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Klein KA, Kocher M, Lourenco AP, Niell BL, Bennett DL, Chetlen A, Freer P, Ivansco LK, Jochelson MS, Kremer ME, Malak SF, McCrary M, Mehta TS, Neal CH, Porpiglia A, Ulaner GA, Moy L. ACR Appropriateness Criteria® Palpable Breast Masses: 2022 Update. J Am Coll Radiol 2023; 20:S146-S163. [PMID: 37236740 DOI: 10.1016/j.jacr.2023.02.013] [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: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Palpable masses in women are the most common symptom associated with breast cancer. This document reviews and evaluates the current evidence for imaging recommendations of palpable masses in women less than 30 to over 40 years of age. There is also a review of several different scenarios and recommendations after initial imaging. Ultrasound is usually the appropriate initial imaging for women under 30 years of age. If ultrasound findings are suspicious or highly suggestive of malignancy (BIRADS 4 or 5), it is usually appropriate to continue with diagnostic tomosynthesis or mammography with image-guided biopsy. No further imaging is recommended if the ultrasound is benign or negative. The patient under 30 years of age with a probably benign ultrasound may undergo further imaging; however, the clinical scenario plays a role in the decision to biopsy. For women between 30 to 39 years of age, ultrasound, diagnostic mammography, tomosynthesis, and ultrasound are usually appropriate. Diagnostic mammography and tomosynthesis are the appropriate initial imaging for women 40 years of age or older, as ultrasound may be appropriate if the patient had a negative mammogram within 6 months of presentation or immediately after mammography findings are suspicious or highly suggestive of malignancy. If the diagnostic mammogram, tomosynthesis, and ultrasound findings are probably benign, no further imaging is necessary unless the clinical scenario indicates a biopsy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Maddi Kocher
- Research Author, Duke University Medical Center, Durham, North Carolina
| | - Ana P Lourenco
- Panel Chair, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bethany L Niell
- Panel Vice-Chair, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Alison Chetlen
- Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | | | | | | | - Mallory E Kremer
- University of Washington, Seattle, Washington; American College of Obstetricians and Gynecologists
| | | | - Marion McCrary
- Duke Signature Care, Durham, North Carolina; American College of Physicians
| | - Tejas S Mehta
- UMass Memorial Medical Center/UMass Chan Medical School, Worcester, Massachusetts
| | | | - Andrea Porpiglia
- Fox Chase Cancer Center, Philadelphia, Pennsylvania; American College of Surgeons
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California and University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York
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Turan M, Sozen F, Eminsoy MG, Sencelikel T, Kut A, Yildirim S, Oksuz E. Practical Utility of Diagnostic Clinical Breast Examination in the Diagnosis of Breast Cancer. Cureus 2021; 13:e17662. [PMID: 34646704 PMCID: PMC8487246 DOI: 10.7759/cureus.17662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives We aimed to investigate the effectiveness of physician-performed diagnostic clinical breast examination (DCBE) for the diagnosis of breast cancer in clinical practice and to determine the rates of breast cancer diagnosed with DCBE compared to the results of breast ultrasonography (US), mammography (MG), and histopathology. Methods In the retrospective cohort study, the files of female patients diagnosed with breast cancer and admitted to the general surgery outpatient clinics of a university hospital over a 10-year period (2011-2021) were examined. Patients with complete DCBE findings in their files were identified and analyzed (n = 1,091). The examinations of the patients were performed by general surgery specialists with 5-22 years of experience and by radiologists with 4-15 years of experience. Results The mean age of breast cancer diagnosis of the patients was 55.1 ± 13.5 years. While the sensitivity of DCBE was found to be 88.9%, MG sensitivity was 89.8% and breast US sensitivity was 95.1%. Cancer was detected by MG, breast US, and DCBE in 47.9% (n = 523), by breast US and DCBE in 38.9% (n = 424), by MG and breast US in 5.6% (n = 61), by DCBE alone in 3.6% (n = 39), by MG and DCBE in 2.4% (n = 26), and by breast US alone in 1.6% (n = 18). Early-stage breast cancer (p = 0.00) consisted of 73.2% (n = 383) of cancers detected with DCBE, breast US and MG, 74.6% (n = 316) of cancers detected with DCBE and breast US, 93.4% of cancers detected with breast US and MG (n = 57), 92.3% (n = 24) of cancers detected with DCBE and MG, 94.4% (n = 17) of cancers detected with breast US alone, and 69.2% of cancers detected with DCBE alone (n = 27). Conclusions CBE still maintains its importance in societies where screening participation and awareness of breast cancer are low. A breast cancer diagnosis is often done after a complaint of a palpable mass in the breast, and only then are more advanced-stage breast cancers are seen. CBE is among the important diagnostic methods preventing breast cancer from being overlooked, especially in places where health resources are limited.
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Affiliation(s)
- Muberra Turan
- Family Medicine, Baskent University Faculty of Medicine, Ankara, TUR
| | - Fisun Sozen
- Family Medicine, Baskent University Faculty of Medicine, Ankara, TUR
| | | | - Tugce Sencelikel
- Biostatistics, Baskent University Faculty of Medicine, Ankara, TUR
| | - Altug Kut
- Family Medicine, Baskent University Faculty of Medicine, Ankara, TUR
| | - Sedat Yildirim
- General Surgery, Baskent University Faculty of Medicine, Ankara, TUR
| | - Ergun Oksuz
- Family Medicine, Baskent University Faculty of Medicine, Ankara, TUR
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Portnow LH, D'Alessio D, Morris EA, Bernard-Davila B, Mango VL. Palpable Breast Findings in High-risk Patients: Are Self- and Clinical Breast Exams Worthwhile? JOURNAL OF BREAST IMAGING 2021; 3:190-195. [PMID: 38424818 DOI: 10.1093/jbi/wbaa105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To assess breast imaging findings, biopsy rates, and malignancy rates in areas of palpable concern in women at high risk for breast cancer. METHODS An IRB-approved retrospective review of a tertiary cancer center's breast imaging database was performed. Breast imaging and electronic medical records of high-risk women with palpable findings detected on self- or clinical breast examination from January 1, 2010, to January 1, 2016, were reviewed. Descriptive statistical analyses were conducted. RESULTS Imaging correlates for 322 palpable findings in 238 high-risk women included 55/203 (27.1%) on mammography, 183/302 (60.6%) on US, and 20/47 (42.6%) on MRI. Biopsies were performed for 104/322 (32.3%) palpable findings: 95/104 (91.3%) under imaging guidance and 9/104 (8.7%) under palpation after negative imaging. Of 322 palpable findings, 16 (5.0%) were malignant in 16/238 (6.7%) women, yielding a positive predictive value of biopsy of 16.8% (95% CI: 9.2%-24%). Women diagnosed with cancer had 16/16 (100%) sonographic, 9/14 (64.3%) mammographic, and 7/7 (100%) MRI correlates. Cancer histopathology included 12 invasive ductal carcinomas, 1 ductal carcinoma in situ, 1 invasive lobular carcinoma, 1 malignant phyllodes tumor, and 1 metastatic carcinoid tumor. Over two years of follow-up imaging in 183/238 (76.9%) women were reviewed; 7/183 (3.8%) were diagnosed with breast cancer at least one year after presenting with a palpable concern in a different location. CONCLUSION High-risk women with palpable findings exhibit a 6.7% malignancy rate, indicating the value of imaging workup in this population. In our cohort, imaging demonstrated a high negative predictive value.
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Affiliation(s)
- Leah H Portnow
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, New York, NY
| | - Donna D'Alessio
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, New York, NY
| | - Elizabeth A Morris
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, New York, NY
| | - Blanca Bernard-Davila
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, New York, NY
| | - Victoria L Mango
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, New York, NY
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Sabet F, Zoghoul S, Alahmad M, Al Qudah H. The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:98. [PMID: 32234037 PMCID: PMC7110726 DOI: 10.1186/s12909-020-02002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex. METHODS A cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students' perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students' confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis. RESULTS One hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student's clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13-3.79) and as high as 3.06 (1.53-6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27-0.88) for cardiovascular and 0.39 (0.21-0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04-0.28) and vaginal examinations 0.22 (0.02-1.98) and more male students conducting prostate examinations OR 11.00 (1.39-87.03) and male genitalia examinations OR 16.31 (3.75-70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all. CONCLUSIONS In our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching. TRIAL REGISTRATION Non interventional thus not required.
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Affiliation(s)
- Farnaz Sabet
- Formerly at Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sohaib Zoghoul
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Murad Alahmad
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba Al Qudah
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Sánchez-Jáuregui T, Téllez A, Juárez-García D, García CH, García FE. Clinical Hypnosis and Music In Breast Biopsy:A Randomized Clinical Trial. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2019; 61:244-257. [PMID: 30632924 DOI: 10.1080/00029157.2018.1489776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A randomized clinical study was conducted to evaluate the effects on anxiety, depression, stress and optimism levels of an audio-recorded clinical hypnosis intervention and a music session and compare them with a control group in women scheduled for breast biopsy. We analyzed the data of 170 patients with an average age of 47 years, who were randomly assigned to each of the groups. The psychosocial variables were measured in three moments: baseline, which corresponds to the period before the intervention with hypnosis, music or waiting in the room before biopsy; a second measurement after the interventions and a third measurement after the breast biopsy procedure was finished. The results showed a statistically significant reduction in the stress (p < .001, η2p = .06); pain, (p < .01, η2p = .04); anxiety, (p < .001, ƞ2p = .07) and depression, (p < .001, ƞ2p = .05) in hypnosis and music groups compared with the control group. Before biopsy, hypnosis decrease significantly pain and depression levels compared with music, but after biopsy there were no differences between both groups. It is recommended to use audio-recorded hypnosis and music interventions to reduce physical and emotional discomfort during the biopsy procedure and to improve the quality of life of patients with suspected breast cancer.
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Abstract
Screening mammography and evolving treatments have improved mortality over the last 25 years. However, breast cancer remains the second leading cause of cancer-related mortality for women in the United States. There are several contradictory recommendations regarding breast cancer screening. Familiarity with these recommendations will allow physicians to counsel their patients and ensure well-informed shared decision making.
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Hawley JR, Kang-Chapman JK, Bonnet SE, Kerger AL, Taylor CR, Erdal BS. Diagnostic Accuracy of Digital Breast Tomosynthesis in the Evaluation of Palpable Breast Abnormalities. Acad Radiol 2018; 25:297-304. [PMID: 29174225 DOI: 10.1016/j.acra.2017.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/14/2017] [Accepted: 09/25/2017] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The role of digital breast tomosynthesis (DBT) in evaluating palpable abnormalities has not been evaluated and its accuracy compared to 2D mammography is unknown. The purpose of this study was to evaluate combined 2D mammography, DBT, and ultrasound (US) at palpable sites. MATERIALS AND METHODS Two breast imagers reviewed blinded consecutive cases with combined 2D mammograms and DBT examinations performed for palpable complaints. By consensus, 2D and DBT findings were recorded and compared to US. Patient characteristics, demographics, subsequent workup, and outcome were recorded. RESULTS A total of 229 sites in 188 patients were included, with 50 biopsies performed identifying 18 cancers. All 18 cancers were identified on 2D and US, whereas 17 cancers were identified on DBT. Cancer detection sensitivities for 2D, DBT, and US were 100.0%, 94.4%, and 100.0%. The negative predictive value, when combined with US, was 100% for both. The sensitivity and the specificity for both benign and malignant findings with 2D and DBT were 70.5% versus 75.4% (P = 0.07) and 95.3% versus 99.1% (P = 0.125). Palpable findings not identified by 2D and DBT were smaller than those identified (11.5 ± 8.3 mm vs 23.9 ± 12.8 mm, P < 0.001). Patients with dense breasts were more likely to have mammographically occult findings than patients with nondense breasts (27.4% vs 8.3%). CONCLUSIONS DBT did not improve cancer detection over 2D or US. Both mammographic modalities failed to identify sonographically confirmed findings primarily in dense breasts. The diagnostic use of DBT at palpable sites provided limited benefit over combined 2D and US. When utilizing DBT, US should be performed to adequately characterize palpable sites.
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Yoshida Y, Schmaltz CL, Jackson-Thompson J, Simoes EJ. The impact of screening on cancer incidence and mortality in Missouri, USA, 2004-2013. Public Health 2017; 154:51-58. [PMID: 29197686 DOI: 10.1016/j.puhe.2017.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Population-based evidence regarding impact of cancer screenings and cancer rates in Missouri is lacking. This study examined whether screenings of breast cancer, cervical cancer, and colorectal cancer impact early-stage cancer incidence and mortality in Missouri. STUDY DESIGN This is an ecological study based on county-specific estimates of selected cancer screening prevalence and early-stage cancer incidence and cancer mortality. METHODS County-specific prevalence of clinical breast examination, mammography, Pap test, sigmoidoscopy or colonoscopy, and fecal occult blood test (FOBT) were generated from Missouri County-Level Study (2003, 2007, and 2011). County-specific crude incidence and mortality were calculated (2004-2013). Pearson's correlation and Poisson regression were used to test association between cancer rate and screening prevalence. Covariates included county-level mean age, percentage of whites, percentage with low income, percentage with less than high school education high school, percentage with no insurance, and percentage having difficulties accessing care. RESULTS In the adjusted model, 'ever had Pap test' was significantly associated with an increase of 8% in early-stage cervical cancer incidence. Having clinical breast examination or Pap test in the past was also associated with decreases in mortality by 3% and 4%, respectively, although the association was not significant for Pap test. In addition, having mammography was statistically significantly associated with early-stage breast cancer incidence, and having FOBT or sigmoidoscopy or colonoscopy was associated with decreased colorectal cancer mortality; however, magnitude for these associations was only around 1%. CONCLUSIONS This study provides ecological evidence of the effectiveness of screening services in predicting early stage cancer incidence and in reducing mortality across Missouri counties. Further incentive to promote these screenings in Missouri is needed.
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Affiliation(s)
- Y Yoshida
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, MO, USA; Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO, USA.
| | - C L Schmaltz
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, MO, USA; Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO, USA
| | - J Jackson-Thompson
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, MO, USA; Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO, USA; MU Informatics Institute, University of Missouri-Columbia, Columbia, MO, USA
| | - E J Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, MO, USA.
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Abstract
Discovery of a breast mass, nipple discharge, or breast pain is a common, anxiety-producing occurrence for many women. Although most irregularities are benign, every woman presenting with a breast complaint should be evaluated to exclude or establish a diagnosis of cancer. The patient visit to the provider for a breast complaint can also present an opportunity for the NP to address and update any needed breast screenings.
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Affiliation(s)
- Mary Alison Smania
- Mary Alison Smania is an assistant professor at Michigan State University, East Lansing, Mich
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Sanvido VM, Watanabe AY, Neto JTDA, Elias S, Facina G, Nazário ACP. Evaluation of the Efficacy of Clinical Breast Examination Gloves in the Diagnosis of Breast Lumps. J Clin Diagn Res 2017; 11:XC01-XC05. [PMID: 28764277 DOI: 10.7860/jcdr/2017/25504.9987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/14/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Recent studies have questioned the efficacy of mammography in reducing breast cancer-related mortality. Additionally, the efficacies of commercially available gloves marketed as aiding the detection of breast lumps have not been independently verified. AIM To evaluate the efficacy of clinical breast examination gloves in the detection of breast lumps. MATERIALS AND METHODS During the period from October 2011 to June 2012, patients were submitted to clinical examination with and without gloves. This prospective study involved 202 patients who underwent conventional clinical breast examination (test 1) or clinical breast examination with Sensifemme® gloves (test 2). All patients underwent subsequent bilateral ultrasonography (test 3) to confirm the findings of the physical examinations. The Chi-square test was used to compare values, while the kappa concordance index was used to determine the concordance between the diagnostic tests. RESULTS The mean age of the patients was 43 years; 298 breast lumps were detected. In the clinical examination group (test 1), sensitivity was 54%, specificity was 78%, and accuracy was 57%. These rates for clinical breast examinations with gloves (test 2) were 68%, 58%, and 66%, respectively. The glove increased the diagnosis of breast nodules by 14%; the rate of false-positives was also higher (42% for test 2 compared to 22% for test 1). The accuracy of the glove was found to be superior to clinical examination after 100 patients had been examined. The kappa indices for test 1 vs. test 3 and for test 2 vs. test 3 were 0.15 and 0.16, respectively. CONCLUSION Clinical examination using the glove was more effective than clinical examination with bare hands for the diagnosis of breast lumps, as it increased the sensitivity and accuracy of lump detection. However, this was at the expense of a higher false-positive rate, which can lead to further tests, unnecessary biopsies, and patient anxiety. The concordance of clinical examination results (whether performed with or without the glove) with those of ultrasonography is weak. Moreover, the glove has a steep learning curve that may discourage its use in certain circumstances.
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Affiliation(s)
- Vanessa Monteiro Sanvido
- Gynaecologist and Mastologist, Department of Gynaecology, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil
| | - Andrea Yumi Watanabe
- Gynaecologist and Mastologist, Department of Gynaecology, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil
| | - Joaquim Teodoro de Araújo Neto
- Gynaecologist and Mastologist, Department of Gynaecology, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil
| | - Simone Elias
- Gynaecologist and Mastologist, Department of Gynaecology, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil
| | - Gil Facina
- Professor, Department of Gynaecology, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil
| | - Afonso Celso Pinto Nazário
- Professor, Department of Gynaecology, Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil
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Moy L, Heller SL, Bailey L, D’Orsi C, DiFlorio RM, Green ED, Holbrook AI, Lee SJ, Lourenco AP, Mainiero MB, Sepulveda KA, Slanetz PJ, Trikha S, Yepes MM, Newell MS. ACR Appropriateness Criteria ® Palpable Breast Masses. J Am Coll Radiol 2017; 14:S203-S224. [DOI: 10.1016/j.jacr.2017.02.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 12/21/2022]
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Breast self-exam and patient interval associate with advanced breast cancer and treatment delay in Mexican women. Clin Transl Oncol 2017; 19:1276-1282. [PMID: 28444642 DOI: 10.1007/s12094-017-1666-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/19/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE The objective of this study was to compare treatment intervals in breast cancer patients according to the detection method (breast self-exam vs screening). PATIENTS AND METHODS We conducted a retrospective analysis including 291 breast cancer patients at a Mexican tertiary referral hospital. RESULTS Breast cancer detection method was mostly breast self-exam (60%). The median patient interval was 60.5 days, and was associated with marital status and socioeconomic level. Differences between the two groups were statistically significant for global interval, p = 0.002; however, health system interval was not statistically different. CONCLUSION In our country, breast cancer screening is opportunistic, with several weaknesses within its management and quality systems. Our study showed that even in specialized health care centers, breast cancer is detected by self-exam in up to 2/3 of patients, which can explain the advanced stages at diagnosis in our country. In developing countries, the immediate health care access for breast cancer patients should be prioritized as an initial step to reduce the global treatment initiation interval in order to reduce mortality.
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Role of Runx2 in breast cancer-mediated bone metastasis. Int J Biol Macromol 2017; 99:608-614. [PMID: 28268169 DOI: 10.1016/j.ijbiomac.2017.03.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/21/2022]
Abstract
Breast cancer is one of the most prevalent forms of cancer in women. The currently available treatment for breast cancer is mostly curative except when it becomes metastatic. One of the major sites for metastasis of breast cancer is the bone. Homing of the circulating tumor cells is tightly regulated including a number of factors present in the cells and their microenvironment. Runx2, a transcription factor plays an important role in osteogenesis and breast cancer mediated bone metastases. One of the recent advances in molecular therapy includes the discovery of the small, non-coding microRNAs (miRNAs) and they target specific genes to reduce their expression at the post-transcriptional level. This review provides an outline of breast cancer mediated bone metastasis and summarizes the recent development on the regulation of Runx2 expression by miRNAs which can lead to novel molecular therapeutics for the same.
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Rajswaroob U, Kannan R, Kannan NS, Tirouaroul T. Effectiveness of Centchroman on Regression of Fibroadenosis and Mastalgia. J Clin Diagn Res 2016; 10:PC10-PC14. [PMID: 27891390 DOI: 10.7860/jcdr/2016/20108.8604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Fibroadenosis and mastalgia are common among the women in reproductive age group. Treatment for these conditions is not yet standardised. Most of the drugs used for fibroadenosis and mastalgia are expensive and have side effects. AIM To find out the efficacy of centchroman, a Selective Estrogens Receptor Modulator (SERM) on regression of fibroadenosis and mastalgia. MATERIALS AND METHODS Fifty one patients with mastalgia/fibroadenosis were treated with centchroman 30mg once daily on alternate days for a period of 3 months and followed up weekly for six months with Mastalgia chart and Visual Analog Scale (VAS) pain score. RESULTS Before starting treatment, four patients presented with pain score of 6 followed by, 37 patients with a score of 4 and 10 patients with a score of 2. All the patients were started on tab centchroman 30mg OD alternate days and were reviewed on weekly basis with Mastalgia chart and VAS pain score for three months. On fifth and sixth visit, 46 patients reported with pain score 0, one with pain score of 2 and four with pain score of 6. The efficacy of centchroman was found to be significant (p-value = 0.001). Three patients (5.9%) reported epigastric pain and ten patients (19.6%) reported menstrual delay. A total of 38 patients did not complain of any side effect. CONCLUSION Our study proves that centchroman is a safe and cost effective drug with significant efficacy on regression of fibroadenosis and mastalgia with minimal side effect.
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Affiliation(s)
- Udayakumar Rajswaroob
- Resident, Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
| | - Rajendiran Kannan
- Associate Professor, Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
| | - Narayanasamy Subbaraju Kannan
- Associate Professor, Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
| | - T Tirouaroul
- Professor and Head, Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
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Keshinro A, Hatzaras I, Rifkind K, Dhage S, Joseph KA. The Impact of Primary Care Providers on Patient Screening Mammography and Initial Presentation in an Underserved Clinical Setting. Ann Surg Oncol 2016; 24:692-697. [PMID: 27766557 DOI: 10.1245/s10434-016-5618-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cancer screening is a key component of primary care, and access to regular screening mammography (SMG) is highly dependent on recommendation and referral by a primary care provider (PCP). Women with no health insurance or who are underinsured often lack access to a regular PCP and thus access to routine screening. METHODS We retrospectively reviewed the charts of 173 surgical patients diagnosed between January 2012 and December 2013. The main outcome variables were PCP status, method of cancer detection, and breast cancer stage at diagnosis. Additional variables included race, age at diagnosis, family history of breast and ovarian cancer, and medical comorbidities. RESULTS Patients with a PCP received more mammograms (SMG) compared with patients without a PCP (61 vs. 37 %; p = 0.003). The majority (73 %) of patients without a PCP presented symptomatically with a palpable mass versus 42 % of patients with a PCP. A significant difference was noted with regard to final pathologic stage of breast cancer between the two groups (p = 0.019), and Caucasian and African American patients were more likely to have locally advanced breast cancer. CONCLUSIONS Underserved patients with a PCP are more likely to present asymptomatically and at an earlier stage of breast cancer compared with patients without a PCP. Community engagement programs that build relationships with patients may help bring vulnerable patients into the healthcare system for routine screening. Moreover, PCP education regarding the subtleties of breast cancer screening guidelines and referral to a breast specialist is also critical in improving outcomes of underserved patients.
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Affiliation(s)
- Ajaratu Keshinro
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA
| | - Ioannis Hatzaras
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA
| | - Kenneth Rifkind
- Department of Surgery, NYU Langone Medical Center, NYU Lutheran Hospital, New York, NY, USA
| | - Shubhada Dhage
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA.
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Provencher L, Hogue J, Desbiens C, Poirier B, Poirier E, Boudreau D, Joyal M, Diorio C, Duchesne N, Chiquette J. Is clinical breast examination important for breast cancer detection? Curr Oncol 2016; 23:e332-9. [PMID: 27536182 PMCID: PMC4974039 DOI: 10.3747/co.23.2881] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Screening clinical breast examination (cbe) is controversial; the use of cbe is declining not only as a screening tool, but also as a diagnostic tool. In the present study, we aimed to assess the value of cbe in breast cancer detection in a tertiary care centre for breast diseases. METHODS This retrospective study of all breast cancers diagnosed between July 1999 and December 2010 at our centre categorized cases according to the mean of detection (cbe, mammography, or both). A cbe was considered "abnormal" in the presence of a mass, nipple discharge, skin or nipple retraction, edema, erythema, peau d'orange, or ulcers. RESULTS During the study period, a complete dataset was available for 6333 treated primary breast cancers. Cancer types were ductal carcinoma in situ (15.3%), invasive ductal carcinoma (75.7%), invasive lobular carcinoma (9.0%), or others (2.2%). Of the 6333 cancers, 36.5% (n = 2312) were detected by mammography alone, 54.8% (n = 3470) by mammography and cbe, and 8.7% (n = 551) by physician-performed cbe alone (or 5.3% if considering ultrasonography). Invasive tumours diagnosed by cbe alone were more often triple-negative, her2-positive, node-positive, and larger than those diagnosed by mammography alone (p < 0.05). CONCLUSIONS A significant number of cancers would have been missed if cbe had not been performed. Compared with cancers detected by mammography alone, those detected by cbe had more aggressive features. Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram.
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Affiliation(s)
- L. Provencher
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- chu de Québec–Université Laval, Quebec City, QC
- Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
| | - J.C. Hogue
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- chu de Québec–Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
| | - C. Desbiens
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- chu de Québec–Université Laval, Quebec City, QC
- Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
| | - B. Poirier
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- chu de Québec–Université Laval, Quebec City, QC
- Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
| | - E. Poirier
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- chu de Québec–Université Laval, Quebec City, QC
- Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
| | - D. Boudreau
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- chu de Québec–Université Laval, Quebec City, QC
- Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
| | - M. Joyal
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- chu de Québec–Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
- Department of Family Medicine, Cancer Research Centre, Université Laval, Quebec City, QC
| | - C. Diorio
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
- Department of Social and Preventive Medicine, Cancer Research Centre, Université Laval, Quebec City, QC
| | - N. Duchesne
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- chu de Québec–Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
- Department of Medical Imaging, Cancer Research Centre, Université Laval, Quebec City, QC
| | - J. Chiquette
- Centre des maladies du sein Deschênes-Fabia, chu de Québec–Université Laval, Quebec City, QC
- chu de Québec–Université Laval, Quebec City, QC
- Oncology Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
- Department of Family Medicine, Cancer Research Centre, Université Laval, Quebec City, QC
- Public Health Research Unit, Centre de Recherche du chu de Québec–Université Laval, Quebec City, QC
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Garg P. Awareness that early cancer lump is painless could decrease breast cancer mortality in developing countries. World J Clin Oncol 2016; 7:321-323. [PMID: 27298772 PMCID: PMC4896900 DOI: 10.5306/wjco.v7.i3.321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/10/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
There are several factors which contribute to patients’ reporting late to healthcare facility even after detecting the breast lump (patient delay). Amongst these, one of the important factors in low- and middle-income countries is lack of awareness that early cancer lump is painless (ECLIPs). Pain is often taken as a danger sign and absence of pain is often not taken seriously. The studies have shown that up to 98% of women in low-income countries are unaware that a painless lump could be a warning sign of early breast cancer. This fact is significant because this could be one of the prime reasons for the women having discovered a painless lump in the breast, accidentally or by breast self-examination, presume it to be harmless and don’t report early to health care facility. Therefore, creating awareness about ECLIPs could be an effective strategy to reduce mortality due to breast cancer in low- and middle-income countries. Moreover, unlike modifying risk factors which requires long term behavior modification, creating awareness about ECLIPs is easy and cost effective.
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Janaki KL, Kannan NS, Palaniappan M, Nandi P. Profile of Breast Diseases in Post Pubertal Women Assessed By Clinical Breast Examination - A Community Based Study in Rural Pondicherry. J Clin Diagn Res 2016; 10:PC07-11. [PMID: 27042516 DOI: 10.7860/jcdr/2016/17264.7276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/07/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Breast diseases in women, whether benign or malignant, are very commonly encountered. Benign diseases are under reported and cancer is one of the leading causes of mortality in women. This study was undertaken with an aim to study the profile of various breast disease in the community. MATERIALS AND METHODS In this observational study all the post pubertal women residing in the selected village (n=1000) were included. The study was done from September 2013 to August 2015. A thorough history taking was done with the help of a predesigned proforma followed by a clinical breast examination and further investigation at our hospital if necessary. RESULTS It was found in this study that mastalgia, both cyclical and non-cyclical as well as lumps were a common finding in the general population. Significant proportions of women were found to be in the peri-menopausal age group. Median age of menarche was 13 years; menopause was 45 years. The average age at first childbirth was 21 years with 1 year being the median duration of breast-feeding. A total of 128 women (1 in 8) had positive symptomatology with 94 (1 in 11) of them having a breast disease on examination. One was diagnosed with breast cancer. The prevalence of cyclical mastalgia was 1 in 11, non-cyclical mastalgia 1 in 34, fibroadenosis 1 in 23 and fibroadenoma 1 in 100. The awareness regarding risk factors and the availability of screening program was very poor. The average age of presentation of mastalgia was 34 years; fibroadenosis was 35 years and fibroadenoma 29 years. None of the women interacted with or had consulted a practitioner regarding mastalgia as it was not perceived to be a sign of malignancy and did not cause any significant discomfort. CONCLUSION It was thus concluded from this study that benign breast diseases are a common occurrence in the general population. Breast cancer continues to be diagnosed only at later stages owing to lack of awareness and inadequately structured screening program. The concept of self-breast examination seems to be poorly understood. CBE is more fruitful with subsequent radiological and histopathological investigation, if warranted.
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Affiliation(s)
- Kavasseri L Janaki
- Resident, Department of General Surgery, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
| | - Narayanasamy Subbaraju Kannan
- Associate Professor, Department of General Surgery, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
| | - M Palaniappan
- Professor, Department of General Surgery, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
| | - Partha Nandi
- Professor, Department of Community Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
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Larson KE, Cowher MS, O'Rourke C, Patel M, Pratt D. Do Primary Care Physician Perform Clinical Breast Exams Prior to Ordering a Mammogram? Breast J 2015; 22:189-93. [PMID: 26687763 DOI: 10.1111/tbj.12546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Both the American Cancer Society and National Comprehensive Cancer Network recommend annual clinical breast examination (CBE) along with screening mammogram (SM) for patients starting at 40 years of age. However, patients with a palpable breast mass should have a diagnostic mammogram (DM) during workup. Review at our institution demonstrated that 11% of patients with newly diagnosed breast cancer and self-identified breast mass had SM instead of DM. This led us to question whether primary care physicians (PCP) perform CBE prior to ordering mammography. As part of the routine preimaging screening, patients were asked if they had undergone breast examination by a medical provider prior to mammogram order. Data on mammogram type, ordering physician specialty, and presence of symptoms on day of mammogram were recorded. Of 6,109 mammograms, 4,823 were ordered by PCPs. CBE was performed prior to 67.2% SM and 64.8% DM (p = 0.12). OB/GYN performed statistically significantly higher CBE (81.6%) compared to internal (45.4%) and family (50.5%) medicine physicians (p < 0.001). Of patients with self-reported breast symptoms, 8.7% had SM ordered rather than DM. Despite recommendations, approximately 1/3 of women report not having CBE prior to mammogram. The chances of having a CBE varied significantly by PCP specialty. Lack of CBE can lead to incorrect type of mammogram, with possibly increased cost and delay in diagnosis. Further evaluation is needed to understand why CBE was not performed in some patients.
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Affiliation(s)
- Kelsey E Larson
- Department of General Surgery (Breast Center), The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael S Cowher
- Department of General Surgery (Breast Center), The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Colin O'Rourke
- Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mita Patel
- Department of General Surgery (Breast Center), The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Debra Pratt
- Department of General Surgery (Breast Center), The Cleveland Clinic Foundation, Cleveland, Ohio
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Godavarty A, Rodriguez S, Jung YJ, Gonzalez S. Optical imaging for breast cancer prescreening. BREAST CANCER-TARGETS AND THERAPY 2015; 7:193-209. [PMID: 26229503 PMCID: PMC4516032 DOI: 10.2147/bctt.s51702] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Breast cancer prescreening is carried out prior to the gold standard screening using X-ray mammography and/or ultrasound. Prescreening is typically carried out using clinical breast examination (CBE) or self-breast examinations (SBEs). Since CBE and SBE have high false-positive rates, there is a need for a low-cost, noninvasive, non-radiative, and portable imaging modality that can be used as a prescreening tool to complement CBE/SBE. This review focuses on the various hand-held optical imaging devices that have been developed and applied toward early-stage breast cancer detection or as a prescreening tool via phantom, in vivo, and breast cancer imaging studies. Apart from the various optical devices developed by different research groups, a wide-field fiber-free near-infrared optical scanner has been developed for transillumination-based breast imaging in our Optical Imaging Laboratory. Preliminary in vivo studies on normal breast tissues, with absorption-contrasted targets placed in the intramammary fold, detected targets as deep as 8.8 cm. Future work involves in vivo imaging studies on breast cancer subjects and comparison with the gold standard X-ray mammography approach.
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Affiliation(s)
- Anuradha Godavarty
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA
| | - Suset Rodriguez
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA
| | - Young-Jin Jung
- Department of Radiological Science, Dongseo University, Busan, South Korea
| | - Stephanie Gonzalez
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA
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Doganer YC, Aydogan U, Kilbas Z, Rohrer JE, Sari O, Usterme N, Yuksel S, Akbulut H, Balkan SM, Saglam K, Tufan T. Predictors affecting breast self-examination practice among Turkish women. Asian Pac J Cancer Prev 2015; 15:9021-5. [PMID: 25374246 DOI: 10.7314/apjcp.2014.15.20.9021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affecting the breast self-examination (BSE) performance vary in developing countries. OBJECTIVE To determine the frequency of BSE performance and predictors of self-reported BSEs among women in the capital city of Turkey. MATERIALS AND METHODS This cross-sectional study was conducted on 376 Turkish women using a self- administered questionnaire covering socio-demographic variables and BSE-related features. RESULTS Of the participants, 78.7% (N=296) reported practicing BSE, whereas 9.5% (N=28) were implementing BSE regularly on a monthly basis, and only 5.7% (N=17) were performing BSE regularly within a week after each menstrual cycle. Multivariate logistic regression modeling revealed that BSE performance was more likely in younger age groups [20-39 years] (p=0.018, OR=3.215) and [40-49 years] (p=0.009, OR=3.162), women having a family history of breast disease (p=0.038, OR=2.028), and housewives (p=0.013, OR=0.353). CONCLUSIONS Although it appears that the rates of BSE performers are high, the number of women conducting appropriate BSE on a regular time interval basis is lower than expected. Younger age groups, family history of breast diseases and not being employed were identified as significant predictors of practicing BSE appropriately. Older age and employment were risk factors for not performing BSE in this sample.
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Affiliation(s)
- Yusuf C Doganer
- Department of Family Medicine, Turkish Military Academy, Primary Care Examination Center, Ankara, Turkey E-mail : ,
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Real-time evaluation of breast self-examination using computer vision. Int J Biomed Imaging 2014; 2014:924759. [PMID: 25435860 PMCID: PMC4244695 DOI: 10.1155/2014/924759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022] Open
Abstract
Breast cancer is the most common cancer among women worldwide and breast self-examination (BSE) is considered as the most cost-effective approach for early breast cancer detection. The general objective of this paper is to design and develop a computer vision algorithm to evaluate the BSE performance in real-time. The first stage of the algorithm presents a method for detecting and tracking the nipples in frames while a woman performs BSE; the second stage presents a method for localizing the breast region and blocks of pixels related to palpation of the breast, and the third stage focuses on detecting the palpated blocks in the breast region. The palpated blocks are highlighted at the time of BSE performance. In a correct BSE performance, all blocks must be palpated, checked, and highlighted, respectively. If any abnormality, such as masses, is detected, then this must be reported to a doctor to confirm the presence of this abnormality and proceed to perform other confirmatory tests. The experimental results have shown that the BSE evaluation algorithm presented in this paper provides robust performance.
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Lee HY, Vang S. Cultural beliefs and clinical breast examination in Hmong American women: the crucial role of modesty. J Immigr Minor Health 2013; 17:746-55. [PMID: 23943016 DOI: 10.1007/s10903-013-9890-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite grave cancer disparities in Hmong American women, investigation of the group's breast cancer screening behavior is sparse. This study examined how cultural factors are associated with breast cancer screening utilization, specifically clinical breast exam (CBE), in this population. One hundred and sixty-four Hmong American women between ages 18 and 67 were recruited from a large Midwestern metropolitan area with a median age of 28.0 years. Logistic regression was used to assess the association of cultural variables with receipt of CBE. Roughly 73% of Hmong American women reported ever having had a CBE. Logistic regression revealed that endorsing more modest views was the greatest barrier to ever having had a CBE. Age and language preference were also found to be significant predictors of past CBE use. Cultural factors should be considered in developing interventions aimed at promoting breast cancer screening in this population. In particular, Hmong American women who have less English proficiency and are relatively younger should be targeted in breast cancer screening efforts.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, Minneapolis-Saint Paul, MN, 55108, USA,
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Dilaveri CA, Szostek JH, Wang AT, Cook DA. Simulation training for breast and pelvic physical examination: a systematic review and meta-analysis. BJOG 2013; 120:1171-82. [PMID: 23750657 DOI: 10.1111/1471-0528.12289] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Breast and pelvic examinations are challenging intimate examinations. Technology-based simulation may help to overcome these challenges. OBJECTIVE To synthesise the evidence regarding the effectiveness of technology-based simulation training for breast and pelvic examination. SEARCH STRATEGY Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, and key journals and review articles; the date of the last search was January 2012. SELECTION CRITERIA Original research studies evaluating technology-enhanced simulation of breast and pelvic examination to teach learners, compared with no intervention or with other educational activities. DATA COLLECTION AND ANALYSIS The reviewers evaluated study eligibility and abstracted data on methodological quality, learners, instructional design, and outcomes, and used random-effects models to pool weighted effect sizes. MAIN RESULTS In total, 11 272 articles were identified for screening, and 22 studies were eligible, enrolling 2036 trainees. In eight studies comparing simulation for breast examination training with no intervention, simulation was associated with a significant improvement in skill, with a pooled effect size of 0.86 (95% CI 0.52-1.19; P < 0.001). Four studies comparing simulation training for pelvic examination with no intervention had a large and significant benefit, with a pooled effect size of 1.18 (95% CI 0.40-1.96; P = 0.003). Among breast examination simulation studies, dynamic models providing feedback were associated with improved outcomes. In pelvic examination simulation studies, the addition of a standardised patient to the simulation model and the use of an electronic model with enhanced feedback improved outcomes. AUTHOR'S CONCLUSIONS In comparison with no intervention, breast and pelvic examination simulation training is associated with moderate to large effects for skills outcomes. Enhanced feedback appears to improve learning.
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Affiliation(s)
- C A Dilaveri
- General Internal Medicine, Mayo Clinic School of Graduate Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Abstract
The clinical breast exam (CBE) is an important tool in the care of women. However, the utility of the screening CBE has been called into question. This article discusses the importance of the CBE as a physical diagnosis tool. Recommendations regarding screening with CBE are reviewed, and evidence surrounding breast cancer screening using CBE is briefly summarized. Clinicians should strive to provide high quality CBEs as part of the general clinical exam for women, particularly those who present with breast complaints, and for patients who choose to have CBE screening. In conclusion, there is a role for the CBE in the care of women, and clinicians should be proficient at performing these exams. Simulation teaching technologies are now available at Department of Veteran Affairs (VA) facilities to enable clinicians to improve their CBE skills.
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Affiliation(s)
- Teresa Bryan
- General Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham Veterans Affairs Medical Center, FOT 720 1720 2nd Ave South, Birmingham, AL 35294-3407 USA
| | - Erin Snyder
- General Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham Veterans Affairs Medical Center, FOT 720 1720 2nd Ave South, Birmingham, AL 35294-3407 USA
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Comparison of the screening practices of unaffected noncarriers under 40 and between 40 and 49 in BRCA1/2 families. J Genet Couns 2013; 22:469-81. [PMID: 23345056 DOI: 10.1007/s10897-012-9569-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022]
Abstract
This study aimed to 1) compare the cancer screening practices of unaffected noncarrier women under 40 and those aged 40 to 49, following the age-based medical screening guidelines, and 2) consider the way the patients justified their practices of screening or over-screening. For this study, 131 unaffected noncarriers-77 women under age 40 and 54 between 40 and 49, all belonging to a BRCA1/2 family-responded to a questionnaire on breast or ovarian cancer screenings they had undergone since receiving their negative genetic test results, their motives for seeking these screenings, and their intentions to pursue these screenings in the future. Unaffected noncarriers under age 40 admitted practices that could be qualified as over-screening. Apart from mammogram and breast ultrasounds, which the women under 40 reported seeking less often, these women's screening practices were comparable to those of women between 40 and 49. Cancer prevention and a family history of cancer were the two most frequently cited justifications for pursuing these screenings. We suggest that health care professionals discuss with women under 50 the ineffectiveness of breast and ovarian cancer screenings so that they will adapt their practices to conform to medical guidelines and limit their exposure to the potentially negative impacts of early cancer screening.
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Solbjør M, Skolbekken JA, Sætnan AR, Hagen AI, Forsmo S. Could screening participation bias symptom interpretation? An interview study on women's interpretations of and responses to cancer symptoms between mammography screening rounds. BMJ Open 2012; 2:bmjopen-2012-001508. [PMID: 23148341 PMCID: PMC3532989 DOI: 10.1136/bmjopen-2012-001508] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore how women with negative mammography screening results, but who were later diagnosed with interval breast cancer, reacted when they observed breast symptoms that could indicate malignancy in-between screening rounds. DESIGN Semistructured individual interviews with women who have been diagnosed with breast cancer during mammography screening intervals. SETTING Two breast diagnostic units covering two counties in Norway. PARTICIPANTS 26 women diagnosed with interval breast cancer. RESULTS Women with a screening negative result react in two ways when experiencing a possible symptom of breast cancer. Among 24 women with a self-detected palpable lesion, 14 sought medical advice immediately. Their argument was to dispose of potential cancer as soon as possible. Ten women delayed seeking medical advice, explaining their delay as a result of practical difficulties such as holidays, uncertainty about the symptom, and previous experiences of healthcare services' ability to handle diffuse symptoms. Also, a recent negative mammography scan led some women to assume that the palpable lesion was benign and wait for the next screening round. CONCLUSIONS Participating in mammography screening may contribute to a postponed reaction to breast cancer symptoms, although most women acted rapidly when detecting a palpable breast lesion. Furthermore, screening participation does not necessarily increase awareness of breast cancer symptoms.
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Affiliation(s)
- Marit Solbjør
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medical Faculty, Trondheim, Norway
| | - John-Arne Skolbekken
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ann Rudinow Sætnan
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Irene Hagen
- Department of Breast and Endocrine Surgery, Trondheim University Hospital, Trondheim, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medical Faculty, Trondheim, Norway
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