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Bucchi L, Belli P, Benelli E, Bernardi D, Brancato B, Calabrese M, Carbonaro LA, Caumo F, Cavallo-Marincola B, Clauser P, Fedato C, Frigerio A, Galli V, Giordano L, Golinelli P, Mariscotti G, Martincich L, Montemezzi S, Morrone D, Naldoni C, Paduos A, Panizza P, Pediconi F, Querci F, Rizzo A, Saguatti G, Tagliafico A, Trimboli RM, Zuiani C, Sardanelli F. Recommendations for breast imaging follow-up of women with a previous history of breast cancer: position paper from the Italian Group for Mammography Screening (GISMa) and the Italian College of Breast Radiologists (ICBR) by SIRM. LA RADIOLOGIA MEDICA 2016; 121:891-896. [PMID: 27601142 PMCID: PMC5102938 DOI: 10.1007/s11547-016-0676-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/16/2016] [Indexed: 10/25/2022]
Abstract
Women who were previously treated for breast cancer (BC) are an important particular subgroup of women at intermediate BC risk. Their breast follow-up should be planned taking in consideration a 1.0-1.5 % annual rate of loco-regional recurrences and new ipsilateral or contralateral BCs during 15-20 years, and be based on a regional/district invitation system. This activity should be carried out by a Department of Radiology integrating screening and diagnostics in the context of a Breast Unit. We recommend the adoption of protocols dedicated to women previously treated for BC, with a clear definition of responsibilities, methods for invitation, site(s) of visits, methods for clinical and radiological evaluation, follow-up duration, role and function of family doctors and specialists. These women will be invited to get a mammogram in dedicated sessions starting from the year after the end of treatment. The planned follow-up duration will be at least 10 years and will be defined on the basis of patient's age and preferences, taking into consideration organizational matters. Special agreements can be defined in the case of women who have their follow-up planned at other qualified centers. Dedicated screening sessions should include: evaluation of familial/personal history (if previously not done) for identifying high-risk conditions which could indicate a different screening strategy; immediate evaluation of mammograms by one or, when possible, two breast radiologists with possible addition of supplemental mammographic views, digital breast tomosynthesis, clinical breast examination, breast ultrasound; and prompt planning of possible further workup. Results of these screening sessions should be set apart from those of general female population screening and presented in dedicated reports. The following research issues are suggested: further risk stratification and effectiveness of follow-up protocols differentiated also for BC pathologic subtype and molecular classification, and evaluation of different models of survivorship care, also in terms of cost-effectiveness.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, via Piero Maroncelli, 40, 47014, Meldola, Forlì, Italy
| | - Paolo Belli
- Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 0168, Rome, Italy
| | - Eva Benelli
- Zadig Scientific Communication Agency, via Arezzo 21, 00161, Rome, Italy
| | - Daniela Bernardi
- Dipartimento di Radiologia, U.O. Senologia Clinica e Screening Mammografico, APSS, Centro per i Servizi Sanitari, Pal. C, viale Verona, 38123, Trento, Italy
| | - Beniamino Brancato
- Struttura Complessa di Senologia Clinica, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Massimo Calabrese
- UOC Senologia Diagnostica, IRCCS AOU San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Luca A Carbonaro
- Unit of Radiology, Research Hospital (IRCCS) Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Francesca Caumo
- UOSD Breast Unit ULSS20, Piazza Lambranzi 1, 37142, Verona, Italy
| | - Beatrice Cavallo-Marincola
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Sapienza Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, 1090, Verona, Austria
- Institute of Radiology, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy
| | - Chiara Fedato
- Regional Screening Coordinating Centre, Veneto Region, Venice, Italy
| | - Alfonso Frigerio
- Regional Reference Centre for Breast Cancer Screening, Turin, Italy
| | - Vania Galli
- Mammography Screening Centre, Local Health Authority, Modena, Italy
| | - Livia Giordano
- Epidemiology Unit, Centre for Cancer Prevention, Turin, Italy
| | - Paola Golinelli
- Medical Physics Service, Local Health Authority, Modena, Italy
| | - Giovanna Mariscotti
- Dipartimento di Diagnostica per Immagini, Radiologia 1U, Università di Torino, A. O. U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Turin, Italy
| | - Laura Martincich
- U.O. Radiodiagnostica, Candiolo Cancer Institute-FPO, IRCCS, Str. Prov. 142, km 3.95, I, 10060, Candiolo, Turin, Italy
| | - Stefania Montemezzi
- DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, P.le A. Stefani 1, 37126, Verona, Italy
| | - Doralba Morrone
- Struttura Complessa di Senologia Clinica, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Carlo Naldoni
- Department of Health, Emilia-Romagna Region, Bologna, Italy
| | - Adriana Paduos
- Epidemiology Unit, Centre for Cancer Prevention, Turin, Italy
| | - Pietro Panizza
- U.O. Radiologia Senologica, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Federica Pediconi
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Sapienza Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fiammetta Querci
- Department of Prevention, Screening Centre, Local Health Authority, Sassari, Italy
| | - Antonio Rizzo
- Pathology Department, Local Health Authority, Asolo, Italy
| | | | - Alberto Tagliafico
- Department of Experimental Medicine, DIMES, Institute of Anatomy, University of Genova, Via de Toni 14, 16132, Genoa, Italy
| | - Rubina M Trimboli
- Unit of Radiology, Research Hospital (IRCCS) Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Chiara Zuiani
- Institute of Radiology, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, Research Hospital (IRCCS) Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
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Bucchi L. Should breast cancer survivors be excluded from, or invited to, organised mammography screening programmes? BMC Health Serv Res 2011; 11:249. [PMID: 21970334 PMCID: PMC3203044 DOI: 10.1186/1472-6963-11-249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 10/04/2011] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The prevalence of breast cancer in developed countries has steadily risen over recent decades. Immediate and long-term health needs of patients, including preventive care and screening services, are receiving increasing attention. A question still unresolved is whether breast cancer survivors should receive mammographic surveillance in the clinical or screening setting and, thus, whether they should be excluded from, or invited to, organised mammography screening programmes. The objective of this article is to discuss the many contradictory aspects of this matter. DISCUSSION Problems with mammographic surveillance of breast cancer survivors include: weak evidence of a reduction in mortality; lack of evidence in favour of one setting or the other; lack of evidence-based guidelines for the frequency and duration of surveillance; disproportionate emphasis placed on the first few years post-treatment, probably dictated by surgical and oncological priorities; a variety of screening policies, as these women are permanently or temporarily or partially excluded from many - but not all - organised screening programmes worldwide; an even greater disparity in follow-up protocols used in the clinical setting; a paucity of data on compliance to mammographic surveillance in both settings; and a difficulty in coordinating the roles of health care providers. In the future, the use of mammography in breast cancer survivors will be influenced by the inclusion of women aged > 69 years in organised screening programmes and the implementation of multidisciplinary breast units, and will probably be investigated by research activities on individual risk assessment and risk-tailored screening. In the interim, current problems can be partially alleviated with some technical solutions in screening data recording, patient flows, and care coordination. SUMMARY Mammographic surveillance of breast cancer survivors is situated at the crossroads of numerous different specialist areas of breast cancer control and management. The solutions for current problems probably lie in some important modifications in the conventional screening procedure that are underway or under study. These developments appear to be directed towards a partial modification of the screening rationale, with an adaptation to meet the diversified breast care needs of women. The complexity of the matter constitutes a call to action for several entities to eliminate the barriers to effective research in this field.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRST, 47014 Meldola, Forlì, Italy.
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Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk italian 1 study): final results. Invest Radiol 2011; 46:94-105. [PMID: 21139507 DOI: 10.1097/rli.0b013e3181f3fcdf] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES : To prospectively compare clinical breast examination, mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (MRI) in a multicenter surveillance of high-risk women. MATERIALS AND METHODS : We enrolled asymptomatic women aged ≥ 25: BRCA mutation carriers; first-degree relatives of BRCA mutation carriers, and women with strong family history of breast/ovarian cancer, including those with previous personal breast cancer. RESULTS : A total of 18 centers enrolled 501 women and performed 1592 rounds (3.2 rounds/woman). Forty-nine screen-detected and 3 interval cancers were diagnosed: 44 invasive, 8 ductal carcinoma in situ; only 4 pT2 stage; 32 G3 grade. Of 39 patients explored for nodal status, 28 (72%) were negative. Incidence per year-woman resulted 3.3% overall, 2.1% <50, and 5.4% ≥ 50 years (P < 0.001), 4.3% in women with previous personal breast cancer and 2.5% in those without (P = 0.045). MRI was more sensitive (91%) than clinical breast examination (18%), mammography (50%), ultrasonography (52%), or mammography plus ultrasonography (63%) (P < 0.001). Specificity ranged 96% to 99%, positive predictive value 53% to 71%, positive likelihood ratio 24 to 52 (P not significant). MRI showed significantly better negative predictive value (99.6) and negative likelihood ratio (0.09) than those of the other modalities. At receiver operating characteristic analysis, the area under the curve of MRI (0.97) was significantly higher than that of mammography (0.83) or ultrasonography (0.82) and not significantly increased when MRI was combined with mammography and/or ultrasonography. Of 52 cancers, 16 (31%) were diagnosed only by MRI, 8 of 21 (38%) in women <50, and 8 of 31 (26%) in women ≥ 50 years of age. CONCLUSION : MRI largely outperformed mammography, ultrasonography, and their combination for screening high-risk women below and over 50.
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Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, Helbich T, Heywang-Köbrunner SH, Kaiser WA, Kerin MJ, Mansel RE, Marotti L, Martincich L, Mauriac L, Meijers-Heijboer H, Orecchia R, Panizza P, Ponti A, Purushotham AD, Regitnig P, Del Turco MR, Thibault F, Wilson R. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 2010; 46:1296-316. [PMID: 20304629 DOI: 10.1016/j.ejca.2010.02.015] [Citation(s) in RCA: 624] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 02/11/2010] [Indexed: 12/22/2022]
Abstract
The use of breast magnetic resonance imaging (MRI) is rapidly increasing. EUSOMA organised a workshop in Milan on 20-21st October 2008 to evaluate the evidence currently available on clinical value and indications for breast MRI. Twenty-three experts from the disciplines involved in breast disease management - including epidemiologists, geneticists, oncologists, radiologists, radiation oncologists, and surgeons - discussed the evidence for the use of this technology in plenary and focused sessions. This paper presents the consensus reached by this working group. General recommendations, technical requirements, methodology, and interpretation were firstly considered. For the following ten indications, an overview of the evidence, a list of recommendations, and a number of research issues were defined: staging before treatment planning; screening of high-risk women; evaluation of response to neoadjuvant chemotherapy; patients with breast augmentation or reconstruction; occult primary breast cancer; breast cancer recurrence; nipple discharge; characterisation of equivocal findings at conventional imaging; inflammatory breast cancer; and male breast. The working group strongly suggests that all breast cancer specialists cooperate for an optimal clinical use of this emerging technology and for future research, focusing on patient outcome as primary end-point.
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Affiliation(s)
- Francesco Sardanelli
- Dipartimento di Scienze Medico-Chirurgiche, Università degli Studi di Milano, IRCCS Policlinico San Donato, Unit of Radiology, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
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Sardanelli F, Podo F, D'Agnolo G, Verdecchia A, Santaquilani M, Musumeci R, Trecate G, Manoukian S, Morassut S, de Giacomi C, Federico M, Cortesi L, Corcione S, Cirillo S, Marra V, Cilotti A, Di Maggio C, Fausto A, Preda L, Zuiani C, Contegiacomo A, Orlacchio A, Calabrese M, Bonomo L, Di Cesare E, Tonutti M, Panizza P, Del Maschio A. Multicenter comparative multimodality surveillance of women at genetic-familial high risk for breast cancer (HIBCRIT study): interim results. Radiology 2007; 242:698-715. [PMID: 17244718 DOI: 10.1148/radiol.2423051965] [Citation(s) in RCA: 262] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To prospectively compare clinical breast examination (CBE), mammography, ultrasonography (US), and contrast material-enhanced magnetic resonance (MR) imaging for screening women at genetic-familial high risk for breast cancer and report interim results, with pathologic findings as standard. MATERIALS AND METHODS Institutional review board of each center approved the research; informed written consent was obtained. CBE, mammography, US, and MR imaging were performed for yearly screening of BRCA1 or BRCA2 mutation carriers, first-degree relatives of BRCA1 or BRCA2 mutation carriers, or women enrolled because of a strong family history of breast or ovarian cancer (three or more events in first- or second-degree relatives in either maternal or paternal line; these included breast cancer in women younger than 60 years, ovarian cancer at any age, and male breast cancer at any age). RESULTS Two hundred seventy-eight women (mean age, 46 years +/- 12 [standard deviation]) were enrolled. Breast cancer was found in 11 of 278 women at first round and seven of 99 at second round (14 invasive, four intraductal; eight were <or=10 mm in diameter). Detection rate per year was 4.8% (18 of 377) overall; 4.3% (11 of 258) in BRCA1 or BRCA2 mutation carriers and first-degree relatives of BRCA1 or BRCA2 mutation carriers versus 5.9% (seven of 119) in women enrolled because of strong family history; and 5.3% (nine of 169) in women with previous personal breast and/or ovarian cancer versus 4.3% (nine of 208) in those without. In six (33%) of 18 patients, cancer was detected only with MR imaging. Sensitivity was as follows: CBE, 50% (95% confidence interval [CI]: 29%, 71%); mammography, 59% (95% CI: 36%, 78%); US, 65% (95% CI: 41%, 83%); and MR imaging, 94% (95% CI: 82%, 99%). Positive predictive value was as follows: CBE, 82% (95% CI: 52%, 95%); mammography, 77% (95% CI: 50%, 92%); US, 65% (95% CI: 41%, 83%); and MR imaging, 63% (95% CI: 43%, 79%). CONCLUSION Addition of MR imaging to the screening regimen for high-risk women may enable detection of otherwise unsuspected breast cancers.
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Affiliation(s)
- Francesco Sardanelli
- University of Milan School of Medicine, Department of Medical and Surgical Sciences, Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
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Sardanelli F, Podo F. Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection? Eur Radiol 2006; 17:873-87. [PMID: 17008989 DOI: 10.1007/s00330-006-0389-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 07/03/2006] [Accepted: 07/07/2006] [Indexed: 12/30/2022]
Abstract
In the last few years, several papers have addressed the introduction of contrast-enhanced MR imaging for screening women at high risk for breast cancer. Taking in consideration five prospective studies, on 3,571 screened women with hereditary predisposition to the disease and 9,652 rounds, we found that 168 patients were diagnosed with breast cancer (155 screen-detected, eight interval, and five cancers excluded from analysis) with a detection rate per year of 1.7%. These cancers were small (49% equal to or less than 10 mm in diameter) but aggressive, 82% being invasive and 49% with histologic grade 3; however, only 19% of these invasive cancers were associated with nodal involvement. The pooled sensitivity was 16% for clinical breast examination, 40% for mammography, 43% for ultrasound, and 81% for MR. The positive predictive value (calculated on the basis of the number of invasive diagnostic procedures due to false positives) was 33%, 47%, 18%, and 53%, respectively. Aim of the present article is to present the historical development of MR imaging of breast tumors that made this application theoretically and technically possible, to explain what strategic problems we face in the presence of a hereditary predisposition to the disease, to review the main results of the published studies, and to outline open problems and future perspectives.
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Affiliation(s)
- Francesco Sardanelli
- Department of Medical and Surgical Sciences, Unit of Radiology, IRCCS Policlinico San Donato, University of Milan School of Medicine, I-20097, San Donato Milanese, MI, Italy.
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