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Elliott MJ, Shen S, Lam DL, Brown T, Lawson MB, Iyengar NM, Cescon DW. Enhancing Early-Stage Breast Cancer Survivorship: Evidence-Based Strategies, Surveillance Testing, and Imaging Guidelines. Am Soc Clin Oncol Educ Book 2024; 44:e432564. [PMID: 38815189 DOI: 10.1200/edbk_432564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Addressing the challenges of survivorship necessitates a comprehensive, patient-centered approach, focusing on mitigating risk through lifestyle modification, identifying distant recurrence, and optimization of breast imaging. This article will discuss the current and emerging clinical strategies for the survivorship period, advocating a multidisciplinary and comprehensive approach. In this manner, early-stage breast cancer survivors are empowered to navigate their journey with enhanced knowledge, facilitating a transition to life beyond cancer.
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Affiliation(s)
- Mitchell J Elliott
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sherry Shen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Diana L Lam
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | - Thelma Brown
- University of Alabama at Birmingham, Birmingham, AL
| | - Marissa B Lawson
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | | | - David W Cescon
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Smith RE, Sprague BL, Henderson LM, Kerlikowske K, Miglioretti DL, Wernli KJ, Onega T, diFlorio-Alexander RM, Tosteson ANA. Breast density knowledge and willingness to delay treatment for pre-operative breast cancer imaging among women with a personal history of breast cancer. Breast Cancer Res 2024; 26:73. [PMID: 38685119 PMCID: PMC11057127 DOI: 10.1186/s13058-024-01820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Following a breast cancer diagnosis, it is uncertain whether women's breast density knowledge influences their willingness to undergo pre-operative imaging to detect additional cancer in their breasts. We evaluated women's breast density knowledge and their willingness to delay treatment for pre-operative testing. METHODS We surveyed women identified in the Breast Cancer Surveillance Consortium aged ≥ 18 years, with first breast cancer diagnosed within the prior 6-18 months, who had at least one breast density measurement within the 5 years prior to their diagnosis. We assessed women's breast density knowledge and correlates of willingness to delay treatment for 6 or more weeks for pre-operative imaging via logistic regression. RESULTS Survey participation was 28.3% (969/3,430). Seventy-two percent (469/647) of women with dense and 11% (34/322) with non-dense breasts correctly knew their density (p < 0.001); 69% (665/969) of all women knew dense breasts make it harder to detect cancers on a mammogram; and 29% (285/969) were willing to delay treatment ≥ 6 weeks to undergo pre-operative imaging. Willingness to delay treatment did not differ by self-reported density (OR:0.99 for non-dense vs. dense; 95%CI: 0.50-1.96). Treatment with chemotherapy was associated with less willingness to delay treatment (OR:0.67; 95%CI: 0.46-0.96). Having previously delayed breast cancer treatment more than 3 months was associated with an increased willingness to delay treatment for pre-operative imaging (OR:2.18; 95%CI: 1.26-3.77). CONCLUSIONS Understanding of personal breast density was not associated with willingness to delay treatment 6 or more weeks for pre-operative imaging, but aspects of a woman's treatment experience were. CLINICALTRIALS GOV : NCT02980848 registered December 2, 2016.
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Affiliation(s)
- Rebecca E Smith
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr. WTRB Level 5, Hinman Box 7251, NH 03756, Lebanon, NH, USA.
| | - Brian L Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
| | - Louise M Henderson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karla Kerlikowske
- Departments of Medicine, and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Tracy Onega
- Department of Population Health Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Roberta M diFlorio-Alexander
- Radiology Department, Dartmouth Health and Geisel School of Medicine at Dartmouth Lebanon, Lebanon, NH, USA
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr. WTRB Level 5, Hinman Box 7251, NH 03756, Lebanon, NH, USA
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Gegios AR, Peterson MS, Fowler AM. Breast Cancer Screening and Diagnosis: Recent Advances in Imaging and Current Limitations. PET Clin 2023; 18:459-471. [PMID: 37296043 DOI: 10.1016/j.cpet.2023.04.003] [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] [Indexed: 06/12/2023]
Abstract
Breast cancer detection has a significant impact on population health. Although there are many breast imaging modalities, mammography is the predominant tool for breast cancer screening. The introduction of digital breast tomosynthesis to mammography has contributed to increased cancer detection rates and decreased recall rates. In average-risk women, starting annual screening mammography at age 40 years has demonstrated the highest mortality reduction. In intermediate- and high-risk women as well as in those with dense breasts, additional modalities, including MRI, ultrasound, and molecular breast imaging, can also be considered for adjunct screening to improve the detection of mammographically occult malignancy.
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Affiliation(s)
- Alison R Gegios
- Section of Breast Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Molly S Peterson
- Section of Breast Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Amy M Fowler
- Section of Breast Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA; University of Wisconsin Carbone Cancer Center, Madison, WI, USA; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.
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Lawson MB, Herschorn SD, Sprague BL, Buist DSM, Lee SJ, Newell MS, Lourenco AP, Lee JM. Imaging Surveillance Options for Individuals With a Personal History of Breast Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 219:854-868. [PMID: 35544374 PMCID: PMC9691521 DOI: 10.2214/ajr.22.27635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Annual surveillance mammography is recommended for breast cancer survivors on the basis of observational studies and meta-analyses showing reduced breast cancer mortality and improved quality of life. However, breast cancer survivors are at higher risk of subsequent breast cancer and have a fourfold increased risk of interval breast cancers compared with individuals without a personal history of breast cancer. Supplemental surveillance modalities offer increased cancer detection compared with mammography alone, but utilization is variable, and benefits must be balanced with possible harms of false-positive findings. In this review, we describe the current state of mammographic surveillance, summarize evidence for supplemental surveillance in breast cancer survivors, and explore a risk-based approach to selecting surveillance imaging strategies. Further research identifying predictors associated with increased risk of interval second breast cancers and development of validated risk prediction tools may help physicians and patients weigh the benefits and harms of surveillance breast imaging and decide on a personalized approach to surveillance for improved breast cancer outcomes.
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Affiliation(s)
- Marissa B Lawson
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E, LG-200, Seattle, WA 98040
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Larner College of Medicine, University of Vermont Cancer Center, Burlington, VT
| | - Brian L Sprague
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Su-Ju Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Mary S Newell
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Ana P Lourenco
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E, LG-200, Seattle, WA 98040
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[Diagnosis of breast diseases in a certified breast center]. Radiologe 2021; 61:137-149. [PMID: 33404685 DOI: 10.1007/s00117-020-00791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
The beginning of the 21st century has seen immense improvements in the quality of diagnosis and treatment of breast cancer due to several, simultaneous developments. In particular, the introduction of a certification program from the German Cancer Society based on level III guidelines has enhanced the transparency and quality of treatment of breast diseases for all actors. As a result, patients have benefited from intensified cooperation especially between core disciplines in breast disease, gynecology, pathology, and radiology. The standardized and synoptic reading of multiple diagnostic modalities has enabled precise sampling of histologic specimen, which has improved prognosis and the successful individualization of therapy. In this article the benefits of breast cancer diagnosis and therapy in a certified breast center are illustrated using four case examples.
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Chen Y, Wang J, Zhang X, Yang W, Chen H, Bao B, Qiu Y, Tian L. Correlation between apparent diffusion coefficient and pathological characteristics of patients with invasive breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:143. [PMID: 33569445 PMCID: PMC7867890 DOI: 10.21037/atm-20-7746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background There is insufficient research on the correlation between the apparent diffusion coefficient and clinicopathological characteristics of breast cancer patients. The present study is to investigate the correlation between the apparent diffusion coefficient and pathological characteristics of patients with invasive breast cancer. Methods From January 2019 to September 2020, 122 cases of invasive breast cancer and 21 cases of benign tumors were retrospectively enrolled. The apparent diffusion coefficient was compared between the two groups, and the correlation between the apparent diffusion coefficient and the pathological characteristics of the patients with invasive breast cancer were analyzed. Results Compared with the benign tumor group, the apparent diffusion coefficient in the invasive breast cancer group was significantly lower (0.89±0.17 vs. 1.47±0.27 10−3 mm2/s, P=0.000). Using the apparent diffusion coefficient to diagnose patients with invasive breast cancer, the area under receiver operating characteristic (ROC) curve was 0.966±0.021 [95% confidence interval (CI): 0.924–1.000, P=0.000], and the best diagnostic cut-off value was 1.16 (10−3 mm2/s), with sensitivity and specificity of 0.905 and 0.902, respectively. The apparent diffusion coefficient was used to diagnose vascular tumor thrombus in patients with invasive breast cancer. The area under the ROC curve was 0.641±0.068 (95% CI: 0.508–0.774, P=0.047), and the best diagnostic threshold was 0.835 (10−3 mm2/s), with sensitivity and specificity of 0.676 and 0.650, respectively. The apparent diffusion coefficient in patients with high expression of Ki-67 (%) was significantly reduced (0.87±0.17 vs. 1.00±0.16 10−3 mm2/s, P=0.000). The apparent diffusion coefficient was not significantly correlated with age, menopause, lesion size, estrogen receptor, progesterone receptor, or lymph node metastasis in patients with invasive breast cancer (P>0.05). Conclusions In patients with invasive breast cancer the apparent diffusion coefficient was significantly reduced. It was able to differentiate invasive breast cancer and vascular tumor thrombus, and was also related to Ki-67 (%) high expression.
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Affiliation(s)
- Yuhui Chen
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jiandong Wang
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiuxiu Zhang
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wuyao Yang
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongye Chen
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Baoshi Bao
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yue Qiu
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lin Tian
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Breast Ultrasound Versus MRI in Prediction of Pathologic Complete Response to Neoadjuvant Chemotherapy for Breast Cancer: A Systematic Review and Meta-Analysis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320964102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Neoadjuvant chemotherapy (NAC) is widely used to treat breast cancer. Sentinel lymph node biopsy has replaced axillary lymph node dissection in patients who convert to node-negative status, after NAC. However, few studies have evaluated the diagnostic performance of ultrasonography (US) and magnetic resonance imaging (MRI) in determining axillary lymph node status after NAC. The aim of this study was to evaluate the diagnostic performance of breast US and MRI in predicting a response to NAC, for breast cancer. Methods: A systematic search, in PubMed, the Cochrane Library, and Web of Science, for original studies was performed. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the methodological quality of the included studies. Patient, study, and imaging characteristics were extracted, and sufficient data were used to reconstruct 2 × 2 tables. Data pooling, heterogeneity testing, forest plot construction, meta-regression analysis, and sensitivity analysis were performed using Meta-DiSc and Stata version 14.0 (StataCorp LP, College Station, TX, USA). Results: Nine studies met all the eligibility criteria and were included. The pooled sensitivity and specificity of MRI were 0.78 and 0.92, while the corresponding values for US were 0.80 and 0.90, respectively. The prevalence of pathologic complete response (pCR), among breast cancer patients, after neoadjuvant therapy was 26%. The prevalence of patients with estrogen receptor (ER)-, human epidermal growth factor receptor (HER)-, and progesterone receptor (PR)-positive tumors were 65%, 22%, and 37%, respectively. Conclusion: These results showed that MRI and US have almost the same accuracy in predicting pCR in patients with breast cancer undergoing neoadjuvant surgery. There is still a need for further investigations to prove that US is not inferior to MRI for this diagnosis.
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