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Shang H, Wu Q, Wu J, Zhou S, Wang Z, Wang H, Yin J. Study on breast cancerization and isolated diagnosis in situ by HOF-ATR-MIR spectroscopy with deep learning. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 319:124546. [PMID: 38824755 DOI: 10.1016/j.saa.2024.124546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Abstract
Mid-infrared (MIR) spectroscopy can characterize the content and structural changes of macromolecular components in different breast tissues, which can be used for feature extraction and model training by machine learning to achieve accurate classification and recognition of different breast tissues. In parallel, the one-dimensional convolutional neural network (1D-CNN) stands out in the field of deep learning for its ability to efficiently process sequential data, such as spectroscopic signals. In this study, MIR spectra of breast tissue were collected in situ by coupling the self-developed MIR hollow optical fiber attenuated total reflection (HOF-ATR) probe with a Fourier transform infrared spectroscopy (FTIR) spectrometer. Staging analysis was conducted on the changes in macromolecular content and structure in breast cancer tissues. For the first time, a trinary classification model was established based on 1D-CNN for recognizing normal, paracancerous and cancerous tissues. The final predication results reveal that the 1D-CNN model based on baseline correction (BC) and data augmentation yields more precise classification results, with a total accuracy of 95.09%, exhibiting superior discrimination ability than machine learning models of SVM-DA (90.00%), SVR (88.89%), PCA-FDA (67.78%) and PCA-KNN (70.00%). The experimental results suggest that the application of 1D-CNN enables accurate classification and recognition of different breast tissues, which can be considered as a precise, efficient and intelligent novel method for breast cancer diagnosis.
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Affiliation(s)
- Hui Shang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Qingxia Wu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Jinjin Wu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Suwei Zhou
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Zihan Wang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Huijie Wang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China.
| | - Jianhua Yin
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China.
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Salem MRH, Chalabi NAMT, Mohammed AAGB, Yacoub GEE. The incidence of breast cancer in Egyptian females in correlation to different mammographic ACR densities. Folia Med (Plovdiv) 2024; 66:213-220. [PMID: 38690816 DOI: 10.3897/folmed.66.e119570] [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: 01/25/2024] [Accepted: 03/30/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION The density of breast tissue, radiologically referred to as fibroglandular mammary tissue, was found to be a predisposing factor for breast cancer (BC). However, the stated degree of elevated BC risk varies widely in the literature.
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Pesapane F, Trentin C, Ferrari F, Signorelli G, Tantrige P, Montesano M, Cicala C, Virgoli R, D'Acquisto S, Nicosia L, Origgi D, Cassano E. Deep learning performance for detection and classification of microcalcifications on mammography. Eur Radiol Exp 2023; 7:69. [PMID: 37934382 PMCID: PMC10630180 DOI: 10.1186/s41747-023-00384-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/07/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Breast cancer screening through mammography is crucial for early detection, yet the demand for mammography services surpasses the capacity of radiologists. Artificial intelligence (AI) can assist in evaluating microcalcifications on mammography. We developed and tested an AI model for localizing and characterizing microcalcifications. METHODS Three expert radiologists annotated a dataset of mammograms using histology-based ground truth. The dataset was partitioned for training, validation, and testing. Three neural networks (AlexNet, ResNet18, and ResNet34) were trained and evaluated using specific metrics including receiver operating characteristics area under the curve (AUC), sensitivity, and specificity. The reported metrics were computed on the test set (10% of the whole dataset). RESULTS The dataset included 1,000 patients aged 21-73 years and 1,986 mammograms (180 density A, 220 density B, 380 density C, and 220 density D), with 389 malignant and 611 benign groups of microcalcifications. AlexNet achieved the best performance with 0.98 sensitivity, 0.89 specificity of, and 0.98 AUC for microcalcifications detection and 0.85 sensitivity, 0.89 specificity, and 0.94 AUC of for microcalcifications classification. For microcalcifications detection, ResNet18 and ResNet34 achieved 0.96 and 0.97 sensitivity, 0.91 and 0.90 specificity and 0.98 and 0.98 AUC, retrospectively. For microcalcifications classification, ResNet18 and ResNet34 exhibited 0.75 and 0.84 sensitivity, 0.85 and 0.84 specificity, and 0.88 and 0.92 AUC, respectively. CONCLUSIONS The developed AI models accurately detect and characterize microcalcifications on mammography. RELEVANCE STATEMENT AI-based systems have the potential to assist radiologists in interpreting microcalcifications on mammograms. The study highlights the importance of developing reliable deep learning models possibly applied to breast cancer screening. KEY POINTS • A novel AI tool was developed and tested to aid radiologists in the interpretation of mammography by accurately detecting and characterizing microcalcifications. • Three neural networks (AlexNet, ResNet18, and ResNet34) were trained, validated, and tested using an annotated dataset of 1,000 patients and 1,986 mammograms. • The AI tool demonstrated high accuracy in detecting/localizing and characterizing microcalcifications on mammography, highlighting the potential of AI-based systems to assist radiologists in the interpretation of mammograms.
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Chiara Trentin
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Ferrari
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Signorelli
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Priyan Tantrige
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Marta Montesano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | | | | | - Luca Nicosia
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Origgi
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
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da Luz Costa T, Dantas DB, de Campos Gomes F, Soares CO, Castelhano JR, Fonseca LC, Neves LMT, Figueiredo ERL, de Melo Neto JS. Impacts of Sociodemographic Factors, Screening, and Organization of Health Services on Breast Cancer Mortality in Brazil: An Ecological Study of 20 Years. Int J Breast Cancer 2023; 2023:6665725. [PMID: 37936925 PMCID: PMC10627721 DOI: 10.1155/2023/6665725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/20/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023] Open
Abstract
Background Breast cancer mortality is increasing in Brazil. This study examines the impact of sociodemographic factors, screening procedures, and primary healthcare (PHC) on breast cancer mortality. Methods An ecological study analyzed secondary data of women diagnosed with breast cancer who died between 2000 and 2019. Sociodemographic factors, screening procedures, and PHC were examined in relation to breast cancer mortality. Statistical analyses included normality tests, Kruskal-Wallis and one-way ANOVA tests with post hoc comparisons, Pearson and Spearman correlation tests, age-period-cohort analysis, Kaplan-Meier analysis, and Cox regression analysis. Significance was set at p < 0.05. Results Mortality rates were higher in the southeast (15.77) and south (15.97) regions compared to the north (5.07) (p < 0.0001). Survival rates were longer in the southeast (70.3 ± 0.05) and south (70.6 ± 0.09) than in the north (63.98 ± 0.053) (p ≤ 0.001). Mortality increased with age after 32 years (p ≤ 0.001). Brown and indigenous women had lower mortality and survival rates. Increased coverage of PHC, ultrasound, and biopsy did not reduce mortality. However, improved cytopathologic analysis led to a decrease in mortality. Conclusions Sociodemographic factors, screening procedures, and PHC are specific predictors of breast cancer mortality in Brazil.
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Affiliation(s)
- Thalita da Luz Costa
- Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, Brazil
| | - Diego Bessa Dantas
- Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, Brazil
| | - Fabiana de Campos Gomes
- Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
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Valadares CN, Couto HL, Soares AN, Toppa PH, Ricardo BP, McIntosh SA, Sharma N, Resende V. Potential role of vacuum-assisted procedures in resecting breast cancers and highlighting selection criteria to support future trials. Front Oncol 2023; 13:1239574. [PMID: 37810980 PMCID: PMC10552518 DOI: 10.3389/fonc.2023.1239574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/03/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the role of vacuum-assisted biopsy (VAB) in resecting breast cancers. Methods Retrospective database analysis of 116 cancers [both invasive breast cancers (IC) and ductal carcinoma in situ (DCIS)] diagnosed by VAB submitted to standard surgical treatment with complete histological data from VAB and surgery. Excision following VAB was defined as complete resection (CR) if there was no residual tumor in the surgical specimen, minimal residual disease (MRD) if residual tumor ≤ 3 mm, gross residual disease (GRD) if residual tumor > 3 mm, and upgrade from DCIS on VAB to IC. CR and MRD were combined as potentially resected percutaneously (PRP). GRD and those with upgrade to IC were determined not eligible for percutaneous resection (NPR). Factors predictive of PRP were evaluated. Results Mean age was 55.6 years (20-91; SD: 12,27). CR was seen in 29 of 116 cases (25%), MRD in 18 of 116 cases (15.5%), GRD in 64 of 116 cases (55.2%), and five of 116 cases (4.3%) were upgraded from DCIS to IC, and those groups combined represented 47 cases of PRP (40.5%) and 69 (59,5%) of NPR. For 77 tumors ≤ 10 mm, 45 (58.5%) were PRP. Multivariate analysis reveals significance for enlarged VAB (EVAB) (p = 0.008, OR: 4.4, 95% CI), low/intermediate nuclear grade (p < 0.001, OR: 12.5, 95% CI) and final tumor size (T) ≤ 10 mm (p = 0.001, OR: 50.1, 95% CI) for PRP. Conclusions This study showed that lesions completely excised with VAB that were cancer could have been treated with VAB rather than surgery but tumor selection in terms of subtype and size is important.
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Affiliation(s)
- C. N. Valadares
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Sociedade Brasileira de Mastologia, Rio de janeiro, Brazil
| | - H. L. Couto
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Sociedade Brasileira de Mastologia, Rio de janeiro, Brazil
| | - A. N. Soares
- Faculdade Santa Casa de Belo Horizonte, Minas Gerais, Brazil
| | - P. H. Toppa
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - B. P. Ricardo
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - S. A. McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | - N. Sharma
- Breast Unit, Leeds Teaching Hospital NHS Trust, St James Hospital, Leeds, United Kingdom
| | - V. Resende
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Rooney BL, Rooney BP, Muralidaran V, Wang W, Furth PA. Mouse Mammary Gland Whole Mount Density Assessment across Different Morphologies Using a Bifurcated Program for Image Processing. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:1407-1417. [PMID: 36115719 PMCID: PMC9552022 DOI: 10.1016/j.ajpath.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/24/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
Mammographic density is associated with increased breast cancer risk. Conventional visual assessment of murine mouse models does not include quantified total density analysis. A bifurcated method was sufficient to obtain relative density scores on a broad range of two-dimensional whole mount images that contained both normal and abnormal findings. Image processing techniques, including a ridge operator and a gaussian denoising method, were used to isolate background away from mammary epithelium and use mean pixel intensity to represent mammary density on genetically engineered mouse models for breast cancer in mice 4 to 29 months of age. The bifurcated method allowed for application of an optimal image processing approach for the structural elements present in the whole mount images. Gaussian denoising was the optimal approach when more dense lobular growth and tertiary branching dominate and a ridge operator when epithelial growth was more sparse and secondary branching was the more dominant structural feature. The two processing approaches were combined in a single experimental flow program using an initial image density measurement as the decision point between the two approaches. Higher density was associated with lobular growth, tertiary branching, fibrotic stroma, and presence of cancer. The significance of the study is development of a readily accessible program for digital assessment of mammary gland whole mount density across a range of mammary gland morphologies.
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Affiliation(s)
| | - Brian P Rooney
- Department of Oncology, Georgetown University, Washington, DC
| | | | - Weisheng Wang
- Department of Oncology, Georgetown University, Washington, DC
| | - Priscilla A Furth
- Department of Oncology, Georgetown University, Washington, DC; Department of Medicine, Georgetown University, Washington, DC.
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Song Z, Wang H, Feng X, Yang X, Han P, Zhao J. Consistency Analysis of CTLM Imaging and Mammography in the Diagnosis of Breast Tumor Lesions. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5391636. [PMID: 39290687 PMCID: PMC11407882 DOI: 10.1155/2022/5391636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/07/2022] [Indexed: 09/19/2024]
Abstract
OBJECTIVE To analyze the consistency of preoperative CTLM imaging in the diagnosis of breast cancer lesions and postoperative pathological examination. METHODS The clinical data of 225 patients with breast tumor in our breast surgery department were collected. All patients underwent mammography, CTLM, and pathological examination. To analyze the image characteristics of breast CTLM imaging, calculate the diagnostic efficacy of CTLM imaging for breast tumors, and compare the image characteristics of CTLM imaging for benign and malignant tumors. RESULTS (1) Postoperative pathological examination showed that 136 cases (60.44%) of lesions were benign tumors, and 89 cases (39.56%) were malignant tumors. (2) The "spokes distribution" of normal breast CTLM images was interrupted. In the 3D reconstructed images, the morphology of the abnormal angiogenesis area is mostly irregular nonbanded structure, which is manifested as slab structure, spindle structure, spherical structure, diverticulum structure, inverted conical structure, rings structure, branched structure, and dumbbell structure. (3) The detection rate of breast tumor by CTLM imaging was 84.44%. The specificity and coincidence rate of CTLM imaging were higher than that of mammography (P < 0.05). (4) The features of CTLM imaging images of breast malignant tumors are mostly bright white locally, with irregular edges and obvious attenuation of laser signal, and the reconstructed shape of 3D images is mostly like a slab structure. CONCLUSION CTLM imaging can provide related information of neovascularization in breast cancer lesions, which is basically consistent with pathologically confirmed lesions.
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Affiliation(s)
- Zhangjun Song
- Department of Oncology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Huxia Wang
- Department of Breast, Shaanxi Provincial Cancer Hospital, Xi'an 710061, China
| | - Xiaorui Feng
- Department of Radiation Oncology, Xi'an High-tech Hospital, Xi'an 710000, China
| | - Xiaomin Yang
- Department of Breast, Shaanxi Provincial Cancer Hospital, Xi'an 710061, China
| | - Pihua Han
- Department of Breast, Shaanxi Provincial Cancer Hospital, Xi'an 710061, China
| | - Jing Zhao
- Department of Breast, Shaanxi Provincial Cancer Hospital, Xi'an 710061, China
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Satoh Y, Imokawa T, Fujioka T, Mori M, Yamaga E, Takahashi K, Takahashi K, Kawase T, Kubota K, Tateishi U, Onishi H. Deep learning for image classification in dedicated breast positron emission tomography (dbPET). Ann Nucl Med 2022; 36:401-410. [PMID: 35084712 DOI: 10.1007/s12149-022-01719-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to investigate and determine the best deep learning (DL) model to predict breast cancer (BC) with dedicated breast positron emission tomography (dbPET) images. METHODS Of the 1598 women who underwent dbPET examination between April 2015 and August 2020, a total of 618 breasts on 309 examinations for 284 women who were diagnosed with BC or non-BC were analyzed in this retrospective study. The Xception-based DL model was trained to predict BC or non-BC using dbPET images from 458 breasts of 109 BCs and 349 non-BCs, which consisted of mediallateral and craniocaudal maximum intensity projection images, respectively. It was tested using dbPET images from 160 breasts of 43 BC and 117 non-BC. Two expert radiologists and two radiology residents also interpreted them. Sensitivity, specificity, and area under the receiver operating characteristic curves (AUCs) were calculated. RESULTS Our DL model had a sensitivity and specificity of 93% and 93%, respectively, while radiologists had a sensitivity and specificity of 77-89% and 79-100%, respectively. Diagnostic performance of our model (AUC = 0.937) tended to be superior to that of residents (AUC = 0.876 and 0.868, p = 0.073 and 0.073), although not significantly different. Moreover, no significant differences were found between the model and experts (AUC = 0.983 and 0.941, p = 0.095 and 0.907). CONCLUSIONS Our DL model could be applied to dbPET and achieve the same diagnostic ability as that of experts.
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Affiliation(s)
- Yoko Satoh
- Yamanashi PET Imaging Clinic, Chuo City, Yamanashi Prefecture, Japan
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Tomoki Imokawa
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan.
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Emi Yamaga
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Kanae Takahashi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Keiko Takahashi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Takahiro Kawase
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama Prefecture, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
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Experiences of Women Who Refuse Recall for Further Investigation of Abnormal Screening Mammography: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031041. [PMID: 35162064 PMCID: PMC8834256 DOI: 10.3390/ijerph19031041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/15/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
Breast cancer has the highest incidence among all cancers for women in Taiwan. The current screening policy in Taiwan provides biennial mammogram tests for all women aged 45 to 69 years. A recommendation for further investigation is sent via post to women with a BI-RADS result of 0. The proportion of women who followed-up with a recall request for further investigation after an abnormal mammogram has been below 92.5% in recent years. Therefore, we aimed to explore the experiences of these women who refused recall for further investigation despite an abnormal mammogram. Purposive sampling was conducted on 13 women who refused recall for further examination of abnormal screening mammograms. Data collection included inductive, in-depth interviews or telephone interviews. A content analysis was applied. Three themes were identified: (1) negative screening experiences, (2) struggling with ’to go or not to go’, and (3) rationalizing without a follow-up examination. The first theme included three subthemes: (1) pain of examination, (2) the inconvenience of medical treatment; waiting, and (3) dissatisfaction with having to pay for further examination. The second major theme included three subthemes: (1) perceiving one’s susceptibility to breast cancer as very low, (2) questioning the accuracy of the results, and (3) procrastinating with a “head-in-the-sand” mentality. The third major theme included two subthemes: (1) fatalism and (2) paying attention to self-cultivation. In conclusion, the findings provide important information to healthcare providers involved in case management related to the actual living experiences of women with abnormal screening mammogram results and the additional education required to raise breast cancer awareness in the general public to achieve overall caring goals.
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García-Cuellar CM, Hernández-Delgadillo R, Solis-Soto JM, Meester I, Sánchez-Pérez Y, Nakagoshi-Cepeda SE, Nakagoshi-Cepeda MAA, Chellam S, Cabral-Romero C. Cetylpyridinium chloride inhibits human breast tumor cells growth in a no-selective way. J Appl Biomater Funct Mater 2022; 20:22808000221092157. [PMID: 35485910 DOI: 10.1177/22808000221092157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Analyze the antitumor capacity of cetylpyridinium chloride (CPC) on human breast tumor cells, and the possible action mechanism. MATERIAL AND METHODS The human breast tumor cells MCF-7 and no-tumor breast cells MCF-10A were exposed to CPC under various condition (concentration and duration). Cell viability was measured with MTT assay, the LIVE/DEAD assay, and fluorescence microscopy. Membrane permeability after CPC exposure was evaluated by Calcein AM assay, mitochondrial morphology with a MitoView staining, and genotoxicity with the comet assay and fluorescence microscopy. RESULTS CPC was cytotoxic to both MCF-7 and MCF-10A as of a 24-h exposure to 0.1 µM. Cytotoxicity was dose-dependent and reached 91% for MCF-7 and 78% for MCF-10A after a 24-h exposure to 100 µM CPC, which outperformed the positive control doxorubicin in effectiveness and selectivity. The LD50 of CPC on was 6 µM for MCF-7 and 8 µM for MCF-10A, yielding a selectivity index of 1.41. A time response analysis revealed 64% dead cells after only 5 min of exposure to 100 µM CPC. With respect to the action mechanisms, the comet assay did not reveal genome fragmentation. On the other hand, membrane damage was dose-dependent and may also affect mitochondrial morphology. CONCLUSION Cetylpyridinium chloride inhibits MCF-7 cell growing in a non-selective way as of 5 min of exposure. The action mechanism of CPC on tumor cells involves cell membrane damage without change neither mitochondrial morphology nor genotoxicity.
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Affiliation(s)
| | - Rene Hernández-Delgadillo
- Laboratorio de Biología Molecular, Facultad de Odontología, Universidad Autónoma de Nuevo León, UANL, Monterrey, Nuevo León, México
| | - Juan Manuel Solis-Soto
- Laboratorio de Biología Molecular, Facultad de Odontología, Universidad Autónoma de Nuevo León, UANL, Monterrey, Nuevo León, México
| | - Irene Meester
- Departamento de Ciencias Básicas, Universidad de Monterrey, San Pedro Garza García, México
| | - Yesennia Sánchez-Pérez
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Ciudad de México, México
| | - Sergio Eduardo Nakagoshi-Cepeda
- Laboratorio de Biología Molecular, Facultad de Odontología, Universidad Autónoma de Nuevo León, UANL, Monterrey, Nuevo León, México
| | | | | | - Claudio Cabral-Romero
- Laboratorio de Biología Molecular, Facultad de Odontología, Universidad Autónoma de Nuevo León, UANL, Monterrey, Nuevo León, México
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Kim LS, Lannin DR. Breast Cancer Screening: Is There Room for De-escalation? CURRENT BREAST CANCER REPORTS 2022; 14:153-161. [PMID: 36404936 PMCID: PMC9640864 DOI: 10.1007/s12609-022-00465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Purpose of Review Breast cancer screening is highly controversial and different agencies have widely varying guidelines. Yet it is currently used extensively in the USA and frequently the thought is "the more, the better." The purpose of this review is to objectively assess the risks and benefits of screening mammography and consider whether there may be areas where it could be de-escalated. Recent Findings Over the past few years, there have been several meta-analyses that are concordant, and it is now agreed that the main benefit of screening mammography is about a 20% reduction in breast cancer mortality. This actually benefits about 5% of patients with mammographically detected tumors. We now appreciate that the main harm of screening is overdiagnosis, i.e. detection of a cancer that will not cause the patient any harm and would not have ever been detected without the screening. This currently represents about 20 to 30% of screening detected cancers. Finding extra cancers with more intense screening is not always good, because in this situation, the risk of overdiagnosis increases and the benefit decreases. In some groups, the risk of overdiagnosis approaches 75%. Summary Our goal should be not only to find more cancers, but to avoid finding cancers that would never have caused the patient any harm and lead to unnecessary treatment. The authors suggest some situations where it may be reasonable to de-escalate screening.
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Affiliation(s)
- Leah S. Kim
- Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520 USA
| | - Donald R. Lannin
- Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520 USA
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Imbriaco M. Reducing False-Positive Screening MRI Rates in Women with Extremely Dense Breasts. Radiology 2021; 301:293-294. [PMID: 34402671 DOI: 10.1148/radiol.2021211547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Massimo Imbriaco
- From the Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
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Damiana TST, Dalm SU. Combination Therapy, a Promising Approach to Enhance the Efficacy of Radionuclide and Targeted Radionuclide Therapy of Prostate and Breast Cancer. Pharmaceutics 2021; 13:pharmaceutics13050674. [PMID: 34067215 PMCID: PMC8151894 DOI: 10.3390/pharmaceutics13050674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022] Open
Abstract
In recent years, radionuclide therapy (RT) and targeted radionuclide therapy (TRT) have gained great interest in cancer treatment. This is due to promising results obtained in both preclinical and clinical studies. However, a complete response is achieved in only a small percentage of patients that receive RT or TRT. As a consequence, there have been several strategies to improve RT and TRT outcomes including the combination of these treatments with other well-established anti-cancer therapies, for example, chemotherapy. Combinations of RT and TRT with other therapies with distinct mechanisms of action represent a promising strategy. As for prostate cancer and breast cancer, the two most prevalent cancer types worldwide, several combination-based therapies have been evaluated. In this review, we will provide an overview of the RT and TRT agents currently used or being investigated in combination with hormone therapy, chemotherapy, immunotherapy, and external beam radiation therapy for the treatment of prostate cancer and breast cancer.
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Rouette J, Elfassy N, Bouganim N, Yin H, Lasry N, Azoulay L. Evaluation of the quality of mammographic breast positioning: a quality improvement study. CMAJ Open 2021; 9:E607-E612. [PMID: 34088731 PMCID: PMC8191588 DOI: 10.9778/cmajo.20200211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although there are concerns that inadequate breast positioning in mammographic examinations may lead to cancers being missed, few studies have examined the quality of breast positioning, especially in the Canadian context. Our objective was to assess the quality of breast positioning in mammographic examinations in a Quebec-wide representative sample of technologists. METHODS This quality improvement study was part of a professional inspection launched by the Ordre des technologues en imagerie médicale, en radio-oncologie et en électrophysiologie médicale du Québec among its members. The inspection was conducted between May and July 2017 on a proportionate stratified random sample of all active technologists certified in mammography in Quebec. Each technologist provided images from 15 consecutive mammographic examinations they performed in the previous 6 months. The quality of positioning was then evaluated by senior technologists using a quality assessment tool specifically developed for this inspection. A technologist was deemed to have failed the professional inspection when at least 7 of the 15 mammographic examinations were scored as critical failures. Proportions were calculated accounting for sampling weights and correction for finite population. RESULTS Among the 520 technologists certified in mammography in Quebec, 76 technologists (14.6%) were randomly selected for the professional inspection and contributed images from 1127 mammographic examinations. Thirty-eight technologists (weighted percentage 50.3%, 95% confidence interval [CI] 37.6% to 63.0%) failed the professional inspection. Overall, 492 mammographic examinations (43.7%, 95% CI 38.6% to 48.8%) had at least 1 image scored as a critical failure. INTERPRETATION Half of the technologists performing mammographic examinations in Quebec who participated in this study failed the inspection, and a substantial proportion of their mammographic examinations demonstrated critical failures in breast positioning. Overall, our findings are concordant with those of previous studies and highlight the need for additional investigations assessing the quality of breast positioning in mammographic examinations in other jurisdictions.
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Affiliation(s)
- Julie Rouette
- Department of Epidemiology, Biostatistics and Occupational Health (Rouette, Azoulay), McGill University; Centre for Clinical Epidemiology (Rouette, Yin, Azoulay), Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Que.; Department of Medicine (Elfassy), University of Toronto, Toronto, Ont.; Gerald Bronfman Department of Oncology (Bouganim, Azoulay), McGill University; iMD Research (Lasry), Montréal, Que
| | - Noémie Elfassy
- Department of Epidemiology, Biostatistics and Occupational Health (Rouette, Azoulay), McGill University; Centre for Clinical Epidemiology (Rouette, Yin, Azoulay), Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Que.; Department of Medicine (Elfassy), University of Toronto, Toronto, Ont.; Gerald Bronfman Department of Oncology (Bouganim, Azoulay), McGill University; iMD Research (Lasry), Montréal, Que
| | - Nathaniel Bouganim
- Department of Epidemiology, Biostatistics and Occupational Health (Rouette, Azoulay), McGill University; Centre for Clinical Epidemiology (Rouette, Yin, Azoulay), Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Que.; Department of Medicine (Elfassy), University of Toronto, Toronto, Ont.; Gerald Bronfman Department of Oncology (Bouganim, Azoulay), McGill University; iMD Research (Lasry), Montréal, Que
| | - Hui Yin
- Department of Epidemiology, Biostatistics and Occupational Health (Rouette, Azoulay), McGill University; Centre for Clinical Epidemiology (Rouette, Yin, Azoulay), Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Que.; Department of Medicine (Elfassy), University of Toronto, Toronto, Ont.; Gerald Bronfman Department of Oncology (Bouganim, Azoulay), McGill University; iMD Research (Lasry), Montréal, Que
| | - Nathaniel Lasry
- Department of Epidemiology, Biostatistics and Occupational Health (Rouette, Azoulay), McGill University; Centre for Clinical Epidemiology (Rouette, Yin, Azoulay), Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Que.; Department of Medicine (Elfassy), University of Toronto, Toronto, Ont.; Gerald Bronfman Department of Oncology (Bouganim, Azoulay), McGill University; iMD Research (Lasry), Montréal, Que
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics and Occupational Health (Rouette, Azoulay), McGill University; Centre for Clinical Epidemiology (Rouette, Yin, Azoulay), Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Que.; Department of Medicine (Elfassy), University of Toronto, Toronto, Ont.; Gerald Bronfman Department of Oncology (Bouganim, Azoulay), McGill University; iMD Research (Lasry), Montréal, Que.
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15
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Quantitative STAU2 measurement in lymphocytes for breast cancer risk assessment. Sci Rep 2021; 11:915. [PMID: 33441653 PMCID: PMC7806934 DOI: 10.1038/s41598-020-79622-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/08/2020] [Indexed: 01/29/2023] Open
Abstract
Although mammograms play a key role in early breast cancer detection, the test is not applicable to all women, for example, women under the age of 40. The development of a noninvasive blood test with high sensitivity and accessibility will improve the effectiveness of breast cancer screening programmes. Secretory factors released from cancer cells can induce the expression of certain genes in a large number of white blood cells (WBCs). Therefore, cancer-dependent proteins in WBCs can be used as tumour markers with high sensitivity. Five proteins (LMAN1, AZI2, STAU2, MMP9 and PLOD1) from a systemic analysis of a variety of array data of breast cancer patients were subjected to immunofluorescence staining to evaluate the presence of fixed WBCs on 96-well plates from 363 healthy females and 358 female breast cancer patients. The results revealed that the average fluorescence intensity of anti-STAU2 and the percentage of STAU2-positive T and B lymphocytes in breast cancer patients (110.50 ± 23.38 and 61.87 ± 12.44, respectively) were significantly increased compared with those in healthy females (56.47 ± 32.03 and 33.02 ± 18.10, respectively) (p = 3.56 × 10-71, odds ratio = 24.59, 95% CI = 16.64-36.34). The effect of secreted molecules from breast cancer cells was proven by the increase in STAU2 intensity in PBMCs cocultured with MCF-7 and T47D cells at 48 h (p = 0.0289). The test demonstrated 98.32%, 82.96%, and 48.32% sensitivity and 56.47%, 83.47%, and 98.62% specificity in correlation with the percentage of STAU2-positive cells at 40, 53.34 and 63.38, respectively. We also demonstrated how to use the STAU2 test for the assessment of risk in women under the age of 40. STAU2 is a novel breast cancer marker that can be assessed by quantitative immunofluorescence staining of fixed WBCs that are transportable at room temperature via mail, representing a useful risk assessment tool for women without access to mammograms.
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16
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Sawyer Lee R, Dunnmon JA, He A, Tang S, Ré C, Rubin DL. Comparison of segmentation-free and segmentation-dependent computer-aided diagnosis of breast masses on a public mammography dataset. J Biomed Inform 2021; 113:103656. [PMID: 33309994 PMCID: PMC7987253 DOI: 10.1016/j.jbi.2020.103656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To compare machine learning methods for classifying mass lesions on mammography images that use predefined image features computed over lesion segmentations to those that leverage segmentation-free representation learning on a standard, public evaluation dataset. METHODS We apply several classification algorithms to the public Curated Breast Imaging Subset of the Digital Database for Screening Mammography (CBIS-DDSM), in which each image contains a mass lesion. Segmentation-free representation learning techniques for classifying lesions as benign or malignant include both a Bag-of-Visual-Words (BoVW) method and a Convolutional Neural Network (CNN). We compare classification performance of these techniques to that obtained using two different segmentation-dependent approaches from the literature that rely on specific combinations of end classifiers (e.g. linear discriminant analysis, neural networks) and predefined features computed over the lesion segmentation (e.g. spiculation measure, morphological characteristics, intensity metrics). RESULTS We report area under the receiver operating characteristic curve (AZ) values for malignancy classification on CBIS-DDSM for each technique. We find average AZ values of 0.73 for a segmentation-free BoVW method, 0.86 for a segmentation-free CNN method, 0.75 for a segmentation-dependent linear discriminant analysis of Rubber-Band Straightening Transform features, and 0.58 for a hybrid rule-based neural network classification using a small number of hand-designed features. CONCLUSIONS We find that malignancy classification performance on the CBIS-DDSM dataset using segmentation-free BoVW features is comparable to that of the best segmentation-dependent methods we study, but also observe that a common segmentation-free CNN model substantially and significantly outperforms each of these (p < 0.05). These results reinforce recent findings suggesting that representation learning techniques such as BoVW and CNNs are advantageous for mammogram analysis because they do not require lesion segmentation, the quality and specific characteristics of which can vary substantially across datasets. We further observe that segmentation-dependent methods achieve performance levels on CBIS-DDSM inferior to those achieved on the original evaluation datasets reported in the literature. Each of these findings reinforces the need for standardization of datasets, segmentation techniques, and model implementations in performance assessments of automated classifiers for medical imaging.
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Affiliation(s)
- Rebecca Sawyer Lee
- Stanford University Biomedical Informatics Training Program, United States
| | - Jared A Dunnmon
- Stanford University Department of Computer Science, United States.
| | - Ann He
- Stanford University Department of Computer Science, United States
| | - Siyi Tang
- Stanford University Department of Electrical Engineering, United States
| | - Christopher Ré
- Stanford University Department of Computer Science, United States
| | - Daniel L Rubin
- Stanford University Departments of Radiology and Biomedical Data Science, United States
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17
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Akansel N, Gülşen M, Gültaş M. Influence of Discomfort Tolerance of Women who Undergo Mammography on the Perceived Pain Intensity Due to the Procedure. Eur J Breast Health 2020; 17:68-75. [PMID: 33796833 DOI: 10.4274/ejbh.2020.6068] [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: 08/28/2020] [Accepted: 12/11/2020] [Indexed: 01/02/2023]
Abstract
Objective This study aims to determine the capacity to tolerate discomfort by women who undergo mammography. Materials and Methods The data were obtained using the face-to-face interview method immediately after the procedure with women who undergo mammography (n=132). Demographic data collection form and the Discomfort Intolerance Scale was used for data collection. Results Among the women, 78.8% experienced pain during mammography and the pain intensity was determined as 3.55 (standard deviation=3.00) on the 0-10 Visual Analogue Scale. Women who were not on pain relievers and nonsmokers have high discomfort tolerance. Women who were consuming substances containing methylxanthine (eg. chocolate) tend to avoid discomfort. Women with a history of breast mass and abnormal test results did not avoid discomfort as much as women who undergo regular checkup mammograms. Most of the women experience pain during mammography, and avoidance from discomfort increases as the perceived pain during the procedure increases. Conclusion Conducting different studies using the same scale can be useful in evaluating the discomfort experienced during mammography and its contribution to reducing pain.
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Affiliation(s)
- Neriman Akansel
- Department of Surgical Nursing, Bursa Uludağ University, Nilüfer, Bursa, Turkey
| | - Muaz Gülşen
- Department of Surgical Nursing, Çukurova University Faculty of Health Sciences, Adana, Turkey
| | - Muhammed Gültaş
- Department of Surgical Nursing, Bursa Uludağ University, Nilüfer, Bursa, Turkey
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18
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Maleyeff J, Chen D. Consumer health informatics approach for personalized cancer screening decisions using utility functions. Health Informatics J 2020; 26:2877-2891. [PMID: 33317380 DOI: 10.1177/1460458220949484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A consumer health informatics approach is used to investigate the development of a patient-centered decision support system (DSS) with individualized utility functions. It supports medical decisions that have uncertain benefits and potential harms. Its use for accepting or declining cancer screening is illustrated. The system's underlying optimization model incorporates two user-specific utility functions-one that quantifies life-saving benefits and one that quantifies harms, such as unnecessary follow-up tests, surgeries, or treatments. The system requires sound decision making. Therefore, the decision making process was studied using a decision aid in the form of a color-coded matrix with the potential outcomes randomly placed in proportion to their likelihoods. Data were collected from 48 study participants, based on a central composite experimental design. The results show that the DSS can be effective, but health consumers may not be rational decision makers.
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Affiliation(s)
| | - Danrong Chen
- College of Arts & Sciences, Boston University, USA
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19
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Pathway Analysis of Selected Circulating miRNAs in Plasma of Breast Cancer Patients: A Preliminary Study. Int J Mol Sci 2020; 21:ijms21197288. [PMID: 33023154 PMCID: PMC7583045 DOI: 10.3390/ijms21197288] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/14/2022] Open
Abstract
MicroRNAs in the circulation of breast cancer (BC) patients have great potential for the early diagnosis, treatment and monitoring of breast cancer. The aim of this preliminary study was to obtain the expression profile of selected miRNAs in the plasma of BC patients that could discriminate BC patients from healthy volunteers and may be useful in early detection of BC. Significantly deregulated miRNAs were evaluated by pathway analysis with the prediction of potential miRNA targets. The study enrolled plasma samples from 65 BC patients and 34 healthy volunteers. Selected miRNAs were screened in pilot testing by the real-time PCR (qPCR) method, and the most appropriate reference genes were selected for normalisation by the geNorm algorithm. In the final testing, we detected miR-99a, miR-130a, miR-484 and miR-1260a (p < 0.05) as significantly up-regulated in the plasma of BC patients. Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway analysis revealed that all significantly deregulated miRNAs are involved in the Hippo and Transforming Growth Factor-beta (TGF-beta) signalling pathways. Our study confirmed a different profile of selected circulating miRNAs in the plasma of BC patients with an emphasis on some critical points in the analysis process.
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20
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Siqueira TC, Frágoas SP, Pelegrini A, de Oliveira AR, da Luz CM. Factors associated with upper limb dysfunction in breast cancer survivors. Support Care Cancer 2020; 29:1933-1940. [PMID: 32808138 DOI: 10.1007/s00520-020-05668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze factors associated with upper limb dysfunction in women after breast cancer treatment. METHODOLOGY A cross-sectional study with 233 women over 18 years of age diagnosed with breast cancer and undergoing at least one cancer treatment (surgery and/or adjuvant treatment). Sociodemographic, anthropometric, and cancer treatment data were collected, as well as current physical and functional complications. Changes in breast tenderness and intercostobrachial nerve pathway, winged scapula, pain, cicatricial adherence, and lymphedema were evaluated by physical examination (inspection and palpation). Upper limb dysfunction was assessed using the DASH questionnaire. Chi-square test and logistic regression were used to verify possible associations between upper limb dysfunction and other variables. RESULTS The results showed that 55.4% of women had some level of upper limb dysfunction. Evaluating treatment conditions, lymphadenectomy, lymphedema, presence of pain, and intercostobrachial nerve injury were associated with some level of upper limb dysfunction in the crude analysis. The adjusted analysis showed that only upper limb dysfunction remained associated with intercostobrachial nerve injury, regardless of age and body mass index. CONCLUSION Upper limb dysfunction is frequent after breast cancer treatment and may be associated with neuropathies due to changes in the intercostobrachial nerve pathway.
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Affiliation(s)
- Thais Cristina Siqueira
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Simone Pedrozo Frágoas
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Andreia Pelegrini
- Human Movement Sciences Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Ana Rosa de Oliveira
- Mastology Service, Carmela Dutra Maternity, Santa Catarina State Department of Health, Florianópolis, Brazil
| | - Clarissa Medeiros da Luz
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil.
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21
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White F. Application of Disease Etiology and Natural History to Prevention in Primary Health Care: A Discourse. Med Princ Pract 2020; 29:501-513. [PMID: 32422632 PMCID: PMC7768156 DOI: 10.1159/000508718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/17/2020] [Indexed: 11/19/2022] Open
Abstract
The principles of etiology and natural history of disease are essential to recognizing opportunities for prevention across the illness spectrum. They have a bearing on how illness is experienced, how differently it can be perceived at the time of first contact with the health system, and how it may appear at later stages. Opportunities for prevention arise at every stage in the process, and three main levels are described: primary, secondary, and tertiary. Prevention strategies include health promotion focused on determinants, clinical prevention to reduce modifiable risk factors, case finding, screening, and addressing functional outcomes relevant to quality of life; the importance of preventing errors is also recognized. The distinction between incidence effects and treatment effects of prevention is explored. This review also examines the differing roles of language in health science and public communication, aspects of disease classification, related issues in patient-centered care, the prevention paradox, and integrated models of disease prevention.
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Affiliation(s)
- Franklin White
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada,
- Pacific Health and Development Sciences, Victoria, British Columbia, Canada,
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22
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Hild S, Johanet M, Valenza A, Thabaud M, Laforest F, Ferrat E, Rat C. Quality of decision aids developed for women at average risk of breast cancer eligible for mammographic screening: Systematic review and assessment according to the International Patient Decision Aid Standards instrument. Cancer 2020; 126:2765-2774. [PMID: 32267546 DOI: 10.1002/cncr.32858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/20/2020] [Accepted: 02/29/2020] [Indexed: 12/21/2022]
Abstract
Mammographic screening contributes to a reduction in specific mortality, but it has disadvantages. Decision aids are tools designed to support people's decisions. Because these aids influence patient choice, their quality is crucial. The objective of the current study was to conduct a systematic review of decision aids developed for women eligible for mammographic screening who have an average breast cancer risk and to assess the quality of these aids. The systematic review included articles published between January 1, 1997, and August 1, 2019, in the PubMed, Embase, Cochrane, and PsycInfo databases. The studies were reviewed independently by 2 reviewers. Any study containing a decision aid for women eligible for mammographic screening with an average breast cancer risk was included. Two double-blind reviewers assessed the quality of the selected decision aids using the International Patient Decision Aid Standards instrument, version 3 (IPDASi). Twenty-three decision aids were extracted. Classification of decision aid quality using the IPDASi demonstrated large variations among the decision aids (maximum IPDASi score, 188; mean ± SD score, 132.6 ± 23.8; range, 85-172). Three decision aids had high overall scores. The 3 best-rated dimensions were disclosure (maximum score, 8; mean score, 6.8), focusing on transparency; information (maximum score, 32; mean score, 26.1), focusing on the provision of sufficient details; and probabilities (maximum score, 32; mean score 25), focusing on the presentation of probabilities. The 3 lowest-rated dimensions were decision support technology evaluation (maximum score, 8; mean score, 4.3), focusing on the effectiveness of the decision aid; development (maximum score, 24; mean score, 12.6), evaluating the development process; and plain language (maximum score, 4; mean score, 1.9), assessing appropriateness for patients with low literacy. The results of this review identified 3 high-quality decision aids for breast cancer screening.
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Affiliation(s)
- Sandrine Hild
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Marion Johanet
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Anna Valenza
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Maïna Thabaud
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Flore Laforest
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Emilie Ferrat
- Primary Care Department, Faculty of Medicine, University of Paris-East Creteil, Creteil, France.,Clinical Epidemiology and Ageing Unit, University of Paris-Est Creteil, Creteil, France
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
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Sussell JA, Sheinson D, Wu N, Shah-Manek B, Seetasith A. HER2-Positive Metastatic Breast Cancer: A Retrospective Cohort Study of Healthcare Costs in the Targeted-Therapy Age. Adv Ther 2020; 37:1632-1645. [PMID: 32172510 DOI: 10.1007/s12325-020-01283-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Claims data (IBM MarketScan Commercial and MarketScan Medicare Supplemental databases) from June 30, 2011 to September 30, 2017 were used to evaluate the cost impact of human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) in this retrospective cohort study. METHODS The primary analysis compared short-term costs for patients diagnosed with HER2+ MBC at least 180 days after the end of first HER2-targeted treatment (MBC+ cohort) versus a propensity score matched cohort of patients with breast cancer who did not develop MBC (MBC- cohort). A pseudo-post period for patients in the HER2+ MBC- cohort was defined by indexing to the HER2+ treatment completion-MBC diagnosis time interval of the matched pair in the HER2+ MBC+ cohort; we then compared average monthly cost differences between these groups for the year preceding and following MBC diagnosis. In secondary analyses, we estimated medium-term aggregate and categorical healthcare costs for patients with HER2+ MBC up to 3 years post-diagnosis. RESULTS In the short-term primary analysis, costs for the HER2+ MBC+ and HER2+ MBC- cohorts were largely comparable in the year preceding MBC diagnosis. Monthly direct costs were significantly higher for the HER2+ MBC+ cohort in the months immediately preceding MBC diagnosis, with differences in the range of $500-5000. Following diagnosis, total monthly costs were $13,000-34,000 higher for patients in the HER2+ MBC+ cohort vs. the HER2+ MBC- cohort. In the medium-term secondary analysis, mean per patient total costs were $218,171 [standard error (SE) $5450] in the first year following MBC diagnosis and $412,903 (SE $13,034) cumulatively over 3 years following diagnosis (among patients with complete follow-up). Primary cost contributors were outpatient visits ($195,162; SE $8043) and HER2-targeted therapy drug costs ($177,489; SE $8120). CONCLUSIONS HER2+ MBC is associated with high short-term and medium-term direct healthcare costs. These could be alleviated with early diagnosis and optimal standard-of-care treatment for early breast cancer, which can significantly reduce the risk of recurrence.
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Abstract
Breast cancer is the most common malignancy in Jordan and the third leading cause of cancer death after lung and colorectal cancers. Although the incidence of breast cancer in Jordan is lower than that in industrialized nations, the number of new cases has been significantly increasing, and women present with breast cancer at a younger age and with more advanced disease than women in Western countries. Jordan is a medium-income country with limited resources and a young population structure. Therefore, breast cancer poses a particularly challenging burden on the country's health care system. Despite ongoing endeavors to improve breast cancer care at both public and private levels, more work is needed to achieve downstaging of the disease and improve access, awareness, and participation in early detection. Multimodality treatment facilities and supportive care are available; however, the quality of care varies widely according to where the patient is treated, and most treatment facilities remain located centrally, thus, creating access difficulties. The King Hussein Cancer Center, the only comprehensive cancer center in Jordan, has changed the practice of oncology in the country via implementation of a multidisciplinary approach to treatment, monitoring of treatment outcomes, and investments in ongoing cancer research. However, there remains no national system for ensuring provision of high-quality cancer care nationwide. Here, we review the epidemiology of breast cancer and the current status of breast cancer care in Jordan, we compare our treatment outcomes with international ones, and we highlight challenges and improvement opportunities.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
- School of Medicine, University of Jordan, Amman, Jordan
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Dima Jaddan
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
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25
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Scholl AR, Flanagan MB. Educational Case: Invasive Ductal Carcinoma of the Breast. Acad Pathol 2020; 7:2374289519897390. [PMID: 32010760 PMCID: PMC6974746 DOI: 10.1177/2374289519897390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/30/2019] [Accepted: 11/02/2019] [Indexed: 12/04/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
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Affiliation(s)
- Ashley Rose Scholl
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia
University, Morgantown, WV, USA
| | - Melina B. Flanagan
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia
University, Morgantown, WV, USA
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26
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Risk-Based Screening Mammography for Women Aged <40: Outcomes From the National Mammography Database. J Am Coll Radiol 2019; 17:368-376. [PMID: 31541655 DOI: 10.1016/j.jacr.2019.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/16/2019] [Accepted: 08/25/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE There is insufficient large-scale evidence for screening mammography in women <40 years at elevated risk. This study compares risk-based screening of women aged 30 to 39 with risk factors versus women aged 40 to 49 without risk factors in the National Mammography Database (NMD). METHODS This retrospective, HIPAA-compliant, institutional review board-exempt study analyzed data from 150 NMD mammography facilities in 31 states. Patients were stratified by 5-year age intervals, availability of prior mammograms, and specific risk factors for breast cancer: family history of breast cancer, personal history of breast cancer, and dense breasts. Four screening performance metrics were calculated for each age and risk group: recall rate (RR), cancer detection rate (CDR), and positive predictive values for biopsy recommended (PPV2) and biopsy performed (PPV3). RESULTS Data from 5,986,131 screening mammograms performed between January 2008 and December 2015 in 2,647,315 women were evaluated. Overall, mean CDR was 3.69 of 1,000 (95% confidence interval: 3.64-3.74), RR was 9.89% (9.87%-9.92%), PPV2 was 20.1% (19.9%-20.4%), and PPV3 was 28.2% (27.0%-28.5%). Women aged 30 to 34 and 35 to 39 had similar CDR, RR, and PPVs, with the presence of the three evaluated risk factors associated with significantly higher CDR. Moreover, compared with a population currently recommended for screening mammography in the United States (aged 40-49 at average risk), incidence screening (at least one prior screening examination) of women aged 30 to 39 with the three evaluated risk factors has similar cancer detection rates and recall rates. DISCUSSION Women with one or more of these three specific risk factors likely benefit from screening commencing at age 30 instead of age 40.
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Rana SP, Dey M, Tiberi G, Sani L, Vispa A, Raspa G, Duranti M, Ghavami M, Dudley S. Machine Learning Approaches for Automated Lesion Detection in Microwave Breast Imaging Clinical Data. Sci Rep 2019; 9:10510. [PMID: 31324863 PMCID: PMC6642213 DOI: 10.1038/s41598-019-46974-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/04/2019] [Indexed: 11/27/2022] Open
Abstract
Breast lesion detection employing state of the art microwave systems provide a safe, non-ionizing technique that can differentiate healthy and non-healthy tissues by exploiting their dielectric properties. In this paper, a microwave apparatus for breast lesion detection is used to accumulate clinical data from subjects undergoing breast examinations at the Department of Diagnostic Imaging, Perugia Hospital, Perugia, Italy. This paper presents the first ever clinical demonstration and comparison of a microwave ultra-wideband (UWB) device augmented by machine learning with subjects who are simultaneously undergoing conventional breast examinations. Non-ionizing microwave signals are transmitted through the breast tissue and the scattering parameters (S-parameter) are received via a dedicated moving transmitting and receiving antenna set-up. The output of a parallel radiologist study for the same subjects, performed using conventional techniques, is taken to pre-process microwave data and create suitable data for the machine intelligence system. These data are used to train and investigate several suitable supervised machine learning algorithms nearest neighbour (NN), multi-layer perceptron (MLP) neural network, and support vector machine (SVM) to create an intelligent classification system towards supporting clinicians to recognise breasts with lesions. The results are rigorously analysed, validated through statistical measurements, and found the quadratic kernel of SVM can classify the breast data with 98% accuracy.
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Affiliation(s)
- Soumya Prakash Rana
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom.
| | - Maitreyee Dey
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom
| | - Gianluigi Tiberi
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom
- UBT Srl, Spin Off of the University of Perugia, Perugia, Italy
| | - Lorenzo Sani
- UBT Srl, Spin Off of the University of Perugia, Perugia, Italy
| | | | - Giovanni Raspa
- UBT Srl, Spin Off of the University of Perugia, Perugia, Italy
| | - Michele Duranti
- Department of Diagnostic Imaging, Perugia Hospital, Perugia, Italy
| | - Mohammad Ghavami
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom
| | - Sandra Dudley
- Division of Electrical and Electronic Engineering, School of Engineering, London South Bank University, London, United Kingdom
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Mocellin S, Goodwin A, Pasquali S. Risk-reducing medications for primary breast cancer: a network meta-analysis. Cochrane Database Syst Rev 2019; 4:CD012191. [PMID: 31032883 PMCID: PMC6487387 DOI: 10.1002/14651858.cd012191.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Breast cancer is the most frequently occurring malignancy and the second cause of death for cancer in women. Cancer prevention agents (CPAs) are a promising approach to reduce the burden of breast cancer. Currently, two main types of CPAs are available: selective estrogen receptor modulators (SERMs, such as tamoxifen and raloxifene) and aromatase inhibitors (AIs, such as exemestane and anastrozole). OBJECTIVES To assess the efficacy and acceptability of single CPAs for the prevention of primary breast cancer, in unaffected women, at an above-average risk of developing breast cancer.Using a network meta-analysis, to rank single CPAs, based on their efficacy and acceptability (an endpoint that is defined as the inverse of CPA-related toxicity). SEARCH METHODS We searched the Cochrane Breast Cancer Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov on 17 August 2018. We handsearched reference lists to identify additional relevant studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) that enrolled women without a personal history of breast cancer but with an above-average risk of developing a tumor. Women had to be treated with a CPA and followed up to record the occurrence of breast cancer and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and conducted risk of bias assessments of the included studies, and assessed the certainty of the evidence using GRADE. Outcome data included incidence of breast carcinoma (both invasive and in situ carcinoma) and adverse events (both overall and severe toxicity). We performed a conventional meta-analysis (for direct comparisons of a single CPA with placebo or a different CPA) and network meta-analysis (for indirect comparisons). MAIN RESULTS We included six studies enrolling 50,927 women randomized to receive one CPA (SERMs: tamoxifen or raloxifene, or AIs: exemestane or anastrozole) or placebo. Three studies compared tamoxifen and placebo, two studies compared AIs (exemestane or anastrozole) versus placebo, and one study compared tamoxifen versus raloxifene. The risk of bias was low for all RCTs.For the tamoxifen versus placebo comparison, tamoxifen likely resulted in a lower risk of developing breast cancer compared to placebo (risk ratio (RR) 0.68, 95% confidence interval (CI) 0.62 to 0.76; 3 studies, 22,832 women; moderate-certainty evidence). In terms of adverse events, tamoxifen likely increased the risk of severe toxicity compared to placebo (RR 1.28, 95% CI 1.12 to 1.47; 2 studies, 20,361 women; moderate-certainty evidence). In particular, women randomized to receive tamoxifen experienced a higher incidence of both endometrial carcinoma (RR 2.26, 95% CI 1.52 to 3.38; high-certainty evidence) and thromboembolism (RR 2.10, 95% CI 1.14 to 3.89; high-certainty evidence) compared to women who received placebo.For the AIs versus placebo comparison, AIs (exemestane or anastrozole) reduced the risk of breast cancer by 53% (RR 0.47, 95% CI 0.35 to 0.63; 2 studies, 8424 women; high-certainty evidence). In terms of adverse events, AIs increased the risk of severe toxicity by 18% (RR 1.18, 95% CI 1.09 to 1.28; 2 studies, 8352 women; high-certainty evidence). These differences were sustained especially by endocrine (e.g. hot flashes), gastrointestinal (e.g. diarrhea), and musculoskeletal (e.g. arthralgia) adverse events, while there were no differences in endometrial cancer or thromboembolism rates between AIs and placebo.For the tamoxifen versus raloxifene comparison, raloxifene probably performed worse than tamoxifen in terms of breast cancer incidence reduction (RR 1.25, 95% CI 1.09 to 1.43; 1 study, 19,490 women; moderate-certainty evidence), but its use was associated with lower toxicity rates (RR 0.87, 95% CI 0.80 to 0.95; 1 study, 19,490 women; moderate-certainty evidence), particularly relating to incidence of endometrial cancer and thromboembolism.An indirect comparison of treatment effects allowed us to compare the SERMs and AIs in this review. In terms of efficacy, AIs (exemestane or anastrozole) may have reduced breast cancer incidence slightly compared to tamoxifen (RR 0.67, 95% CI 0.46 to 0.98; 5 RCTs, 31,256 women); however, the certainty of evidence was low. A lack of model convergence did not allow us to analyze toxicity data. AUTHORS' CONCLUSIONS For women with an above-average risk of developing breast cancer, CPAs can reduce the incidence of this disease. AIs appear to be more effective than SERMs (tamoxifen) in reducing the risk of developing breast cancer. AIs are not associated with an increased risk of endometrial cancer and thromboembolic events. However, long-term data on toxicities from tamoxifen are available while the follow-up toxicity data on unaffected women taking AIs is relatively short. Additional data from direct comparisons are needed to fully address the issues of breast cancer prevention by risk-reducing medications, with special regards to acceptability (i.e. the benefit/harm ratio).
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Affiliation(s)
| | | | - Sandro Pasquali
- Fondazione IRCCS Istituto Nazionale dei TumoriSarcoma ServiceVia G. Venezian 1MilanoItaly20133
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Qaseem A, Lin JS, Mustafa RA, Horwitch CA, Wilt TJ, Forciea MA, Fitterman N, Iorio A, Kansagara D, Maroto M, McLean RM, Tufte JE, Vijan S. Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians. Ann Intern Med 2019; 170:547-560. [PMID: 30959525 DOI: 10.7326/m18-2147] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The purpose of this guidance statement is to provide advice to clinicians on breast cancer screening in average-risk women based on a review of existing guidelines and the evidence they include. METHODS This guidance statement is derived from an appraisal of selected guidelines from around the world that address breast cancer screening, as well as their included evidence. All national guidelines published in English between 1 January 2013 and 15 November 2017 in the National Guideline Clearinghouse or Guidelines International Network library were included. In addition, the authors selected other guidelines commonly used in clinical practice. Web sites associated with all selected guidelines were checked for updates on 10 December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines. TARGET AUDIENCE AND PATIENT POPULATION The target audience is all clinicians, and the target patient population is all asymptomatic women with average risk for breast cancer. GUIDANCE STATEMENT 1 In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. Discussion should include the potential benefits and harms and a woman's preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years. GUIDANCE STATEMENT 2 In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography. GUIDANCE STATEMENT 3 In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer. GUIDANCE STATEMENT 4 In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | | | - Reem A Mustafa
- University of Kansas Medical Center, Kansas City, Kansas (R.A.M.)
| | | | - Timothy J Wilt
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.)
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Aribal E, Mora P, Chaturvedi AK, Hertl K, Davidović J, Salama DH, Gershan V, Kadivec M, Odio C, Popli M, Kisembo H, Sabih Z, Vujnović S, Kayhan A, Delis H, Paez D, Giammarile F. Improvement of early detection of breast cancer through collaborative multi-country efforts: Observational clinical study. Eur J Radiol 2019; 115:31-38. [PMID: 31084756 DOI: 10.1016/j.ejrad.2019.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Abstract
AIM The aim of this paper is to present baseline imaging data and the improvement that was achieved by the participating centers after applying practice-specific interventions that were identified during the course of a multicentric multinational research coordinated project. INTRODUCTION The incidence and mortality rates from breast cancer are rising worldwide and particularly rapidly across the countries with limited resources. Due to lack of awareness and screening options it is usually detected at a later stage. Breast cancer screening programs and even clinical services on breast cancer have been neglected in such countries particularly due to lack of available equipment, funds, organizational structure and quality criteria. MATERIALS AND METHODS A harmonized form was designed in order to facilitate uniformity of data collection. Baseline data such as type of equipment, number of exams, type and number of biopsy procedures, stage of cancer at detection were collected from 10 centers (9 countries: Bosnia-Herzegovina, Costa Rica, Egypt, India, North Macedonia, Pakistan, Slovenia, Turkey, Uganda) were collected. Local practices were evaluated for good practice and specific interventions such as training of professionals and quality assurance programs were identified. The centers were asked to recapture the data after a 2-year period to identify the impact of the interventions. RESULTS The data showed increase in the number of training of relevant professionals, positive changes in the mammography practice and image guided interventions. All the centers achieved higher levels of success in the implementation of the quality assurance procedures. CONCLUSION The study has encountered different levels of breast imaging practice in terms of expertise, financial and human resources, infrastructure and awareness. The most common challenges were the lack of appropriate quality assurance programs and lack of trained skilled personnel and lack of high-quality equipment. The project was able to create higher levels of breast cancer awareness, collaboration amongst participating centers and professionals. It also improved quality, capability and expertise in breast imaging particularly in centers involved diagnostic imaging.
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Affiliation(s)
- Erkin Aribal
- Acibadem M.A.A.University, Radiology Department, Altunizade Hospital, Breast Health Center, Istanbul, Turkey.
| | - Patricia Mora
- Centro de Investigación en Ciencias Atómicas, Nucleares y Moleculares, Universidad de Costa Rica, Costa Rica
| | | | | | - Jasna Davidović
- University Clinical Centre of the Republic of Srpska, Department of Medical Physics and Radiation Protection, Banja Luka, Bosnia and Herzegovina
| | - Dina H Salama
- National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Egypt
| | - Vesna Gershan
- Faculty of Natural Sciences and Mathematics, Skopje, The Former Yugolav Republic of Macedonia
| | | | - Clara Odio
- Departamento de Radiología, Hospital Max Peralta, Costa Rica
| | - Manju Popli
- Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Harriet Kisembo
- Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Zahida Sabih
- Multan Institute of Nuclear Medicine and Radiotherapy, Multan, Pakistan
| | - Saša Vujnović
- University Clinical Centre of the Republic of Srpska, Department of Clinical Radiology, Banja Luka, Bosnia and Herzegovina; Faculty of Medicine, Banja Luka, Department of Radiology and Nuclear Medicine, Bosnia and Herzegovina
| | - Arda Kayhan
- Saglik Bilimleri University, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey
| | - Harry Delis
- International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- International Atomic Energy Agency, Vienna, Austria
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Hot S, Coşkun ZÜ, Akçakaya A, Bender Ö, Türkmen ÜA, Nayır PÖ, Sarı A, Hot AB. The breast lesion excision system procedure: An optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety. Saudi Med J 2018; 39:891-896. [PMID: 30251732 PMCID: PMC6201004 DOI: 10.15537/smj.2018.9.22573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the efficacy of the Breast lesion excision system (BLES) procedure as a primary excisional biopsy for the management of breast imaging-reporting and data system (BI-RADS) category 3, small, and solid breast lesions in women having severe breast cancer anxiety. Methods: A retospective study was conducted on 68 patients who underwent a BLES procedure. The study protocol was approved by the local ethical committee of Yeni Yuzyıl University in Istanbul, Turkey. The study was carried out according to the principles of the Helsinki Declaration. Small breast lesions removed using a (12, 15 or 20 mm) wand from September 2011 to November 2014. These were category 3 lesions as determined by ultrasound (US) imaging according to BI-RADS. The radiological and pathological sizes of these lesions, the complete excision rates, the procedure durations, the pathological diagnosis, the complications, and the imaging findings before and after the procedure were all recorded. Results: All the patients had a benign pathology. The mean duration of procedure was 12 (range=8-22) minutes. There was no major complication during the procedure and in the following period. Only some small hematomas were determined in 3 (4.2%) patients, and no additional surgical intervention was performed. Conclusion: The BLES procedure is an optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety.
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Affiliation(s)
- Semih Hot
- Department of Surgery, Okmeydanı Education Research Hospital, University of Health Science, Istanbul, Turkey. E-mail.
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Padela AI, Malik S, Ally SA, Quinn M, Hall S, Peek M. Reducing Muslim Mammography Disparities: Outcomes From a Religiously Tailored Mosque-Based Intervention. HEALTH EDUCATION & BEHAVIOR 2018; 45:1025-1035. [PMID: 29673255 DOI: 10.1177/1090198118769371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the design of, and participant-level outcomes related to, a religiously tailored, peer-led group education program aimed at enhancing Muslim women's mammography intention. METHOD Using a community-engaged approach and mixed methods, we identified and addressed barrier beliefs impeding mammography screening among Muslim American women. Our religiously tailored, mosque-based, peer-led intervention involved facilitated discussions and expert-led didactics conveying health-related religious teachings, and information about the benefits and process of mammography. Barrier beliefs were addressed through reframing, reprioritizing, or reforming such beliefs. Participant surveys were collected preintervention, postintervention, 6 months postintervention, and 1 year postintervention. These measured changes in mammography intention, likelihood, confidence, and resonance with barrier and facilitator beliefs. RESULTS A total of 58 Muslim women (mean age = 50 years) that had not had a mammogram in the past 2 years participated in the two-session program. Self-reported likelihood of obtaining a mammogram increased significantly ( p = .01) and coincided with a positive trend in confidence ( p = .08). Individuals with higher agreement with barrier beliefs preintervention had lower odds for positive change in likelihood (odds ratio = 0.80, p = .03), while those who were married had higher odds for positive change in likelihood (odds ratio = 37.69, p = .02). At 1-year follow-up, 22 participants had obtained a mammogram. CONCLUSION Our pilot mosque-based intervention demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms, and increased their mammography utilization, with nearly 40% obtaining a mammogram within 12 months of the intervention. IMPACT Our conceptual model for religiously tailoring messages, along with its implementation curriculum, proved effective in enhancing the likelihood and receipt of mammograms among Muslim American women. Accordingly, our work advances both the theory and practice of faith-based interventions and provides a model for addressing Muslim women's cancer screening disparities.
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Affiliation(s)
| | - Sana Malik
- 1 The University of Chicago, Chicago, IL, USA.,2 Stony Brook University, Stony Brook, NY, USA
| | | | | | | | - Monica Peek
- 1 The University of Chicago, Chicago, IL, USA
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Abstract
Advances in imaging of the female breast have substantially influenced the diagnosis and probably also the therapy and prognosis of breast cancer in the past few years. This article gives an overview of the most important imaging modalities in the diagnosis of breast cancer. Digital mammography is considered to be the gold standard for the early detection of breast cancer. Digital breast tomosynthesis can increase the diagnostic accuracy of mammography and is used for the assessment of equivocal or suspicious mammography findings. Other modalities, such as ultrasound and contrast-enhanced magnetic resonance imaging (MRI) play an important role in the diagnostics, staging and follow-up of breast cancer. Percutaneous needle biopsy is a rapid and minimally invasive method for the histological verification of breast cancer. New breast imaging modalities, such as contrast-enhanced spectral mammography, diffusion-weighted MRI and MR spectroscopy can possibly further improve breast cancer diagnostics; however, further studies are necessary to prove the advantages of these methods so that they cannot yet be recommended for routine clinical use.
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Affiliation(s)
- M Funke
- Radiologische Klinik, Klinikum Baden-Baden, Balger Str. 50, 76532, Baden-Baden, Deutschland.
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A novel long-acting biodegradable depot formulation of anastrozole for breast cancer therapy. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 75:535-544. [DOI: 10.1016/j.msec.2017.02.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/05/2016] [Accepted: 02/14/2017] [Indexed: 12/14/2022]
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Shi L, Chevolot Y, Souteyrand E, Laurenceau E. Autoantibodies against heat shock proteins as biomarkers for the diagnosis and prognosis of cancer. Cancer Biomark 2017; 18:105-116. [DOI: 10.3233/cbm-160117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
The war on cancer has been fought during the past several decades primarily based on the somatic mutation model of cancer. This has resulted in the emphasis on cancer screening and elimination of any detected cancerous/precancerous cells as the primary method of cancer prevention. This approach has reduced mortality from some cancers, but age-adjusted cancer mortality rates continue to be high. The lack of significant progress in reducing cancer mortality rates may be indicative of a fundamental flaw in the cancer model used. An alternative model of cancer is the immune suppression model of cancer based on the tremendous increase in cancers when the immune system is suppressed. According to this model, the key carcinogenic event is the suppression of the immune system which enables the already existing covert cancers to grow uncontrollably, causing cancer. Hence, cancer screening would consist of identifying those with weak immune system response. The primary mode of cancer prevention and treatment would be boosting of the immune system, for example, through exercise, infection, and low-dose radiation, as they are all known to enhance immune system response and reduce cancers. There is sufficient evidence to justify clinical trials of this approach for cancer screening, prevention, and treatment.
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Affiliation(s)
- Mohan Doss
- Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, PA, USA
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Mocellin S, Goodwin A, Pasquali S. Risk-reducing medication for primary breast cancer: a network meta-analysis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Simone Mocellin
- University of Padova; Dept. Surgery Oncology and Gastroenterology; Via Giustiniani 2 Padova Veneto Italy 35128
- IOV-IRCCS; Istituto Oncologico Veneto; Padova Italy 35100
| | - Annabel Goodwin
- The University of Sydney, Concord Repatriation General Hospital; Concord Clinical School; Concord NSW Australia 2137
- Concord Repatriation General Hospital; Medical Oncology Department; Concord Australia
- Sydney Local Health District and South Western Sydney Local Health District; Cancer Genetics Department; Sydney Australia
| | - Sandro Pasquali
- Veneto Institute of Oncology - IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Italy 35128
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Mendes FM, Pontes LRA, Gimenez T, Lara JS, de Camargo LB, Michel-Crosato E, Pannuti CM, Raggio DP, Braga MM, Novaes TF. Impact of the radiographic examination on diagnosis and treatment decision of caries lesions in primary teeth--the Caries Detection in Children (CARDEC-01) trial: study protocol for a randomized controlled trial. Trials 2016; 17:69. [PMID: 26857821 PMCID: PMC4746806 DOI: 10.1186/s13063-016-1196-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although most clinical guidelines throughout the world indicate that clinicians take two bitewings for detecting caries lesions in primary molars of all children, evidence for this recommendation is essentially based on cross-sectional studies performed in laboratory settings or using convenience samples. The benefits and impact of performing radiographs on diagnosis and treatment decision of caries lesions in primary teeth, mainly considering relevant outcomes for patients, have not been evaluated yet. Thus, the aim of this randomized clinical trial will be to evaluate the impact of performing radiographic examination adjunct to the visual inspection for detecting and making treatment decision regarding caries lesions in primary teeth compared with visual inspection performed alone. We will consider different outcomes related to children's health and welfare. METHODS/DESIGN To reach this objective, 250 children ages 3 to 6 years who sought dental treatment in our dental school will be randomly allocated in two groups according to the diagnostic strategy used for caries detection: visual inspection performed alone or visual inspection associated to radiographic examination. Two trained and calibrated examiners will carry out the examinations and elaborate the treatment decision plan. Then, children will be treated and followed up for 2 years, with evaluations after 12 and 24 months after the inclusion of children in the study. Children will also return after 6 and 18 months to reinforce the preventive orientations. Primary outcome will be the number of dental surfaces in need of dental treatment at the follow-up. Secondary outcomes will be the components of the primary outcome separately, as well as, proportion of false-positive results, the oral health-related quality of life, cost-efficacy, cost-adjusted life years, and number of new lesions in the first permanent molars. DISCUSSION Our working hypothesis is that radiographic examination would actually exert little influence on patient-centered outcomes, and visual inspection would be enough as diagnostic strategy for caries detection in primary teeth. TRIAL REGISTRATION NCT02078453. Registered 4 March 2015.
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Affiliation(s)
- Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | | | - Thais Gimenez
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Juan Sebastian Lara
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | | | - Edgard Michel-Crosato
- Departament of Community Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Claudio Mendes Pannuti
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Daniela Prócida Raggio
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
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McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM. Clinical Diagnosis and Management of Breast Cancer. J Nucl Med 2016; 57 Suppl 1:9S-16S. [DOI: 10.2967/jnumed.115.157834] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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