301
|
Individually tailored screening of breast cancer with genes, tumour phenotypes, clinical attributes, and conventional risk factors. Br J Cancer 2013; 108:2241-9. [PMID: 23674086 PMCID: PMC3681026 DOI: 10.1038/bjc.2013.202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: We demonstrated how to comprehensively translate the existing and updated scientific evidence on genomic discovery, tumour phenotype, clinical features, and conventional risk factors in association with breast cancer to facilitate individually tailored screening for breast cancer. Methods: We proposed an individual-risk-score-based approach that translates state-of-the-art scientific evidence into the initiators and promoters affecting onset and subsequent progression of breast tumour underpinning a novel multi-variable three-state temporal natural history model. We applied such a quantitative approach to a population-based Taiwanese women periodical screening cohort. Results: Risk prediction for pre-clinical detectable and clinical-detected breast cancer was made by the two risk scores to stratify the underlying population to assess the optimal age to begin screening and the inter-screening interval for each category and to ascertain which high-risk group requires an alternative image technique. The risk-score-based approach significantly reduced the interval cancer rate as a percentage of the expected rate in the absence of screening by 30% and also reduced 8.2% false positive cases compared with triennial universal screening. Conclusion: We developed a novel quantitative approach following the principle of translational research to provide a roadmap with state-of-the-art genomic discovery and clinical parameters to facilitate individually tailored breast cancer screening.
Collapse
|
302
|
Pal T, Vadaparampil ST. Genetic risk assessments in individuals at high risk for inherited breast cancer in the breast oncology care setting. Cancer Control 2013; 19:255-66. [PMID: 23037493 DOI: 10.1177/107327481201900402] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It has become increasingly common to consider BRCA mutation status when determining optimal cancer risk management and treatment options in order to improve patient outcomes. Knowledge about the risk for hereditary cancer at or as close as possible to the time of diagnosis allows patients access to the most risk reduction options available. METHODS This paper illustrates the role of genetic risk assessment for hereditary breast cancer, using hereditary breast and ovarian cancer (HBOC) syndrome as a model due to germline mutations in the BRCA1 and BRCA2. Specifically, the value of genetic counseling and testing for HBOC across the cancer prevention and control continuum is outlined as it pertains to breast cancer. RESULTS In recognition of the importance of risk assessment for hereditary breast cancer, leading health professional organizations have developed specific guidelines and recommendations to providers for identification of women at increased risk for carrying a BRCA mutation. CONCLUSIONS Institutional efforts specific to genetic counseling and testing have resulted in the implementation of a model driven by physician recommendation as a referral system for high-risk breast cancer patients. Establishing an infrastructure to support research, education, and outreach initiatives focused on BRCA genetic counseling and testing will provide information that can improve the delivery of cancer genetics services.
Collapse
Affiliation(s)
- Tuya Pal
- Population Sciences Department of Cancer Epidemiology, Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
| | | |
Collapse
|
303
|
Ng AK, Garber JE, Diller LR, Birdwell RL, Feng Y, Neuberg DS, Silver B, Fisher DC, Marcus KJ, Mauch PM. Prospective study of the efficacy of breast magnetic resonance imaging and mammographic screening in survivors of Hodgkin lymphoma. J Clin Oncol 2013; 31:2282-8. [PMID: 23610104 DOI: 10.1200/jco.2012.46.5732] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Current guidelines recommend breast magnetic resonance imaging (MRI) as an adjunct to mammography for breast cancer screening in female cancer survivors treated with chest irradiation at a young age, beginning 8 to 10 years after treatment. Prospective data evaluating its efficacy in female cancer survivors are lacking. This study sought to compare the sensitivity and specificity of breast MRI with those of mammography in women who received chest irradiation for Hodgkin lymphoma (HL). PATIENTS AND METHODS We enrolled 148 women treated with chest irradiation for HL at age ≤ 35 years who were > 8 years beyond treatment. Yearly breast MRI and mammogram were performed over a 3-year period. Sensitivity and specificity of the two screening modalities were compared. RESULTS With the screening, 63 biopsies were performed in 45 women; 18 (29%) showed a malignancy. All but one of the screen-detected malignancies were preinvasive or subcentimeter node-negative breast cancers. After excluding first-screen MRI and mammogram, mammogram sensitivity was 68% as compared with 67% for MRI (P = 1.0). Sensitivity increased to 94% using both screening modalities. The specificities of mammogram alone, MRI alone, and both were 93%, 94%, and 90%, respectively. CONCLUSION In contrast to women with genetic or familial risk, in HL survivors breast MRI was not more sensitive than mammogram for breast cancer detection. However, the two screening modalities complement each other in the detection of early cases of disease. Early diagnosis is particularly important in these patients, given the breast cancer treatment challenges in patients who have received prior cancer therapy.
Collapse
Affiliation(s)
- Andrea K Ng
- Brigham and Women's Hospital, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
304
|
Buchbender S, Obenauer S, Mohrmann S, Martirosian P, Buchbender C, Miese F, Wittsack H, Miekley M, Antoch G, Lanzman R. Arterial spin labelling perfusion MRI of breast cancer using FAIR TrueFISP: Initial results. Clin Radiol 2013; 68:e123-7. [DOI: 10.1016/j.crad.2012.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 10/08/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
|
305
|
Pfeiffer F, Herzen J, Willner M, Chabior M, Auweter S, Reiser M, Bamberg F. Grating-based X-ray phase contrast for biomedical imaging applications. Z Med Phys 2013; 23:176-85. [PMID: 23453793 DOI: 10.1016/j.zemedi.2013.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 02/01/2023]
Abstract
In this review article we describe the development of grating-based X-ray phase-contrast imaging, with particular emphasis on potential biomedical applications of the technology. We review the basics of image formation in grating-based phase-contrast and dark-field radiography and present some exemplary multimodal radiography results obtained with laboratory X-ray sources. Furthermore, we discuss the theoretical concepts to extend grating-based multimodal radiography to quantitative transmission, phase-contrast, and dark-field scattering computed tomography.
Collapse
Affiliation(s)
- Franz Pfeiffer
- Department of Physics, Technical University Munich, 85748 Garching, Germany.
| | | | | | | | | | | | | |
Collapse
|
306
|
Lee VS. MRI: From science to society. J Magn Reson Imaging 2013; 37:753-60. [DOI: 10.1002/jmri.24044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 12/13/2012] [Indexed: 11/08/2022] Open
|
307
|
De Los Santos JF, Cantor A, Amos KD, Forero A, Golshan M, Horton JK, Hudis CA, Hylton NM, McGuire K, Meric-Bernstam F, Meszoely IM, Nanda R, Hwang ES. Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer. Translational Breast Cancer Research Consortium trial 017. Cancer 2013; 119:1776-83. [PMID: 23436342 DOI: 10.1002/cncr.27995] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/08/2013] [Accepted: 01/09/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased pathologic complete response (pCR) rates observed with neoadjuvant chemotherapy (NCT) for some subsets of patients with invasive breast cancer have prompted interest in whether patients who achieved a pCR can be identified preoperatively and potentially spared the morbidity of surgery. The objective of this multicenter, retrospective study was to estimate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting a pCR in the breast. METHODS MRI studies at baseline and after the completion of NCT plus data regarding pathologic response were collected retrospectively from 746 women who received treatment at 8 institutions between 2002 and 2011. Tumors were characterized by immunohistochemical phenotype into 4 categories based on receptor expression: hormone (estrogen and progesterone) receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative (n = 327), HR-positive/HER2-positive, (n = 148), HR-negative/HER2-positive, (n = 101), and triple-negative (HR-negative/HER2 negative; n = 155). In all, 194 of 249 patients (78%) with HER2-positive tumors received trastuzumab. Univariate and multivariate analyses of factors associated with radiographic complete response (rCR) and pCR were performed. RESULT For the total group, the rCR and pCR rates were 182 of 746 patients (24%) and 179 of 746 patients (24%), respectively, and the highest pCR rate was observed for the triple-negative subtype (57 of 155 patients; 37%) and the HER2-positive subtype (38 of 101 patients; 38%). The overall accuracy of MRI for predicting pCR was 74%. The variables sensitivity, negative predictive value, positive predictive value, and accuracy differed significantly among tumor subtypes, and the greatest negative predictive value was observed in the triple-negative (60%) and HER2-positive (62%) subtypes. CONCLUSIONS The overall accuracy of MRI for predicting pCR in invasive breast cancer patients who were receiving NCT was 74%. The performance of MRI differed between subtypes, possibly influenced by differences in pCR rates between groups. Future studies will determine whether MRI in combination with directed core biopsy improves the predictive value of MRI for pathologic response.
Collapse
Affiliation(s)
- Jennifer F De Los Santos
- Department of Radiation Oncology, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
308
|
In response to Cuce et al. Menopause 2013; 20:241-2. [PMID: 23340261 DOI: 10.1097/gme.0b013e318280a499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
309
|
Urban LABD, Schaefer MB, Duarte DL, Santos RPD, Maranhão NMDA, Kefalas AL, Canella EDO, Ferreira CAP, Peixoto JE, Chala LF, Costa RP, Francisco JLE, Martinelli SE, Amorim HLED, Pasqualette HA, Pereira PMS, Camargo Junior HSAD, Sondermann VR. Recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para rastreamento do câncer de mama por métodos de imagem. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000600009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
310
|
Lee CI, Bassett LW, Lehman CD. Breast density legislation and opportunities for patient-centered outcomes research. Radiology 2012; 264:632-6. [PMID: 22919037 DOI: 10.1148/radiol.12120184] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA 98109-1023, USA.
| | | | | |
Collapse
|
311
|
Alonso Roca S, Jiménez Arranz S, Delgado Laguna A, Quintana Checa V, Grifol Clar E. Breast cancer screening in high risk populations. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
312
|
Cardoso F, Loibl S, Pagani O, Graziottin A, Panizza P, Martincich L, Gentilini O, Peccatori F, Fourquet A, Delaloge S, Marotti L, Penault-Llorca F, Kotti-Kitromilidou AM, Rodger A, Harbeck N. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer 2012; 48:3355-77. [PMID: 23116682 DOI: 10.1016/j.ejca.2012.10.004] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 10/02/2012] [Accepted: 10/02/2012] [Indexed: 12/22/2022]
Abstract
EUSOMA (The European Society of Breast Cancer Specialists) is committed to writing recommendations on different topics of breast cancer care which can be easily adopted and used by health professionals dedicated to the care of patients with breast cancer in their daily practice. In 2011, EUSOMA identified the management of young women with breast cancer as one of the hot topics for which a consensus among European experts was needed. Therefore, the society recently organised a workshop to define such recommendations. Thirteen experts from the different disciplines met for two days to discuss the topic. This international and multidisciplinary panel thoroughly reviewed the literature in order to prepare evidence-based recommendations. During the meeting, two working groups were set up to discuss in detail diagnosis and loco-regional and systemic treatments, including both group aspects of psychology and sexuality. The conclusions reached by the working groups were then discussed in a plenary session to reach panel consensus. Whenever possible, a measure of the level of evidence (LoE) from 1 (the highest) to 4 (the lowest) degree, based on the methodology proposed by the US Agency for Healthcare Research and Quality (AHRQ), was assigned to each recommendation. The present manuscript presents the recommendations of this consensus group for the management of young women with breast cancer in daily clinical practice.
Collapse
Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
313
|
Saadatmand S, Rutgers EJT, Tollenaar RAEM, Zonderland HM, Ausems MGEM, Keymeulen KBMI, Schlooz-Vries MS, Koppert LB, Heijnsdijk EAM, Seynaeve C, Verhoef C, Oosterwijk JC, Obdeijn IM, de Koning HJ, Tilanus-Linthorst MMA. Breast density as indicator for the use of mammography or MRI to screen women with familial risk for breast cancer (FaMRIsc): a multicentre randomized controlled trial. BMC Cancer 2012; 12:440. [PMID: 23031619 PMCID: PMC3488502 DOI: 10.1186/1471-2407-12-440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To reduce mortality, women with a family history of breast cancer often start mammography screening at a younger age than the general population. Breast density is high in over 50% of women younger than 50 years. With high breast density, breast cancer incidence increases, but sensitivity of mammography decreases. Therefore, mammography might not be the optimal method for breast cancer screening in young women. Adding MRI increases sensitivity, but also the risk of false-positive results. The limitation of all previous MRI screening studies is that they do not contain a comparison group; all participants received both MRI and mammography. Therefore, we cannot empirically assess in which stage tumours would have been detected by either test.The aim of the Familial MRI Screening Study (FaMRIsc) is to compare the efficacy of MRI screening to mammography for women with a familial risk. Furthermore, we will assess the influence of breast density. METHODS/DESIGN This Dutch multicentre, randomized controlled trial, with balanced randomisation (1:1) has a parallel grouped design. Women with a cumulative lifetime risk for breast cancer due to their family history of ≥20%, aged 30-55 years are eligible. Identified BRCA1/2 mutation carriers or women with 50% risk of carrying a mutation are excluded. Group 1 receives yearly mammography and clinical breast examination (n = 1000), and group 2 yearly MRI and clinical breast examination, and mammography biennially (n = 1000).Primary endpoints are the number and stage of the detected breast cancers in each arm. Secondary endpoints are the number of false-positive results in both screening arms. Furthermore, sensitivity and positive predictive value of both screening strategies will be assessed. Cost-effectiveness of both strategies will be assessed. Analyses will also be performed with mammographic density as stratification factor. DISCUSSION Personalized breast cancer screening might optimize mortality reduction with less over diagnosis. Breast density may be a key discriminator for selecting the optimal screening strategy for women < 55 years with familial breast cancer risk; mammography or MRI. These issues are addressed in the FaMRIsc study including high risk women due to a familial predisposition. TRIAL REGISTRATION Netherland Trial Register NTR2789.
Collapse
Affiliation(s)
- Sepideh Saadatmand
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
314
|
Hillman BJ, Harms SE, Stevens G, Stough RG, Hollingsworth AB, Kozlowski KF, Moss LJ. Diagnostic Performance of a Dedicated 1.5-T Breast MR Imaging System. Radiology 2012; 265:51-8. [DOI: 10.1148/radiol.12110600] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
315
|
Freitas V, Scaranelo A, Menezes R, Kulkarni S, Hodgson D, Crystal P. Added cancer yield of breast magnetic resonance imaging screening in women with a prior history of chest radiation therapy. Cancer 2012; 119:495-503. [DOI: 10.1002/cncr.27771] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/17/2012] [Accepted: 07/17/2012] [Indexed: 01/11/2023]
|
316
|
Kaiser CG, Reich C, Wasser K, Schönberg SO, Kaiser WA. Economic aspects of MR-mammography in dense breasts. Eur J Radiol 2012; 81 Suppl 1:S69-71. [DOI: 10.1016/s0720-048x(12)70027-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
317
|
Maxwell KN, Domchek SM. Prophylactic Mastectomy and Risk-Reducing Salpingo-oophorectomy in BRCA1/2 Mutation Carriers. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
318
|
Cortesi L, Matteis ED, Cirilli C, Filieri E, Pecchi A, Battista R, Canossi B, Torricelli P, Federico M. MRI before initial surgery outside of clinical trials: the real world! Eur J Radiol 2012; 81 Suppl 1:S21-3. [DOI: 10.1016/s0720-048x(12)70009-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
319
|
Cortesi L, Pecchi A, De Matteis E, Filieri E, Battista R, Canossi B, Torricelli P, Federico M. MRI in high risk women: benefits and problems. Eur J Radiol 2012; 81 Suppl 1:S19-20. [DOI: 10.1016/s0720-048x(12)70008-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
320
|
Urban L, Urban C. Role of Mammography versus Magnetic Resonance Imaging for Breast Cancer Screening. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
321
|
Heijnsdijk EAM, Warner E, Gilbert FJ, Tilanus-Linthorst MMA, Evans G, Causer PA, Eeles RA, Kaas R, Draisma G, Ramsay EA, Warren RML, Hill KA, Hoogerbrugge N, Wasser MNJM, Bergers E, Oosterwijk JC, Hooning MJ, Rutgers EJT, Klijn JGM, Plewes DB, Leach MO, de Koning HJ. Differences in natural history between breast cancers in BRCA1 and BRCA2 mutation carriers and effects of MRI screening-MRISC, MARIBS, and Canadian studies combined. Cancer Epidemiol Biomarkers Prev 2012; 21:1458-68. [PMID: 22744338 DOI: 10.1158/1055-9965.epi-11-1196] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is recommended that BRCA1/2 mutation carriers undergo breast cancer screening using MRI because of their very high cancer risk and the high sensitivity of MRI in detecting invasive cancers. Clinical observations suggest important differences in the natural history between breast cancers due to mutations in BRCA1 and BRCA2, potentially requiring different screening guidelines. METHODS Three studies of mutation carriers using annual MRI and mammography were analyzed. Separate natural history models for BRCA1 and BRCA2 were calibrated to the results of these studies and used to predict the impact of various screening protocols on detection characteristics and mortality. RESULTS BRCA1/2 mutation carriers (N = 1,275) participated in the studies and 124 cancers (99 invasive) were diagnosed. Cancers detected in BRCA2 mutation carriers were smaller [80% ductal carcinoma in situ (DCIS) or ≤10 mm vs. 49% for BRCA1, P < 0.001]. Below the age of 40, one (invasive) cancer of the 25 screen-detected cancers in BRCA1 mutation carriers was detected by mammography alone, compared with seven (three invasive) of 11 screen-detected cancers in BRCA2 (P < 0.0001). In the model, the preclinical period during which cancer is screen-detectable was 1 to 4 years for BRCA1 and 2 to 7 years for BRCA2. The model predicted breast cancer mortality reductions of 42% to 47% for mammography, 48% to 61% for MRI, and 50% to 62% for combined screening. CONCLUSIONS Our studies suggest substantial mortality benefits in using MRI to screen BRCA1/2 mutation carriers aged 25 to 60 years but show important clinical differences in natural history. IMPACT BRCA1 and BRCA2 mutation carriers may benefit from different screening protocols, for example, below the age of 40.
Collapse
|
322
|
Fausto A, Casella D, Mantovani L, Giacalone G, Volterrani L. Clinical value of second-look ultrasound: Is there a way to make it objective? Eur J Radiol 2012; 81 Suppl 1:S36-40. [DOI: 10.1016/s0720-048x(12)70015-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
323
|
Crivello ML, Ruth K, Sigurdson ER, Egleston BL, Evers K, Wong YN, Boraas M, Bleicher RJ. Advanced imaging modalities in early stage breast cancer: preoperative use in the United States Medicare population. Ann Surg Oncol 2012; 20:102-10. [PMID: 22878617 DOI: 10.1245/s10434-012-2571-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Guidelines for breast cancer staging exist, but adherence remains unknown. This study evaluates patterns of imaging in early stage breast cancer usually reserved for advanced disease. METHODS Surveillance Epidemiology, and End Results data linked to Medicare claims from 1992-2005 were reviewed for stage I/II breast cancer patients. Claims were searched for preoperative performance of computed tomography (CT), positron emission tomography (PET), bone scans, and brain magnetic resonance imaging (MRI) ("advanced imaging"). RESULTS There were 67,874 stage I/II breast cancer patients; 18.8% (n=12,740) had preoperative advanced imaging. The proportion of patients having CT scans, PET scans, and brain MRI increased from 5.7% to 12.4% (P<0.0001), 0.8% to 3.4% (P<0.0001) and 0.2% to 1.1% (P=0.008), respectively, from 1992 to 2005. Bone scans declined from 20.1% to 10.7% (P<0.0001). "Breast cancer" (174.x) was the only diagnosis code associated with 62.1% of PET scans, 37.7% of bone scans, 24.2% of CT, and 5.1% of brain MRI. One or more symptoms or metastatic site was suggested for 19.6% of bone scans, 13.0% of CT, 13.0% of PET, and 6.2% of brain MRI. Factors associated (P<0.05) with use of all modalities were urban setting, breast MRI and ultrasound. Breast MRI was the strongest predictor (P<0.0001) of bone scan (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.44-1.86), Brain MRI (OR 1.74, 95% CI 1.15-2.63), CT (OR 2.42, 95% CI 2.12-2.76), and PET (OR 5.71, 95% CI 4.52-7.22). CONCLUSIONS Aside from bone scans, performance of advanced imaging is increasing in early stage Medicare breast cancer patients, with limited rationale provided by coded diagnoses. In light of existing guidelines and increasing scrutiny about health care costs, greater reinforcement of current indications is warranted.
Collapse
Affiliation(s)
- Margaret L Crivello
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | | | | | | | | | | | | |
Collapse
|
324
|
Bzyl J, Palmowski M, Rix A, Arns S, Hyvelin JM, Pochon S, Ehling J, Schrading S, Kiessling F, Lederle W. The high angiogenic activity in very early breast cancer enables reliable imaging with VEGFR2-targeted microbubbles (BR55). Eur Radiol 2012; 23:468-75. [DOI: 10.1007/s00330-012-2594-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/16/2012] [Accepted: 07/01/2012] [Indexed: 10/28/2022]
|
325
|
Abstract
Identification of germline mutations associated with significant cancer susceptibility has the potential to change all aspects of an individual's care, from screening to cancer treatment. For example, women with germline mutations in BRCA1 and BRCA2 have markedly elevated risks of breast and ovarian cancer and the identification of these germline mutations has led to specific screening and prevention strategies. More recently, advances in the understanding of the biological function of BRCA1 and BRCA2 have led to clinical trials testing targeted therapies in this population, particularly poly(ADP-ribose) polymerase (PARP) inhibitors. Unfortunately, the development of PARP inhibitors has not been as rapid as anticipated and has been more challenging than expected. Somatic mutations identified in many cancer types have allowed the development of therapeutics that target these mutated genes, and many of these agents obtained rapid regulatory approval and are currently in widespread clinical practice. Diagnostic testing has a central role in targeted cancer therapeutics for both somatic and germline mutations. Although the era of molecular medicine and targeted therapies has led to significant changes in the practice of oncology, new challenges continue to arise.
Collapse
|
326
|
Effect of preoperative breast magnetic resonance imaging on surgical decision making and cancer recurrence rates. Invest Radiol 2012; 47:128-35. [PMID: 21934515 DOI: 10.1097/rli.0b013e318230061c] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate breast magnetic resonance imaging (MRI) for cancer staging and surgical planning in patients with known breast cancer, and to evaluate recurrence rates at long-term follow-up. METHODS AND MATERIALS Institutional review board approval and patient consent were obtained. Preoperative MRI with 0.1 mmol/kg gadobenate dimeglumine (MultiHance) was performed in 203/274 women with confirmed breast cancer. The sensitivity, accuracy, and positive predictive value of MRI compared with mammography/ultrasound for malignant lesion detection were calculated, and the effect of MRI on surgical decision making evaluated. The cancer recurrence rate was determined for 172 patients with available 2- to 8-year follow-up data. RESULTS Mammography/ultrasound detected 229 suspicious lesions. Breast MRI detected 159 additional lesions in 48/203 (23.6%) patients; of which 110/110 were correctly classified as malignant and 28/49 as benign, giving sensitivity, accuracy, and positive predictive values for malignant lesion detection of 100% (110/110), 86.8% (138/159), and 84.0% (110/131), respectively. MRI revealed unsuspected multifocal, multicentric, and synchronous contralateral lesions in 7/48, 16/48, and 16/48 patients, respectively, and pectoralis muscle infiltration in 3/38 patients. In 6/48 women, MRI revealed lesions not seen on conventional imaging (n = 5) or discounted suspected multifocal disease (n = 1). Therapy was changed for 50/203 (24.6%) patients: 38 patients underwent more extensive surgery and 12 less extensive surgery. Six (3.5%) recurrences occurred, in all cases at >4 years. CONCLUSION Breast MRI positively affects patient management and is recommended for mapping tumor extent in patients with newly diagnosed cancer. The cancer recurrence rate at long-term follow-up after MRI is low.
Collapse
|
327
|
Alonso Roca S, Jiménez Arranz S, Delgado Laguna AB, Quintana Checa V, Grifol Clar E. [Breast cancer screening in high risk populations]. RADIOLOGIA 2012; 54:490-502. [PMID: 22579381 DOI: 10.1016/j.rx.2011.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 11/16/2011] [Accepted: 11/16/2011] [Indexed: 11/28/2022]
Abstract
We aim to define which patients make up the populations with high and intermediate risk of developing breast cancer, to review the studies of screening with magnetic resonance imaging in addition to mammography in high risk patients (describing the imaging characteristics of the cancers in this group), to review the studies of screening with magnetic resonance imaging in patients with intermediate risk, and to update the guidelines for screening in patients with high or intermediate risk (based on the recent recommendations of the main scientific societies/American and European guidelines).
Collapse
Affiliation(s)
- S Alonso Roca
- Sección de mama, Servicio de Diagnóstico por Imagen, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | | | | | | | | |
Collapse
|
328
|
Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG, Böhm-Vélez M, Mahoney MC, Evans WP, Larsen LH, Morton MJ, Mendelson EB, Farria DM, Cormack JB, Marques HS, Adams A, Yeh NM, Gabrielli G. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 2012; 307:1394-404. [PMID: 22474203 PMCID: PMC3891886 DOI: 10.1001/jama.2012.388] [Citation(s) in RCA: 763] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography. Magnetic resonance imaging (MRI) may reveal additional breast cancers missed by both mammography and ultrasound screening. OBJECTIVE To determine supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer. DESIGN, SETTING, AND PARTICIPANTS From April 2004-February 2006, 2809 women at 21 sites with elevated cancer risk and dense breasts consented to 3 annual independent screens with mammography and ultrasound in randomized order. After 3 rounds of both screenings, 612 of 703 women who chose to undergo an MRI had complete data. The reference standard was defined as a combination of pathology (biopsy results that showed in situ or infiltrating ductal carcinoma or infiltrating lobular carcinoma in the breast or axillary lymph nodes) and 12-month follow-up. MAIN OUTCOME MEASURES Cancer detection rate (yield), sensitivity, specificity, positive predictive value (PPV3) of biopsies performed and interval cancer rate. RESULTS A total of 2662 women underwent 7473 mammogram and ultrasound screenings, 110 of whom had 111 breast cancer events: 33 detected by mammography only, 32 by ultrasound only, 26 by both, and 9 by MRI after mammography plus ultrasound; 11 were not detected by any imaging screen. Among 4814 incidence screens in the second and third years combined, 75 women were diagnosed with cancer. Supplemental incidence-screening ultrasound identified 3.7 cancers per 1000 screens (95% CI, 2.1-5.8; P < .001). Sensitivity for mammography plus ultrasound was 0.76 (95% CI, 0.65-0.85); specificity, 0.84 (95% CI, 0.83-0.85); and PPV3, 0.16 (95% CI, 0.12-0.21). For mammography alone, sensitivity was 0.52 (95% CI, 0.40-0.64); specificity, 0.91 (95% CI, 0.90-0.92); and PPV3, 0.38 (95% CI, 0.28-0.49; P < .001 all comparisons). Of the MRI participants, 16 women (2.6%) had breast cancer diagnosed. The supplemental yield of MRI was 14.7 per 1000 (95% CI, 3.5-25.9; P = .004). Sensitivity for MRI and mammography plus ultrasound was 1.00 (95% CI, 0.79-1.00); specificity, 0.65 (95% CI, 0.61-0.69); and PPV3, 0.19 (95% CI, 0.11-0.29). For mammography and ultrasound, sensitivity was 0.44 (95% CI, 0.20-0.70, P = .004); specificity 0.84 (95% CI, 0.81-0.87; P < .001); and PPV3, 0.18 (95% CI, 0.08 to 0.34; P = .98). The number of screens needed to detect 1 cancer was 127 (95% CI, 99-167) for mammography; 234 (95% CI, 173-345) for supplemental ultrasound; and 68 (95% CI, 39-286) for MRI after negative mammography and ultrasound results. CONCLUSION The addition of screening ultrasound or MRI to mammography in women at increased risk of breast cancer resulted in not only a higher cancer detection yield but also an increase in false-positive findings. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00072501.
Collapse
Affiliation(s)
- Wendie A Berg
- American College of Radiology Imaging Network, Philadelphia, Pennsylvania, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
329
|
Fischer U, Korthauer A, Baum F, Luftner-Nagel S, Heyden D, Marten-Engelke K. Short first-pass MRI of the breast. Acta Radiol 2012; 53:267-9. [PMID: 22334872 DOI: 10.1258/ar.2012.110638] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To reduce examination time and costs, a new concept for MRI of the breast is presented. This short first-pass MRI takes 4-5 minutes and could be applied to approximately three-quarters of all women.
Collapse
|
330
|
Agliozzo S, De Luca M, Bracco C, Vignati A, Giannini V, Martincich L, Carbonaro LA, Bert A, Sardanelli F, Regge D. Computer-aided diagnosis for dynamic contrast-enhanced breast MRI of mass-like lesions using a multiparametric model combining a selection of morphological, kinetic, and spatiotemporal features. Med Phys 2012; 39:1704-15. [DOI: 10.1118/1.3691178] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
|
331
|
Abstract
PURPOSE OF REVIEW Breast cancer is the most common malignancy in women in the United States and the second most common cause of cancer death in women. This review will focus on the current and clinically relevant recommendations for breast cancer diagnosis, staging, and treatment. RECENT FINDINGS Screening for breast cancer is based on patient history, exam, mammography, and ultrasound. In select patient populations, MRI adds additional detection benefit. Once pathology is found, nipple-sparing mastectomy is felt to be an oncologically well tolerated procedure for both ductal carcinoma in situ and invasive tumors in properly selected patients. Prophylactic mastectomy rates are increasing despite no clear survival benefit. Sentinel lymph node biopsy continues to be the staging procedure of choice, but data are available that completion axillary dissection for a positive sentinel node may not affect outcomes. SUMMARY Strategies for caring for breast cancer patients continue to evolve. Multiple variables including genetic predisposition, disease burden, tumor markers, receptor status, and patient preference are integral to the decision making for each individual patient.
Collapse
|
332
|
Cheng YC, Wu NY, Ko JS, Lin PW, Lin WC, Juang SJ, Tsai TT, Chang CY, Chen JH, Cheng HC. Breast cancers detected by breast MRI screening and ultrasound in asymptomatic Asian women: 8 years of experience in Taiwan. Oncology 2012; 82:98-107. [PMID: 22328009 DOI: 10.1159/000335958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/07/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study investigated one-stop breast screening combining magnetic resonance imaging (MRI) and ultrasound (US) in asymptomatic Asian women. METHODS 3,586 asymptomatic women (mean age, 45.3 years) were retrospectively analyzed by breast MRI followed by US. US-guided biopsy was performed when the MRI-detected lesion was confirmed by US. When the lesion was not detected on the initial US, a second-look US guided by MRI findings was performed. Then biopsy was done. MRI-positive and US-negative patients were followed up according to MRI lesion size, MRI lesion morphology, and mammographic diagnosis. RESULTS In total, 115 subjects had suspicious malignant lesions and received US-guided biopsy, and 47 malignant lesions, including 35 invasive cancers and 12 carcinoma in situ (CIS) lesions, were diagnosed. More than half (22/35, 63%) of the women with invasive cancer were <50 years of age, and 27 (57.4%) of the 47 cancer cases had early breast cancers. Two invasive cancers (5.7%) and 7 CIS lesions (58.3%) were found at the second-look US. The overall cancer incidence was 1.31% (47/3,586) and increased to 2.2% (78/3,586) if precancerous lesions were included. Subjects aged 41-50 years had the highest incidence of cancer detection (1.97%). Five MRI and US-negative cases had cancers found 1 year after the screening. CONCLUSIONS The results from the one-stop breast screening in this study showed that combining MRI and US is an efficient multimodality tool for screening asymptomatic Asian women in a metropolitan area of Taiwan who had concerns about the diagnosis and radiation of mammography.
Collapse
|
333
|
Godény M, Szabó E, Bidlek M, Fehér K, Nagy T, Kásler M. [Role of imaging in the diagnostic and therapeutic algorithms of breast cancer]. Orv Hetil 2012; 153:3-13. [PMID: 22204829 DOI: 10.1556/oh.2012.29250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Early diagnosis and prevention have the most significant effect on overall disease specific outcome; 90% of all breast cancer cases could be cured if diagnosed early and treated accurately. As for all diagnostic methods the most important requirement for diagnostic imaging is to detect breast cancer in its early stage, and to determine accurate tumor staging, in order to select the appropriate therapy. Its role is to monitor the effectiveness of therapy, to follow up patients reliably for early detection of recurrent disease. The spectrum of radiological imaging methods in breast cancer became broader in the past two decades; imaging that provides functional or metabolic data and whole body information such as CT, MRI and PET-CT are now available besides common X-ray and ultrasound mammography. The MRI is getting more and more important for the detection and characterization of breast cancer. Multimodal imaging techniques provide more accurate analysis, which is confirmed by increasing statistics authentically, but none of the imaging methods was specific enough to provide histological diagnosis. However, imaging-guided biopsies enable precise histological or cytological confirmation.
Collapse
Affiliation(s)
- Mária Godény
- Országos Onkológiai Intézet Radiológiai Diagnosztikai Osztály Budapest Ráth György u. 7-9. 1122.
| | | | | | | | | | | |
Collapse
|
334
|
Melbourne A, Hipwell J, Modat M, Mertzanidou T, Huisman H, Ourselin S, Hawkes DJ. The effect of motion correction on pharmacokinetic parameter estimation in dynamic-contrast-enhanced MRI. Phys Med Biol 2011; 56:7693-708. [PMID: 22086390 DOI: 10.1088/0031-9155/56/24/001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A dynamic-contrast-enhanced magnetic resonance imaging (DCE-MRI) dataset consists of many imaging frames, often acquired both before and after contrast injection. Due to the length of time spent acquiring images, patient motion is likely and image re-alignment or registration is required before further analysis such as pharmacokinetic model fitting. Non-rigid image registration procedures may be used to correct motion artefacts; however, a careful choice of registration strategy is required to reduce misregistration artefacts associated with enhancing features. This work investigates the effect of registration on the results of model-fitting algorithms for 52 DCE-MR mammography cases for 14 patients. Results are divided into two sections: a comparison of registration strategies in which a DCE-MRI-specific algorithm is preferred in 50% of cases, followed by an investigation of parameter changes with known applied deformations, inspecting the effect of magnitude and timing of motion artefacts. Increased motion magnitude correlates with increased model-fit residual and is seen to have a strong influence on the visibility of strongly enhancing features. Motion artefacts in images close to the contrast agent arrival have a disproportionate effect on discrepancies in parameter estimation. The choice of algorithm, magnitude of motion and timing of the motion are each shown to influence estimated pharmacokinetic parameters even when motion magnitude is small.
Collapse
Affiliation(s)
- A Melbourne
- Centre for Medical Image Computing, University College London, Gower Street, London WC1E 6BT, UK.
| | | | | | | | | | | | | |
Collapse
|
335
|
Schaefer C, Weissbach L. [Cancer screening: curative or harmful? An ethical dilemma facing the physician]. Urologe A 2011; 50:1595-9. [PMID: 22009258 DOI: 10.1007/s00120-011-2727-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Early detection based on prostate-specific antigen (PSA) presumably can reduce prostate cancer mortality. At the same time it is associated with a comparatively high rate of overdiagnosis involving tumors that would not have become apparent without screening since they would have remained asymptomatic during the patient's entire life. Current studies show that the probability of such an overdiagnosis is 12-48 times higher than one which would save a man's life. Thus, overdiagnosis poses an ethical dilemma for physicians: their actions (screening examination) can turn a healthy individual into a chronically ill person. This profoundly contradicts the principle of medical ethics to"do no harm." An open debate on whether early detection can be reconciled with doctors' ethical duties is hampered by the implications of liability law, faulty economic incentives, and the pressures of competition as well as the empirical practice of many physicians to overestimate the benefits of cancer screening.
Collapse
Affiliation(s)
- C Schaefer
- Stiftung Männergesundheit, Reinhardtstraße 2, 10117 Berlin, Deutschland
| | | |
Collapse
|
336
|
Leung JW. Utility of Second-Look Ultrasound in the Evaluation of MRI-Detected Breast Lesions. Semin Roentgenol 2011; 46:260-74. [DOI: 10.1053/j.ro.2011.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
337
|
De Los Santos J, Bernreuter W, Keene K, Krontiras H, Carpenter J, Bland K, Cantor A, Forero A. Accuracy of breast magnetic resonance imaging in predicting pathologic response in patients treated with neoadjuvant chemotherapy. Clin Breast Cancer 2011; 11:312-9. [PMID: 21831721 DOI: 10.1016/j.clbc.2011.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 05/30/2011] [Accepted: 06/15/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prior studies of the ability of magnetic resonance imaging (MRI) to predict pathologic response to neoadjuvant chemotherapy have shown conflicting results that vary depending on baseline molecular characteristics. This study examines the ability of MRI to predict pathologic complete response (pCR) and explores the influence of tumor molecular profiles on MRI sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). METHODS Eighty-one patients with invasive breast cancer treated with neoadjuvantsystemic therapy between 2002 and 2009 who were imaged with breast MRI pre- and post-treatment were reviewed. Patient, tumor, and treatment characteristics were recorded. Comparisons of molecular subsets and their influence on MRI sensitivity, specificity, PPV, and NPV were made using χ(2)contingency tables. RESULTS The sensitivity, specificity, PPV, and NPV of MRI for predicting pCR for the total group were 92%, 50%, 74%, and 80%, respectively. Patients had the following molecular subtypes: 33/81 (41%) HR+Her2-, 23/81 (28%) HR+/-Her2 +, and 25/81(31%) triple receptor negative (TN). Molecular subtype did not demonstrate a significant correlation of radiographic and pathologic response, although MRI NPV was highest in the TN subset (100%) followed by those with HR+/-Her2+ disease (87.5%). Multivariate analysis did not show that tumor characteristics (estrogen receptor status, progesterone receptor status, HER2 status) or neoadjuvant treatment (doxorubicin, cyclophosphamide, paclitaxel versus other or trastuzumab) had any effect on MRI sensitivity or specificity. CONCLUSIONS In patients receiving neoadjuvant systemic therapy for invasive breast cancer, molecular subtype and systemic regimen administered did not significantly influence the sensitivity, specificity, PPV, or NPV of MRI in predicting pathologic response.
Collapse
Affiliation(s)
- Jennifer De Los Santos
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35243, USA.
| | | | | | | | | | | | | | | |
Collapse
|
338
|
Ziogas A, Horick NK, Kinney AY, Lowery JT, Domchek SM, Isaacs C, Griffin CA, Moorman PG, Edwards KL, Hill DA, Berg JS, Tomlinson GE, Anton-Culver H, Strong LC, Kasten CH, Finkelstein DM, Plon SE. Clinically relevant changes in family history of cancer over time. JAMA 2011; 306:172-8. [PMID: 21750294 PMCID: PMC3367662 DOI: 10.1001/jama.2011.955] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Knowledge of family cancer history is important for assessing cancer risk and guiding screening recommendations. OBJECTIVE To quantify how often throughout adulthood clinically significant changes occur in cancer family history that would result in recommendations for earlier or intense screening. DESIGN AND SETTING Descriptive study examining baseline and follow-up family history data from participants in the Cancer Genetics Network (CGN), a US national population-based cancer registry, between 1999 and 2009. PARTICIPANTS Adults with a personal history, family history, or both of cancer enrolled in the CGN through population-based cancer registries. Retrospective colorectal, breast, and prostate cancer screening-specific analyses included 9861, 2547, and 1817 participants, respectively; prospective analyses included 1533, 617, and 163 participants, respectively. Median follow-up was 8 years (range, 0-11 years). Screening-specific analyses excluded participants with the cancer of interest. MAIN OUTCOME MEASURES Percentage of individuals with clinically significant family histories and rate of change over 2 periods: (1) retrospectively, from birth until CGN enrollment and (2) prospectively, from enrollment to last follow-up. RESULTS Retrospective analysis revealed that the percentages of participants who met criteria for high-risk screening based on family history at ages 30 and 50 years, respectively, were as follows: for colorectal cancer, 2.1% (95% confidence interval [CI], 1.8%-2.4%) and 7.1% (95% CI, 6.5%-7.6%); for breast cancer, 7.2% (95% CI, 6.1%-8.4%) and 11.4% (95% CI, 10.0%-12.8%); and for prostate cancer, 0.9% (95% CI, 0.5%-1.4%) and 2.0% (95% CI, 1.4%-2.7%). In prospective analysis, the numbers of participants who newly met criteria for high-risk screening based on family history per 100 persons followed up for 20 years were 2 (95% CI, 0-7) for colorectal cancer, 6 (95% CI, 2-13) for breast cancer, and 8 (95% CI, 3-16) for prostate cancer. The rate of change in cancer family history was similar for colorectal and breast cancer between the 2 analyses. CONCLUSION Clinically relevant family history of colorectal, breast, and prostate cancer that would result in recommendations for earlier or intense cancer screening increases between ages 30 and 50 years, although the absolute rate is low for prostate cancer.
Collapse
|
339
|
Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk italian 1 study): final results. Invest Radiol 2011; 46:94-105. [PMID: 21139507 DOI: 10.1097/rli.0b013e3181f3fcdf] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES : To prospectively compare clinical breast examination, mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (MRI) in a multicenter surveillance of high-risk women. MATERIALS AND METHODS : We enrolled asymptomatic women aged ≥ 25: BRCA mutation carriers; first-degree relatives of BRCA mutation carriers, and women with strong family history of breast/ovarian cancer, including those with previous personal breast cancer. RESULTS : A total of 18 centers enrolled 501 women and performed 1592 rounds (3.2 rounds/woman). Forty-nine screen-detected and 3 interval cancers were diagnosed: 44 invasive, 8 ductal carcinoma in situ; only 4 pT2 stage; 32 G3 grade. Of 39 patients explored for nodal status, 28 (72%) were negative. Incidence per year-woman resulted 3.3% overall, 2.1% <50, and 5.4% ≥ 50 years (P < 0.001), 4.3% in women with previous personal breast cancer and 2.5% in those without (P = 0.045). MRI was more sensitive (91%) than clinical breast examination (18%), mammography (50%), ultrasonography (52%), or mammography plus ultrasonography (63%) (P < 0.001). Specificity ranged 96% to 99%, positive predictive value 53% to 71%, positive likelihood ratio 24 to 52 (P not significant). MRI showed significantly better negative predictive value (99.6) and negative likelihood ratio (0.09) than those of the other modalities. At receiver operating characteristic analysis, the area under the curve of MRI (0.97) was significantly higher than that of mammography (0.83) or ultrasonography (0.82) and not significantly increased when MRI was combined with mammography and/or ultrasonography. Of 52 cancers, 16 (31%) were diagnosed only by MRI, 8 of 21 (38%) in women <50, and 8 of 31 (26%) in women ≥ 50 years of age. CONCLUSION : MRI largely outperformed mammography, ultrasonography, and their combination for screening high-risk women below and over 50.
Collapse
|
340
|
Clark AS, Domchek SM. Clinical management of hereditary breast cancer syndromes. J Mammary Gland Biol Neoplasia 2011; 16:17-25. [PMID: 21360002 DOI: 10.1007/s10911-011-9200-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/08/2011] [Indexed: 12/24/2022] Open
Abstract
Over the past 15 years there has been substantial improvement in the understanding of hereditary breast cancer. Germline genetic testing for mutations in BRCA1, BRCA2, PTEN and TP53 allows for the identification of individuals at increased risk for breast, ovarian and other cancers. Advances in screening, prevention and treatment have led to improved clinical management which is best defined for BRCA1 and BRCA2 mutation carriers. The addition of screening techniques such as breast magnetic resonance imaging has been shown to lead to earlier detection. Risk-reducing salpingo-oophorectomy leads to a reduction in the risk of both ovarian cancer and breast cancer and also is associated with an improvement in overall survival. BRCA1/2 mutation status may be applicable to systemic therapy decisions. Preclinical and early clinical research suggests that specific classes of chemotherapy may be more effective in mutation carriers. Finally, PARP inhibitors represent a novel therapeutic strategy that exploits the weaknesses of BRCA1/2-associated malignancies.
Collapse
Affiliation(s)
- Amy S Clark
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | | |
Collapse
|
341
|
Affiliation(s)
- Katherine L. Nathanson
- Department of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104; ,
| | - Susan M. Domchek
- Department of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104; ,
| |
Collapse
|
342
|
Martincich L, Faivre-Pierret M, Zechmann CM, Corcione S, van den Bosch HCM, Peng WJ, Petrillo A, Siegmann KC, Heverhagen JT, Panizza P, Gehl HB, Diekmann F, Pediconi F, Ma L, Gilbert FJ, Sardanelli F, Belli P, Salvatore M, Kreitner KF, Weiss CM, Zuiani C. Multicenter, Double-Blind, Randomized, Intraindividual Crossover Comparison of Gadobenate Dimeglumine and Gadopentetate Dimeglumine for Breast MR Imaging (DETECT Trial). Radiology 2011; 258:396-408. [DOI: 10.1148/radiol.10100968] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
343
|
Rijnsburger AJ, Obdeijn IM, Kaas R, Tilanus-Linthorst MM, Boetes C, Loo CE, Wasser MN, Bergers E, Kok T, Muller SH, Peterse H, Tollenaar RA, Hoogerbrugge N, Meijer S, Bartels CC, Seynaeve C, Hooning MJ, Kriege M, Schmitz PIM, Oosterwijk JC, de Koning HJ, Rutgers EJ, Klijn JG. BRCA1-Associated Breast Cancers Present Differently From BRCA2-Associated and Familial Cases: Long-Term Follow-Up of the Dutch MRISC Screening Study. J Clin Oncol 2010; 28:5265-73. [DOI: 10.1200/jco.2009.27.2294] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The Dutch MRI Screening Study on early detection of hereditary breast cancer started in 1999. We evaluated the long-term results including separate analyses of BRCA1 and BRCA2 mutation carriers and first results on survival. Patients and Methods Women with higher than 15% cumulative lifetime risk (CLTR) of breast cancer were screened with biannual clinical breast examination and annual mammography and magnetic resonance imaging (MRI). Participants were divided into subgroups: carriers of a gene mutation (50% to 85% CLTR) and two familial groups with high (30% to 50% CLTR) or moderate risk (15% to 30% CLTR). Results Our update contains 2,157 eligible women including 599 mutation carriers (median follow-up of 4.9 years from entry) with 97 primary breast cancers detected (median follow-up of 5.0 years from diagnosis). MRI sensitivity was superior to that of mammography for invasive cancer (77.4% v 35.5%; P < .00005), but not for ductal carcinoma in situ. Results in the BRCA1 group were worse compared to the BRCA2, the high-, and the moderate-risk groups, respectively, for mammography sensitivity (25.0% v 61.5%, 45.5%, 46.7%), tumor size at diagnosis ≤ 1 cm (21.4% v 61.5%, 40.9%, 63.6%), proportion of DCIS (6.5% v 18.8%, 14.8%, 31.3%) and interval cancers (32.3% v 6.3%, 3.7%, 6.3%), and age at diagnosis younger than 30 years (9.7% v 0%). Cumulative distant metastasis-free and overall survival at 6 years in all 42 BRCA1/2 mutation carriers with invasive breast cancer were 83.9% (95% CI, 64.1% to 93.3%) and 92.7% (95% CI, 79.0% to 97.6%), respectively, and 100% in the familial groups (n = 43). Conclusion Screening results were somewhat worse in BRCA1 mutation carriers, but 6-year survival was high in all risk groups.
Collapse
Affiliation(s)
- Adriana J. Rijnsburger
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Inge-Marie Obdeijn
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Reinoutje Kaas
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Madeleine M.A. Tilanus-Linthorst
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Carla Boetes
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Claudette E. Loo
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Martin N.J.M. Wasser
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Elisabeth Bergers
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Theo Kok
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Sara H. Muller
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Hans Peterse
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Rob A.E.M. Tollenaar
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Nicoline Hoogerbrugge
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Sybren Meijer
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Carina C.M. Bartels
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Caroline Seynaeve
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Maartje J. Hooning
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Mieke Kriege
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Paul I. M. Schmitz
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Jan C. Oosterwijk
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Harry J. de Koning
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Emiel J.T. Rutgers
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| | - Jan G.M. Klijn
- From the Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam; Family Cancer Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; Free University Medical Center, Amsterdam; Radboud University Medical Center and Hereditary Cancer Clinic, Nijmegen; Leiden University Medical Center, Leiden; and the Groningen University Medical Center, Groningen University, Groningen, the Netherlands
| |
Collapse
|
344
|
Teller P, Kramer RK. Management of the asymptomatic BRCA mutation carrier. APPLICATION OF CLINICAL GENETICS 2010; 3:121-31. [PMID: 23776357 PMCID: PMC3681169 DOI: 10.2147/tacg.s8882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Current management of an asymptomatic BRCA mutation carrier includes early initiation and intensive cancer screening in combination with risk reduction strategies. The primary objectives of these interventions are earlier detection and cancer prevention to increase quality of life and prolonged survival. Existing recommendations are often based on the consensus of experts as there are few, supportive, randomized control trials. Management strategies for unaffected patients with BRCA mutations are continually redefined and customized as more evidence-based knowledge is acquired with regard to current intervention efficacy, mutation-related histology, and new treatment modalities. This review provides an outline of current, supported management principles, and interventions in the care of the asymptomatic BRCA mutation carrier. Topics covered include surveillance modalities and risk reduction achieved through behavioral modification, chemoprevention, and prophylactic surgery.
Collapse
Affiliation(s)
- Paige Teller
- Surgical Oncology, Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
345
|
Schmutzler RK, Engel C, Schreer I. Screening in Women at Elevated Risk for Breast Cancer. J Clin Oncol 2010; 28:e607-8; author reply e609-10. [DOI: 10.1200/jco.2010.29.8034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Christoph Engel
- Institute of Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Ingrid Schreer
- Breast Center, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| |
Collapse
|
346
|
Kuhl CK, Bieling H, Schrading S, Rieber A, Reiser M, Schild HH. Reply to R.K. Schmutzler et al. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.29.8406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Andrea Rieber
- University of Ulm, Ulm; Munich Neuperlach Hospital, Munich, Germany
| | | | | |
Collapse
|
347
|
Riedl CC, Ponhold L, Gruber R, Pinker K, Helbich TH. [New information on high risk breast screening]. Radiologe 2010; 50:955-6, 958-63. [PMID: 20945147 DOI: 10.1007/s00117-010-2011-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Women with an elevated risk for breast cancer require intensified screening beginning at an early age. Such high risk screening differs considerably from screening in the general population. After an expert has evaluated the exact risk a breast MRI examination should be offered at least once a year and beginning latest at the age of 30 depending on the patients risk category. Complementary mammograms should not be performed before the age of 35. An additional ultrasound examination is no longer recommended. To ensure a high sensitivity and specificity high risk screening should be performed only at a nationally or regionally approved and audited service. Adequate knowledge about the phenotypical characteristics of familial breast cancer is essential. Besides the common malignant phenotypes, benign morphologies (round or oval shape and smooth margins) as well as a low prevalence of calcifications have been described. Using MRI benign contrast media kinetics as well as non-solid lesions with focal, regional and segmental enhancement can often be visualized.
Collapse
Affiliation(s)
- C C Riedl
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Division für Molekulare und Gender-Bildgebung, Universitätsklinik für Radiodiagnostik, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090 Wien, Österreich
| | | | | | | | | |
Collapse
|
348
|
Klijn JGM. Early diagnosis of hereditary breast cancer by magnetic resonance imaging: what is realistic? J Clin Oncol 2010; 28:1441-5. [PMID: 20177020 DOI: 10.1200/jco.2009.26.3467] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|