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Kubota K, Nakashima K, Nakashima K, Kataoka M, Inoue K, Goto M, Kanbayashi C, Hirokaga K, Yamaguchi K, Suzuki A. The Japanese breast cancer society clinical practice guidelines for breast cancer screening and diagnosis, 2022 edition. Breast Cancer 2024; 31:157-164. [PMID: 37973686 PMCID: PMC10901949 DOI: 10.1007/s12282-023-01521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
This article provides updates to readers based on the newly published Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2022 Edition. These guidelines incorporate the latest evaluation of evidence from studies of diagnostic accuracy. For each clinical question, outcomes for benefits and harms were established, and qualitative or quantitative systematic reviews were conducted. Recommendations were determined through voting by a multidisciplinary group, and guidelines were documented to facilitate shared decision-making among patients and medical professionals. The guidelines address screening, surveillance, and pre- and postoperative diagnosis of breast cancer. In an environment that demands an integrated approach, decisions are needed on how to utilize modalities, such as mammography, ultrasound, MRI, and PET/CT. Additionally, it is vital to understand the appropriate use of new technologies, such as tomosynthesis, elastography, and contrast-enhanced ultrasound, and to consider how best to adapt these methods for individual patients.
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Affiliation(s)
- Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-koshigaya, Koshigaya, Saitama, 343-8555, Japan.
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan.
| | - Kazutaka Nakashima
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Kazuaki Nakashima
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Division of Breast Imaging and Breast Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masako Kataoka
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenich Inoue
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Breast Cancer Center, Shonan Memorial Hospital, Kanagawa, Japan
| | - Mariko Goto
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chizuko Kanbayashi
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Akihiko Suzuki
- Division of Breast and Endocrine Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Cömert D, van Gils CH, Veldhuis WB, Mann RM. Challenges and Changes of the Breast Cancer Screening Paradigm. J Magn Reson Imaging 2023; 57:706-726. [PMID: 36349728 DOI: 10.1002/jmri.28495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
Since four decades mammography is used for early breast cancer detection in asymptomatic women and still remains the gold standard imaging modality. However, population screening programs can be personalized and women can be divided into different groups based on risk factors and personal preferences. The availability of new and evolving imaging modalities, for example, digital breast tomosynthesis, dynamic-contrast-enhanced magnetic resonance imaging (MRI), abbreviated MRI protocols, diffusion-weighted MRI, and contrast-enhanced mammography leads to new challenges and perspectives regarding the feasibility and potential harms of breast cancer screening. The aim of this review is to discuss the current guidelines for different risk groups, to analyze the recent published studies about the diagnostic performance of the imaging modalities and to discuss new developments and future perspectives. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 6.
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Affiliation(s)
- Didem Cömert
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Fruchtman-Brot H, Mango VL. Pregnancy-Associated Breast Cancer in BRCA1/2 Carriers: Is Intensified Breast Ultrasound Surveillance Warranted? Acad Radiol 2023; 30:255-257. [PMID: 36543686 DOI: 10.1016/j.acra.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022]
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Comparison of the diagnostic performance of Magnetic Resonance Imaging (MRI), ultrasound and mammography for detection of breast cancer based on tumor type, breast density and patient's history: A review. Radiography (Lond) 2022; 28:848-856. [DOI: 10.1016/j.radi.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
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Takaoka M, Ohsumi S, Miyoshi Y, Takahashi M, Takashima S, Aogi K, Shimizu T, Teramoto N, Yamamoto Y, Okamura M. Four magnetic resonance imaging surveillance-detected breast cancer cases in cancer-free BRCA1/2 mutation carriers. Surg Case Rep 2021; 7:228. [PMID: 34674065 PMCID: PMC8531180 DOI: 10.1186/s40792-021-01313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hereditary breast and ovarian cancer (HBOC) syndrome is a susceptibility syndrome for cancers, such as breast and ovarian cancer, and BRCA1/2 are its causative genes. Annual breast-enhanced magnetic resonance imaging (MRI) is recommended for BRCA1/2 mutation carriers aged over 25 years as a secondary prevention of breast cancer. However, breast MRI surveillance is rarely performed in Japan, and only four cases of breast cancer diagnosis triggered by MRI surveillance have been reported. Case presentation At our hospital, MRI triggered the diagnosis of breast cancer in four cancer-free BRCA1/2 mutation carriers. In one of our four cases, although MRI showed only a 3-mm focus, we could diagnose breast cancer by shortening the surveillance interval considering the patient’s high-risk for developing breast cancer. Conclusions Image-guided biopsy, including MRI-guided biopsy, depending on the size of the lesion, and shorter surveillance intervals are useful when there are potentially malignant findings on breast MRI surveillance for cancer-free patients with HBOC.
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Affiliation(s)
- Megumi Takaoka
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan.
| | - Shozo Ohsumi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan
| | - Yuichiro Miyoshi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan
| | - Mina Takahashi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan
| | - Seiki Takashima
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan
| | - Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan
| | - Teruhiko Shimizu
- Department of Radiology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan
| | - Norihiro Teramoto
- Department of Pathology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan
| | - Yasuko Yamamoto
- Department of Familial Tumor, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan
| | - Miki Okamura
- Department of Familial Tumor, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umenomoto-machi, Matsuyama, 791-0280, Japan
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Gao Y, Reig B, Heacock L, Bennett DL, Heller SL, Moy L. Magnetic Resonance Imaging in Screening of Breast Cancer. Radiol Clin North Am 2021; 59:85-98. [PMID: 33223002 PMCID: PMC8178936 DOI: 10.1016/j.rcl.2020.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Magnetic Resonance (MR) imaging is the most sensitive modality for breast cancer detection but is currently limited to screening women at high risk due to limited specificity and test accessibility. However, specificity of MR imaging improves with successive rounds of screening, and abbreviated approaches have the potential to increase access and decrease cost. There is growing evidence to support supplemental MR imaging in moderate-risk women, and current guidelines continue to evolve. Functional imaging has the potential to maximize survival benefit of screening. Leveraging MR imaging as a possible primary screening tool is therefore also being investigated in average-risk women.
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Affiliation(s)
- Yiming Gao
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA.
| | - Beatriu Reig
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Laura Heacock
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Debbie L Bennett
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, St Louis, MO 63110, USA
| | - Samantha L Heller
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Linda Moy
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA; Department of Radiology, NYU Center for Biomedical Imaging, 660 First Avenue, New York, NY 10016, USA; Department of Radiology, NYU Center for Advanced Imaging Innovation and Research, 660 First Avenue, New York, NY 10016, USA
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Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.04.006] [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]
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Alonso Roca S, Delgado Laguna AB, Arantzeta Lexarreta J, Cajal Campo B, López Ruiz A. Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. RADIOLOGIA 2020; 62:417-433. [PMID: 32527577 DOI: 10.1016/j.rx.2020.04.009] [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: 03/28/2019] [Revised: 03/12/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
For women with a high risk of breast cancer, early detection plays an important role. Due to the high incidence of breast cancer, and at a younger age than in the general population, screening begins earlier, and there is considerable evidence that magnetic resonance is the most sensitive diagnostic tool, and the principal American and European guidelines agree on the recommendation to perform annual magnetic resonance (with supplemental annual mammography) as an optimal mode of screening. In addition to the absence of current consensus on which patients should be included in the recommendation for magnetic resonance screening (widely discussed in the introduction of part 1 of this work), there are other aspects that are different between guidelines, that are not specified, or that are susceptible to change based on the evidence of several years of experience, that we have called «controversies», such as the age to begin screening, the possible advisability of using a different strategy in different subgroups, performing alternate versus synchronous magnetic resonance and mammography, the age at which to terminate the two techniques, or how to follow up after risk reduction surgery.The aim of the second part of the paper is, by reviewing the literature, to provide an update in relation to some of the main «controversies» in high risk screening with magnetic resonance. And finally, based on all this, to propose a possible model of optimal and updated screening protocol.
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Affiliation(s)
- S Alonso Roca
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - A B Delgado Laguna
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J Arantzeta Lexarreta
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - B Cajal Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - A López Ruiz
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Blending Insights from Implementation Science and the Social Sciences to Mitigate Inequities in Screening for Hereditary Cancer Syndromes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203899. [PMID: 31618814 PMCID: PMC6843353 DOI: 10.3390/ijerph16203899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/16/2022]
Abstract
Genomic screening to identify people at high risk for adult-onset hereditary conditions has potential to improve population health. However, if not equitably accessible, genomics-informed screening programs will exacerbate existing health inequities or give rise to new ones. To realize the disease prevention potential of these screening tools, we need strategies to broaden their reach. We propose a conceptual framework that merges insights from implementation science and sociological research on health inequities. Our framework does three things: first, it broadens the arenas of action beyond those typically addressed in implementation science frameworks; second, it argues for recruiting more diverse partners to share the work of implementation and dissemination; and third, it shows how implementation activities can be coordinated more effectively among those partners. We use screening for hereditary breast and ovarian cancers (HBOC) as a case to illustrate how this enhanced framework could guide implementation science and distribute the benefits of genomic medicine more equitably. Although our example is specific to genomics, this approach is more broadly applicable to the field of implementation science. Coordinated action among multiple stakeholders could translate a host of new technologies from the bench to the trench without creating new inequities or exacerbating existing ones.
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O'Neill SC, Evans C, Hamilton RJ, Peshkin BN, Isaacs C, Friedman S, Tercyak KP. Information and support needs of young women regarding breast cancer risk and genetic testing: adapting effective interventions for a novel population. Fam Cancer 2019; 17:351-360. [PMID: 29124494 DOI: 10.1007/s10689-017-0059-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Young women from hereditary breast and ovarian cancer (HBOC) families face a unique set of challenges in managing their HBOC risk, where obtaining essential information to inform decision making is key. Previous work suggests that this need for specific health information also comes at a time of heightened distress and greater individuation from family. In this report, we describe our adaptation of a previously-studied behavioral intervention for this population, utilizing a systematic approach outlined by the Centers for Disease Control and Prevention. First, we assessed the information needs and levels of distress in this population and correlates of this distress. These data then were used to inform the adaptation and piloting of a three-session telephone-based peer coaching intervention. One hundred young women (M age = 25 years) who were first or second degree relatives of BRCA1/2 mutation carriers participated. Sixty-three percent of the sample endorsed unmet HBOC information needs and they, on average, reported moderate levels of cancer-related distress (M = 21.9, SD = 14.6). Greater familial disruption was associated with greater cancer-related distress in multivariable models (p < .05). Ten women who participated in the survey completed the intervention pilot. They reported lower distress from pre- to post- (15.8 vs. 12.0), as well as significantly lower decisional conflict (p < .05) and greater endorsement of an array of healthy coping strategies (i.e., active coping, instrumental coping, positive reframing, planning, p's < .05). Our survey results suggest that young adult women from HBOC families have unmet cancer genetic information and support needs. Our pilot intervention was able to reduce levels of decisional conflict and promote the use of effective coping strategies. This approach needs to be further tested in a larger randomized trial.
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Affiliation(s)
- Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Chalanda Evans
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Rebekah J Hamilton
- Armour Academic Center, College of Nursing, Rush University, 600 S. Paulina Street, Suite 1080, Chicago, IL, 60612, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road, NW, Washington, DC, 20007, USA
| | - Sue Friedman
- FORCE, Inc., 16057 Tampa Palms Blvd. W, PMB #373, Tampa, FL, 33647, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
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Mann RM, Kuhl CK, Moy L. Contrast-enhanced MRI for breast cancer screening. J Magn Reson Imaging 2019; 50:377-390. [PMID: 30659696 PMCID: PMC6767440 DOI: 10.1002/jmri.26654] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/15/2022] Open
Abstract
Multiple studies in the first decade of the 21st century have established contrast-enhanced breast MRI as a screening modality for women with a hereditary or familial increased risk for the development of breast cancer. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. The specificity increases in follow-up rounds to around 97%, with positive predictive values for biopsy in the same range as for mammography. MRI preferentially detects the more aggressive/invasive types of breast cancer, but has a higher sensitivity than mammography for any type of cancer. This performance implies that in women screened with breast MRI, all other examinations must be regarded as supplemental. Mammography may yield ~5% additional cancers, mostly ductal carcinoma in situ, while slightly decreasing specificity and increasing the costs. Ultrasound has no supplemental value when MRI is used. Evidence is mounting that in other groups of women the performance of MRI is likewise superior to more conventional screening techniques. Particularly in women with a personal history of breast cancer, the gain seems to be high, but also in women with a biopsy history of lobular carcinoma in situ and even women at average risk, similar results are reported. Initial outcome studies show that breast MRI detects cancer earlier, which induces a stage-shift increasing the survival benefit of screening. Cost-effectiveness is still an issue, particularly for women at lower risk. Since costs of the MRI scan itself are a driving factor, efforts to reduce these costs are essential. The use of abbreviated MRI protocols may enable more widespread use of breast MRI for screening. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:377-390.
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Affiliation(s)
- Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Radiology, the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen, Aachen, Germany
| | - Linda Moy
- Center for Advanced Imaging Innovation and Research / Department of Radiology, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York, USA
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High rate of occult cancer found in prophylactic mastectomy specimens despite thorough presurgical assessment with MRI and ultrasound: findings from the Hereditary Breast and Ovarian Cancer Registration 2016 in Japan. Breast Cancer Res Treat 2018; 172:679-687. [PMID: 30203341 PMCID: PMC6245054 DOI: 10.1007/s10549-018-4953-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/01/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Prophylactic surgery is a preemptive strategy for hereditary breast and ovarian cancer (HBOC). Prophylactic mastectomy (PM) reduces breast cancer risk by > 90%. The aim of our study is to analyze the information of the Japanese pedigrees and to utilize the results for clinical practice. METHODS We statistically analyzed records of HBOC registrees who had undergone BRCA1/2 genetic testing at seven medical institutions up until 2016. In the cases of PM, we examined breasts with the use of mammography (MMG), ultrasound (US), and magnetic resonance imaging (MRI) before surgery. After PM, the specimens were divided about 1 cm serially and examined in their entirety. RESULTS Of 1527 registrees who underwent BRCA testing, 1125 (73.7%) were negative for BRCA1/2 mutation, 297 (19.5%) were positive for BRCA1/2 mutation (BRCA1/2MUT+), and 105 (6.9%) had uncertain results. To decide whether to undergo total mastectomy vs. breast-conserving surgery (BCS), 370 registrees underwent presurgical genetic testing. During the follow-up period, four new-onset breast cancers were found among the 55 non-affected BRCA carriers. Among the 73 BRCA1/2MUT+ carriers who underwent BCS, 3 were found to have ipsilateral breast cancer. Of 189 BRCA1/2MUT+ carriers with unilateral breast cancer, 8 were found to have contralateral breast cancer. Of 53 PM specimens, 6 (11.3%) were found to have occult breast cancer despite using MMG, US, and MRI. CONCLUSIONS Our report showed a relatively higher incidence rate of occult cancer at 11.3% in PM specimens despite thorough pre-operative radiological evaluations, which included a breast MRI. Considering the occult cancer rates and the various pathological methods of our study and published studies, we propose the necessity of a histopathological protocol.
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Laitman Y, Feldman DM, Sklair-Levy M, Yosepovich A, Barshack-Nakar I, Brodsky M, Halshtok O, Shalmon A, Gotlieb M, Friedman E. Abnormal Findings Detected by Multi-modality Breast Imaging and Biopsy Results in a High-risk Clinic. Clin Breast Cancer 2018; 18:e695-e698. [PMID: 29292184 DOI: 10.1016/j.clbc.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND High-risk BRCA mutation carriers are offered a surveillance scheme aimed at early detection of breast cancer. Although the efficacy of this scheme in breast cancer detection is well-established, the rate of breast cancer diagnosis of radiologically suspicious lesions and the effect of this screening scheme on breast cancer grade and stage are less well-defined. PATIENTS AND METHODS Female BRCA1 and BRCA2 mutation carriers who were cancer-free at the beginning of follow-up at the Meirav High-risk Clinic, Sheba Medical Center, were eligible. Radiological imaging data (mammography, ultrasound, magnetic resonance imaging, Breast Imaging Reporting and Data System scores), and histopathologic data on breast biopsies were retrieved. RESULTS Overall, 1055 women participated in the study; 760 (72%) were Ashkenazim, 661 (62.6%) were BRCA1 mutation carriers, the mean age at first visit was 44.1 ± 11.8 years, and there was a mean follow-up of 6.2 years. All participants underwent 6641 breast imaging tests: 2613 magnetic resonance imagings, 2662 breast ultrasounds, and 1366 mammograms. Overall, 295 biopsies were performed on 254 women: 82 (27%) biopsies on 79 women were diagnosed with breast cancer, including ductal carcinoma in situ: invasive breast cancer was diagnosed in 58 (70.7%), of whom 36 (62% of invasive cancer) were grade 3, and all but 10 were stage 1 to 2. Benign findings were noted in 213 biopsies performed on 175 women, with fibrocystic disease (n = 134; 62.9%) or fibroadenoma (n = 60; 28.16%) most commonly diagnosed. CONCLUSIONS Adherence to a breast cancer surveillance scheme enables breast cancer detection at an early stage but at advanced grade. Most biopsies (72%) performed in this high-risk clinic are benign.
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Affiliation(s)
- Yael Laitman
- Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Miri Sklair-Levy
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ady Yosepovich
- Department of Pathology, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Breast Pathology Service, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iris Barshack-Nakar
- Department of Pathology, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Malka Brodsky
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Osnat Halshtok
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Anat Shalmon
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Michael Gotlieb
- Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eitan Friedman
- Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Meirav High-risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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van Zelst JCM, Mus RDM, Woldringh G, Rutten MJCM, Bult P, Vreemann S, de Jong M, Karssemeijer N, Hoogerbrugge N, Mann RM. Surveillance of Women with the BRCA1 or BRCA2 Mutation by Using Biannual Automated Breast US, MR Imaging, and Mammography. Radiology 2017; 285:376-388. [PMID: 28609204 DOI: 10.1148/radiol.2017161218] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate a multimodal surveillance regimen including yearly full-field digital (FFD) mammography, dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) imaging, and biannual automated breast (AB) ultrasonography (US) in women with BRCA1 and BRCA2 mutations. Materials and Methods This prospective multicenter trial enrolled 296 carriers of the BRCA mutation (153 BRCA1 and 128 BRCA2 carriers, and 15 women with first-degree untested relatives) between September 2010 and November 2012, with follow-up until November 2015. Participants underwent 2 years of intensified surveillance including biannual AB US, and routine yearly DCE MR imaging and FFD mammography. The surveillance performance for each modality and possible combinations were determined. Results Breast cancer was screening-detected in 16 women (age range, 33-58 years). Three interval cancers were detected by self-examination, all in carriers of the BRCA1 mutation under age 43 years. One cancer was detected in a carrier of the BRCA1 mutation with a palpable abnormality in the contralateral breast. One incidental breast cancer was detected in a prophylactic mastectomy specimen. Respectively, sensitivity of DCE MR imaging, FFD mammography, and AB US was 68.1% (14 of 21; 95% confidence interval [CI]: 42.9%, 85.8%), 37.2% (eight of 21; 95% CI: 19.8%, 58.7%), and 32.1% (seven of 21; 95% CI: 16.1%, 53.8%); specificity was 95.0% (643 of 682; 95% CI: 92.7%, 96.5%), 98.1% (638 of 652; 95% CI: 96.7%, 98.9%), and 95.1% (1030 of 1088; 95% CI: 93.5%, 96.3%); cancer detection rate was 2.0% (14 of 702), 1.2% (eight of 671), and 1.0% (seven of 711) per 100 women-years; and positive predictive value was 25.2% (14 of 54), 33.7% (nine of 23), and 9.5% (seven of 68). DCE MR imaging and FFD mammography combined yielded the highest sensitivity of 76.3% (16 of 21; 95% CI: 53.8%, 89.9%) and specificity of 93.6% (643 of 691; 95% CI: 91.3%, 95.3%). AB US did not depict additional cancers. FFD mammography yielded no additional cancers in women younger than 43 years, the mean age at diagnosis. In carriers of the BRCA2 mutation, sensitivity of FFD mammography with DCE MR imaging surveillance was 90.9% (10 of 11; 95% CI: 72.7%, 100%) and 60.0% (six of 10; 95% CI: 30.0%, 90.0%) in carriers of the BRCA1 mutation because of the high interval cancer rate in carriers of the BRCA1 mutation. Conclusion AB US may not be of added value to yearly FFD mammography and DCE MR imaging surveillance of carriers of the BRCA mutation. Study results suggest that carriers of the BRCA mutation younger than 40 years may not benefit from FFD mammography surveillance in addition to DCE MR imaging. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Jan C M van Zelst
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Roel D M Mus
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Gwendolyn Woldringh
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Matthieu J C M Rutten
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Peter Bult
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Suzan Vreemann
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Mathijn de Jong
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Nico Karssemeijer
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Nicoline Hoogerbrugge
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Ritse M Mann
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
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Kidd AD, Colbert AM, Jatoi I. Mammography: review of the controversy, health disparities, and impact on young african american women. Clin J Oncol Nurs 2016; 19:E52-8. [PMID: 26000591 DOI: 10.1188/15.cjon.e52-e58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ongoing debate about mammography screening for women in their 40s has brought awareness to the opportunities and challenges for achieving optimal breast health in young African American women and in battling health inequities that place them at greater risk for mortality from breast cancer. Despite the screening controversy, a need exists to understand the complex issues related to mammography knowledge, attitudes, and behaviors of young minority women, while empowering them to take an active role in their breast health care. OBJECTIVES The purpose of this article is to describe the complicated issues related to screening in young African American women within the context of the uncertainty about the evidence surrounding screening practices. METHODS Literature was reviewed to garner a comprehensive update of the mammography screening controversy and its impact on mammography practices. FINDINGS Nurses should be aware of the mammography screening controversy and breast cancer risk assessment and how they affect young women's participation in mammography screening. Mammography screening should be a shared decision between the patient and healthcare provider. A better understanding of breast health and its effect on young minority women is needed. Nurses have a prominent role to advocate for, empower, and educate patients as they face the task of deciding whether to begin or continue mammography in their 40s.
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Affiliation(s)
| | | | - Ismail Jatoi
- University of Texas Health Science Center in San Antonio
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16
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Liedtke C, Thill M, Hanf V, Schütz F. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2014. Breast Care (Basel) 2014; 9:189-200. [PMID: 25177261 PMCID: PMC4132219 DOI: 10.1159/000363591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Cornelia Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig Holstein, Campus Lübeck, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Geburtshilfe, Agaplesion Markus Krankenhaus, Frankfurt/M., Germany
| | - Volker Hanf
- Frauenklinik, Klinikum Fürth, Universitätsklinikum Heidelberg, Germany
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