Clinical breast examination for screening of asymptomatic women: the importance of clinical breast examination for breast cancer detection

Harnessing the power of Microscale AcoustoFluidics: A perspective based on BAW cancer diagnostics

Cancer directly affects one in every three people, and mortality rates strongly correlate with the stage at which diagnosis occurs. Each of the multitude of methods used in cancer diagnostics has its own set of advantages and disadvantages. Two common drawbacks are a limited information value of image based diagnostic methods and high invasiveness when opting for methods that provide greater insight. Microfluidics offers a promising avenue for isolating circulating tumor cells from blood samples, offering high informational value at predetermined time intervals while being minimally invasive. Microscale AcoustoFluidics, an active method capable of manipulating objects within a fluid, has shown its potential use for the isolation and measurement of circulating tumor cells, but its full potential has yet to be harnessed. Extensive research has focused on isolating single cells, although the significance of clusters should not be overlooked and requires attention within the field. Moreover, there is room for improvement by designing smaller and automated devices to enhance user-friendliness and efficiency as illustrated by the use of bulk acoustic wave devices in cancer diagnostics. This next generation of setups and devices could minimize streaming forces and thereby enable the manipulation of smaller objects, thus aiding in the implementation of personalized oncology for the next generation of cancer treatments.

Thermography as a Breast Cancer Screening Technique: A Review Article

Globally, breast cancer is the most frequently occurring cancer in women and is the reason for more disability-adjusted life years lost than any other type of cancer. Hence, early screening plays a vital role in reducing breast cancer mortality. Although mammography is the standard procedure used for screening and diagnosis of breast cancer, it still has some limitations. Other methods used for screening include ultrasound and clinical breast examination. Despite its limitations, mammography is the gold standard for screening breast malignancy. Another emerging method for screening is thermography. With recent technological advances, breast cancer screening through thermography has demonstrated several advantages over existing modalities. For this review, a literature search was performed using databases such as PubMed, Google Scholar, and ScienceDirect. The keywords searched included breast cancer, early detection, breast cancer screening, mammography, and thermography. This review discusses the benefits of thermography showing that it can be a significant modality for breast cancer screening. The recent developments in thermal sensors, imaging protocols, and computer-aided software diagnostics hold great promise for making this technique a mainstream screening method for cancer. Moreover, the use of artificial intelligence and thermal imaging to detect early-stage breast cancer can provide impressive results. Therefore, thermography will be a promising technology for the early detection of breast cancer.

Cost-effectiveness of clinical breast assessment-based screening in rural Egypt

INTRODUCTION

Breast cancer is the most common cancer in Egyptian women. However, the mean tumor size at diagnosis is 4.5 cm, and the median age is approximately 46 years. Both of these factors decrease the utility and cost-effectiveness of a mammography-based screening program typically designed for developed countries. We report the first clinical breast assessment-based screening project in an entirely rural Egyptian community.

METHODS

Targeted population: Women aged 25-65 years in three municipal regions of Dakahlia province, Egypt. The estimated targeted population was 57,500 and participation was voluntary. First stage was performed at primary health care points. Surgeons performed systematic clinical breast examination. All data were collected at Mansoura University. Abnormal findings in the primary examination led to an invitation to the Oncology Center--Mansoura University--where the second stage of the study took place. It comprised repeat examination, ultrasonography, and/or mammography. Therapeutic interventions were performed at the governmentally funded Mansoura Oncology Center.

RESULTS

Voluntary participation reached 10.2% of the target group and abnormal clinical examination represented 3.2% (191/5,900). The screen-detected cancers were (18/5,900) of examined population, and thus the cancer detection rate of clinical breast assessment-based screening was 30.5 per 100,000 of participating women during 2 years. The tumor size was 1.5 cm (median) and 1.3 cm (mean). The cost of screening per cancer case detected was approximately 415 US$, and the overall cost of treating a screen-detected cancer was 1,015-1,215 US$.

CONCLUSIONS

Clinical breast assessment-based screening with selective mammography is an effective modality, which improves the results of breast cancer management in Egypt.

Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation

A key determinant of breast cancer outcome in any population is the degree to which cancers are detected at early stages of disease. Populations in which cancers are detected at earlier stages have lower breast cancer mortality rates. The Breast Health Global Initiative (BHGI) held its third Global Summit in Budapest, Hungary in October 2007, bringing together internationally recognized experts to address the implementation of breast healthcare guidelines for early detection, diagnosis, and treatment in low- and middle-income countries (LMCs). A multidisciplinary panel of experts specifically addressed the implementation of BHGI guidelines for the early detection of disease as they related to resource allocation for public education and awareness, cancer detection methods, and evaluation goals. Public education and awareness are the key first steps, because early detection programs cannot be successful if the public is unaware of the value of early detection. The effectiveness and efficiency of screening modalities, including screening mammography, clinical breast examination (CBE), and breast self-examination, were reviewed in the context of resource availability and population-based need by the panel. Social and cultural barriers should be considered when early detection programs are being established, and the evaluation of early detection programs should include the use of well developed, methodologically sound process metrics to determine the effectiveness of program implementation. The approach and scope of any screening program will determine the success of any early detection program as measured by cancer stage at diagnosis and will drive the breadth of resource allocation needed for program implementation.

A Comparative Review of Thermography as a Breast Cancer Screening Technique

Breast cancer is the most frequently diagnosed cancer of women in North America. Despite advances in treatment that have reduced mortality, breast cancer remains the second leading cause of cancer induced death. Several well established tools are used to screen for breast cancer including clinical breast exams, mammograms, and ultrasound. Thermography was first introduced as a screening tool in 1956 and was initially well accepted. However, after a 1977 study found thermography to lag behind other screening tools, the medical community lost interest in this diagnostic approach. This review discusses each screening tool with a focus brought to thermography. No single tool provides excellent predictability; however, a combination that incorporates thermography may boost both sensitivity and specificity. In light of technological advances and maturation of the thermographic industry, additional research is required to confirm the potential of this technology to provide an effective non-invasive, low risk adjunctive tool for the early detection of breast cancer.

Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum

OBJECTIVES

We evaluated the effect of standardized clinical breast examination (CBE) training on residents' ability to detect a 3-mm breast mass in a silicone breast model.

METHODS

In this nonrandomized controlled trial, 75 first year residents (R1s) at 8 family medicine, internal medicine, and obstetrics and gynecology training programs received the intervention and second year residents (R2s) did not. Trained residency faculty taught R1s vertical strip, three-pressure method (VS3PM) CBE using a standardized curriculum, including a 1- to 2-hour online self-study with video and 2.5-hour practicum using silicone models and a trained patient surrogate.

RESULTS

Solitary mass detection: 84% by R1s, 46% by R2s (RR = 1.82, 95%CI = 1.36, 2.43, P < 0.0001). Of those finding a mass, 62% of R1s and 10% of R2s used at least 5 of 8 standardized descriptors (RR = 6.19, 95%CI = 2.06, 18.59, P = 0.001). R1s false positive findings were not statistically different from R2s (P = 0.54). Both the use of VS3PM and total time spent on CBE were independently highly predictive of finding the mass in either group.

CONCLUSIONS

Most untrained primary care residents are not proficient in CBE. Standardized VS3PM CBE training improves the ability to detect and describe a small mass in a silicone breast model. Better CBE training for residents may improve the early detection of breast cancer.

Breast implants and breast cancer screening

Concern about breast prostheses impairing breast cancer detection has become a priority issue. This article provides a review of the literature on the influence of implants on early detection methods of breast cancer, specifically breast self-examination (BSE), clinical breast examination (CBE), and mammography. Background information on implants is presented, including indications for surgery, types of prostheses, location of placement, and associated complications. Conclusions from the literature suggest that the presence of implants may facilitate BSE and CBE, yet challenge interpretation of mammography. However, there is no evidence that these women will have a later stage diagnosis or a poorer prognosis if diagnosed with breast cancer.

Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35

BACKGROUND

The age specific breast cancer incidence rate for African-American women under age 35 is more than twice the rate for white women of similar age, and the mortality rate is more than three times higher. To determine factors that may explain racial/ethnic variation in outcomes among young women diagnosed with breast cancer, the authors examined the clinical presentation, treatment, and survival of African-American, Hispanic, and white women under age 35 years.

METHODS

Surveillance, Epidemiology, and End Results (SEER) Program data for 1990-1998 and SEER Patterns of Care data for 1990, 1991, and 1995 were used for this analysis. Multivariate logistic regression analyses were performed to examine factors associated with the receipt of selected breast cancer treatments. Kaplan-Meier survival analyses and Cox proportional hazards regression analyses were used to examine 5-year overall survival and disease-specific survival.

RESULTS

The authors found racial/ethnic variation in clinical presentation, treatment, and survival. Both African-American and Hispanic women presented with higher disease stage and a higher prevalence of adverse prognostic indicators compared to white women. African-American and Hispanic women received cancer-directed surgery and radiation less frequently after undergoing breast-conserving surgery. Racial/ethnic differences in clinical presentation and treatment were associated with poorer overall survival in unadjusted analyses. African-American and Hispanic women also had poorer overall survival after controlling for clinical and demographic characteristics and type of treatment.

CONCLUSIONS

Future research studies should further examine the factors that influence racial/ethnic differences in incidence, clinical presentation, and treatment differentials among young women diagnosed with breast cancer. A better understanding of these factors will facilitate the development of strategies to help eliminate this health disparity.

Effect of clinical breast examination training on practitioner's perceived competence

Effective clinical breast exam (CBE) training should not only improve screening technique but also reduce barriers to performing CBE by increasing perceived competence and self-efficacy. Using the vertical strip technique with silicone breast models and live patients, 4-day CBE training sessions were provided to 34 nurse-practitioners. Trainees perceived a significant decrease in the size of breast lesion they could detect after training (P < 0.0001). The size of the detectable lesion reported prior to training was correlated with the years of CBE experience (P < 0.05); however, the size of the detectable lesion after training was not significantly related to previous CBE experience. Trainees with less CBE experience prior to training reported greater improvement in the ability to detect smaller lesions (P < 0.05). Results indicate a significant CBE training effect on perceived competence, and suggest that nurse practitioners from all levels of experience can benefit significantly from CBE training. O 2002 International Society for Preventive Oncology.

In vivo and in vitro measurement of apoptosis in breast cancer cells using 99mTc-EC-annexin V

OBJECTIVE

The purpose of this study was to develop an imaging technique to measure and monitor tumor cells undergoing programmed death caused by radiation and chemotherapy using 99mTc-EC-annexin V. Annexin V has been used to measure programmed cell death both in vitro and in vivo. Assessment of apoptosis would be useful to evaluate the efficacy and mechanisms of therapy and disease progression or regression.

METHODS

Ethylenedicysteine (EC) was conjugated to annexin V using sulfo-N-hydroxysuccinimide and 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide-HCl as coupling agents. The yield of EC-annexin V was 100%. In vitro cellular uptake, pre- and post-radiation (10-30 Gy) and paclitaxel treatment, was quantified using 99mTc-EC-annexin V. Tissue distribution and planar imaging of 99mTc-EC-annexin V were determined in breast tumor-bearing rats at 0.5, 2, and 4 hrs. To demonstrate in vivo cell apoptosis that occurred during chemotherapy, a group of rats was treated with paclitaxel and planar imaging studies were conducted at 0.5-4 hrs. Computer outlined region of interest (ROI) was used to quantify tumor uptake on day 3 and day 5 post-treatment.

RESULTS

In vitro cellular uptake showed that there was significantly increased uptake of 99mTc-EC-annexin V after irradiation (10-30 Gy) and paclitaxel treatment. In vivo biodistribution of 99mTc-EC-annexin in breast tumor-bearing rats showed increased tumor-to-blood, tumor-to-lung and tumor-to-muscle count density ratios as a function of time. Conversely, tumor-to-blood count density ratios showed a time-dependent decrease with 99mTc-EC in the same time period. Planar images confirmed that the tumors could be visualized clearly with 99mTc-EC-annexin. There was a significant difference of ROI ratios between pre- and post-paclitaxel treatment groups at 2 and 4 hrs post injection.

CONCLUSION

The results indicate that apoptosis can be quantified using 99mTc-EC-annexin and that it is feasible to use 99mTc-EC-annexin to image tumor apoptosis.