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Endrikat J, Schmidt G, Haverstock D, Weber O, Trnkova ZJ, Barkhausen J. Sensitivity of Contrast-Enhanced Breast MRI vs X-ray Mammography Based on Cancer Histology, Tumor Grading, Receptor Status, and Molecular Subtype: A Supplemental Analysis of 2 Large Phase III Studies. BREAST CANCER: BASIC AND CLINICAL RESEARCH 2022; 16:11782234221092155. [PMID: 35462754 PMCID: PMC9021463 DOI: 10.1177/11782234221092155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The impact of certain tumor parameters on the sensitivity of imaging tools is unknown. The purpose was to study the impact of breast cancer histology, tumor grading, single receptor status, and molecular subtype on the sensitivity of contrast-enhanced breast magnetic resonance imaging (CE-BMRI) vs X-ray mammography (XRM) to detect breast cancer. Materials and Methods: We ran a supplemental analysis of 2 global Phase III studies which recruited patients with histologically proven breast cancers. The sensitivity of CE-BMRI vs XRM to detect cancer lesions with different histologies, tumor grading, single receptor status, and molecular subtype was compared. Six blinded readers for each study evaluated the images. Results were summarized as the “Mean Reader.” For each reader, sensitivity was defined as the proportion of detected lesions vs the total number of lesions identified by the standard of reference. Two-sided 95% confidence intervals were calculated for within-group proportions, and for the difference between CE-BMRI and XRM, using a normal approximation to the binomial distribution. Results: In 778 patients, 1273 cancer lesions were detected. A total of 435 patients had 1 lesion, 254 had 2 lesions, and 77 had 3 or more lesions. The sensitivity of CE-BMRI was significantly higher compared with XRM irrespective of the histology. The largest difference was seen for invasive lobular carcinoma (22.3%) and ductal carcinoma in situ (19%). Across all 3 tumor grades, the sensitivity advantage of CE-BMRI over XRM ranged from 15.7% to 18.5%. Contrast-enhanced breast magnetic resonance imaging showed higher sensitivity compared with XRM irrespective of single receptor expressions (15.3%-19.4%). The sensitivities for both imaging methods were numerically higher for the more aggressive ER– (estrogen receptor), PR– (progesterone receptor), and HER2+ (human epidermal growth factor receptor 2) tumors. Irrespective of molecular subtype, sensitivity of CE-BMRI was 14.8% to 18.9% higher compared with XRM. Conclusions: Contrast-enhanced breast magnetic resonance imaging showed significantly higher sensitivity compared with XRM independent of tumor histology, tumor grading, single receptor status, and molecular subtype. Trial Registration: ClinicalTrials.gov: NCT01067976 and NCT01104584.
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Affiliation(s)
- Jan Endrikat
- Bayer AG, Radiology R&D, Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
| | - Gilda Schmidt
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
| | | | - Olaf Weber
- Bayer AG, Radiology R&D, Berlin, Germany
| | | | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
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2
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Henze Bancroft LC, Strigel RM, Macdonald EB, Longhurst C, Johnson J, Hernando D, Reeder SB. Proton density water fraction as a reproducible MR-based measurement of breast density. Magn Reson Med 2021; 87:1742-1757. [PMID: 34775638 DOI: 10.1002/mrm.29076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To introduce proton density water fraction (PDWF) as a confounder-corrected (CC) MR-based biomarker of mammographic breast density, a known risk factor for breast cancer. METHODS Chemical shift encoded (CSE) MR images were acquired using a low flip angle to provide proton density contrast from multiple echo times. Fat and water images, corrected for known biases, were produced by a six-echo CC CSE-MRI algorithm. Fibroglandular tissue (FGT) volume was calculated from whole-breast segmented PDWF maps at 1.5T and 3T. The method was evaluated in (1) a physical fat-water phantom and (2) normal volunteers. Results from two- and three-echo CSE-MRI methods were included for comparison. RESULTS Six-echo CC-CSE-MRI produced unbiased estimates of the total water volume in the phantom (mean bias 3.3%) and was reproducible across protocol changes (repeatability coefficient [RC] = 14.8 cm3 and 13.97 cm3 at 1.5T and 3.0T, respectively) and field strengths (RC = 51.7 cm3 ) in volunteers, while the two- and three-echo CSE-MRI approaches produced biased results in phantoms (mean bias 30.7% and 10.4%) that was less reproducible across field strengths in volunteers (RC = 82.3 cm3 and 126.3 cm3 ). Significant differences in measured FGT volume were found between the six-echo CC-CSE-MRI and the two- and three-echo CSE-MRI approaches (p = 0.002 and p = 0.001, respectively). CONCLUSION The use of six-echo CC-CSE-MRI to create unbiased PDWF maps that reproducibly quantify FGT in the breast is demonstrated. Further studies are needed to correlate this quantitative MR biomarker for breast density with mammography and overall risk for breast cancer.
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Affiliation(s)
| | - Roberta M Strigel
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erin B Macdonald
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Clinical Imaging Physics Group, Duke University Medical Center, Durham, North Carolina, USA
| | - Colin Longhurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jacob Johnson
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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3
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Vegunta S, Kling JM, Patel BK. Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals. Mayo Clin Proc 2021; 96:2891-2904. [PMID: 34686363 DOI: 10.1016/j.mayocp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Mammography is the standard for breast cancer screening. The sensitivity of mammography in identifying breast cancer, however, is reduced for women with dense breasts. Thirty-eight states have passed laws requiring that all women be notified of breast tissue density results in their mammogram report. The notification includes a statement that differs by state, encouraging women to discuss supplemental screening options with their health care professionals (HCPs). Several supplemental screening tests are available for women with dense breast tissue, but no established guidelines exist to direct HCPs in their recommendation of preferred supplemental screening test. Tailored screening, which takes into consideration the patient's mammographic breast density and lifetime breast cancer risk, can guide breast cancer screening strategies that are more comprehensive. This review describes the benefits and limitations of the various available supplemental screening tests to guide HCPs and patients in choosing the appropriate breast cancer screening.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ.
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Bhavika K Patel
- Division of Breast Imaging, Mayo Clinic Hospital, Phoenix, AZ
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4
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Barkhausen J, Bischof A, Haverstock D, Klemens M, Brueggenwerth G, Weber O, Endrikat J. Diagnostic efficacy of contrast-enhanced breast MRI versus X-ray mammography in women with different degrees of breast density. Acta Radiol 2021; 62:586-593. [PMID: 32678675 DOI: 10.1177/0284185120936271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Detection of breast cancer in women with high breast densities is a clinical challenge. PURPOSE To study the influence of different degrees of breast density on the sensitivity of contrast-enhanced breast magnetic resonance imaging (CE-BMRI) versus X-ray mammography (XRM). MATERIAL AND METHODS We performed an additional analysis of two large Phase III clinical trials (G1; G2) which included women with histologically proven breast cancers, called "index cancers." Additional cancers were detected during image reading. We compared the sensitivity of CE-BMRI and XRM in women with different breast densities (ACR A→D; Version 5). For each study, six blinded readers evaluated the images. Results are given as the "Median Reader." RESULTS A total of 774 patients were included, 169 had additional cancers. While sensitivity of CE-BMRI for detecting all index cancers was independent of breast density (ACR A→D) (G1: 83%→83%; G2: 91%→91%) the sensitivity of XRM declined (ACR A→D) (G1: 79%→62%; G2: 82%→64%). Thus, the sensitivity difference between both imaging modalities in ACR A breasts of 3% (G1) and 9% (G2) increased to 21% (G1) and 26% (G2) in ACR D breasts. Sensitivity of CE-BMRI for detecting at least one additional cancer increased with increasing breast density (ACR A→D) (G1: 50%→73%, G2: 57%→81%). XRM's sensitivity decreased (G1: 34%→20%) or remained stable (G2: 24%→25%). CONCLUSION CE-BMRI showed significantly higher sensitivity compared to XRM.
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Affiliation(s)
- Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Luebeck, Germany
| | - Arpad Bischof
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Luebeck, Germany
| | | | - Mark Klemens
- Bayer AG, General Clinical Imaging Services, 13353, Germany
| | | | - Olaf Weber
- Bayer AG, Radiology R&D, Berlin, Germany
- Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
| | - Jan Endrikat
- Bayer AG, Radiology R&D, Berlin, Germany
- University Medical School of Saarland, Dept of Gynecology, Obstetrics and Reproductive Medicine, Homburg/Saar, Germany
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5
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Huang JS, Pan HB, Yang TL, Hung BH, Chiang CL, Tsai MY, Chou CP. Kinetic patterns of benign and malignant breast lesions on contrast enhanced digital mammogram. PLoS One 2020; 15:e0239271. [PMID: 32941537 PMCID: PMC7498093 DOI: 10.1371/journal.pone.0239271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the kinetic patterns of benign and malignant breast lesions using contrast-enhanced digital mammogram (CEDM). Methods Women with suspicious breast lesions on mammography or ultrasound were enrolled. Single-view mediolateral oblique (MLO) CEDM of an affected breast was acquired at 2, 3, 4, 7, and 10 min after injection of contrast agent. Three readers visually and semi-quantitatively analyzed the enhancement of suspicious lesions. The kinetic pattern of each lesion was classified as persistent, plateau, or washout over two time intervals, 2–4 min and 2–10 min, by comparing the signal intensity at the first time interval with that at the second. Results There were 73 malignant and 75 benign lesions in 148 patients (mean age: 52 years). Benign and malignant breast lesions showed the highest signal intensity at 3 min and 2 min, respectively. Average areas under receiver operating characteristic (ROC) curve for diagnostic accuracy based on lesion enhancement at different time points were 0.73 at 2 min, 0.72 at 3 min, 0.69 at 4 min, 0.67 at 7 min, and 0.64 at 10 min. Diagnostic performance was significantly better at 2, 3, and 4 min than at 7 and 10 min (all p < 0.05). A washout kinetic pattern was significantly associated with malignant lesions at 2–4 min and 2–10 min frames according to two of the three readers’ interpretations (all p ≤ 0.001). Conclusion Applications of optimal time intervals and kinetic patterns show promise in differentiation of benign and malignant breast lesions on CEDM.
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Affiliation(s)
- Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Tsung-Lung Yang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Bao-Hui Hung
- Department of Radiology, Golden Hospital, Pingtung, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Meng-Yuan Tsai
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan, ROC
- * E-mail:
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6
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Trends of Supplemental Screening in Women With Dense Breasts. J Am Coll Radiol 2020; 17:990-998. [DOI: 10.1016/j.jacr.2019.12.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 01/17/2023]
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Hinton B, Ma L, Mahmoudzadeh AP, Malkov S, Fan B, Greenwood H, Joe B, Lee V, Kerlikowske K, Shepherd J. Deep learning networks find unique mammographic differences in previous negative mammograms between interval and screen-detected cancers: a case-case study. Cancer Imaging 2019; 19:41. [PMID: 31228956 PMCID: PMC6589178 DOI: 10.1186/s40644-019-0227-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022] Open
Abstract
Background To determine if mammographic features from deep learning networks can be applied in breast cancer to identify groups at interval invasive cancer risk due to masking beyond using traditional breast density measures. Methods Full-field digital screening mammograms acquired in our clinics between 2006 and 2015 were reviewed. Transfer learning of a deep learning network with weights initialized from ImageNet was performed to classify mammograms that were followed by an invasive interval or screen-detected cancer within 12 months of the mammogram. Hyperparameter optimization was performed and the network was visualized through saliency maps. Prediction loss and accuracy were calculated using this deep learning network. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were generated with the outcome of interval cancer using the deep learning network and compared to predictions from conditional logistic regression with errors quantified through contingency tables. Results Pre-cancer mammograms of 182 interval and 173 screen-detected cancers were split into training/test cases at an 80/20 ratio. Using Breast Imaging-Reporting and Data System (BI-RADS) density alone, the ability to correctly classify interval cancers was moderate (AUC = 0.65). The optimized deep learning model achieved an AUC of 0.82. Contingency table analysis showed the network was correctly classifying 75.2% of the mammograms and that incorrect classifications were slightly more common for the interval cancer mammograms. Saliency maps of each cancer case found that local information could highly drive classification of cases more than global image information. Conclusions Pre-cancerous mammograms contain imaging information beyond breast density that can be identified with deep learning networks to predict the probability of breast cancer detection.
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Affiliation(s)
- Benjamin Hinton
- Department of Bioengineering, University of California-San Francisco Berkeley Joint Program, Room A-C106-B, 1 Irving St, San Francisco, CA, 94143, USA. .,Department of Radiology and Biomedical Imaging, UC-San Francisco, San Francisco, CA, 94143, USA.
| | - Lin Ma
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | | | | | - Bo Fan
- Department of Bioengineering, University of California-San Francisco Berkeley Joint Program, Room A-C106-B, 1 Irving St, San Francisco, CA, 94143, USA
| | - Heather Greenwood
- Department of Radiology and Biomedical Imaging, UC-San Francisco, San Francisco, CA, 94143, USA
| | - Bonnie Joe
- Department of Radiology and Biomedical Imaging, UC-San Francisco, San Francisco, CA, 94143, USA
| | - Vivian Lee
- Research Advocate, UCSF Breast Science Advocacy Core, San Francisco, CA, 94143, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, UCSF, San Francisco, CA, 94143, USA
| | - John Shepherd
- Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
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Brown AL, Phillips J, Mehta TS, Brook A, Sharpe RE, Slanetz PJ, Dialani V. Breast MRI ordering practices in a large health care network. Breast J 2019; 25:262-268. [DOI: 10.1111/tbj.13198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Ann L. Brown
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
- Division of Breast Imaging; Department of Radiology; University of Cincinnati Medical Center and College of Medicine; Cincinnati OH USA
| | - Jordana Phillips
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Tejas S. Mehta
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Alexander Brook
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Richard E. Sharpe
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
- Colorado Permanente Medical Group; Kaiser Permanente; Denver CO USA
| | - Priscilla J. Slanetz
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Vandana Dialani
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
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9
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Wengert GJ, Helbich TH, Leithner D, Morris EA, Baltzer PAT, Pinker K. Multimodality Imaging of Breast Parenchymal Density and Correlation with Risk Assessment. CURRENT BREAST CANCER REPORTS 2019; 11:23-33. [PMID: 35496471 PMCID: PMC9044508 DOI: 10.1007/s12609-019-0302-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose of Review Breast density, or the amount of fibroglandular tissue in the breast, has become a recognized and independent marker for breast cancer risk. Public awareness of breast density as a possible risk factor for breast cancer has resulted in legislation for risk stratification purposes in many US states. This review will provide a comprehensive overview of the currently available imaging modalities for qualitative and quantitative breast density assessment and the current evidence on breast density and breast cancer risk assessment. Recent Findings To date, breast density assessment is mainly performed with mammography and to some extent with magnetic resonance imaging. Data indicate that computerized, quantitative techniques in comparison with subjective visual estimations are characterized by higher reproducibility and robustness. Summary Breast density reduces the sensitivity of mammography due to a masking effect and is also a recognized independent risk factor for breast cancer. Standardized breast density assessment using automated volumetric quantitative methods has the potential to be used for risk prediction and stratification and in determining the best screening plan for each woman.
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10
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Gunn CM, Kressin NR, Cooper K, Marturano C, Freund KM, Battaglia TA. Primary Care Provider Experience with Breast Density Legislation in Massachusetts. J Womens Health (Larchmt) 2018; 27:615-622. [PMID: 29338539 DOI: 10.1089/jwh.2017.6539] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Dense breasts on mammography independently increases breast cancer risk and decreases mammography sensitivity. Thirty-two states have adopted notification laws to raise awareness among women with dense breasts about supplemental screening. Little is known about these policies' impact on clinical practice among primary care providers (PCPs). MATERIALS AND METHODS This study explores PCP attitudes, knowledge, and the impact of the Massachusetts dense breast notification legislation on clinical practice after its enactment in 2015. An anonymous, online survey at two urban safety-net hospitals was administered in 2015-2016. Practicing MDs and nurse practitioners in primary care were invited to participate. RESULTS All 145 PCPs in general internal medicine at the two sites were e-mailed a survey link and 80 (55%) were completed. While 64 of 80 PCPs surveyed (80%) had some familiarity with the legislation, none identified the 8 required components of notifications contained in the Massachusetts legislation. Forty-nine percent (39/80) did not feel prepared to respond to patient questions about dense breasts. Forty-one percent (33/80) correctly identified that no current guidelines recommend the use of supplemental screening tests solely based on breast density and 85% (68/80) indicated interest in further training. Female and less experienced providers were more likely to be in favor of the legislation (49% vs. 11% by gender; 76% <5 years vs. 9%> 20 years). Women practitioners (55%) who were more likely than men (17%, p = 0.01) to agree with the policy changed their discussions of mammography results with patients. CONCLUSIONS PCPs feel underprepared to counsel women about breast density identified on mammography and its implications.
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Affiliation(s)
- Christine M Gunn
- 1 Women's Health Unit, Evans Department of Medicine, Section of General Internal Medicine, Boston Medical Center , Boston, Massachusetts.,2 Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, Massachusetts
| | - Nancy R Kressin
- 1 Women's Health Unit, Evans Department of Medicine, Section of General Internal Medicine, Boston Medical Center , Boston, Massachusetts.,3 Boston University School of Medicine , Evans Department of Medicine, Section of General Internal Medicine Boston, MA
| | - Kristina Cooper
- 1 Women's Health Unit, Evans Department of Medicine, Section of General Internal Medicine, Boston Medical Center , Boston, Massachusetts
| | - Cinthya Marturano
- 4 Division of Internal Medicine and Primary Care, Tufts Medical Center , Boston, Massachusetts
| | - Karen M Freund
- 4 Division of Internal Medicine and Primary Care, Tufts Medical Center , Boston, Massachusetts.,5 Institute for Clinical Research and Health Policy Studies , Tufts Medical Center, Boston, Massachusetts
| | - Tracy A Battaglia
- 1 Women's Health Unit, Evans Department of Medicine, Section of General Internal Medicine, Boston Medical Center , Boston, Massachusetts.,3 Boston University School of Medicine , Evans Department of Medicine, Section of General Internal Medicine Boston, MA
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11
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Difficulties with diagnosis of malignancies in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:19-32. [DOI: 10.1016/j.bpobgyn.2015.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/09/2015] [Indexed: 11/22/2022]
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12
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Kam K, Lee E, Pairawan S, Anderson K, Cora C, Bae W, Senthil M, Solomon N, Lum S. The Effect of Breast Implants on Mammogram Outcomes. Am Surg 2015. [DOI: 10.1177/000313481508101028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast cancer detection in women with implants has been questioned. We sought to evaluate the impact of breast implants on mammographic outcomes. A retrospective review of women undergoing mammography between March 1 and October 30, 2013 was performed. Demographic characteristics and mammogram results were compared between women with and without breast implants. Overall, 4.8 per cent of 1863 women identified during the study period had breast implants. Median age was 59 years (26–93). Women with implants were younger (53.9 vs 59.2 years, P < 0.0001), had lower body mass index (25.4 vs 28.9, P < 0.0001), and were more likely to have dense breast tissue (72.1% vs 56.4%, P = 0.004) than those without. There were no statistically significant differences with regards to Breast Imaging Recording and Data System 0 score (13.3% with implants vs 21.4% without), call back exam (18.9% with vs 24.1% without), time to resolution of abnormal imaging (58.6 days with vs 43.3 without), or cancer detection rate (0% with implants vs 1.0% without). Because implants did not significantly affect mammogram results, women with implants should be reassured that mammography remains useful in detecting cancer. However, future research is required to determine whether lower call back rates and longer time to resolution of imaging findings contribute to delays in diagnosis in patients with implants.
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Affiliation(s)
- Kelli Kam
- From the Loma Linda University Medical Center, Loma Linda, California
| | - Esther Lee
- From the Loma Linda University Medical Center, Loma Linda, California
| | - Seyed Pairawan
- From the Loma Linda University Medical Center, Loma Linda, California
| | - Kendra Anderson
- From the Loma Linda University Medical Center, Loma Linda, California
| | - Cherie Cora
- From the Loma Linda University Medical Center, Loma Linda, California
| | - Won Bae
- From the Loma Linda University Medical Center, Loma Linda, California
| | - Maheswari Senthil
- From the Loma Linda University Medical Center, Loma Linda, California
| | - Naveenraj Solomon
- From the Loma Linda University Medical Center, Loma Linda, California
| | - Sharon Lum
- From the Loma Linda University Medical Center, Loma Linda, California
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