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Wu S, Liang D, Shi J, Li D, Liu Y, Hao Y, Shi M, Du X, He Y. Evaluation of a population-based breast cancer screening in North China. J Cancer Res Clin Oncol 2023; 149:10119-10130. [PMID: 37266660 PMCID: PMC10423103 DOI: 10.1007/s00432-023-04905-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Despite mammography-based screening for breast cancer has been conducted in many countries, there are still little data on participation and diagnostic yield in population-based breast cancer screening in China. METHODS We enrolled 151,973 eligible women from four cities in Hebei Province within the period 2013-2021 and followed up until December 31, 2021. Participants aged 40-74 who assessed as high risk were invited to undergo breast ultrasound and mammography examination. Overall and group-specific participation rates were calculated. Multivariable analyses were used to estimate the factors associated with participation rates. The diagnostic yield of both screening and no screening groups was calculated. We further analyzed the stage distribution and molecular subtype of breast cancer cases by different modes of cancer detection. RESULTS A total of 42,547 participants were evaluated to be high risk of breast cancer. Among them, 23,009 subjects undertook screening services, with participation rate of 54.08%. Multivariable logistic regression model showed that aged 45-64, high education level, postmenopausal, current smoking, alcohol consumption, family history of breast cancer, and benign breast disease were associated with increased participation of screening. After median follow-up of 3.79 years, there were 456 breast cancer diagnoses of which 65 were screen-detected breast cancers (SBCs), 27 were interval breast cancers (IBCs), 68 were no screening cancers, and 296 were cancers detected outside the screening program. Among them, 92 participants in the screening group (0.40%) and 364 in the non-screening group (0.28%) had breast cancer detected, which resulted in an odds ratio of 1.42 (95% CI 1.13-1.78; P = 0.003). We observed a higher detection rate of breast cancer in the screening group, with ORs of 2.42 (95% CI 1.72-3.41) for early stage (stages 0-I) and 2.12 (95% CI 1.26-3.54) for luminal A subtype. SBCs had higher proportion of early stage (71.93%) and luminal A subtype (47.22%) than other groups. CONCLUSIONS The significant differences in breast cancer diagnosis between the screening and non-screening group imply an urgent need for increased breast cancer awareness and early detection in China.
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Affiliation(s)
- Siqi Wu
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Di Liang
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Jin Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Daojuan Li
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Yanyu Liu
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Yahui Hao
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Miaomiao Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Xinyu Du
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Yutong He
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China.
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2
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In-depth Retrospective Review of Originally Negative Screening Mammograms from Women with Confirmed Breast Cancer. J Belg Soc Radiol 2022; 106:108. [DOI: 10.5334/jbsr.2796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
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3
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Timmermans L, De Brabander I, Van Damme N, Bleyen L, Martens P, Van Herck K, Thierens H, Bacher K, Depypere H. Tumour characteristics of screen-detected and interval cancers in the Flemish Breast Cancer Screening Programme: A mammographic breast density study. Maturitas 2022; 158:55-60. [DOI: 10.1016/j.maturitas.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/29/2021] [Accepted: 12/12/2021] [Indexed: 12/25/2022]
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4
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Patel H, Raghuram A, McClure KE, Alcon A, DeStefano L, Srinivasa DR. A Comprehensive Analysis of Breast Malignancies in Transgender Patients: A Systematic Review of Breast Cancer Incidence and Pathology with Provider Survey Results on Long-Term Screening. Transgend Health 2022. [DOI: 10.1089/trgh.2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Harsh Patel
- Department of Plastics and Reconstructive Surgery at Cedars-Sinai Medical Center, University of California Los Angeles (UCLA), Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | | | - Kelsey E. McClure
- Division of Plastic and Reconstructive Surgery at University of California San Francisco (UCSF), San Francisco, California, USA
| | - Andre Alcon
- Division of Plastic and Reconstructive Surgery at University of California San Francisco (UCSF), San Francisco, California, USA
| | - Lauren DeStefano
- Department of Surgery at Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhivya R. Srinivasa
- Department of Plastics and Reconstructive Surgery at Cedars-Sinai Medical Center, University of California Los Angeles (UCLA), Los Angeles, California, USA
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Lin CN, Lee KT, Chang SM, Wang JD. Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data. J Formos Med Assoc 2021; 121:633-642. [PMID: 34246512 DOI: 10.1016/j.jfma.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/18/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/PURPOSE We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. METHODS We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002-2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC. RESULTS The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million. CONCLUSION Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted.
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Affiliation(s)
- Chia-Ni Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Ting Lee
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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6
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Farber R, Houssami N, Wortley S, Jacklyn G, Marinovich ML, McGeechan K, Barratt A, Bell K. Impact of Full-Field Digital Mammography Versus Film-Screen Mammography in Population Screening: A Meta-Analysis. J Natl Cancer Inst 2021; 113:16-26. [PMID: 32572492 PMCID: PMC7781455 DOI: 10.1093/jnci/djaa080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/02/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast screening programs replaced film mammography with digital mammography, and the effects of this practice shift in population screening on health outcomes can be measured through examination of cancer detection and interval cancer rates. METHODS A systematic review and random effects meta-analysis were undertaken. Seven databases were searched for publications that compared film with digital mammography within the same population of asymptomatic women and reported cancer detection and/or interval cancer rates. RESULTS The analysis included 24 studies with 16 583 743 screening examinations (10 968 843 film and 5 614 900 digital). The pooled difference in the cancer detection rate showed an increase of 0.51 per 1000 screens (95% confidence interval [CI] = 0.19 to 0.83), greater relative increase for ductal carcinoma in situ (25.2%, 95% CI = 17.4% to 33.5%) than invasive (4%, 95% CI = -3% to 13%), and a recall rate increase of 6.95 (95% CI = 3.47 to 10.42) per 1000 screens after the transition from film to digital mammography. Seven studies (80.8% of screens) reported interval cancers: the pooled difference showed no change in the interval cancer rate with -0.02 per 1000 screens (95% CI = -0.06 to 0.03). Restricting analysis to studies at low risk of bias resulted in findings consistent with the overall pooled results for all outcomes. CONCLUSIONS The increase in cancer detection following the practice shift to digital mammography did not translate into a reduction in the interval cancer rate. Recall rates were increased. These results suggest the transition from film to digital mammography did not result in health benefits for screened women. This analysis reinforces the need to carefully evaluate effects of future changes in technology, such as tomosynthesis, to ensure new technology leads to improved health outcomes and beyond technical gains.
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Affiliation(s)
- Rachel Farber
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Sally Wortley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Gemma Jacklyn
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Michael L Marinovich
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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7
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Irvin VL, Zhang Z, Simon MS, Chlebowski RT, Luoh SW, Shadyab AH, Krok-Schoen JL, Tabung FK, Qi L, Stefanick ML, Schedin P, Jindal S. Comparison of Mortality Among Participants of Women's Health Initiative Trials With Screening-Detected Breast Cancers vs Interval Breast Cancers. JAMA Netw Open 2020; 3:e207227. [PMID: 32602908 PMCID: PMC7327543 DOI: 10.1001/jamanetworkopen.2020.7227] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Interval breast cancers (IBCs) are cancers that emerge after a mammogram with negative results but before the patient's next scheduled screening. Interval breast cancer has a worse prognosis than cancers detected by screening; however, it is unknown whether the length of the interscreening period is associated with prognostic features and mortality. OBJECTIVE To compare the prognostic features and mortality rate of women with IBCs diagnosed within 1 year or between 1 and 2.5 years of a mammogram with negative results with the prognostic features and mortality rate of women with breast cancers detected by screening. DESIGN, SETTING, AND PARTICIPANTS This cohort study used mammography data, tumor characteristics, and patient demographic data from the Women's Health Initiative study, which recruited participants from 1993 to 1998 and followed up with participants for a median of 19 years. The present study sample for these analyses included women aged 50 to 79 years who participated in the Women's Health Initiative study and includes data collected through March 31, 2018. There were 5455 incidents of breast cancer; only 3019 women compliant with screening were retained in analyses. Statistical analysis was performed from October 25, 2018, to November 24, 2019. Breast cancers detected by screening and IBCs were defined based on mammogram history, date of last mammogram, type of visit, and results of examination. Interval breast cancers were subdivided into those occurring within 1 year or between 1 and 2.5 years after the last protocol-mandated mammogram with negative results. MAIN OUTCOMES AND MEASURES The primary outcome of this study was breast cancer-specific mortality for each case of breast cancer detected by screening and IBCs detected within 1 year or between 1 and 2.5 years from a mammogram with negative results. Secondary outcomes included prognostic and tumor characteristics for each group. Comparisons between groups were made using the t test, the χ2 test, and Fine-Gray multivariable cumulative incidence regression analyses. RESULTS Among the 3019 participants in this analysis, all were women with a mean (SD) age of 63.1 (6.8) years at enrollment and 68.5 (7.1) years at diagnosis. A total of 1050 cases of IBC were identified, with 324 (30.9%) diagnosed within 1 year from a mammogram with negative results and 726 (69.1%) diagnosed between 1 and 2.5 years after last mammogram with negative results. The remaining 1969 cases were breast cancers detected by screening. Interval breast cancers diagnosed within 1 year from a mammogram with negative results had significantly more lobular histologic characteristics (13.0% vs. 8.1%), a larger tumor size (1.97 cm vs 1.43 cm), a higher clinical stage (28.4% vs 17.3% regional and 3.7% vs 0.6% distant), and more lymph node involvement (27.1% vs 17.0%) than cancers detected by screening. Unadjusted breast cancer-specific mortality hazard ratios were significantly higher for IBCs diagnosed within 1 year from a mammogram with negative results compared with breast cancers detected by screening (hazard ratio, 1.92; 95% CI, 1.39-2.65). Higher breast cancer-specific mortality remained statistically significant for IBCs diagnosed within 1 year after adjusting for trial group, molecular subtype, waist to hip ratio, histologic characteristics, and either tumor size (hazard ratio, 1.46; 95% CI, 1.03-2.08) or lymph node involvement (hazard ratio, 1.44; 95% CI, 1.03-2.01). However, significance was lost when tumor size and lymph node involvement were both included in the model (hazard ratio, 1.34; 95% CI, 0.96-1.88). Interval breast cancers diagnosed between 1 and 2.5 years from a mammogram with negative results were not different from breast cancers detected by screening based on prognostic factors or mortality. CONCLUSIONS AND RELEVANCE Women with IBCs diagnosed within 1 year of negative mammogram results overall were associated with worse survival than women with breast cancers detected by screening. These differences in survival may be due to a uniquely aggressive biology among IBC cases.
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Affiliation(s)
- Veronica L. Irvin
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Zhenzhen Zhang
- Division of Oncological Sciences, Oregon Health & Science University, Portland
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Michael S. Simon
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, Michigan
| | - Rowan T. Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Shiuh-Wen Luoh
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Aladdin H. Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla
| | | | - Fred K. Tabung
- College of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus
| | - Lihong Qi
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis
| | - Marcia L. Stefanick
- Department of Medicine (Stanford Prevention Research Center), School of Medicine, Stanford University, Stanford, California
| | - Pepper Schedin
- Knight Cancer Institute, Oregon Health & Science University, Portland
- Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland
| | - Sonali Jindal
- Knight Cancer Institute, Oregon Health & Science University, Portland
- Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland
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Rebolj M, Blyuss O, Chia KS, Duffy SW. Long-term excess risk of breast cancer after a single breast density measurement. Eur J Cancer 2019; 117:41-47. [PMID: 31229948 PMCID: PMC6658627 DOI: 10.1016/j.ejca.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
Abstract
AIM Breast density is a risk factor for breast cancer. As density changes across a woman's life span, we studied for how long a single density measurement taken in (post-)menopausal women remains informative. METHODS We used data from Singaporean women who underwent a single mammography screen at age 50-64 years. For each case with breast cancer diagnosed at screening or in the subsequent 10 years, whether screen detected or diagnosed following symptoms, two age-matched controls were selected. We studied the excess risk of breast cancer, calculated as an odds ratio (OR) with conditional logistic regression and adjusted for body mass index, associated with 26-50% and with 51-100% density compared with ≤25% density by time since screening. RESULTS In total, 490 women had breast cancer, of which 361 were diagnosed because of symptoms after screening. Women with 51-100% breast density had an excess risk of breast cancer that did not seem to attenuate with time. In 1-3 years after screening, the OR was 2.22 (95% confidence interval [CI]: 1.07-4.61); in 4-6 years after screening, the OR was 4.09 (95% CI: 2.21-7.58), and in 7-10 years after screening, the OR was 5.35 (95% CI: 2.57-11.15). Excess risk with a stable OR of about 2 was also observed for women with 26-50% breast density. These patterns were robust when the analyses were limited to post-menopausal women, non-users of hormonal replacement therapy and after stratification by age at density measurement. CONCLUSION A single breast density measurement identifies women with an excess risk of breast cancer during at least the subsequent 10 years.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London SE1 9RT, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Oleg Blyuss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; Department of Paediatrics, Sechenov University, Moscow, Russia
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
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9
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A review of the influence of mammographic density on breast cancer clinical and pathological phenotype. Breast Cancer Res Treat 2019; 177:251-276. [PMID: 31177342 DOI: 10.1007/s10549-019-05300-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE It is well established that high mammographic density (MD), when adjusted for age and body mass index, is one of the strongest known risk factors for breast cancer (BC), and also associates with higher incidence of interval cancers in screening due to the masking of early mammographic abnormalities. Increasing research is being undertaken to determine the underlying histological and biochemical determinants of MD and their consequences for BC pathogenesis, anticipating that improved mechanistic insights may lead to novel preventative or treatment interventions. At the same time, technological advances in digital and contrast mammography are such that the validity of well-established relationships needs to be re-examined in this context. METHODS With attention to old versus new technologies, we conducted a literature review to summarise the relationships between clinicopathologic features of BC and the density of the surrounding breast tissue on mammography, including the associations with BC biological features inclusive of subtype, and implications for the clinical disease course encompassing relapse, progression, treatment response and survival. RESULTS AND CONCLUSIONS There is reasonable evidence to support positive relationships between high MD (HMD) and tumour size, lymph node positivity and local relapse in the absence of radiotherapy, but not between HMD and LVI, regional relapse or distant metastasis. Conflicting data exist for associations of HMD with tumour location, grade, intrinsic subtype, receptor status, second primary incidence and survival, which need further confirmatory studies. We did not identify any relationships that did not hold up when data involving newer imaging techniques were employed in analysis.
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10
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Manapragada PP. Molecular Imaging in Management of Breast Cancer. Semin Roentgenol 2018; 53:301-310. [PMID: 30449348 DOI: 10.1053/j.ro.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Heller SL, Young Lin LL, Melsaether AN, Moy L, Gao Y. Hormonal Effects on Breast Density, Fibroglandular Tissue, and Background Parenchymal Enhancement. Radiographics 2018; 38:983-996. [DOI: 10.1148/rg.2018180035] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Samantha L. Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Leng Leng Young Lin
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Amy N. Melsaether
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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12
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Rebolj M, Assi V, Brentnall A, Parmar D, Duffy SW. Addition of ultrasound to mammography in the case of dense breast tissue: systematic review and meta-analysis. Br J Cancer 2018; 118:1559-1570. [PMID: 29736009 PMCID: PMC6008336 DOI: 10.1038/s41416-018-0080-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mammography is less effective in detecting cancer in dense than in fatty breasts. METHODS We undertook a systematic search in PubMed to identify studies on women with dense breasts who underwent screening with mammography supplemented with ultrasound. A meta-analysis was undertaken on the proportion of cancers detected only by ultrasound, out of all screen-detected cancers, and the proportion of women with negative mammography who were referred for assessment following ultrasound screening. RESULTS Twenty-nine studies satisfied our inclusion criteria. The proportion of total cancers detected only by ultrasound was 0.29 (95% CI: 0.27-0.31), consistent with an approximately 40% increase in the detection of cancers compared to mammography. In the studied populations, this translated into an additional 3.8 (95% CI: 3.4-4.2) screen-detected cases per 1000 mammography-negative women. About 13% (32/248) of cancers were in situ from 17 studies with information on this subgroup. Ultrasound approximately doubled the referral for assessment in three studies with these data. CONCLUSIONS Studies have consistently shown an increased detection of breast cancer by supplementary ultrasound screening. An inclusion of supplementary ultrasound into routine screening will need to consider the availability of ultrasound and diagnostic assessment capacities.
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Affiliation(s)
- Matejka Rebolj
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Valentina Assi
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Adam Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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13
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Van Renterghem SMJ, Van Dorpe J, Monstrey SJ, Defreyne J, Claes KEY, Praet M, Verbeke SLJ, T'Sjoen GGR, Van Bockstal MR. Routine histopathological examination after female-to-male gender-confirming mastectomy. Br J Surg 2018; 105:885-892. [DOI: 10.1002/bjs.10794] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/22/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022]
Abstract
Abstract
Background
The number of transmen seeking gender-confirming surgery has risen steadily throughout the last decade. Pathologists are increasingly confronted with transmale mastectomy specimens. It is not clear whether routine histopathological examination is useful. This study explored the possible benefit of routine investigation through detailed description of lesions encountered in mastectomy specimens after female-to-male gender-confirming surgery.
Methods
Breast tissue from a cohort of transmen was reviewed. The presence of benign and malignant breast lesions was recorded. The number of terminal duct–lobule units (TDLUs) per ten low-power fields (LPFs) was quantified. Information on hormone therapy and morphometry was retrieved for selected patients.
Results
The cohort included 344 subjects with a mean age of 25·8 (range 16–61) years at the time of surgery; the age at surgery decreased significantly over time. Older individuals presented with a significantly higher number of breast lesions. The number of TDLUs per LPF was lower in heavier breasts, but did not correlate with age. Breast lesions, either benign or malignant, were present in 166 individuals (48·3 per cent). Invasive breast cancer was found in two (0·6 per cent); one tumour was an unexpected finding. The number of breast lesions encountered on histopathological examination increased significantly when more tissue blocks were taken.
Conclusion
The discovery of an unexpected breast cancer in a 31-year-old transman emphasizes the importance of thorough routine histopathological examination of mastectomy specimens. The number of tissue blocks taken should be based on age and breast weight.
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Affiliation(s)
| | - J Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - S J Monstrey
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - J Defreyne
- Centre for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent, Belgium
| | - K E Y Claes
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - M Praet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - S L J Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - G G R T'Sjoen
- Centre for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent, Belgium
| | - M R Van Bockstal
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
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14
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Raj SD, Fein-Zachary V, Slanetz PJ. Deciphering the Breast Density Inform Law Movement: Implications for Practice. Semin Ultrasound CT MR 2018; 39:16-24. [PMID: 29317035 DOI: 10.1053/j.sult.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although dense breast tissue is a normal and routine finding on screening mammography, dense breast tissue is associated with an independent increased risk for breast cancer. It is well known that screening mammography has a decreased sensitivity for cancer detection in women with dense breasts. Over the past decade, there has been increased interest generated among patients, physicians, and legislators regarding how best to screen dense-breasted women culminating in 2009 with the passage of a breast density notification law in Connecticut. Since that time, over half the United States has passed similar notification laws. Despite this, controversy remains as to the optimal supplemental screening modality to complement mammography as each imaging modality (digital breast tomosynthesis, whole breast ultrasound, magnetic resonance imaging, contrast-enhanced mammography, and molecular breast imaging) has variable benefits and limitations.
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Affiliation(s)
- Sean D Raj
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Valerie Fein-Zachary
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Priscilla J Slanetz
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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