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Orsini L, Czene K, Humphreys K. Random effects models of tumour growth for investigating interval breast cancer. Stat Med 2024; 43:2957-2971. [PMID: 38747450 DOI: 10.1002/sim.10105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 06/19/2024]
Abstract
In Nordic countries and across Europe, breast cancer screening participation is high. However, a significant number of breast cancer cases are still diagnosed due to symptoms between screening rounds, termed "interval cancers". Radiologists use the interval cancer proportion as a proxy for the screening false negative rate (ie, 1-sensitivity). Our objective is to enhance our understanding of interval cancers by applying continuous tumour growth models to data from a study involving incident invasive breast cancer cases. Building upon previous findings regarding stationary distributions of tumour size and growth rate distributions in non-screened populations, we develop an analytical expression for the proportion of interval breast cancer cases among regularly screened women. Our approach avoids relying on estimated background cancer rates. We make specific parametric assumptions concerning tumour growth and detection processes (screening or symptoms), but our framework easily accommodates alternative assumptions. We also show how our developed analytical expression for the proportion of interval breast cancers within a screened population can be incorporated into an approach for fitting tumour growth models to incident case data. We fit a model on 3493 cases diagnosed in Sweden between 2001 and 2008. Our methodology allows us to estimate the distribution of tumour sizes at the most recent screening for interval cancers. Importantly, we find that our model-based expected incidence of interval breast cancers aligns closely with observed patterns in our study and in a large Nordic screening cohort. Finally, we evaluate the association between screening interval length and the interval cancer proportion. Our analytical expression represents a useful tool for gaining insights into the performance of population-based breast cancer screening programs.
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Affiliation(s)
- Letizia Orsini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Swedish e-Science Research Centre, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Swedish e-Science Research Centre, Karolinska Institutet, Stockholm, Sweden
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Hudson SM, Wilkinson LS, De Stavola BL, dos-Santos-Silva I. Are mammography image acquisition factors, compression pressure and paddle tilt, associated with breast cancer detection in screening? Br J Radiol 2023; 96:20230085. [PMID: 37660396 PMCID: PMC10546457 DOI: 10.1259/bjr.20230085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES To assess the associations between objectively measured mammographic compression pressure and paddle tilt and breast cancer (BC) detected at the same ("contemporaneous") screen, subsequent screens, or in-between screens (interval cancers). METHODS Automated pressure and paddle tilt estimates were derived for 80,495 mammographic examinations in a UK population-based screening programme. Adjusted logistic regression models were fitted to estimate the associations of compression parameters with BC detected at contemporaneous screen (777 cases).Nested case-control designs were used to estimate associations of pressure and tilt with: (a) interval cancer (148 cases/625 age-matched controls) and (b) subsequent screen-detected cancer (344/1436), via conditional logistic regression. RESULTS Compression pressure was negatively associated with odds of BC at contemporaneous screen (odds ratio (OR) for top versus bottom third of the pressure distribution: 0.74; 95% CI 0.60, 0.92; P-for-linear-trend (Pt) = 0.007). There was weak evidence that moderate pressure at screening was associated with lower odds of interval cancer (OR for middle versus bottom third: 0.63; 95% CI 0.38, 1.05; p = 0.079), but no association was found between pressure and the odds of BC at subsequent screen. There was no evidence that paddle tilt was associated with the odds of contemporaneous, subsequent screen or interval cancer detection. CONCLUSIONS Findings are consistent with compression pressure, but not paddle tilt, affecting the performance of mammographic screening by interfering with its ability to detect cancers. ADVANCES IN KNOWLEDGE Inadequate or excessive compression pressure at screening may contribute to a reduced ability to detect cancers, resulting in a greater number of interval cancer cases.
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Affiliation(s)
- Sue M Hudson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Louise S Wilkinson
- Oxford Breast Imaging Centre, Churchill Hospital,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Bianca L De Stavola
- Faculty of Pop Health Sciences, Institute of Child Health, University College London, London, United Kingdom
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Strandberg R, Illipse M, Czene K, Hall P, Humphreys K. Influence of mammographic density and compressed breast thickness on true mammographic sensitivity: a cohort study. Sci Rep 2023; 13:14194. [PMID: 37648804 PMCID: PMC10468499 DOI: 10.1038/s41598-023-41356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Abstract
Understanding the detectability of breast cancer using mammography is important when considering nation-wide screening programmes. Although the role of imaging settings on image quality has been studied extensively, their role in detectability of cancer at a population level is less well studied. We wish to quantify the association between mammographic screening sensitivity and various imaging parameters. Using a novel approach applied to a population-based breast cancer screening cohort, we specifically focus on sensitivity as defined in the classical diagnostic testing literature, as opposed to the screen-detected cancer rate, which is often used as a measure of sensitivity for monitoring and evaluating breast cancer screening. We use a natural history approach to model the presence and size of latent tumors at risk of detection at mammography screening, and the screening sensitivity is modeled as a logistic function of tumor size. With this approach we study the influence of compressed breast thickness, x-ray exposure, and compression pressure, in addition to (percent) breast density, on the screening test sensitivity. When adjusting for all screening parameters in addition to latent tumor size, we find that percent breast density and compressed breast thickness are statistically significant factors for the detectability of breast cancer. A change in breast density from 6.6 to 33.5% (the inter-quartile range) reduced the odds of detection by 61% (95% CI 48-71). Similarly, a change in compressed breast thickness from 46 to 66 mm reduced the odds by 42% (95% CI 21-57). The true sensitivity of mammography, defined as the probability that an examination leads to a positive result if a tumour is present in the breast, is associated with compressed breast thickness after accounting for mammographic density and tumour size. This can be used to guide studies of setups aimed at improving lesion detection. Compressed breast thickness-in addition to breast density-should be considered when assigning complementary screening modalities and personalized screening intervals.
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Affiliation(s)
- Rickard Strandberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- Swedish eScience Research Centre (SeRC), Karolinska Institutet, Stockholm, Sweden.
| | - Maya Illipse
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Swedish eScience Research Centre (SeRC), Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Swedish eScience Research Centre (SeRC), Karolinska Institutet, Stockholm, Sweden
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Moshina N, Sagstad S, Holen ÅS, Backmann HA, Westermann LC, Hofvind S. Experience of pain during mammographic screening by three different compression paddles. Radiography (Lond) 2023; 29:903-910. [PMID: 37453253 DOI: 10.1016/j.radi.2023.06.013] [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: 05/04/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Experience of pain during screening mammography is shown to affect further attendance negatively. We aimed to explore the experience of pain during screening mammography using three different breast compression paddles. METHODS Using a self-report questionnaire, we collected information on pain experienced during mammography from 938 women screened in Bodø at Nordland Hospital County in 2018, as a part of BreastScreen Norway. Pain was assessed by a numeric rating scale (NRS, 0-10). A fixed paddle, a flexible paddle or a fixed paddle standardizing pressure (study paddle) were used during screening. Compression force (kg) was recorded by the radiographers for each screening examination. Log-binomial regression was used to determine the relative risk (RR) of severe (≥7 on NRS) versus mild/moderate (<7 on NRS) experience of pain associated with type of compression paddle, adjusting for breast tenderness, shoulder(s) and/or neck pain prior to screening, compression force, age, body mass index and screening history. RESULTS Mean score of self-reported experienced pain was 2.8 for the fixed, 2.3 for the flexible and 2.8 for the study paddle (p < 0.03 for fixed versus flexible and for flexible versus study paddle). Adjusted RR of severe pain was higher for the fixed (RRAdj 2.01, 95%CI 1.13-3.59) and the study paddle (RRAdj 2.52, 95%CI 1.44-4.42) compared to the flexible paddle. Breast tenderness was associated with a higher risk (RRAdj 1.93, 95%CI 1.04-3.58) of severe pain compared to no breast tenderness. CONCLUSION Women screened with the flexible paddle reported lower experience of pain than those screened with the fixed or study paddle. IMPLICATION FOR PRACTICE The flexible compression paddle might be the best choice regarding experience of pain in screening mammography. Breast tenderness should be considered by the radiographers in a practical screening setting.
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Affiliation(s)
- N Moshina
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
| | - S Sagstad
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
| | - Å S Holen
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
| | - H A Backmann
- Department of Radiology, Nordland Hospital Trust, Bodø, Norway.
| | - L C Westermann
- Department of Radiology, Nordland Hospital Trust, Bodø, Norway.
| | - S Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Department of Health and Care Sciences, The Arctic University of Norway, Tromsø, Norway.
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Arenas N, Alcantara R, Posso M, Louro J, Perez-Leon D, Ejarque B, Arranz M, Maiques J, Castells X, Macià F, Román M, Rodríguez-Arana A. Comparison of technical parameters and women's experience between self-compression and standard compression modes in mammography screening: a single-blind randomized clinical trial. Eur Radiol 2022; 32:7480-7487. [PMID: 35536390 DOI: 10.1007/s00330-022-08835-y] [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: 10/04/2021] [Revised: 03/19/2022] [Accepted: 03/29/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We compared the compression force, breast thickness, and glandular dose, as well as the severity of discomfort and women's experience between the patient-assisted compression (PAC) and standard compression (SC) modes. MATERIALS AND METHODS We conducted a prospective randomized controlled study at Hospital del Mar in Barcelona, Spain. We included 448 asymptomatic women aged 50 to 69 years old, attending their screening round from December 2017 to December 2019. Mammograms included the two bilateral views. In each woman, one breast was studied with SC and the other with PAC. The mode used in each breast was selected following a randomized list. Compression force, breast thickness, and average glandular dose were obtained for each of the 1792 images. We also recorded the degree of discomfort and women's experience, after mammogram acquisitions, using a predefined survey. RESULTS Higher compression forces were obtained with PAC than with SC (99.27 N vs 83.25 N, p < 0.001). Breast thickness mode (56.11 mm vs 57.52 mm, p = 0.015) and glandular dose (1.34 mGy vs 1.37 mGy, p = 0.018) were lower in PAC. The discomfort score was slightly higher with PAC (mean 3.94 vs 3.69, p = 0.042), but in the satisfaction survey, more women reported that PAC caused less discomfort. Additionally, 63.2% of women (289/448) preferred PAC. CONCLUSION PAC achieved higher compression forces without impairing the other technical imaging parameters and enhanced women's experience of screening mammography. We believe there were no clinically significant differences in the severity of discomfort between the two modes. KEY POINTS • Self-compression allows higher compression forces than the standard compression mode. • Self-compression does not affect technical imaging parameters. • Self-compression improved women's experience of screening mammography when standard compression was used on one breast and self-compression on the other.
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Affiliation(s)
- Natalia Arenas
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | | | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain.
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Daniela Perez-Leon
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Barcelona, Spain
| | - Belén Ejarque
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Mónica Arranz
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Jose Maiques
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Ana Rodríguez-Arana
- Radiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Holen ÅS, Larsen M, Moshina N, Wåade GG, Sechopoulos I, Hanestad B, Tøsdal L, Hofvind S. Visualization of the Nipple in Profile: Does It Really Affect Selected Outcomes in Organized Mammographic Screening? JOURNAL OF BREAST IMAGING 2021; 3:427-437. [PMID: 38424798 DOI: 10.1093/jbi/wbab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To investigate whether having the nipple imaged in profile was associated with breast characteristics or compression parameters, and whether it affected selected outcomes in screening with standard digital mammography or digital breast tomosynthesis. METHODS In this IRB-approved retrospective study, results from 87 450 examinations (174 900 breasts) performed as part of BreastScreen Norway, 2016-2019, were compared by nipple in profile status and screening technique using descriptive statistics and generalized estimating equations. Unadjusted and adjusted odds ratios with 95% confidence intervals (95% CIs) were estimated for outcomes of interest, including age, breast volume, volumetric breast density, and compression force as covariates. RESULTS Achieving the nipple in profile versus not in profile was associated with lower breast volume (845.1 cm3 versus 1059.9 cm3, P < 0.01) and higher mammographic density (5.6% versus 4.4%, P < 0.01). Lower compression force and higher compression pressure were applied to breasts with the nipple in profile (106.6 N and 11.5 kPa) compared to the nipple not in profile (110.8 N and 10.5 kPa, P < 0.01 for both). The adjusted odds ratio was 0.95 (95% CI: 0.88-1.02; P = 0.15) for recall and 0.92 (95% CI: 0.77-1.10; P = 0.36) for screen-detected cancer for nipple in profile versus not in profile. CONCLUSION Breast characteristics and compression parameters might hamper imaging of the nipple in profile. However, whether the nipple was in profile or not on the screening mammograms did not influence the odds of recall or screen-detected cancer, regardless of screening technique.
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Affiliation(s)
- Åsne S Holen
- Cancer Registry of Norway, Section for Breast Cancer Screening, Oslo, Norway
| | - Marthe Larsen
- Cancer Registry of Norway, Section for Breast Cancer Screening, Oslo, Norway
| | - Nataliia Moshina
- Cancer Registry of Norway, Section for Breast Cancer Screening, Oslo, Norway
| | - Gunvor G Wåade
- Oslo Metropolitan University, Department of Life Sciences and Health, Oslo, Norway
| | - Ioannis Sechopoulos
- Radboud University Medical Center, Department of Medical Imaging, Nijmegen, the Netherlands
- Dutch Expert Centre for Screening (LRCB), Nijmegen, the Netherlands
| | - Berit Hanestad
- Haukeland University Hospital, Department of Radiology, Bergen, Norway
| | - Linn Tøsdal
- Stavanger University Hospital, Department of Radiology, Stavanger, Norway
| | - Solveig Hofvind
- Cancer Registry of Norway, Section for Breast Cancer Screening, Oslo, Norway
- Oslo Metropolitan University, Department of Life Sciences and Health, Oslo, Norway
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Moshina N, Larsen M, Holen ÅS, Waade GG, Aase HS, Hofvind S. Digital breast tomosynthesis in a population based mammographic screening program: Breast compression and early performance measures. Eur J Radiol 2021; 139:109665. [PMID: 33823373 DOI: 10.1016/j.ejrad.2021.109665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE We aimed to determine if compression force or pressure could be associated with early performance measures for women screened with digital breast tomosynthesis (DBT) in BreastScreen Norway. Early performance measures included rates of consensus, recall, and screen-detected breast cancer. METHOD Data on compression force and pressure, compressed breast thickness and breast characteristics were extracted from an automated software for density assessment of DBT screening examinations for 25,286 women. For descriptive analyses, force (Newton, N) and pressure (kilopascal, kPa) were categorized into quartiles. Analyses were stratified by mammographic view, craniocaudal (CC) and mediolateral oblique (MLO). Logistic regression with restricted cubic splines was used to investigate the association between force and pressure as continuous exposures and early performance measures adjusted for age, compressed breast thickness and fibroglandular volume. RESULTS Mean age of the screened women was 60.7 (SD = 5.2) years. Mean compression force was 90.8 (SD = 14.2) N for CC and 106.3 (SD = 20.6) N for MLO, and pressure was 11.3 (SD = 3.6) kPa for CC and 8.7 (SD = 2.0) kPa for MLO. The highest rates of screen-detected cancer were observed for low force (1.04 % for <82.5 N for CC and 1.07 % for <92.0 N for MLO) and low pressure (1.07 % for <7.2 kPa for MLO). No association was found between force or pressure as continuous exposures and early performance measures in adjusted regression analyses. CONCLUSIONS We found the highest rates of screen-detected cancer for low force and pressure, but no significant association between continuous values of force or pressure and early performance measures in DBT. The findings might indicate that the levels of force and pressure in DBT are of lower significance for screening performance than reported in standard digital mammography.
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Affiliation(s)
| | | | | | - Gunvor G Waade
- Cancer Registry of Norway, Oslo, Norway; Faculty of Health Sciences Oslo Metropolitan University, Oslo, Norway.
| | - Hildegunn S Aase
- Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway; Faculty of Health Sciences Oslo Metropolitan University, Oslo, Norway.
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Moshina N, Danielsen AS, Hølen ÅS, Hanestad B, Stephansen E, Pedersen IH, Hofvind S. Self-reported Pain Associated With Screening With Digital Breast Tomosynthesis. JOURNAL OF BREAST IMAGING 2021; 3:25-33. [PMID: 38424841 DOI: 10.1093/jbi/wbaa096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE We aimed to investigate self-reported pain during screening with digital breast tomosynthesis (DBT). METHODS The study was approved by the Regional Committee for Medical and Health Research Ethics in the South East of Norway (2015/424). Women completed a questionnaire about experienced pain directly after the examination, August-November 2019. A numeric rating scale (NRS, 0-10) was used. Data on compression force (N), pressure (kPa), and compressed breast thickness (mm) were obtained from the Digital Imaging and Communication in Medicine header and density assessment software. Stepwise ordinary least-squares regression was used to estimate mean self-reported pain score with 95% confidence interval (CI) for values of compression force, pressure, and compressed breast thickness. RESULTS The mean pain score was 1.9, whereof 19.3% (822/4266) of the women reported moderate or severe pain. The mean pain score of 2.6 (95% CI: 2.4-2.7) was observed at a compression force of 60 N, decreasing to 1.3 (95% CI: 1.2-1.4) at 130 N. The mean pain score of 1.3 (95% CI: 1.1-1.4) was at a compression pressure of 6 kPa, increasing to 2.9 (95% CI: 2.7-3.1) at 16 kPa. The mean pain score was 0.6 (95% CI: 0.4-0.6) at a compressed breast thickness of 20 mm, increasing to 2.9 (95% CI: 2.7-3.1) at 90 mm. CONCLUSION The mean pain score was low, 1.9 on NRS, for women screened with DBT. A compression force of 60-130 N and a pressure 6-16 kPa were associated with no or mild pain.
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Affiliation(s)
| | | | | | | | | | | | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway
- Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
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9
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Mechanical standardisation of mammographic compression using Volpara software. Radiography (Lond) 2021; 27:789-794. [PMID: 33419655 DOI: 10.1016/j.radi.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Although breast compression is required in routine mammographic practices, current subjective protocols enforcing 'breast tautness' have minimal clinical reproducibility. Whilst objective guidelines of target force (daN) do not consider breast volumes, new measures of pressure (kPa) account for associated variations. The study aims to determine characteristic compressive forces applied at an Australian diagnostic breast clinic, thereby establishing performance success in achieving ideal pressures of 10 kPa. METHODS Parameters of 1972 mammograms were analysed retrospectively from a South Australian diagnostic breast clinic. Raw data were processed using VolparaDensity software; applied compression (force/pressure), breast thickness, breast volume, breast density and average glandular dose estimates were investigated based on breast/paddle contact areas. RESULTS Distributions of applied average forces is large, yet distributions of applied average pressures are larger; this is internationally comparable. Regarding force-compressions, 98.6% are >5 daN, 16.6% are >10 daN, and 0.0% are >15 daN. Regarding pressure-compressions, 94.5% are >5 kPa, 36.0% are >10 kPa, and 6.3% are >15 kPa. Measures of average breast thickness, volume and density show anatomically consistent trends, with average glandular dose values constant, albeit high. CONCLUSIONS There was a high level of variation of applied compression forces in relation to breast/paddle contact area and an even higher variation in applied pressure. This is comparable with existing literature. Real-time compression pressure standardisation may benefit examination consistency. The relationship between breast volume, contact area, compression force and resultant compression pressure may aid in developing an objective compression protocol for clinical practice. IMPLICATIONS FOR PRACTICE Practical guidelines may increase the reproducibility of image acquisition, whilst optimizing patient discomfort and additional radiation dose from image repeats. Patient compliance may increase in accordance with perceived advantages of mechanical standardisation, ultimately aiding in the detection of early-stage breast cancer.
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10
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van Lier MGJTB, de Groot JE, Muller S, den Heeten GJ, Schilling KJ. Pressure-based Compression Guidance of the Breast in Digital Breast Tomosynthesis Using Flexible Paddles Compared to Conventional Compression. JOURNAL OF BREAST IMAGING 2020; 2:541-551. [PMID: 38424851 DOI: 10.1093/jbi/wbaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE We investigated the effect of introducing a pressure-based flexible paddle on compression parameters and user and patient experience of digital breast tomosynthesis (DBT) combined with patient-assisted compression or technologist compression. METHODS After institutional review board approval, women with a DBT appointment who gave informed consent received pressure-based flexible paddle breast compression. Eight lights on the paddle were illuminated (1.9 kPa per light) as pressure was applied, aiming for an 8-13.9 kPa target range. The compression level was applied by the technologist or the participant utilizing a remote control device. The participant's and technologist's experiences were assessed by a questionnaire. Compression parameters were compared to previous examinations. Comparative statistics were performed using t-tests. RESULTS Pressure-based compression (PBC) was judged to be similar or more comfortable compared with previous traditional exams (80%, 83/103), and 87% (90/103) of participants would recommend PBC to friends. Pressure variability decreased for craniocaudal (CC) views (-55%, P < 0.001) and mediolateral oblique (MLO) views (-34%, P < 0.0001). Subgroup analysis showed a similar glandular dose for CC views, while breast thickness was reduced (-3.74 mm, P < 0.0001). For MLO views, both glandular dose (-0.13 mGy, P < 0.0001) and breast thickness were reduced (-6.70 mm, P < 0.0001). Mean compression parameters were similar for technologist compression and patient-assisted examinations. CONCLUSION Use of the pressure-based flexible paddle in DBT, with or without patient-assisted compression, improved participant and technologist experience and reduced compression pressure variability, mean breast thickness, and glandular dose.
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Affiliation(s)
| | | | | | - Gerard J den Heeten
- Sigmascreening, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands
| | - Kathy J Schilling
- Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital, Boca Raton, FL
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Serwan E, Matthews D, Davies J, Chau M. Mammographic compression practices of force- and pressure-standardisation protocol: A scoping review. J Med Radiat Sci 2020; 67:233-242. [PMID: 32420700 PMCID: PMC7476195 DOI: 10.1002/jmrs.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION As an efficient, effective and moderately inexpensive modality, mammography has been implemented as a cancer screening tool and in diagnostic management. However, appropriate breast compression is necessary for optimal outcomes. Current key measures of compression force are subjective and variable, giving rise to the concept of a 'personalised' pressure-standardisation protocol. METHODS A scoping review of the literature was performed using the Arksey and O'Malley framework to explore the existing force- and pressure-standardisation protocols in clinical application. A comprehensive search strategy and standardised study selection and evaluation were completed. This synthesis of existing knowledge can lead to the implementation of mechanically standardised mammographic compression pressure as a feasible tailored approach to clinical practice. Four databases (PubMed, MEDLINE, Embase and Scopus) were searched from the databases' inception to 13 December 2019 for relevant information, and eighteen articles were selected for analysis. RESULTS In addition to current protocol comparison, emerging key concepts include the reasoning behind standardisation, the benefits of improved diagnostic outcomes/decreased pain with negligible change in image quality and average glandular dose (AGD), and the recommendation of a 10kPa (approximate) pressure-standardisation protocol. Research to date is largely based abroad (Netherlands), with a strong focus on screening practices. Consequently, several gaps in the current literature were identified as potential directions for future investigation. CONCLUSIONS As a suggested mammographic guideline, compression pressures of approximately 10kPa aid in image acquisition reproducibility both within and between women; pain levels decrease, with minimal variations to breast thickness, AGD and image quality.
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Affiliation(s)
- Elizabeth Serwan
- UniSA Allied Health & Human PerformanceUniversity of South AustraliaAdelaideAustralia
| | - Donna Matthews
- UniSA Allied Health & Human PerformanceUniversity of South AustraliaAdelaideAustralia
| | - Josephine Davies
- Medical Imaging DepartmentFlinders Medical CentreBedford ParkSAAustralia
| | - Minh Chau
- UniSA Allied Health & Human PerformanceUniversity of South AustraliaAdelaideAustralia
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Moshina N, Sagstad S, Sebuødegård S, Waade GG, Gran E, Music J, Hofvind S. Breast compression and reported pain during mammographic screening. Radiography (Lond) 2019; 26:133-139. [PMID: 32052779 DOI: 10.1016/j.radi.2019.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION We aimed to investigate the association between breast compression and experienced pain during mammographic screening. METHODS Using a questionnaire, we collected information on pain experienced during mammography from 1155 women screened in Akershus, February-March 2018, as a part of BreastScreen Norway. The questionnaire provided information on pain using a numeric rating scale (NRS, 0-10) and related factors. Data on compression force (Newton, N), pressure (kilopascal, kPa) and breast characteristics were extracted from the DICOM-header and a breast density software. Log-binomial regression was used to determine the relative risk (RR) of severe versus mild/moderate experienced pain associated with compression parameters, adjusting for breast characteristics and related factors. RESULTS Mean score of experienced pain was 2.2, whereas 6% of the women reported severe pain (≥7) during the examination. High body mass index (BMI) (≥27.3 kg/m2) was associated with a higher RR of pain scores ≥7 (RR 1.86, 95%CI 1.02-3.36) compared to medium BMI (23.7-27.2 kg/m2). Low compression pressure (4.0-10.2 kPa) was associated with a higher RR of severe pain (RR 2.93, 95%CI 1.39-6.20), compared with medium compression pressure (10.3-13.5 kPa) after adjusting for contact area, age, compressed breast thickness, volumetric breast density and BMI. The risk of severe versus mild/moderate pain (≥7 versus <7) decreased by 2% with increasing compression force (RR 0.98, 95%CI 0.97-1.00). CONCLUSION Women reported low levels of pain during mammography. Further knowledge about factors affecting experienced pain is needed to personalize the examination to the individual woman. IMPLICATIONS FOR PRACTICE Pain in shoulder(s) and/or neck prior to screening should be considered by the radiographers in a practical screening setting. A compression force of 100-140 N and pressure of 10.3-13.5 kPa are acceptable with respect to reported pain during mammography.
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Affiliation(s)
- N Moshina
- Cancer Registry of Norway, P.O. 5313 Majorstuen, 0304, Oslo, Norway.
| | - S Sagstad
- Cancer Registry of Norway, P.O. 5313 Majorstuen, 0304, Oslo, Norway.
| | - S Sebuødegård
- Cancer Registry of Norway, P.O. 5313 Majorstuen, 0304, Oslo, Norway.
| | - G G Waade
- Oslo Metropolitan University, P.O. 4, St. Olavs Plass, 0130, Oslo, Norway.
| | - E Gran
- Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
| | - J Music
- Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
| | - S Hofvind
- Cancer Registry of Norway, P.O. 5313 Majorstuen, 0304, Oslo, Norway; Oslo Metropolitan University, P.O. 4, St. Olavs Plass, 0130, Oslo, Norway.
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13
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Strand F, Zackrisson S. Breast cancer imaging - A rapidly evolving discipline. Breast 2019; 46:58-63. [DOI: 10.1016/j.breast.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022] Open
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Moshina N, Sebuødegård S, Evensen KT, Hantho C, Iden KA, Hofvind S. Breast compression and experienced pain during mammography by use of three different compression paddles. Eur J Radiol 2019; 115:59-65. [DOI: 10.1016/j.ejrad.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
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Moshina N, Sebuødegård S, Holen ÅS, Waade GG, Tsuruda K, Hofvind S. The impact of compression force and pressure at prevalent screening on subsequent re-attendance in a national screening program. Prev Med 2018; 108:129-136. [PMID: 29337068 DOI: 10.1016/j.ypmed.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/15/2017] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Abstract
Adherence to screening may indirectly help assess whether a prior screening examination deters women from returning for a subsequent examination. We investigated whether compression force and pressure in mammography were associated with re-attendance among prevalently screened women in the organized breast cancer screening program in Norway. Data on compression force (kg) and pressure (kPa) from women's first screening examination in the program (prevalent screening) and subsequent re-attendance were available for 31,225 women aged 50-68, screened during 2007-2013. Crude re-attendance rates and log-binomial regression models estimating the prevalence ratio of re-attendance were used to identify the association between compression force or pressure and re-attendance two-years later. Age and year at prevalent screening, county of residence, screening result (negative or false positive), breast volume, and breast density were included in analyses. Overall, 27,197 (87.1%) women re-attended the program. Re-attendance was highest for women who received a compression force of 10.0-13.9 kg (87.5%) or pressure of 9.0-17.9 kPa (87.8%) and lowest for those who received a compression force of <10.0 kg (85.0%) or pressure of <9.0 kPa (84.7%). The adjusted prevalence of re-attendance was 3% lower for women who received low compression force (<10.0 kg) and 2% lower for women who received low compression pressure (<9.0 kPa) relative to the reference groups (10.0-13.9 kg and 9.0-17.9 kPa, respectively). Future research related to re-attendance should also include information about women's experience of pain, anxiety and stress, as well as image quality.
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Affiliation(s)
- Nataliia Moshina
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway.
| | - Sofie Sebuødegård
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway.
| | - Åsne S Holen
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway.
| | - Gunvor G Waade
- Oslo and Akershus University College of Applied Sciences, P.O. 4, St. Olavs plass, 0130 Oslo, Norway.
| | - Kaitlyn Tsuruda
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway.
| | - Solveig Hofvind
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway; Oslo and Akershus University College of Applied Sciences, P.O. 4, St. Olavs plass, 0130 Oslo, Norway.
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Holland K, Sechopoulos I, Mann RM, den Heeten GJ, van Gils CH, Karssemeijer N. Influence of breast compression pressure on the performance of population-based mammography screening. Breast Cancer Res 2017; 19:126. [PMID: 29183348 PMCID: PMC5706300 DOI: 10.1186/s13058-017-0917-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 11/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In mammography, breast compression is applied to reduce the thickness of the breast. While it is widely accepted that firm breast compression is needed to ensure acceptable image quality, guidelines remain vague about how much compression should be applied during mammogram acquisition. A quantitative parameter indicating the desirable amount of compression is not available. Consequently, little is known about the relationship between the amount of breast compression and breast cancer detectability. The purpose of this study is to determine the effect of breast compression pressure in mammography on breast cancer screening outcomes. METHODS We used digital image analysis methods to determine breast volume, percent dense volume, and pressure from 132,776 examinations of 57,179 women participating in the Dutch population-based biennial breast cancer screening program. Pressure was estimated by dividing the compression force by the area of the contact surface between breast and compression paddle. The data was subdivided into quintiles of pressure and the number of screen-detected cancers, interval cancers, false positives, and true negatives were determined for each group. Generalized estimating equations were used to account for correlation between examinations of the same woman and for the effect of breast density and volume when estimating sensitivity, specificity, and other performance measures. Sensitivity was computed using interval cancers occurring between two screening rounds and using interval cancers within 12 months after screening. Pair-wise testing for significant differences was performed. RESULTS Percent dense volume increased with increasing pressure, while breast volume decreased. Sensitivity in quintiles with increasing pressure was 82.0%, 77.1%, 79.8%, 71.1%, and 70.8%. Sensitivity based on interval cancers within 12 months was significantly lower in the highest pressure quintile compared to the third (84.3% vs 93.9%, p = 0.034). Specificity was lower in the lowest pressure quintile (98.0%) compared to the second, third, and fourth group (98.5%, p < 0.005). Specificity of the fifth quintile was 98.4%. CONCLUSION Results suggest that if too much pressure is applied during mammography this may reduce sensitivity. In contrast, if pressure is low this may decrease specificity.
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Affiliation(s)
- Katharina Holland
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Ritse M. Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Gerard J. den Heeten
- Department of Radiology/Biomedical Engineering and Physics, Academic Medical Center Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Carla H. van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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17
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Breast compression parameters and mammographic density in the Norwegian Breast Cancer Screening Programme. Eur Radiol 2017; 28:1662-1672. [DOI: 10.1007/s00330-017-5104-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/30/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
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18
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Branderhorst W, Groot JE, Lier MG, Highnam RP, Heeten GJ, Grimbergen CA. Technical Note: Validation of two methods to determine contact area between breast and compression paddle in mammography. Med Phys 2017; 44:4040-4044. [DOI: 10.1002/mp.12392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/25/2017] [Accepted: 05/26/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Woutjan Branderhorst
- Department of Biomedical Engineering and Physics Academic Medical Center P.O. Box 22660 1100 DD Amsterdam The Netherlands
- Sigmascreening B.V. Meibergdreef 45 1105 BA Amsterdam The Netherlands
- Volpara Solutions Limited P.O. Box 24404 Manners St Central Wellington 6142 New Zealand
| | - Jerry E. Groot
- Department of Biomedical Engineering and Physics Academic Medical Center P.O. Box 22660 1100 DD Amsterdam The Netherlands
- Sigmascreening B.V. Meibergdreef 45 1105 BA Amsterdam The Netherlands
| | - Monique G.J.T.B. Lier
- Department of Biomedical Engineering and Physics Academic Medical Center P.O. Box 22660 1100 DD Amsterdam The Netherlands
- Sigmascreening B.V. Meibergdreef 45 1105 BA Amsterdam The Netherlands
| | - Ralph P. Highnam
- Volpara Solutions Limited P.O. Box 24404 Manners St Central Wellington 6142 New Zealand
| | - Gerard J. Heeten
- Department of Biomedical Engineering and Physics Academic Medical Center P.O. Box 22660 1100 DD Amsterdam The Netherlands
- Sigmascreening B.V. Meibergdreef 45 1105 BA Amsterdam The Netherlands
| | - Cornelis A. Grimbergen
- Department of Biomedical Engineering and Physics Academic Medical Center P.O. Box 22660 1100 DD Amsterdam The Netherlands
- Sigmascreening B.V. Meibergdreef 45 1105 BA Amsterdam The Netherlands
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