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Nicholson WK, Silverstein M, Wong JB, Barry MJ, Chelmow D, Coker TR, Davis EM, Jaén CR, Krousel-Wood M, Lee S, Li L, Mangione CM, Rao G, Ruiz JM, Stevermer JJ, Tsevat J, Underwood SM, Wiehe S. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2024; 331:1918-1930. [PMID: 38687503 DOI: 10.1001/jama.2024.5534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Importance Among all US women, breast cancer is the second most common cancer and the second most common cause of cancer death. In 2023, an estimated 43 170 women died of breast cancer. Non-Hispanic White women have the highest incidence of breast cancer and non-Hispanic Black women have the highest mortality rate. Objective The USPSTF commissioned a systematic review to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, screening interval, modality, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer-specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review. Population Cisgender women and all other persons assigned female at birth aged 40 years or older at average risk of breast cancer. Evidence Assessment The USPSTF concludes with moderate certainty that biennial screening mammography in women aged 40 to 74 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of screening mammography in women 75 years or older and the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or magnetic resonance imaging (MRI), regardless of breast density. Recommendation The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram. (I statement).
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Affiliation(s)
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
| | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Sei Lee
- University of California, San Francisco
| | - Li Li
- University of Virginia, Charlottesville
| | | | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- The University of Texas Health Science Center, San Antonio
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Obermann M, Nohava L, Frass-Kriegl R, Soanca O, Ginefri JC, Felblinger J, Clauser P, Baltzer PA, Laistler E. Panoramic Magnetic Resonance Imaging of the Breast With a Wearable Coil Vest. Invest Radiol 2023; 58:799-810. [PMID: 37227137 PMCID: PMC10581436 DOI: 10.1097/rli.0000000000000991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Breast cancer, the most common malignant cancer in women worldwide, is typically diagnosed by x-ray mammography, which is an unpleasant procedure, has low sensitivity in women with dense breasts, and involves ionizing radiation. Breast magnetic resonance imaging (MRI) is the most sensitive imaging modality and works without ionizing radiation, but is currently constrained to the prone imaging position due to suboptimal hardware, therefore hampering the clinical workflow. OBJECTIVES The aim of this work is to improve image quality in breast MRI, to simplify the clinical workflow, shorten measurement time, and achieve consistency in breast shape with other procedures such as ultrasound, surgery, and radiation therapy. MATERIALS AND METHODS To this end, we propose "panoramic breast MRI"-an approach combining a wearable radiofrequency coil for 3 T breast MRI (the "BraCoil"), acquisition in the supine position, and a panoramic visualization of the images. We demonstrate the potential of panoramic breast MRI in a pilot study on 12 healthy volunteers and 1 patient, and compare it to the state of the art. RESULTS With the BraCoil, we demonstrate up to 3-fold signal-to-noise ratio compared with clinical standard coils and acceleration factors up to 6 × 4. Panoramic visualization of supine breast images reduces the number of slices to be viewed by a factor of 2-4. CONCLUSIONS Panoramic breast MRI allows for high-quality diagnostic imaging and facilitated correlation to other diagnostic and interventional procedures. The developed wearable radiofrequency coil in combination with dedicated image processing has the potential to improve patient comfort while enabling more time-efficient breast MRI compared with clinical coils.
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3
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Salim M, Dembrower K, Eklund M, Smith K, Strand F. Differences and similarities in false interpretations by AI CAD and radiologists in screening mammography. Br J Radiol 2023; 96:20230210. [PMID: 37660400 PMCID: PMC10607417 DOI: 10.1259/bjr.20230210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the false interpretations between artificial intelligence (AI) and radiologists in screening mammography to get a better understanding of how the distribution of diagnostic mistakes might change when moving from entirely radiologist-driven to AI-integrated breast cancer screening. METHODS AND MATERIALS This retrospective case-control study was based on a mammography screening cohort from 2008 to 2015. The final study population included screening examinations for 714 women diagnosed with breast cancer and 8029 randomly selected healthy controls. Oversampling of controls was applied to attain a similar cancer proportion as in the source screening cohort. We examined how false-positive (FP) and false-negative (FN) assessments by AI, the first reader (RAD 1) and the second reader (RAD 2), were associated with age, density, tumor histology and cancer invasiveness in a single- and double-reader setting. RESULTS For each reader, the FN assessments were distributed between low- and high-density females with 53 (42%) and 72 (58%) for AI; 59 (36%) and 104 (64%) for RAD 1 and 47 (36%) and 84 (64%) for RAD 2. The corresponding numbers for FP assessments were 1820 (47%) and 2016 (53%) for AI; 1568 (46%) and 1834 (54%) for RAD 1 and 1190 (43%) and 1610 (58%) for RAD 2. For ductal cancer, the FN assessments were 79 (77%) for AI CAD; with 120 (83%) for RAD 1 and with 96 (16%) for RAD 2. For the double-reading simulation, the FP assessments were distributed between younger and older females with 2828 (2.5%) and 1554 (1.4%) for RAD 1 + RAD 2; 3850 (3.4%) and 2940 (2.6%) for AI+RAD 1 and 3430 (3%) and 2772 (2.5%) for AI+RAD 2. CONCLUSION The most pronounced decrease in FN assessments was noted for females over the age of 55 and for high density-women. In conclusion, AI could have an important complementary role when combined with radiologists to increase sensitivity for high-density and older females. ADVANCES IN KNOWLEDGE Our results highlight the potential impact of integrating AI in breast cancer screening, particularly to improve interpretation accuracy. The use of AI could enhance screening outcomes for high-density and older females.
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Affiliation(s)
| | | | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Kevin Smith
- Science for Life Laboratory, KTH Royal Insitute of Technology, Stockholm, Sweden
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4
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Beidler LB, Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Perceptions of Breast Cancer Risks Among Women Receiving Mammograph Screening. JAMA Netw Open 2023; 6:e2252209. [PMID: 36689223 PMCID: PMC9871800 DOI: 10.1001/jamanetworkopen.2022.52209] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/02/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Breast density is an independent risk factor for breast cancer. Despite the proliferation of mandated written notifications about breast density following mammography, there is little understanding of how women perceive the relative breast cancer risk associated with breast density. Objective To assess women's perception of breast density compared with other breast cancer risks and explore their understanding of risk reduction. Design, Setting, and Participants This mixed-methods qualitative study used telephone surveys and semistructured interviews to investigate perceptions about breast cancer risk among a nationally representative, population-based sample of women. Eligible study participants were aged 40 to 76 years, reported having recently undergone mammography, had no history of prior breast cancer, and had heard of breast density. Survey participants who had been informed of their personal breast density were invited for a qualitative interview. Survey administration spanned July 1, 2019, to April 30, 2020, with 2306 women completing the survey. Qualitative interviews were conducted from February 1 to May 30, 2020. Main Outcomes and Measures Respondents compared the breast cancer risk associated with breast density with 5 other risk factors. Participants qualitatively described what they thought contributed to breast cancer risk and ways to reduce risk. Results Of the 2306 women who completed the survey, 1858 (166 [9%] Asian, 503 [27%] Black, 268 [14%] Hispanic, 792 [43%] White, and 128 [7%] other race or ethnicity; 358 [19%] aged 40-49 years, 906 [49%] aged 50-64 years, and 594 [32%] aged ≥65 years) completed the revised risk perception questions and were included in the analysis. Half of respondents thought breast density to be a greater risk than not having children (957 [52%]), having more than 1 alcoholic drink per day (975 [53%]), or having a prior breast biopsy (867 [48%]). Most respondents felt breast density was a lesser risk than having a first-degree relative with breast cancer (1706 [93%]) or being overweight or obese (1188 [65%]). Of the 61 women who were interviewed, 6 (10%) described breast density as contributing to breast cancer risk, and 43 (70%) emphasized family history as a breast cancer risk factor. Of the interviewed women, 17 (28%) stated they did not know whether it was possible to reduce their breast cancer risk. Conclusions and Relevance In this qualitative study of women of breast cancer screening age, family history was perceived as the primary breast cancer risk factor. Most interviewees did not identify breast density as a risk factor and did not feel confident about actions to mitigate breast cancer risk. Comprehensive education about breast cancer risks and prevention strategies is needed.
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Affiliation(s)
- Laura B. Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Nancy R. Kressin
- Section of General Internal Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | | | - Tracy A. Battaglia
- Section of General Internal Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | - Priscilla J. Slanetz
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Christine M. Gunn
- Dartmouth Cancer Center, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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5
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Androulakis I, Sumser K, Machielse MND, Koppert L, Jager A, Nout R, Franckena M, van Rhoon GC, Curto S. Patient-derived breast model repository, a tool for hyperthermia treatment planning and applicator design. Int J Hyperthermia 2022; 39:1213-1221. [DOI: 10.1080/02656736.2022.2121862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Ioannis Androulakis
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Kemal Sumser
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Melanie N. D. Machielse
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Linetta Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Remi Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Martine Franckena
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Gerard C. van Rhoon
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Department of Radiation Science and Technology, Delft University of Technology, Delft, The Netherlands
| | - Sergio Curto
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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6
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Wiechmann L, Friedlander LC. Management of Radiographic Lesions of the Breast. Surg Clin North Am 2022; 102:1031-1041. [DOI: 10.1016/j.suc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Jin Z, Zhang S, Zhang L, Chen Q, Liu S, Zhang B. Artificial Intelligence Risk Model (Mirai) Delivers Robust Generalization and Outperforms Tyrer-Cuzick Guidelines in Breast Cancer Screening. J Clin Oncol 2022; 40:2280-2281. [PMID: 35452262 DOI: 10.1200/jco.21.02908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Zhe Jin
- Zhe Jin, MD, Shuixing Zhang, PhD, Lu Zhang, PhD, Qiuying Chen, PhD, Shuyi Liu, PhD, and Bin Zhang, PhD, Department of Radiology, the First Affiliated Hospital of Jinan University, Guangdong, Guangzhou, China
| | - Shuixing Zhang
- Zhe Jin, MD, Shuixing Zhang, PhD, Lu Zhang, PhD, Qiuying Chen, PhD, Shuyi Liu, PhD, and Bin Zhang, PhD, Department of Radiology, the First Affiliated Hospital of Jinan University, Guangdong, Guangzhou, China
| | - Lu Zhang
- Zhe Jin, MD, Shuixing Zhang, PhD, Lu Zhang, PhD, Qiuying Chen, PhD, Shuyi Liu, PhD, and Bin Zhang, PhD, Department of Radiology, the First Affiliated Hospital of Jinan University, Guangdong, Guangzhou, China
| | - Qiuying Chen
- Zhe Jin, MD, Shuixing Zhang, PhD, Lu Zhang, PhD, Qiuying Chen, PhD, Shuyi Liu, PhD, and Bin Zhang, PhD, Department of Radiology, the First Affiliated Hospital of Jinan University, Guangdong, Guangzhou, China
| | - Shuyi Liu
- Zhe Jin, MD, Shuixing Zhang, PhD, Lu Zhang, PhD, Qiuying Chen, PhD, Shuyi Liu, PhD, and Bin Zhang, PhD, Department of Radiology, the First Affiliated Hospital of Jinan University, Guangdong, Guangzhou, China
| | - Bin Zhang
- Zhe Jin, MD, Shuixing Zhang, PhD, Lu Zhang, PhD, Qiuying Chen, PhD, Shuyi Liu, PhD, and Bin Zhang, PhD, Department of Radiology, the First Affiliated Hospital of Jinan University, Guangdong, Guangzhou, China
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8
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Moini A, Salari E, Rashidi H, Maajani K, Abedi M, Bayani L, Alipour S. Evaluation of the association of endometriosis and mammographic breast density, a cross-sectional study. BMC Womens Health 2022; 22:81. [PMID: 35313883 PMCID: PMC8935711 DOI: 10.1186/s12905-022-01663-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Endometriosis is a common benign but painful gynecologic condition. Studies suggest that the risk of some types of malignancies such as breast cancer is higher in women with endometriosis. Mammographic breast density (MBD) is known as an important predictor for breast cancer. The present study aimed to investigate the potential relationship between endometriosis and MBD. Methods This cross-sectional study was conducted on 370 women over 40 years of age. Laparoscopic surgery was carried out for the diagnosis of endometriosis. MBD was classified into four categories according to the ACR BI-RADS classification. Statistical analysis was performed using SPSS software to evaluate the potential association between variables. Results The mean age of all participants was 47.2 ± 6.4 years, and most participants (76.8%) were premenopausal. Multivariate analysis of the potential predictors of MBD, including age, body mass index, oral contraceptive consumption, progesterone consumption, family history of breast cancer and endometriosis showed that age (P value = 0.002), history of progesterone consumption (P value = 0.004) and endometriosis (P value = 0.006) were independent factors for MBD. Conclusion This study indicated that endometriosis had an inverse association with MBD. Age and history of progesterone use were also independent influential factors for MBD. This finding shows that the positive association between breast cancer and endometriosis is not mediated through MBD.
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Affiliation(s)
- Ashraf Moini
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Shahid Baghdarnia (North Rashid) Street, Ressalat Street, 1653915911, Tehran, Iran.,Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Elnaz Salari
- Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Shahid Baghdarnia (North Rashid) Street, Ressalat Street, 1653915911, Tehran, Iran
| | - Hadi Rashidi
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Khadije Maajani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Abedi
- Department of Radiology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Bayani
- Department of Radiology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf Alipour
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran. .,Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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9
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Hipp LE, Hulswit BB, Milliron KJ. Clinical Tools and Counseling Considerations for Breast Cancer Risk Assessment and Evaluation for Hereditary Cancer Risk. Best Pract Res Clin Obstet Gynaecol 2022; 82:12-29. [DOI: 10.1016/j.bpobgyn.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
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10
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Choi WJ, Sim H, Kim HJ, Cha JH, Shin HJ, Chae EY, Kim HH. Association of mammography and ultrasound features with MammaPrint in patients with estrogen receptor-positive, HER2-negative, node-positive invasive breast cancer. Acta Radiol 2021; 62:1592-1600. [PMID: 33302692 DOI: 10.1177/0284185120980003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND MammaPrint is a 70-gene signature microarray assay that predicts the likelihood of recurrence of breast cancer and chemotherapeutic benefits. PURPOSE To investigate the association between mammography and ultrasound (US) features and MammaPrint results in patients with estrogen receptor (ER)-positive, HER2-negative, node-positive invasive breast cancer, and to identify the predictive factors for high risk of recurrence. MATERIAL AND METHODS This retrospective study included 251 patients with ER-positive, HER2-negative, 1-3 node-positive invasive breast cancer. Mammography and US findings were reviewed according to the BI-RADS criteria. The association between MammaPrint results and the clinicopathological and imaging features was evaluated. Logistic regression analysis was performed to identify independent predictors for high risk of recurrence. RESULTS Of the patients, 143 (57.0%) and 108 (43.0%) had low and high risks for recurrence on MammaPrint, respectively. Young age (odds ratio [OR] 1.08; 95% confidence interval (CI) 1.04-1.12; P<0.001), posterior enhancement on US (OR 2.45; 95% CI 1.16-5.20; P = 0.019), absence of posterior shadowing on US (OR 3.19; 95% CI 1.17-8.62; P = 0.023), high histologic grade (OR 113.36; 95% CI 6.79-1893.53; P = 0.001), and high Ki-67 level (OR 4.90; 95% CI 2.62-9.17; P<0.001) were independently associated with high risk of recurrence on multivariate logistic regression analysis. CONCLUSION Posterior features in US may predict a high risk of recurrence in patients with ER-positive, HER2-negative, node-positive invasive breast cancer, which may be useful in enhancing the diagnostic value of MammaPrint and aid in the decision-making process regarding treatment.
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Affiliation(s)
- Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hayan Sim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hee Jeong Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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11
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Geuzinge HA, Bakker MF, Heijnsdijk EAM, van Ravesteyn NT, Veldhuis WB, Pijnappel RM, de Lange SV, Emaus MJ, Mann RM, Monninkhof EM, de Koekkoek-Doll PK, van Gils CH, de Koning HJ. Cost-Effectiveness of Magnetic Resonance Imaging Screening for Women With Extremely Dense Breast Tissue. J Natl Cancer Inst 2021; 113:1476-1483. [PMID: 34585249 PMCID: PMC8562952 DOI: 10.1093/jnci/djab119] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/05/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extremely dense breast tissue is associated with increased breast cancer risk and limited sensitivity of mammography. The DENSE trial showed that additional magnetic resonance imaging (MRI) screening in women with extremely dense breasts resulted in a substantial reduction in interval cancers. The cost-effectiveness of MRI screening for these women is unknown. METHODS We used the MISCAN-breast microsimulation model to simulate several screening protocols containing mammography and/or MRI to estimate long-term effects and costs. The model was calibrated using results of the DENSE trial and adjusted to incorporate decreases in breast density with increasing age. Screening strategies varied in the number of MRIs and mammograms offered to women ages 50-75 years. Outcomes were numbers of breast cancers, life-years, quality-adjusted life-years (QALYs), breast cancer deaths, and overdiagnosis. Incremental cost-effectiveness ratios (ICERs) were calculated (3% discounting), with a willingness-to-pay threshold of €22 000. RESULTS Calibration resulted in a conservative fit of the model regarding MRI detection. Both strategies of the DENSE trial were dominated (biennial mammography; biennial mammography plus MRI). MRI alone every 4 years was cost-effective with €15 620 per QALY. Screening every 3 years with MRI alone resulted in an incremental cost-effectiveness ratio of €37 181 per QALY. All strategies with mammography and/or a 2-year interval were dominated because other strategies resulted in more additional QALYs per additional euro. Alternating mammography and MRI every 2 years was close to the efficiency frontier. CONCLUSIONS MRI screening is cost-effective for women with extremely dense breasts, when applied at a 4-year interval. For a willingness to pay more than €22 000 per QALY gained, MRI at a 3-year interval is cost-effective as well.
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Affiliation(s)
- H Amarens Geuzinge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Stéphanie V de Lange
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marleen J Emaus
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Petra K de Koekkoek-Doll
- Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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12
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Verburg E, van Gils CH, van der Velden BHM, Bakker MF, Pijnappel RM, Veldhuis WB, Gilhuijs KGA. Deep Learning for Automated Triaging of 4581 Breast MRI Examinations from the DENSE Trial. Radiology 2021; 302:29-36. [PMID: 34609196 DOI: 10.1148/radiol.2021203960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Supplemental screening with MRI has proved beneficial in women with extremely dense breasts. Most MRI examinations show normal anatomic and physiologic variation that may not require radiologic review. Thus, ways to triage these normal MRI examinations to reduce radiologist workload are needed. Purpose To determine the feasibility of an automated triaging method using deep learning (DL) to dismiss the highest number of MRI examinations without lesions while still identifying malignant disease. Materials and Methods This secondary analysis of data from the Dense Tissue and Early Breast Neoplasm Screening, or DENSE, trial evaluated breast MRI examinations from the first screening round performed in eight hospitals between December 2011 and January 2016. A DL model was developed to differentiate between breasts with lesions and breasts without lesions. The model was trained to dismiss breasts with normal phenotypical variation and to triage lesions (Breast Imaging Reporting and Data System [BI-RADS] categories 2-5) using eightfold internal-external validation. The model was trained on data from seven hospitals and tested on data from the eighth hospital, alternating such that each hospital was used once as an external test set. Performance was assessed using receiver operating characteristic analysis. At 100% sensitivity for malignant disease, the fraction of examinations dismissed from radiologic review was estimated. Results A total of 4581 MRI examinations of extremely dense breasts from 4581women (mean age, 54.3 years; interquartile range, 51.5-59.8 years) were included. Of the 9162 breasts, 838 had at least one lesion (BI-RADS category 2-5, of which 77 were malignant) and 8324 had no lesions. At 100% sensitivity for malignant lesions, the DL model considered 90.7% (95% CI: 86.7, 94.7) of the MRI examinations with lesions to be nonnormal and triaged them to radiologic review. The DL model dismissed 39.7% (95% CI: 30.0, 49.4) of the MRI examinations without lesions. The DL model had an average area under the receiver operating characteristic curve of 0.83 (95% CI: 0.80, 0.85) in the differentiation between normal breast MRI examinations and MRI examinations with lesions. Conclusion Automated analysis of breast MRI examinations in women with dense breasts dismissed nearly 40% of MRI scans without lesions while not missing any cancers. ClinicalTrials.gov: NCT01315015 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Joe in this issue.
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Affiliation(s)
- Erik Verburg
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Carla H van Gils
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Bas H M van der Velden
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Marije F Bakker
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Ruud M Pijnappel
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Wouter B Veldhuis
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Kenneth G A Gilhuijs
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
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13
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Manning M, O'Neill S, Purrington K. Physicians' perceptions of breast density notification laws and appropriate patient follow-up. Breast J 2021; 27:586-594. [PMID: 33991030 DOI: 10.1111/tbj.14240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/19/2022]
Abstract
Breast density notification laws have been adopted in the absence of consistent guidelines for post-notification follow-up. This can lead to inconsistent and potentially deficient management of women's health due to inconsistent physician practices. We examined physicians' knowledge and practices regarding follow-up for patients who receive density notifications. Physicians who referred patients to a Michigan hospital network for screening mammograms were recruited to participate in survey study; 105 (29.8%) responded. The survey assessed physicians' demographics, knowledge, and awareness of breast density and breast cancer risk and of density notification laws, and perceptions of appropriate follow-up behaviors for their patients who received density notifications. Most physicians (75%) knew about the notification law, and they were generally comfortable responding to breast density questions and deciding on follow-up. Most indicated that additional breast imaging (68.0%), followed by assessing breast cancer risk (24.7%) were appropriate follow-up responses. Physicians who performed breast cancer risk assessments, and who were more comfortable with breast density questions and follow-up decision making, were more likely to propose additional imaging. Male physicians were less likely to propose assessing breast cancer risk, and less likely to propose clinical and/or breast self-examinations. Divergence between practice and guidelines when it comes to supplemental breast cancer screening, coupled with density notification language that promotes additional screening in the absence of consistent evidence, remains concerning. Improved understanding of how density notification recipients and their physicians make decisions about supplemental screening is warranted to ensure that breast cancer risk is properly considered.
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Affiliation(s)
- Mark Manning
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Suzanne O'Neill
- Department of Oncology, Lombardi Cancer Center, Georgetown University, Washington, DC, USA
| | - Kristen Purrington
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
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14
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Yu L, Wang Y, Xing D, Gong P, Chen Q, Lv Y. Background parenchymal enhancement on contrast-enhanced spectral mammography does not represent an influencing factor for breast cancer: A preliminary study. Medicine (Baltimore) 2020; 99:e23857. [PMID: 33350778 PMCID: PMC7769306 DOI: 10.1097/md.0000000000023857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022] Open
Abstract
To compare the relationship between background parenchymal enhancement (BPE) on contrast-enhanced spectral mammography (CESM), mammographic breast density (MBD), age, in the group with benign vs malignant breast lesions.Four hundred thirty three non-high-risk patients from January 2018 to May 2019 were retrospectively analyzed. Patients were assigned into 4 groups: premenopausal benign lesions, premenopausal malignant lesions, postmenopausal benign lesions, and postmenopausal malignant lesions. The differences in CESM BPE and MBD between premenopausal benign lesions and premenopausal malignant lesions, between postmenopausal benign lesions and postmenopausal malignant lesions, between premenopausal and postmenopausal benign lesions, and between premenopausal and postmenopausal malignant lesions were evaluated. Pearson Chi-Squared test was used to analyze the differences between the above groups. Spearman rank correlation analysis was used to evaluate the correlations between BPE, MBD, and age. Multiple logistic regression was used to analyze the influencing factors of breast cancer. P < .05 was considered statistically significant.There was no significant difference in CESM BPE or MBD of benign and malignant lesions regardless of premenopausal or postmenopausal status, but there was a significant difference in CESM BPE and MBD of premenopausal and postmenopausal patients regardless of the presence of benign or malignant lesions. The intensity of CESM BPE was positively correlated with MBD, and the intensity of CESM BPE and MBD were negatively correlated with age. Multiple logistic regression analysis showed that age was an influencing factor for breast cancer in both premenopausal and postmenopausal patients.For non-high-risk women, CESM BPE and MBD were not correlated with benign or malignant breast lesions, and age was an influencing factor for breast cancer.
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Affiliation(s)
| | | | - Dong Xing
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, Shandong
| | - Peiyou Gong
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, Shandong
| | - Qianqian Chen
- GE Healthcare, Institute of Precision Medicine, Shanghai, PR China
| | - Yongbin Lv
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, Shandong
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15
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Henderson LM, Marsh MW, Earnhardt K, Pritchard M, Benefield TS, Agans R, Lee SS. Understanding the response of mammography facilities to breast density notification. Cancer 2020; 126:5230-5238. [PMID: 32926413 PMCID: PMC7944399 DOI: 10.1002/cncr.33198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND State-specific breast density notification legislation requires that women undergoing mammography be informed about breast density, with variation among states. Because mammography facilities are among the main points of contact for women undergoing mammography, research is needed to understand how facilities communicate information on breast density, cancer risk, and supplemental screening to women. METHODS A cross-sectional, 50-item, mailed survey of 156 American College of Radiology-certified mammography facilities in North Carolina was conducted in 2017 via the Tailored Design Method. Breast density notification practices, supplemental screening services, and patient educational materials were compared by supplemental screening availability via t tests and chi-square tests. RESULTS All responding facilities (n = 94; 60.3% response rate) notified women of their breast density in the mammography results letter. Breast cancer risk assessments were performed by 36.2% of the facilities, with risk information communicated in the final radiology report for the referring provider to discuss with the woman (79.4%) or in the results letter (58.8%). Supplemental breast cancer screening was offered by 63.8% of the facilities, with use based on multiple factors, including recommendations from the referring physician (63.3%) or reading radiologist (63.3%), breast density (48.3%), other risk factors (48.3%), and patient request (40.0%). Although 75.0% of the facilities offered breast density educational materials, only 36.6% offered educational materials on supplemental screening. CONCLUSIONS In a state with a breast density notification law, mammography facilities communicate breast density, cancer risk, and supplemental screening information to women through various approaches. When supplemental screening is offered, facilities use multiple decision-making criteria rather than breast density alone.
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Affiliation(s)
| | - Mary W. Marsh
- Radiology Department, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Robert Agans
- Biostatistics Department, University of North Carolina, Chapel Hill, NC
| | - Sheila S. Lee
- Radiology Department, University of North Carolina, Chapel Hill, NC
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16
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Azzam H, Kamal RM, Hanafy MM, Youssef A, Hashem LMB. Comparative study between contrast-enhanced mammography, tomosynthesis, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00268-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
Mammography is accused of having low sensitivity and specificity in dense breast parenchyma. Also, women with dense breasts show an increased risk of developing breast cancer. Breast ultrasound has been used for several years for a better characterization of breast lesions. Contrast-enhanced mammography and tomosynthesis are relative novel imaging techniques that have been implicated in breast cancer detection and diagnosis. We aimed to compare breast tomosynthesis, contrast-enhanced mammography, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma.
Results
The study included 37 patients with 63 inconclusive mammography breast lesions. They all performed contrast-enhanced mammography, single-view tomosynthesis, and breast ultrasound. Mammography had a sensitivity of 83%, a specificity of 48%, a positive predictive value of 68%, a negative predictive value of 68%, and a diagnostic accuracy of 68%. Contrast-enhanced mammography had a sensitivity of 89%, a specificity of 89%, a positive predictive value of 91%, a negative predictive value of 86%, and a diagnostic accuracy of 89%. Tomosynthesis had a sensitivity of 86%, a specificity of 81%, a positive predictive value of 86%, a negative predictive value of 81%, and a diagnostic accuracy of 84%. Breast ultrasound had a sensitivity of 97%, a specificity of 85%, a positive predictive value of 90%, a negative predictive value of 96%, and a diagnostic accuracy of 92%.
Conclusion
Breast ultrasound, tomosynthesis, and contrast-enhanced mammography showed better performance compared to mammography in dense breasts. However, ultrasound being safe with no radiation hazards should be the second step modality of choice after mammography in the assessment of mammography dense breasts. Adding tomosynthesis to mammography in screening increases its sensitivity. Contrast-enhanced mammography should be reserved for cases with inconclusive sonomammographic results.
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17
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Kim J, Kim HJ, Kim C, Kim WH. Artificial intelligence in breast ultrasonography. Ultrasonography 2020; 40:183-190. [PMID: 33430577 PMCID: PMC7994743 DOI: 10.14366/usg.20117] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
Although breast ultrasonography is the mainstay modality for differentiating between benign and malignant breast masses, it has intrinsic problems with false positives and substantial interobserver variability. Artificial intelligence (AI), particularly with deep learning models, is expected to improve workflow efficiency and serve as a second opinion. AI is highly useful for performing three main clinical tasks in breast ultrasonography: detection (localization/segmentation), differential diagnosis (classification), and prognostication (prediction). This article provides a current overview of AI applications in breast ultrasonography, with a discussion of methodological considerations in the development of AI models and an up-to-date literature review of potential clinical applications.
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Affiliation(s)
- Jaeil Kim
- School of Computer Science and Engineering, Kyungpook National University, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Chanho Kim
- School of Computer Science and Engineering, Kyungpook National University, Daegu, Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
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18
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Gunn C, Maschke A, Bickmore T, Kennedy M, Hopkins MF, Fishman MDC, Paasche-Orlow MK, Warner ET. Acceptability of an Interactive Computer-Animated Agent to Promote Patient-Provider Communication About Breast Density: a Mixed Method Pilot Study. J Gen Intern Med 2020; 35:1069-1077. [PMID: 31919723 PMCID: PMC7174461 DOI: 10.1007/s11606-019-05622-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/13/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Half of women undergoing mammography have dense breasts. Mandatory dense breast notification and educational materials have been shown to confuse women, rather than empower them. OBJECTIVE This study used a mixed method, multi-stakeholder approach to assess acceptability of an interactive, computer-animated agent that provided breast density information to women and changes in knowledge, satisfaction, and informational needs. DESIGN A pre-post survey and qualitative focus groups assessed the acceptability of the computer-animated agent among women. An anonymous, online survey measuring acceptability was delivered to a multi-stakeholder group. PARTICIPANTS English-speaking, mammography-eligible women ages 40-74 were invited and 44 women participated in one of nine focus groups. In addition, 14 stakeholders representing primary care, radiology, patient advocates, public health practitioners, and researchers completed the online survey. INTERVENTIONS A prototype of a computer-animated agent was delivered to women in a group setting; stakeholders viewed the prototype independently. MAIN MEASURES Data collected included open-ended qualitative questions that guided discussion about the content and form of the computer-animated agent. Structured surveys included domains related to knowledge, acceptability, and satisfaction. Stakeholder acceptability was measured with a series of statements about aspects of the intervention and delivery approach and are reported as the proportion of respondents who endorsed each statement. KEY RESULTS Six of 12 knowledge items demonstrated improvement post-intervention, satisfaction with the agent was high (81%), but the number of unanswered questions did not improve (67% vs. 54%, p = 0.37). Understanding of the distinction between connective and fatty tissue in the breast did not increase (30% vs. 26%, p = 0.48). Results of the multi-stakeholder survey suggest broad acceptability of the approach and agent. CONCLUSIONS Findings highlight the benefits of a brief interactive educational exposure as well as misperceptions that persisted. Results demonstrate the need for an evidence-based, accessible intervention that is easy to understand for patients.
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Affiliation(s)
- Christine Gunn
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA, 02118, USA.
| | - Ariel Maschke
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA, 02118, USA
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, USA
| | | | | | - Michael D C Fishman
- Department of Radiology, Boston Medical Center, Section of Breast Imaging, Boston University School of Medicine, Boston, USA
| | - Michael K Paasche-Orlow
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Erica T Warner
- Department of Medicine, Massachusetts General Hospital, Boston, USA
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Nguyen DL, Ambinder EB, Jones MK, Mullen LA, Harvey SC. Improving State-Mandated Breast Density Notifications. J Am Coll Radiol 2020; 17:384-390. [DOI: 10.1016/j.jacr.2019.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/13/2019] [Accepted: 08/25/2019] [Indexed: 10/26/2022]
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20
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Ko ES, Morris EA. Abbreviated Magnetic Resonance Imaging for Breast Cancer Screening: Concept, Early Results, and Considerations. Korean J Radiol 2020; 20:533-541. [PMID: 30887736 PMCID: PMC6424827 DOI: 10.3348/kjr.2018.0722] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/27/2018] [Indexed: 12/29/2022] Open
Abstract
Breast magnetic resonance imaging (MRI) has been increasingly utilized, especially in screening for high-risk cases, because of its high sensitivity and superior ability to detect cancers as compared with mammography and ultrasound. Several limitations such as higher cost, longer examination time, longer interpretation time, and low availability have hindered the wider application of MRI, especially for screening of average-risk women. To overcome some of these limitations and increase access to MRI screening, an abbreviated breast MRI protocol has been introduced. Abbreviated breast MRI is becoming popular and challenges the status quo. This review aims to present an overview of abbreviated MRI, discuss the current findings, and introduce ongoing prospective trials.
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Affiliation(s)
- Eun Sook Ko
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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21
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Verburg E, Wolterink JM, Waard SN, Išgum I, Gils CH, Veldhuis WB, Gilhuijs KGA. Knowledge‐based and deep learning‐based automated chest wall segmentation in magnetic resonance images of extremely dense breasts. Med Phys 2019; 46:4405-4416. [DOI: 10.1002/mp.13699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Erik Verburg
- Image Sciences Institute University Medical Center Utrecht, Utrecht University Utrecht 3584 CX the Netherlands
| | - Jelmer M. Wolterink
- Image Sciences Institute University Medical Center Utrecht, Utrecht University Utrecht 3584 CX the Netherlands
| | - Stephanie N. Waard
- Department of Radiology University Medical Center Utrecht, Utrecht University Utrecht 3584 CX the Netherlands
| | - Ivana Išgum
- Image Sciences Institute University Medical Center Utrecht, Utrecht University Utrecht 3584 CX the Netherlands
| | - Carla H. Gils
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht University Utrecht 3584 CX the Netherlands
| | - Wouter B. Veldhuis
- Department of Radiology University Medical Center Utrecht, Utrecht University Utrecht 3584 CX the Netherlands
| | - Kenneth G. A. Gilhuijs
- Image Sciences Institute University Medical Center Utrecht, Utrecht University Utrecht 3584 CX the Netherlands
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22
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Li J, Mo Y, He B, Gao Q, Luo C, Peng C, Zhao W, Ma Y, Yang Y. Association between MRI background parenchymal enhancement and lymphovascular invasion and estrogen receptor status in invasive breast cancer. Br J Radiol 2019; 92:20190417. [PMID: 31398071 PMCID: PMC6849688 DOI: 10.1259/bjr.20190417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: In magnetic resonance imaging (MRI), background parenchymal enhancement (BPE) is associated with breast cancer risk, but the associations between BPE and clinical characteristics and histological features are unknown. This study aimed to investigate the association between BPE and clinical characteristics (including age, menopausal status, and tumor histological characteristics) in patients with invasive breast cancer. Methods: This was a retrospective study of 163 patients with invasive breast cancer (164 lesions, 1 patient had bilateral cancer) confirmed by surgery and pathological examination, treated between January 2014 and December 2016 at our university (Kunming Medical University). The patients were divided into two groups: extremely minimal and mild enhancement (low BPE group, n = 78) vs moderate and marked enhancement (high BPE group, n = 86). Results: Compared with the low BPE group, the high BPE group showed higher frequencies of patients < 50 years of age (88% vs 38%, p < 0.0001), premenopausal (87% vs 29%, p < 0.0001), T1 staging (35% vs 15%, p = 0.027), Grade II (57% vs 37%, p = 0.03), lymphovascular invasion (83% vs 13%, p < 0.0001), and positive estrogen receptor (ER) (79% vs 42%, p < 0.0001). The Spearman correlation coefficients (r) between BPE and age, menopausal status, lymphovascular invasion, and ER status were −0.521 (p < 0.0001), –0.588 (p < 0.0001), 0.697 (p < 0.0001), and 0.377 (p < 0.0001), respectively. Conclusion: BPE is negatively associated with age and menopausal status, and is positively associated with lymphovascular invasion and positive ER status. Advances in knowledge: BPE is not correlated with T staging and histological classification in patients with invasive breast cancer.
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Affiliation(s)
- Jun Li
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Yin Mo
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Bo He
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Qian Gao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Chunyan Luo
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Chao Peng
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Wei Zhao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Yun Ma
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Ying Yang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
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23
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Petersen SS, Sarkissyan M, Wu Y, Clayton S, Vadgama JV. Time to Clinical Follow-up after Abnormal Mammogram among African American and Hispanic Women. J Health Care Poor Underserved 2019; 29:448-462. [PMID: 29503311 DOI: 10.1353/hpu.2018.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Time to clinical follow-up after an abnormal mammogram may be a significant factor contributing to breast cancer health disparities. OBJECTIVE Evaluate time to follow-up in a cross-sectional cohort of African American and Hispanic women who obtained mammogram screening at a county facility. METHODS Time to follow-up was assessed in days after an abnormal mammogram to subsequent clinical care in a cross-sectional study of 74 women. RESULTS The median number of days until clinical follow-up after an abnormal mammogram for women in the study was 30 days (Range: 0-357 days). There was a statistically significant difference in the time-to-biopsy among women who had incomplete mammograms and women who had comorbid conditions. CONCLUSIONS This data indicates that county services provide clinical follow-up in compliance with recommended guidelines of 30 days. However, women with incomplete mammograms and comorbid conditions may be at a higher risk of experiencing delays in diagnosis and treatment.
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24
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Gunn CM, Fitzpatrick A, Waugh S, Carrera M, Kressin NR, Paasche-Orlow MK, Battaglia TA. A Qualitative Study of Spanish-Speakers' Experience with Dense Breast Notifications in a Massachusetts Safety-Net Hospital. J Gen Intern Med 2019; 34:198-205. [PMID: 30350031 PMCID: PMC6374252 DOI: 10.1007/s11606-018-4709-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/04/2018] [Accepted: 10/01/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Legislation requiring mammography facilities to notify women if they have dense breast tissue found on mammography has been enacted in 34 US states. The impact of dense breast notifications (DBNs) on women with limited English proficiency (LEP) is unknown. OBJECTIVE This study sought to understand Spanish-speaking women's experience receiving DBNs in a Massachusetts safety-net hospital. DESIGN Eligible women completed one audio-recorded, semi-structured interview via telephone with a native Spanish-speaking research assistant trained in qualitative methods. Interviews were professionally transcribed verbatim and translated. The translation was verified by a third reviewer to ensure fidelity with audio recordings. PARTICIPANTS Nineteen Spanish-speaking women ages 40-74 who received mammography with a normal result and recalled receiving a DBN. APPROACH Using the verified English transcripts, we conducted a content analysis to identify women's perceptions and actions related to receiving the notification. A structured codebook was developed. Transcripts were independently coded and assessed for agreement with a modification of Cohen's kappa. Content codes were grouped to build themes related to women's perceptions and actions after receiving a DBN. KEY RESULTS Nineteen Spanish-speaking women completed interviews. Nine reported not receiving the notification in their native language. Four key themes emerged: (1) The novelty of breast density contributed to notification-induced confusion; (2) women misinterpreted key messages in the notification; (3) varied actions were taken to seek further information; and (4) women held unrealized expectations and preferences for follow-up. CONCLUSIONS Not having previous knowledge of breast density and receiving notifications in English contributed to confusion about its meaning and inaccurate interpretations of key messages by Spanish speakers. Tools that promote understanding should be leveraged in seeking equity in risk-based breast cancer screening for women with dense breasts.
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Affiliation(s)
- Christine M Gunn
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA. .,Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA.
| | - Amy Fitzpatrick
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| | - Sarah Waugh
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| | - Michelle Carrera
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| | - Nancy R Kressin
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.,Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
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25
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Wengert GJ, Helbich TH, Leithner D, Morris EA, Baltzer PAT, Pinker K. Multimodality Imaging of Breast Parenchymal Density and Correlation with Risk Assessment. CURRENT BREAST CANCER REPORTS 2019; 11:23-33. [PMID: 35496471 PMCID: PMC9044508 DOI: 10.1007/s12609-019-0302-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose of Review Breast density, or the amount of fibroglandular tissue in the breast, has become a recognized and independent marker for breast cancer risk. Public awareness of breast density as a possible risk factor for breast cancer has resulted in legislation for risk stratification purposes in many US states. This review will provide a comprehensive overview of the currently available imaging modalities for qualitative and quantitative breast density assessment and the current evidence on breast density and breast cancer risk assessment. Recent Findings To date, breast density assessment is mainly performed with mammography and to some extent with magnetic resonance imaging. Data indicate that computerized, quantitative techniques in comparison with subjective visual estimations are characterized by higher reproducibility and robustness. Summary Breast density reduces the sensitivity of mammography due to a masking effect and is also a recognized independent risk factor for breast cancer. Standardized breast density assessment using automated volumetric quantitative methods has the potential to be used for risk prediction and stratification and in determining the best screening plan for each woman.
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Ram S, Sarma N, López JE, Liu Y, Li CS, Aminololama-Shakeri S. Impact of the California Breast Density Law on Screening Breast MR Utilization, Provider Ordering Practices, and Patient Demographics. J Am Coll Radiol 2019; 15:594-600. [PMID: 29622173 DOI: 10.1016/j.jacr.2017.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/27/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the impact of California's Breast Density Law (BDL) on MRI utilization and clinician ordering practices. MATERIALS AND METHODS Our institutional review board approved this study that retrospectively compared the ordering pattern for screening breast MRI examinations in the 30-month period before and after the BDL was enacted. Examinations were subcategorized into those with breast density mentioned as an examination indication. Patients were classified into (1) high risk; (2) above average risk, defined but not quantified; and (3) undefined or average risk. χ2 test or Fisher's exact test was used to compare MRI utilization, use of breast density as an indication, patient demographics, and provider characteristics. RESULTS Screening MRI examinations with breast density as the indication increased from 8.5% (32 of 376) to 21.1% (136 of 646, P < .0001) after BDL. When high-risk patients were excluded, the increase was from 8% to 17.2% (P < .0001). Patient demographics before and after BDL were, by race: white 71.8% versus 71.2%; Asian 6.4% versus 10.5%; black 3.7% versus 3.1%; American Indian 0.3% versus 1.4%; Native Hawaiian or Pacific Islander 1.6% versus 1.7%; by ethnicity: Hispanic or Latino 10.6% versus 7.9%. Before and after BDL, predominantly female providers (81.4% and 77.4%, P = not significant [NS]) and specialists (62.5% and 63.5%, P = NS) ordered the majority of breast MRI examinations compared with males (18.6% and 22.6%, P = NS). CONCLUSION Screening breast MRI utilization for non-high-risk women more than doubled after the California BDL went into effect. BDL has had an impact on MRI utilization, and its clinical value for changing outcomes deserves further study.
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Affiliation(s)
- Shruthi Ram
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - Nandini Sarma
- University of California Davis School of Medicine, Sacramento, California
| | - Javier E López
- Internal Medicine Department, Cardiovascular Division, University of California Davis Medical Center, Davis, California
| | - Yu Liu
- Department of Statistics, University of California, Davis, California
| | - Chin-Shang Li
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, California
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Wengert GJ, Helbich TH, Kapetas P, Baltzer PA, Pinker K. Density and tailored breast cancer screening: practice and prediction - an overview. Acta Radiol Open 2018; 7:2058460118791212. [PMID: 30245850 PMCID: PMC6144518 DOI: 10.1177/2058460118791212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/27/2018] [Indexed: 01/13/2023] Open
Abstract
Mammography, as the primary screening modality, has facilitated a substantial
decrease in breast cancer-related mortality in the general population. However,
the sensitivity of mammography for breast cancer detection is decreased in women
with higher breast densities, which is an independent risk factor for breast
cancer. With increasing public awareness of the implications of a high breast
density, there is an increasing demand for supplemental screening in these
patients. Yet, improvements in breast cancer detection with supplemental
screening methods come at the expense of increased false-positives, recall
rates, patient anxiety, and costs. Therefore, breast cancer screening practice
must change from a general one-size-fits-all approach to a more personalized,
risk-based one that is tailored to the individual woman’s risk, personal
beliefs, and preferences, while accounting for cost, potential harm, and
benefits. This overview will provide an overview of the available breast density assessment
modalities, the current breast density screening recommendations for women at
average risk of breast cancer, and supplemental methods for breast cancer
screening. In addition, we will provide a look at the possibilities for a
risk-adapted breast cancer screening.
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Affiliation(s)
- Georg J Wengert
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Pascal At Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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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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Gunn CM, Battaglia TA, Paasche-Orlow MK, West AK, Kressin NR. Women's perceptions of dense breast notifications in a Massachusetts safety net hospital: "So what is that supposed to mean?". PATIENT EDUCATION AND COUNSELING 2018; 101:1123-1129. [PMID: 29426765 DOI: 10.1016/j.pec.2018.01.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Currently, 30 US states mandate that radiologists notify women when dense breast tissue is found on mammography. Little is understood about how notifications are perceived by recipients. This qualitative study sought to understand how dense breast notifications (DBNs) impact women's perceptions and their participation in follow-up care. METHODS We assessed rates of DBN recall and conducted semi-structured telephone interviews with 30 English-speaking women ages 40 to 74 after receiving a DBN from a Massachusetts hospital. Content coding characterized women's recall of the notification content, perceptions of breast density, and planned or actual participation in follow-up care. RESULTS Most women (81%) recalled receiving a DBN, but few could recall specific content. Women described struggling to understand the meaning of breast density and created their own explanatory models of dense breasts that differed from medical explanations. Many women planned to or did talk with their doctors about breast density as a result of receiving the notification. CONCLUSIONS Women receiving DBNs have limited knowledge and many misperceptions about the implications of having dense breasts. PRACTICE IMPLICATIONS Educational support is needed to promote informed decision- making about breast cancer screening that incorporates personal risk in the setting of dense breast legislation.
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Affiliation(s)
- Christine M Gunn
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA; Boston Medical Center, Boston, MA, USA
| | - Amanda K West
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Nancy R Kressin
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Jamaica Plain, MA, USA
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Gunn CM, Kressin NR, Cooper K, Marturano C, Freund KM, Battaglia TA. Primary Care Provider Experience with Breast Density Legislation in Massachusetts. J Womens Health (Larchmt) 2018; 27:615-622. [PMID: 29338539 DOI: 10.1089/jwh.2017.6539] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Dense breasts on mammography independently increases breast cancer risk and decreases mammography sensitivity. Thirty-two states have adopted notification laws to raise awareness among women with dense breasts about supplemental screening. Little is known about these policies' impact on clinical practice among primary care providers (PCPs). MATERIALS AND METHODS This study explores PCP attitudes, knowledge, and the impact of the Massachusetts dense breast notification legislation on clinical practice after its enactment in 2015. An anonymous, online survey at two urban safety-net hospitals was administered in 2015-2016. Practicing MDs and nurse practitioners in primary care were invited to participate. RESULTS All 145 PCPs in general internal medicine at the two sites were e-mailed a survey link and 80 (55%) were completed. While 64 of 80 PCPs surveyed (80%) had some familiarity with the legislation, none identified the 8 required components of notifications contained in the Massachusetts legislation. Forty-nine percent (39/80) did not feel prepared to respond to patient questions about dense breasts. Forty-one percent (33/80) correctly identified that no current guidelines recommend the use of supplemental screening tests solely based on breast density and 85% (68/80) indicated interest in further training. Female and less experienced providers were more likely to be in favor of the legislation (49% vs. 11% by gender; 76% <5 years vs. 9%> 20 years). Women practitioners (55%) who were more likely than men (17%, p = 0.01) to agree with the policy changed their discussions of mammography results with patients. CONCLUSIONS PCPs feel underprepared to counsel women about breast density identified on mammography and its implications.
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Affiliation(s)
- Christine M Gunn
- 1 Women's Health Unit, Evans Department of Medicine, Section of General Internal Medicine, Boston Medical Center , Boston, Massachusetts.,2 Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, Massachusetts
| | - Nancy R Kressin
- 1 Women's Health Unit, Evans Department of Medicine, Section of General Internal Medicine, Boston Medical Center , Boston, Massachusetts.,3 Boston University School of Medicine , Evans Department of Medicine, Section of General Internal Medicine Boston, MA
| | - Kristina Cooper
- 1 Women's Health Unit, Evans Department of Medicine, Section of General Internal Medicine, Boston Medical Center , Boston, Massachusetts
| | - Cinthya Marturano
- 4 Division of Internal Medicine and Primary Care, Tufts Medical Center , Boston, Massachusetts
| | - Karen M Freund
- 4 Division of Internal Medicine and Primary Care, Tufts Medical Center , Boston, Massachusetts.,5 Institute for Clinical Research and Health Policy Studies , Tufts Medical Center, Boston, Massachusetts
| | - Tracy A Battaglia
- 1 Women's Health Unit, Evans Department of Medicine, Section of General Internal Medicine, Boston Medical Center , Boston, Massachusetts.,3 Boston University School of Medicine , Evans Department of Medicine, Section of General Internal Medicine Boston, MA
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Dillon CR, Farrer A, McLean H, Almquist S, Christensen D, Payne A. Experimental assessment of phase aberration correction for breast MRgFUS therapy. Int J Hyperthermia 2017; 34:731-743. [PMID: 29278946 DOI: 10.1080/02656736.2017.1422029] [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: 01/13/2023] Open
Abstract
PURPOSE This study validates that phase aberrations in breast magnetic resonance-guided focussed ultrasound (MRgFUS) therapies can be corrected in a clinically relevant time frame to generate more intense, smaller and more spatially accurate foci. MATERIALS AND METHODS Hybrid angular spectrum (HAS) ultrasound calculations in an magnetic resonance imaging (MRI)-based tissue model, were used to compute phase aberration corrections for improved experimental MRgFUS heating in four heterogeneous breast-mimicking phantoms (n = 18 total locations). Magnetic resonance(MR) temperature imaging was used to evaluate the maximum temperature rise, focus volume and focus accuracy for uncorrected and phase aberration-corrected sonications. Thermal simulations assessed the effectiveness of the phase aberration correction implementation. RESULTS In 13 of 18 locations, the maximum temperature rise increased by an average of 30%, focus volume was reduced by 40% and focus accuracy improved from 4.6 to 3.6 mm. Mixed results were observed in five of the 18 locations, with focus accuracy improving from 6.1 to 2.5 mm and the maximum temperature rise decreasing by 8% and focus volume increasing by 10%. Overall, the study demonstrated significant improvements (p < 0.005) in maximum temperature rise, focus volume and focus accuracy. Simulations predicted greater improvements than observed experimentally, suggesting potential for improvement in implementing the technique. The complete phase aberration correction procedure, including model generation, segmentation and phase aberration computations, required less than 45 min per sonication location. CONCLUSION The significant improvements demonstrated in this study i.e., focus intensity, size and accuracy from phase aberration correction have the potential to improve the efficacy, time-efficiency and safety of breast MRgFUS therapies.
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Affiliation(s)
- Christopher R Dillon
- a Department of Radiology and Imaging Sciences , University of Utah , Salt Lake City , UT , USA
| | - Alexis Farrer
- b Department of Bioengineering , University of Utah , Salt Lake City , UT , USA
| | - Hailey McLean
- a Department of Radiology and Imaging Sciences , University of Utah , Salt Lake City , UT , USA
| | - Scott Almquist
- c School of Computing , University of Utah , Salt Lake City , UT , USA
| | - Douglas Christensen
- b Department of Bioengineering , University of Utah , Salt Lake City , UT , USA.,d Department of Electrical and Computer Engineering , University of Utah , Salt Lake City , UT , USA
| | - Allison Payne
- a Department of Radiology and Imaging Sciences , University of Utah , Salt Lake City , UT , USA
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Krishnan K, Baglietto L, Stone J, McLean C, Southey MC, English DR, Giles GG, Hopper JL. Mammographic density and risk of breast cancer by tumor characteristics: a case-control study. BMC Cancer 2017; 17:859. [PMID: 29246131 PMCID: PMC5732428 DOI: 10.1186/s12885-017-3871-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/04/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In a previous paper, we had assumed that the risk of screen-detected breast cancer mostly reflects inherent risk, and the risk of whether a breast cancer is interval versus screen-detected mostly reflects risk of masking. We found that inherent risk was predicted by body mass index (BMI) and dense area (DA) or percent dense area (PDA), but not by non-dense area (NDA). Masking, however, was best predicted by PDA but not BMI. In this study, we aimed to investigate if these associations vary by tumor characteristics and mode of detection. METHODS We conducted a case-control study nested within the Melbourne Collaborative Cohort Study of 244 screen-detected cases matched to 700 controls and 148 interval cases matched to 446 controls. DA, NDA and PDA were measured using the Cumulus software. Tumor characteristics included size, grade, lymph node involvement, and ER, PR, and HER2 status. Conditional and unconditional logistic regression were applied as appropriate to estimate the Odds per Adjusted Standard Deviation (OPERA) adjusted for age and BMI, allowing the association with BMI to be a function of age at diagnosis. RESULTS For screen-detected cancer, both DA and PDA were associated to an increased risk of tumors of large size (OPERA ~ 1.6) and positive lymph node involvement (OPERA ~ 1.8); no association was observed for BMI and NDA. For risk of interval versus screen-detected breast cancer, the association with risk for any of the three mammographic measures did not vary by tumor characteristics; an association was observed for BMI for positive lymph nodes (OPERA ~ 0.6). No associations were observed for tumor grade and ER, PR and HER2 status of tumor. CONCLUSIONS Both DA and PDA were predictors of inherent risk of larger breast tumors and positive nodal status, whereas for each of the three mammographic density measures the association with risk of masking did not vary by tumor characteristics. This might raise the hypothesis that the risk of breast tumours with poorer prognosis, such as larger and node positive tumours, is intrinsically associated with increased mammographic density and not through delay of diagnosis due to masking.
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Affiliation(s)
- Kavitha Krishnan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC 3053 Australia
| | - Laura Baglietto
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC 3053 Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Gustave Roussy, F-94805 Villejuif, France
| | - Jennifer Stone
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC 3053 Australia
- Centre for Genetic Origins of Health and Disease, University of Western Australia, Perth, Australia
| | | | - Melissa C. Southey
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Dallas R. English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC 3053 Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - Graham G. Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC 3053 Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC 3053 Australia
- Seoul Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
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Casas RS, Ramachandran A, Gunn CM, Weinberg JM, Shaffer K. Explaining Breast Density Recommendations: An Introductory Workshop for Breast Health Providers. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10654. [PMID: 30800855 PMCID: PMC6338146 DOI: 10.15766/mep_2374-8265.10654] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/01/2017] [Indexed: 05/22/2023]
Abstract
Introduction High breast density is an independent risk factor for breast cancer and can decrease the sensitivity of mammography. However, evidence surrounding recommendations for patient risk stratification and supplemental screening is evolving, and providers receive limited training on breast density counseling. Methods We implemented an introductory, interactive workshop about breast density including current evidence behind supplemental screening and risk stratification. Designed for providers who counsel women on breast health, this workshop was evaluated with internal medicine providers, primary care residents, and radiology residents. We surveyed participants about knowledge and attitudes at baseline, postintervention (residents and providers), and 3-month follow-up (providers only). We compared baseline and postintervention scores and postintervention and 3-month follow-up scores using paired t tests and McNemar's tests. Results Internal medicine providers had significant gains in knowledge when comparing baseline to postintervention surveys (6.5-8.5 on a 10-point scale, p < .0001), with knowledge gains maintained when comparing postintervention to 3-month follow-up surveys (p = .06). Primary care and radiology residents also had significant gains in knowledge when comparing baseline to postintervention surveys (p < .004 for both). All learner groups reported increases in their confidence regarding counseling women about breast density and referring for supplemental screening. Discussion Through this breast density session, we showed trends for increased knowledge and change in attitudes for multiple learner groups. Because we aim to prepare providers with the best currently available recommendations, these materials will require frequent updating as breast density evidence and national consensus evolve.
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Affiliation(s)
- Rachel S. Casas
- Assistant Professor, Department of Medicine, Pennsylvania State University College of Medicine
| | - Ambili Ramachandran
- Assistant Professor, Department of Medicine, University of Texas Health San Antonio
| | - Christine M. Gunn
- Assistant Professor, Department of Public Health, Boston University
- Assistant Professor, Evans Department of Medicine, Boston University School of Medicine
| | - Janice M. Weinberg
- Professor, Department of Biostatistics, Boston University School of Public Health
| | - Kitt Shaffer
- Professor, Department of Radiology, Boston University School of Medicine
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Supplemental Screening With Automated Breast Ultrasound in Women With Dense Breasts: Comparing Notification Methods and Screening Behaviors. AJR Am J Roentgenol 2017; 210:W22-W28. [PMID: 29045183 DOI: 10.2214/ajr.17.18158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Supplemental screening with ultrasound has been shown to detect additional breast malignancies in women with dense breast tissue and normal mammogram findings. The frequency of supplemental screening with automated breast ultrasound and the effect and type of breast tissue density notification on automated screening breast ultrasound utilization rates are unknown. MATERIALS AND METHODS We examined normal mammogram results letters for patients with heterogeneously or extremely dense breast tissue between July 1, 2013, and June 30, 2014, by type of results letter, notification method, and sociodemographic characteristics. Logistic regression was used to examine the association between type of results letter and subsequent automated screening breast ultrasound. RESULTS Among 3012 women with dense breast tissue and normal mammogram findings, 15% returned for supplemental automated screening breast ultrasound within 18 months of results letter notification. Compared with a similarly sized control group of women who did not undergo automated ultrasound, a significantly greater proportion of patients (86.9%) returned for breast ultrasound if they received a results letter indicating breast density in combination with a courtesy phone call (p < 0.001). Patients who received results letters with breast density notification including a statement that they may benefit from additional screening with automated breast ultrasound examination were 9.91 times (95% CI, 6.08-16.16) more likely to return for the examination than patients who did not receive breast density notification or mention of supplemental screening. CONCLUSION Patient breast density notification and radiologists' recommendations for supplemental screening with breast ultrasound increase patient utilization of automated screening breast ultrasound examinations.
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Woodard GA, Ray KM, Joe BN, Price ER. Qualitative Radiogenomics: Association between Oncotype DX Test Recurrence Score and BI-RADS Mammographic and Breast MR Imaging Features. Radiology 2017; 286:60-70. [PMID: 28885890 DOI: 10.1148/radiol.2017162333] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the association between Breast Imaging Reporting and Data System (BI-RADS) mammographic and magnetic resonance (MR) imaging features and breast cancer recurrence risk in patients with estrogen receptor-positive breast cancer who underwent the Oncotype DX assay. Materials and Methods In this institutional review board-approved and HIPAA-compliant protocol, 408 patients diagnosed with invasive breast cancer between 2004 and 2013 who underwent the Oncotype DX assay were identified. Mammographic and MR imaging features were retrospectively collected according to the BI-RADS lexicon. Linear regression assessed the association between imaging features and Oncotype DX test recurrence score (ODxRS), and post hoc pairwise comparisons assessed ODxRS means by using imaging features. Results Mammographic breast density was inversely associated with ODxRS (P ≤ .05). Average ODxRS for density category A was 24.4 and that for density category D was 16.5 (P < .02). Both indistinct mass margins and fine linear branching calcifications at mammography were significantly associated with higher ODxRS (P < .01 and P < .03, respectively). Masses with indistinct margins had an average ODxRS of 31.3, which significantly differed from the ODxRS of 18.5 for all other mass margins (P < .01). The average ODxRS for fine linear branching calcifications was 29.6, whereas the ODxRS for all other suspicious calcification morphologies was 19.4 (P < .03). Average ODxRS was significantly higher for irregular mass margins at MR imaging compared with spiculated mass margins (24.0 vs 17.6; P < .02). The presence of nonmass enhancement at MR imaging was associated with lower ODxRS than was its absence (16.4 vs 19.9; P < .05). Conclusion The BI-RADS features of mammographic breast density, calcification morphology, mass margins at mammography and MR imaging, and nonmass enhancement at MR imaging have the potential to serve as imaging biomarkers of breast cancer recurrence risk. Further prospective studies involving larger patient cohorts are needed to validate these preliminary findings. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Genevieve A Woodard
- From the Department of Radiology and Biomedical Imaging, Division of Breast Imaging, University of California, San Francisco, 1600 Divisadero St, Room C250, San Francisco, CA 94115 (G.A.W., K.M.R., B.N.J, E.R.P.)
| | - Kimberly M Ray
- From the Department of Radiology and Biomedical Imaging, Division of Breast Imaging, University of California, San Francisco, 1600 Divisadero St, Room C250, San Francisco, CA 94115 (G.A.W., K.M.R., B.N.J, E.R.P.)
| | - Bonnie N Joe
- From the Department of Radiology and Biomedical Imaging, Division of Breast Imaging, University of California, San Francisco, 1600 Divisadero St, Room C250, San Francisco, CA 94115 (G.A.W., K.M.R., B.N.J, E.R.P.)
| | - Elissa R Price
- From the Department of Radiology and Biomedical Imaging, Division of Breast Imaging, University of California, San Francisco, 1600 Divisadero St, Room C250, San Francisco, CA 94115 (G.A.W., K.M.R., B.N.J, E.R.P.)
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Falcon S, Williams A, Weinfurtner J, Drukteinis JS. Imaging Management of Breast Density, a Controversial Risk Factor for Breast Cancer. Cancer Control 2017; 24:125-136. [PMID: 28441367 DOI: 10.1177/107327481702400205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Breast density is well recognized as an independent risk factor for the development of breast cancer. However, the magnitude of risk is controversial. As the public becomes increasingly aware of breast density as a risk factor, legislation and notification laws in relation to breast density have become common throughout the United States. Awareness of breast density as a risk factor for breast cancer presents new challenges for the clinician in the approach to the management and screening of women with dense breasts. METHODS The evidence and controversy surrounding breast density as a risk factor for the development of breast cancer are discussed. Common supplemental screening modalities for breast cancer are also discussed, including tomosynthesis, ultrasonography, and magnetic resonance imaging. A management strategy for screening women with dense breasts is also presented. RESULTS The American College of Radiology recognizes breast density as a controversial risk factor for breast cancer, whereas the American Congress of Obstetricians and Gynecologists recognizes breast density as a modest risk factor. Neither organization recommends the routine use of supplemental screening in women with dense breasts without considering additional patient-related risk factors. CONCLUSIONS Breast density is a poorly understood and controversial risk factor for the development of breast cancer. Mammography is a screening modality proven to reduce breast cancer-related mortality rates and is the single most appropriate tool for population-based screening. Use of supplemental screening modalities should be tailored to individual risk assessment.
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Affiliation(s)
- Shannon Falcon
- Department of Radiology, Moffitt Cancer Center, Tampa, FL.
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Timmermans L, Bleyen L, Bacher K, Van Herck K, Lemmens K, Van Ongeval C, Van Steen A, Martens P, De Brabander I, Goossens M, Thierens H. Screen-detected versus interval cancers: Effect of imaging modality and breast density in the Flemish Breast Cancer Screening Programme. Eur Radiol 2017; 27:3810-3819. [PMID: 28289944 DOI: 10.1007/s00330-017-4757-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/22/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate if direct radiography (DR) performs better than screen-film mammography (SF) and computed radiography (CR) in dense breasts in a decentralized organised Breast Cancer Screening Programme. To this end, screen-detected versus interval cancers were studied in different BI-RADS density classes for these imaging modalities. METHODS The study cohort consisted of 351,532 women who participated in the Flemish Breast Cancer Screening Programme in 2009 and 2010. Information on screen-detected and interval cancers, breast density scores of radiologist second readers, and imaging modality was obtained by linkage of the databases of the Centre of Cancer Detection and the Belgian Cancer Registry. RESULTS Overall, 67% of occurring breast cancers are screen detected and 33% are interval cancers, with DR performing better than SF and CR. The interval cancer rate increases gradually with breast density, regardless of modality. In the high-density class, the interval cancer rate exceeds the cancer detection rate for SF and CR, but not for DR. CONCLUSIONS DR is superior to SF and CR with respect to cancer detection rates for high-density breasts. To reduce the high interval cancer rate in dense breasts, use of an additional imaging technique in screening can be taken into consideration. KEY POINTS • Interval cancer rate increases gradually with breast density, regardless of modality. • Cancer detection rate in high-density breasts is superior in DR. • IC rate exceeds CDR for SF and CR in high-density breasts. • DR performs better in high-density breasts for third readings and false-positives.
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Affiliation(s)
- Lore Timmermans
- Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium.
| | - Luc Bleyen
- Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium
| | - Klaus Bacher
- Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium
| | - Koen Van Herck
- Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium
| | - Kim Lemmens
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Andre Van Steen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Hubert Thierens
- Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium
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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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Knerr S, Wernli KJ, Leppig K, Ehrlich K, Graham AL, Farrell D, Evans C, Luta G, Schwartz MD, O'Neill SC. A web-based personalized risk communication and decision-making tool for women with dense breasts: Design and methods of a randomized controlled trial within an integrated health care system. Contemp Clin Trials 2017; 56:25-33. [PMID: 28257920 DOI: 10.1016/j.cct.2017.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mammographic breast density is one of the strongest risk factors for breast cancer after age and family history. Mandatory breast density disclosure policies are increasing nationally without clear guidance on how to communicate density status to women. Coupling density disclosure with personalized risk counseling and decision support through a web-based tool may be an effective way to allow women to make informed, values-consistent risk management decisions without increasing distress. METHODS/DESIGN This paper describes the design and methods of Engaged, a prospective, randomized controlled trial examining the effect of online personalized risk counseling and decision support on risk management decisions in women with dense breasts and increased breast cancer risk. The trial is embedded in a large integrated health care system in the Pacific Northwest. A total of 1250 female health plan members aged 40-69 with a recent negative screening mammogram who are at increased risk for interval cancer based on their 5-year breast cancer risk and BI-RADS® breast density will be randomly assigned to access either a personalized web-based counseling and decision support tool or standard educational content. Primary outcomes will be assessed using electronic health record data (i.e., chemoprevention and breast MRI utilization) and telephone surveys (i.e., distress) at baseline, six weeks, and twelve months. DISCUSSION Engaged will provide evidence about whether a web-based personalized risk counseling and decision support tool is an effective method for communicating with women about breast density and risk management. An effective intervention could be disseminated with minimal clinical burden to align with density disclosure mandates. Clinical Trials Registration Number:NCT03029286.
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Affiliation(s)
- Sarah Knerr
- Group Health Research Institute, Seattle, WA 98101, USA(1).
| | - Karen J Wernli
- Group Health Research Institute, Seattle, WA 98101, USA(1)
| | - Kathleen Leppig
- Clinical Genetics, Group Health Cooperative, Seattle, WA 98112, USA(1)
| | - Kelly Ehrlich
- Group Health Research Institute, Seattle, WA 98101, USA(1)
| | - Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC 20001, USA
| | | | - Chalanda Evans
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC 20007, USA
| | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
| | - Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
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Diagnostic performance of tomosynthesis and breast ultrasonography in women with dense breasts: a prospective comparison study. Breast Cancer Res Treat 2017; 162:85-94. [DOI: 10.1007/s10549-017-4105-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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41
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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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Moothathu NS, Philpotts LE, Busch SH, Gross CP, Staib LH, Hooley RJ. Knowledge of Density and Screening Ultrasound. Breast J 2016; 23:323-332. [DOI: 10.1111/tbj.12734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nitya S. Moothathu
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven Connecticut
| | - Liane E. Philpotts
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven Connecticut
| | - Susan H. Busch
- Department of Health Policy and Management; Yale School of Public Health; New Haven Connecticut
| | - Cary P. Gross
- General Internal Medicine and the Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center; Yale School of Medicine; New Haven Connecticut
| | - Lawrence H. Staib
- Departments of Radiology and Biomedical Imaging, Biomedical Engineering, and Electrical Engineering; Yale School of Medicine; New Haven Connecticut
| | - Regina J. Hooley
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven Connecticut
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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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Chau SL, Alabaster A, Luikart K, Brenman LM, Habel LA. The Effect of California's Breast Density Notification Legislation on Breast Cancer Screening. J Prim Care Community Health 2016; 8:55-62. [PMID: 27799412 PMCID: PMC5932660 DOI: 10.1177/2150131916674889] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: Half of US states mandate women be notified if they have dense breasts on their mammogram, yet guidelines and data on supplemental screening modalities are limited. Breast density (BD) refers to the extent that breast tissue appears radiographically dense on mammograms. High BD reduces the sensitivity of screening mammography and increases breast cancer risk. The aim of this study was to determine the potential impact of California’s 2013 BD notification legislation on breast cancer screening patterns. Methods: We conducted a cohort study of women aged 40 to 74 years who were members of a large Northern California integrated health plan (approximately 3.9 million members) in 2011-2015. We calculated pre- and post-legislation rates of screening mammography and magnetic resonance imaging (MRI). We also examined whether women with dense breasts (defined as BI-RADS density c or d) had higher MRI rates than women with nondense breasts (defined as BI-RADS density a or b). Results: After adjustment for race/ethnicity, age, body mass index, medical facility, neighborhood median income, and cancer history, there was a relative 6.6% decrease (relative risk [RR] 0.934, confidence interval [CI] 0.92-0.95) in the rate of screening mammography, largely driven by a decrease among women <50 years. While infrequent, there was a relative 16% increase (RR 1.16, CI 1.07-1.25) in the rate of screening MRI, with the greatest increase among the youngest women. In the postlegislation period, women with extremely dense breasts (BI-RADS d) had 2.77 times (CI 1.93-3.95) the odds of a MRI within 9 months of a screening mammogram compared with women with nondense breasts (BI-RADS b). Conclusions: In this setting, MRI rates increased in the postlegislation period. In addition, women with higher BD were more likely to have supplementary MRI. The decrease in mammography rates seen primarily among younger women may have been due to changes in national screening guidelines.
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Affiliation(s)
| | - Amy Alabaster
- 2 Kaiser Permanente Northern California, Oakland, CA, USA
| | - Karin Luikart
- 2 Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Laurel A Habel
- 2 Kaiser Permanente Northern California, Oakland, CA, USA
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Breast density (BD) assessment with digital breast tomosynthesis (DBT): Agreement between Quantra™ and 5th edition BI-RADS ®. Breast 2016; 30:185-190. [PMID: 27769015 DOI: 10.1016/j.breast.2016.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/30/2016] [Accepted: 10/01/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the agreement between digital breast tomosynthesis (DBT) breast density (BD) assessment made using Quantra™ and fifth edition BI-RADS®. MATERIALS AND METHODS This board approved study involved BD assessment of 234 women undergoing DBT investigation. BD estimation was performed from the raw DBT images using Quantra™ 3 (v.2.1.1, Hologic, Bedford MA). BI-RADS® assessment was performed using prior digital mammograms displayed simultaneously with 2D images synthesized from DBT by three radiologists using the fifth edition BI-RADS® (A, B, C, D). Kappa (к) was used to assess inter-reader agreement, agreement between Quantra™ and each reader, as well as the majority report of all readers. Receiver Operating Characteristic (ROC) analysis was used to assess the performance of Quantra™ in reproducing the majority BI-RADS® assessment. Data was then grouped into a two-category scale [almost entirely fatty and scattered fibroglandular tissue (A-B) versus heterogeneously dense and extremely dense (C-D)], and a further analysis performed. RESULTS Inter-reader agreement varied from fair [0.38 (95%CI: 0.30-0.46)] to substantial [0.68 (95%CI: 0.61-0.75)] on a four-category scale and substantial [0.70 (95%CI: 0.61-0.78)] to almost perfect [0.85 (95%CI: 0.78-0.92)] on a two-category scale. Using the majority report, the agreement between BI-RADS® and Quantra™ was 0.68 (95%CI: 0.59-0.75) on a four-category scale and 0.86 (95%CI: 0.79-0.93) on a two-category scale. Quantra™ distinguished BI-RADS® A-B from C-D with 97.1% sensitivity and 83.1% specificity. CONCLUSION Data demonstrate moderate to substantial agreement in BD assessment between fifth edition BI-RADS® and Quantra™.
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Effects of Changes in BI-RADS Density Assessment Guidelines (Fourth Versus Fifth Edition) on Breast Density Assessment: Intra- and Interreader Agreements and Density Distribution. AJR Am J Roentgenol 2016; 207:1366-1371. [PMID: 27656766 DOI: 10.2214/ajr.16.16561] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of our study was to determine intra- and interreader agreements for density assessment using the fifth edition of the BI-RADS guidelines and to compare with those for density assessment using the fourth edition of the BI-RADS guidelines. MATERIALS AND METHODS Five radiologists assessed breast density four times in 104 mammographic examinations: twice using the fourth edition of the BI-RADS guidelines and twice using the fifth edition. The intra- and interreader agreements for density assessment based on each guideline were determined and compared. The density distribution pattern under each of the four BI-RADS density categories using each guideline was also noted and compared. RESULTS The intrareader agreement for density assessment using the fifth-edition criteria was lower than that using the fourth-edition criteria (p = 0.0179). The overall intrareader agreement (weighted kappa) using the old criteria was 0.84 (95% CI, 0.80-0.87), and the individual intrareader agreement values in five readers ranged from 0.78 (95% CI, 0.69-0.88) to 0.92 (95% CI, 0.87-0.97). The overall intrareader agreement using the new BI-RADS criteria was 0.77 (95% CI, 0.73-0.81), and the individual intrareader agreement values in five readers ranged from 0.74 (95% CI, 0.64-0.84) to 0.99 (95% CI, 0.98-1.00). The interreader agreement values obtained using the fifth-edition criteria were also lower than those obtained using the fourth-edition criteria (p = 0.006). The overall interreader agreement using the old BI-RADS criteria was 0.65 (95% CI, 0.61-0.69), whereas the overall interreader agreement using the new BI-RADS criteria was 0.57 (95% CI, 0.53-0.61). Overall a higher number of dense assessments were given when the fifth-edition guidelines were used (p < 0.0001). CONCLUSION Compared with the intra- and interreader agreements obtained using the fourth edition of the BI-RADS guidelines, the intra- and interreader agreements were lower using the fifth-edition guidelines. An increased number of dense assessments were given when the fifth-edition guidelines were used.
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47
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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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48
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Throckmorton AD, Rhodes DJ, Hughes KS, Degnim AC, Dickson-Witmer D. Dense Breasts: What Do Our Patients Need to Be Told and Why? Ann Surg Oncol 2016; 23:3119-27. [PMID: 27401446 DOI: 10.1245/s10434-016-5400-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 11/18/2022]
Abstract
More than 50 % of states have state-mandated density notification for patients with heterogeneously or extremely dense breasts. Increased breast density carries a risk of masking a cancer and delaying diagnosis. Supplemental imaging is optional and often recommended for certain patients. There are no evidence-based consensus guidelines for screening patients with density as their only risk factor. Breast cancer risk assessment and breast cancer prevention strategies should be discussed with women with dense breasts.
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Affiliation(s)
- Alyssa D Throckmorton
- Department of Surgery, Vanderbilt University, Nashville, TN, USA. .,Baptist Cancer Center, Memphis, TN, USA.
| | | | - Kevin S Hughes
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Diana Dickson-Witmer
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
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Krishnan K, Baglietto L, Apicella C, Stone J, Southey MC, English DR, Giles GG, Hopper JL. Mammographic density and risk of breast cancer by mode of detection and tumor size: a case-control study. Breast Cancer Res 2016; 18:63. [PMID: 27316945 PMCID: PMC4912759 DOI: 10.1186/s13058-016-0722-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/28/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Risk of screen-detected breast cancer mostly reflects inherent risk, while risk of interval cancer reflects inherent risk and risk of masking (risk of the tumor not being detected due to increased dense tissue). Therefore the predictors of whether a breast cancer is interval or screen-detected include those that predict masking. Our aim was to investigate the associations between mammographic measures and (1) inherent risk, and (2) masking. METHODS We conducted a case-control study nested within the Melbourne collaborative cohort study of 244 screen-detected cases (192 small tumors (<2 cm)) matched to 700 controls and 148 interval cases (76 small tumors) matched to 446 controls. Dense area (DA), percent dense area (PDA), and non-dense area (NDA) were measured using the Cumulus software. Conditional and unconditional logistic regression were applied as appropriate to estimate the odds per adjusted standard deviation (OPERA) adjusted for age and body mass index (BMI), allowing for the association with BMI to be a function of age at diagnosis. Tests of fit were performed using the Bayesian information criterion (BIC) and the area under the receiver operating characteristic curve. RESULTS For screen-detected cancer, the association with BMI had a marginally significant dependence on age at diagnosis, and after adjustment both DA and PDA were associated with risk (OPERA approximately 1.2) and gave a similar fit. NDA was not associated with risk. For interval cancer, the BMI risk association was not dependent on age at diagnosis and the best fitting model was PDA alone (OPERA = 2.24, 95 % confidence interval 1.75, 2.86). Prediction of interval versus screen-detected cancer was best achieved by PDA alone (OPERA = 1.76, 95 % confidence interval 1.39, 2.22) with no association with BMI. When the analysis was restricted to small tumors to reduce the influence of tumor growth, we obtained similar results. CONCLUSIONS Inherent breast cancer risk is predicted by BMI and DA or PDA, but not NDA. Masking is predicted by PDA, and not by BMI. Understanding risk and masking could help tailor mammographic screening.
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Affiliation(s)
- Kavitha Krishnan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Laura Baglietto
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Jennifer Stone
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Centre for Genetic Origins of Health and Disease, Curtin University and University of Western Australia, Crawley, Australia
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
- Seoul Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Korea.
- Institute of Health and Environment, Seoul National University, Seoul, Korea.
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50
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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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