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Lee M, Kotake R, Yamauchi H. Physical Activity and Mammographic Density in Japanese Women. Cancer Epidemiol Biomarkers Prev 2024; 33:365-370. [PMID: 38147061 PMCID: PMC10905669 DOI: 10.1158/1055-9965.epi-23-0777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/11/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Dense breast is one of the strong risk factors for breast cancer among women. While it has been established that physical activity is associated with decreased risk for breast cancer, results have been inconsistent in terms of mammographic density. Thus, we examined physical activity in relation to mammographic density among Japanese women in Tokyo. METHODS We used 123,026 records from 33,698 Japanese women without a history of breast cancer who got mammograms at St. Luke's International Hospital in Tokyo, Japan from 2004 to 2019. Mammographic density was classified according to the Breast Imaging Reporting and Data System (BI-RADS), and women self-reported their physical activity level over the past year. ORs were estimated using logistic generalized estimating equations after adjusting for age, body mass index, menopausal status, parity, family history of breast or ovarian cancer, hormone therapy use, smoking status, alcohol consumption, and year. RESULTS We observed inverse associations of physical activity with dense breasts. Adjusted ORs were 0.96 (95% confidence interval: 0.91-1.00) for women with physical exercise for 1-2 days per week, 0.94 (0.88-0.99) for those with physical exercise for 3-5 days per week, and 0.91 (0.84-0.99) for those with daily physical exercise when compared with those reported seldom physical exercise. CONCLUSIONS Higher levels of physical activity may be associated with decreased mammographic density levels in Japanese women. IMPACT Increasing physical activity may serve as a reasonable intervention to reduce mammographic density, and thereby, to mitigate the risk of breast cancer in Asian women.
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Affiliation(s)
- Mihye Lee
- St. Luke's School of Public Health, Tokyo, Japan
| | - Rina Kotake
- St. Luke's School of Public Health, Tokyo, Japan
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2
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Milton AJ, Flores EJ, Charles EF, Elezaby MA, Ward EC, Lee CI, Woods RW, Martin Rother MD, Strigel RM, Narayan AK. Community-based Participatory Research: A Practical Guide for Radiologists. Radiographics 2023; 43:e220145. [PMID: 37104126 PMCID: PMC10190132 DOI: 10.1148/rg.220145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 04/28/2023]
Abstract
Community-based participatory research (CBPR) is defined by the Kellogg Community Health Scholars Program as a collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each community member brings. The CBPR process begins with a research topic of importance to the community, with the goal of combining knowledge and action with social change to improve community health and eliminate health disparities. CBPR engages and empowers affected communities to collaborate in defining the research question; sharing the study design process; collecting, analyzing, and disseminating the data; and implementing solutions. A CBPR approach in radiology has several potential applications, including removing limitations to high-quality imaging, improving secondary prevention, identifying barriers to technology access, and increasing diversity in the research participation for clinical trials. The authors provide an overview with the definitions of CBPR, explain how to conduct CBPR, and illustrate its applications in radiology. Finally, the challenges of CBPR and useful resources are discussed in detail. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Arissa J. Milton
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Efrén J. Flores
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Eden F. Charles
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Mai A. Elezaby
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Earlise C. Ward
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Christoph I. Lee
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Ryan W. Woods
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Maria D. Martin Rother
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Roberta M. Strigel
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Anand K. Narayan
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
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Dontchos BN, Cavallo-Hom K, Lamb LR, Mercaldo SF, Eklund M, Dang P, Lehman CD. Impact of a Deep Learning Model for Predicting Mammographic Breast Density in Routine Clinical Practice. J Am Coll Radiol 2022; 19:1021-1030. [DOI: 10.1016/j.jacr.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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Nickel B, Farber R, Brennan M, Hersch J, McCaffery K, Houssami N. Breast density notification: evidence on whether benefit outweighs harm is required to inform future screening practice. BMJ Evid Based Med 2021; 26:309-311. [PMID: 32665223 DOI: 10.1136/bmjebm-2020-111364] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Meagan Brennan
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Hadadi I, Rae W, Clarke J, McEntee M, Ekpo E. Diagnostic Performance of Adjunctive Imaging Modalities Compared to Mammography Alone in Women with Non-Dense and Dense Breasts: A Systematic Review and Meta-Analysis. Clin Breast Cancer 2021; 21:278-291. [PMID: 33846098 DOI: 10.1016/j.clbc.2021.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/25/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the diagnostic performance of mammography (MG) alone versus MG combined with adjunctive imaging modalities, including handheld ultrasound (HHUS), automated breast ultrasound (ABUS), digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), and magnetic resonance imaging (MRI) in women with non-dense and dense breasts. PATIENTS AND METHODS Medline, Embase, PubMed, CINAHL, Scopus, and the Web of Science databases were searched up to October 2019. Quality assessment was performed using QUADAS-2. RevMan 5.3 was used to conduct a meta-analysis of the studies. RESULTS In dense breasts, adding adjunctive modalities significantly increased cancer detection rates (CDRs): HHUS (relative risk [RR] = 1.49; 95% confidence interval [CI], 1.19-1.86; P = .0005); ABUS (RR = 1.44; 95% CI, 1.16-1.78; P = .0008); DBT (RR = 1.38; 95% CI, 1.14-1.67; P = .001); CEM (RR = 1.37; 95% CI, 1.12-1.69; P = .003); and MRI (RR = 2.16; 95% CI, 1.81-2.58; P < .00001). The recall rate was significantly increased by HHUS (RR = 2.03; 95% CI, 1.89-2.17; P < .00001), ABUS (RR = 1.90; 95% CI, 1.81-1.99; P < .00001), and MRI (RR = 2.71; 95% CI, 1.73-4.25; P < .0001), but not by DBT (RR = 1.14; 95% CI, 0.95-1.36; P = .15). In non-dense breasts, HHUS and MRI showed significant increases in CDRs but not DBT: HHUS (RR = 1.14; 95% CI, 1.01-1.29; P = .04); MRI (RR = 1.78; 95% CI, 1.14-2.77; P = .01); and DBT (RR = 1.09; 95% CI, 1.13-1.75; P = .08). The recall rate was also significantly increased by HHUS (RR = 1.43; 95% CI, 1.28-1.59; P < .00001) and MRI (RR = 3.01; 95% CI, 1.68-5.39; P = .0002), whereas DBT showed a non-significant reduction (RR = 0.83; 95% CI, 0.65-1.05; P = .12). CONCLUSION Adding adjunctive modalities to MG increases CDRs in women with dense and non-dense breasts. Ultrasound and MRI increase recall rates across all breast densities; however, MRI results in higher values for both CDRs and recall rates.
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Affiliation(s)
- Ibrahim Hadadi
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
| | - William Rae
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Jillian Clarke
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Mark McEntee
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; University College Cork, Discipline of Diagnostic Radiography, UG 12 Áras Watson, Brookfield Health Sciences, College Road, Cork, T12 AK54
| | - Ernest Ekpo
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
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Lei B, Huang S, Li H, Li R, Bian C, Chou YH, Qin J, Zhou P, Gong X, Cheng JZ. Self-co-attention neural network for anatomy segmentation in whole breast ultrasound. Med Image Anal 2020; 64:101753. [DOI: 10.1016/j.media.2020.101753] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/27/2020] [Accepted: 06/06/2020] [Indexed: 11/25/2022]
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Impact of Breast Density Awareness on Knowledge about Breast Cancer Risk Factors and the Self-Perceived Risk of Breast Cancer. Diagnostics (Basel) 2020; 10:diagnostics10070496. [PMID: 32698375 PMCID: PMC7399945 DOI: 10.3390/diagnostics10070496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/12/2020] [Accepted: 07/18/2020] [Indexed: 12/24/2022] Open
Abstract
Breast density (BD) reduces sensitivity of mammography, and is a strong risk factor for breast cancer (BC). Data about women's awareness and knowledge of BD are limited. Our aim is to examine whether the BD information disclosure and BD awareness among women without BC are related to their knowledge about BC risk factors. We examined self-reported BC risk perception and its association to BD awareness and level of health literacy. A cross-sectional, single site study included 263 Croatian women without BC who had mammographic examination. Data were collected by interviews using questionnaires and a validated survey. Of the total, 77.1% had never heard of BD, and 22.9% were aware of their BD. Most participants who knew their BD (88.2%, p < 0.001) had higher levels of education. Majority of subjects (66.8%) had non-dense breasts and 33.2% had dense breasts. Subjects aware of their BD knew that post-menopausal hormone replacement therapy (p = 0.04) and higher BD (p = 0.03) are BC risk factors. They could more easily access information about health promotion (p = 0.03). High-BD informed women assessed their lifetime BC risk as significantly higher than all others (p = 0.03). Comprehension of BD awareness and knowledge is crucial for reinforcement of educational strategies and development of amendatory BC screening decisions.
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The Impact of Breast Density Notification Laws on Supplemental Breast Imaging and Breast Biopsy. J Gen Intern Med 2019; 34:1441-1451. [PMID: 31144277 PMCID: PMC6667574 DOI: 10.1007/s11606-019-05026-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/06/2019] [Accepted: 03/26/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Dense breast tissue increases breast cancer risk and lowers mammography sensitivity, but the value of supplemental imaging for dense breasts remains uncertain. Since 2009, 37 states and Washington DC have passed legislation requiring patient notification about breast density. OBJECTIVE Examine the effects of state breast density notification laws on use of supplemental breast imaging and breast biopsies. DESIGN Difference-in-differences analysis of supplemental imaging and biopsies before and after notification laws in 12 states enacting breast density notification laws from 2009 to 2014 and 12 matched control states. Supplemental imaging/biopsy within 6 months following an index mammogram were evaluated during four time periods related to legislation: (1) 6 months before, (2) 0-6 months after, (3) 6-12 months after, and (4) 12-18 months after. PARTICIPANTS Women ages 40-64 years receiving an initial mammogram in a state that passed a breast density notification law or a control state. INTERVENTION Mandatory breast density notification following an index mammogram. MAIN MEASURES Use of breast biopsies and supplemental breast imaging (breast ultrasound, tomosynthesis, magnetic resonance imaging, scintimammography, and thermography), overall and by specific test. KEY RESULTS Supplemental breast imaging and biopsy increased modestly in states with notification laws and changed minimally in control states. Adjusted rates of supplemental imaging and biopsy within 6 months of mammography before legislation were 8.5% and 3.1%, respectively. Compared with pre-legislation in intervention and control states, legislation was associated with adjusted difference-in-differences estimates of + 1.3% (p < 0.0001) and + 0.4% (p < 0.0001) for supplemental imaging and biopsies, respectively, in the 6-12 months after the law and difference-in-differences estimates of + 3.3% (p < 0.0001) and + 0.8% (p < 0.0001) for supplemental imaging and biopsies, respectively, 12-18 months after the law. CONCLUSIONS As breast density notification laws are considered, policymakers and clinicians should expect increases in breast imaging/biopsies. Additional research is needed on these laws' effects on cost and patient outcomes.
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Cappello NM, Richetelli D, Lee CI. The Impact of Breast Density Reporting Laws on Women’s Awareness of Density-Associated Risks and Conversations Regarding Supplemental Screening With Providers. J Am Coll Radiol 2019; 16:139-146. [DOI: 10.1016/j.jacr.2018.08.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022]
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Lei B, Huang S, Li R, Bian C, Li H, Chou YH, Cheng JZ. Segmentation of breast anatomy for automated whole breast ultrasound images with boundary regularized convolutional encoder–decoder network. Neurocomputing 2018. [DOI: 10.1016/j.neucom.2018.09.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The impact of legislation mandating breast density notification - Review of the evidence. Breast 2018; 42:102-112. [PMID: 30236594 DOI: 10.1016/j.breast.2018.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022] Open
Abstract
Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. The enactment of BD legislation in a majority of states in the USA mandating notification of risks associated with BD directly to women undergoing mammography has catapulted interest in BD among women, physicians, and policymakers. We therefore report a descriptive review of the evidence on the impact of enactment of BD legislation. Based on 22 eligible studies, we identified four broad themes of research: studies of the impact on screening rates, most showing increased utilisation of supplemental screening; studies exploring the effect on women, radiologists, or primary physicians (reporting heterogeneous effects on knowledge, awareness, perceptions, attitudes and behaviour; and changes in practice); few studies assessing the population impact (effect on screening outcomes or breast cancer stage); and studies of costs highlighting the economic burden from supplemental screening. Given that many of the studies were retrospective single institution studies (comparing pre- and post-legislation) or small surveys with a paucity of population-level studies, we highlight areas meriting additional research. The information described in this review can inform research priorities where BD legislation has been introduced and can be used to guide world-wide policy or practice decisions where BD legislation may be under debate or contemplation.
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Miles RC, Onega T, Lee CI. Addressing Potential Health Disparities in the Adoption of Advanced Breast Imaging Technologies. Acad Radiol 2018; 25:547-551. [PMID: 29729855 DOI: 10.1016/j.acra.2017.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/31/2017] [Indexed: 11/16/2022]
Abstract
With the advent of new screening technologies, including digital breast tomosynthesis, screening ultrasound, and breast magnetic resonance imaging, there is growing concern that existing disparities among traditionally underserved populations will worsen. These newer screening modalities purport improved cancer detection over mammography alone but are not offered at all screening facilities and often require a larger co-pay or out-of-pocket expense. Thus, the potential for worsening disparities with regard to access and appropriate utilization of supplemental screening technologies exists. Currently, there is a dearth of literature on the topic of health disparities related to access and the use of supplemental breast cancer screening and their impact on outcomes. Identifying and addressing explanatory factors for persistent and potentially worsening disparities remain a central focus of efforts to improve equity in breast cancer care. Therefore, this paper provides an overview of factors that may contribute to present and future disparities in breast cancer screening and outcomes, and explores specific relevant topics requiring greater research efforts as more personalized, multimodality breast cancer screening approaches are adopted into clinical practice.
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Affiliation(s)
- Randy C Miles
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
| | - Tracy Onega
- Departments of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Department of Health Services, University of Washington School of Public Health, Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
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Weber B, Hayes J, Phil Evans W. Breast Density and the Importance of Supplemental Screening. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0275-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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14
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Lee CI, Lehman CD. Digital Breast Tomosynthesis and the Challenges of Implementing an Emerging Breast Cancer Screening Technology Into Clinical Practice. J Am Coll Radiol 2018; 13:R61-R66. [PMID: 27814817 DOI: 10.1016/j.jacr.2016.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Emerging imaging technologies, including digital breast tomosynthesis, have the potential to transform breast cancer screening. However, the rapid adoption of these new technologies outpaces the evidence of their clinical and cost-effectiveness. The authors describe the forces driving the rapid diffusion of tomosynthesis into clinical practice, comparing it with the rapid diffusion of digital mammography shortly after its introduction. They outline the potential positive and negative effects that adoption can have on imaging workflow and describe the practice management challenges when incorporating tomosynthesis. The authors also provide recommendations for collecting evidence supporting the development of policies and best practices.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Constance D Lehman
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Raj SD, Fein-Zachary V, Slanetz PJ. Deciphering the Breast Density Inform Law Movement: Implications for Practice. Semin Ultrasound CT MR 2018; 39:16-24. [PMID: 29317035 DOI: 10.1053/j.sult.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although dense breast tissue is a normal and routine finding on screening mammography, dense breast tissue is associated with an independent increased risk for breast cancer. It is well known that screening mammography has a decreased sensitivity for cancer detection in women with dense breasts. Over the past decade, there has been increased interest generated among patients, physicians, and legislators regarding how best to screen dense-breasted women culminating in 2009 with the passage of a breast density notification law in Connecticut. Since that time, over half the United States has passed similar notification laws. Despite this, controversy remains as to the optimal supplemental screening modality to complement mammography as each imaging modality (digital breast tomosynthesis, whole breast ultrasound, magnetic resonance imaging, contrast-enhanced mammography, and molecular breast imaging) has variable benefits and limitations.
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Affiliation(s)
- Sean D Raj
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Valerie Fein-Zachary
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Priscilla J Slanetz
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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16
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Translating New Imaging Technologies to Clinical Practice. Acad Radiol 2018; 25:3-8. [PMID: 28843464 DOI: 10.1016/j.acra.2017.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 11/24/2022]
Abstract
Radiology continues to benefit from constant innovation and technological advances. However, for promising new imaging technologies to reach widespread clinical practice, several milestones must be met. These include regulatory approval, early clinical evaluation, payer reimbursement, and broader marketplace adoption. Successful implementation of new imaging tests into clinical practice requires active stakeholder engagement and a focus on demonstrating clinical value during each phase of translation.
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Maximizing Value Through Innovations in Radiologist-Driven Communications in Breast Imaging. AJR Am J Roentgenol 2017; 209:1001-1005. [PMID: 28726506 DOI: 10.2214/ajr.17.18410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purposes of this article are to provide an overview of current and emerging practices in radiologist communications with both referring physicians and patients across the breast cancer care continuum; to highlight areas in which radiologist-driven communications can improve value in breast cancer screening, diagnosis, and treatment; and describe how the integrative reporting and consultative practices of breast imagers can serve as models of higher-value patient-centered care in other radiology subspecialties. CONCLUSION The traditional radiology report will eventually no longer be viewed as the sole consultation by radiologists but instead act as a starting point for more detailed communications between radiologists and both patients and physicians. The value-creating practices of breast imagers can be used as a road map for similar practices across other radiologic specialties, similar to the use of BI-RADS as a road map for structured breast imaging reporting.
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Abstract
The approach to breast cancer screening has changed over time from a general approach to a more personalized, risk-based approach. Women with dense breasts, one of the most prevalent risk factors, are now being informed that they are at increased risk of developing breast cancer and should consider supplemental screening beyond mammography. This article reviews the current evidence regarding the impact of breast density relative to other known risk factors, the evidence regarding supplemental screening for women with dense breasts, supplemental screening options, and recommendations for physicians having shared decision-making discussions with women who have dense breasts.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA; Department of Health Services, University of Washington School of Public Health, 1959 Northeast Pacific Street, Seattle, WA 98195, USA; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Research Cancer Center, 1100 Fairview Avenue N, Box 19024, Seattle, WA 98109, USA.
| | - Linda E Chen
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, 325 Ninth Avenue, Box 359780, Seattle, WA 98104, USA; Department of Epidemiology, University of Washington School of Public Health, 325 Ninth Avenue, Box 359780, Seattle, WA 98104, USA
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Castillo-García M, Chevalier M, Garayoa J, Rodriguez-Ruiz A, García-Pinto D, Valverde J. Automated Breast Density Computation in Digital Mammography and Digital Breast Tomosynthesis: Influence on Mean Glandular Dose and BIRADS Density Categorization. Acad Radiol 2017; 24:802-810. [PMID: 28214227 DOI: 10.1016/j.acra.2017.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/16/2016] [Accepted: 01/08/2017] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to compare the breast density estimates from two algorithms on full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) and to analyze the clinical implications. MATERIALS AND METHODS We selected 561 FFDM and DBT examinations from patients without breast pathologies. Two versions of a commercial software (Quantra 2D and Quantra 3D) calculated the volumetric breast density automatically in FFDM and DBT, respectively. Other parameters such as area breast density and total breast volume were evaluated. We compared the results from both algorithms using the Mann-Whitney U non-parametric test and the Spearman's rank coefficient for data correlation analysis. Mean glandular dose (MGD) was calculated following the methodology proposed by Dance et al. RESULTS Measurements with both algorithms are well correlated (r ≥ 0.77). However, there are statistically significant differences between the medians (P < 0.05) of most parameters. The volumetric and area breast density median values from FFDM are, respectively, 8% and 77% higher than DBT estimations. Both algorithms classify 35% and 55% of breasts into BIRADS (Breast Imaging-Reporting and Data System) b and c categories, respectively. There are no significant differences between the MGD calculated using the breast density from each algorithm. DBT delivers higher MGD than FFDM, with a lower difference (5%) for breasts in the BIRADS d category. MGD is, on average, 6% higher than values obtained with the breast glandularity proposed by Dance et al. CONCLUSIONS Breast density measurements from both algorithms lead to equivalent BIRADS classification and MGD values, hence showing no difference in clinical outcomes. The median MGD values of FFDM and DBT examinations are similar for dense breasts (BIRADS d category).
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20
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Comparison Between Digital and Synthetic 2D Mammograms in Breast Density Interpretation. AJR Am J Roentgenol 2017; 209:W36-W41. [PMID: 28504593 DOI: 10.2214/ajr.16.16966] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare assessments of breast density on synthetic 2D images as compared with digital 2D mammograms. MATERIALS AND METHODS This retrospective study included consecutive women undergoing screening with digital 2D mammography and tomosynthesis during May 2015 with a negative or benign outcome. In separate reading sessions, three radiologists with 5-25 years of clinical experience and 1 year of experience with synthetic 2D mammography read digital 2D and synthetic 2D images and assigned breast density categories according to the 5th edition of BI-RADS. Inter- and intrareader agreement was assessed for each BI-RADS density assessment and combined dense and nondense categories using percent agreement and Cohen kappa coefficient for consensus and all reads. RESULTS A total of 309 patients met study inclusion criteria. Agreement between consensus BI-RADS density categories assigned for digital and synthetic 2D mammography was 80.3% (95% CI, 75.4-84.5%) with κ = 0.73 (95% CI, 0.66-0.79). For combined dense and nondense categories, agreement reached 91.9% (95% CI, 88.2-94.7%). For consensus readings, similar numbers of patients were shifted between nondense and dense categories (11 and 14, respectively) with the synthetic 2D compared with digital 2D mammography. Interreader differences were apparent; assignment to dense categories was greater with digital 2D mammography for reader 1 (odds ratio [OR], 1.26; p = 0.002), the same for reader 2 (OR, 0.91; p = 0.262), and greater with synthetic 2D mammography for reader 3 (OR, 0.86; p = 0.033). CONCLUSION Overall, synthetic 2D mammography is comparable with digital 2D mammography in assessment of breast density, though there is some variability by reader. Practices can readily adopt synthetic 2D mammography without concern that it will affect density assessment and subsequent recommendations for supplemental screening.
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Durand MA, Hooley RJ. Implementation of Whole-Breast Screening Ultrasonography. Radiol Clin North Am 2017; 55:527-539. [DOI: 10.1016/j.rcl.2016.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Maimone S, McDonough MD, Hines SL. Breast Density Reporting Laws and Supplemental Screening—A Survey of Referring Providers’ Experiences and Understanding. Curr Probl Diagn Radiol 2017; 46:105-109. [DOI: 10.1067/j.cpradiol.2016.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
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24
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Guterbock TM, Cohn WF, Rexrode DL, Eggleston CM, Dean-McKinney M, Novicoff WM, Yaffe MJ, Knaus WA, Harvey JA. What Do Women Know About Breast Density? Results From a Population Survey of Virginia Women. J Am Coll Radiol 2017; 14:34-44. [DOI: 10.1016/j.jacr.2016.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/23/2016] [Accepted: 07/03/2016] [Indexed: 11/17/2022]
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Maimone S, McDonough M. Dense Breast Notification and Supplemental Screening: A Survey of Current Strategies and Sentiments. Breast J 2016; 23:193-199. [PMID: 27797130 DOI: 10.1111/tbj.12712] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dense breast parenchyma obscures breast lesions and has been shown to be an independent risk factor for development of breast cancer. An ever-increasing number of states have approved laws requiring patient notification of dense breast tissue. Reviews of supplemental screening imaging modalities are available, but there is no consensus and little discussion regarding what radiologists are specifically doing to manage patients with dense breasts. Our goal was to survey breast imagers facing these issues in an effort to simplify dense breast management. A survey was administered via email to the Society of Breast Imaging member directory, designed to collect information regarding current practices in dense breast notification and supplemental screening. There were 223 surveys completed to entirety, including 38% from respondents in states without mandatory breast density reporting laws and 62% from states with reporting laws. A majority of respondents from both groups, 60% and 51% in those without and with laws, respectively, felt they lacked adequate resources to offer or sustain supplemental screening. In those offering supplemental imaging, the modalities offered varied widely as did the manner of offering a supplemental exam. Levels of satisfaction, concerns, and standard practices of respondents were also queried. Strategizing optimal imaging approaches and algorithms to handle dense breast management issues is important to maintain efficiency in breast imaging departments. Sharing current ideas and practices may facilitate a smoother workflow in mandatory dense breast reporting and supplemental imaging, allowing breast imagers to correct or prevent systems-based flaws.
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Affiliation(s)
- Santo Maimone
- Department of Radiology; Mayo Clinic Florida; Jacksonville Florida
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26
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Bahl M, Baker JA, Bhargavan-Chatfield M, Brandt EK, Ghate SV. Impact of Breast Density Notification Legislation on Radiologists’ Practices of Reporting Breast Density: A Multi-State Study. Radiology 2016; 280:701-6. [PMID: 27018643 DOI: 10.1148/radiol.2016152457] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manisha Bahl
- From the Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710 (M. Bahl, J.A.B., S.V.G.); and American College of Radiology, Reston, Va (M. Bhargavan-Chatfield, E.K.B.)
| | - Jay A Baker
- From the Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710 (M. Bahl, J.A.B., S.V.G.); and American College of Radiology, Reston, Va (M. Bhargavan-Chatfield, E.K.B.)
| | - Mythreyi Bhargavan-Chatfield
- From the Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710 (M. Bahl, J.A.B., S.V.G.); and American College of Radiology, Reston, Va (M. Bhargavan-Chatfield, E.K.B.)
| | - Eugenia K Brandt
- From the Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710 (M. Bahl, J.A.B., S.V.G.); and American College of Radiology, Reston, Va (M. Bhargavan-Chatfield, E.K.B.)
| | - Sujata V Ghate
- From the Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710 (M. Bahl, J.A.B., S.V.G.); and American College of Radiology, Reston, Va (M. Bhargavan-Chatfield, E.K.B.)
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Nayak L, Miyake KK, Leung JWT, Price ER, Liu YI, Joe BN, Sickles EA, Thomas WR, Lipson JA, Daniel BL, Hargreaves J, Brenner RJ, Bassett LW, Ojeda-Fournier H, Lindfors KK, Feig SA, Ikeda DM. Impact of Breast Density Legislation on Breast Cancer Risk Assessment and Supplemental Screening: A Survey of 110 Radiology Facilities. Breast J 2016; 22:493-500. [DOI: 10.1111/tbj.12624] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lina Nayak
- Stanford University; Stanford California
| | | | | | - Elissa R. Price
- University of California San Francisco; San Francisco California
| | | | - Bonnie N. Joe
- University of California San Francisco; San Francisco California
| | | | | | | | | | | | - R. James Brenner
- Alta Bates Summit Medical Center; Berkeley California
- University of California San Diego; San Diego California
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Assessment of Interradiologist Agreement Regarding Mammographic Breast Density Classification Using the Fifth Edition of the BI-RADS Atlas. AJR Am J Roentgenol 2016; 206:1119-23. [PMID: 26999655 DOI: 10.2214/ajr.15.15049] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the present study was to assess interradiologist agreement regarding mammographic breast density assessment performed using the rating scale outlined in the fifth edition of the BI-RADS atlas of the American College of Radiology. MATERIALS AND METHODS Breast density assessments of 1000 cases were conducted by five radiologists from the same institution who together had recently undergone retraining in mammographic breast density classification based on the fifth edition of BI-RADS. The readers assigned breast density grades (A-D) on the basis of the BI-RADS classification scheme. Repeat assessment of 100 cases was performed by all readers 1 month after the initial assessment. A weighted kappa was used to calculate intrareader and interreader agreement. RESULTS Intrareader agreement ranged from a kappa value of 0.86 (95% CI, 0.77-0.93) to 0.89 (95% CI, 0.81-0.95) on a four-category scale (categories A-D) and from 0.89 (95% CI, 0.86-0.92) to 0.94 (95% CI, 0.89-0.97) on a two-category scale (category A-B vs category C-D). Interreader agreement ranged from substantial (κ = 0.76; 95% CI, 0.73-0.78) to almost perfect (κ = 0.87; 95% CI, 0.86-0.89) on a four-category scale, and the overall weighted kappa value was substantial (0.79; 95% CI, 0.78-0.83). Interreader agreement on a two-category scale ranged from a kappa value of 0.85 (95% CI, 0.83-0.86) to 0.91 (95% CI, 0.90-0.92), and the overall weighted kappa was 0.88 (95% CI, 0.87-0.89). CONCLUSION Overall, with regard to mammographic breast density classification, radiologists had substantial interreader agreement when a four-category scale was used and almost perfect interreader agreement when a dichotomous scale was used.
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Winkler NS, Raza S, Mackesy M, Birdwell RL. Breast density: clinical implications and assessment methods. Radiographics 2016; 35:316-24. [PMID: 25763719 DOI: 10.1148/rg.352140134] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breast density assessment is an important component of the screening mammography report and conveys information to referring clinicians about mammographic sensitivity and the relative risk for developing breast cancer. These topics have gained substantial attention because of recent legislation in several states that requires patients to be informed of dense breast tissue and the potential for associated breast cancer risk and decreased mammographic sensitivity. Because of the considerable implications of diagnosing a woman with dense breast tissue, radiologists should strive to be as consistent as possible when assessing breast density. Commonly used methods of breast density assessment range from subjective visual estimation to quantitative calculations of area and volume density percentages made with complex computer algorithms. The basic principles of currently available commercial methods of calculating fibroglandular density are described and illustrated. There is no criterion standard for determining breast density, but understanding the pros and cons of the various assessment methods will allow radiologists to make informed decisions. Radiologists should understand the basic factors involved in breast density assessment, the changes related to density assessment described in the fifth edition of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon, and the capabilities of currently available software. Online supplemental material is available for this article.
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Affiliation(s)
- Nicole S Winkler
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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Ekpo EU, Egbe NO, Egom AE, McEntee MF. Mammographic Breast Density: Comparison Across Women with Conclusive and Inconclusive Mammography Reports. J Med Imaging Radiat Sci 2015; 47:55-59. [PMID: 31047165 DOI: 10.1016/j.jmir.2015.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
Abstract
AIMS To compare breast density (BD) across women with conclusive and inconclusive reports to establish whether BD impacts decisions to recall patients in Nigeria. METHODS A total of 653 mammograms with associated radiologists' reports were retrieved from mammography archives across Nigeria. Ultrasound and biopsy results of cases reported as inconclusive and referred for additional examination were examined. Data were divided into two groups based on radiologists' reports (conclusive, 1 and inconclusive, 2). Each group was subgrouped into A-B and C-D, representing cases with low- and high-mammographic BD, respectively. A Mann-Whitney U test was used to compare breast densities (A-B vs. C-D) in subjects with conclusive and inconclusive mammographic reports. RESULT About 75.4% (n = 492) of mammograms had a conclusive report and comprised negative (n = 216), benign (n = 208), and equivocal to highly suggestive of malignancy (n = 68). A total of 161 cases had inconclusive reports, of which, 103 demonstrated high mammographic BD (C-D). Low BD (A-B) was significantly higher in subjects with conclusive mammography reports (mean = 0.88 ± 0.36) compared with high BD (z-score = 4.5; P = .0001). High BD (C-D) was significantly higher in subjects with inconclusive reports (mean = 0.64 ± 0.48) compared with low BD (z-score = 5.2; P = .005). CONCLUSION Findings demonstrate that high mammographic BD impact on radiologists' inconclusive decisions in Nigeria, suggesting a need to explore avenues to improve reader efficiency.
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Affiliation(s)
- Ernest U Ekpo
- Department of Radiography and Radiology, Faculty of Health Sciences, University of Calabar, Calabar, Nigeria; Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia.
| | - Nneoyi Onen Egbe
- Department of Radiography and Radiology, Faculty of Health Sciences, University of Calabar, Calabar, Nigeria
| | - Akwa E Egom
- Department of Radiography and Radiology, Faculty of Health Sciences, University of Calabar, Calabar, Nigeria
| | - Mark F McEntee
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
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Lee CI, Bogart A, Hubbard RA, Obadina ET, Hill DA, Haas JS, Tosteson ANA, Alford-Teaster JA, Sprague BL, DeMartini WB, Lehman CD, Onega TL. Advanced Breast Imaging Availability by Screening Facility Characteristics. Acad Radiol 2015; 22:846-52. [PMID: 25851643 PMCID: PMC4465038 DOI: 10.1016/j.acra.2015.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the relationship between screening mammography facility characteristics and on-site availability of advanced breast imaging services required for supplemental screening and the diagnostic evaluation of abnormal screening findings. MATERIALS AND METHODS We analyzed data from all active imaging facilities across six regional registries of the National Cancer Institute-funded Breast Cancer Surveillance Consortium offering screening mammography in calendar years 2011-2012 (n = 105). We used generalized estimating equations regression models to identify associations between facility characteristics (eg, academic affiliation, practice type) and availability of on-site advanced breast imaging (eg, ultrasound [US], magnetic resonance imaging [MRI]) and image-guided biopsy services. RESULTS Breast MRI was not available at any nonradiology or breast imaging-only facilities. A combination of breast US, breast MRI, and imaging-guided breast biopsy services was available at 76.0% of multispecialty breast centers compared to 22.2% of full diagnostic radiology practices (P = .0047) and 75.0% of facilities with academic affiliations compared to 29.0% of those without academic affiliations (P = .04). Both supplemental screening breast US and screening breast MRI were available at 28.0% of multispecialty breast centers compared to 4.7% of full diagnostic radiology practices (P < .01) and 25.0% of academic facilities compared to 8.5% of nonacademic facilities (P = .02). CONCLUSIONS Screening facility characteristics are strongly associated with the availability of on-site advanced breast imaging and image-guided biopsy service. Therefore, the type of imaging facility a woman attends for screening may have important implications on her timely access to supplemental screening and diagnostic breast imaging services.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
| | - Andy Bogart
- Group Health Research Institute, Seattle, Washington
| | | | - Eniola T Obadina
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Deirdre A Hill
- Department of Internal Medicine, Cancer Research and Treatment Center, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Dana Farber Harvard Cancer Institute, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Anna N A Tosteson
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Jennifer A Alford-Teaster
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Brian L Sprague
- Department of Surgery and Office of Health Promotion Research, University of Vermont, Burlington, Vermont
| | - Wendy B DeMartini
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Constance D Lehman
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Tracy L Onega
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
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Lee CI, Bogart A, Germino JC, Goldman LE, Hubbard RA, Haas JS, Hill DA, Tosteson AN, Alford-Teaster JA, DeMartini WB, Lehman CD, Onega TL. Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations. J Med Screen 2015; 23:24-30. [PMID: 26078275 DOI: 10.1177/0969141315591616] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/26/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavourable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound, magnetic resonance imaging [MRI], and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations. SETTING 73 imaging facilities across five Breast Cancer Surveillance Consortium regional registries in the United States during 2011 and 2012. METHODS We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence.We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women. RESULTS Facilities serving vulnerable populations were as likely (Relative risk [RR] for MRI = 0.71, 95% Confidence Interval [CI] 0.42, 1.19; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for ultrasound = 1.38 [95% CI 1.09, 1.74]; RR for ultrasound-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations. CONCLUSIONS Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use.
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Affiliation(s)
- Christoph I Lee
- Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109 Dept of Health Services, University of Washington School of Public Health; 825 Eastlake Avenue East, Seattle, WA 98109
| | - Andy Bogart
- Group Health Research Institute; 1730 Minor Avenue #1600, Seattle, WA, 98101
| | - Jessica C Germino
- Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109
| | - L Elizabeth Goldman
- Dept of Internal Medicine, University of California, San Francisco School of Medicine; 1001 Potrero Ave, Box 1364, San Francisco, CA 94110
| | - Rebecca A Hubbard
- Dept of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania; 423 Guardian Drive, Philadelphia, PA 19104
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Dept of Medicine, Harvard Medical School; Dana Farber Harvard Cancer Institute; Dept of Social and Behavioral Sciences, Harvard School of Public Health; 1620 Tremont Street, Boston, MA 02120
| | - Deirdre A Hill
- Dept of Internal Medicine, Cancer Research and Treatment Center, University of New Mexico; 1201 Camino de Salud NE, 1 University of New Mexico, Albuquerque, NM, 87102
| | - Anna Na Tosteson
- Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756
| | - Jennifer A Alford-Teaster
- Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756
| | - Wendy B DeMartini
- Dept of Radiology, University of Wisconsin School of Medicine and Public Health; 600 Highland Avenue, Madison WI 53792
| | - Constance D Lehman
- Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109
| | - Tracy L Onega
- Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756
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Abstract
Routine screening mammography is recommended by most groups issuing breast cancer screening guidelines, especially for women 50 years of age and older. However, both the potential benefits and risks of screening should be discussed with individual patients to allow for shared decision making regarding their participation in screening, age of commencement and conclusion, and interval of mammography screening.
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Affiliation(s)
- Mackenzie S Fuller
- Department of Medicine, University of Washington, 325 Ninth Avenue, Mailbox 359780, Seattle, WA 98104, USA
| | - Christoph I Lee
- Department of Health Services, University of Washington School of Public Health, Box 357660, Seattle, WA 98195, USA; Department of Radiology, University of Washington, 825 Eastlake Avenue East, G3-200, Seattle, WA 98109, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington, 325 Ninth Avenue, Mailbox 359780, Seattle, WA 98104, USA.
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Elmore JG, Longton GM, Carney PA, Geller BM, Onega T, Tosteson ANA, Nelson HD, Pepe MS, Allison KH, Schnitt SJ, O'Malley FP, Weaver DL. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA 2015; 313:1122-32. [PMID: 25781441 PMCID: PMC4516388 DOI: 10.1001/jama.2015.1405] [Citation(s) in RCA: 360] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE A breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood. OBJECTIVES To quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics. DESIGN, SETTING, AND PARTICIPANTS Study of pathologists who interpret breast biopsies in clinical practices in 8 US states. EXPOSURES Participants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%. MAIN OUTCOMES AND MEASURES The proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed. RESULTS Sixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3% (95% CI, 73.4%-77.0%; 5194 of 6900 interpretations). Among invasive carcinoma cases (663 interpretations), 96% (95% CI, 94%-97%) were concordant, and 4% (95% CI, 3%-6%) were underinterpreted; among DCIS cases (2097 interpretations), 84% (95% CI, 82%-86%) were concordant, 3% (95% CI, 2%-4%) were overinterpreted, and 13% (95% CI, 12%-15%) were underinterpreted; among atypia cases (2070 interpretations), 48% (95% CI, 44%-52%) were concordant, 17% (95% CI, 15%-21%) were overinterpreted, and 35% (95% CI, 31%-39%) were underinterpreted; and among benign cases without atypia (2070 interpretations), 87% (95% CI, 85%-89%) were concordant and 13% (95% CI, 11%-15%) were overinterpreted. Disagreement with the reference diagnosis was statistically significantly higher among biopsies from women with higher (n = 122) vs lower (n = 118) breast density on prior mammograms (overall concordance rate, 73% [95% CI, 71%-75%] for higher vs 77% [95% CI, 75%-80%] for lower, P < .001), and among pathologists who interpreted lower weekly case volumes (P < .001) or worked in smaller practices (P = .034) or nonacademic settings (P = .007). CONCLUSIONS AND RELEVANCE In this study of pathologists, in which diagnostic interpretation was based on a single breast biopsy slide, overall agreement between the individual pathologists' interpretations and the expert consensus-derived reference diagnoses was 75.3%, with the highest level of concordance for invasive carcinoma and lower levels of concordance for DCIS and atypia. Further research is needed to understand the relationship of these findings with patient management.
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Affiliation(s)
- Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Gary M Longton
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Patricia A Carney
- Department of Family Medicine, Oregon Health and Science University, Portland
| | - Berta M Geller
- Department of Family Medicine, University of Vermont, Vineyard Haven, Massachusetts
| | - Tracy Onega
- Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Anna N A Tosteson
- Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire6Department of Medicine, Geisel School of Medicine at
| | - Heidi D Nelson
- Providence Cancer Center, Providence Health and Services Oregon, Portland8Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland9Department of Clinical Epidemiology and Medicine, Oregon Health and Scien
| | - Margaret S Pepe
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Stuart J Schnitt
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts12Harvard Medical School, Boston, Massachusetts
| | - Frances P O'Malley
- Department of Laboratory Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada14St Michael's Hospital and the University of Toronto, Ontario, Canada
| | - Donald L Weaver
- Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington
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Rhodes DJ, Radecki Breitkopf C, Ziegenfuss JY, Jenkins SM, Vachon CM. Awareness of breast density and its impact on breast cancer detection and risk. J Clin Oncol 2015; 33:1143-50. [PMID: 25732156 DOI: 10.1200/jco.2014.57.0325] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Legislation mandating disclosure of breast density (BD) information has passed in 21 states; however, actual awareness of BD and knowledge of its impact on breast cancer detection and risk are unknown. METHODS We conducted a national cross-sectional survey administered in English and Spanish using a probability-based sample of screening-age women, with oversampling of Connecticut, the only state with BD legislation in effect for > 1 year before the survey. RESULTS Of 2,311 women surveyed, 65% responded. Overall, 58% of women had heard of BD, 49% knew that BD affects breast cancer detection, and 53% knew that BD affects cancer risk. After multivariable adjustment, increased BD awareness was associated with white non-Hispanic race/ethnicity (Hispanic v white non-Hispanic: odds ratio [OR], 0.23; P < .001), household income (OR, 1.07 per category increase; P < .001), education (OR, 1.19 per category increase; P < .001), diagnostic evaluation after a mammogram (OR, 2.64; P < .001), and postmenopausal hormone therapy (OR, 1.69; P = .002). Knowledge of the masking effect of BD was associated with higher household income (OR, 1.10; P < .001), education (OR, 1.22; P = .01), prior breast biopsy (OR, 2.16; P < .001), and residing in Connecticut (Connecticut v other states: OR, 3.82; P = .003). Connecticut residents were also more likely to have discussed their BD with a health care provider (67% v 43% for residents of other US states; P = .001). CONCLUSION Disparities in BD awareness and knowledge exist by race/ethnicity, education, and income. BD legislation seems to be effective in increasing knowledge of BD impact on breast cancer detection. These findings support continued and targeted efforts to improve BD awareness and knowledge among women eligible for screening mammography.
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Affiliation(s)
- Deborah J Rhodes
- Deborah J. Rhodes, Carmen Radecki Breitkopf, Sarah M. Jenkins, and Celine M. Vachon, Mayo Clinic, Rochester; and Jeanette Y. Ziegenfuss, HealthPartners Institute for Education and Research, Minneapolis, MN.
| | - Carmen Radecki Breitkopf
- Deborah J. Rhodes, Carmen Radecki Breitkopf, Sarah M. Jenkins, and Celine M. Vachon, Mayo Clinic, Rochester; and Jeanette Y. Ziegenfuss, HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Jeanette Y Ziegenfuss
- Deborah J. Rhodes, Carmen Radecki Breitkopf, Sarah M. Jenkins, and Celine M. Vachon, Mayo Clinic, Rochester; and Jeanette Y. Ziegenfuss, HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Sarah M Jenkins
- Deborah J. Rhodes, Carmen Radecki Breitkopf, Sarah M. Jenkins, and Celine M. Vachon, Mayo Clinic, Rochester; and Jeanette Y. Ziegenfuss, HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Celine M Vachon
- Deborah J. Rhodes, Carmen Radecki Breitkopf, Sarah M. Jenkins, and Celine M. Vachon, Mayo Clinic, Rochester; and Jeanette Y. Ziegenfuss, HealthPartners Institute for Education and Research, Minneapolis, MN
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Freer PE. Mammographic Breast Density: Impact on Breast Cancer Risk and Implications for Screening. Radiographics 2015; 35:302-15. [PMID: 25763718 DOI: 10.1148/rg.352140106] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Phoebe E Freer
- From the Department of Radiology, MGH Imaging, Massachusetts General Hospital, 15 Parkman St, Wang Building, ACC-240, Boston, MA 02114
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Sprague BL, Stout NK, Schechter C, van Ravesteyn NT, Cevik M, Alagoz O, Lee CI, van den Broek JJ, Miglioretti DL, Mandelblatt JS, de Koning HJ, Kerlikowske K, Lehman CD, Tosteson AN. Benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts. Ann Intern Med 2015; 162:157-66. [PMID: 25486550 PMCID: PMC4314343 DOI: 10.7326/m14-0692] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many states have laws requiring mammography facilities to tell women with dense breasts and negative results on screening mammography to discuss supplemental screening tests with their providers. The most readily available supplemental screening method is ultrasonography, but little is known about its effectiveness. OBJECTIVE To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts. DESIGN Comparative modeling with 3 validated simulation models. DATA SOURCES Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; and medical literature. TARGET POPULATION Contemporary cohort of women eligible for routine screening. TIME HORIZON Lifetime. PERSPECTIVE Payer. INTERVENTION Supplemental ultrasonography screening for women with dense breasts after a negative screening mammography result. OUTCOME MEASURES Breast cancer deaths averted, quality-adjusted life-years (QALYs) gained, biopsies recommended after a false-positive ultrasonography result, and costs. RESULTS OF BASE-CASE ANALYSIS Supplemental ultrasonography screening after a negative mammography result for women aged 50 to 74 years with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models, 0.14 to 0.75), gained 1.7 QALYs (range, 0.9 to 4.7), and resulted in 354 biopsy recommendations after a false-positive ultrasonography result (range, 345 to 421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained (range, $112,000 to $766,000). Supplemental ultrasonography screening for only women with extremely dense breasts cost $246,000 per QALY gained (range, $74,000 to $535,000). RESULTS OF SENSITIVITY ANALYSIS The conclusions were not sensitive to ultrasonography performance characteristics, screening frequency, or starting age. LIMITATION Provider costs for coordinating supplemental ultrasonography were not considered. CONCLUSION Supplemental ultrasonography screening for women with dense breasts would substantially increase costs while producing relatively small benefits. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Brian L. Sprague
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Natasha K. Stout
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Clyde Schechter
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Nicolien T. van Ravesteyn
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Mucahit Cevik
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Oguzhan Alagoz
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Christoph I. Lee
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jeroen J. van den Broek
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Diana L. Miglioretti
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jeanne S. Mandelblatt
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Harry J. de Koning
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karla Kerlikowske
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Constance D. Lehman
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Anna N.A. Tosteson
- From the University of Vermont, Burlington, Vermont; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Albert Einstein School of Medicine, Bronx, New York; Erasmus Medical Center, Rotterdam, the Netherlands; University of Wisconsin–Madison, Wisconsin; University of Washington School of Medicine and Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California, Davis, School of Medicine, Davis, California
- Georgetown University, Washington, DC; University of California, San Francisco, California; and Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Abstract
OBJECTIVE. The purpose of this article is to review the use of MRI in breast density measurement and breast cancer risk estimation and to discuss the role of MRI as an alternative screening to mammography for screening women with dense breasts. CONCLUSION. The potential of MRI for screening women with dense breasts remains controversial because of the paucity of clinical evidence, the possibility of overdiagnosis, and the cost-effectiveness of the technique in this population. Although methods of MRI measurement require standardization and automation, future addition of MRI density to risk models may positively impact their value.
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Affiliation(s)
- Elizabeth A M O'Flynn
- 1 All authors: Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
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39
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Scheel JR, Lee JM, Sprague BL, Lee CI, Lehman CD. Screening ultrasound as an adjunct to mammography in women with mammographically dense breasts. Am J Obstet Gynecol 2015; 212:9-17. [PMID: 24959654 DOI: 10.1016/j.ajog.2014.06.048] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/07/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
There are potential benefits and harms of screening ultrasound (US) to supplement mammographic screening of women with dense breast tissue. We conducted a comprehensive literature review of studies assessing the efficacy of screening US to supplement mammography among women with dense breasts. From a total of 189 peer-reviewed publications on the performance of screening US, 12 studies were relevant to our analysis. The reporting of breast cancer risk factors varied across studies; however, the study populations tended to be at greater than average risk for developing breast cancer. Overall, US detected an additional 0.3-7.7 cancers per 1000 examinations (median, 4.2) and was associated with an additional 11.7-106.6 biopsies per 1000 examinations (median, 52.2). Significant improvements in cancer detection in dense breasts have been achieved with the transition from film to digital mammography. Thus adjunctive screening with ultrasound should be considered in the context of current screening mammography performance. Clinicians should discuss breast density as 1 of several important breast cancer risk factors, consider the potential harms of adjunctive screening, and arrive at a shared decision consistent with each woman's preferences and values.
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40
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Sprague BL, Gangnon RE, Burt V, Trentham-Dietz A, Hampton JM, Wellman RD, Kerlikowske K, Miglioretti DL. Prevalence of mammographically dense breasts in the United States. J Natl Cancer Inst 2014; 106:dju255. [PMID: 25217577 DOI: 10.1093/jnci/dju255] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND National legislation is under consideration that would require women with mammographically dense breasts to be informed of their breast density and encouraged to discuss supplemental breast cancer screening with their health care providers. The number of US women potentially affected by this legislation is unknown. METHODS We determined the mammographic breast density distribution by age and body mass index (BMI) using data from 1518 599 mammograms conducted from 2007 through 2010 at mammography facilities in the Breast Cancer Surveillance Consortium (BCSC). We applied these breast density distributions to age- and BMI-specific counts of the US female population derived from the 2010 US Census and the National Health and Nutrition Examination Survey (NHANES) to estimate the number of US women with dense breasts. RESULTS Overall, 43.3% (95% confidence interval [CI] = 43.1% to 43.4%) of women 40 to 74 years of age had heterogeneously or extremely dense breasts, and this proportion was inversely associated with age and BMI. Based on the age and BMI distribution of US women, we estimated that 27.6 million women (95% CI = 27.5 to 27.7 million) aged 40 to 74 years in the United States have heterogeneously or extremely dense breasts. Women aged 40 to 49 years (N = 12.3 million) accounted for 44.3% of this group. CONCLUSION The prevalence of dense breasts among US women of common breast cancer screening ages exceeds 25 million. Policymakers and healthcare providers should consider this large prevalence when debating breast density notification legislation and designing strategies to ensure that women who are notified have opportunities to evaluate breast cancer risk and discuss and pursue supplemental screening options if deemed appropriate.
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Affiliation(s)
- Brian L Sprague
- Department of Surgery, Office of Health Promotion Research and Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Health Sciences, University of Wisconsin, Madison, WI (REG, VB, ATD); University of Wisconsin Carbone Cancer Center, Madison, WI (REG, ATD, JMH); Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI (REG); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (RDW, DLM).
| | - Ronald E Gangnon
- Department of Surgery, Office of Health Promotion Research and Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Health Sciences, University of Wisconsin, Madison, WI (REG, VB, ATD); University of Wisconsin Carbone Cancer Center, Madison, WI (REG, ATD, JMH); Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI (REG); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (RDW, DLM)
| | - Veronica Burt
- Department of Surgery, Office of Health Promotion Research and Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Health Sciences, University of Wisconsin, Madison, WI (REG, VB, ATD); University of Wisconsin Carbone Cancer Center, Madison, WI (REG, ATD, JMH); Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI (REG); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (RDW, DLM)
| | - Amy Trentham-Dietz
- Department of Surgery, Office of Health Promotion Research and Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Health Sciences, University of Wisconsin, Madison, WI (REG, VB, ATD); University of Wisconsin Carbone Cancer Center, Madison, WI (REG, ATD, JMH); Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI (REG); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (RDW, DLM)
| | - John M Hampton
- Department of Surgery, Office of Health Promotion Research and Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Health Sciences, University of Wisconsin, Madison, WI (REG, VB, ATD); University of Wisconsin Carbone Cancer Center, Madison, WI (REG, ATD, JMH); Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI (REG); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (RDW, DLM)
| | - Robert D Wellman
- Department of Surgery, Office of Health Promotion Research and Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Health Sciences, University of Wisconsin, Madison, WI (REG, VB, ATD); University of Wisconsin Carbone Cancer Center, Madison, WI (REG, ATD, JMH); Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI (REG); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (RDW, DLM)
| | - Karla Kerlikowske
- Department of Surgery, Office of Health Promotion Research and Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Health Sciences, University of Wisconsin, Madison, WI (REG, VB, ATD); University of Wisconsin Carbone Cancer Center, Madison, WI (REG, ATD, JMH); Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI (REG); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (RDW, DLM)
| | - Diana L Miglioretti
- Department of Surgery, Office of Health Promotion Research and Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Health Sciences, University of Wisconsin, Madison, WI (REG, VB, ATD); University of Wisconsin Carbone Cancer Center, Madison, WI (REG, ATD, JMH); Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI (REG); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (RDW, DLM)
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Onega T, Hubbard R, Hill D, Lee CI, Haas JS, Carlos HA, Alford-Teaster J, Bogart A, DeMartini WB, Kerlikowske K, Virnig BA, Buist DSM, Henderson L, Tosteson ANA. Geographic access to breast imaging for US women. J Am Coll Radiol 2014; 11:874-82. [PMID: 24889479 PMCID: PMC4156905 DOI: 10.1016/j.jacr.2014.03.022] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/30/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The breast imaging modalities of mammography, ultrasound, and MRI are widely used for screening, diagnosis, treatment, and surveillance of breast cancer. Geographic access to breast imaging services in various modalities is not known at a national level overall or for population subgroups. METHODS A retrospective study of 2004-2008 Medicare claims data was conducted to identify ZIP codes in which breast imaging occurred, and data were mapped. Estimated travel times were made for each modality for 215,798 census block groups in the contiguous United States. Using Census 2010 data, travel times were characterized by sociodemographic factors for 92,788,909 women aged ≥30 years, overall, and by subgroups of age, race/ethnicity, rurality, education, and median income. RESULTS Overall, 85% of women had travel times of ≤20 minutes to nearest mammography or ultrasound services, and 70% had travel times of ≤20 minutes for MRI with little variation by age. Native American women had median travel times 2-3 times longer for all 3 modalities, compared to women of other racial/ethnic groups. For rural women, median travel times to breast imaging services were 4-8-fold longer than they were for urban women. Black and Asian women had the shortest median travel times to services for all 3 modalities. CONCLUSIONS Travel times to mammography and ultrasound breast imaging facilities are short for most women, but for breast MRI, travel times are notably longer. Native American and rural women are disadvantaged in geographic access based on travel times to breast imaging services. This work informs potential interventions to reduce inequities in access and utilization.
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Affiliation(s)
- Tracy Onega
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | | | - Deirdre Hill
- University of New Mexico, Albuquerque, New Mexico
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Jennifer S Haas
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachussetts
| | - Heather A Carlos
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jennifer Alford-Teaster
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Andy Bogart
- Group Health Research Institute, Seattle, Washington
| | - Wendy B DeMartini
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Beth A Virnig
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Louise Henderson
- Department of Radiology, The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Anna N A Tosteson
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Lee CI, Lehman CD. Digital breast tomosynthesis and the challenges of implementing an emerging breast cancer screening technology into clinical practice. J Am Coll Radiol 2014; 10:913-7. [PMID: 24295940 DOI: 10.1016/j.jacr.2013.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
Emerging imaging technologies, including digital breast tomosynthesis, have the potential to transform breast cancer screening. However, the rapid adoption of these new technologies outpaces the evidence of their clinical and cost-effectiveness. The authors describe the forces driving the rapid diffusion of tomosynthesis into clinical practice, comparing it with the rapid diffusion of digital mammography shortly after its introduction. They outline the potential positive and negative effects that adoption can have on imaging workflow and describe the practice management challenges when incorporating tomosynthesis. The authors also provide recommendations for collecting evidence supporting the development of policies and best practices.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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Garfield CF, Duncan G, Rutsohn J, McDade TW, Adam EK, Coley RL, Chase-Lansdale PL. A longitudinal study of paternal mental health during transition to fatherhood as young adults. Pediatrics 2014; 133:836-43. [PMID: 24733877 PMCID: PMC4006439 DOI: 10.1542/peds.2013-3262] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Rates of paternal depression range from 5% to 10% with a growing body of literature describing the harm to fathers, children, and families. Changes in depression symptoms over the life course, and the role of social factors, are not well known. This study examines associations with changes in depression symptoms during the transition to fatherhood for young fathers and whether this association differed by key social factors. METHODS We combined all 4 waves of the National Longitudinal Study of Adolescent Health to support a 23-year longitudinal analysis of 10 623 men and then created a "fatherhood-year" data set, regressing age-adjusted standardized depressive symptoms scores on fatherhood status (nonresidence/residence), fatherhood-years, and covariates to determine associations between Center for Epidemiologic Studies Depression Scale scores and fatherhood life course intervals. RESULTS Depressive symptom scores reported at the entry into fatherhood are higher for nonresident fathers than nonfathers, which in turn are higher than those of resident fathers. Resident fathers have a significant decrease in scores during late adolescence (β = -0.035, P = .023), but a significant increase in scores during early fatherhood (β = 0.023, P = .041). From entrance into fatherhood to the end of early fatherhood (+5 years), the depressive symptoms score for resident fathers increases on average by 68%. CONCLUSIONS In our longitudinal, population-based study, resident fathers show increasing depressive symptom scores during children's key attachment years of 0-5. Identifying at-risk fathers based on social factors and designing effective interventions may ultimately improve health outcomes for the entire family.
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Affiliation(s)
- Craig F Garfield
- Northwestern University Feinberg School of Medicine, Departments of Pediatrics and Medical Social Sciences, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Institute for Policy Research, Northwestern University, Evanston, Illinois;
| | - Greg Duncan
- School of Education, University of California-Irvine, Irvine, California
| | - Joshua Rutsohn
- Northwestern University Feinberg School of Medicine, Departments of Pediatrics and Medical Social Sciences, Chicago, Illinois
| | - Thomas W McDade
- Institute for Policy Research, Northwestern University, Evanston, Illinois; Department of Anthropology, Northwestern University, Evanston, Illinois
| | - Emma K Adam
- Institute for Policy Research, Northwestern University, Evanston, Illinois; School of Education and Social Policy, Northwestern University
| | | | - P Lindsay Chase-Lansdale
- Institute for Policy Research, Northwestern University, Evanston, Illinois; School of Education and Social Policy, Northwestern University
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Ko SY, Kim EK, Kim MJ, Moon HJ. Mammographic density estimation with automated volumetric breast density measurement. Korean J Radiol 2014; 15:313-21. [PMID: 24843235 PMCID: PMC4023049 DOI: 10.3348/kjr.2014.15.3.313] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 03/01/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare automated volumetric breast density measurement (VBDM) with radiologists' evaluations based on the Breast Imaging Reporting and Data System (BI-RADS), and to identify the factors associated with technical failure of VBDM. MATERIALS AND METHODS In this study, 1129 women aged 19-82 years who underwent mammography from December 2011 to January 2012 were included. Breast density evaluations by radiologists based on BI-RADS and by VBDM (Volpara Version 1.5.1) were compared. The agreement in interpreting breast density between radiologists and VBDM was determined based on four density grades (D1, D2, D3, and D4) and a binary classification of fatty (D1-2) vs. dense (D3-4) breast using kappa statistics. The association between technical failure of VBDM and patient age, total breast volume, fibroglandular tissue volume, history of partial mastectomy, the frequency of mass > 3 cm, and breast density was analyzed. RESULTS The agreement between breast density evaluations by radiologists and VBDM was fair (k value = 0.26) when the four density grades (D1/D2/D3/D4) were used and moderate (k value = 0.47) for the binary classification (D1-2/D3-4). Twenty-seven women (2.4%) showed failure of VBDM. Small total breast volume, history of partial mastectomy, and high breast density were significantly associated with technical failure of VBDM (p = 0.001 to 0.015). CONCLUSION There is fair or moderate agreement in breast density evaluation between radiologists and VBDM. Technical failure of VBDM may be related to small total breast volume, a history of partial mastectomy, and high breast density.
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Affiliation(s)
- Su Yeon Ko
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea. ; Department of Radiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 690-767, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
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O'Neill SC, Leventhal KG, Scarles M, Evans CN, Makariou E, Pien E, Willey S. Mammographic breast density as a risk factor for breast cancer: awareness in a recently screened clinical sample. Womens Health Issues 2014; 24:e321-6. [PMID: 24725756 DOI: 10.1016/j.whi.2014.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast density is an established, independent risk factor for breast cancer. Despite this, density has not been included in standard risk models or routinely disclosed to patients. However, this is changing in the face of legal mandates and advocacy efforts. Little information exists regarding women's awareness of density as a risk factor, their personal risk, and risk management options. METHODS We assessed awareness of density as a risk factor and whether sociodemographic variables, breast cancer risk factors. and perceived breast cancer risk were associated with awareness in 344 women with a recent screening mammogram at a tertiary care center. FINDINGS Overall, 62% of women had heard about density as a risk factor and 33% had spoken to a provider about breast density. Of the sample, 18% reported that their provider indicated that they had high breast density. Awareness of density as a risk factor was greater among White women and those with other breast cancer risk factors. CONCLUSION Our results suggest that although a growing number of women are aware of breast density as a risk factor, this awareness varies. Growing mandates for disclosure suggest the need for patient education interventions for women at increased risk for the disease and to ensure all women are equally aware of their risks.
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Affiliation(s)
- Suzanne C O'Neill
- Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
| | - Kara Grace Leventhal
- Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Marie Scarles
- Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Chalanda N Evans
- Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Erini Makariou
- Department of Radiology, Georgetown University Hospital, Washington, DC
| | - Edward Pien
- Department of Radiology, Georgetown University Hospital, Washington, DC
| | - Shawna Willey
- Department of Surgery, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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