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Evans DG, Kotre CJ, Harkness E, Wilson M, Maxwell AJ, Howell A. No strong evidence for increased risk of breast cancer 8-26 years after multiple mammograms in their 30s in females at moderate and high familial risk. Br J Radiol 2016; 89:20150960. [PMID: 26795734 DOI: 10.1259/bjr.20150960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the risks of induction of breast tumours from frequent screening mammography in younger females. METHODS A study group of 853 females was identified who had at least 5 mammograms starting before 37 years of age, with 4 or more before the age of 40 years. These were followed up from their 40th birthday or 8 years from their first mammogram, and their cancer incidence was compared with that of a control group of 1103 females who had an average of 5 mammograms between the ages of 40 and 46 years. All females in the study were previously assessed to be at moderate familial risk or higher. RESULTS There were 43 incident breast cancers in the study group after the 8-year start point, whereas 38.3 were expected from life-table calculations (RR 1.12; 95% CI: 0.83 to 1.51). In the control group, 50 incident breast cancers developed some time after their first mammogram in follow up to age 60 years. The observed, expected ratio from life tables in this group was 0.94 (95% CI: 0.71-1.24), similar to that in the study group. CONCLUSION There was no trend to greater cancer incidence in those receiving mammograms earlier. ADVANCES IN KNOWLEDGE This study shows that there is no substantial effect on the induction of additional primary breast tumours from frequent mammography starting at <37 years of age. Further work on larger numbers of females is necessary to assess longer term risks and determine whether a small excess cancer effect may be present.
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Affiliation(s)
- D Gareth Evans
- 1 Genesis Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Wythenshawe, Manchester, UK.,2 Genomic Medicine, Manchester Academic Health Sciences Centre, University of Manchester and Central Manchester Foundation Trust, Manchester, UK.,3 The Christie NHS Foundation Trust, Manchester, UK
| | - C John Kotre
- 3 The Christie NHS Foundation Trust, Manchester, UK
| | - Elaine Harkness
- 1 Genesis Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Wythenshawe, Manchester, UK.,4 Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Manchester, UK
| | - Mary Wilson
- 1 Genesis Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Wythenshawe, Manchester, UK
| | - Anthony J Maxwell
- 1 Genesis Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Wythenshawe, Manchester, UK.,4 Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Manchester, UK
| | - Anthony Howell
- 1 Genesis Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Wythenshawe, Manchester, UK.,3 The Christie NHS Foundation Trust, Manchester, UK
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Abstract
As the testing criteria for BRCA expand, we are identifying a greater number of young women at significant risk for breast and ovarian cancer. Fortunately, there is strong evidence to support risk reduction from mastectomy and oophorectomy. However, these surgeries come with significant psychological and physical health consequences. For breast cancer, screening with mammogram and magnetic resonance imaging may be a reasonable approach for a woman who does not desire surgery. However, there is no evidence to suggest any efficacy in screening for ovarian cancer, and women electing to not undergo surgery must have a detailed discussion with their physician regarding the risks and benefits of different management strategies. As more women are electing to undergo surgical risk reduction, providers must also be able to counsel and care for these women who will face unique health challenges after surgical menopause at a young age. A review of the current evidence behind management of the BRCA woman follows, with a focus on areas of controversy and current research.
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104
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Daly C, Urbach DR, Stukel TA, Nathan PC, Deitel W, Paszat LF, Wilton AS, Baxter NN. Patterns of diagnostic imaging and associated radiation exposure among long-term survivors of young adult cancer: a population-based cohort study. BMC Cancer 2015; 15:612. [PMID: 26334879 PMCID: PMC4559270 DOI: 10.1186/s12885-015-1578-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 07/27/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Survivors of young adult malignancies are at risk of accumulated exposures to radiation from repetitive diagnostic imaging. We designed a population-based cohort study to describe patterns of diagnostic imaging and cumulative diagnostic radiation exposure among survivors of young adult cancer during a survivorship time period where surveillance imaging is not typically warranted. METHODS Young adults aged 20-44 diagnosed with invasive malignancy in Ontario from 1992-1999 who lived at least 5 years from diagnosis were identified using the Ontario Cancer Registry and matched 5 to 1 to randomly selected cancer-free persons. We determined receipt of 5 modalities of diagnostic imaging and associated radiation dose received by survivors and controls from years 5-15 after diagnosis or matched referent date through administrative data. Matched pairs were censored six months prior to evidence of recurrence. RESULTS 20,911 survivors and 104,524 controls had a median of 13.5 years observation. Survivors received all modalities of diagnostic imaging at significantly higher rates than controls. Survivors received CT at a 3.49-fold higher rate (95% Confidence Interval [CI]:3.37, 3.62) than controls in years 5 to 15 after diagnosis. Survivors received a mean radiation dose of 26 miliSieverts solely from diagnostic imaging in the same time period, a 4.57-fold higher dose than matched controls (95% CI: 4.39, 4.81). CONCLUSIONS Long-term survivors of young adult cancer have a markedly higher rate of diagnostic imaging over time than matched controls, imaging associated with substantial radiation exposure, during a time period when surveillance is not routinely recommended.
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Affiliation(s)
- Corinne Daly
- Department of Surgery, Li Ki Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
| | - David R Urbach
- Department of Surgery, University Health Network, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Thérèse A Stukel
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Paul C Nathan
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
| | - Wayne Deitel
- Department of Radiology, St. Michael's Hospital, Toronto, Canada.
| | - Lawrence F Paszat
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, Canada.
| | - Andrew S Wilton
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Nancy N Baxter
- Department of Surgery, Li Ki Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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Perez AF, Devic C, Colin C, Foray N. [The low doses of radiation: Towards a new reading of the risk assessment]. Bull Cancer 2015; 102:527-38. [PMID: 25959519 DOI: 10.1016/j.bulcan.2015.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/29/2015] [Indexed: 11/16/2022]
Abstract
From Hiroshima bomb explosion data, the risk of radiation-induced cancer is significant from 100 mSv for a population considered as uniform and radioresistant. However, the recent radiobiological data bring some new elements that highlight some features that were not taken into account: the individual factor, the dose rate and the repeated dose effect. The objective evaluation of the cancer risk due to doses lower than 100 mSv is conditioned by high levels of measurability and statistical significance. However, it appears that methodological rigor is not systematically applied in all the papers. Furthermore, unclear communication in press often leads to some announcement effects, which does not improve the readability of the issue. This papers aims to better understand the complexity of the low-dose-specific phenomena as a whole, by confronting the recent biological data with epidemiological data.
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Affiliation(s)
- Anne-Fleur Perez
- Centre de recherche en cancérologie de Lyon, groupe de radiobiologie, Inserm, UMR 1052, bâtiment Cheney A, rue Laennec, 69008 Lyon, France
| | - Clément Devic
- Centre de recherche en cancérologie de Lyon, groupe de radiobiologie, Inserm, UMR 1052, bâtiment Cheney A, rue Laennec, 69008 Lyon, France
| | - Catherine Colin
- Centre de recherche en cancérologie de Lyon, groupe de radiobiologie, Inserm, UMR 1052, bâtiment Cheney A, rue Laennec, 69008 Lyon, France
| | - Nicolas Foray
- Centre de recherche en cancérologie de Lyon, groupe de radiobiologie, Inserm, UMR 1052, bâtiment Cheney A, rue Laennec, 69008 Lyon, France.
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Levin D, Seo JB, Kiely DG, Hatabu H, Gefter W, van Beek EJR, Schiebler ML. Triage for suspected acute Pulmonary Embolism: Think before opening Pandora's Box. Eur J Radiol 2015; 84:1202-11. [PMID: 25864020 DOI: 10.1016/j.ejrad.2015.03.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/26/2015] [Accepted: 03/23/2015] [Indexed: 12/22/2022]
Abstract
This is a review of the current strengths and weaknesses of the various imaging modalities available for the diagnosis of suspected non-massive Pulmonary Embolism (PE). Without careful consideration for the clinical presentation, and the timely application of clinical decision support (CDS) methodology, the current overutilization of imaging resources for this disease will continue. For a patient with a low clinical risk profile and a negative D-dimer there is no reason to consider further workup with imaging; as the negative predictive value in this scenario is the same as imaging. While the current efficacy and effectiveness data support the continued use of Computed Tomographic angiography (CTA) as the imaging golden standard for the diagnosis of PE; this test does have the unintended consequences of radiation exposure, possible overdiagnosis and overuse. There is a persistent lack of appreciation on the part of ordering physicians for the effectiveness of the alternatives to CTA (ventilation-perfusion imaging and contrast enhanced magnetic resonance angiography) in these patients. Careful use of standardized protocols for patient triage and the application of CDS will allow for a better use of imaging resources.
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Affiliation(s)
- David Levin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, M-15, M-Floor, Royal Hallamshire Hospital, Sheffield, UK
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School Boston, MA, USA
| | - Warren Gefter
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mark L Schiebler
- Department of Radiology, UW-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA.
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Heiniger L, Butow PN, Charles M, Price MA. Intuition versus cognition: a qualitative exploration of how women understand and manage their increased breast cancer risk. J Behav Med 2015; 38:727-39. [PMID: 25820809 DOI: 10.1007/s10865-015-9632-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/18/2015] [Indexed: 01/05/2023]
Abstract
Risk comprehension in individuals at increased familial risk of cancer is suboptimal and little is known about how risk is understood and managed by at-risk individuals who do not undergo genetic testing. We qualitatively studied these issues in 36 unaffected women from high-risk breast cancer families, including both women who had and had not undergone genetic testing. Data were collected through semi-structured interviews and data analysis was guided by Grounded Theory. Risk comprehension and risk management were largely influenced by the individual's experience of coming from a high-risk family, with both tested and untested women relying heavily on their intuition. Although women's cognitive understanding of their risk appeared generally accurate, this objective risk information was considered of secondary value. The findings could be used to guide the development and delivery of information about risk and risk management to genetically tested and untested individuals at increased risk of hereditary cancer.
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Affiliation(s)
- Louise Heiniger
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia. .,Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia.
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Margaret Charles
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | | | - Melanie A Price
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
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108
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Bick U. Intensified surveillance for early detection of breast cancer in high-risk patients. Breast Care (Basel) 2015; 10:13-20. [PMID: 25960720 PMCID: PMC4395819 DOI: 10.1159/000375390] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Efforts for early detection of breast cancer play an important role in the care of high-risk women. This will include both women with a pathological mutation in one of the known breast cancer susceptibility genes as well as women with a high breast cancer risk based on family history only. Due to the much higher incidence of breast cancer in premenopausal women with a genetic predisposition or a familial background, to be most effective, imaging-based breast surveillance should start at an age as early as 25-30 years. There is now ample evidence that magnetic resonance imaging (MRI) is by far the most sensitive imaging modality in young high-risk women. With high-risk multimodality screening at least 30% of breast cancers will be detected primarily by MRI and would have been missed at regular screening without MRI. Therefore, most high-risk breast surveillance programs now offer annual MRI to eligible high-risk women from age 25 to 30, usually supplemented by regular mammography starting at least from age 40. The inclusion of clinical breast exam (CBE) and/or ultrasound in the high-risk surveillance has little impact on the detection of additional cancers, but may improve compliance and reduce unnecessary callbacks for nonspecific findings on MRI. To reduce advanced stage interval cancers, especially in BRCA1/2 mutation carriers, some programs offer additional semiannual CBE and/or ultrasound or alternate MRI and mammography every 6 months. How long regular MRI should be continued in high-risk women is a matter of considerable debate. It appears feasible that MRI can safely be discontinued even in BRCA1/2 mutation carriers between the age of 60 and 70, especially if mammographic breast density is low. Even though several cohort studies have now demonstrated a very favorable stage distribution of breast cancers found in women undergoing high-risk surveillance with MRI, data on long-term survival and mortality in these patients is still rare.
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Affiliation(s)
- Ulrich Bick
- Department of Radiology, Charité Berlin, Germany
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110
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Drooger JC, Hooning MJ, Seynaeve CM, Baaijens MHA, Obdeijn IM, Sleijfer S, Jager A. Diagnostic and therapeutic ionizing radiation and the risk of a first and second primary breast cancer, with special attention for BRCA1 and BRCA2 mutation carriers: a critical review of the literature. Cancer Treat Rev 2014; 41:187-96. [PMID: 25533736 DOI: 10.1016/j.ctrv.2014.12.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 12/15/2022]
Abstract
Occurrence of breast cancer is a well-known long-term side effect of ionizing radiation (both diagnostic and therapeutic). The radiation-induced breast cancer risk increases with longer follow-up, higher radiation dose and younger age of exposure. The risk for breast cancer following irradiation for lymphomas is well known. Although data regarding the carcinogenic risk of adjuvant radiotherapy for a primary breast cancer are sparse, an increased risk is suggested with longer follow-up mainly when exposed at younger age. Particularly, patients with a BRCA1/2 mutation might be more sensitive for the deleterious effects of ionizing radiation due to an impaired capacity of repairing double strand DNA breaks. This might have consequences for the use of mammography in breast cancer screening, as well as the choice between breast conserving therapy including radiotherapy and mastectomy at primary breast cancer diagnosis in young BRCA1/2 mutation carriers. Good data regarding this topic, however, are scarce, mainly due to constraints in the design of performed studies. In this review, we will discuss the current literature on the association between ionizing radiation and developing breast cancer, with particular attention to patients with a BRCA1/2 mutation.
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Affiliation(s)
- Jan C Drooger
- Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands; Ikazia Hospital, Department of Internal Medicine, PO Box 3008 AA, Rotterdam, The Netherlands.
| | - Maartje J Hooning
- Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Caroline M Seynaeve
- Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Margreet H A Baaijens
- Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Radiotherapy, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Inge Marie Obdeijn
- Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Radiology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Agnes Jager
- Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Department of Medical Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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Abstract
BACKGROUND Radiation exposure from diagnostic imaging procedures is associated with increased cancer risk. No published data currently exist regarding ionizing radiation exposure in total ankle replacement surgery. This study quantified intraoperative fluoroscopic dose and duration during ankle replacement surgery and examined patient and technical factors affecting the level of exposure. METHODS Fifty-five patients underwent ankle replacement using STAR, Salto-Talaris, or INBONE total ankles. Intraoperative fluoroscopic dose and duration, patient demographics, implant design, and accompanying additional procedures were documented for each case. The relationship between each relevant variable and radiation dose and time was determined. RESULTS The mean fluoroscopic dose and duration for all cases were 1.15 ± 0.84 milliGray per case and 77 ± 34 seconds per case, respectively. There was a positive correlation between the absorbed radiation dose and the duration of fluoroscopy (r = .50, P < .001). The mean fluoroscopic doses were 1.53 milliGray, 0.99 milliGray, and 0.88 milliGray for INBONE, STAR, and Salto-Talaris prostheses, respectively. Fluoroscopic dose was significantly influenced by implant design (P = .035), with implants using an intramedullary referencing guide associated with higher radiation doses. After excluding cases requiring additional procedures, the fluoroscopic time and radiation dose associated with intramedullary referencing guide implants continued to exceed those of the other implants, but the differences were no longer statistically significant (P = .22, P = .09, respectively). CONCLUSION The average patient radiation dose during total ankle replacement was approximately one-fifth the recommended maximum yearly radiation exposure. The radiation dose was positively associated with fluoroscopy duration. Among factors controllable by the surgeon, selection of an implant with an extramedullary alignment system and conscious effort to minimize duration of fluoroscopy can reduce harmful radiation exposure and decrease cancer risk in total ankle replacement patients and associated operating room personnel. LEVEL OF EVIDENCE Level III, comparative series.
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113
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Doutriaux-Dumoulin I, Meingan P, Delnatte C. Dépistage et imagerie chez les femmes à haut risque génétique. Standards et développements. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2450-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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114
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Chen YA, Gray BG, Bandiera G, MacKinnon D, Deva DP. Variation in the utilization and positivity rates of CT pulmonary angiography among emergency physicians at a tertiary academic emergency department. Emerg Radiol 2014; 22:221-9. [DOI: 10.1007/s10140-014-1265-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/27/2014] [Indexed: 01/17/2023]
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115
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Taira N, Arai M, Ikeda M, Iwasaki M, Okamura H, Takamatsu K, Yamamoto S, Ohsumi S, Mukai H. The Japanese Breast Cancer Society clinical practice guideline for epidemiology and prevention of breast cancer. Breast Cancer 2014; 22:16-27. [DOI: 10.1007/s12282-014-0555-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/14/2014] [Indexed: 12/29/2022]
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Giannakeas V, Lubinski J, Gronwald J, Moller P, Armel S, Lynch HT, Foulkes WD, Kim-Sing C, Singer C, Neuhausen SL, Friedman E, Tung N, Senter L, Sun P, Narod SA. Mammography screening and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers: a prospective study. Breast Cancer Res Treat 2014; 147:113-8. [DOI: 10.1007/s10549-014-3063-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 11/24/2022]
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Abstract
BACKGROUND The commercial introduction of next-generation sequencing has made it possible to test for mutations in all known or suspected breast cancer predisposition genes in one panel, at one time, for about the same cost as a BRCA gene test. Clinicians are increasingly presented with the challenge of advising patients with mutations in rare breast cancer predisposition genes. METHODS Literature review and personal experience with panel tests. RESULTS Panel tests are more likely to identify a variant of uncertain clinical significance than a deleterious mutation. In addition, not all of the genes included in panel tests are unequivocally linked to increased breast cancer risk, and for most genes the penetrance is highly variable, making it difficult to translate a specific mutation into an absolute breast cancer risk. The three-generation cancer family history should be used to select truly high-risk families for panel testing, and then referred to again when the results are received in order to guide risk-management decisions. Knowing a breast cancer patient's mutation status can influence decisions about local-regional and systemic therapy, but turnaround times for many tests are still too long to incorporate them into the initial evaluation of a new breast cancer. CONCLUSION The commercialization of next-generation sequencing has the potential to greatly enhance the identification and management of individuals with an inherited predisposition to breast cancer. A period of uncertainty is anticipated before the full potential of this new technology is realized.
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Friebel TM, Domchek SM, Rebbeck TR. Modifiers of cancer risk in BRCA1 and BRCA2 mutation carriers: systematic review and meta-analysis. J Natl Cancer Inst 2014; 106:dju091. [PMID: 24824314 DOI: 10.1093/jnci/dju091] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is substantial variability in cancer risk in women who have inherited a BRCA1 or BRCA2 (BRCA1/2) mutation. Numerous factors have been hypothesized to modify these risks, but studies are of variable quality, and it remains unclear which of these may be of value in clinical risk assessment. METHODS PubMed and Web of Science databases were searched for articles published through September 2013. Fixed effects meta-analysis was done using the hazard ratios and/or odds ratios to estimate the pooled effect estimates (ES) and 95% confidence intervals (CIs) to identify factors that are associated with cancer risk modification in BRCA1/2 mutation carriers. RESULTS We identified 44 nonoverlapping studies that met predefined quality criteria. Sufficient evidence is available to make clinically relevant inferences about a number of cancer risk modifiers. The only variable examined that produced a probable association was late age at first live birth, a meta-analysis showed a decrease in the risk of breast cancer in BRCA1 mutation carriers with women aged 30 years or older vs. women younger than 30 years (ES = 0.65; 95% CI =0.42 to 0.99). The same was shown for women aged 25 to 29 years versus those aged less than 25 years (ES = 0.69; 95% CI = 0.48 to 0.99). Breastfeeding and tubal ligation were associated with reduced ovarian cancer risk in BRCA1 mutation carriers; oral contraceptives were associated with reduced risk among BRCA1/2 mutation carriers. Smoking was associated with increased breast cancer risk in BRCA2 mutation carriers only. CONCLUSIONS Data assessing many potential risk modifiers are inadequate, and many have not been externally validated. Although additional studies are required to confirm some associations, sufficient information is available for some risk factors to be used in risk counseling or lifestyle modification to minimize cancer risk in BRCA1/2 mutation carriers
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Mieres JH, Gulati M, Bairey Merz N, Berman DS, Gerber TC, Hayes SN, Kramer CM, Min JK, Newby LK, Nixon JVI, Srichai MB, Pellikka PA, Redberg RF, Wenger NK, Shaw LJ. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation 2014; 130:350-79. [PMID: 25047587 DOI: 10.1161/cir.0000000000000061] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Densely ionizing radiation has always been a main topic in radiobiology. In fact, α-particles and neutrons are sources of radiation exposure for the general population and workers in nuclear power plants. More recently, high-energy protons and heavy ions attracted a large interest for two applications: hadrontherapy in oncology and space radiation protection in manned space missions. For many years, studies concentrated on measurements of the relative biological effectiveness (RBE) of the energetic particles for different end points, especially cell killing (for radiotherapy) and carcinogenesis (for late effects). Although more recently, it has been shown that densely ionizing radiation elicits signalling pathways quite distinct from those involved in the cell and tissue response to photons. The response of the microenvironment to charged particles is therefore under scrutiny, and both the damage in the target and non-target tissues are relevant. The role of individual susceptibility in therapy and risk is obviously a major topic in radiation research in general, and for ion radiobiology as well. Particle radiobiology is therefore now entering into a new phase, where beyond RBE, the tissue response is considered. These results may open new applications for both cancer therapy and protection in deep space.
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Affiliation(s)
- M Durante
- GSI Helmholtz Center for Heavy Ion Research, Biophysics Department, Darmstadt, Germany
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121
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Cooper BT, Murphy JO, Sacchini V, Formenti SC. Local approaches to hereditary breast cancer. Ann Oncol 2014; 24 Suppl 8:viii54-viii60. [PMID: 24131971 DOI: 10.1093/annonc/mdt327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The diagnostic and local treatment modalities of hereditary breast cancer (HBC) are evolving based on emerging evidence from new imaging, radiotherapy and surgical studies. The optimal selection of diagnostic and therapeutic strategies for the individual HBC patient remains an area of active research in this relatively new patient population. In this context, some rational pathways of intervention are currently available to both reduce cancer risk in mutation carriers without a cancer diagnosis, as well as to reduce the risk of recurrence or new cancers among the carriers already diagnosed with a malignancy. It is encouraging to notice to what degree certain interventions have successfully reduced both the risk of malignancy and the anxiety associated with this genetic diagnosis. This updated report aims at summarizing the most recent findings, while it identifies the areas of uncertainty that remain, and continue to present difficult challenges, particularly among younger HBC patients.
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Affiliation(s)
- B T Cooper
- Department of Radiation Oncology, New York University School of Medicine, 550 First Avenue, New York, New York
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Little MP, Schaeffer ML, Reulen RC, Abramson DH, Stovall M, Weathers R, de Vathaire F, Diallo I, Seddon JM, Hawkins MM, Tucker MA, Kleinerman RA. Breast cancer risk after radiotherapy for heritable and non-heritable retinoblastoma: a US-UK study. Br J Cancer 2014; 110:2623-32. [PMID: 24755883 PMCID: PMC4021527 DOI: 10.1038/bjc.2014.193] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/13/2014] [Accepted: 03/15/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Retinoblastoma is a rare childhood eye cancer caused by germline or somatic mutations in the RB1 gene. Previous studies observed elevated breast cancer risk among retinoblastoma survivors. However, there has been no research on breast cancer risk in relation to radiation (primarily scatter radiation from the primary treatment) and genetic susceptibility of retinoblastoma survivors. METHODS Two groups of retinoblastoma survivors from the US and UK were selected, and breast cancer risk analysed using a case-control methodology, nesting within the respective cohorts, matching on heritability (that is to say, having bilateral retinoblastoma or being unilateral cases with at least one relative with retinoblastoma), and using exact statistical methods. There were a total of 31 cases and 77 controls. RESULTS Overall there was no significant variation of breast cancer risk with dose (P>0.5). However, there was a pronounced and significant (P=0.047) increase in the risk of breast cancer with increasing radiation dose for non-heritable retinoblastoma patients and a slight and borderline significant (P=0.072) decrease in risk of breast cancer with increasing radiation dose for heritable retinoblastoma patients, implying significant (P=0.024) heterogeneity in radiation risk between the heritable and non-heritable retinoblastoma groups; this was unaffected by the blindness status. There was no significant effect of any type of alkylating-agent chemotherapy on breast cancer risk (P>0.5). CONCLUSIONS There is significant radiation-related risk of breast cancer for non-heritable retinoblastoma survivors but no excess risk for heritable retinoblastoma survivors, and no significant risk overall. However, these results are based on very small numbers of cases; therefore, they must be interpreted with caution.
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Affiliation(s)
- M P Little
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - M L Schaeffer
- Department of Statistics, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - R C Reulen
- Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - D H Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - M Stovall
- Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - R Weathers
- Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - F de Vathaire
- Radiation Epidemiology Group, Unit 1018 INSERM, Institut Gustave Roussy, 98000 Villejuif, France
| | - I Diallo
- Radiation Epidemiology Group, Unit 1018 INSERM, Institut Gustave Roussy, 98000 Villejuif, France
| | - J M Seddon
- Ophthalmic Epidemiology and Genetics Service, Tufts-New England Medical Center, Boston, MA 02111, USA
| | - M M Hawkins
- Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - M A Tucker
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - R A Kleinerman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Hiraki S, Rinella ES, Schnabel F, Oratz R, Ostrer H. Cancer risk assessment using genetic panel testing: considerations for clinical application. J Genet Couns 2014; 23:604-17. [PMID: 24599651 DOI: 10.1007/s10897-014-9695-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 01/28/2014] [Indexed: 02/07/2023]
Abstract
With the completion of the Human Genome Project and the development of high throughput technologies, such as next-generation sequencing, the use of multiplex genetic testing, in which multiple genes are sequenced simultaneously to test for one or more conditions, is growing rapidly. Reflecting underlying heterogeneity where a broad range of genes confer risks for one or more cancers, the development of genetic cancer panels to assess these risks represents just one example of how multiplex testing is being applied clinically. There are a number of issues and challenges to consider when conducting genetic testing for cancer risk assessment, and these issues become exceedingly more complex when moving from the traditional single-gene approach to panel testing. Here, we address the practical considerations for clinical use of panel testing for breast, ovarian, and colon cancers, including the benefits, limitations and challenges, genetic counseling issues, and management guidelines.
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Affiliation(s)
- Susan Hiraki
- Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 819, Bronx, NY, 10046, USA,
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124
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Obdeijn IM, Winter-Warnars GAO, Mann RM, Hooning MJ, Hunink MGM, Tilanus-Linthorst MMA. Should we screen BRCA1 mutation carriers only with MRI? A multicenter study. Breast Cancer Res Treat 2014; 144:577-82. [PMID: 24567197 DOI: 10.1007/s10549-014-2888-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/14/2014] [Indexed: 11/29/2022]
Abstract
BRCA1 mutation carriers are offered screening with MRI and mammography. Aim of the study was to investigate the additional value of digital mammography over MRI screening. BRCA1 mutation carriers, who developed breast cancer since the introduction of digital mammography between January 2003 and March 2013, were included. The images and reports were reviewed in order to assess whether the breast cancers were screen-detected or interval cancers and whether they were visible on mammography and MRI, using the breast imaging and data system classification allocated at the time of diagnosis. In 93 BRCA1 mutation carriers who underwent screening with MRI and mammography, 82 invasive breast cancers and 12 ductal carcinomas in situ (DCIS) were found. Screening sensitivity was 95.7 % (90/94). MRI detected 88 of 94 breast cancers (sensitivity 93.6 %), and mammography detected 48 breast cancers (sensitivity 51.1 %) (two-sided p < 0.001). Forty-two malignancies were detected only by MRI (42/94 = 44.7 %). Two DCIS were detected only with mammography (2/94 = 2.1 %) concerning a grade 3 in a 50-year-old patient and a grade 2 in a 67-year-old patient. Four interval cancers occurred (4/94 = 4.3 %), all grade 3 triple negative invasive ductal carcinomas. In conclusion, digital mammography added only 2 % to the breast cancer detection in BRCA1 patients. There was no benefit of additional mammography in women below age 40. Given the potential risk of radiation-induced breast cancer in young mutation carriers, we propose to screen BRCA1 mutation carriers yearly with MRI from age 25 onwards and to start with mammographic screening not earlier than age 40.
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Affiliation(s)
- Inge-Marie Obdeijn
- Department of Radiology, Erasmus University Medical Center Rotterdam, Groene Hilledijk 301, 3075, EA, Rotterdam, The Netherlands,
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Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2014; 14:e621-9. [PMID: 24275135 DOI: 10.1016/s1470-2045(13)70303-6] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were given radiation to fields that include breast tissue (ie, chest radiation) have an increased risk of breast cancer. Clinical practice guidelines are essential to ensure that these individuals receive optimum care and to reduce the detrimental consequences of cancer treatment; however, surveillance recommendations vary among the existing long-term follow-up guidelines. We applied evidence-based methods to develop international, harmonised recommendations for breast cancer surveillance among female survivors of CAYA cancer who were given chest radiation before age 30 years. The recommendations were formulated by an international, multidisciplinary panel and are graded according to the strength of the underlying evidence.
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Seymour CB, Mothersill C. Breast cancer causes and treatment: where are we going wrong? BREAST CANCER (DOVE MEDICAL PRESS) 2013; 5:111-9. [PMID: 24648764 PMCID: PMC3929331 DOI: 10.2147/bctt.s44399] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This discussion paper seeks to provoke thoughts about cancer research in general, and why breast cancer in particular is not yet "curable". It asks the question - are we looking at the disease in the right way? Should we regard cancer as a progressive state, which is part of aging? Should we tailor treatment to "reset" the system or slow progression rather than try using toxic and aggressive therapy to kill every cancer cell (and sometimes also the patient)? The thesis is presented that we need to revisit our fundamental beliefs about the disease and then ask why we cling to beliefs that clearly are no longer valid. The paper also questions the role of ethics boards in hampering research and discusses the concept that breast cancer is an industry with vested interests involving profiteering by preventive, diagnostic, and therapeutic players. Finally, the paper suggests some ways forward based on emerging concepts in system biology and epigenetics.
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Affiliation(s)
- Colin B Seymour
- Medical Physics and Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Carmel Mothersill
- Medical Physics and Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
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127
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Magnetic resonance and computed tomography imaging of the structural and functional changes of pulmonary arterial hypertension. J Thorac Imaging 2013; 28:178-93. [PMID: 23612440 DOI: 10.1097/rti.0b013e31828d5c48] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The current Dana Point Classification system (2009) distinguishes elevation of pulmonary arterial pressure into pulmonary arterial hypertension (PAH) and pulmonary hypertension. Fortunately, PAH is not a common disease. However, with the aging of the First World's population, heart failure has become an important outcome of pulmonary hypertension, with up to 9% of the population involved. PAH is usually asymptomatic until late in the disease process. Although features that are indirectly related to PAH are found on noninvasive imaging studies, its diagnosis and management still require right heart catheterization. Imaging features of PAH include the following: (1) enlargement of the pulmonary trunk and main pulmonary arteries; (2) decreased pulmonary arterial compliance; (3) tapering of the peripheral pulmonary arteries; (4) enlargement of the inferior vena cava; and (5) increased mean transit time. The chronic requirement to generate high pulmonary arterial pressure measurably affects the right heart and main pulmonary artery. This change in physiology causes the following structural and functional alterations that have been shown to have prognostic significance: relative area change (RAC) of the pulmonary trunk, right ventricular stroke volume index, right ventricular stroke volume, right ventricular end-diastolic volume index, left ventricular end-diastolic volume index, and baseline right ventricular ejection fraction <35%. All of these variables can be quantified noninvasively and followed up longitudinally in each patient using magnetic resonance imaging to modify the treatment regimen. Untreated PAH frequently results in rapid clinical decline and death within 3 years of diagnosis. Unfortunately, even with treatment, fewer than half of these patients are alive at 4 years.
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Stankevicins L, Almeida da Silva AP, Ventura Dos Passos F, Dos Santos Ferreira E, Menks Ribeiro MC, G David M, J Pires E, Ferreira-Machado SC, Vassetzky Y, de Almeida CE, de Moura Gallo CV. MiR-34a is up-regulated in response to low dose, low energy X-ray induced DNA damage in breast cells. Radiat Oncol 2013; 8:231. [PMID: 24094113 PMCID: PMC3829672 DOI: 10.1186/1748-717x-8-231] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/01/2013] [Indexed: 12/31/2022] Open
Abstract
Background MicroRNAs are non-coding RNAs involved in the regulation of gene expression including DNA damage responses. Low doses of low energy X-ray radiation, similar to those used in mammographic exams, has been described to be genotoxic. In the present work we investigated the expression of miR-34a; a well described p53-regulated miRNA implicated in cell responses to X-ray irradiation at low doses. Methods Non-cancerous breast cell line MCF-10A and cancerous T-47D and MCF-7 cell lines were submitted to a low-energy X-ray irradiation (ranging from 28–30 Kv) using a dose of 5 Gy. The expression level of miR-34a, let-7a and miR-21 was assessed by qRT-PCR at 4 and 24 hours post-irradiation. DNA damage was then measured by comet assay and micronuclei estimation in MCF-10A and MCF-7 cell lines, where an increase of miR-34a levels could be observed after irradiation. The rate of apoptotic cells was estimated by nuclear staining and fluorescence microscopy. These experiments were also performed at low doses (3; 12 and 48 mGy) in MCF-10A and MCF-7 cell lines. Results We have observed an increase in miR-34a expression 4 hours post-irradiation at 5 Gy in MCF-10A and MCF-7 cell lines while its level did not change in T-47D, a breast cancer cell line bearing non-functional p53. At low doses, miR-34a was up-regulated in non-tumoral MCF-10A to a higher extent as compared to MCF-7. MiR-34a levels decreased 24 hours post-irradiation. We have also observed DNA damage and apoptosis at low-energy X-ray irradiation at low doses and the high dose in MCF-10A and MCF-7 4 and 24 hours post-irradiation relative to the mock control. Conclusion Low energy X-ray is able to promote DNA strand breaks and miR-34a might be involved in cell responses to low energy X-ray DNA damage. MiR-34a expression correlates with X-ray dose, time after irradiation and cell type. The present study reinforces the need of investigating consequences of low dose X-ray irradiation of breast cells.
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Affiliation(s)
- Luiza Stankevicins
- Departamento de Genética, Universidade do Estado do Rio de Janeiro, Instituto de Biologia Roberto Alcantara Gomes, 20550-013 Rio de Janeiro, Brazil.
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Schiebler ML, Nagle SK, François CJ, Repplinger MD, Hamedani AG, Vigen KK, Yarlagadda R, Grist TM, Reeder SB. Effectiveness of MR angiography for the primary diagnosis of acute pulmonary embolism: clinical outcomes at 3 months and 1 year. J Magn Reson Imaging 2013; 38:914-25. [PMID: 23553735 PMCID: PMC3970266 DOI: 10.1002/jmri.24057] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 01/07/2013] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To determine the effectiveness of MR angiography for pulmonary embolism (MRA-PE) in symptomatic patients. MATERIALS AND METHODS We retrospectively reviewed all patients whom were evaluated for possible pulmonary embolism (PE) using MRA-PE. A 3-month and 1-year from MRA-PE electronic medical record (EMR) review was performed. Evidence for venous thromboembolism (VTE) (or death from PE) within the year of follow-up was the outcome surrogate for this study. RESULTS There were 190 MRA-PE exams performed with 97.4% (185/190) of diagnostic quality. There were 148 patients (120 F: 28 M) that had both a diagnostic MRA-PE exam and 1 complete year of EMR follow-up. There were 167 patients (137 F: 30 M) with 3 months or greater follow-up. We found 83% (139/167) and 81% (120/148) MRA-PE exams negative for PE at 3 months and 1 year, respectively. Positive exams for PE were seen in 14% (23/167). During the 1-year follow-up period, five patients (false negative) were diagnosed with DVT (5/148 = 3.4 %), and one of these patients also experienced a non-life-threatening PE. The negative predictive value (NPV) for MRA-PE was 97% (92-99; 95% CI) at 3 months and 96% (90-98; 95% CI) with 1 year of follow-up. CONCLUSION The NPV of MRA-PE, when used for the primary diagnosis of pulmonary embolism in symptomatic patients, were found to be similar to the published values for CTA-PE. In addition, the technical success rate and safety of MRA-PE were excellent.
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Affiliation(s)
- Mark L. Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Scott K. Nagle
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, USA
| | - Christopher J. François
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Azita G. Hamedani
- Department of Emergency Medicine, Uinveristy of Wisconsin, Madison, WI, USA
| | - Karl K. Vigen
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Rajkumar Yarlagadda
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Omaha Imaging, Omaha, Nebraska, USA
| | - Thomas M. Grist
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
| | - Scott B. Reeder
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
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130
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Entrance skin dosimetry and size-specific dose estimate from pediatric chest CTA. J Cardiovasc Comput Tomogr 2013; 8:97-107. [PMID: 24211194 DOI: 10.1016/j.jcct.2013.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/27/2013] [Accepted: 08/16/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Size-specific dose estimate (SSDE), which corrects CT dose index (CTDI) for body diameter and is a better measure of organ dose than is CTDI, has not yet been validated in vivo. OBJECTIVE The purpose was to determine the correlation between SSDE and measured breast entrance skin dose (ESD) for pediatric chest CT angiography across a variety of techniques, scanner models, and patient sizes. METHODS During 42 examinations done on 4 different scanners over 7 years, we measured mid-sternal ESD as an approximation of breast dose with skin dosimeters. We recorded age, weight, effective tube current, kilovoltage potential, console CTDI, and dose-length product, from which we calculated effective dose. We measured effective chest diameter to convert CTDI to SSDE, and we correlated SSDE with measured ESD, using linear regression. We evaluated image quality to answer the clinical question. RESULTS Patient mean (±SD) age was 8.4 ± 6.1 years (median, 7.9 years; range, 0.02-19.5 years); mean weight was 35 ± 27 kg (median, 26 kg; range, 3.5-115 kg); effective chest diameter was 20 ± 7 cm (median, 19 cm; range, 10-35 cm). Mean effective dose was 2.9 ± 2.8 mSv (median, 2.2 mSv; range, 0.1-14.4 mSv). We observed a linear correlation (R(2) = 0.98, P < .005) between SSDE (mean, 11 ± 11mGy; median, 7 mGy; range, 0.5-40 mGy) and breast ESD (mean, 12 ± 11 mGy; median, 7 mGy; range, 0.3-44 mGy). Our doses, which compared favorably with those previously reported, decreased significantly (P < .05) during the course of our study, because of the introduction of automatic exposure control, low kilovoltage, and high pitch techniques. All studies were of diagnostic quality. CONCLUSION SSDE is a valid dose measure in children undergoing chest CT angiography over a wide range of scanner platforms, techniques, and patient sizes, and it may be used to model breast dose and to document the results of dose reduction strategies.
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131
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Miesfeldt S, Lamb A, Duarte C. Management of genetic syndromes predisposing to gynecologic cancers. Curr Treat Options Oncol 2013; 14:34-50. [PMID: 23315239 DOI: 10.1007/s11864-012-0215-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Women with personal and family histories consistent with gynecologic cancer-associated hereditary cancer susceptibility disorders should be referred for genetic risk assessment and counseling. Genetic counseling facilitates informed medical decision making regarding genetic testing, screening, and treatment, including chemoprevention and risk-reducing surgery. Because of limitations of ovarian cancer screening, hereditary breast and ovarian cancer-affected women are offered risk-reducing bilateral salpingo-oophorectomy (BSO) between ages 35 and 40 years, or when childbearing is complete. Women with documented Lynch syndrome, associated with mutations in mismatch repair genes, should be screened at a young age and provided prevention options, including consideration of risk-reducing total abdominal hysterectomy and BSO, as well as intensive gastrointestinal screening. Clinicians caring for high-risk women must consider the potential adverse ethical, legal, and social issues associated with hereditary cancer risk assessment and testing. Additionally, at-risk family members should be alerted to their cancer risks, as well as the availability of risk assessment, counseling, and treatment services.
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Affiliation(s)
- Susan Miesfeldt
- Cancer Risk and Prevention Program, Maine Medical Center Cancer Institute, Scarborough, ME 04074, USA.
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132
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John EM, McGuire V, Thomas D, Haile R, Ozcelik H, Milne RL, Felberg A, West DW, Miron A, Knight JA, Terry MB, Daly M, Buys SS, Andrulis IL, Hopper JL, Southey MC, Giles GG, Apicella C, Thorne H, Whittemore AS. Diagnostic chest X-rays and breast cancer risk before age 50 years for BRCA1 and BRCA2 mutation carriers. Cancer Epidemiol Biomarkers Prev 2013; 22:1547-56. [PMID: 23853209 DOI: 10.1158/1055-9965.epi-13-0189] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The effects of low-dose medical radiation on breast cancer risk are uncertain, and few studies have included genetically susceptible women, such as those who carry germline BRCA1 and BRCA2 mutations. METHODS We studied 454 BRCA1 and 273 BRCA2 mutation carriers ages younger than 50 years from three breast cancer family registries in the United States, Canada, and Australia/New Zealand. We estimated breast cancer risk associated with diagnostic chest X-rays by comparing mutation carriers with breast cancer (cases) with those without breast cancer (controls). Exposure to chest X-rays was self-reported. Mammograms were not considered in the analysis. RESULTS After adjusting for known risk factors for breast cancer, the ORs for a history of diagnostic chest X-rays, excluding those for tuberculosis or pneumonia, were 1.16 [95% confidence interval (CI), 0.64-2.11] for BRCA1 mutations carriers and 1.22 (95% CI, 0.62-2.42) for BRCA2 mutations carriers. The OR was statistically elevated for BRCA2 mutation carriers with three to five diagnostic chest X-rays (P = 0.01) but not for those with six or more chest X-rays. Few women reported chest fluoroscopy for tuberculosis or chest X-rays for pneumonia; the OR estimates were elevated, but not statistically significant, for BRCA1 mutation carriers. CONCLUSIONS Our findings do not support a positive association between diagnostic chest X-rays and breast cancer risk before the ages of 50 years for BRCA1 or BRCA2 mutation carriers. IMPACT Given the increasing use of diagnostic imaging involving higher ionizing radiation doses, further studies of genetically predisposed women are warranted.
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Affiliation(s)
- Esther M John
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538-2334, USA.
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Murphy MFG, Bithell JF, Stiller CA, Kendall GM, O'Neill KA. Childhood and adult cancers: contrasts and commonalities. Maturitas 2013; 76:95-8. [PMID: 23830077 DOI: 10.1016/j.maturitas.2013.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/29/2013] [Indexed: 11/26/2022]
Abstract
Tumours occurring in children differ considerably from those occurring at older ages but exhibit common features. Those occurring in the teenage/young adult (TYA) years represent a transitional mixture of child and adult tumours and pose a considerable challenge for optimal clinical management and service provision. Nevertheless the fundamental processes of malignant change, arising from genetic/epigenetic interaction with environmental exposures, seem to operate across all ages and the entire tumour spectrum. We focus here on the ways in which genotype (and epigenetic modification), growth processes (particularly in utero), and exposure to ionising radiation (in conjunction with genetic susceptibility) affect cancer risk from childhood to adulthood, whether as a primary occurrence, or a second primary tumour following earlier primary occurrence and treatment.
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Affiliation(s)
- Michael F G Murphy
- Childhood Cancer Research Group, New Richards Building, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LG, United Kingdom.
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134
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Drukteinis JS, Mooney BP, Flowers CI, Gatenby RA. Beyond mammography: new frontiers in breast cancer screening. Am J Med 2013; 126:472-9. [PMID: 23561631 PMCID: PMC4010151 DOI: 10.1016/j.amjmed.2012.11.025] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 11/27/2012] [Accepted: 11/30/2012] [Indexed: 12/16/2022]
Abstract
Breast cancer screening remains a subject of intense and, at times, passionate debate. Mammography has long been the mainstay of breast cancer detection and is the only screening test proven to reduce mortality. Although it remains the gold standard of breast cancer screening, there is increasing awareness of subpopulations of women for whom mammography has reduced sensitivity. Mammography also has undergone increased scrutiny for false positives and excessive biopsies, which increase radiation dose, cost, and patient anxiety. In response to these challenges, new technologies for breast cancer screening have been developed, including low-dose mammography, contrast-enhanced mammography, tomosynthesis, automated whole breast ultrasound, molecular imaging, and magnetic resonance imaging. Here we examine some of the current controversies and promising new technologies that may improve detection of breast cancer both in the general population and in high-risk groups, such as women with dense breasts. We propose that optimal breast cancer screening will ultimately require a personalized approach based on metrics of cancer risk with selective application of specific screening technologies best suited to the individual's age, risk, and breast density.
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135
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Orchard JJ, Orchard JW, Grenfell T, Mitchell A. Ionising radiation: three game-changing studies for imaging in sports medicine. Br J Sports Med 2013; 48:677-8. [DOI: 10.1136/bjsports-2013-092499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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136
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Boyer B, Balleyguier C. Quand prescrire une mammographie avant 40ans ? IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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137
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Particularités de l’imagerie des cancers du sein chez les femmes jeunes et mutées. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bernstein JL, Thomas DC, Shore RE, Robson M, Boice JD, Stovall M, Andersson M, Bernstein L, Malone KE, Reiner AS, Lynch CF, Capanu M, Smith SA, Tellhed L, Teraoka SN, Begg CB, Olsen JH, Mellemkjaer L, Liang X, Diep AT, Borg A, Concannon P, Haile RW. Contralateral breast cancer after radiotherapy among BRCA1 and BRCA2 mutation carriers: a WECARE study report. Eur J Cancer 2013; 49:2979-85. [PMID: 23706288 DOI: 10.1016/j.ejca.2013.04.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/04/2013] [Accepted: 04/27/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND Women with germline BRCA1 or BRCA2 (BRCA1/BRCA2) mutations are at very high risk of developing breast cancer, including asynchronous contralateral breast cancer (CBC). BRCA1/BRCA2 genes help maintain genome stability and assist in DNA repair. We examined whether the risk of CBC associated with radiation treatment was higher among women with germline BRCA1/BRCA2 mutations than among non-carriers. METHODS A population-based, nested case-control study was conducted within a cohort of 52,536 survivors of unilateral breast cancer (UBC). Cases were 603 women with CBC and controls were 1199 women with UBC individually matched on age at diagnosis, race, year of first diagnosis and cancer registry. All women were tested for BRCA1 and BRCA2 mutations. Radiation absorbed dose from the initial radiotherapy (RT) to the CBC location within the contralateral breast was reconstructed from measurements in a tissue-equivalent phantom and details available in the therapy records. FINDINGS Among women treated with radiation, the mean radiation dose was 1.1 Gy (range = 0.02-6.2 Gy). Risk of developing CBC was elevated among women who carried a deleterious BRCA1/BRCA2 mutation (rate ratio, RR = 4.5, confidence interval, CI = 3.0-6.8), and also among those treated with RT (RR = 1.2, CI = 1.0-1.6). However, among mutation carriers, an incremental increase in risk associated with radiation dose was not statistically significant. INTERPRETATION Multiplicative interaction of RT with mutation status would be reflected by a larger association of RT with CBC among carriers than among non-carriers, but this was not apparent. Accordingly, there was no clear indication that carriers of deleterious BRCA/BRCA2 mutations were more susceptible to the carcinogenic effects of radiation than non-carriers. These findings are reassuring and have important clinical implications for treatment decisions and the clinical management of patients harbouring deleterious BRCA1/BRCA2 mutations. FUNDING All work associated with this study was supported by the U.S. National Cancer Institute [R01CA097397, U01CA083178].
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Affiliation(s)
- Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Christinat A, Pagani O. Practical aspects of genetic counseling in breast cancer: lights and shadows. Breast 2013; 22:375-82. [PMID: 23673076 DOI: 10.1016/j.breast.2013.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 01/20/2013] [Accepted: 04/03/2013] [Indexed: 12/13/2022] Open
Abstract
In unselected populations, less than 10% of breast cancers are associated with germline mutations in predisposing genes. Breast cancer type 1 and 2 (BRCA1 and BRCA2) susceptibility genes are the most common involved genes and confer a 10-30 times higher risk of developing the disease compared to the general population. A personal or family history suggestive of inherited breast cancer syndrome may be further evaluated to assess the risk of genetic predisposition and the presence of a genetic mutation. Breast cancer genetic counseling should include a careful risk assessment with associated psychosocial evaluation and support, possible molecular testing, personalized discussion of results. Knowledge of BRCA status can influence individualized cancer risk-reduction strategies. i.e. active surveillance, prophylactic surgery and/or pharmacoprevention.
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de Bock GH, Vermeulen KM, Jansen L, Oosterwijk JC, Siesling S, Dorrius MD, Feenstra T, Houssami N, Greuter MJW. Which screening strategy should be offered to women with BRCA1 or BRCA2 mutations? A simulation of comparative cost-effectiveness. Br J Cancer 2013; 108:1579-86. [PMID: 23579217 PMCID: PMC3668482 DOI: 10.1038/bjc.2013.149] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: There is no consensus on the most effective strategy (mammography or magnetic resonance imaging (MRI)) for screening women with BRCA1 or BRCA2 mutations. The effectiveness and cost-effectiveness of the Dutch, UK and US screening strategies, which involve mammography and MRI at different ages and intervals were evaluated in high-risk women with BRCA1 or BRCA2 mutations. Methods: Into a validated simulation screening model, outcomes and cost parameters were integrated from published and cancer registry data. Main outcomes were life-years gained and incremental cost-effectiveness ratios. The simulation was situated in the Netherlands as well as in the United Kingdom, comparing the Dutch, UK and US strategies with the population screening as a reference. A discount rate of 3% was applied to both costs and health benefits. Results: In terms of life-years gained, the strategies from least to most cost-effective were the UK, Dutch and US screening strategy, respectively. However, the differences were small. Applying the US strategy in the Netherlands, the costs were €43 800 and 68 800 for an additional life-year gained for BRCA1 and BRCA2, respectively. At a threshold of €20 000 per life-year gained, implementing the US strategy in the Netherlands has a very low probability of being cost-effective. Stepping back to the less-effective UK strategy would save relatively little in costs and results in life-years lost. When implementing the screening strategies in the United Kingdom, the Dutch, as well as the US screening strategy have a high probability of being cost-effective. Conclusion: From a cost-effectiveness perspective, the Dutch screening strategy is preferred for screening high-risk women in the Netherlands as well as in the United Kingdom.
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Affiliation(s)
- G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands.
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Cott Chubiz JE, Lee JM, Gilmore ME, Kong CY, Lowry KP, Halpern EF, McMahon PM, Ryan PD, Gazelle GS. Cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers. Cancer 2012. [PMID: 23184400 DOI: 10.1002/cncr.27864] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Current clinical guidelines recommend earlier, more intensive breast cancer screening with both magnetic resonance imaging (MRI) and mammography for women with breast cancer susceptibility gene (BRCA) mutations. Unspecified details of screening schedules are a challenge for implementing guidelines. METHODS A Markov Monte Carlo computer model was used to simulate screening in asymptomatic women who were BRCA1 and BRCA2 mutation carriers. Three dual-modality strategies were compared with digital mammography (DM) alone: 1) DM and MRI alternating at 6-month intervals beginning at age 25 years (Alt25), 2) annual MRI beginning at age 25 years with alternating DM added at age 30 years (MRI25/Alt30), and 3) DM and MRI alternating at 6-month intervals beginning at age 30 years (Alt30). Primary outcomes were quality-adjusted life years (QALYs), lifetime costs (in 2010 US dollars), and incremental cost-effectiveness (dollars per QALY gained). Additional outcomes included potential harms of screening, and lifetime costs stratified into component categories (screening and diagnosis, treatment, mortality, and patient time costs). RESULTS All 3 dual-modality screening strategies increased QALYs and costs. Alt30 screening had the lowest incremental costs per additional QALY gained (BRCA1, $74,200 per QALY; BRCA2, $215,700 per QALY). False-positive test results increased substantially with dual-modality screening and occurred more frequently in BRCA2 carriers. Downstream savings in both breast cancer treatment and mortality costs were outweighed by increases in up-front screening and diagnosis costs. The results were influenced most by estimates of breast cancer risk and MRI costs. CONCLUSIONS Alternating MRI and DM screening at 6-month intervals beginning at age 30 years was identified as a clinically effective approach to applying current guidelines, and was more cost-effective in BRCA1 gene mutation carriers compared with BRCA2 gene mutation carriers.
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Affiliation(s)
- Jessica E Cott Chubiz
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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