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Ray KM. Interval Cancers in Understanding Screening Outcomes. Radiol Clin North Am 2024; 62:559-569. [PMID: 38777533 DOI: 10.1016/j.rcl.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Interval breast cancers are not detected at routine screening and are diagnosed in the interval between screening examinations. A variety of factors contribute to interval cancers, including patient and tumor characteristics as well as the screening technique and frequency. The interval cancer rate is an important metric by which the effectiveness of screening may be assessed and may serve as a surrogate for mortality benefit.
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Affiliation(s)
- Kimberly M Ray
- Department of Radiology and Biomedical Sciences, University of California, San Francisco, UCSF Medical Center, 1825 4th Street, L3185, Box 4034, San Francisco, CA 94107, USA.
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2
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Omoleye OJ, Esserman LJ, Olopade OI. RE: Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density. J Natl Cancer Inst 2024; 116:627-628. [PMID: 38281077 DOI: 10.1093/jnci/djae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/29/2024] Open
Affiliation(s)
- Olasubomi J Omoleye
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Laura J Esserman
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, IL, USA
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3
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Ntowe KW, Lee MS, Plichta JK. Clinical genetics in breast cancer. J Surg Oncol 2024. [PMID: 38557982 DOI: 10.1002/jso.27630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
As genetic testing becomes increasingly more accessible and more applicable with a broader range of clinical implications, it may also become more challenging for breast cancer providers to remain up-to-date. This review outlines some of the current clinical guidelines and recent literature surrounding germline genetic testing, as well as genomic testing, in the screening, prevention, diagnosis, and treatment of breast cancer, while identifying potential areas of further research.
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Affiliation(s)
- Koumani W Ntowe
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael S Lee
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA
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4
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Kubota K, Nakashima K, Nakashima K, Kataoka M, Inoue K, Goto M, Kanbayashi C, Hirokaga K, Yamaguchi K, Suzuki A. The Japanese breast cancer society clinical practice guidelines for breast cancer screening and diagnosis, 2022 edition. Breast Cancer 2024; 31:157-164. [PMID: 37973686 PMCID: PMC10901949 DOI: 10.1007/s12282-023-01521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
This article provides updates to readers based on the newly published Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2022 Edition. These guidelines incorporate the latest evaluation of evidence from studies of diagnostic accuracy. For each clinical question, outcomes for benefits and harms were established, and qualitative or quantitative systematic reviews were conducted. Recommendations were determined through voting by a multidisciplinary group, and guidelines were documented to facilitate shared decision-making among patients and medical professionals. The guidelines address screening, surveillance, and pre- and postoperative diagnosis of breast cancer. In an environment that demands an integrated approach, decisions are needed on how to utilize modalities, such as mammography, ultrasound, MRI, and PET/CT. Additionally, it is vital to understand the appropriate use of new technologies, such as tomosynthesis, elastography, and contrast-enhanced ultrasound, and to consider how best to adapt these methods for individual patients.
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Affiliation(s)
- Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-koshigaya, Koshigaya, Saitama, 343-8555, Japan.
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan.
| | - Kazutaka Nakashima
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Kazuaki Nakashima
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Division of Breast Imaging and Breast Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masako Kataoka
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenich Inoue
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Breast Cancer Center, Shonan Memorial Hospital, Kanagawa, Japan
| | - Mariko Goto
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chizuko Kanbayashi
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Akihiko Suzuki
- Division of Breast and Endocrine Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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5
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Greenwood HI, Dodelzon K. Screening in Women With BRCA Mutations Revisited. JOURNAL OF BREAST IMAGING 2024; 6:4-13. [PMID: 38166173 DOI: 10.1093/jbi/wbad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 01/04/2024]
Abstract
Patients with BRCA1 or BRCA2 gene mutations are at high risk for the development of breast cancer. This article reviews the current evidence for breast cancer screening of patients with BRCA1 or BRCA2 pathogenic gene mutations if they have not undergone prophylactic mastectomy. It will review the current evidence-based imaging recommendations for different modalities and ages of screening initiation in screening this patient population at high risk. Special considerations in transgender BRCA1 and BRCA2 mutation carriers are also discussed.
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Affiliation(s)
- Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
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6
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Omoleye OJ, Woodard AE, Howard FM, Zhao F, Yoshimatsu TF, Zheng Y, Pearson AT, Levental M, Aribisala BS, Kulkarni K, Karczmar GS, Olopade OI, Abe H, Huo D. External Evaluation of a Mammography-based Deep Learning Model for Predicting Breast Cancer in an Ethnically Diverse Population. Radiol Artif Intell 2023; 5:e220299. [PMID: 38074785 PMCID: PMC10698602 DOI: 10.1148/ryai.220299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/25/2023] [Accepted: 07/03/2023] [Indexed: 01/31/2024]
Abstract
Purpose To externally evaluate a mammography-based deep learning (DL) model (Mirai) in a high-risk racially diverse population and compare its performance with other mammographic measures. Materials and Methods A total of 6435 screening mammograms in 2096 female patients (median age, 56.4 years ± 11.2 [SD]) enrolled in a hospital-based case-control study from 2006 to 2020 were retrospectively evaluated. Pathologically confirmed breast cancer was the primary outcome. Mirai scores were the primary predictors. Breast density and Breast Imaging Reporting and Data System (BI-RADS) assessment categories were comparative predictors. Performance was evaluated using area under the receiver operating characteristic curve (AUC) and concordance index analyses. Results Mirai achieved 1- and 5-year AUCs of 0.71 (95% CI: 0.68, 0.74) and 0.65 (95% CI: 0.64, 0.67), respectively. One-year AUCs for nondense versus dense breasts were 0.72 versus 0.58 (P = .10). There was no evidence of a difference in near-term discrimination performance between BI-RADS and Mirai (1-year AUC, 0.73 vs 0.68; P = .34). For longer-term prediction (2-5 years), Mirai outperformed BI-RADS assessment (5-year AUC, 0.63 vs 0.54; P < .001). Using only images of the unaffected breast reduced the discriminatory performance of the DL model (P < .001 at all time points), suggesting that its predictions are likely dependent on the detection of ipsilateral premalignant patterns. Conclusion A mammography DL model showed good performance in a high-risk external dataset enriched for African American patients, benign breast disease, and BRCA mutation carriers, and study findings suggest that the model performance is likely driven by the detection of precancerous changes.Keywords: Breast, Cancer, Computer Applications, Convolutional Neural Network, Deep Learning Algorithms, Informatics, Epidemiology, Machine Learning, Mammography, Oncology, Radiomics Supplemental material is available for this article. © RSNA, 2023See also commentary by Kontos and Kalpathy-Cramer in this issue.
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Affiliation(s)
- Olasubomi J. Omoleye
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Anna E. Woodard
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Frederick M. Howard
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Fangyuan Zhao
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Toshio F. Yoshimatsu
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Yonglan Zheng
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Alexander T. Pearson
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Maksim Levental
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Benjamin S. Aribisala
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Kirti Kulkarni
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Gregory S. Karczmar
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Olufunmilayo I. Olopade
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
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7
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Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol 2023; 20:902-914. [PMID: 37150275 DOI: 10.1016/j.jacr.2023.04.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Early detection decreases breast cancer death. The ACR recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive screening for women at higher-than-average risk. For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI. Women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at young ages are recommended to undergo MRI surveillance starting at ages 25 to 30 and annual mammography (with a variable starting age between 25 and 40, depending on the type of risk). Mutation carriers can delay mammographic screening until age 40 if annual screening breast MRI is performed as recommended. Women diagnosed with breast cancer before age 50 or with personal histories of breast cancer and dense breasts should undergo annual supplemental breast MRI. Others with personal histories, and those with atypia at biopsy, should strongly consider MRI screening, especially if other risk factors are present. For women with dense breasts who desire supplemental screening, breast MRI is recommended. For those who qualify for but cannot undergo breast MRI, contrast-enhanced mammography or ultrasound could be considered. All women should undergo risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, so that those at higher-than-average risk can be identified and appropriate screening initiated.
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Affiliation(s)
- Debra L Monticciolo
- Division Chief, Breast Imaging, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mary S Newell
- Interim Division Chief, Breast Imaging, Emory University, Atlanta, Georgia
| | - Linda Moy
- Associate Chair for Faculty Mentoring, New York University Grossman School of Medicine, New York, New York; Editor-in-Chief, Radiology
| | - Cindy S Lee
- New York University Grossman School of Medicine, New York, New York
| | - Stamatia V Destounis
- Elizabeth Wende Breast Care, Rochester, New York; Chair, ACR Commission on Breast Imaging
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8
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Anaby D, Shavin D, Zimmerman-Moreno G, Nissan N, Friedman E, Sklair-Levy M. 'Earlier than Early' Detection of Breast Cancer in Israeli BRCA Mutation Carriers Applying AI-Based Analysis to Consecutive MRI Scans. Cancers (Basel) 2023; 15:3120. [PMID: 37370730 DOI: 10.3390/cancers15123120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Female BRCA1/BRCA2 (=BRCA) pathogenic variants (PVs) carriers are at a substantially higher risk for developing breast cancer (BC) compared with the average risk population. Detection of BC at an early stage significantly improves prognosis. To facilitate early BC detection, a surveillance scheme is offered to BRCA PV carriers from age 25-30 years that includes annual MRI based breast imaging. Indeed, adherence to the recommended scheme has been shown to be associated with earlier disease stages at BC diagnosis, more in-situ pathology, smaller tumors, and less axillary involvement. While MRI is the most sensitive modality for BC detection in BRCA PV carriers, there are a significant number of overlooked or misinterpreted radiological lesions (mostly enhancing foci), leading to a delayed BC diagnosis at a more advanced stage. In this study we developed an artificial intelligence (AI)-network, aimed at a more accurate classification of enhancing foci, in MRIs of BRCA PV carriers, thus reducing false-negative interpretations. Retrospectively identified foci in prior MRIs that were either diagnosed as BC or benign/normal in a subsequent MRI were manually segmented and served as input for a convolutional network architecture. The model was successful in classification of 65% of the cancerous foci, most of them triple-negative BC. If validated, applying this scheme routinely may facilitate 'earlier than early' BC diagnosis in BRCA PV carriers.
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Affiliation(s)
- Debbie Anaby
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6910201, Israel
| | - David Shavin
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan 52621, Israel
| | | | - Noam Nissan
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6910201, Israel
| | - Eitan Friedman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6910201, Israel
- Meirav High Risk Center, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Miri Sklair-Levy
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6910201, Israel
- Meirav High Risk Center, Sheba Medical Center, Ramat Gan 52621, Israel
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9
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Elias K, Smyczynska U, Stawiski K, Nowicka Z, Webber J, Kaplan J, Landen C, Lubinski J, Mukhopadhyay A, Chakraborty D, Connolly DC, Symecko H, Domchek SM, Garber JE, Konstantinopoulos P, Fendler W, Chowdhury D. Identification of BRCA1/2 mutation female carriers using circulating microRNA profiles. Nat Commun 2023; 14:3350. [PMID: 37291133 PMCID: PMC10250543 DOI: 10.1038/s41467-023-38925-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/19/2023] [Indexed: 06/10/2023] Open
Abstract
Identifying germline BRCA1/2 mutation carriers is vital for reducing their risk of breast and ovarian cancer. To derive a serum miRNA-based diagnostic test we used samples from 653 healthy women from six international cohorts, including 350 (53.6%) with BRCA1/2 mutations and 303 (46.4%) BRCA1/2 wild-type. All individuals were cancer-free before and at least 12 months after sampling. RNA-sequencing followed by differential expression analysis identified 19 miRNAs significantly associated with BRCA mutations, 10 of which were ultimately used for classification: hsa-miR-20b-5p, hsa-miR-19b-3p, hsa-let-7b-5p, hsa-miR-320b, hsa-miR-139-3p, hsa-miR-30d-5p, hsa-miR-17-5p, hsa-miR-182-5p, hsa-miR-421, hsa-miR-375-3p. The final logistic regression model achieved area under the receiver operating characteristic curve 0.89 (95% CI: 0.87-0.93), 93.88% sensitivity and 80.72% specificity in an independent validation cohort. Mutated gene, menopausal status or having preemptive oophorectomy did not affect classification performance. Circulating microRNAs may be used to identify BRCA1/2 mutations in patients of high risk of cancer, offering an opportunity to reduce screening costs.
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Affiliation(s)
- Kevin Elias
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Urszula Smyczynska
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Konrad Stawiski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - James Webber
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jakub Kaplan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charles Landen
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Jan Lubinski
- International Hereditary Cancer Center of the Pomeranian Medical University, Szczecin, Poland
| | - Asima Mukhopadhyay
- Kolkata Gynecology Oncology Trials and Translational Research Group, Kolkata, West Bengal, India
| | - Dona Chakraborty
- Kolkata Gynecology Oncology Trials and Translational Research Group, Kolkata, West Bengal, India
| | | | - Heather Symecko
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, PA, USA
| | - Judy E Garber
- Center for BRCA and Related Genes, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Panagiotis Konstantinopoulos
- Center for BRCA and Related Genes, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland.
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Dipanjan Chowdhury
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Center for BRCA and Related Genes, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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10
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Soldato D, Arecco L, Agostinetto E, Franzoi MA, Mariamidze E, Begijanashvili S, Brunetti N, Spinaci S, Solinas C, Vaz-Luis I, Di Meglio A, Lambertini M. The Future of Breast Cancer Research in the Survivorship Field. Oncol Ther 2023:10.1007/s40487-023-00225-8. [PMID: 37005952 DOI: 10.1007/s40487-023-00225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 04/04/2023] Open
Abstract
Prevalence of survivors of breast cancer has been steadily increasing in the last 20 years. Currently, more than 90% of women diagnosed with early-stage breast cancer are expected to be alive at 5 years from diagnosis thanks to early detection and breakthrough innovations in multimodal treatment strategies. Alongside this advancement in clinical outcomes, survivors of breast cancer might experience several specific challenges and present with unique needs. Survivorship trajectories after diagnosis and treatment of breast cancer can be significantly impacted by long-lasting and severe treatment-related side effects, including physical problems, psychological distress, fertility issues in young women, and impaired social and work reintegration, which add up to patients' individual risk of cancer recurrence and second primary malignancies. Alongside cancer-specific sequelae, survivors still present with general health needs, including management of chronic preexisting or ensuing conditions. Survivorship care should implement high-quality, evidence-based strategies to promptly screen, identify, and address survivors' needs in a comprehensive way and minimize the impact of severe treatment sequelae, preexisting comorbidities, unhealthy lifestyles, and risk of recurrence on quality of life. This narrative review focuses on core areas of survivorship care and discuss the state of the art and future research perspectives in key domains including selected long-term side effects, surveillance for recurrences and second cancers, well-being promotion, and specific survivors' needs.
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Affiliation(s)
- D Soldato
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - L Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - E Agostinetto
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M A Franzoi
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - E Mariamidze
- Department of Oncology and Hematology, Todua Clinic, Tbilisi, Georgia
| | - S Begijanashvili
- Department of Clinical Oncology, American Hospital Tbilisi, Tbilisi, Georgia
| | - N Brunetti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - S Spinaci
- Division of Breast Surgery, Villa Scassi Hospital, Genoa, Italy
| | - C Solinas
- Medical Oncology, AOU Cagliari, Policlinico Duilio Casula, Monserrato, Italy
| | - I Vaz-Luis
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy.
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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11
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Ding W, Fan Z, Xu Y, Wei C, Li Z, Lin Y, Zhu J, Ruan G. Magnetic resonance imaging in screening women at high risk of breast cancer: A meta-analysis. Medicine (Baltimore) 2023; 102:e33146. [PMID: 36897691 PMCID: PMC9997824 DOI: 10.1097/md.0000000000033146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is more accurate than mammography in screening for breast cancer. Exposure to ionizing radiation from repeated diagnostic X-rays may be a cause of breast cancer. METHODS We conducted systematic searches on PubMed, Cochrane and Embase to identify studies on women who underwent mammography or MRI screening. A meta-analysis was performed to compare the detection rate of breast cancer by mammography, MRI or both. RESULTS A total of 18 diagnostic publications were identified and included in the meta-analysis. Among the 1000 screened women, MRI alone increased the detection rate of breast cancer by 8 compared with mammography alone (RR 0.48, 95% CI 0.42-0.54), and MRI plus mammography increased the detection rate of breast cancer by 1 compared with MRI alone (RR 0.86, 95% CI 0.78-0.96). Subgroup analysis demonstrated that the diagnostic efficacy of MRI plus mammography in breast was obviously better than that of MRI alone or mammography alone. CONCLUSIONS Screening with MRI alone might be the best choice for women at high risk of breast cancer.
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Affiliation(s)
- Wu Ding
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, China
| | - Zaiwei Fan
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, China
| | - Yuehuai Xu
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, China
| | - Chunshou Wei
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Zhian Li
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Yingli Lin
- Department of Early Childhood Education, Shaoxing Vocational and Technical College, Shaoxing, China
| | - Jianming Zhu
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Guodong Ruan
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
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12
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Cömert D, van Gils CH, Veldhuis WB, Mann RM. Challenges and Changes of the Breast Cancer Screening Paradigm. J Magn Reson Imaging 2023; 57:706-726. [PMID: 36349728 DOI: 10.1002/jmri.28495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
Since four decades mammography is used for early breast cancer detection in asymptomatic women and still remains the gold standard imaging modality. However, population screening programs can be personalized and women can be divided into different groups based on risk factors and personal preferences. The availability of new and evolving imaging modalities, for example, digital breast tomosynthesis, dynamic-contrast-enhanced magnetic resonance imaging (MRI), abbreviated MRI protocols, diffusion-weighted MRI, and contrast-enhanced mammography leads to new challenges and perspectives regarding the feasibility and potential harms of breast cancer screening. The aim of this review is to discuss the current guidelines for different risk groups, to analyze the recent published studies about the diagnostic performance of the imaging modalities and to discuss new developments and future perspectives. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 6.
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Affiliation(s)
- Didem Cömert
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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13
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Abstract
The incidence of breast cancer in younger women is rising. Although early-onset breast cancer is highly associated with biologically aggressive tumors such as triple-negative and human epidermal growth factor 2 (HER2)-positive cancers, the more recent increase is disproportionately driven by an increase in the incidence of luminal cancer. In particular, the increase in de novo stage IV disease and the inherent age-based poorer survival rate among younger women with even early-stage luminal cancers suggest underlying distinct biologic characteristics that are not well understood. Further contributing to the higher number of early-onset breast cancers is pregnancy-associated breast cancer (PABC), which is attributed to persistent increases in maternal age over time. Although guidelines for screening of patients who carry a BRCA1 or BRCA2 gene mutation are well established, this population comprises only a fraction of those with early-onset breast cancer. A lack of screening in most young patients precludes timely diagnosis, underscoring the importance of early education and awareness. The disproportionate disease burden in young women of certain racial and ethnic groups, which is further exacerbated by socioeconomic disparity in health care, results in worse outcomes. An invited commentary by Monticciolo is available online. ©RSNA, 2022.
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Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Naziya Samreen
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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14
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Comparing breast cancer imaging characteristics of CHEK2 with BRCA1 and BRCA2 gene mutation carriers. Eur J Radiol 2021; 146:110074. [PMID: 34902667 DOI: 10.1016/j.ejrad.2021.110074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Breast cancer gene (BRCA) 1 and 2 mutations are frequently studied gene mutations (GM); the incidence of checkpoint kinase 2 (CHEK2) is increasing. We describe the imaging features of breast cancer (BC) in CHEK2 mutations, compared to BRCA 1 and 2 using mammography, ultrasound (US) and magnetic resonance imaging (MRI). METHOD Inclusion criteria were primary BC in GM carriers, treated in the same hospital. Age at diagnosis, histology, hormone receptor and human epidermal growth factor receptor 2 (HER2) status were retrieved. Mammography descriptors were mass, asymmetry and suspicious microcalcifications. The enhancement pattern (MRI), shape and border, architectural distortion, the presence of a hyperechoic rim and cystic complex structure (US) were documented. Analyses were performed using SAS software (version 9.4). Fishers' exact test was used to test associations between two categorical variables. RESULTS In 191 women, 233 malignant lesions were diagnosed (78 in BRCA1, 109 in BRCA2, 46 in CHEK2). In CHEK2 carriers, mammographically, suspicious microcalcifications (54%) were more prevalent (BRCA2 (48%) and BRCA1 carriers (33%)) (p-value = 0.057) compared to mass lesions (35%). On US, lesions were most frequently ill-defined (86%) (p = 0.579) and irregular (94.5%) (p = 0.098) compared to BRCA2 (77% and 80% resp.) and BRCA1 carriers (71% and 72% resp.). On MRI, mass lesions showed a type 3 curve in CHEK2 (67%) compared to BRCA1 (36%) and BRCA2 (50%) (p = 0.056). CONCLUSIONS Malignant radiological characteristics of breast cancer, more specifically suspicious microcalcifications, were more frequently seen in CHEK2 and BRCA2 compared to BRCA1 mutation carriers (without a significant difference) indicating the importance of mammography in follow-up of CHEK2 carriers.
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15
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Kiely BE, Goodwin A. Is it time to abandon clinical breast examination? Med J Aust 2021; 215:458-459. [PMID: 34611913 DOI: 10.5694/mja2.51285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Belinda E Kiely
- NHMRC Clinical Trials Centre, the University of Sydney, Sydney, NSW.,Concord Repatriation General Hospital, Sydney, NSW
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16
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Abstract
ABSTRACT Triple-negative breast cancer accounted for 12% of breast cancers diagnosed in the United States from 2012 to 2016, with a 5-year survival 8% to 16% lower than hormone receptor-positive disease. However, preventive and screening strategies remain tailored to the demographics of less lethal luminal cancers. This review examines the ethnic, genetic, and modifiable risk factors associated with triple-negative breast cancer, which providers must recognize to address the societal disparities of this deadly disease. Most notable is that triple-negative cancers disproportionately affect African American women and carriers of germline BRCA and PALB2 mutations. Even controlling for treatment delays, stage, and socioeconomic factors, African Americans with triple-negative breast cancer remain nearly twice as likely to die of their disease. To level the playing field, we must integrate genomic predictors of disease and epidemiologic characteristics of molecular breast cancer subtypes to provide personalized risk assessment, screening, and treatment for each patient.
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17
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Berger ER, Golshan M. Surgical Management of Hereditary Breast Cancer. Genes (Basel) 2021; 12:1371. [PMID: 34573353 PMCID: PMC8470490 DOI: 10.3390/genes12091371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 12/26/2022] Open
Abstract
The identification that breast cancer is hereditary was first described in the nineteenth century. With the identification of the BRCA1 and BRCA 2 breast/ovarian cancer susceptibility genes in the mid-1990s and the introduction of genetic testing, significant advancements have been made in tailoring surveillance, guiding decisions on medical or surgical risk reduction and cancer treatments for genetic variant carriers. This review discusses various medical and surgical management options for hereditary breast cancers.
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Affiliation(s)
- Elizabeth R. Berger
- Department of Surgery, School of Medicine, Yale University, New Haven, CT 06511, USA;
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18
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Kaiser CG, Dietzel M, Vag T, Rübenthaler J, Froelich MF, Tollens F. Impact of specificity on cost-effectiveness of screening women at high risk of breast cancer with magnetic resonance imaging, mammography and ultrasound. Eur J Radiol 2021; 137:109576. [PMID: 33556759 DOI: 10.1016/j.ejrad.2021.109576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Aim of this study was to analyze the comparative cost-effectiveness of MR-mammography vs conventional imaging in a screening setting for women with high risk of breast cancer, with particular focus on the impact of specificity of MRM. METHOD Decision analytic modelling and Markov Modelling were applied to evaluate cumulative costs of each screening modality and their subsequent treatments as well as cumulative outcomes in quality adjusted life years (QALYs). For the selected time horizon of 30 years, false positive and false negative results were included. Model input parameters for women with high risk of breast cancer were estimated based on published data from a US healthcare system perspective. Major influence factors were identified and evaluated in a deterministic sensitivity analysis. Based on current recommendations for economic evaluations, a probabilistic sensitivity analysis was conducted to test the model stability. RESULTS In a base-case analysis, screening with XM vs. MRM and treatment resulted in overall costs of $36,201.57 vs. $39,050.97 and a cumulative effectiveness of 19.53 QALYs vs. 19.59 QALYs. This led to an incremental cost-effectiveness ratio (ICER) of $ 45,373.94 per QALY for MRM. US and XM + US resulted in ICER values higher than the willingness to pay (WTP). In the sensitivity analyses, MRM remained a cost-effective strategy for screening high-risk patients as long as the specificity of MRM did not drop below 86.7 %. CONCLUSION In high-risk breast cancer patients, MRM can be regarded as a cost-effective alternative to XM in a yearly screening setting. Specificity may be an important cost driver in settings with yearly screening intervals.
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Affiliation(s)
- Clemens G Kaiser
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Germany.
| | - Matthias Dietzel
- Department of Radiology, Friedrich-Alexander-University Hospital Erlangen, Germany
| | - Tibor Vag
- Conradia Radiology & Medical Prevention Munich, Germany
| | | | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Germany
| | - Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Germany
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19
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Abstract
BACKGROUND Specialized breast cancer early detection programs with magnetic resonance imaging (MRI) in high-risk patients are by now well established in several countries. In Germany, such a program has been running as part of routine care since 2005. OBJECTIVES This review article will summarize current developments in high-risk screening with MRI. MATERIALS AND METHODS Experiences with the high-risk screening program in Germany over now more than 10 years as well as a review of the current literature will form the basis for this article. RESULTS The MRI of the breast is by far the most sensitive imaging modality for the detection of breast cancer and represents the back bone of high-risk screening. More than 90% of cancers detected at high-risk screening are visible on the MRI and more than 30% of cancers are detected primarily by MRI alone. However, a prerequisite for effective screening with MRI is a sufficiently high breast cancer incidence in the screened population. This is demonstrated by the fact that the positive predictive value of screening with MRI in women without a BRCA1/2 mutation in the age group between 30 and 39 years is unacceptably low with 2.9%. CONCLUSIONS In high-risk screening, MRI is the primary imaging tool with mammography and/or ultrasound added as adjunct if necessary. In women with a strong family history of breast cancer but no proven pathogenic mutation in one of the known risk genes in the index patient in the family, the high-risk screening should not routinely start at age 30, but should be postponed until the 10-year breast cancer risk passes a threshold of 5%.
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Affiliation(s)
- Ulrich Bick
- Klinik für Radiologie, CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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20
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Gao Y, Reig B, Heacock L, Bennett DL, Heller SL, Moy L. Magnetic Resonance Imaging in Screening of Breast Cancer. Radiol Clin North Am 2021; 59:85-98. [PMID: 33223002 PMCID: PMC8178936 DOI: 10.1016/j.rcl.2020.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Magnetic Resonance (MR) imaging is the most sensitive modality for breast cancer detection but is currently limited to screening women at high risk due to limited specificity and test accessibility. However, specificity of MR imaging improves with successive rounds of screening, and abbreviated approaches have the potential to increase access and decrease cost. There is growing evidence to support supplemental MR imaging in moderate-risk women, and current guidelines continue to evolve. Functional imaging has the potential to maximize survival benefit of screening. Leveraging MR imaging as a possible primary screening tool is therefore also being investigated in average-risk women.
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Affiliation(s)
- Yiming Gao
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA.
| | - Beatriu Reig
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Laura Heacock
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Debbie L Bennett
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, St Louis, MO 63110, USA
| | - Samantha L Heller
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Linda Moy
- Department of Radiology, NYU School of Medicine, 160 East 34th Street, New York, NY 10016, USA; Department of Radiology, NYU Center for Biomedical Imaging, 660 First Avenue, New York, NY 10016, USA; Department of Radiology, NYU Center for Advanced Imaging Innovation and Research, 660 First Avenue, New York, NY 10016, USA
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21
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Zhou X, Fan X, Mustafi D, Pineda F, Markiewicz E, Zamora M, Sheth D, Olopade OI, Oto A, Karczmar GS. Comparison of DCE-MRI of murine model cancers with a low dose and high dose of contrast agent. Phys Med 2021; 81:31-39. [PMID: 33373779 DOI: 10.1016/j.ejmp.2020.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 02/08/2023] Open
Abstract
There are increasing concerns regarding intracellular accumulation of gadolinium (Gd) after multiple dynamic contrast enhanced (DCE) MRI scans. We investigated whether a low dose (LD) of Gd-based contrast agent is as effective as a high dose (HD) for quantitative analysis of DCE-MRI data, and evaluated the use of a split dose protocol to obtain new diagnostic parameters. Female C3H mice (n = 6) were injected with mammary carcinoma cells in the hind leg. MRI experiments were performed on 9.4 T scanner. DCE-MRI data were acquired with 1.5 s temporal resolution before and after a LD (0.04 mmol/kg), then again after 30 min followed by a HD (0.2 mmol/kg) bolus injection of Omniscan. The standard Tofts model was used to extract physiological parameters (Ktrans and ve) with the arterial input function derived from muscle reference tissue. In addition, an empirical mathematical model was used to characterize maximum contrast agent uptake (A), contrast agent uptake rate (α) and washout rate (β and γ). There were moderate to strong correlations (r = 0.69-0.97, p < 0001) for parameters Ktrans, ve, A, α and β from LD versus HD data. On average, tumor parameters obtained from LD data were significantly larger (p < 0.05) than those from HD data. The parameter ratios, Ktrans, ve, A and α calculated from the LD data divided by the HD data, were all significantly larger than 1.0 (p < 0.003) for tumor. T2* changes following contrast agent injection affected parameters calculated from HD data, but this was not the case for LD data. The results suggest that quantitative analysis of LD data may be at least as effective for cancer characterization as quantitative analysis of HD data. In addition, the combination of parameters from two different doses may provide useful diagnostic information.
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Affiliation(s)
- Xueyan Zhou
- School of Technology, Harbin University, Harbin, China; Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | - Xiaobing Fan
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | - Devkumar Mustafi
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | - Federico Pineda
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | - Erica Markiewicz
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | - Marta Zamora
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | - Deepa Sheth
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | | | - Aytekin Oto
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | - Gregory S Karczmar
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States.
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22
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Abstract
In this Comment, Balogun and Olopade highlight opportunities and initiatives for incorporating genomics into cancer management to promote health equity.
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23
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Moran CJ. Editorial for "Investigation of synthetic relaxometry and diffusion measures in the differentiation of benign and malignant breast lesions as compared to BI-RADS". J Magn Reson Imaging 2020; 53:1128-1129. [PMID: 33345382 DOI: 10.1002/jmri.27480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/23/2023] Open
Affiliation(s)
- Catherine J Moran
- Department of Radiology, Stanford University, Stanford, California, USA
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24
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Mulder RL, Hudson MM, Bhatia S, Landier W, Levitt G, Constine LS, Wallace WH, van Leeuwen FE, Ronckers CM, Henderson TO, Moskowitz CS, Friedman DN, Ng AK, Jenkinson HC, Demoor-Goldschmidt C, Skinner R, Kremer LC, Oeffinger KC. Updated Breast Cancer Surveillance Recommendations for Female Survivors of Childhood, Adolescent, and Young Adult Cancer From the International Guideline Harmonization Group. J Clin Oncol 2020; 38:4194-4207. [PMID: 33078972 PMCID: PMC7723685 DOI: 10.1200/jco.20.00562] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE As new evidence is available, the International Late Effects of Childhood Cancer Guideline Harmonization Group has updated breast cancer surveillance recommendations for female survivors of childhood, adolescent, and young adult cancer. METHODS We used evidence-based methods to apply new knowledge in refining the international harmonized recommendations developed in 2013. The guideline panel updated the systematic literature review, developed evidence summaries, appraised the evidence, and updated recommendations on the basis of evidence, clinical judgement, and consideration of benefits versus the harms of the surveillance interventions while attaining flexibility in implementation across different health care systems. The GRADE Evidence-to-Decision framework was used to translate evidence to recommendations. A survivor information form was developed to counsel survivors about the potential harms and benefits of surveillance. RESULTS The literature update identified new study findings related to the effects of prescribed moderate-dose chest radiation (10 to 19 Gy), radiation dose-volume, anthracyclines and alkylating agents in non-chest irradiated survivors, and the effects of ovarian function on breast cancer risk. Moreover, new data from prospective investigations were available regarding the performance metrics of mammography and magnetic resonance imaging among survivors of Hodgkin lymphoma. Modified recommendations include the performance of mammography and breast magnetic resonance imaging for survivors treated with 10 Gy or greater chest radiation (strong recommendation) and upper abdominal radiation exposing breast tissue at a young age (moderate recommendation) at least annually up to age 60 years. As a result of inconsistent evidence, no recommendation could be formulated for routine breast cancer surveillance for survivors treated with any type of anthracyclines in the absence of chest radiation. CONCLUSION The newly identified evidence prompted significant change to the recommendations formulated in 2013 related to moderate-dose chest radiation and anthracycline exposure as well as breast cancer surveillance modality.
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Affiliation(s)
- Renée L. Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Melissa M. Hudson
- Departments of Epidemiology and Cancer Control, and Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship and Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship and Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gill Levitt
- Department of Oncology/Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Louis S. Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - W. Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Flora E. van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Cécile M. Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Institute for Biostatistics and Registry Research, Medical University Brandenburg, Theodor Fontane, Neuruppin, Germany
| | - Tara O. Henderson
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Chaya S. Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle N. Friedman
- Departments of Pediatrics and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Helen C. Jenkinson
- Department of Paediatric Oncology, Birmingham Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom
| | - Charlotte Demoor-Goldschmidt
- Centre for Research in Epidemiology and Population Health, Cancer and Radiation team, University of Paris-Sud, Villejuif, France
- Department of Pediatric and Adolescent Hematology/Oncology, CHU Angers, Angers, France
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children’s Hospital and Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Leontien C.M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
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Breast Cancer Mortality among Women with a BRCA1 or BRCA2 Mutation in a Magnetic Resonance Imaging Plus Mammography Screening Program. Cancers (Basel) 2020; 12:cancers12113479. [PMID: 33238387 PMCID: PMC7700272 DOI: 10.3390/cancers12113479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Women with a BRCA1 or BRCA2 gene mutation have up to an 80% lifetime risk of breast cancer unless their breasts are surgically removed, but many decline or defer surgery and choose screening, hoping that if cancer occurs, it will be detected at a curable stage. In this study 489 women with a BRCA1 or BRCA2 mutation aged from 25 to 65 years, who had never had breast or ovarian cancer, were screened annually with breast magnetic resonance imaging (MRI) in addition to mammography and were followed for an average of 13 years (range: 9 to 23 years). Ninety-five of the 489 women enrolled in the study had a bilateral preventive mastectomy in the follow-up period. Of the 91 women diagnosed with breast cancer, four died of breast cancer. The most common cause of death was ovarian cancer. For women with BRCA mutations who choose annual screening with MRI and mammography, the probability of dying of breast cancer within 20 years is 2%. Abstract Annual breast magnetic resonance imaging (MRI) plus mammography is the standard of care for screening women with inherited BRCA1/2 mutations. However, long-term breast cancer-related mortality with screening is unknown. Between 1997 and June 2011, 489 previously unaffected BRCA1/2 mutation carriers aged 25 to 65 years were screened with annual MRI plus mammography on our study. Thereafter, participants were eligible to continue MRI screening through the high-risk Ontario Breast Screening Program. In 2019, our data were linked to the Ontario Cancer Registry of Cancer Care Ontario to identify all incident cancers, vital status and causes of death. Observed breast cancer mortality was compared to expected mortality for age-matched women in the general population. There were 91 women diagnosed with breast cancer (72 invasive and 19 ductal carcinoma in situ (DCIS)) with median follow-up 7.4 (range: 0.1 to 19.2) years. Four deaths from breast cancer were observed, compared to 2.0 deaths expected (standardized mortality ratio (SMR) 2.0, p = 0.14). For the 489 women in the study, the probability of not dying of breast cancer at 20 years from the date of the first MRI was 98.2%. Annual screening with MRI plus mammography is a reasonable option for women who decline or defer risk-reducing mastectomy.
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Abstract
Breast cancer screening is a recognized tool for early detection of the disease in asymptomatic women, improving treatment efficacy and reducing the mortality rate. There is raised awareness that a "one-size-fits-all" approach cannot be applied for breast cancer screening. Currently, despite specific guidelines for a minority of women who are at very high risk of breast cancer, all other women are still treated alike. This article reviews the current recommendations for breast cancer risk assessment and breast cancer screening in average-risk and higher-than-average-risk women. Also discussed are new developments and future perspectives for personalized breast cancer screening.
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Affiliation(s)
- Carolina Rossi Saccarelli
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA; Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil
| | - Almir G V Bitencourt
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA; Department of Imaging, A.C. Camargo Cancer Center, Rua Prof. Antônio Prudente, 211, São Paulo, SP 01509-010, Brazil
| | - Elizabeth A Morris
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
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Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Adrada BE, Moseley T, Kappadath SC, Whitman GJ, Rauch GM. Molecular Breast Imaging-guided Percutaneous Biopsy of Breast Lesions: A New Frontier on Breast Intervention. JOURNAL OF BREAST IMAGING 2020; 2:484-491. [PMID: 33015619 DOI: 10.1093/jbi/wbaa057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 01/29/2023]
Abstract
Molecular breast imaging (MBI) is an increasingly recognized nuclear medicine imaging modality to detect breast lesions suspicious for malignancy. Recent advances have allowed the development of tissue sampling of MBI-detected lesions using a single-headed camera (breast-specific gamma imaging system) or a dual-headed camera system (MBI system). In this article, we will review current indications of MBI, differences of the two single- and dual-headed camera systems, the appropriate selection of biopsy equipment, billing considerations, and radiation safety. It will also include practical considerations and guidance on how to integrate MBI and MBI-guided biopsy in the current breast imaging workflow.
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Affiliation(s)
- Beatriz E Adrada
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - Tanya Moseley
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - S Cheenu Kappadath
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Gary J Whitman
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
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Dynamic contrast-enhanced magnetic resonance imaging for risk-stratified screening in women with BRCA mutations or high familial risk for breast cancer: are we there yet? Breast Cancer Res Treat 2020; 183:243-250. [PMID: 32621252 DOI: 10.1007/s10549-020-05759-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Women at an elevated lifetime risk for breast cancer (BC), including carriers of pathogenic mutations in BC predisposition genes, are recommended intensified BC screening that includes annual mammography (MG) and annual breast MRI. Controversy exists regarding the clinical utility of MRI as a screening tool in high-risk women. This paper is intended to review recent advances and remaining areas of uncertainty in order to further facilitate the incorporation of breast MRI into an intensified BC screening protocol for women at high familial risk and BRCA carriers. METHODS A multidisciplinary team of medical oncologists and a radiologist specializing in the treatment of BC and high-risk patients searched PubMed to identify studies deemed to have the highest scientific value. Since none of the initial MRI studies were randomized, meta-analyses examining breast MRI screening in high-risk women were prioritized for inclusion. RESULTS Breast MRI performs well in high-risk women, including mutation carriers. Breast MRI screening allows for the detection of early stage, likely curable invasive BC. It is mandatory that radiologists receive appropriate MRI training to reduce false positives and unnecessary biopsies. MRI screening is cost-effective in the highest risk patients and new clinical trials are open examining abbreviated and ultra-fast MRI techniques as a tool to drive down costs and improve specificity. CONCLUSIONS As breast MRI is recommended as part of an intensified screening program in addition to mammography for high-risk women, it important that health care providers understand the benefits and limitations of this screening modality for high-risk women, as well as areas for further investigation.
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Alonso Roca S, Delgado Laguna AB, Arantzeta Lexarreta J, Cajal Campo B, López Ruiz A. Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. RADIOLOGIA 2020; 62:417-433. [PMID: 32527577 DOI: 10.1016/j.rx.2020.04.009] [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: 03/28/2019] [Revised: 03/12/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
For women with a high risk of breast cancer, early detection plays an important role. Due to the high incidence of breast cancer, and at a younger age than in the general population, screening begins earlier, and there is considerable evidence that magnetic resonance is the most sensitive diagnostic tool, and the principal American and European guidelines agree on the recommendation to perform annual magnetic resonance (with supplemental annual mammography) as an optimal mode of screening. In addition to the absence of current consensus on which patients should be included in the recommendation for magnetic resonance screening (widely discussed in the introduction of part 1 of this work), there are other aspects that are different between guidelines, that are not specified, or that are susceptible to change based on the evidence of several years of experience, that we have called «controversies», such as the age to begin screening, the possible advisability of using a different strategy in different subgroups, performing alternate versus synchronous magnetic resonance and mammography, the age at which to terminate the two techniques, or how to follow up after risk reduction surgery.The aim of the second part of the paper is, by reviewing the literature, to provide an update in relation to some of the main «controversies» in high risk screening with magnetic resonance. And finally, based on all this, to propose a possible model of optimal and updated screening protocol.
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Affiliation(s)
- S Alonso Roca
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - A B Delgado Laguna
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J Arantzeta Lexarreta
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - B Cajal Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - A López Ruiz
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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He Z, Chen Z, Tan M, Elingarami S, Liu Y, Li T, Deng Y, He N, Li S, Fu J, Li W. A review on methods for diagnosis of breast cancer cells and tissues. Cell Prolif 2020; 53:e12822. [PMID: 32530560 PMCID: PMC7377933 DOI: 10.1111/cpr.12822] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023] Open
Abstract
Breast cancer has seriously been threatening physical and mental health of women in the world, and its morbidity and mortality also show clearly upward trend in China over time. Through inquiry, we find that survival rate of patients with early‐stage breast cancer is significantly higher than those with middle‐ and late‐stage breast cancer, hence, it is essential to conduct research to quickly diagnose breast cancer. Until now, many methods for diagnosing breast cancer have been developed, mainly based on imaging and molecular biotechnology examination. These methods have great contributions in screening and confirmation of breast cancer. In this review article, we introduce and elaborate the advances of these methods, and then conclude some gold standard diagnostic methods for certain breast cancer patients. We lastly discuss how to choose the most suitable diagnostic methods for breast cancer patients. In general, this article not only summarizes application and development of these diagnostic methods, but also provides the guidance for researchers who work on diagnosis of breast cancer.
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Affiliation(s)
- Ziyu He
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China
| | - Zhu Chen
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China.,State Key Laboratory of Bioelectronics, School of Biological and Medical Engineering, Southeast University, Nanjing, China
| | - Miduo Tan
- Surgery Department of Galactophore, Central Hospital of Zhuzhou City, Zhuzhou, China
| | - Sauli Elingarami
- School of Life Sciences and Bioengineering (LiSBE), The Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Yuan Liu
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China.,State Key Laboratory of Bioelectronics, School of Biological and Medical Engineering, Southeast University, Nanjing, China
| | - Taotao Li
- Hunan Provincial Key Lab of Dark Tea and Jin-hua, School of Materials and Chemical Engineering, Hunan City University, Yiyang, China
| | - Yan Deng
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China
| | - Nongyue He
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China.,State Key Laboratory of Bioelectronics, School of Biological and Medical Engineering, Southeast University, Nanjing, China
| | - Song Li
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China
| | - Juan Fu
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Wen Li
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China
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Lee RT, Amico A, Malaka D, Lewin R, Cummings SA, Verp M, Patrick-Miller L, Bradbury AR, Olopade OI. Utilization of Complementary Alternative Medicine, Diet, and Exercise Among Women at High Risk for Developing Breast Cancer. Integr Cancer Ther 2020; 19:1534735420922610. [PMID: 32448019 PMCID: PMC7249552 DOI: 10.1177/1534735420922610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Women diagnosed as having a high risk for breast cancer
(HR-BC) often seek different health behaviors (HBs) such as complementary and
alternative medicine (CAM), diet, and exercise to improve their health and
cancer outcome. Methods: Women already enrolled in a multimodality
screening study for patients at HR-BC (gene mutation carrier or >20%
cumulative lifetime risk) were given a questionnaire to evaluate their use of
CAM therapies, diet, and exercise before and after a diagnosis of HR-BC.
Patients were also asked to complete the Short-Form 36, State-Trait Anxiety
Inventory, and Beck Depression Inventory. Results: A total of 134
(67%) subjects completed the survey from the original cohort. General
characteristics included a median age of 46 years (range = 24-73 years),
majority were White (91%), BRCA1/2 gene mutation carrier (49%),
and prior diagnosis of breast and/or ovarian cancer (30%). Almost all of the
patients reported a lifetime prevalence of any HB (97%) and CAM utilization
(91%). Subjects also had a high lifetime utilization of exercise (83%), herbs
and supplements(72%), and diet programs (58%). All of these HBs declined in
utilization after diagnosis of HR-BC by as much as 30%. After diagnosis of a
HR-BC, a personal history of breast and/or ovarian cancer was significantly
correlated with increased use of CAM (odds ratio [OR] = 5.9, P
< .01), herbs and supplements (OR = 4.3, P < .01), and
diet program (OR = 4.4, P < .01) in multivariate analysis.
Conclusions: HBs such as CAM, diet, and exercise are highly
prevalent among women with HR-BC, and the utilization of HB decreases
significantly after diagnosis of HR-BC.
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Affiliation(s)
- Richard T Lee
- Case Western Reserve University and University Hospitals, Cleveland, OH, USA
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Tumor Contrast Enhancement and Whole-Body Elimination of the Manganese-Based Magnetic Resonance Imaging Contrast Agent Mn-PyC3A. Invest Radiol 2020; 54:697-703. [PMID: 31356382 DOI: 10.1097/rli.0000000000000593] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The goals of this study were to compare the efficacy of the new manganese-based magnetic resonance imaging (MRI) contrast agent Mn-PyC3A to the commercial gadolinium-based agents Gd-DOTA and to Gd-EOB-DTPA to detect tumors in murine models of breast cancer and metastatic liver disease, respectively, and to quantify the fractional excretion and elimination of Mn-PyC3A in rats. METHODS T1-weighted contrast-enhanced MRI with 0.1 mmol/kg Mn-PyC3A was compared with 0.1 mmol/kg Gd-DOTA in a breast cancer mouse model (n = 8) and to 0.025 mmol/kg Gd-EOB-DTPA in a liver metastasis mouse model (n = 6). The fractional excretion, 1-day biodistribution, and 7-day biodistribution in rats after injection of 2.0 mmol/kg [Mn]Mn-PyC3A or Gd-DOTA were quantified by Mn gamma counting or Gd elemental analysis. Imaging data were compared with a paired t test; biodistribution data were compared with an unpaired t test. RESULTS The postinjection-preinjection increases in tumor-to-muscle contrast-to-noise ratio (ΔCNR) 3 minutes after injection of Mn-PyC3A and Gd-DOTA (mean ± standard deviation) were 17 ± 3.8 and 20 ± 4.4, respectively (P = 0.34). Liver-to-tumor ΔCNR values at 8 minutes postinjection of Mn-PyC3A and Gd-EOB-DTPA were 28 ± 9.0 and 48 ± 23, respectively (P = 0.11). Mn-PyC3A is eliminated with 85% into the urine and 15% into the feces after administration to rats. The percentage of the injected doses (%ID) of Mn and Gd recovered in tissues after 1 day were 0.32 ± 0.12 and 0.57 ± 0.12, respectively (P = 0.0030), and after 7 days were 0.058 ± 0.051 and 0.19 ± 0.052, respectively (P < 0.0001). CONCLUSIONS Mn-PyC3A provides comparable tumor contrast enhancement to Gd-DOTA in a mouse breast cancer model and is more completely eliminated than Gd-DOTA; partial hepatobiliary elimination of Mn-PyC3A enables conspicuous delayed phase visualization of liver metastases.
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Achatz MI, Caleffi M, Guindalini R, Marques RM, Nogueira-Rodrigues A, Ashton-Prolla P. Recommendations for Advancing the Diagnosis and Management of Hereditary Breast and Ovarian Cancer in Brazil. JCO Glob Oncol 2020; 6:439-452. [PMID: 32155091 PMCID: PMC7113069 DOI: 10.1200/jgo.19.00170] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The objective of this review was to address the barriers limiting access to genetic cancer risk assessment and genetic testing for individuals with suspected hereditary breast and ovarian cancer (HBOC) through a review of the diagnosis and management steps of HBOC. METHODS A selected panel of Brazilian experts in fields related to HBOC was provided with a series of relevant questions to address before the multiday conference. During this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion, until a consensus was achieved. RESULTS The authors propose specific and realistic recommendations for improving access to early diagnosis, risk management, and cancer care of HBOC specific to Brazil. Moreover, in creating these recommendations, the authors strived to address all the barriers and impediments mentioned in this article. CONCLUSION There is a great need to expand hereditary cancer testing and counseling in Brazil, and changing current policies is essential to accomplishing this goal. Increased knowledge and awareness, together with regulatory actions to increase access to this technology, have the potential to improve patient care and prevention and treatment efforts for patients with cancer across the country.
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Affiliation(s)
| | - Maira Caleffi
- Nucleo Mama Porto Alegre and Associação Hospitalar Moinhos de Vento, Porto Alegre, Brazil
| | - Rodrigo Guindalini
- Oncologia D’or, Rede D’or São Luiz, Brazil
- Centro de Investigação Translacional em Oncologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Renato Moretti Marques
- Programa da Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Centro de Oncologia e Hematologia, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Angelica Nogueira-Rodrigues
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Grupo Brasileiro de Oncologia Ginecológica, Belo Horizonte, Brazil
- DOM Oncologia, Minas Gerais, Brazil
| | - Patricia Ashton-Prolla
- Departmento de Genética, Universidade Federal do Rio Grande do Sul
- Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Saccarelli CR, Bitencourt AGV, Morris EA. Breast Cancer Screening in High-Risk Women: Is MRI Alone Enough? J Natl Cancer Inst 2020; 112:121-122. [PMID: 31233125 PMCID: PMC7019094 DOI: 10.1093/jnci/djz130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carolina Rossi Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Almir G V Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Imaging, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY
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Breast cancer surveillance for BRCA1/2 mutation carriers - is "early detection" early enough? Breast 2019; 49:81-86. [PMID: 31760168 PMCID: PMC7375664 DOI: 10.1016/j.breast.2019.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 11/18/2022] Open
Abstract
Background Annual MRI screening is associated with a significant reduction in advanced-stage breast cancer diagnosis in BRCA1/2 mutation carriers. The impact that early detection has on subsequent oncological treatment is less frequently reported. In this study we compared disease stage and therapeutic approaches in BRCA1/2 mutation carriers who developed breast cancer while adhering to the recommended surveillance scheme (“known carriers”), with women who became aware of their BRCA mutation status after breast cancer diagnosis (“latent carriers"). Methods Data on tumor characteristics, disease stage, and therapeutic decisions were collected on BRCA1/2 mutation carriers treated for breast cancer at the Chaim Sheba Medical Center. Results Data were available for 298 BRCA1/2 carriers. Median follow-up was 77.4 months (range, 3.5–520). Age at diagnosis was not statistically different between known carriers (n = 96; median age at diagnosis 44.7 years) and latent carriers (n = 202; 43.7 years); p = 0.8284. Of known carriers, 19.8% were diagnosed with carcinoma in situ vs. 5% of latent carriers (p = 0.0012). Stage T1N0 disease was diagnosed in 54/96 (56.3%) of known carriers vs. 59/202 (29.2%) of latent carriers (p < 0.00001). Neoadjuvant or adjuvant chemotherapy was administered to 46/96 (47.9%) of known carriers compared with 162/202 (80.2%) of latent carriers (p < 0.00001). Conclusions While early stage breast cancer was diagnosed frequently among known BRCA1/2 carriers under tight surveillance, almost half of these women were treated with chemotherapy. Healthy BRCA1/2 mutation carriers should be informed about these rates while discussing risk-reducing surgical options. Annual MRI screening is recommended to healthy BRCA1/2 mutation carriers. Intensive surveillance enables breast cancer diagnosis at early stages. In this study ∼50% of early stage diagnosed patients received chemotherapy. This rate should be discussed with BRCA carriers considering risk-reducing options.
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Slepicka PF, Cyrill SL, Dos Santos CO. Pregnancy and Breast Cancer: Pathways to Understand Risk and Prevention. Trends Mol Med 2019; 25:866-881. [PMID: 31383623 DOI: 10.1016/j.molmed.2019.06.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 12/14/2022]
Abstract
Several studies have made strong efforts to understand how age and parity modulate the risk of breast cancer. A holistic understanding of the dynamic regulation of the morphological, cellular, and molecular milieu of the mammary gland offers insights into the drivers of breast cancer development as well as into potential prophylactic interventions, the latter being a longstanding ambition of the research and clinical community aspiring to eradicate the disease. In this review we discuss mechanisms that react to pregnancy signals, and we delineate the nuances of pregnancy-associated dynamism that contribute towards either breast cancer development or prevention. Further definition of the molecular basis of parity and breast cancer risk may allow the elaboration of tools to predict and survey those who are at risk of breast cancer development.
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Affiliation(s)
- Priscila F Slepicka
- Cold Spring Harbor Laboratory, 1 Bungtown Road, Cold Spring Harbor, NY 11724, USA
| | - Samantha L Cyrill
- Cold Spring Harbor Laboratory, 1 Bungtown Road, Cold Spring Harbor, NY 11724, USA
| | - Camila O Dos Santos
- Cold Spring Harbor Laboratory, 1 Bungtown Road, Cold Spring Harbor, NY 11724, USA.
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Rajagopal PS, Nielsen S, Olopade OI. USPSTF Recommendations for BRCA1 and BRCA2 Testing in the Context of a Transformative National Cancer Control Plan. JAMA Netw Open 2019; 2:e1910142. [PMID: 31434110 DOI: 10.1001/jamanetworkopen.2019.10142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Sarah Nielsen
- Center for Clinical Cancer Genetics, The University of Chicago, Chicago, Illinois
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics, The University of Chicago, Chicago, Illinois
- Center for Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
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Mann RM, Kuhl CK, Moy L. Contrast-enhanced MRI for breast cancer screening. J Magn Reson Imaging 2019; 50:377-390. [PMID: 30659696 PMCID: PMC6767440 DOI: 10.1002/jmri.26654] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/15/2022] Open
Abstract
Multiple studies in the first decade of the 21st century have established contrast-enhanced breast MRI as a screening modality for women with a hereditary or familial increased risk for the development of breast cancer. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. The specificity increases in follow-up rounds to around 97%, with positive predictive values for biopsy in the same range as for mammography. MRI preferentially detects the more aggressive/invasive types of breast cancer, but has a higher sensitivity than mammography for any type of cancer. This performance implies that in women screened with breast MRI, all other examinations must be regarded as supplemental. Mammography may yield ~5% additional cancers, mostly ductal carcinoma in situ, while slightly decreasing specificity and increasing the costs. Ultrasound has no supplemental value when MRI is used. Evidence is mounting that in other groups of women the performance of MRI is likewise superior to more conventional screening techniques. Particularly in women with a personal history of breast cancer, the gain seems to be high, but also in women with a biopsy history of lobular carcinoma in situ and even women at average risk, similar results are reported. Initial outcome studies show that breast MRI detects cancer earlier, which induces a stage-shift increasing the survival benefit of screening. Cost-effectiveness is still an issue, particularly for women at lower risk. Since costs of the MRI scan itself are a driving factor, efforts to reduce these costs are essential. The use of abbreviated MRI protocols may enable more widespread use of breast MRI for screening. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:377-390.
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Affiliation(s)
- Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Radiology, the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen, Aachen, Germany
| | - Linda Moy
- Center for Advanced Imaging Innovation and Research / Department of Radiology, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York, USA
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Kuhl CK, Schrading S. More Is More: Semiannual Breast MRI Screening in BRCA1 Mutation Carriers. Clin Cancer Res 2018; 25:1693-1695. [PMID: 30429200 DOI: 10.1158/1078-0432.ccr-18-3145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 10/30/2018] [Accepted: 11/09/2018] [Indexed: 11/16/2022]
Abstract
Although annual MRI screening has improved early diagnosis of hereditary breast cancer, fast growth rates of BRCA1-associated cancers can still lead to interval cancers and/or node-positive disease. Using MRI with shorter screening intervals helps to effectively avoid both interval cancers and node-positive stages, whereas there is no role for mammography in these women.See related article by Guindalini et al., p. 1786.
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Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, Aachen, Germany.
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, Aachen, Germany
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