt Benardis
- Cyrcadia Health, 1325 Airmotive Way, Ste. 175-L, Reno, NV 89502, United States
| | - Jim Holmes
- Cyrcadia Health, 1325 Airmotive Way, Ste. 175-L, Reno, NV 89502, United States
| | - Ronald L Fletcher
- Cyrcadia Health, 1325 Airmotive Way, Ste. 175-L, Reno, NV 89502, United States
| | - Ng Eyk
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798
| | - U Rajendra Acharya
- School of Engineering, Division of ECE, Ngee Ann Polytechnic, Singapore 599489; Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore; Department of Biomedical Informatics and Medical Engineering, Asia University, Taiwan
| | - Joshua D I Ellenhorn
- Cyrcadia Health, 1325 Airmotive Way, Ste. 175-L, Reno, NV 89502, United States; Cyrcadia Asia, Ltd., Hong Kong; Surgery Group LA, Cedars-Sinai Medical Towers, Los Angeles, CA 90048, United States; John Wayne Cancer Clinics, Santa Monica, CA 90404, United States
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Procz S, Roque G, Avila C, Racedo J, Rueda R, Santos I, Fiederle M. Investigation of CdTe, GaAs, Se and Si as Sensor Materials for Mammography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3766-3778. [PMID: 32746121 DOI: 10.1109/tmi.2020.3004648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the benefits of mammography investigations, some studies have shown that X-ray exposure from the mammography screening itself can statistically cause breast cancer in a small fraction of women. Therefore, a dose reduction in mammography is desirable. At the same time, there is a demand for a higher spatial resolution in mammographic imaging. The most promising way to achieve these goals is the use of advanced photon-processing semiconductor X-ray detectors with optimum sensor materials. This study addresses the investigation of the optimum semiconductor sensor material for mammography in combination with the photon-processing detector Medipix3RX. The influence of K-shell fluorescence from the sensor material on the achievable contrast-to-noise ratio is investigated, as well as the attenuation efficiency. The three different sensor materials, CdTe, GaAs, and Si are studied, showing advances of CdTe-sensors for mammography. Furthermore, a comparison of the contrast-to-noise ratio between a clinical Se-detector and Medipix3RX detectors with Si- and CdTe-sensors is shown using a self-produced mammography phantom that is based on real human tissue.
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Al‐Mousa DS, Alakhras M, Spuur KM, Alewaidat H, Abdelrahman M, Rawashdeh M, Brennan PC. The implications of increased mammographic breast density for breast screening in Jordan. J Med Radiat Sci 2020; 67:277-283. [PMID: 32578380 PMCID: PMC7753846 DOI: 10.1002/jmrs.414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Mammographic breast density is associated with a four to six times increased risk for breast cancer. Mammographic breast density varies by ethnicity, geographical region and age. The aim of this study was to document for the first time the mammographic breast density of Jordanian women and to explore its relationship with age. METHODS Mammograms completed at King Abdullah University Hospital (Irbid, Jordan) between January 2016 and August 2018 were retrospectively reviewed and classified for breast density using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS). Descriptive analyses and Kurskal-Wallis test were used to examine the association between age and mammographic breast density. RESULTS A total of 659 mammograms were reviewed. A significant inverse relationship was observed between age and breast density (P < 0.001). In women aged 40-49 years, 83.2% had dense breasts (ACR BI-RADS (c) and (d)). This percentage decreased to 59.8% of women aged 50-59 years; 38.4% of women in their 60s and 37.9% of women aged 70 years or older (ACR BI-RADS (c) only). CONCLUSION The mammographic breast density of Jordanian women has been shown to be high across all age groups. Increased mammographic breast density is associated with increased breast cancer risk and renders mammography a less effective technique for the early detection of breast cancer. Breast cancer screening of Jordanian women should be individualised to develop screening protocols and include additional adjunct imaging to best manage women at high risk.
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Affiliation(s)
- Dana S. Al‐Mousa
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Maram Alakhras
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Kelly M. Spuur
- School of Dentistry and Health SciencesCharles Sturt UniversityWagga WaggaNSWAustralia
| | - Haytham Alewaidat
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Mostafa Abdelrahman
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Mohammad Rawashdeh
- Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
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Pal UM, Gk AV, Gogoi G, Rila S, Shroff S, Am G, Borah P, Varma M, Kurpad V, Baruah D, Vaidya JS, Pandya HJ. Towards a Portable Platform Integrated With Multispectral Noncontact Probes for Delineating Normal and Breast Cancer Tissue Based on Near-Infrared Spectroscopy. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2020; 14:879-888. [PMID: 32746350 DOI: 10.1109/tbcas.2020.3005971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Currently, the confirmation of diagnosis of breast cancer is made by microscopic examination of an ultra-thin slice of a needle biopsy specimen. This slice is conventionally formalin-fixed and stained with hematoxylin-eosin and visually examined under a light microscope. This process is labor-intensive and requires highly skilled doctors (pathologists). In this paper, we report a novel tool based on near-infrared spectroscopy (Spectral-IRDx) which is a portable, non-contact, and cost-effective system and could provide a rapid and accurate diagnosis of cancer. The Spectral-IRDx tool performs absorption spectroscopy at near-infrared (NIR) wavelengths of 850, 935, and 1060 nm. We measure normalized detected voltage (Vdn) with the tool in 10 deparaffinized breast biopsy tissue samples, 5 of which were cancer (C) and 5 were normal (N) tissues. The difference in Vdn at 935 nm and 1060 nm between cancer and normal tissues is statistically significant with p-values of 0.0038 and 0.0022 respectively. Absorption contrast factor (N/C) of 1.303, 1.551, and 1.45 are observed for 850, 935, and 1060 nm respectively. The volume fraction contrast (N/C) of lipids and collagens are reported as 1.28 and 1.10 respectively. Higher absorption contrast factor (N/C) and volume fraction contrast (N/C) signifies higher concentration of lipids in normal tissues as compared to cancerous tissues, a basis for delineation. These preliminary results support the envisioned concept for noninvasive and noncarcinogenic NIR-based breast cancer diagnostic platform, which will be tested using a larger number of samples.
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60
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Orringer CE, Maki KC. HOPE for Rational Statin Allocation for Primary Prevention: A Coronary Artery Calcium Picture Is Worth 1000 Words. Mayo Clin Proc 2020; 95:1740-1749. [PMID: 32646743 DOI: 10.1016/j.mayocp.2020.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 02/01/2023]
Abstract
Allocation of statin therapy for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) in borderline- and intermediate-risk patients has traditionally been based on population-based global risk assessment and other clinical and laboratory characteristics. Patient-specific treatment decisions are needed to provide maximal benefit and avoid unnecessary treatment. Guideline-based lipid management proposes that coronary artery calcium scoring is reasonable to implement in patients with a 10-year risk of 5.0% to 19.9% (borderline to intermediate risk) by using the pooled cohort equations when the decision about whether to initiate statin therapy is uncertain. We report data from both observational studies and a large primary prevention randomized controlled trial that support the position that this decision is, in fact, uncertain in about half of such patients because of risk misclassification. Such misclassification can be largely avoided by more widespread implementation of coronary calcium scoring, which helps to identify those with coronary artery calcium scores of 0, a finding associated with a less than 5.0% 10-year probability of an ASCVD event. Deferral of statin therapy in such patients, in the absence of smoking, diabetes, or a family history of premature ASCVD, provides more individualized and appropriate care and avoids the expense and potential adverse effects of statin therapy in those with low potential for absolute risk reduction. A rationale is also provided for the importance of coronary artery calcium scoring in women 50 years and older, possibly in place of 1 screening mammogram in women at least 55 years of age to avoid incremental radiation exposure, on the basis of the substantially higher lifetime risk of morbidity and mortality from ASCVD than from breast cancer. In patients with borderline or intermediate ASCVD risk, coronary artery calcium scoring should be used, whenever possible, as an aid to rational statin allocation for the primary prevention of ASCVD.
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Affiliation(s)
- Carl E Orringer
- Cardiovascular Division, Miller School of Medicine, University of Miami, FL.
| | - Kevin C Maki
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, IN
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Joyce S, O'Connor OJ, Maher MM, McEntee MF. Strategies for dose reduction with specific clinical indications during computed tomography. Radiography (Lond) 2020; 26 Suppl 2:S62-S68. [PMID: 32682731 DOI: 10.1016/j.radi.2020.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022]
Abstract
Increasing integration of computed tomography (CT) into routine patient care has escalated concerns regarding associated radiation exposure. Specific patient cohorts, particularly those with cystic fibrosis (CF) and Crohn's disease, have repeat exposures and thus have an increased risk of high lifetime cumulative effective dose exposures. Thoracic CT is the gold standard imaging method in the diagnosis, assessment and management of pulmonary disease. In the setting of CF, CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography. Furthermore, in specific cases of Crohn's disease, CT demonstrates diagnostic superiority over magnetic resonance imaging (MRI) for radiological evaluation. Low dose CT protocols have proven beneficial in the evaluation of CF, Crohn's disease and renal calculi, and in the follow up of testicular cancer patients. For individuals with chronic conditions warranting frequent radiological follow up, the focus must continue to be the incorporation of appropriate CT use into patient care. This is of particular importance for the paediatric population who are most susceptible to potential radiation induced malignancy. CT technological developments continue to focus on radiation dose optimisation. This article aims to highlight these advancements, which prioritise the acquisition of diagnostically satisfactory images with the least amount of radiation possible.
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Affiliation(s)
- S Joyce
- Department of Radiology, University College Cork, Cork, Ireland.
| | - O J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M M Maher
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F McEntee
- Discipline of Diagnostic Radiography, University College Cork, Cork, Ireland
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Breast Cancer Rate and Mortality in Female Flight Attendants: A Systematic Review and Pooled Analysis. Clin Breast Cancer 2020; 20:371-376. [PMID: 32605812 DOI: 10.1016/j.clbc.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/15/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
Previous reports have suggested that breast cancer is more common among flight attendants than that in the general population. Constant exposure to cosmic radiation and circadian disruption are postulated to be the culprits of the problem. A systematic review was performed by 2 independent reviewers with predefined search strategy, in line with the PRISMA protocol. A total of 43 studies were identified using the preset keywords defined in the study protocol. After excluding irrelevant papers, 12 studies were included for pooled analysis. Ten studies evaluated the breast cancer prevalence in flight attendants, whereas 3 studies evaluated the breast cancer-related deaths. Pooled analysis found that, of the 45,111 flight attendants censored, 1061 (2.35%) had breast cancer. The standardized prevalence ratios were 1.08 (95% confidence interval [CI], 0.37-1.59) and 1.09 (95% Cl, 0.37-1.60), respectively, when compared with the American and European general population. Pooled analysis of the 3 studies on breast cancer mortality found that, of the 44,508 flight attendants censored, 139 (0.32%) had breast cancer-related mortality. Standardized mortality ratios to the American/European general population were 1.8 (95% CI, 0.63-4.25) and 1.3 (95% CI, 0.47-3.15), respectively. A review of the available literature indicates that there is insufficient evidence to suggest an association between cosmic irradiation, circadian disruption, and breast cancer in flight attendants. Breast cancer prevalence and mortality among flight attendants are comparable with that of the general population.
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63
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Hendrick RE. Radiation Doses and Risks in Breast Screening. JOURNAL OF BREAST IMAGING 2020; 2:188-200. [PMID: 38424982 DOI: 10.1093/jbi/wbaa016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 03/02/2024]
Abstract
This article describes radiation doses and cancer risks of digital breast imaging technologies used for breast cancer detection. These include digital mammography (DM), digital breast tomosynthesis (DBT), and newer technologies such as contrast-enhanced digital or spectral mammography (CEM), whole-breast computed tomography, breast-specific gamma imaging (BSGI), molecular breast imaging (MBI), and positron emission mammography (PEM). This article describes the basis for radiation risk estimates, compares radiation doses and risks, and provides benefit-to-radiation-risk ratios for different breast imaging modalities that use ionizing radiation. Current x-ray-based screening modalities such as DM and DBT have small to negligible risks of causing radiation-induced cancers in women of normal screening age. Possible new screening modalities such as CEM have similar small cancer risks. Potential screening modalities that involve radionuclide injection such as BSGI, MBI, and PEM have significantly higher cancer risks unless efficient detection systems and reduced administered doses are used. Benefit-to-radiation-risk estimates are highly favorable for screening with DM and other modalities having comparable (or higher) cancer detection rates and comparably low radiation doses.
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Affiliation(s)
- R Edward Hendrick
- University of Colorado School of Medicine, Department of Radiology, Aurora, CO
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Barufaldi B, Zuckerman SP, Medeiros RB, Maidment AD, Schiabel H. Characterization of the imaging settings in screening mammography using a tracking and reporting system: A multi-center and multi-vendor analysis. Phys Med 2020; 71:137-149. [PMID: 32143121 PMCID: PMC7187399 DOI: 10.1016/j.ejmp.2020.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/07/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022] Open
Abstract
A tracking and reporting system was developed to monitor radiation dose in X-ray breast imaging. We used our tracking system to characterize and compare the mammographic practices of five breast imaging centers located in the United States and Brazil. Clinical data were acquired using eight mammography systems comprising three modalities: computed radiography (CR), full-field digital mammography (FFDM), and digital breast tomosynthesis (DBT). Our database consists of metadata extracted from 334,234 images. We analyzed distributions and correlations of compressed breast thickness (CBT), compression force, target-filter combinations, X-ray tube voltage, and average glandular dose (AGD). AGD reference curves were calculated based on AGD distributions as a function of CBT. These curves represent an AGD reference for a particular population and system. Differences in AGD and imaging settings were attributed to a combination of factors, such as improvements in technology, imaging protocol, and patient demographics. The tracking system allows the comparison of various imaging settings used in screening mammography, as well as the tracking of patient- and population-specific breast data collected from different populations.
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Affiliation(s)
- Bruno Barufaldi
- University of Pennsylvania, Department of Radiology, 3620 Hamilton Walk, Philadelphia, PA 19104, USA.
| | - Samantha P Zuckerman
- University of Pennsylvania, Department of Radiology, 3620 Hamilton Walk, Philadelphia, PA 19104, USA.
| | - Regina B Medeiros
- Federal University of Sao Paulo, Escola Paulista de Medicina, 740 Rua Botucatu, Sao Paulo, SP 04023-062, Brazil
| | - Andrew D Maidment
- University of Pennsylvania, Department of Radiology, 3620 Hamilton Walk, Philadelphia, PA 19104, USA.
| | - Homero Schiabel
- University of Sao Paulo, Department of Electrical Engineering, 400 Trabalhador Sao-Carlense, Sao Carlos, SP 13566-590, Brazil.
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Santiago-Montero R, Sossa H, Gutiérrez-Hernández DA, Zamudio V, Hernández-Bautista I, Valadez-Godínez S. Novel Mathematical Model of Breast Cancer Diagnostics Using an Associative Pattern Classification. Diagnostics (Basel) 2020; 10:diagnostics10030136. [PMID: 32121569 PMCID: PMC7151177 DOI: 10.3390/diagnostics10030136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
Breast cancer is a disease that has emerged as the second leading cause of cancer deaths in women worldwide. The annual mortality rate is estimated to continue growing. Cancer detection at an early stage could significantly reduce breast cancer death rates long-term. Many investigators have studied different breast diagnostic approaches, such as mammography, magnetic resonance imaging, ultrasound, computerized tomography, positron emission tomography and biopsy. However, these techniques have limitations, such as being expensive, time consuming and not suitable for women of all ages. Proposing techniques that support the effective medical diagnosis of this disease has undoubtedly become a priority for the government, for health institutions and for civil society in general. In this paper, an associative pattern classifier (APC) was used for the diagnosis of breast cancer. The rate of efficiency obtained on the Wisconsin breast cancer database was 97.31%. The APC’s performance was compared with the performance of a support vector machine (SVM) model, back-propagation neural networks, C4.5, naive Bayes, k-nearest neighbor (k-NN) and minimum distance classifiers. According to our results, the APC performed best. The algorithm of the APC was written and executed in a JAVA platform, as well as the experimental and comparativeness between algorithms.
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Affiliation(s)
- Raúl Santiago-Montero
- Tecnológico Nacional de México/Instituto Tecnológico de León, León 37290, Guanajuato, Mexico; (R.S.-M.); (V.Z.)
| | - Humberto Sossa
- Instituto Politécnico Nacional (CIC), CD de México 07738, Mexico;
- Tecnológico de Monterrey, Campus Guadalajara, Zapopan 45138, Jalisco, Mexico
| | - David A. Gutiérrez-Hernández
- Tecnológico Nacional de México/Instituto Tecnológico de León, León 37290, Guanajuato, Mexico; (R.S.-M.); (V.Z.)
- Correspondence:
| | - Víctor Zamudio
- Tecnológico Nacional de México/Instituto Tecnológico de León, León 37290, Guanajuato, Mexico; (R.S.-M.); (V.Z.)
| | | | - Sergio Valadez-Godínez
- Universidad Humani Mundial, Campus San Francisco del Rincón, San Francisco del Rincón 37378, Guanajuato, Mexico;
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Schünemann HJ, Lerda D, Quinn C, Follmann M, Alonso-Coello P, Rossi PG, Lebeau A, Nyström L, Broeders M, Ioannidou-Mouzaka L, Duffy SW, Borisch B, Fitzpatrick P, Hofvind S, Castells X, Giordano L, Canelo-Aybar C, Warman S, Mansel R, Sardanelli F, Parmelli E, Gräwingholt A, Saz-Parkinson Z. Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines. Ann Intern Med 2020; 172:46-56. [PMID: 31766052 DOI: 10.7326/m19-2125] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines (European Breast Guidelines) are coordinated by the European Commission's Joint Research Centre. The target audience for the guidelines includes women, health professionals, and policymakers. METHODS An international guideline panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests by enhancing transparency. Questions and recommendations, expressed as strong or conditional, focused on outcomes that matter to women and provided a rating of the certainty of evidence. RECOMMENDATIONS This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also discuss the frequency of screening and inform decision making for women at average risk who are recalled for suspicious lesions or who have high breast density.
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Affiliation(s)
| | - Donata Lerda
- European Commission, Joint Research Centre, Ispra, Italy (D.L., E.P., Z.S.)
| | - Cecily Quinn
- St. Vincent's University Hospital, Dublin, Ireland (C.Q.)
| | | | | | - Paolo Giorgi Rossi
- Azienda Unitá Sanitaria Locale-IRCCS di Reggio Emilia, Reggia Emilia, Italy (P.G.R.)
| | - Annette Lebeau
- Private Group Practice for Pathology, Lübeck, Germany (A.L.)
| | | | | | | | - Stephen W Duffy
- Queen Mary University of London, London, United Kingdom (S.W.D.)
| | | | | | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain (X.C.)
| | - Livia Giordano
- CPO-Piedmont - AOU Cittá della Salute e della Scienza, Torino, Italy (L.G.)
| | | | - Sue Warman
- Langford, North Somerset, United Kingdom (S.W.)
| | | | | | - Elena Parmelli
- European Commission, Joint Research Centre, Ispra, Italy (D.L., E.P., Z.S.)
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Kizina K, Stolte B, Totzeck A, Bolz S, Fleischer M, Mönninghoff C, Guberina N, Oldenburg D, Forsting M, Kleinschnitz C, Hagenacker T. Clinical Implication of Dosimetry of Computed Tomography- and Fluoroscopy-Guided Intrathecal Therapy With Nusinersen in Adult Patients With Spinal Muscular Atrophy. Front Neurol 2019; 10:1166. [PMID: 31787921 PMCID: PMC6856637 DOI: 10.3389/fneur.2019.01166] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/15/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Spinal muscular atrophy (SMA) is a genetic disorder that leads to progressive tetraparesis. Nusinersen is the first approved drug for the treatment of SMA and is administered via intrathecal injections. Neuromyopathic scoliosis and spondylodesis can impede lumbar punctures, thus necessitating the use of radiological imaging. Furthermore, dosimetry of this potentially lifelong therapy should be supervised. Methods: Fluoroscopy-assisted or computed tomography (CT)-guided intrathecal injections of nusinersen were performed in adult patients with SMA type 2 and 3. The mean effective dose was compared in patients with and without spondylodesis as well as in those with SMA type 2 and 3. The dosimetry was analyzed in relation to the motor function evaluated with the Revised Upper Limb module (RULM) score and the Hammersmith Functional Motor Scale-Expanded (HFMSE) score. Results: Fifteen patients with SMA type 2 and 3 underwent radiological imaging-assisted intrathecal injections. The mean effective dose per CT-guided injection per patient was 2.59 (±1.67) mSv (n = 12). The mean dose area product (DAP) per fluoroscopy-guided injection per patient was 200.48 (±323.67) μGym2 (n = 3). With increase in the number of injections, the effective dose (r = −0.23) (p < 0.05) and the DAP (r = −0.09) (p > 0.05) decreased. The mean effective dose in 4 patients without spinal fusion (SMA type 2) was 1.39 (±0.51) mSv, whereas that in 8 patients with spondylodesis (SMA type 2 and 3) was 3.21 (±1.73) mSv. The mean effective dose in 5 SMA type 2 patients with spondylodesis was 2.68 (±1.47) mSv (n = 5) and in 3 SMA type 3 patients was 4.00 (±1.82) mSv. Dosimetry did not show significant correlation with the clinical severity of the disease (RULM score: r = −0.045, p > 0.05 and HFMSE score: r = −0.001, p > 0.05). Conclusions: In SMA type 2 and 3 patients undergoing radiological imaging-assisted injections, the effective dose and DAP decreased during therapy with nusinersen. The mean effective dose in patients with spondylodesis was higher than that in patients without spondylodesis. Dosimetry should be monitored carefully in order to detect and prevent unnecessary radiation exposure.
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Affiliation(s)
- Kathrin Kizina
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Benjamin Stolte
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Andreas Totzeck
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Saskia Bolz
- Department of Neurology, University Hospital Essen, Essen, Germany
| | | | - Christoph Mönninghoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Denise Oldenburg
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Essen, Germany
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Brown M, Covington MF. Comparative Benefit-to-Radiation Risk Ratio of Molecular Breast Imaging, Two-Dimensional Full-Field Digital Mammography with and without Tomosynthesis, and Synthetic Mammography with Tomosynthesis. Radiol Imaging Cancer 2019; 1:e190005. [PMID: 33778669 DOI: 10.1148/rycan.2019190005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 02/02/2023]
Abstract
Purpose To apply previously published benefit-to-risk ratio methods for mammography and molecular breast imaging (MBI) risk estimates to an expanded range of mammographic screening techniques, compressed breast thicknesses, and screening views. Materials and Methods Only previously published estimates were used; therefore, this study was exempt from the requirement to obtain institutional review board approval. Benefit-to-risk ratios were calculated as the ratio of breast cancer deaths averted and lives lost to screening over 10-year intervals starting at age 40 years for MBI, two-dimensional (2D) full-field digital mammography (FFDM) alone, 2D FFDM with synthetic mammography, and 2D FFDM with tomosynthesis for two-, four-, and five-view screening mammography and compressed breast thicknesses of 20-29 mm, 50-59 mm, and 80-89 mm. Results Central estimates of the benefit-to-risk ratios ranged from 3 to 179 for screening mammography and from 5 to 9 for MBI. Benefit-to-risk ratios for MBI were inferior to those for mammography for most scenarios, but MBI may be performed at an equal or superior benefit-to-risk ratio for women aged 40-59 years with a compressed breast thickness of at least 80 mm and for those undergoing mammographic screening examinations with four or five views per breast. The benefit-to-risk ratios across all ages with use of tomosynthesis plus 2D FFDM as a screening examination were 45% lower than those for tomosynthesis plus synthetic mammography. Conclusion Benefit-to-risk ratios for MBI are within the lower range of those for mammography when accounting for variation in mammography technique, compressed breast thickness, and age. Benefit-to-risk ratios of synthetic mammography plus tomosynthesis are superior to those of tomosynthesis plus 2D FFDM.Keywords: Breast, Mammography, Molecular Imaging, Molecular Imaging-Cancer, Radiation Safety, Radionuclide Studies, Screening, Tomosynthesis© RSNA, 2019See also the commentary by Hruska in this issue.
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Affiliation(s)
- Matthew Brown
- Sections of Nuclear Medicine (M.B., M.F.C.) and Breast Imaging (M.F.C.), Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Matthew F Covington
- Sections of Nuclear Medicine (M.B., M.F.C.) and Breast Imaging (M.F.C.), Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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Should we expect all-cause mortality reductions in large screening studies? Br J Gen Pract 2019; 68:290-291. [PMID: 29853594 DOI: 10.3399/bjgp18x696545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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70
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van den Broek JJ, van Ravesteyn NT, Heijnsdijk EA, de Koning HJ. Simulating the Impact of Risk-Based Screening and Treatment on Breast Cancer Outcomes with MISCAN-Fadia. Med Decis Making 2019; 38:54S-65S. [PMID: 29554469 DOI: 10.1177/0272989x17711928] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The MISCAN-Fadia microsimulation model uses continuous tumor growth to simulate the natural history of breast cancer and has been used extensively to estimate the impact of screening and adjuvant treatment on breast cancer incidence and mortality trends. The model simulates individual life histories from birth to death, with and without breast cancer, in the presence and in the absence of screening and treatment. Life histories are simulated according to discrete events such as birth, tumor inception, the tumor's clinical diagnosis diameter in the absence of screening, and death from breast cancer or death from other causes. MISCAN-Fadia consists of 4 main components: demography, natural history of breast cancer, screening, and treatment. Screening impact on the natural history of breast cancer is assessed by simulating continuous tumor growth and the "fatal diameter" concept. This concept implies that tumors diagnosed at a size that is between the screen detection threshold and the fatal diameter are cured, while tumors diagnosed at a diameter larger than the fatal tumor diameter metastasize and lead to breast cancer death. MISCAN-Fadia has been extended by including a different natural history for molecular subtypes based on a tumor's estrogen receptor (ER) status and human epidermal growth factor receptor 2 (HER2) status. In addition, personalized screening strategies that target women based on their risk such as breast density have been incorporated into the model. This personalized approach to screening will continue to develop in light of potential polygenic risk stratification possibilities and new screening modalities.
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Affiliation(s)
| | | | | | - Harry J de Koning
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
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Rana SP, Dey M, Tiberi G, Sani L, Vispa A, Raspa G, Duranti M, Ghavami M, Dudley S. Machine Learning Approaches for Automated Lesion Detection in Microwave Breast Imaging Clinical Data. Sci Rep 2019; 9:10510. [PMID: 31324863 PMCID: PMC6642213 DOI: 10.1038/s41598-019-46974-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/04/2019] [Indexed: 11/27/2022] Open
Abstract
Breast lesion detection employing state of the art microwave systems provide a safe, non-ionizing technique that can differentiate healthy and non-healthy tissues by exploiting their dielectric properties. In this paper, a microwave apparatus for breast lesion detection is used to accumulate clinical data from subjects undergoing breast examinations at the Department of Diagnostic Imaging, Perugia Hospital, Perugia, Italy. This paper presents the first ever clinical demonstration and comparison of a microwave ultra-wideband (UWB) device augmented by machine learning with subjects who are simultaneously undergoing conventional breast examinations. Non-ionizing microwave signals are transmitted through the breast tissue and the scattering parameters (S-parameter) are received via a dedicated moving transmitting and receiving antenna set-up. The output of a parallel radiologist study for the same subjects, performed using conventional techniques, is taken to pre-process microwave data and create suitable data for the machine intelligence system. These data are used to train and investigate several suitable supervised machine learning algorithms nearest neighbour (NN), multi-layer perceptron (MLP) neural network, and support vector machine (SVM) to create an intelligent classification system towards supporting clinicians to recognise breasts with lesions. The results are rigorously analysed, validated through statistical measurements, and found the quadratic kernel of SVM can classify the breast data with 98% accuracy.
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Affiliation(s)
- Soumya Prakash Rana
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom.
| | - Maitreyee Dey
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom
| | - Gianluigi Tiberi
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom
- UBT Srl, Spin Off of the University of Perugia, Perugia, Italy
| | - Lorenzo Sani
- UBT Srl, Spin Off of the University of Perugia, Perugia, Italy
| | | | - Giovanni Raspa
- UBT Srl, Spin Off of the University of Perugia, Perugia, Italy
| | - Michele Duranti
- Department of Diagnostic Imaging, Perugia Hospital, Perugia, Italy
| | - Mohammad Ghavami
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom
| | - Sandra Dudley
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom
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Qaseem A, Lin JS, Mustafa RA, Horwitch CA, Wilt TJ, Forciea MA, Fitterman N, Iorio A, Kansagara D, Maroto M, McLean RM, Tufte JE, Vijan S. Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians. Ann Intern Med 2019; 170:547-560. [PMID: 30959525 DOI: 10.7326/m18-2147] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The purpose of this guidance statement is to provide advice to clinicians on breast cancer screening in average-risk women based on a review of existing guidelines and the evidence they include. METHODS This guidance statement is derived from an appraisal of selected guidelines from around the world that address breast cancer screening, as well as their included evidence. All national guidelines published in English between 1 January 2013 and 15 November 2017 in the National Guideline Clearinghouse or Guidelines International Network library were included. In addition, the authors selected other guidelines commonly used in clinical practice. Web sites associated with all selected guidelines were checked for updates on 10 December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines. TARGET AUDIENCE AND PATIENT POPULATION The target audience is all clinicians, and the target patient population is all asymptomatic women with average risk for breast cancer. GUIDANCE STATEMENT 1 In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. Discussion should include the potential benefits and harms and a woman's preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years. GUIDANCE STATEMENT 2 In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography. GUIDANCE STATEMENT 3 In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer. GUIDANCE STATEMENT 4 In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | | | - Reem A Mustafa
- University of Kansas Medical Center, Kansas City, Kansas (R.A.M.)
| | | | - Timothy J Wilt
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.)
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Salerno S, Laghi A, Cantone MC, Sartori P, Pinto A, Frija G. Overdiagnosis and overimaging: an ethical issue for radiological protection. Radiol Med 2019; 124:714-720. [PMID: 30900132 DOI: 10.1007/s11547-019-01029-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to analyse the key factors that influence the overimaging using X-ray such as self-referral, defensive medicine and duplicate imaging studies and to emphasize the ethical problem that derives from it. MATERIALS AND METHODS In this study, we focused on the more frequent sources of overdiagnosis such as the total-body CT, proposed in the form of screening in both public and private sector, the choice of the most sensitive test for each pathology such as pulmonary embolism, ultrasound investigations mostly of the thyroid and of the prostate and MR examinations, especially of the musculoskeletal system. RESULTS The direct follow of overdiagnosis and overimaging is the increase in the risk of contrast media infusion, radiant damage, and costs in the worldwide healthcare system. The theme of the costs of overdiagnosis is strongly related to inappropriate or poorly appropriate imaging examination. CONCLUSIONS We underline the ethical imperatives of trust and right conduct, because the major ethical problems in radiology emerge in the justification of medical exposures of patients in the practice. A close cooperation and collaboration across all the physicians responsible for patient care in requiring imaging examination is also important, balancing possible ionizing radiation disadvantages and patient benefits in terms of care.
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Affiliation(s)
- Sergio Salerno
- Department of Diagnostic Radiology, University of Palermo, Policlinico Via del Vespro 127, 90127, Palermo, Italy.
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza-University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Marie-Claire Cantone
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Pascal 36, 20133, Milan, Italy
| | - Paolo Sartori
- Department of Radiology, SS Giovanni e Paolo Hospital, Castello 6777, 30122, Venice, Italy
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Guy Frija
- Department of Diagnostic Radiology, Hopital Européen Georges Pompidou Paris APHP, Université Paris-Descartes, Paris, France
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75
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Ho PJ, Bok CM, Ishak HMM, Lim LY, Liu J, Wong FY, Chia KS, Tan MH, Chay WY, Hartman M, Li J. Factors associated with false-positive mammography at first screen in an Asian population. PLoS One 2019; 14:e0213615. [PMID: 30856210 PMCID: PMC6411141 DOI: 10.1371/journal.pone.0213615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction False-positive recall is an issue in national screening programmes. The aim of this study is to investigate the recall rate at first screen and to identify potential predictors of false-positive recall in a multi-ethnic Asian population-based breast cancer screening programme. Methods Women aged 50–64 years attending screening mammography for the first time (n = 25,318) were included in this study. The associations between potential predictors (sociodemographic, lifestyle and reproductive) and false-positive recall were evaluated using multivariable logistic regression models. Results The recall rate was 7.6% (n = 1,923), of which with 93.8% were false-positive. Factors independently associated with higher false-positive recall included Indian ethnicity (odds ratio [95% confidence interval]: 1.52 [1.25 to 1.84]), premenopause (1.23 [1.04 to 1.44]), nulliparity (1.85 [1.57 to 2.17]), recent breast symptoms (1.72 [1.31 to 2.23]) and history of breast lump excision (1.87 [1.53 to 2.26]). Factors associated with lower risk of false-positive recall included older age at screen (0.84 [0.73 to 0.97]) and use of oral contraceptives (0.87 [0.78 to 0.97]). After further adjustment of percent mammographic density, associations with older age at screening (0.97 [0.84 to 1.11]) and menopausal status (1.12 [0.95 to 1.32]) were attenuated and no longer significant. Conclusion For every breast cancer identified, 15 women without cancer were subjected to further testing. Efforts to educate Asian women on what it means to be recalled will be useful in reducing unnecessary stress and anxiety.
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Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore, Genome, Singapore, Singapore, Singapore
| | - Chek Mei Bok
- Genome Institute of Singapore, Genome, Singapore, Singapore, Singapore
| | | | - Li Yan Lim
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Jenny Liu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | | | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Min-Han Tan
- National Cancer Centre, Singapore, Singapore
- Institute of Bioengineering and Nanotechnology, Singapore, Singapore
| | | | - Mikael Hartman
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Jingmei Li
- Genome Institute of Singapore, Genome, Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
- * E-mail:
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Jatoi I, Anderson WF, Miller AB, Brawley OW. The history of cancer screening. Curr Probl Surg 2019; 56:138-163. [PMID: 30922446 DOI: 10.1067/j.cpsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology, Dale H. Dorn Endowed Chair in Surgery, University of Texas Health Science Center, San Antonio, TX.
| | - William F Anderson
- National Institutes of Health/National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MA
| | - Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Otis W Brawley
- Michael Bloomberg Distinguished Professor of Oncology and Public Health, Johns Hopkins University, Baltimore, MA
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77
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Yuan B, Schafferer S, Tang Q, Scheffler M, Nees J, Heil J, Schott S, Golatta M, Wallwiener M, Sohn C, Koal T, Wolf B, Schneeweiß A, Burwinkel B. A plasma metabolite panel as biomarkers for early primary breast cancer detection. Int J Cancer 2019; 144:2833-2842. [PMID: 30426507 DOI: 10.1002/ijc.31996] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/19/2018] [Accepted: 10/16/2018] [Indexed: 01/14/2023]
Abstract
In recent years, metabolites have attracted substantial attention as promising novel biomarkers of various diseases. However, breast cancer plasma metabolite studies are still in their infancy. Here, we investigated the potential of metabolites to serve as minimally invasive, early detection markers of primary breast cancer. We profiled metabolites extracted from the plasma of primary breast cancer patients and healthy controls using tandem mass spectrometry (UHPLC-MS/MS and FIA-MS/MS). Two metabolites were found to be upregulated, while 16 metabolites were downregulated in primary breast cancer patients compared to healthy controls in both the training and validation cohorts. A panel of seven metabolites was selected by LASSO regression analysis. This panel could differentiate primary breast cancer patients from healthy controls, with an AUC of 0.87 (95% CI: 0.81 ~ 0.92) in the training cohort and an AUC of 0.80 (95% CI: 0.71 ~ 0.87) in the validation cohort. These significantly differentiated metabolites are mainly involved in the amino acid metabolism and breast cancer cell growth pathways. In conclusion, using a metabolomics approach, we identified metabolites that have potential value for development of a multimarker blood-based test to complement and improve early breast cancer detection. The panel identified herein might be part of a prescreening tool, especially for younger women or for closely observing women with certain risks, to facilitate decision making regarding which individuals should undergo further diagnostic tests. In the future, the combination of metabolites and other blood-based molecular marker sets, such as DNA methylation, microRNA, and cell-free DNA mutation markers, will be an attractive option.
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Affiliation(s)
- Baowen Yuan
- Molecular Biology of Breast Cancer, Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.,Division of Molecular Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Qiuqiong Tang
- Molecular Biology of Breast Cancer, Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.,Division of Molecular Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Juliane Nees
- National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Sarah Schott
- Molecular Biology of Breast Cancer, Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Markus Wallwiener
- National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | | | | | - Andreas Schneeweiß
- National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Barbara Burwinkel
- Molecular Biology of Breast Cancer, Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.,Division of Molecular Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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78
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Gapstur SM, Drope JM, Jacobs EJ, Teras LR, McCullough ML, Douglas CE, Patel AV, Wender RC, Brawley OW. A blueprint for the primary prevention of cancer: Targeting established, modifiable risk factors. CA Cancer J Clin 2018; 68:446-470. [PMID: 30303518 DOI: 10.3322/caac.21496] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 01/27/2023] Open
Abstract
In the United States, it is estimated that more than 1.7 million people will be diagnosed with cancer, and more than 600,000 will die of the disease in 2018. The financial costs associated with cancer risk factors and cancer care are enormous. To substantially reduce both the number of individuals diagnosed with and dying from cancer and the costs associated with cancer each year in the United States, government and industry and the public health, medical, and scientific communities must work together to develop, invest in, and implement comprehensive cancer control goals and strategies at the national level and expand ongoing initiatives at the state and local levels. This report is the second in a series of articles in this journal that, together, describe trends in cancer rates and the scientific evidence on cancer prevention, early detection, treatment, and survivorship to inform the identification of priorities for a comprehensive cancer control plan. Herein, we focus on existing evidence about established, modifiable risk factors for cancer, including prevalence estimates and the cancer burden due to each risk factor in the United States, and established primary prevention recommendations and interventions to reduce exposure to each risk factor.
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Affiliation(s)
- Susan M Gapstur
- Senior Vice President, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Jeffrey M Drope
- Vice President, Economic & Health Policy Research, American Cancer Society, Atlanta, GA
| | - Eric J Jacobs
- Senior Scientific Director, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Lauren R Teras
- Senior Principal Scientist, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Marjorie L McCullough
- Senior Scientific Director, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Clifford E Douglas
- Vice President, Tobacco Control, and Director, Center for Tobacco Control, American Cancer Society, Atlanta, GA
| | - Alpa V Patel
- Senior Scientific Director, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical and Scientific Officer and Executive Vice President of Research, American Cancer Society, Atlanta, GA
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79
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Low-Dose Computed Tomography for the Optimization of Radiation Dose Exposure in Patients with Crohn's Disease. Gastroenterol Res Pract 2018; 2018:1768716. [PMID: 30515203 PMCID: PMC6234436 DOI: 10.1155/2018/1768716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/03/2018] [Accepted: 09/30/2018] [Indexed: 12/13/2022] Open
Abstract
Magnetic resonance imaging (MRI) is the mainstay method for the radiological imaging of the small bowel in patients with inflammatory bowel disease without the use of ionizing radiation. There are circumstances where imaging using ionizing radiation is required, particularly in the acute setting. This usually takes the form of computed tomography (CT). There has been a significant increase in the utilization of computed tomography (CT) for patients with Crohn's disease as patients are frequently diagnosed at a relatively young age and require repeated imaging. Between seven and eleven percent of patients with IBD are exposed to high cumulative effective radiation doses (CEDs) (>35–75 mSv), mostly patients with Crohn's disease (Newnham E 2007, Levi Z 2009, Hou JK 2014, Estay C 2015). This is primarily due to the more widespread and repeated use of CT, which accounts for 77% of radiation dose exposure amongst patients with Crohn's disease (Desmond et al., 2008). Reports of the projected cancer risks from the increasing CT use (Berrington et al., 2007) have led to increased patient awareness regarding the potential health risks from ionizing radiation (Coakley et al., 2011). Our responsibilities as physicians caring for these patients include education regarding radiation risk and, when an investigation that utilizes ionizing radiation is required, to keep radiation doses as low as reasonably achievable: the “ALARA” principle. Recent advances in CT technology have facilitated substantial radiation dose reductions in many clinical settings, and several studies have demonstrated significantly decreased radiation doses in Crohn's disease patients while maintaining diagnostic image quality. However, there is a balance to be struck between reducing radiation exposure and maintaining satisfactory image quality; if radiation dose is reduced excessively, the resulting CT images can be of poor quality and may be nondiagnostic. In this paper, we summarize the available evidence related to imaging of Crohn's disease, radiation exposure, and risk, and we report recent advances in low-dose CT technology that have particular relevance.
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80
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Kearney AJ, Polisena J, Morrison A. A Review and Comparative Analysis of Information Targeted to the General Public on the Websites of Breast Screening Programs in Canada. ACTA ACUST UNITED AC 2018; 13:57-67. [PMID: 29274227 PMCID: PMC5749524 DOI: 10.12927/hcpol.2017.25322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Organized breast screening programs in Canada recommend that women, usually 50-74 years of age, are screened regularly with mammography to reduce their risk of breast cancer death. There is increasing evidence that estimates of mortality reduction are overestimated and harms under-reported. This article will report on a review of the websites of 12 breast screening programs in Canada. The primary goal is to determine what information is provided to enable women to make an informed decision about mammography and whether choice is emphasized. All publicly available English language information was extracted from the 12 websites by two independent reviewers, using a data extraction sheet. Information extracted included eligible age, screening interval and potential benefits and harms. This review is relevant to policy makers and breast screening program staff so they can determine what additional or alternative information is required on their websites to enable women to make informed decisions.
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Affiliation(s)
- Anne J Kearney
- Associate Professor, School of Nursing, Memorial University of Newfoundland, St. John's, NL
| | - Julie Polisena
- Manager, Clinical Research, Canadian Agency for Drugs & Technologies in Health, Ottawa, ON
| | - Andra Morrison
- Program Development Officer, Canadian Agency for Drugs & Technologies in Health, Ottawa, ON
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82
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Migowski A, Silva GAE, Dias MBK, Diz MDPE, Sant'Ana DR, Nadanovsky P. Guidelines for early detection of breast cancer in Brazil. II - New national recommendations, main evidence, and controversies. CAD SAUDE PUBLICA 2018; 34:e00074817. [PMID: 29947654 DOI: 10.1590/0102-311x00074817] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 02/23/2018] [Indexed: 11/21/2022] Open
Abstract
Breast cancer is the leading cause of cancer mortality in Brazilian women. The new Brazilian guidelines for early detection of breast cancer were drafted on the basis of systematic literature reviews on the possible harms and benefits of various early detection strategies. This article aims to present the recommendations and update the summary of evidence, discussing the main controversies. Breast cancer screening recommendations (in asymptomatic women) were: (i) strong recommendation against mammogram screening in women under 50 years of age; (ii) weak recommendation for mammogram screening in women 50 to 69 years of age; (iii) weak recommendation against mammogram screening in women 70 to 74 years of age; (iv) strong recommendation against mammogram screening in women 75 years or older; (v) strong recommendation that screening in the recommended age brackets should be every two years as opposed to shorter intervals; (vi) weak recommendation against teaching breast self-examination as screening; (vii) absence of recommendation for or against screening with clinical breast examination; and (viii) strong recommendation against screening with magnetic resonance imaging, ultrasonography, thermography, or tomosynthesis alone or as a complement to mammography. The recommendations for early diagnosis of breast cancer (in women with suspicious signs or symptoms) were: (i) weak recommendation for the implementation of awareness-raising strategies for early diagnosis of breast cancer; (ii) weak recommendation for use of selected signs and symptoms in the current guidelines as the criterion for urgent referral to specialized breast diagnosis services; and (iii) weak recommendation that every breast cancer diagnostic workup after the identification of suspicious signs and symptoms in primary care should be done in the same referral center.
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Affiliation(s)
- Arn Migowski
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil.,Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
| | - Gulnar Azevedo E Silva
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | | | - Paulo Nadanovsky
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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83
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Zhang X, Lin X, Tan Y, Zhu Y, Wang H, Feng R, Tang G, Zhou X, Li A, Qiao Y. A multicenter hospital-based diagnosis study of automated breast ultrasound system in detecting breast cancer among Chinese women. Chin J Cancer Res 2018; 30:231-239. [PMID: 29861608 DOI: 10.21147/j.issn.1000-9604.2018.02.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective The automated breast ultrasound system (ABUS) is a potential method for breast cancer detection; however, its diagnostic performance remains unclear. We conducted a hospital-based multicenter diagnostic study to evaluate the clinical performance of the ABUS for breast cancer detection by comparing it to handheld ultrasound (HHUS) and mammography (MG). Methods Eligible participants underwent HHUS and ABUS testing; women aged 40-69 years additionally underwent MG. Images were interpreted using the Breast Imaging Reporting and Data System (BI-RADS). Women in the BI-RADS categories 1-2 were considered negative. Women classified as BI-RADS 3 underwent magnetic resonance imaging to distinguish true- and false-negative results. Core aspiration or surgical biopsy was performed in women classified as BI-RADS 4-5, followed by a pathological diagnosis. Kappa values and agreement rates were calculated between ABUS, HHUS and MG. Results A total of 1,973 women were included in the final analysis. Of these, 1,353 (68.6%) and 620 (31.4%) were classified as BI-RADS categories 1-3 and 4-5, respectively. In the older age group, the agreement rate and Kappa value between the ABUS and HHUS were 94.0% and 0.860 (P<0.001), respectively; they were 89.2% and 0.735 (P<0.001) between the ABUS and MG, respectively. Regarding consistency between imaging and pathology results, 78.6% of women classified as BI-RADS 4-5 based on the ABUS were diagnosed with precancerous lesions or cancer; which was 7.2% higher than that of women based on HHUS. For BI-RADS 1-2, the false-negative rates of the ABUS and HHUS were almost identical and were much lower than those of MG. Conclusions We observed a good diagnostic reliability for the ABUS. Considering its performance for breast cancer detection in women with high-density breasts and its lower operator dependence, the ABUS is a promising option for breast cancer detection in China.
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Affiliation(s)
- Xi Zhang
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xi Lin
- Department of Ultrasound, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Yanjuan Tan
- Department of Ultrasound, the First People's Hospital of Hangzhou, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou 310006, China
| | - Ying Zhu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Hui Wang
- Department of Ultrasound, Xin Hua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Ruimei Feng
- Department of Cancer Prevention Research, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Guoxue Tang
- Department of Ultrasound, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Xiang Zhou
- Department of Interventional Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Anhua Li
- Department of Ultrasound, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Youlin Qiao
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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84
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Mango V, Bryce Y, Morris EA, Gianotti E, Pinker K. Commentary ACOG Practice Bulletin July 2017: Breast Cancer Risk Assessment and Screening in Average-Risk Women. Br J Radiol 2018; 91:20170907. [PMID: 29688040 DOI: 10.1259/bjr.20170907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Screening mammography reduces breast cancer mortality in average-risk women. However, adverse consequences include false-positive findings possibly leading to benign breast biopsies and patient anxiety. There is also potential for overdiagnosis and overtreatment. Differences in how to balance benefits and harms have led to varying recommendations by the U.S. Preventive Services Task Force, the American Cancer Society, the National Comprehensive Cancer Network and the American College of Radiology/Society of Breast Imaging. These recommendations differ with respect to what age to start, what age to stop, and frequency of screening in average-risk women. Most recently, the American College of Obstetricians and Gynecologists have issued updated clinical management guidelines for breast cancer risk assessment and screening in average-risk women that aim to maximize the benefits of screening while keeping in mind the potential harms of false-positive results. This commentary summarizes the clinical management guidelines of the American College of Obstetricians and Gynecologists Practice Bulletin July 2017 for breast cancer risk assessment and screening in average-risk women. We review evidence of the benefits and adverse consequences of screening mammography and briefly discuss new advances in breast cancer screening with recent technologies such digital breast tomosynthesis and risk-adapted screening.
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Affiliation(s)
- Victoria Mango
- 1 Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center , New York, NY , USA
| | - Yolanda Bryce
- 2 Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna , Vienna , Austria
| | - Elizabeth Anne Morris
- 1 Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center , New York, NY , USA
| | - Elisabetta Gianotti
- 1 Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center , New York, NY , USA
| | - Katja Pinker
- 1 Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center , New York, NY , USA.,2 Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna , Vienna , Austria
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85
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Radiation Risk Associated With X-Ray Mammography Screening: Communication and Exchange of Information via Tweets. J Am Coll Radiol 2018; 15:1033-1039. [PMID: 29661518 DOI: 10.1016/j.jacr.2018.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/13/2018] [Accepted: 02/22/2018] [Indexed: 11/22/2022]
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86
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Thomassin-Naggara I, Chabbert-Buffet N, Trop I. Du dépistage de masse au dépistage stratifié selon le risque. IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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87
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Liberatore M, Cucchi JM, Fighiera M, Binet A, Missana MC, Brunner P, Mourou MY, Iannessi A. Interest of systematic tomosynthesis (3D mammography) with synthetic 2D mammography in breast cancer screening. Horm Mol Biol Clin Investig 2017; 32:/j/hmbci.2017.32.issue-2/hmbci-2017-0024/hmbci-2017-0024.xml. [PMID: 29252195 DOI: 10.1515/hmbci-2017-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/30/2017] [Indexed: 11/15/2022]
Abstract
Full field digital mammography (FFDM) is the current pillar of breast cancer screening program. However, the emerging technique digital breast tomosynthesis (DBT) has demonstrated a significant increase in the sensibility of cancer detection in several large cohort trials. DBT is particularly helpful for young patients, dense breasts and soft masses due to its ability to reduce overlapping of tissue. In such a population of women, radiologists are more confident and the recall rates are reduced together with a higher positive predictive value. To reduce the breast absorbed doses of screened women and facilitate the workflow, a synthetized two-dimensional (2D) digital mammography (sDM) is obtained from DBT to replace the FFDM. No significant differences regarding detection of anomalies have been reported with respect to FFDM. These results validate a modern strategy for breast cancer screening supported by two views of DBT with sDM. In terms of mean absorbed doses, this strategy is around 1.5 mGy/view and almost equivalent to FFDM. In Europe, major limitations to such evolution are public health policies especially agreements and reimbursement for the technique being used in organized screening.
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Affiliation(s)
- Mathieu Liberatore
- Diagnostic Imaging Department, Princess Grace Hospital, 1 Avenue Pasteur 98012, Monaco, Monaco
| | - Jean-Michel Cucchi
- Diagnostic Imaging Department, Princess Grace Hospital, 1 Avenue Pasteur 98012, Monaco, Monaco
| | - Martine Fighiera
- Centre d'Imagerie Médical de Monaco, 11 rue du Gabian 98000, Monaco, Monaco
| | - Anne Binet
- Diagnostic Imaging Department, Princess Grace Hospital, 1 Avenue Pasteur 98012, Monaco, Monaco
| | - Marie Christine Missana
- Diagnostic Imaging Department, Princess Grace Hospital, 1 Avenue Pasteur 98012, Monaco, Monaco
| | - Philippe Brunner
- Diagnostic Imaging Department, Princess Grace Hospital, 1 Avenue Pasteur 98012, Monaco, Monaco
| | - Michel Yves Mourou
- Centre d'Imagerie Médical de Monaco, 11 rue du Gabian 98000, Monaco, Monaco
| | - Antoine Iannessi
- Diagnostic Imaging Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France
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Gray JM, Rasanayagam S, Engel C, Rizzo J. State of the evidence 2017: an update on the connection between breast cancer and the environment. Environ Health 2017; 16:94. [PMID: 28865460 PMCID: PMC5581466 DOI: 10.1186/s12940-017-0287-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/17/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND In this review, we examine the continually expanding and increasingly compelling data linking radiation and various chemicals in our environment to the current high incidence of breast cancer. Singly and in combination, these toxicants may have contributed significantly to the increasing rates of breast cancer observed over the past several decades. Exposures early in development from gestation through adolescence and early adulthood are particularly of concern as they re-shape the program of genetic, epigenetic and physiological processes in the developing mammary system, leading to an increased risk for developing breast cancer. In the 8 years since we last published a comprehensive review of the relevant literature, hundreds of new papers have appeared supporting this link, and in this update, the evidence on this topic is more extensive and of better quality than that previously available. CONCLUSION Increasing evidence from epidemiological studies, as well as a better understanding of mechanisms linking toxicants with development of breast cancer, all reinforce the conclusion that exposures to these substances - many of which are found in common, everyday products and byproducts - may lead to increased risk of developing breast cancer. Moving forward, attention to methodological limitations, especially in relevant epidemiological and animal models, will need to be addressed to allow clearer and more direct connections to be evaluated.
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Affiliation(s)
- Janet M. Gray
- Department of Psychology and Program in Science, Technology, and Society, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604-0246 USA
| | - Sharima Rasanayagam
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Connie Engel
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Jeanne Rizzo
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
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Diniz CSG, Pellini ACG, Ribeiro AG, Tedardi MV, de Miranda MJ, Touso MM, Baquero OS, dos Santos PC, Chiaravalloti-Neto F. Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis. BMJ Open 2017; 7:e016395. [PMID: 28838894 PMCID: PMC5629728 DOI: 10.1136/bmjopen-2017-016395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/09/2017] [Accepted: 07/05/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Identify the factors associated with the age-standardised breast cancer mortality rate in the municipalities of State of São Paulo (SSP), Brazil, in the period from 2006 to 2012. DESIGN Ecological study of the breast cancer mortality rate standardised by age, as the dependent variable, having each of the 645 municipalities in the SSP as the unit of analysis. SETTINGS The female resident population aged 15 years or older, by age group and municipality, in 2009 (mid-term), obtained from public dataset (Informatics Department of the Unified Health System). PARTICIPANTS Women 15 years or older who died of breast cancer in the SSP were selected for the calculation of the breast cancer mortality rate, according to the municipality and age group, from 2006 to 2012. MAIN OUTCOME MEASURES Mortality rates for each municipality calculated by the direct standardisation method, using the age structure of the population of SSP in 2009 as the standard. RESULTS In the final linear regression model, breast cancer mortality, in the municipal level, was directly associated with rates of nulliparity (p<0.0001), mammography (p<0.0001) and private healthcare (p=0.006). CONCLUSIONS The findings that mammography ratio was associated, in the municipal level, with increased mortality add to the evidence of a probable overestimation of benefits and underestimation of risks associated with this form of screening. The same paradoxical trend of increased mortality with screening was found in recent individual-level studies, indicating the need to expand informed choice for patients, primary prevention actions and individualised screening. Additional studies should be conducted to explore if there is a causality link in this association.
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Affiliation(s)
- Carmen Simone Grilo Diniz
- Departamento de Saúde, Ciclos de Vida e Sociedade da Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | | | - Adeylson Guimarães Ribeiro
- Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Marcello Vannucci Tedardi
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil
| | - Marina Jorge de Miranda
- Departamento de Saúde, Ciclos de Vida e Sociedade da Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Michelle Mosna Touso
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - Oswaldo Santos Baquero
- Departamento de Medicina Veterinária Preventiva, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil
| | - Patrícia Carlos dos Santos
- Secretaria Municipal de Saúde de São Paulo, Coordenação de Epidemiologia e Informação, São Paulo, Brazil
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Badal K, Rampersad F, Warner WA, Toriola AT, Mohammed H, Scheffel HA, Ali R, Moosoodeen M, Konduru S, Russel A, Haraksingh R. A situational analysis of breast cancer early detection services in Trinidad and Tobago. Cancer Causes Control 2017; 29:33-42. [DOI: 10.1007/s10552-017-0937-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023]
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91
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Abstract
Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women (1). Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women (2). Screening, however, also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions. Differences in balancing benefits and harms have led to differences among major guidelines about what age to start, what age to stop, and how frequently to recommend mammography screening in average-risk women (2-4).Breast cancer risk assessment is very important for identifying women who may benefit from more intensive breast cancer surveillance; however, there is no standardized approach to office-based breast cancer risk assessment in the United States. This can lead to missed opportunities to identify women at high risk of breast cancer and may result in applying average-risk screening recommendations to high-risk women. Risk assessment and identification of women at high risk allow for referral to health care providers with expertise in cancer genetics counseling and testing for breast cancer-related germline mutations (eg, BRCA), patient counseling about risk-reduction options, and cascade testing to identify family members who also may be at increased risk.The purpose of this Practice Bulletin is to discuss breast cancer risk assessment, review breast cancer screening guidelines in average-risk women, and outline some of the controversies surrounding breast cancer screening. It will present recommendations for using a framework of shared decision making to assist women in balancing their personal values regarding benefits and harms of screening at various ages and intervals to make personal screening choices from within a range of reasonable options. Recommendations for women at elevated risk and discussion of new technologies, such as tomosynthesis, are beyond the scope of this document and are addressed in other publications of the American College of Obstetricians and Gynecologists (ACOG) (5-7).
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93
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Peairs KS, Choi Y, Stewart RW, Sateia HF. Screening for breast cancer. Semin Oncol 2017; 44:60-72. [PMID: 28395765 DOI: 10.1053/j.seminoncol.2017.02.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/29/2017] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
This review will give a general overview of the impact of breast cancer, as well as breast cancer risk factors, identification of high-risk groups, screening modalities, and guidelines for screening average-risk and high-risk individuals, including a case discussion of the primary care provider's approach to screening.
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Affiliation(s)
- Kimberly S Peairs
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
| | - Youngjee Choi
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Rosalyn W Stewart
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Heather F Sateia
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
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94
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Delaloge S, Bachelot T, Bidard FC, Espie M, Brain E, Bonnefoi H, Gligorov J, Dalenc F, Hardy-Bessard AC, Azria D, Jacquin JP, Lemonnier J, Jacot W, Goncalves A, Coutant C, Ganem G, Petit T, Penault-Llorca F, Debled M, Campone M, Levy C, Coudert B, Lortholary A, Venat-Bouvet L, Grenier J, Bourgeois H, Asselain B, Arvis J, Castro M, Tardivon A, Cox DG, Arveux P, Balleyguier C, André F, Rouzier R. [Breast cancer screening: On our way to the future]. Bull Cancer 2016; 103:753-63. [PMID: 27473920 DOI: 10.1016/j.bulcan.2016.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/02/2016] [Accepted: 06/19/2016] [Indexed: 01/24/2023]
Abstract
Breast cancer remains a potentially lethal disease, which requires aggressive treatments and is associated with long-term consequences. Its prognosis is linked to both tumor biology and burden at diagnosis. Although treatments have allowed important improvements in prognosis over the past 20 years, breast cancer screening remains necessary. Mammographic screening allows earlier stage diagnoses and a decrease of breast cancer specific mortality. However, breast cancer screening modalities should be revised with the objective to address demonstrated limitations of mammographic screening (limited benefit, imperfect sensitivity and specificity, overdiagnoses, radiation-induced morbidity). Furthermore, both objective and perceived performances of screening procedures should be improved. Numerous large international efforts are ongoing, leading to scientific progresses that should have rapid clinical implications in this area. Among them is improvement of imaging techniques performance, development of real time diagnosis, and development of new non radiological screening techniques such as the search for circulating tumor DNA, development of biomarkers able to allow precise risk evaluation and stratified screening. As well, overtreatment is currently addressed by biomarker-based de-escalation clinical trials. These advances need to be associated with strong societal support, as well as major paradigm changes regarding the way health and cancer prevention is perceived by individuals.
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Affiliation(s)
- Suzette Delaloge
- Université Paris Saclay, institut Gustave-Roussy, département de médecine oncologique, Inserm U981, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - Thomas Bachelot
- Centre Léon-Bérard, département de cancérologie médicale, 28, rue Laënnec, 69008 Lyon cedex 08, France
| | - François-Clément Bidard
- Université de recherche Paris, sciences et lettres, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Marc Espie
- Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Etienne Brain
- Institut Curie, Saint-Cloud, 35, rue Dailly, 92210 Saint-Cloud, France; Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - Hervé Bonnefoi
- Université de Bordeaux, institut Bergonie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Joseph Gligorov
- Hôpital Tenon, université Paris-Sorbonne, Inserm U938, 4, rue de la Chine, 75020 Paris, France
| | - Florence Dalenc
- Institut universitaire du cancer-Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | | | - David Azria
- Université de Montpellier, institut du cancer, IRCM U1194, 34298 Montpellier, France
| | - Jean-Philippe Jacquin
- Institut de cancérologie de la Loire, 108 B, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | | | - William Jacot
- Université de Montpellier, institut du cancer, IRCM U1194, 34298 Montpellier, France
| | - Anthony Goncalves
- Université Aix-Marseille, institut Paoli-Calmettes, Inserm U1068, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Charles Coutant
- Université de Bourgogne, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21000 Dijon, France
| | - Gérard Ganem
- Centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - Thierry Petit
- Université de Strasbourg, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
| | | | - Marc Debled
- Université de Bordeaux, institut Bergonie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Mario Campone
- Institut d'oncologie de l'Ouest, Inserm U892, IRT-UN, 8, quai Moncousu, 44007 Nantes cedex, France
| | - Christelle Levy
- Centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - Bruno Coudert
- Université de Bourgogne, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21000 Dijon, France
| | - Alain Lortholary
- Centre Catherine-de-Sienne, 2, rue Éric-Tabarly, 44202 Nantes, France
| | - Laurence Venat-Bouvet
- CHU de Limoges, service d'oncologie médicale, 22, avenue Martin-Luther-King, 87000 Limoges, France
| | - Julien Grenier
- Institut Sainte-Catherine, 250, chemin de Baignes-Pieds, 84918 Avignon cedex 9, France
| | | | | | - Johanna Arvis
- Ligue nationale contre le cancer, comité du Lot, 28, boulevard Gambetta, 46000 Cahors, France
| | - Martine Castro
- Europadonna France, 14, rue Corvisart, 75013 Paris, France
| | - Anne Tardivon
- Université de recherche Paris, sciences et lettres, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - David G Cox
- Université de Lyon, 69000 Lyon, France; Université Lyon 1, 69100 Villeurbanne, France; Centre de recherche en cancérologie de Lyon, Inserm U1052, CNRS UMR5286, 69000 Lyon, France; Centre Léon-Bérard, 69008 Lyon, France
| | - Patrick Arveux
- Registre de Côte d'Or, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21000 Dijon, France
| | - Corinne Balleyguier
- Institut Gustave-Roussy, département d'imagerie médicale, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Fabrice André
- Université Paris Saclay, institut Gustave-Roussy, département de médecine oncologique, Inserm U981, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Roman Rouzier
- Université de recherche Paris, sciences et lettres, institut Curie, 26, rue d'Ulm, 75005 Paris, France; Institut Curie, Saint-Cloud, 35, rue Dailly, 92210 Saint-Cloud, France; Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
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95
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Zuckerman SP, Conant EF, Keller BM, Maidment ADA, Barufaldi B, Weinstein SP, Synnestvedt M, McDonald ES. Implementation of Synthesized Two-dimensional Mammography in a Population-based Digital Breast Tomosynthesis Screening Program. Radiology 2016; 281:730-736. [PMID: 27467468 DOI: 10.1148/radiol.2016160366] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the early implementation of synthesized two-dimensional (s2D) mammography in a population screened entirely with s2D and digital breast tomosynthesis (DBT) (referred to as s2D/DBT) and compare recall rates and cancer detection rates to historic outcomes of digital mammography combined with DBT (referred to as digital mammography/DBT) screening. Materials and Methods This was an institutional review board-approved and HIPAA-compliant retrospective interpretation of prospectively acquired data with waiver of informed consent. Compared were recall rates, biopsy rates, cancer detection rates, and radiation dose for 15 571 women screened with digital mammography/DBT from October 1, 2011, to February 28, 2013, and 5366 women screened with s2D/DBT from January 7, 2015, to June 30, 2015. Two-sample z tests of equal proportions were used to determine statistical significance. Results Recall rate for s2D/DBT versus digital mammography/DBT was 7.1% versus 8.8%, respectively (P < .001). Biopsy rate for s2D/DBT versus digital mammography/DBT decreased (1.3% vs 2.0%, respectively; P = .001). There was no significant difference in cancer detection rate for s2D/DBT versus digital mammography/DBT (5.03 of 1000 vs 5.45 of 1000, respectively; P = .72). The average glandular dose was 39% lower in s2D/DBT versus digital mammography/DBT (4.88 mGy vs 7.97 mGy, respectively; P < .001). Conclusion Screening with s2D/DBT in a large urban practice resulted in similar outcomes compared with digital mammography/DBT imaging. Screening with s2D/DBT allowed for the benefits of DBT with a decrease in radiation dose compared with digital mammography/DBT. © RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on August 11, 2016.
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Affiliation(s)
- Samantha P Zuckerman
- From the Breast Imaging Division, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein Place, Philadelphia, PA 19104
| | - Emily F Conant
- From the Breast Imaging Division, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein Place, Philadelphia, PA 19104
| | - Brad M Keller
- From the Breast Imaging Division, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein Place, Philadelphia, PA 19104
| | - Andrew D A Maidment
- From the Breast Imaging Division, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein Place, Philadelphia, PA 19104
| | - Bruno Barufaldi
- From the Breast Imaging Division, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein Place, Philadelphia, PA 19104
| | - Susan P Weinstein
- From the Breast Imaging Division, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein Place, Philadelphia, PA 19104
| | - Marie Synnestvedt
- From the Breast Imaging Division, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein Place, Philadelphia, PA 19104
| | - Elizabeth S McDonald
- From the Breast Imaging Division, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein Place, Philadelphia, PA 19104
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Obdeijn IM, Heijnsdijk EAM, Hunink MGM, Tilanus-Linthorst MMA, de Koning HJ. Mammographic screening in BRCA1 mutation carriers postponed until age 40: Evaluation of benefits, costs and radiation risks using models. Eur J Cancer 2016; 63:135-42. [PMID: 27318001 DOI: 10.1016/j.ejca.2016.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE BRCA1 mutation carriers are offered screening with magnetic resonance imaging (MRI) and mammography. The aim of this study was to weigh benefits and risks of postponing mammographic screening until age 40. METHODS With the MISCAN microsimulation model two screening protocols were evaluated: 1) the current Dutch guidelines: annual MRI from age 25-60, annual mammography from age 30-60, and biennial mammography in the nationwide program from age 60-74, and 2) the modified protocol: with annual mammography postponed until age 40. A cost-effectiveness analysis was performed. The risks of radiation-induced breast cancer mortality were estimated with absolute and relative exposure-risk models of the 7th Biological Effects of Ionising Radiation Committee. RESULTS Current screening guidelines prevent 13,139 breast cancer deaths per 100,000 BRCA1 mutation carriers. Postponing mammography until age 40 would increase breast cancer deaths by 23 (0.17%), but would also reduce radiation-induced breast cancer deaths by 15 or 105 using the absolute and relative risk model respectively per 100,000 women screened. The estimated net effect is an increase of eight or a reduction of 82 breast cancer deaths per 100,000 women screened (depending on the risk model used). The incremental cost of mammograms between age 30-39 is €272,900 per life year gained. CONCLUSIONS The modified protocol may be slightly less effective or even better than the current guidelines. The high cost-savings justify a possible small loss of effectiveness.
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Affiliation(s)
- Inge-Marie Obdeijn
- Department of Radiology, Erasmus University Medical Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands.
| | - Eveline A M Heijnsdijk
- Erasmus University Medical Center, Department of Public Health, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - M G Myriam Hunink
- Department of Radiology, Erasmus University Medical Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands; Erasmus University Medical Center, Department of Epidemiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, 677 Huntington Ave, Boston, MA 02115, USA.
| | | | - Harry J de Koning
- Erasmus University Medical Center, Department of Public Health, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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Hendrick RE, Tredennick T. Benefit to Radiation Risk of Breast-specific Gamma Imaging Compared with Mammography in Screening Asymptomatic Women with Dense Breasts. Radiology 2016; 281:583-588. [PMID: 27257949 DOI: 10.1148/radiol.2016151581] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To estimate the benefit-to-radiation risk ratios of mammography alone, breast-specific gamma imaging (BSGI) alone, and mammography plus BSGI in women with dense breasts who were asymptomatic and examined in the 2015 study by Rhodes et al. Materials and Methods This study uses previously published breast cancer detection rates and estimates of radiation dose and radiation risk and is, therefore, exempt from institutional review board approval. By using breast cancer detection rates for mammography alone, BSGI alone, and mammography plus BSGI from the study by Rhodes et al, as well as lifetime estimates of radiation-induced cancer mortality for mammography and BSGI on the basis of the Biologic Effects of Ionizing Radiation VII report, the benefit-to-radiation risk ratios of mammography alone, BSGI alone, and mammography plus BSGI performed annually over 10-year age intervals from ages 40 to 79 years are estimated. Results The benefit-to-radiation risk ratio is estimated to be 13 for women who are 40-49 years old and are screened with mammography, a figure that approximately doubles for each subsequent 10-year age interval up to 70-79 years old. For low-dose BSGI, annual screening benefit-to-radiation risk ratios are estimated to be 5 for women 40-49 years old and to double by age 70-79 years, while mammography plus BSGI has benefit-to-radiation risk ratios similar to those of BSGI alone. There are wide ranges for all of these estimates. Conclusion While lower dose (300 MBq) BSGI has estimated benefit-to-radiation risk ratios well in excess of 1 for screening of asymptomatic women with dense breasts who are 40 years old and older, it does not match the benefit-to-radiation risk ratio of screening mammography. © RSNA, 2016.
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Affiliation(s)
- R Edward Hendrick
- From the Department of Radiology, University of Colorado-Denver, School of Medicine, 12700 E 19th Ave, Mail Stop C278, Aurora, CO 80045 (R.E.H.); and Breast Imaging Section, Department of Radiology, University of Colorado-Denver, Anschutz Medical Campus, Aurora, Colo (T.T.)
| | - Tara Tredennick
- From the Department of Radiology, University of Colorado-Denver, School of Medicine, 12700 E 19th Ave, Mail Stop C278, Aurora, CO 80045 (R.E.H.); and Breast Imaging Section, Department of Radiology, University of Colorado-Denver, Anschutz Medical Campus, Aurora, Colo (T.T.)
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