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Yiallourou A, Pantavou K, Markozannes G, Pilavas A, Georgiou A, Hadjikou A, Economou M, Christodoulou N, Letsos K, Khattab E, Kossyva C, Constantinou M, Theodoridou M, Piovani D, Tsilidis KΚ, Bonovas S, Nikolopoulos GK. Non-genetic factors and breast cancer: an umbrella review of meta-analyses. BMC Cancer 2024; 24:903. [PMID: 39061008 PMCID: PMC11282738 DOI: 10.1186/s12885-024-12641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Previous research has found associations between various non-genetic factors and breast cancer (BrCa) risk. This study summarises and appraises the credibility of the available evidence on the association between non-genetic factors and BrCa risk. METHODS We conducted an umbrella review of meta-analyses. Medline, Scopus, and the Cochrane databases were systematically searched for meta-analyses examining non-genetic factors and BrCa incidence or mortality. The strength of the evidence was graded in four categories (i.e., weak, suggestive, highly suggestive, convincing). RESULTS A total of 781 meta-analyses from 280 publications were evaluated and graded. We included exposures related to anthropometric measurements, biomarkers, breast characteristics and diseases, diet and supplements, environment, exogenous hormones, lifestyle and social factors, medical history, medication, reproductive history, and pregnancy. The largest number of examined associations was found for the category of diet and supplements and for exposures such as aspirin use and active smoking. The statistically significant (P-value < 0.05) meta-analyses were 382 (49%), of which 204 (53.4%) reported factors associated with increased BrCa risk. Most of the statistically significant evidence (n = 224, 58.6%) was graded as weak. Convincing harmful associations with heightened BrCa risk were found for increased body mass index (BMI), BMI and weight gain in postmenopausal women, oral contraceptive use in premenopausal women, increased androstenedione, estradiol, estrone, and testosterone concentrations, high Breast Imaging Reporting and Data System (BIRADS) classification, and increased breast density. Convincing protective factors associated with lower BrCa risk included high fiber intake and high sex hormone binding globulin (SHBG) levels while highly suggestive protective factors included high 25 hydroxy vitamin D [25(OH)D] levels, adherence to healthy lifestyle, and moderate-vigorous physical activity. CONCLUSIONS Our findings suggest some highly modifiable factors that protect from BrCa. Interestingly, while diet was the most studied exposure category, the related associations failed to reach higher levels of evidence, indicating the methodological limitations in the field. To improve the validity of these associations, future research should utilise more robust study designs and better exposure assessment techniques. Overall, our study provides knowledge that supports the development of evidence-based BrCa prevention recommendations and guidance, both at an individual level and for public health initiatives. TRIAL REGISTRATION PROSPERO CRD42022370675.
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Affiliation(s)
- Anneza Yiallourou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Katerina Pantavou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, 45110, Greece
| | - Antonis Pilavas
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Andrea Georgiou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Andria Hadjikou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Mary Economou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | | | | | - Elina Khattab
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | | | - Maria Constantinou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | | | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Milan, 20089, Italy
| | - Konstantinos Κ Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, 45110, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Milan, 20089, Italy
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Shen Y, He J, Liu M, Hu J, Wan Y, Zhang T, Ding J, Dong J, Fu X. Diagnostic value of contrast-enhanced ultrasound and shear-wave elastography for small breast nodules. PeerJ 2024; 12:e17677. [PMID: 38974410 PMCID: PMC11227273 DOI: 10.7717/peerj.17677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Abstract
Background The study aims to evaluate the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE) in detecting small malignant breast nodules in an effort to inform further refinements of the Breast Imaging Reporting and Data System (BI-RADS) classification system. Methods This study retrospectively analyzed patients with breast nodules who underwent conventional ultrasound, CEUS, and SWE at Gongli Hospital from November 2015 to December 2019. The inclusion criteria were nodules ≤ 2 cm in diameter with pathological outcomes determined by biopsy, no prior treatments, and solid or predominantly solid nodules. The exclusion criteria included pregnancy or lactation and low-quality images. Imaging features were detailed and classified per BI-RADS. Diagnostic accuracy was assessed using receiver operating characteristic curves. Results The study included 302 patients with 305 breast nodules, 113 of which were malignant. The diagnostic accuracy was significantly improved by combining the BI-RADS classification with CEUS and SWE. The combined approach yielded a sensitivity of 88.5%, specificity of 87.0%, positive predictive value of 80.0%, negative predictive value of 92.8%, and accuracy of 87.5% with an area under the curve of 0.877. Notably, 55.8% of BI-RADS 4A nodules were downgraded to BI-RADS 3 and confirmed as benign after pathological examination, suggesting the potential to avoid unnecessary biopsies. Conclusion The integrated use of the BI-RADS classification, CEUS, and SWE enhances the accuracy of differentiating benign and malignant small breast nodule, potentially reducing the need for unnecessary biopsies.
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Affiliation(s)
- Yan Shen
- Department of Medical Ultrasound, Gongli Hospital, Shanghai, China
| | - Jie He
- Department of Medical Ultrasound, Gongli Hospital, Shanghai, China
| | - Miao Liu
- Department of Medical Ultrasound, Gongli Hospital, Shanghai, China
| | - Jiaojiao Hu
- Department of Medical Ultrasound, Gongli Hospital, Shanghai, China
| | - Yonglin Wan
- Department of Medical Ultrasound, Gongli Hospital, Shanghai, China
| | - Tingting Zhang
- Department of Medical Ultrasound, Gongli Hospital, Shanghai, China
| | - Jun Ding
- Department of Pathology, Gongli Hospital, Shanghai, China
| | - Jiangnan Dong
- Department of Surgery, Gongli Hospital, Shanghai, China
| | - Xiaohong Fu
- Department of Medical Ultrasound, Gongli Hospital, Shanghai, China
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Liu S, Zheng S, Qin M, Xie Y, Yang K, Liu X. Knowledge, attitude, and practice toward ultrasound screening for breast cancer among women. Front Public Health 2024; 12:1309797. [PMID: 38855455 PMCID: PMC11160319 DOI: 10.3389/fpubh.2024.1309797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Background Several obstacles can hinder breast cancer screening. This study aimed to investigate the knowledge, attitude, and practice (KAP) toward ultrasound screening for breast cancer in women. Methods This cross-sectional study recruited women who visited the breast specialist clinic of Zhongshan City People's Hospital (a tertiary hospital) between August 2022 and April 2023 through convenience sampling. KAP scores ≥70% were considered adequate. Results This study enrolled 501 participants. The mean knowledge, attitude, and practice levels were 8.56 ± 1.81/12 (possible range 0-12, 71.33%), 29.80 ± 2.71 (possible range 8-40, 74.50%), and 32.04 ± 3.09 (possible range 8-40, 80.10%). Senior high school education (vs. junior high school and below, coefficient = 1.531, 95%CI: 1.013-2.312, p = 0.044), bachelor's education and above (vs. junior high school and below, coefficient = 5.315, 95%CI: 3.546-7.966, p < 0.001), housewife or unemployed (vs. employed, coefficient = 0.671, 95%CI: 0.466-0.966, p = 0.032), and a history of breast ultrasound (vs. no, coefficient = 1.466, 95%CI: 1.121-1.917, p = 0.005) were independently and positively associated with knowledge. Knowledge (coefficient = 1.303, 95%CI: 1.100-1.544, p = 0.002) and monthly income >10,000 (vs. <5,000, coefficient = 4.364, 95%CI: 1.738-10.956, p = 0.002) were independently and positively associated with attitude. Only attitude (coefficient = 1.212, 95%CI: 1.096-1.340, p < 0.001) was independently and positively associated with the practice. A structural equation modeling (SEM) analysis was used to estimate causality among KAP dimensions, showing that knowledge directly influenced attitude (β = -1.090, p = 0.015), knowledge did not directly influence practice (β = -0.117, p = 0.681) but had an indirect influence (β = 0.826, p = 0.028), and attitude directly influenced practice (β = -0.757, p = 0.016). Conclusion Women in Zhongshan City had good knowledge, favorable attitudes, and active practice toward breast ultrasound screening for breast cancer. Women's characteristics associated with a poorer KAP were identified, allowing for more targeted interventions.
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Affiliation(s)
- Shaozhong Liu
- Department of Ultrasound Imaging, Zhongshan City People’s Hospital, Zhongshan, China
| | - Shukai Zheng
- Department of Breast Surgery, Zhongshan City People’s Hospital, Zhongshan, China
| | - Mengzhen Qin
- Department of Ultrasound Imaging, Zhongshan City People’s Hospital, Zhongshan, China
| | - Yifeng Xie
- Department of Ultrasound Imaging, Zhongshan City People’s Hospital, Zhongshan, China
| | - Kun Yang
- Department of Ultrasound Imaging, Zhongshan City People’s Hospital, Zhongshan, China
| | - Xiaozhen Liu
- Department of Ultrasound Imaging, Zhongshan City People’s Hospital, Zhongshan, China
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Mariapun S, Ho WK, Eriksson M, Mohd Taib NA, Yip CH, Rahmat K, Hall P, Teo SH. Association of area- and volumetric-mammographic density and breast cancer risk in women of Asian descent: a case control study. Breast Cancer Res 2024; 26:79. [PMID: 38750574 PMCID: PMC11094942 DOI: 10.1186/s13058-024-01829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Mammographic density (MD) has been shown to be a strong and independent risk factor for breast cancer in women of European and Asian descent. However, the majority of Asian studies to date have used BI-RADS as the scoring method and none have evaluated area and volumetric densities in the same cohort of women. This study aims to compare the association of MD measured by two automated methods with the risk of breast cancer in Asian women, and to investigate if the association is different for premenopausal and postmenopausal women. METHODS In this case-control study of 531 cases and 2297 controls, we evaluated the association of area-based MD measures and volumetric-based MD measures with breast cancer risk in Asian women using conditional logistic regression analysis, adjusting for relevant confounders. The corresponding association by menopausal status were assessed using unconditional logistic regression. RESULTS We found that both area and volume-based MD measures were associated with breast cancer risk. Strongest associations were observed for percent densities (OR (95% CI) was 2.06 (1.42-2.99) for percent dense area and 2.21 (1.44-3.39) for percent dense volume, comparing women in highest density quartile with those in the lowest quartile). The corresponding associations were significant in postmenopausal but not premenopausal women (premenopausal versus postmenopausal were 1.59 (0.95-2.67) and 1.89 (1.22-2.96) for percent dense area and 1.24 (0.70-2.22) and 1.96 (1.19-3.27) for percent dense volume). However, the odds ratios were not statistically different by menopausal status [p difference = 0.782 for percent dense area and 0.486 for percent dense volume]. CONCLUSIONS This study confirms the associations of mammographic density measured by both area and volumetric methods and breast cancer risk in Asian women. Stronger associations were observed for percent dense area and percent dense volume, and strongest effects were seen in postmenopausal individuals.
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Affiliation(s)
- Shivaani Mariapun
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Weang-Kee Ho
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nur Aishah Mohd Taib
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Cheng-Har Yip
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Kartini Rahmat
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia
- Biomedical Imaging Department, Faculty of Medicine, Universiti Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Soo-Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia.
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia.
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Løyland B, Sandbekken IH, Grov EK, Utne I. Causes and Risk Factors of Breast Cancer, What Do We Know for Sure? An Evidence Synthesis of Systematic Reviews and Meta-Analyses. Cancers (Basel) 2024; 16:1583. [PMID: 38672665 PMCID: PMC11049405 DOI: 10.3390/cancers16081583] [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: 03/28/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Breast cancer affected more than 2.3 million women in 2022 and is the most diagnosed cancer among women worldwide. The incidence rates are greater in developed regions and are significantly higher among women with higher education and socioeconomic status. Therefore, it is reasonable to assume that the way women live their lives may impact their risk of being diagnosed with breast cancer. This systematic review aimed to identify what is known about the causes and risk factors of breast cancer, excluding genetic causes. A comprehensive systematic search identified 2387 systematic reviews, 122 were included and six overall themes identified. In our "top list" with the 36 most important findings, a study of breast density had the highest effect size for increasing the risk of breast cancer, and a high sex-hormone-binding globulin level was the most protective factor. Many of the included studies investigating the same topics had conflicting results. The conclusion from this evidence synthesis reveals a lack of consensus of factors associated with the causes and risk of breast cancer. These findings suggest that recommendations about lifestyle and breast cancer should be made with caution.
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Affiliation(s)
- Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (I.H.S.); (E.K.G.); (I.U.)
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Hung CC, Moi SH, Huang HI, Hsiao TH, Huang CC. Polygenic risk score-based prediction of breast cancer risk in Taiwanese women with dense breast using a retrospective cohort study. Sci Rep 2024; 14:6324. [PMID: 38491043 PMCID: PMC10943108 DOI: 10.1038/s41598-024-55976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/29/2024] [Indexed: 03/18/2024] Open
Abstract
Mammographic screening has contributed to a significant reduction in breast cancer mortality. Several studies have highlighted the correlation between breast density, as detected through mammography, and a higher likelihood of developing breast cancer. A polygenic risk score (PRS) is a numerical score that is calculated based on an individual's genetic information. This study aims to explore the potential roles of PRS as candidate markers for breast cancer development and investigate the genetic profiles associated with clinical characteristics in Asian females with dense breasts. This is a retrospective cohort study integrated breast cancer screening, population genotyping, and cancer registry database. The PRSs of the study cohort were estimated using genotyping data of 77 single nucleotide polymorphisms based on the PGS000001 Catalog. A subgroup analysis was conducted for females without breast symptoms. Breast cancer patients constituted a higher proportion of individuals in PRS Q4 (37.8% vs. 24.8% in controls). Among dense breast patients with no symptoms, the high PRS group (Q4) consistently showed a significantly elevated breast cancer risk compared to the low PRS group (Q1-Q3) in both univariate (OR = 2.25, 95% CI 1.43-3.50, P < 0.001) and multivariate analyses (OR: 2.23; 95% CI 1.41-3.48, P < 0.001). The study was extended to predict breast cancer risk using common low-penetrance risk variants in a PRS model, which could be integrated into personalized screening strategies for Taiwanese females with dense breasts without prominent symptoms.
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Affiliation(s)
- Chih-Chiang Hung
- Division of Breast Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, 407, Taiwan
- Department of Applied Cosmetology, College of Human Science and Social Innovation, Hung Kuang University, Taichung, 433, Taiwan
- College of Life Sciences, National Chung Hsing University, Taichung, 402, Taiwan
| | - Sin-Hua Moi
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Hsin-I Huang
- Department of Information Management, National Sun Yat-Sen University, Kaohsiung, 804, Taiwan
- International Integrated Systems, INC, Kaohsiung, 806, Taiwan
| | - Tzu-Hung Hsiao
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan.
- Department of Public Health, Fu Jen Catholic University, New Taipei City, 242, Taiwan.
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 402, Taiwan.
| | - Chi-Cheng Huang
- Division of Breast Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, 112, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xuzhou Rd., Taipei City, 100, Taiwan.
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Lee M, Kotake R, Yamauchi H. Physical Activity and Mammographic Density in Japanese Women. Cancer Epidemiol Biomarkers Prev 2024; 33:365-370. [PMID: 38147061 PMCID: PMC10905669 DOI: 10.1158/1055-9965.epi-23-0777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/11/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Dense breast is one of the strong risk factors for breast cancer among women. While it has been established that physical activity is associated with decreased risk for breast cancer, results have been inconsistent in terms of mammographic density. Thus, we examined physical activity in relation to mammographic density among Japanese women in Tokyo. METHODS We used 123,026 records from 33,698 Japanese women without a history of breast cancer who got mammograms at St. Luke's International Hospital in Tokyo, Japan from 2004 to 2019. Mammographic density was classified according to the Breast Imaging Reporting and Data System (BI-RADS), and women self-reported their physical activity level over the past year. ORs were estimated using logistic generalized estimating equations after adjusting for age, body mass index, menopausal status, parity, family history of breast or ovarian cancer, hormone therapy use, smoking status, alcohol consumption, and year. RESULTS We observed inverse associations of physical activity with dense breasts. Adjusted ORs were 0.96 (95% confidence interval: 0.91-1.00) for women with physical exercise for 1-2 days per week, 0.94 (0.88-0.99) for those with physical exercise for 3-5 days per week, and 0.91 (0.84-0.99) for those with daily physical exercise when compared with those reported seldom physical exercise. CONCLUSIONS Higher levels of physical activity may be associated with decreased mammographic density levels in Japanese women. IMPACT Increasing physical activity may serve as a reasonable intervention to reduce mammographic density, and thereby, to mitigate the risk of breast cancer in Asian women.
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Affiliation(s)
- Mihye Lee
- St. Luke's School of Public Health, Tokyo, Japan
| | - Rina Kotake
- St. Luke's School of Public Health, Tokyo, Japan
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Li Y, Zhang Y, Yu Q, He C, Yuan X. Intelligent scoring system based on dynamic optical breast imaging for early detection of breast cancer. BIOMEDICAL OPTICS EXPRESS 2024; 15:1515-1527. [PMID: 38495695 PMCID: PMC10942703 DOI: 10.1364/boe.515135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/06/2024] [Accepted: 01/31/2024] [Indexed: 03/19/2024]
Abstract
Early detection of breast cancer can significantly improve patient outcomes and five-year survival in clinical screening. Dynamic optical breast imaging (DOBI) technology reflects the blood oxygen metabolism level of tumors based on the theory of tumor neovascularization, which offers a technical possibility for early detection of breast cancer. In this paper, we propose an intelligent scoring system integrating DOBI features assessment and a malignancy score grading reporting system for early detection of breast cancer. Specifically, we build six intelligent feature definition models to depict characteristics of regions of interest (ROIs) from location, space, time and context separately. Similar to the breast imaging-reporting and data system (BI-RADS), we conclude the malignancy score grading reporting system to score and evaluate ROIs as follows: Malignant (≥ 80 score), Likely Malignant (60-80 score), Intermediate (35-60 score), Likely Benign (10-35 score), and Benign (<10 score). This system eliminates the influence of subjective physician judgments on the assessment of the malignant probability of ROIs. Extensive experiments on 352 Chinese patients demonstrate the effectiveness of the proposed system compared to state-of-the-art methods.
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Affiliation(s)
- Yaoyao Li
- Hangzhou Institute of Technology, Xidian University, Qiannong Dong Road No. 8, Hangzhou, Zhejiang, 311231, China
| | - Yipei Zhang
- Hangzhou Institute of Technology, Xidian University, Qiannong Dong Road No. 8, Hangzhou, Zhejiang, 311231, China
| | - Qiang Yu
- Hangzhou Institute of Technology, Xidian University, Qiannong Dong Road No. 8, Hangzhou, Zhejiang, 311231, China
| | - Chenglong He
- Hangzhou Institute of Technology, Xidian University, Qiannong Dong Road No. 8, Hangzhou, Zhejiang, 311231, China
| | - Xiguo Yuan
- Hangzhou Institute of Technology, Xidian University, Qiannong Dong Road No. 8, Hangzhou, Zhejiang, 311231, China
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Bai S, Song D, Chen M, Lai X, Xu J, Dong F. The association between mammographic density and breast cancer risk in Chinese women: a systematic review and meta-analysis. BMC Womens Health 2024; 24:131. [PMID: 38378562 PMCID: PMC10877813 DOI: 10.1186/s12905-024-02960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE Breast density has consistently been shown to be an independent risk factor for breast cancer in Western populations; however, few studies have evaluated this topic in Chinese women and there is not yet a unified view. This study investigated the association between mammographic density (MD) and breast cancer risk in Chinese women. METHODS The PubMed, Cochrane Library, Embase, and Wanfang databases were systematically searched in June 2023 to include all studies on the association between MD and breast cancer risk in Chinese women. A total of 13,977 breast cancer cases from 14 studies were chosen, including 10 case-control/cross-sectional studies, and 4 case-only studies. For case-control/cross-sectional studies, the odds ratios (ORs) of MD were combined using random effects models, and for case-only studies, relative odds ratios (RORs) were combinations of premenopausal versus postmenopausal breast cancer cases. RESULTS Women with BI-RADS density category II-IV in case-control/cross-sectional studies had a 0.93-fold (95% confidence interval [CI] 0.55, 1.57), 1.08-fold (95% CI 0.40, 2.94), and 1.24-fold (95% CI 0.42, 3.69) higher risk compared to women with the lowest density category. Combined RORs for premenopausal versus postmenopausal women in case-only studies were 3.84 (95% CI 2.92, 5.05), 22.65 (95% CI 7.21, 71.13), and 42.06 (95% CI 4.22, 419.52), respectively, for BI-RADS density category II-IV versus I. CONCLUSIONS For Chinese women, breast cancer risk is weakly associated with MD; however, breast cancer risk is more strongly correlated with mammographic density in premenopausal women than postmenopausal women. Further research on the factors influencing MD in premenopausal women may provide meaningful insights into breast cancer prevention in China.
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Affiliation(s)
- Song Bai
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
| | - Di Song
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
| | - Ming Chen
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
| | - Xiaoshu Lai
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China.
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China.
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Pathanasethpong P, Nawapun S, Chadbunchachai P, Somintara O, Apivatanasiri C, Boonrod A. The diagnostic accuracy of mammography and ultrasonography for recurrent breast cancer after breast conserving treatment. Eur J Radiol Open 2023; 11:100514. [PMID: 37609045 PMCID: PMC10440391 DOI: 10.1016/j.ejro.2023.100514] [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: 05/08/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Objective To evaluate the performance of mammography and breast ultrasonography to diagnose tumor recurrence in patients after breast conserving therapy. Material and Methods Imaging findings of 130 breast cancer patients treated by breast conserving therapy (BCT) who have followed up with mammography and ultrasonography at our center between 1 st January 2010 and 1st January 2016 were interpreted by two radiologists. The information of recurrent tumor and baseline data were blinded. Imaging interpretation followed the ACR Breast imaging-reporting and data system (BI-RADS) 5th edition guideline. Findings of mammography, breast ultrasonography, demographic data and histological data were recorded and analyzed. Results The presence of mass in mammography (P-value=0.025) and internal vascularity in mass in ultrasonography (P-value<0.001) were associated with recurrent tumor at the surgical bed. All the recurrent tumors were interpreted as BI-RADS 4 (71 patients) with sensitivity= 100%, specificity= 89.5%. BIRADS4 is significant in the diagnosis of recurrent breast cancer in BCT patients (AUC of the ROC curve = 0.742 and 95% CI=(0.7-0.79)). Conclusion The presence of mass in mammography and internal vascularity in the mass in ultrasonography are the imaging findings which were significantly related to recurrent tumor at surgical bed in patient with breast conserving treatment.
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Affiliation(s)
| | - Supajit Nawapun
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Payia Chadbunchachai
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | | | - Arunnit Boonrod
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 40002, Thailand
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11
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Kim H, Lim J, Kim HG, Lim Y, Seo BK, Bae MS. Deep Learning Analysis of Mammography for Breast Cancer Risk Prediction in Asian Women. Diagnostics (Basel) 2023; 13:2247. [PMID: 37443642 DOI: 10.3390/diagnostics13132247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
The purpose of this study was to develop a mammography-based deep learning (DL) model for predicting the risk of breast cancer in Asian women. This retrospective study included 287 examinations in 153 women in the cancer group and 736 examinations in 447 women in the negative group, obtained from the databases of two tertiary hospitals between November 2012 and March 2022. All examinations were labeled as either dense breast or nondense breast, and then randomly assigned to either training, validation, or test sets. DL models, referred to as image-level and examination-level models, were developed. Both models were trained to predict whether or not the breast would develop breast cancer with two datasets: the whole dataset and the dense-only dataset. The performance of DL models was evaluated using the accuracy, precision, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC). On a test set, performance metrics for the four scenarios were obtained: image-level model with whole dataset, image-level model with dense-only dataset, examination-level model with whole dataset, and examination-level model with dense-only dataset with AUCs of 0.71, 0.75, 0.66, and 0.67, respectively. Our DL models using mammograms have the potential to predict breast cancer risk in Asian women.
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Affiliation(s)
- Hayoung Kim
- Department of Radiology, College of Medicine, Inha University Hospital, Inhang-ro 27, Jung-gu, Incheon 22332, Republic of Korea
| | - Jihe Lim
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si 18450, Gyeonggi-do, Republic of Korea
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University Hospital, Seoul 02447, Republic of Korea
| | - Yunji Lim
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si 18450, Gyeonggi-do, Republic of Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan-si 15355, Gyeonggi-do, Republic of Korea
| | - Min Sun Bae
- Department of Radiology, College of Medicine, Inha University Hospital, Inhang-ro 27, Jung-gu, Incheon 22332, Republic of Korea
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12
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Portnow LH, Choridah L, Kardinah K, Handarini T, Pijnappel R, Bluekens AMJ, Duijm LEM, Schoub PK, Smilg PS, Malek L, Leung JWT, Raza S. International Interobserver Variability of Breast Density Assessment. J Am Coll Radiol 2023; 20:671-684. [PMID: 37127220 DOI: 10.1016/j.jacr.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of this study was to determine variability in visually assessed mammographic breast density categorization among radiologists practicing in Indonesia, the Netherlands, South Africa, and the United States. METHODS Two hundred consecutive 2-D full-field digital screening mammograms obtained from September to December 2017 were selected and retrospectively reviewed from four global locations, for a total of 800 mammograms. Three breast radiologists in each location (team) provided consensus density assessments of all 800 mammograms using BI-RADS® density categorization. Interreader agreement was compared using Gwet's AC2 with quadratic weighting across all four density categories and Gwet's AC1 for binary comparison of combined not dense versus dense categories. Variability of distribution among teams was calculated using the Stuart-Maxwell test of marginal homogeneity across all four categories and using the McNemar test for not dense versus dense categories. To compare readers from a particular country on their own 200 mammograms versus the other three teams, density distribution was calculated using conditional logistic regression. RESULTS For all 800 mammograms, interreader weighted agreement for distribution among four density categories was 0.86 (Gwet's AC2 with quadratic weighting; 95% confidence interval, 0.85-0.88), and for not dense versus dense categories, it was 0.66 (Gwet's AC1; 95% confidence interval, 0.63-0.70). Density distribution across four density categories was significantly different when teams were compared with one another and one team versus the other three teams combined (P < .001). Overall, all readers placed the largest number of mammograms in the scattered and heterogeneous categories. CONCLUSIONS Although reader teams from four different global locations had almost perfect interreader agreement in BI-RADS density categorization, variability in density distribution across four categories remained statistically significant.
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Affiliation(s)
- Leah H Portnow
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; and Instructor, Department of Radiology, Harvard Medical School, Boston, Massachusetts.
| | - Lina Choridah
- Vice Dean of Research and Development, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Farmako, Sekip Utara, Yogyakarta, Indonesia
| | - Kardinah Kardinah
- Director of Early Breast Cancer Detection Program for the Ministry of Health and Medical Committee Leader of Quality Assurance; Department of Radiology, Faculty of Medicine, Dharmais Cancer Hospital/National Cancer Center, Jakarta, Indonesia
| | - Triwulan Handarini
- Chair of the Radiology Medical Staff, Department of Radiology, Faculty of Medicine, Airlangga University-Dr Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Ruud Pijnappel
- Department of Radiology, University Medical Center, Utrecht, the Netherlands; Professor, Utrecht University, Utrecht, the Netherlands; Chair, Dutch Expert Centre for Screening; and President, European Society of Breast Imaging
| | - Adriana M J Bluekens
- Department of Radiology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Peter K Schoub
- Department of Radiology, Parklane Radiology, Johannesburg, South Africa; Chair, Breast Imaging Society of South Africa
| | - Pamela S Smilg
- Department of Radiology, Parklane Radiology, Johannesburg, South Africa; Department of Radiology, Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Liat Malek
- The Breast Wellness Centre, Johannesburg, South Africa
| | - Jessica W T Leung
- Deputy Chair, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Chair, Ultrasound Subcommittee, BI-RADS Committee, American College of Radiology. https://twitter.com/DrJessicaLeung
| | - Sughra Raza
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Dartmouth Hitchcock Medical Center, Hanover, NH; and Editor-in-Chief, Journal of Global Radiology
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13
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Pan IW, Yen TW, Bedrosian I, Shih YCT. Current Trends in the Utilization of Preoperative Breast Magnetic Resonance Imaging Among Women With Newly Diagnosed Breast Cancer. JCO Oncol Pract 2023; 19:446-455. [PMID: 37071025 PMCID: PMC10337726 DOI: 10.1200/op.22.00578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 04/19/2023] Open
Abstract
PURPOSE The clinical benefit of preoperative breast magnetic resonance imaging (MRI) for early-stage breast cancer (BC) remains controversial. We examined trends and the associated factors of preoperative breast MRI use. METHODS This study cohort, constructed from Optum Clinformatics database, included women with early-stage BC who had a cancer surgery between March 1, 2008, and December 31, 2020. Preoperative breast MRI was performed between the date of BC diagnosis and index surgery. Multivariable logistic regressions, one for elderly (65 years and older) and the other for non-elderly patients (younger than 65 years), were performed to examine factors associated with the use of preoperative MRI. RESULTS Among 92,077 women with early-stage BC, the crude rate of preoperative breast MRI increased from 48% in 2008 to 60% in 2020 for nonelderly and from 27% to 34% for elderly women. For both age groups, non-Hispanic Blacks were less likely (odds ratio [OR]; 95% CI, younger than 65 years: 0.75, 0.70 to 0.81; 65 years and older: 0.77, 0.72 to 0.83) to receive preoperative MRI than non-Hispanic White patients. Across Census divisions, the highest adjusted rate was observed in Mountain division (OR compared with New England; 95% CI, younger than 65 years: 1.45, 1.27 to 1.65; 65 years and older: 2.42, 2.16 to 2.72). Other factors included younger age, fewer comorbidities, family history of BC, axillary node involvement, and neoadjuvant chemotherapy for both age groups. CONCLUSION The use of preoperative breast MRI has steadily increased. Aside from clinical factors, age, race/ethnicity, and geographic location were associated with preoperative MRI use. This information is important for future implementation or deimplementation strategies of preoperative MRI.
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Affiliation(s)
- I-Wen Pan
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tina W.F. Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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14
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Jee YH, Ho WK, Park S, Easton DF, Teo SH, Jung KJ, Kraft P. Polygenic risk scores for prediction of breast cancer in Korean women. Int J Epidemiol 2023; 52:796-805. [PMID: 36343017 PMCID: PMC10244045 DOI: 10.1093/ije/dyac206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Polygenic risk scores (PRSs) for breast cancer, developed using European and Asian genome-wide association studies (GWAS), have been shown to have good discrimination in Asian women. However, prospective calibration of absolute risk prediction models, based on a PRS or PRS combined with lifestyle, clinical and environmental factors, in Asian women is limited. METHODS We consider several PRSs trained using European and/or Asian GWAS. For each PRS, we evaluate the discrimination and calibration of three absolute risk models among 41 031 women from the Korean Cancer Prevention Study (KCPS)-II Biobank: (i) a model using incidence, mortality and risk factor distributions (reference inputs) among US women and European relative risks; (ii) a recalibrated model, using Korean reference but European relative risks; and (iii) a fully Korean-based model using Korean reference and relative risk estimates from KCPS. RESULTS All Asian and European PRS improved discrimination over lifestyle, clinical and environmental (Qx) factors in Korean women. US-based absolute risk models overestimated the risks for women aged ≥50 years, and this overestimation was larger for models that only included PRS (expected-to-observed ratio E/O = 1.2 for women <50, E/O = 2.7 for women ≥50). Recalibrated and Korean-based risk models had better calibration in the large, although the risk in the highest decile was consistently overestimated. Absolute risk projections suggest that risk-reducing lifestyle changes would lead to larger absolute risk reductions among women at higher PRS. CONCLUSIONS Absolute risk models incorporating PRS trained in European and Asian GWAS and population-appropriate average age-specific incidences may be useful for risk-stratified interventions in Korean women.
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Affiliation(s)
- Yon Ho Jee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Weang-Kee Ho
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Sohee Park
- Department of Biostatistics, Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Soo-Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- Sime Darby Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Keum Ji Jung
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
- Nuffield Department Population Health, University of Oxford, Oxford, UK
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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15
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Choi E, Suh M, Jung SY, Jung KW, Park S, Jun JK, Choi KS. Estimating Age-Specific Mean Sojourn Time of Breast Cancer and Sensitivity of Mammographic Screening by Breast Density among Korean Women. Cancer Res Treat 2023; 55:136-144. [PMID: 35381162 PMCID: PMC9873334 DOI: 10.4143/crt.2021.962] [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: 08/26/2021] [Accepted: 04/01/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE High breast cancer incidence and dense breast prevalence among women in forties are specific to Asian. This study examined the natural history of breast cancer among Korean women. MATERIALS AND METHODS We applied a three-state Markov model (i.e., healthy, preclinical, and clinical state) to fit the natural history of breast cancer to data in the Korean National Cancer Screening Program. Breast cancer was ascertained by linkage to the Korean Central Cancer Registry. Disease-progression rates (i.e., transition rates between three states), mean sojourn time (MST) and mammographic sensitivity were estimated across 10-year age groups and levels of breast density determined by the Breast Imaging, Reporting and Data System. RESULTS Overall prevalence of dense breast was 53.9%. Transition rate from healthy to preclinical state, indicating the preclinical incidence of breast cancer, was higher among women in forties (0.0019; 95% confidence interval [CI], 0.0017 to 0.0021) and fifties (0.0020; 95% CI, 0.0017 to 0.0022), than women in sixties (0.0014; 95% CI, 0.0012 to 0.0017). The MSTs, in which the tumor is asymptomatic but detectable by screening, were also fastest among younger age groups, estimated as 1.98 years (95% CI, 1.67 to 2.33), 2.49 years (95% CI, 1.92 to 3.22), and 3.07 years (95% CI, 2.11 to 4.46) for women in forties, fifties, and sixties, respectively. Having dense breasts increased the likelihood of the preclinical cancer risk (1.96 to 2.35 times) and decreased the duration of MST (1.53 to 2.02 times). CONCLUSION This study estimated Korean-specific natural history parameters of breast cancer that would be utilized for establishing optimal screening strategies in countries with higher dense breast prevalence.
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Affiliation(s)
- Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang,
Korea
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang,
Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang,
Korea
| | - Sohee Park
- Graduate School of Public Health, Yonsei University, Seoul,
Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang,
Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea
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16
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Anandarajah A, Chen Y, Colditz GA, Hardi A, Stoll C, Jiang S. Studies of parenchymal texture added to mammographic breast density and risk of breast cancer: a systematic review of the methods used in the literature. Breast Cancer Res 2022; 24:101. [PMID: 36585732 PMCID: PMC9805242 DOI: 10.1186/s13058-022-01600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
This systematic review aimed to assess the methods used to classify mammographic breast parenchymal features in relation to the prediction of future breast cancer. The databases including Medline (Ovid) 1946-, Embase.com 1947-, CINAHL Plus 1937-, Scopus 1823-, Cochrane Library (including CENTRAL), and Clinicaltrials.gov were searched through October 2021 to extract published articles in English describing the relationship of parenchymal texture features with the risk of breast cancer. Twenty-eight articles published since 2016 were included in the final review. The identification of parenchymal texture features varied from using a predefined list to machine-driven identification. A reduction in the number of features chosen for subsequent analysis in relation to cancer incidence then varied across statistical approaches and machine learning methods. The variation in approach and number of features identified for inclusion in analysis precluded generating a quantitative summary or meta-analysis of the value of these features to improve predicting risk of future breast cancers. This updated overview of the state of the art revealed research gaps; based on these, we provide recommendations for future studies using parenchymal features for mammogram images to make use of accumulating image data, and external validation of prediction models that extend to 5 and 10 years to guide clinical risk management. Following these recommendations could enhance the applicability of models, helping improve risk classification and risk prediction for women to tailor screening and prevention strategies to the level of risk.
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Affiliation(s)
- Akila Anandarajah
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave MSC 8100-0094-2200, Saint Louis, MO, 63110, USA
| | - Yongzhen Chen
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave MSC 8100-0094-2200, Saint Louis, MO, 63110, USA
| | - Angela Hardi
- Bernard Becker Medical Library, Washington University School of Medicine, MSC 8132-12-01, 660 S Euclid Ave, Saint Louis, MO, 63110, USA
| | - Carolyn Stoll
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave MSC 8100-0094-2200, Saint Louis, MO, 63110, USA
| | - Shu Jiang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave MSC 8100-0094-2200, Saint Louis, MO, 63110, USA.
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17
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Fane L, Biswas T, Jindal C, Choi YM, Efird JT. Breast Cancer Disparities in Asian Women: The Need for Disaggregated Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9790. [PMID: 36011424 PMCID: PMC9408195 DOI: 10.3390/ijerph19169790] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/06/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
Asian (AZN) women are a heterogeneous group, comprising a wide array of cultural beliefs, languages, and healthcare needs. Yet, studies of breast cancer (BCa) risks and outcomes predominately consider AZNs in aggregate, assuming that the distinct ethnicities have similar disease profiles and homogeneous responses to treatment. This stereotypical portrayal of AZNs as a homogenous group tends to mask disparities. For example, healthcare-seeking behaviors and attitudes of medical providers toward AZN BCa patients frequently differ within this group and from other races. Misconceptions may arise that significantly influence the prevention, detection, treatment, and post-therapeutic care of AZN women. In addition to low BCa screening rates among AZN women, disparities also exist in various stages of BCa treatment-omission of radiation after breast-conserving surgery, less access to hypofractionation, underutilization of hormonal therapy, and higher-cost treatment owing to high HER2+ incidence. In this perspective, we highlight the need for disaggregated research of BCa among AZN women and advocate for comprehensive, culturally sensitive strategies to address health disparities in this priority population. Improving BCa literacy and awareness, access to care, and equitable recruitment into clinical trials are a few amelioratory goals to consider in the future.
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Affiliation(s)
- Lauren Fane
- MD University Program, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Charulata Jindal
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | | | - Jimmy T. Efird
- VA Cooperative Studies Program Coordinating Center, Boston, MA 02130, USA
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Ren W, Chen M, Qiao Y, Zhao F. Global guidelines for breast cancer screening: A systematic review. Breast 2022; 64:85-99. [PMID: 35636342 PMCID: PMC9142711 DOI: 10.1016/j.breast.2022.04.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/28/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Breast cancer screening guidelines could provide valuable tools for clinical decision making by reviewing the available evidence and providing recommendations. Little information is known about how many countries have issued breast cancer screening guidelines and the differences among existing guidelines. We systematically reviewed current guidelines and summarized corresponding recommendations, to provide references for good clinical practice in different countries. Methods Systematic searches of MEDLINE, EMBASE, Web of Science, and Scopus from inception to March 27th, 2021 were conducted and supplemented by reviewing the guideline development organizations. The quality of screening guidelines was assessed from six domains of the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument by two appraisers. The basic information and recommendations of the issued guidelines were extracted and summarized. Results A total of 23 guidelines issued between 2010 and 2021 in 11 countries or regions were identified for further review. The content and quality varied across the guidelines. The average AGREE Ⅱ scores of the guidelines ranged from 33.3% to 87.5%. The highest domain score was "clarity of presentation" while the domain with the lowest score was "applicability". For average-risk women, most of the guidelines recommended mammographic screening for those aged 40–74 years, specifically, those aged 50–69 years were regarded as the optimal age group for screening. Nine of 23 guidelines recommended against an upper age limit for breast cancer screening. Mammography (MAM) was recommended as the primary screening modality for average-risk women by all included guidelines. Most guidelines suggested annual or biennial mammographic screening. Risk factors of breast cancer identified in the guidelines mainly fell within five categories which could be broadly summarized as the personal history of pre-cancerous lesions and/or breast cancer; the family history of breast cancer; the known genetic predisposition of breast cancer; the history of mantle or chest radiation therapy; and dense breasts. For women at higher risk, there was a consensus among most guidelines that annual MAM or annual magnetic resonance imaging (MRI) should be given, and the screening should begin earlier than the average-risk group. Conclusions The majority of 23 included international guidelines were issued by developed countries which contained roughly the same but not identical recommendations on breast cancer screening age, methods, and intervals. Most guidelines recommended annual or biennial mammographic screening between 40 and 74 years for average-risk populations and annual MAM or annual MRI starting from a younger age for high-risk populations. Current guidelines varied in quality and increased efforts are needed to improve the methodological quality of guidance documents. Due to lacking clinical practice guidelines tailored to different economic levels, low- and middle-income countries (LMICs) should apply and implement the evidence-based guidelines with higher AGREE Ⅱ scores considering local adaption. This systematic review comprehensively maps the recommendations of the latest international breast screening guidelines, providing valuable tools for clinical decision making in different settings. Most guidelines recommend annual or biennial mammographic screening between 40 and 74 years for the average-risk populations and annual MAM or annual MRI starting from a younger age for the high-risk populations. However, there are indeed discrepancies in screening age, methods, and intervals among countries. High-quality evidence and rigorous methodology are the keys to guidance development, but current guidelines vary in methodological quality.
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Affiliation(s)
- Wenhui Ren
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Mingyang Chen
- Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Youlin Qiao
- Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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19
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Yamamuro M, Asai Y, Hashimoto N, Yasuda N, Kimura H, Yamada T, Nemoto M, Kimura Y, Handa H, Yoshida H, Abe K, Tada M, Habe H, Nagaoka T, Nin S, Ishii K, Kondo Y. Utility of U-Net for the objective segmentation of the fibroglandular tissue region on clinical digital mammograms. Biomed Phys Eng Express 2022; 8. [PMID: 35728581 DOI: 10.1088/2057-1976/ac7ada] [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: 02/15/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
This study investigates the equivalence or compatibility between U-Net and visual segmentations of fibroglandular tissue regions by mammography experts for calculating the breast density and mean glandular dose (MGD). A total of 703 mediolateral oblique-view mammograms were used for segmentation. Two region types were set as the ground truth (determined visually): (1) one type included only the region where fibroglandular tissue was identifiable (called the 'dense region'); (2) the other type included the region where the fibroglandular tissue may have existed in the past, provided that apparent adipose-only parts, such as the retromammary space, are excluded (the 'diffuse region'). U-Net was trained to segment the fibroglandular tissue region with an adaptive moment estimation optimiser, five-fold cross-validated with 400 training and 100 validation mammograms, and tested with 203 mammograms. The breast density and MGD were calculated using the van Engeland and Dance formulas, respectively, and compared between U-Net and the ground truth with the Dice similarity coefficient and Bland-Altman analysis. Dice similarity coefficients between U-Net and the ground truth were 0.895 and 0.939 for the dense and diffuse regions, respectively. In the Bland-Altman analysis, no proportional or fixed errors were discovered in either the dense or diffuse region for breast density, whereas a slight proportional error was discovered in both regions for the MGD (the slopes of the regression lines were -0.0299 and -0.0443 for the dense and diffuse regions, respectively). Consequently, the U-Net and ground truth were deemed equivalent (interchangeable) for breast density and compatible (interchangeable following four simple arithmetic operations) for MGD. U-Net-based segmentation of the fibroglandular tissue region was satisfactory for both regions, providing reliable segmentation for breast density and MGD calculations. U-Net will be useful in developing a reliable individualised screening-mammography programme, instead of relying on the visual judgement of mammography experts.
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Affiliation(s)
- Mika Yamamuro
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan.,Graduate School of Health Sciences, Niigata University, 2-746, Asahimachidori, Chuouku, Niigata 951-8518, Japan
| | - Yoshiyuki Asai
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Naomi Hashimoto
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Nao Yasuda
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Hiorto Kimura
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Takahiro Yamada
- Division of Positron Emission Tomography Institute of Advanced Clinical Medicine, Kindai University, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Mitsutaka Nemoto
- Department of Computational Systems Biology, Kindai University Faculty of Biology-Oriented Science and Technology, 930, Nishimitani, Kinokawa, Wakayama 649-6433, Japan
| | - Yuichi Kimura
- Department of Computational Systems Biology, Kindai University Faculty of Biology-Oriented Science and Technology, 930, Nishimitani, Kinokawa, Wakayama 649-6433, Japan
| | - Hisashi Handa
- Department of Informatics, Kindai University Faculty of Science and Engineering, 3-4-1, Kowakae, Higashi-osaka, Osaka 577-8502, Japan
| | - Hisashi Yoshida
- Department of Computational Systems Biology, Kindai University Faculty of Biology-Oriented Science and Technology, 930, Nishimitani, Kinokawa, Wakayama 649-6433, Japan
| | - Koji Abe
- Department of Informatics, Kindai University Faculty of Science and Engineering, 3-4-1, Kowakae, Higashi-osaka, Osaka 577-8502, Japan
| | - Masahiro Tada
- Department of Informatics, Kindai University Faculty of Science and Engineering, 3-4-1, Kowakae, Higashi-osaka, Osaka 577-8502, Japan
| | - Hitoshi Habe
- Department of Informatics, Kindai University Faculty of Science and Engineering, 3-4-1, Kowakae, Higashi-osaka, Osaka 577-8502, Japan
| | - Takashi Nagaoka
- Department of Computational Systems Biology, Kindai University Faculty of Biology-Oriented Science and Technology, 930, Nishimitani, Kinokawa, Wakayama 649-6433, Japan
| | - Seiun Nin
- Department of Radiology, Kindai University Faculty of Medicine, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Yohan Kondo
- Graduate School of Health Sciences, Niigata University, 2-746, Asahimachidori, Chuouku, Niigata 951-8518, Japan
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A Machine Learning Ensemble Based on Radiomics to Predict BI-RADS Category and Reduce the Biopsy Rate of Ultrasound-Detected Suspicious Breast Masses. Diagnostics (Basel) 2022; 12:diagnostics12010187. [PMID: 35054354 PMCID: PMC8774734 DOI: 10.3390/diagnostics12010187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/01/2023] Open
Abstract
We developed a machine learning model based on radiomics to predict the BI-RADS category of ultrasound-detected suspicious breast lesions and support medical decision-making towards short-interval follow-up versus tissue sampling. From a retrospective 2015–2019 series of ultrasound-guided core needle biopsies performed by four board-certified breast radiologists using six ultrasound systems from three vendors, we collected 821 images of 834 suspicious breast masses from 819 patients, 404 malignant and 430 benign according to histopathology. A balanced image set of biopsy-proven benign (n = 299) and malignant (n = 299) lesions was used for training and cross-validation of ensembles of machine learning algorithms supervised during learning by histopathological diagnosis as a reference standard. Based on a majority vote (over 80% of the votes to have a valid prediction of benign lesion), an ensemble of support vector machines showed an ability to reduce the biopsy rate of benign lesions by 15% to 18%, always keeping a sensitivity over 94%, when externally tested on 236 images from two image sets: (1) 123 lesions (51 malignant and 72 benign) obtained from two ultrasound systems used for training and from a different one, resulting in a positive predictive value (PPV) of 45.9% (95% confidence interval 36.3–55.7%) versus a radiologists’ PPV of 41.5% (p < 0.005), combined with a 98.0% sensitivity (89.6–99.9%); (2) 113 lesions (54 malignant and 59 benign) obtained from two ultrasound systems from vendors different from those used for training, resulting into a 50.5% PPV (40.4–60.6%) versus a radiologists’ PPV of 47.8% (p < 0.005), combined with a 94.4% sensitivity (84.6–98.8%). Errors in BI-RADS 3 category (i.e., assigned by the model as BI-RADS 4) were 0.8% and 2.7% in the Testing set I and II, respectively. The board-certified breast radiologist accepted the BI-RADS classes assigned by the model in 114 masses (92.7%) and modified the BI-RADS classes of 9 breast masses (7.3%). In six of nine cases, the model performed better than the radiologist did, since it assigned a BI-RADS 3 classification to histopathology-confirmed benign masses that were classified as BI-RADS 4 by the radiologist.
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21
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Adachi M, Nakagawa T, Fujioka T, Mori M, Kubota K, Oda G, Kikkawa T. Feasibility of Portable Microwave Imaging Device for Breast Cancer Detection. Diagnostics (Basel) 2021; 12:diagnostics12010027. [PMID: 35054193 PMCID: PMC8774784 DOI: 10.3390/diagnostics12010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: Microwave radar-based breast imaging technology utilizes the principle of radar, in which radio waves reflect at the interface between target and normal tissues, which have different permittivities. This study aims to investigate the feasibility and safety of a portable microwave breast imaging device in clinical practice. Materials and methods: We retrospectively collected the imaging data of ten breast cancers in nine women (median age: 66.0 years; range: 37–78 years) who had undergone microwave imaging examination before surgery. All were Japanese and the tumor sizes were from 4 to 10 cm. Using a five-point scale (1 = very poor; 2 = poor; 3 = fair; 4 = good; and 5 = excellent), a radiologist specialized in breast imaging evaluated the ability of microwave imaging to detect breast cancer and delineate its location and size in comparison with conventional mammography and the pathological findings. Results: Microwave imaging detected 10/10 pathologically proven breast cancers, including non-invasive ductal carcinoma in situ (DCIS) and micro-invasive carcinoma, whereas mammography failed to detect 2/10 breast cancers due to dense breast tissue. In the five-point evaluation, median score of location and size were 4.5 and 4.0, respectively. Conclusion: The results of the evaluation suggest that the microwave imaging device is a safe examination that can be used repeatedly and has the potential to be useful in detecting breast cancer.
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Affiliation(s)
- Mio Adachi
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (M.A.); (G.O.)
| | - Tsuyoshi Nakagawa
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (M.A.); (G.O.)
- Correspondence:
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (M.M.); (K.K.)
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (M.M.); (K.K.)
| | - Kazunori Kubota
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (M.M.); (K.K.)
- Department of Radiology, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Goshi Oda
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (M.A.); (G.O.)
| | - Takamaro Kikkawa
- Research Institute for Nanodevice and Bio Systems, Hiroshima University, Hiroshima 739-8527, Japan;
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22
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Futamura M, Yoshida K. Current status of AYA-generation breast cancer: trends worldwide and in Japan. Int J Clin Oncol 2021; 27:16-24. [PMID: 34921319 DOI: 10.1007/s10147-021-02087-4] [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: 09/26/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
Breast cancer (BC) is the most common cancer worldwide among women. In Japan, the incidence of BC gradually increased. The recent number of adolescent and young adult (AYA)-BC patients is approximately 4,000-5,000 every year, accounting for 5% of all BC cases. BC in young people has been attracting attention since Japan's third basic plan to promote cancer control programs incorporated cancer control measures for pediatric (age ≤ 14 years) and adolescent and young adult (AYA)-generation (age 15-39 years) cancers in 2018. Attention is needed to detect AYA-BC because of the presence of dense breasts. AYA-BC patients are clinically characterized by larger tumor size, more lymph node metastases, advanced stages, and a higher rate of aggressive phenotypes, such as triple-negative or HER2-positive subtypes, and are strongly associated with family history and genetic germline alterations, including hereditary breast and ovarian cancers. Given that AYA-BC patients show a poorer prognosis than older BC patients, they often require intensive therapies, including surgery, radiation, chemotherapy, and endocrine therapy. We must solve many survivorship-associated problems in AYA-BC patients, including fertility preservation, comorbidity after treatment, and long-term follow-up. Under these circumstances, national and local governments and various academic societies have started addressing these problems by formulating laws and guidelines, establishing medical systems, and offering financial support to conquer cancer and maintain a better quality of life. This review summarizes the current trends of AYA-BC worldwide and in Japan. Further Japan-specific data on AYA-BC are required to clarify its characteristics and improve prognosis and survivorship.
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Affiliation(s)
- Manabu Futamura
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Kazuhiro Yoshida
- Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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23
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Zhou X, Lei S, Li L, Xu T, Gu W, Ma F, Yang R. [Peripheral blood EMR3 gene methylation level is correlated with breast cancer in Chinese women]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1456-1463. [PMID: 34755660 DOI: 10.12122/j.issn.1673-4254.2021.10.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the association of methylation levels of C19orf57, MAP9, EMR3, NEK6 and PCOLCE2 genes in peripheral blood with breast cancer (BC) in Chinese women. METHODS We collected peripheral blood samples from 258 early-stage BC patients and 272 healthy women. Agena matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was utilized to quantitatively measure the methylation levels of CpG sites in the genes. The association between DNA methylation and BC was analyzed using a logistic regression model adjusted for covariants. Spearman's correlation analysis was performed to analyze the association between the gene methylation levels and age. The methylation levels of the genes in the BC patients with different clinical characteristics were investigated using non-parametric tests. RESULTS In stead of EMR3 gene hypermethylation as found in BC patients as found in the Caucasian population, EMR3 gene hypomethylation was found to correlate with BC in Chinese women, but this correlation was significant only in women beyond the age of 50 years (for every 10% reduction of the methylation level, EMR3_CpG_1: OR=1.40; EMR3_CpG_2: OR=2.31; EMR3_CpG_3: OR=2.76, P < 0.05). EMR3 methylation was not or was only weakly correlated with tumor stage, size, lymphatic metastasis, ER, PR, HER2, or Ki67. Our data did not show a correlation between C19orf57 methylation and BC. CONCLUSION Peripheral blood EMR3 gene hypomethylation is associated with BC in Chinese women, especially in those at an old age and in postmenopausal women.
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Affiliation(s)
- X Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - S Lei
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - L Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - T Xu
- Department of Clinical Laboratory, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
| | - W Gu
- Department of Clinical Laboratory, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
| | - F Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - R Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
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24
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Bao Z, Zhao Y, Chen S, Chen X, Xu X, Wei L, Chen L. Evidence and assessment of parenchymal patterns of ultrasonography for breast cancer detection among Chinese women: a cross-sectional study. BMC Med Imaging 2021; 21:152. [PMID: 34666701 PMCID: PMC8527662 DOI: 10.1186/s12880-021-00687-0] [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: 06/05/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Screening of breast cancer in asymptomatic women is important to evaluate for early diagnosis. In China ultrasound is a more frequently used method than mammography for the detection of breast cancer. The objectives of the study were to provide evidence and assessment of parenchymal patterns of ultrasonography for breast cancer detection among Chinese women. Methods Breast ultrasound examinations including the parenchymatous pattern of cytopathological confirmed breast cancer (n = 541) and age-matched cytopathological not confirmed breast cancer (n = 849) women were retrospectively reviewed by seven sonographer physicians. According to compositions of ducts, the thickness of the breast, diameter of ducts, fat lobules, and fibro glandular tissues, the breast parenchymatous pattern was categorized into heterogeneous (high percentage of fatty tissues), ductal (the inner diameters of ducts > 50% of the thick mass of the breast), mixed (the inner diameters of ducts was 50% of the thick mass of the breast), and fibrous categories (a dense classification of the breast). Results Heterogeneous (p < 0.0001, OR = 3.972) and fibrous categories (p < 0.0001, OR = 2.702) were higher among women who have cytopathological confirmed breast cancer than those who have not cytopathological confirmed breast cancer. The heterogeneous category was high-risk ultrasonographic examination category followed by the fibrous category. Agreements between sonographer physicians for categories of ultrasonic examinations were fair to good (Cohen’s k = 0.591). Conclusions Breast cancer risk in Chinese asymptomatic women differ according to the ultrasonographic breast parenchymal pattern. Level of Evidence: III. Technical efficacy stage: 2.
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Affiliation(s)
- Zhongtao Bao
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, No 20 Cha zhong Road, Taijiang District, Fuzhou, 350000, Fujian, China.
| | - Yanchun Zhao
- Department of Ultrasound, Provincial Clinical Academy of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Shuqiang Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, No 20 Cha zhong Road, Taijiang District, Fuzhou, 350000, Fujian, China
| | - Xiaoyu Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, No 20 Cha zhong Road, Taijiang District, Fuzhou, 350000, Fujian, China
| | - Xiang Xu
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, No 20 Cha zhong Road, Taijiang District, Fuzhou, 350000, Fujian, China
| | - Linglin Wei
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, No 20 Cha zhong Road, Taijiang District, Fuzhou, 350000, Fujian, China
| | - Ling Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, No 20 Cha zhong Road, Taijiang District, Fuzhou, 350000, Fujian, China
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25
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Kang D, Kim JY, Kim JY, Mun HS, Yoon SJ, Lee J, Han G, Im YH, Shin SY, Lee SK, Yu JH, Lee KH, Kim M, Park D, Choi YH, Jeong OS, Lee JH, Jekal SY, Choi JS, Guallar E, Chang Y, Ryu S, Cho J, Kang M. The Relationship Between Breast Density Change During Menopause and the Risk of Breast Cancer in Korean Women. Cancer Prev Res (Phila) 2021; 14:1119-1128. [PMID: 34507971 DOI: 10.1158/1940-6207.capr-20-0542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/14/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between changes in breast density during menopause and breast cancer risk. METHODS This study was a retrospective, longitudinal cohort study for women over 30 years of age who had undergone breast mammography serially at baseline and postmenopause during regular health checkups at Samsung Medical Center. None of the participants had been diagnosed with breast cancer at baseline. Mammographic breast density was measured using the American College of Radiology Breast Imaging Reporting and Data System. RESULTS During 18,615 person-years of follow-up (median follow-up 4.8 years; interquartile range 2.8-7.5 years), 45 participants were diagnosed with breast cancer. The prevalence of dense breasts was higher in those who were younger, underweight, had low parity or using contraceptives. The cumulative incidence of breast cancer increased 4 years after menopause in participants, and the consistently extremely dense group had a significantly higher cumulative incidence (CI) of breast cancer compared with other groups [CI of extremely dense vs. others (incidence rate per 100,000 person-years): 375 vs. 203, P < 0.01]. CONCLUSION Korean women whose breast density was extremely dense before menopause and who maintained this density after menopause were at two-fold greater risk of breast cancer. PREVENTION RELEVANCE Extremely dense breast density that is maintained persistently from premenopause to postmenopause increases risk of breast cancer two fold in Korean women. Therefore, women having risk factors should receive mammography frequently and if persistently extremely dense breast had been detected, additional modalities of BC screening could be considered.
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Affiliation(s)
- Danbee Kang
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Yeon Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Young Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Song Mun
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sook Ja Yoon
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jieun Lee
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gayeon Han
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Hyuck Im
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Shin
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.,Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Department of Breast Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Han Yu
- Department of Breast Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Hyun Lee
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Mincheol Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Dohyun Park
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Yoon-Ho Choi
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ok Soon Jeong
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jean Hyoung Lee
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Yong Jekal
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Soo Choi
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eliseo Guallar
- Department of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yoosoo Chang
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Occupational and Environmental Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.,Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Seungho Ryu
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Occupational and Environmental Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.,Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Juhee Cho
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea. .,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mira Kang
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. .,Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Comparison of the diagnostic performances of circulating tumor cells and the serum tumor markers CEA, CA125, and CA15-3 for breast cancer: a retrospective case-control study. JOURNAL OF BIO-X RESEARCH 2021. [DOI: 10.1097/jbr.0000000000000093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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27
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Li WM, Sun QW, Fan XF, Zhang JC, Xu T, Shen QQ, Jia L. Mammography breast density: an effective supplemental modality for the precise grading of ultrasound BI-RADS 4 categories. Gland Surg 2021; 10:2010-2018. [PMID: 34268085 DOI: 10.21037/gs-21-313] [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: 04/02/2021] [Accepted: 06/17/2021] [Indexed: 11/06/2022]
Abstract
Background High breast density is significantly associated with an increased risk of breast diseases. Presently, suspected breast masses assessed as Breast Imaging-Reporting and Data System (BI-RADS) grade 4 provide a wide range of positive predictive values. Moreover, subcategories (4a, 4b, and 4c) are still under consideration as the diagnostic criteria are neither comprehensive nor objective. However, whether mammography breast density (MBD) has any impact on the accurate grading of BI-RADS 4 assessed by ultrasound (US) remains unknown. Methods A total of 1,086 women with 1,293 breast masses were included and assessed as BI-RADS 3-5 by US. The subcategories of MBD (from the ACR-a to the ACR-d group) were assessed by mammography according to the criteria of the American College of Radiology (ACR). The clinicopathological characteristics of these patients were reviewed retrospectively. The malignancy rates of breast masses among different subgroups assessed by BI-RADS were re-estimated with MBD. Results Almost all BI-RADS 3 masses were classified as benign and nearly all BI-RADS 5 masses were identified as malignant. Significant inverse associations between MBD and malignancy rates were detected between the BI-RADS 4a and BI-RADS 4b groups. Moreover, malignancy rates decreased significantly from ACR-a to ACR-d for BI-RADS 4a and 4b breast lesions (P<0.001). However, this trend was not observed in BI-RADS 4c breast lesions. Conclusions MBD could serve as a crucial factor for the accurate grading of BI-RADS 4 lesions assessed by US. We strongly recommend the adoption of the MBD as a possible supplemental screening modality for US. Furthermore, it is equally beneficial for accurate risk assessment and screening recommendations based on MBD.
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Affiliation(s)
- Wei-Min Li
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Qiu-Wei Sun
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xiao-Fang Fan
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jun-Chao Zhang
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Ting Xu
- Department of Clinical and Research, Shenzhen Mindray Biomedical Electronics Co., Ltd, Shenzhen, China
| | - Qi-Qi Shen
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Lei Jia
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
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Gao Y, Fan WH, Duan C, Zhao W, Zhang J, Kang X. Enhancing the Screening Efficiency of Breast Cancer by Combining Conventional Medical Imaging Examinations With Circulating Tumor Cells. Front Oncol 2021; 11:643003. [PMID: 34094929 PMCID: PMC8170472 DOI: 10.3389/fonc.2021.643003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Ultrasound (US) and mammogram (MMG) are the two most common breast cancer (BC) screening tools. This study aimed to assess how the combination of circulating tumor cells (CTC) with US and MMG would improve the diagnostic performance. METHODS CTC detection and imaging examinations, US and MMG, were performed in 238 treatment-naive BC patients, 217 patients with benign breast diseases (BBD), and 20 healthy females. Correlations of CTC, US and MMG with patients' clinicopathological characteristics were evaluated. Diagnostic performances of CTC, US and MMG were estimated by the receiver operating characteristic curves. RESULTS CTC, US and MMG could all distinguish BC patients from the control (p < 0.0001). Area under curve (AUC) of CTC, US and MMG are 0.855, 0.861 and 0.759, respectively. While US has the highest sensitivity of 0.79, CTC and MMG have the same specificity of 0.92. Notably, CTC has the highest accuracy of 0.83. Combination with CTC increases the AUC of US and MMG to 0.922 and 0.899, respectively. Combining MMG with CTC or US increases the sensitivity of MMG to 0.87, however "CTC + MMG" has a higher specificity of 0.85. "CTC + US" performs the best in BC diagnosis, followed by "CTC + MMG" and then "US + MMG". CONCLUSION CTC can be used as a diagnostic aid for BC screening. Combination with CTC increases the diagnostic potency of conventional BC screening imaging examinations, US and MMG, in BC diagnosis, especially for MMG.
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Affiliation(s)
- Yang Gao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Wan-Hung Fan
- Department of Clinical Medical Affairs, Hangzhou Watson Biotech, Hangzhou, China
| | - Chaohui Duan
- Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenhe Zhao
- Department of Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Zhang
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xixiong Kang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
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29
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Houghton SC, Hankinson SE. Cancer Progress and Priorities: Breast Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:822-844. [PMID: 33947744 PMCID: PMC8104131 DOI: 10.1158/1055-9965.epi-20-1193] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/13/2020] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Serena C Houghton
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
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30
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Contrast-enhanced spectral mammography without and with a delayed image for diagnosing malignancy among mass lesions in dense breast. Contemp Oncol (Pozn) 2021; 25:17-22. [PMID: 33911977 PMCID: PMC8063896 DOI: 10.5114/wo.2021.105030] [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: 01/27/2021] [Accepted: 02/27/2021] [Indexed: 11/20/2022] Open
Abstract
Aim of the study To analyse the diagnostic performance of contrast-enhanced spectral mammography (CESM) based on morphologic and enhancement patterns of mass lesions in dense breast using different protocols: CESM without delayed image and CESM with delayed image. Material and methods A total of 151 informed women with suspicious for malignancy mass lesions in dense breast were included in this study. All of them underwent CESM using 2 protocols. A total of 155 lesions were pathomorphologically verified. We analysed morphologic patterns on low-energy (LE) images and recombined images (RI) by defining the shape, margin, and dynamic patterns based on delayed images. Results The comparative analysis revealed that the shape and margins on RI were more significant than those on LE images. The dynamic indicators of CESM were found to be highly significant in dense breasts. The correlation between kinetic curve and histological results demonstrated that a persistent type of curve was common for benign lesions, accounting for 15/22 (68.1%); plateau and washout – for malignant lesions, accounting for 24/89 (26.9%) and 61/89 (68.5%), respectively. Delayed image leads to an increase of specificity up to 12.4%, which is statistically significant. The area under the curve (AUC) in CESM with delayed image is larger than that in CESM without delayed image (p < 0.01). Conclusions CESM is sensitive for the differential diagnosis of breast lesions. CESM with delayed image has higher specificity than CESM without delayed image. Delayed images with plateau and washout are typical for malignancy.
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31
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Noonpradej S, Wangkulangkul P, Woodtichartpreecha P, Laohawiriyakamol S. Prediction for Breast Cancer in BI-RADS Category 4 Lesion Categorized by Age and Breast Composition of Women in Songklanagarind Hospital. Asian Pac J Cancer Prev 2021; 22:531-536. [PMID: 33639670 PMCID: PMC8190358 DOI: 10.31557/apjcp.2021.22.2.531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Older age and dense breast are the important risk factors for breast cancer. The ACR BI-RADS lexicon 5th edition does not mention how patient age and breast density may affect the category assessment. The aim of this study was to investigate whether patient age and breast density influence the positive predictive value (PPV) of mammographic and ultrasonographic findings categorized as BI-RADS category 4 and subcategories 4a, 4b, and 4c among female patients. Materials and Methods: A retrospective study was conducted in Songklanagarind Hospital between January 1, 2016 and December 31, 2017 in female patients older than 18 years who had breast lesions categorized as BI-RADS category 4 and subcategories 4a, 4b, 4c. A total of 961 breast lesions consisted of 772 (80.33%) benign lesions and 189 (19.67%) malignant lesions. Categorization was done in each lesion based on age ranges of ≤35 years, >35 to 60 years, and >60 years and breast density according to mammographic breast composition. The PPV for each BI-RADS category was calculated based on the pathological diagnoses and were compared using the chi-square test. Results: The overall PPV in each subcategory was in the reference range. The PPV increased with increasing age: 4% vs. 22.63% vs. 36.67% for category 4 (p-value=0.01); 0% vs. 5.81% vs. 6.88% for subcategory 4a (p-value=0.002); 6.67% vs. 26.62% vs. 51.35% for subcategory 4b (p-value=0.001); and 33.33% vs. 76.92% vs. 81.82% for subcategory 4c (p-value=0.02). An association was not found between PPV and breast density. Conclusion: A significantly positive association was found between PPV and age in patients in BI-RADS subcategories 4a, 4b, and 4c. This study could not determine that mammographic breast composition according to the ACR BI-RADS 5th edition was associated with PPV due to improper sample distribution.
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Affiliation(s)
- Seechad Noonpradej
- Division of General Surgery, Faculty of Medicine, Songklanagarind hospital. Prince of Songkla University, Songkla, Thailand
| | - Piyanun Wangkulangkul
- Division of General Surgery, Faculty of Medicine, Songklanagarind hospital. Prince of Songkla University, Songkla, Thailand
| | - Piyanoot Woodtichartpreecha
- Division of Radiology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Suphawat Laohawiriyakamol
- Division of General Surgery, Faculty of Medicine, Songklanagarind hospital. Prince of Songkla University, Songkla, Thailand
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32
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Lotter W, Diab AR, Haslam B, Kim JG, Grisot G, Wu E, Wu K, Onieva JO, Boyer Y, Boxerman JL, Wang M, Bandler M, Vijayaraghavan GR, Gregory Sorensen A. Robust breast cancer detection in mammography and digital breast tomosynthesis using an annotation-efficient deep learning approach. Nat Med 2021; 27:244-249. [PMID: 33432172 DOI: 10.1038/s41591-020-01174-9] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
Breast cancer remains a global challenge, causing over 600,000 deaths in 2018 (ref. 1). To achieve earlier cancer detection, health organizations worldwide recommend screening mammography, which is estimated to decrease breast cancer mortality by 20-40% (refs. 2,3). Despite the clear value of screening mammography, significant false positive and false negative rates along with non-uniformities in expert reader availability leave opportunities for improving quality and access4,5. To address these limitations, there has been much recent interest in applying deep learning to mammography6-18, and these efforts have highlighted two key difficulties: obtaining large amounts of annotated training data and ensuring generalization across populations, acquisition equipment and modalities. Here we present an annotation-efficient deep learning approach that (1) achieves state-of-the-art performance in mammogram classification, (2) successfully extends to digital breast tomosynthesis (DBT; '3D mammography'), (3) detects cancers in clinically negative prior mammograms of patients with cancer, (4) generalizes well to a population with low screening rates and (5) outperforms five out of five full-time breast-imaging specialists with an average increase in sensitivity of 14%. By creating new 'maximum suspicion projection' (MSP) images from DBT data, our progressively trained, multiple-instance learning approach effectively trains on DBT exams using only breast-level labels while maintaining localization-based interpretability. Altogether, our results demonstrate promise towards software that can improve the accuracy of and access to screening mammography worldwide.
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Affiliation(s)
- William Lotter
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA.
| | | | - Bryan Haslam
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA
| | - Jiye G Kim
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA
| | - Giorgia Grisot
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA
| | - Eric Wu
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA.,Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Kevin Wu
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA.,Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | | | - Yun Boyer
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA
| | - Jerrold L Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA.,Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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Kim S, Park B. Association between changes in mammographic density category and the risk of breast cancer: A nationwide cohort study in East-Asian women. Int J Cancer 2021; 148:2674-2684. [PMID: 33368233 DOI: 10.1002/ijc.33455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 12/09/2022]
Abstract
Breast density is strongly associated with breast cancer risk; however, studies on the association between density changes and breast cancer risk have controversial results. The aim of our study was to determine the association between breast density changes and breast cancer risk in East-Asian women. We included 3 301 279 women aged ≥40 years screened for breast cancer twice during 2009 to 2010 and 2011 to 2012. Data were obtained from the National Health Insurance Service (NHIS) database. Breast density was evaluated using the Breast Imaging-Reporting and Data System (BI-RADS). Relative risk (RR) and 5-year risk of developing breast cancer according to density category changes were calculated. Overall, 23.0% of the women had a higher breast density and 22.2% of the women had a lower breast density in second screening compared to the first. An increase in the BI-RADS density category between two subsequent mammographic screenings was associated with an increase in breast cancer risk and vice versa in terms of RR. The 5-year breast cancer risk was affected by the initial BI-RADS density category, changes in density category and patients' characteristics such as age, menopausal status and family history of breast cancer. In patients with breast cancer family history, the 5-year breast cancer risk was prominent, at a maximum of 2.39% (95% CI = 1.23-3.55) in women with breast density category of 2 to 4. Changes in the BI-RADS density category were associated with breast cancer risk. Longitudinal measures of BI-RADS density may be helpful in identifying high-risk women, especially those with a breast cancer family history.
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Affiliation(s)
- Soyeoun Kim
- Department of Health Sciences, Hanyang University College of Medicine, Seoul, South Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, South Korea
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34
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Kressin NR, Battaglia TA, Wormwood JB, Slanetz PJ, Gunn CM. Dense Breast Notification Laws' Association With Outcomes in the US Population: A Cross-Sectional Study. J Am Coll Radiol 2020; 18:685-695. [PMID: 33358722 DOI: 10.1016/j.jacr.2020.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Understanding whether states' breast density notifications are associated with desired effects, or disparities, can inform federal policy. We examined self-reported receipt of personal breast density information, breast density discussions with providers, knowledge about density's masking effect, and association with increased breast cancer risk by state legislation status and women's sociodemographic characteristics. METHODS Cross-sectional observational population-based telephone survey of women aged >40 years who underwent mammography within prior 2 years, had no history of breast cancer, and had heard the term "breast density." RESULTS Among 2,306 women, 57% received personal breast density information. Multivariate regression models adjusted for covariates indicated that women in notification states were 1.5 times more likely to receive density information, and older Black and Asian women of lower income and lower health literacy were less likely. Overall, only 39% of women discussed density with providers; women in notification states were 1.75 times as likely. Older and Asian women were less likely to have spoken with providers; women with high literacy or prior biopsy were more likely. State legislation status was not associated with differences in density knowledge, but Hispanic women and women of lower income or low health literacy had less knowledge regarding density's masking effects; older women were more knowledgeable. Hispanic women and women of lower income or low health literacy were more likely, and middle-aged women less likely, to recognize increased breast cancer risk. DISCUSSION Some positive effects were observed, but sociodemographic disparities suggest tailoring of future breast density communications for specific populations of women to ensure equitable understanding.
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Affiliation(s)
- Nancy R Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Associate Director of the Belkin Breast Health Center, Boston Medical Center, and Director, Women's Health Group, Boston Medical Center
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Priscilla J Slanetz
- Vice Chair of Academic Affairs and Associate Program Director of the Diagnostic Radiology Residency, Department of Radiology, Boston University Medical Center; President-Elect of the Massachusetts Radiological Society and Chair of the ACR Appropriateness Criteria Committee Breast Imaging Panel; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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Li Y, Li W, Lin J, Lv C, Qiao G. miR-146a Enhances the Sensitivity of Breast Cancer Cells to Paclitaxel by Downregulating IRAK1. Cancer Biother Radiopharm 2020; 37:624-635. [PMID: 33259730 DOI: 10.1089/cbr.2020.3873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: To investigate the effect of miR-146a on the sensitivity of breast cancer cells to paclitaxel (PTX). Materials and Methods: The mRNA expressions of miR-146a in normal breast cancer cells, MCF-7, and PTX-resistant breast cancer cells, MCF-7/PTX, were detected by reverse transcriptase-polymerase chain reaction (RT-PCR). MTS was used to analyze the cytotoxicity treated with different concentrations of PTX. Overexpressed and silenced cell lines of miR-146a and interleukin-1 receptor-associated kinase 1 (IRAK1) were constructed, respectively. Cells were treated with PTX and observed the changes of cell morphology. Proliferation was detected by clone formation assay. Invasion and migration were measured by transwell. RT-PCR was applied to detect the expression of IRAK1 gene. Dual luciferase report was performed to validate the target relationship between miR-146a and IRAK1. Salvage experiments were used to further verify the relationship between miR-146a and IRAK1. Results: PTX reduces the viability of MCF-7 and MCF-7/PTX cells in a dose-dependent manner. The IC50 of PTX in MCF-7 cells was significantly lower compared with MCF-7/PTX cells (p < 0.05). Compared with MCF-7/PTX cells, the expression of miR-146a gene in MCF-7 cells was significantly increased, while the expression of IRAK1 gene was significantly reduced (p < 0.05). Cell proliferation, invasion, and migration were decreased after miR-146a overexpression or IRAK1 silencing. Whereas, miR-146a silencing and IRAK1 overexpression can increase cell proliferation, invasion, and migration ability. Salvage experiments further verify that IRAK1 can weaken the role of miR-146a. Conclusion: miR-146a can enhance the sensitivity of breast cancer cells to PTX; the mechanism may be related to the downregulation of IRAK1.
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Affiliation(s)
- Yalun Li
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, China.,Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Weilong Li
- Department of Nuclear Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jun Lin
- Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Chunjing Lv
- Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Guangdong Qiao
- Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
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Rahmat K, Ab Mumin N, Ramli Hamid MT, Fadzli F, Ng WL, Muhammad Gowdh NF. Evaluation of automated volumetric breast density software in comparison with visual assessments in an Asian population: A retrospective observational study. Medicine (Baltimore) 2020; 99:e22405. [PMID: 32991467 PMCID: PMC7523847 DOI: 10.1097/md.0000000000022405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aims to compare Quantra, as an automated volumetric breast density (Vbd) tool, with visual assessment according to ACR BI-RADS density categories and to determine its potential usage in clinical practice.Five hundred randomly selected screening and diagnostic mammograms were included in this retrospective study. Three radiologists independently assigned qualitative ACR BI-RADS density categories to the mammograms. Quantra automatically calculates the volumetric density data into the system. The readers were blinded to the Quantra and other readers assessment. Inter-reader agreement and agreement between Quantra and each reader were tested. Region under the curve (ROC) analysis was performed to obtain the cut-off value to separate dense from a non-dense breast. Results with P value <.05 was taken as significant.There were 40.4% Chinese, 27% Malays, 19% Indian and 3.6% represent other ethnicities. The mean age of the patients was 57. 15%, 45.6%, 30.4%, and 9% of patients fall under BI-RADS A, B, C and D density category respectively. Fair agreement with Kappa (κ) value: 0.49, 0.38, and 0.30 were seen for Reader 1, 2 and 3 versus Quantra. Moderate agreement with κ value: 0.63, 0.64, 0.51 was seen when the data were dichotomized (density A and B to "non-dense", C and D to "dense"). The cut-off Vbd value was 13.5% to stratify dense from non-dense breasts with a sensitivity of 86.2% and specificity of 83.1% (AUC 91.4%; confidence interval: 88.8, 94.1).Quantra showed moderate agreement with radiologists visual assessment. Hence, this study adds to the available evidence to support the potential use of Quantra as an adjunct tool for breast density assessment in routine clinical practice in the Asian population. We found 13.5% is the best cut-off value to stratify dense to non-dense breasts in our study population. Its application will provide an objective, consistent and reproducible results as well as aiding clinical decision-making on the need for supplementary breast ultrasound in our screening population.
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Affiliation(s)
- Kartini Rahmat
- Department of Biomedical Imaging, University of Malaya Research Imaging Centre, Kuala Lumpur
| | - Nazimah Ab Mumin
- Department of Biomedical Imaging, University of Malaya Research Imaging Centre, Kuala Lumpur
- Department of Radiology, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Marlina Tanty Ramli Hamid
- Department of Biomedical Imaging, University of Malaya Research Imaging Centre, Kuala Lumpur
- Department of Radiology, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Farhana Fadzli
- Department of Biomedical Imaging, University of Malaya Research Imaging Centre, Kuala Lumpur
| | - Wei Lin Ng
- Department of Biomedical Imaging, University of Malaya Research Imaging Centre, Kuala Lumpur
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Li T, Taba ST, Khong PL, Tan TXL, Trieu PDY, Chan E, Suleiman ME, Li Y, Brennan P, Lewis S. Reading High Breast Density Mammograms: Differences in Diagnostic Performance between Radiologists from Hong Kong SAR/Guangdong Province in China and Australia. Asian Pac J Cancer Prev 2020; 21:2623-2629. [PMID: 32986361 PMCID: PMC7779441 DOI: 10.31557/apjcp.2020.21.9.2623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Variations in the performance of radiologists reading mammographic images are well reported, but key parameters explaining such variations in different countries are not fully explored. The main aim of this study is to investigate performances of Chinese (Hong Kong SAR and Guangdong Province) and Australian radiologists in interpreting dense breast mammographic images. Methods: A test set, contained 60 mammographic examinations with high breast density, was used to assess radiologists’ performance. Twelve Chinese and thirteen Australian radiologists read all the cases independently and were asked to identify all lesions and provide a grade from 1 to 5 to each lesion. Case sensitivity, specificity, lesion sensitivity, AUC and JAFROC were used to assess radiologists’ performances. Demographic information and reading experience were also collected from the readers. Performance scores were compared between the two populations and the relationships between performance scores and their reading experience were discovered. Results: For radiologists who were less than 40-year-old, lesion sensitivity, AUC and JAFROC were significantly lower in Chinese radiologists than those in Australian (52.10% vs 71.45%, p=0.043; 0.76 vs 0.84, p=0.031; 0.59 vs 0.72, p=0.045; respectively). Australian radiologists with less than 10 years of reading experience had higher AUC and JAFROC scores compared with their Chinese counterparts (0.83 vs 0.76, p=0.039; 0.70 vs 0.56, p=0.020, respectively). Conclusions: We found that younger Australian radiologists performed better at reading dense breast cases which is likely to be linked to intensive fellowship training, immersion in a screening program and exposure to the benefits of a performance-measuring education tool.
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Affiliation(s)
- Tong Li
- Breastscreen REader Assessment Strategy (BREAST), Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Seyedamir Tavakoli Taba
- Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tom X-L Tan
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Hong Kong, China
| | - Phuong Dung Yun Trieu
- Breastscreen REader Assessment Strategy (BREAST), Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Edward Chan
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Hong Kong, China
| | - Moayyad E Suleiman
- Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ying Li
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Hong Kong, China
| | - Patrick Brennan
- Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sarah Lewis
- Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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38
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Kim EY, Chang Y, Ahn J, Yun JS, Park YL, Park CH, Shin H, Ryu S. Mammographic breast density, its changes, and breast cancer risk in premenopausal and postmenopausal women. Cancer 2020; 126:4687-4696. [PMID: 32767699 DOI: 10.1002/cncr.33138] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The risk of breast cancer related to changes in breast density over time, including its regression and persistence, remains controversial. The authors investigated the relationship between breast density and its changes over time with the development of breast cancer in premenopausal and postmenopausal women. METHODS The current cohort study included 74,249 middle-aged Korean women (aged ≥35 years) who were free of breast cancer at baseline and who underwent repeated screening mammograms. Mammographic breast density was categorized according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). A dense breast was defined as heterogeneously dense or extremely dense, and changes in dense breasts between baseline and subsequent follow-up were classified as none, developed, regressed, or persistent dense breast. RESULTS During a median follow-up of 6.1 years (interquartile range, 4.1-8.8 years), a total of 803 incident breast cancers were identified. Baseline breast density was found to be positively associated with incident breast cancer in a dose-response manner, and this association did not significantly differ by menopausal status. The multivariable-adjusted hazard ratios (HRs) for breast cancer comparing "heterogeneously dense" and "extremely dense" categories with the nondense category were 1.96 (95% confidence interval [95% CI], 1.40-2.75) and 2.86 (95% CI, 2.04-4.01), respectively. With respect to changes in dense breasts over time, multivariable-adjusted HRs for breast cancer comparing persistent dense breast with none were 2.37 (95% CI, 1.34-4.21) in premenopausal women and 3.61 (95% CI, 1.78-7.30) in postmenopausal women. CONCLUSIONS Both baseline dense breasts and their persistence over time were found to be strongly associated with an increased risk of incident breast cancer in premenopausal and postmenopausal women. LAY SUMMARY Both baseline breast density and its changes over time were found to be independently associated with the risk of breast cancer in both premenopausal and postmenopausal women. The risk of incident breast cancer increased in women with persistent dense breasts, whereas the breast cancer risk decreased as dense breasts regressed. The findings of the current study support that both dense breasts at baseline and their persistence over time are independent risk factors for developing breast cancer.
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Affiliation(s)
- Eun Young Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jiin Ahn
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hocheol Shin
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Lian J, Li K. A Review of Breast Density Implications and Breast Cancer Screening. Clin Breast Cancer 2020; 20:283-290. [DOI: 10.1016/j.clbc.2020.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
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How can additional ultrasonography screening improve the detection of occult breast cancer in women with dense breasts? Pol J Radiol 2020; 85:e353-e360. [PMID: 32817768 PMCID: PMC7425225 DOI: 10.5114/pjr.2020.97944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 05/14/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose Although mammography is a gold standard for breast cancer screening, the number of cancers that cannot be detected with mammography is substantial, especially in dense-breast (DB) women. Breast sonography can be a useful and powerful screening tool in these cases. The aim of this study is to assess the application of whole-breast sonography in the evaluation of breast lesions in women with DB tissue and estimate its accuracy in comparison with mammography. Material and methods A total of 207 asymptomatic DB women participated in this study. The breast tissue density was assessed using ACR BI-RADS. Patients underwent high-resolution ultrasonography of the breast in addition to physical examination and mammography. Different risk factors were also assessed. Results 152 of 207 (73.4%) cases who had mammography performed had DB, and 55 (26.6%) cases had very dense breasts (very DBs). None of the cases had a positive history of malignancy, while 19% of them had a positive history of breast cancer in first- or second-degree relatives. Conclusions All findings were higher in cases with DB compared to very DBs except for fibroadenoma, which was detected more in cases with very DBs. Our study showed that the prevalence of different breast lesions had a significant relationship with the density of the breast. In our study, 48.3% of the cases were diagnosed with a lesion in their sonography result, although 81.0% of them were benign lesions, and the other 19.0% needed follow-up or biopsy evaluation. A substantial number of mammographically occult breast lesions, either benign or malignant, could be detected by ultrasound in DB tissue.
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Supplemental breast cancer-screening ultrasonography in women with dense breasts: a systematic review and meta-analysis. Br J Cancer 2020; 123:673-688. [PMID: 32528118 PMCID: PMC7434777 DOI: 10.1038/s41416-020-0928-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 01/09/2023] Open
Abstract
Background Mammography is not effective in detecting breast cancer in dense breasts. Methods A search in Medline, Cochrane, EMBASE and Google Scholar databases was conducted from January 1, 1980 to April 10, 2019 to identify women with dense breasts screened by mammography (M) and/or ultrasound (US). Meta-analysis was performed using the random-effect model. Results A total of 21 studies were included. The pooled sensitivity values of M alone and M + US in patients were 74% and 96%, while specificity of the two methods were 93% and 87%, respectively. Screening sensitivity was significantly higher in M + US than M alone (risk ratio: M alone vs. M + US = 0.699, P < 0.001), but the slight difference in specificity was statistically significant (risk ratio = 1.060, P = 0.001). Pooled diagnostic performance of follow-up US after initial negative mammography demonstrated a high pooled sensitivity (96%) and specificity (88%). The findings were supported by subgroup analysis stratified by study country, US method and timing of US. Conclusions Breast cancer screening by supplemental US among women with dense breasts shows added detection sensitivity compared with M alone. However, US slightly decreased the diagnostic specificity for breast cancer. The cost-effectiveness of supplemental US in detecting malignancy in dense breasts should be considered additionally.
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Gemici AA, Arıbal E, Özaydın AN, Gürdal SÖ, Özçınar B, Cabioğlu N, Özmen V. Comparison of Qualitative and Volumetric Assessments of Breast Density and Analyses of Breast Compression Parameters and Breast Volume of Women in Bahcesehir Mammography Screening Project. Eur J Breast Health 2020; 16:110-116. [PMID: 32285032 DOI: 10.5152/ejbh.2020.4943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 12/25/2019] [Indexed: 11/22/2022]
Abstract
Objective We aimed to compare visual and quantitative measurements of breast density and to reveal the density profile with compression characteristics. Materials and Methods Screening mammograms of 1399 women between May 2014 and May 2015 were evaluated by using Volpara 4th and 5th version. First 379 mammograms were assessed according to ACR BI-RADS 4th edition and compared to Volpara. We categorized the breast density in two subgroups as dens or non-dens. Two radiologists reviewed the images in consensus. Agreement level between visual and volumetric methods and volumetric methods between themselves assessed using weighted kappa statistics. Volpara data such as fibroglandular volume (FGV), breast volume (BV), compression thickness (CT), compression force (CF), compression pressure (CP) were also analyzed with relation to the age. Results 1399 mammograms were distributed as follows: 12.7% VDG1, 39.3% VDG2, 34.1% VDG3, 13.9% VDG4 according to the 4th edition of Volpara; 1.2% VDG1, 46% VDG2, 36.8% VDG3, 15.9% VDG4 according to the 5th edition of Volpara. The difference between two editions was 4.7% increase in dense category. 379 mammograms, according to ACR BI-RADS 4th edition, were distributed as follows: 25.9% category A, 50.9% category B, 19.8% category C, 3.4% category D. The strength of agreement between the Volpara 4th and 5th editions was found substantial (k=0.726). The agreements between visual assessment and both Volpara editions were poor (k=-0.413, k=-0.399 respectively). There was a 142% increase in dense group with the VDG 4th edition and 162% with the VDG 5th edition when compared to visual assessment. Compression force decreased while compression pressure increased with increasing Volpara Density Grade (VDG) (p for trend <0.001 for both). Compression thickness and breast volume decreased with increasing VDG (p for trend <0.001 for both). The FGV decreases with age and the breast volume increases with increasing age (p<0.001). Conclusion Visual assessment of breast density doesn't correlate well with volumetric assessments. Obtaining additional information about physical parameters and breast profile by the results of quantified methods is important for breast cancer risk assessments and prevention strategies.
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Affiliation(s)
- Ayşegül Akdoğan Gemici
- Department of Radiology, Health Science University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Erkin Arıbal
- Department of Radiology, Acıbadem Mehmet Aydınlar University School of Medicine, İstanbul, Turkey
| | - Ayşe Nilüfer Özaydın
- Department of Public Health, Marmara University School of Medicine, İstanbul, Turkey
| | - Sibel Özkan Gürdal
- Department of General Surgery, Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Beyza Özçınar
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Neslihan Cabioğlu
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Tuan AW, Davis Lynn BC, Chernyavskiy P, Yu M, Gomez SL, Gierach GL, Rosenberg PS. Breast Cancer Incidence Trends by Estrogen Receptor Status Among Asian American Ethnic Groups, 1990-2014. JNCI Cancer Spectr 2020; 4:pkaa005. [PMID: 33392441 PMCID: PMC7192028 DOI: 10.1093/jncics/pkaa005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/06/2020] [Accepted: 01/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Westernization and etiologic heterogeneity may play a role in the rising breast cancer incidence in Asian American (AA) women. We report breast cancer incidence in Asian-origin populations. METHODS Using a specialized Surveillance, Epidemiology, and End Results-9 Plus API Database (1990-2014), we analyzed breast cancer incidence overall, by estrogen receptor (ER) status, and age group among non-Hispanic white (NHW) and AA women. We used age-period-cohort models to assess time trends and quantify heterogeneity by ER status, race and ethnicity, and age. RESULTS Overall, breast cancer incidence increased for most AA ethnicities (Filipina: estimated annual percentage change [EAPC] = 0.96%/year, 95% confidence interval [CI] = 0.61% to 1.32%; South Asian: EAPC = 1.68%/year, 95% CI = 0.24% to 3.13%; Chinese: EAPC = 0.65%/year, 95% CI = 0.03% to 1.27%; Korean: EAPC = 2.55%/year, 95% CI = 0.13% to 5.02%; and Vietnamese women: EAPC = 0.88%/year, 95% CI = 0.37% to 1.38%); rates did not change for NHW (EAPC = -0.2%/year, 95% CI = -0.73% to 0.33%) or Japanese women (EAPC = 0.22%/year, 95% CI = -1.26% to 1.72%). For most AA ethnicities, ER-positive rates statistically significantly increased, whereas ER-negative rates statistically significantly decreased. Among older women, ER-positive rates were stable for NHW and Japanese women. ER-negative rates decreased fastest in NHW and Japanese women among both age groups. CONCLUSIONS Increasing ER-positive incidence is driving an increase overall for most AA women despite declining ER-negative incidence. The similar trends in NHW and Japanese women (vs other AA ethnic groups) highlight the need to better understand the influences of westernization and other etiologic factors on breast cancer incidence patterns in AA women. Heterogeneous trends among AA ethnicities underscore the importance of disaggregating AA data and studying how breast cancer differentially affects the growing populations of diverse AA ethnic groups.
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Affiliation(s)
- Alyssa W Tuan
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Brittny C Davis Lynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Pavel Chernyavskiy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
- Department of Mathematics and Statistics, University of Wyoming, Laramie, WY, USA
| | - Mandi Yu
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
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Lee JS, Oh M. Breast Density of Mammography is Correlated with Reproductive Risk Factors Regardless of Menopausal Status: A Cross-Sectional Study of the Korean National Screening Program. Asian Pac J Cancer Prev 2020; 21:1011-1018. [PMID: 32334463 PMCID: PMC7445990 DOI: 10.31557/apjcp.2020.21.4.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To clarify the limitations of mammography screening for women with dense breasts, we examined breast density and its effects on screening results. PATIENTS AND METHODS We performed a cross-sectional, observational study on women who underwent mammography. Data from the National Cancer Screening Program(NCSP) from 2009 to 2013 were used. The study population consisted of participants with high breast density. We used a logistic regression analysis to evaluate the relationships between breast density and reproductive factors and screening results according to menopause status. RESULTS High breast density was reported for 57.5% of all participants (3,417,319 participants). Screening results indicated breast density of <25%, 25-50%, 51-75%, and ≥76% for 16.4%, 26.3%, 37.8%, and 19.5%, respectively, of participants. According to the screening results, high breast density was correlated with high deferment and recall rates. Reproductive factors, especially parity, breastfeeding, and use of oral contraceptives, had consistent effects on screening results of premenopausal and postmenopausal women. Regardless of menopausal status, age, early onset of menarche (15 years or younger), fewer live births (≤1 birth), and previous benign breast disease were correlated with increased breast density. In postmenopausal women, early-onset menopause and longer-term hormone replacement therapy (≥2 years) also independently increased breast density. CONCLUSION Breast density influenced screening results, which could increase the rate of recall. Breast density was also influenced by reproductive factors, with patterns similar to those of breast cancer risk, regardless of menopausal status. We need to identify high-risk women with high density who would probably benefit from supplemental breast cancer screening.
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Affiliation(s)
- Jung Sun Lee
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Minkyung Oh
- Department of Pharmacology, Inje University College of Medicine, Clinical Trial Center, Inje University Busan Paik Hospital, Busan, Korea
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Lo CH, Chai XY, Ting SSW, Ang SC, Chin X, Tan LT, Saania P, Tuan Mat TNA, Mat Sikin S, Gandhi A. Density of breast: An independent risk factor for developing breast cancer, a prospective study at two premium breast centers. Cancer Med 2020; 9:3244-3251. [PMID: 32130790 PMCID: PMC7196055 DOI: 10.1002/cam4.2821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022] Open
Abstract
Background Breast cancer is the leading cause of death among women worldwide. Studies have identified breast density as a controversial risk factor of breast cancer. Moreover, studies found that breast density reduction through Tamoxifen could reduce risk of breast cancer significantly. To date, no study on the association between breast density and breast cancer has been carried out in Malaysia. If breast density is proven to be a risk factor of breast cancer, intervention could be carried out to reduce breast cancer risk through breast density reduction. Purpose To determine if density of breast is an independent risk factor which will contribute to development of breast cancer. Materials and Methods A prospective cohort study is carried out in two hospitals targeting adult female patients who presented to the Breast Clinic with symptoms suspicious of breast cancer. Participants recruited were investigated for breast cancer based on their symptoms. Breast density assessed from mammogram was correlated with tissue biopsy results and final diagnosis of benign or malignant breast disease. Results Participants with dense breasts showed 29% increased risk of breast cancer when compared to those with almost entirely fatty breasts (odds ratio [OR] 1.29, 95% CI 0.38‐4.44, P = .683). Among the postmenopausal women, those with dense breasts were 3.1 times more likely to develop breast cancer compared with those with fatty breasts (OR 3.125, 95% CI 0.72‐13.64, P = .13). Moreover, the chance of developing breast cancer increases with age (OR 1.046, 95% CI 1.003‐1.090, P < .05). In contrast, the density of breast decreases with increasing age (P < .05) and body mass index (P = .051). The proportion of high breast density whether in the whole sample size, premenopausal, or postmenopausal group was consistently high. Conclusion Although results were not statistically significant, important association between breast density and risk of breast cancer cannot be ruled out. The study is limited by a small sample size and subjective assessment of breast density. More studies are required to reconcile the differences between studies of contrasting evidence.
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Affiliation(s)
- Chia Hwee Lo
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
| | - Xin Ying Chai
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
| | - Shirley Shy Wen Ting
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
| | - Sze Chao Ang
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
| | - Xinlin Chin
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
| | - Lay Teng Tan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
| | - Peeroo Saania
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
| | | | - Seniyah Mat Sikin
- Department of Surgery, Hospital Sultan Ismail (HSI), Johor Bahru, Malaysia
| | - Anil Gandhi
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
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Yamada A, Narui K, Satake T, Adachi S, Tanabe M, Shimizu D, Ishikawa T, Endo I. Long-Term Outcomes of Immediate Autologous Breast Reconstruction for Breast Cancer Patients. J Surg Res 2020; 251:78-84. [PMID: 32113041 DOI: 10.1016/j.jss.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND There is limited information on the oncological outcomes of immediate autologous breast reconstruction in the Asian population. This study aimed to evaluate the oncological outcomes of immediate one-stage autologous breast reconstruction using a free perforator flap for breast cancer patients at a single institution in Japan. METHODS We retrospectively reviewed 239 patients who underwent immediate one-stage autologous breast reconstruction using a free perforator flap after skin- or nipple-sparing mastectomy. The whole breast was pathologically analyzed in 5-mm sections. Clinical and pathological data were collected from medical records. RESULTS For tumor stage among the 239 patients, 101 (42.3%) had stage 0, 127 (53.1%) had stage I and II, and 11 (4.6%) had stage III. Twenty-three patients (9.6%) had margin involvement in the surgical specimen. Adjuvant chemotherapy was performed in 75 patients (30%), and endocrine therapy was administered in 153 patients (64%). Radiation therapy was performed in 15 patients (6.3%) because of multiple lymph node metastases or margin involvement. With a median follow-up time of 73 mo, local recurrence was found in 3.3%, distant metastases in 2.5%, and contralateral breast cancer in 3.7%. All patients with local recurrence did not receive radiation therapy as adjuvant treatment. CONCLUSIONS Among the patients who underwent immediate one-stage autologous reconstruction after breast surgery, 3.3% had local recurrence. For patients with margin involvement, radiation therapy is a promising option.
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Affiliation(s)
- Akimitsu Yamada
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Kanazawa, Yokohama, Kanagawa, Japan; Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Minami, Yokohama, Kanagawa, Japan
| | - Kazutaka Narui
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Minami, Yokohama, Kanagawa, Japan.
| | - Toshihiko Satake
- Department of Plastic Surgery, Yokohama City University Medical Center, Minami, Yokohama, Kanagawa, Japan
| | - Shoko Adachi
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Minami, Yokohama, Kanagawa, Japan
| | - Mikiko Tanabe
- Department of Pathology, Yokohama City University Medical Center, Minami, Yokohama, Kanagawa, Japan
| | - Daisuke Shimizu
- Department of Breast Surgery, Yokohama City Minato Red Cross Hospital, Naka, Yokohama, Kanagawa, Japan
| | - Takashi Ishikawa
- Department of Breast Surgery and Oncology, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Kanazawa, Yokohama, Kanagawa, Japan
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Lee E, Doanvo N, Lee M, Soe Z, Lee AW, Van Doan C, Deapen D, Ursin G, Spicer D, Reynolds P, Wu AH. Immigration history, lifestyle characteristics, and breast density in the Vietnamese American Women's Health Study: a cross-sectional analysis. Cancer Causes Control 2020; 31:127-138. [PMID: 31916076 PMCID: PMC7842111 DOI: 10.1007/s10552-019-01264-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Breast density is an important risk factor for breast cancer and varies substantially across racial-ethnic groups. However, determinants of breast density in Vietnamese immigrants in the United States (US) have not been studied. We investigated whether reproductive factors, immigration history, and other demographic and lifestyle factors were associated with breast density in Vietnamese Americans. METHODS We collected information on demographics, immigration history, and other lifestyle factors and mammogram reports from a convenience sample of 380 Vietnamese American women in California aged 40 to 70 years. Breast Imaging Reporting and Data System (BI-RADS) breast density was abstracted from mammogram reports. Multivariable logistic regression was used to investigate the association between lifestyle factors and having dense breasts (BI-RADS 3 or 4). RESULTS All participants were born in Viet Nam and 82% had lived in the US for 10 years or longer. Younger age, lower body mass index, nulliparity/lower number of deliveries, and longer US residence (or younger age at migration) were associated with having dense breasts. Compared to women who migrated at age 40 or later, the odds ratios and 95% confidence intervals for having dense breasts among women who migrated between the ages of 30 and 39 and before age 30 were 1.72 (0.96-3.07) and 2.48 (1.43-4.32), respectively. CONCLUSIONS Longer US residence and younger age at migration were associated with greater breast density in Vietnamese American women. Identifying modifiable mediating factors to reduce lifestyle changes that adversely impact breast density in this traditionally low-risk population for breast cancer is warranted.
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Affiliation(s)
- Eunjung Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Namphuong Doanvo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - MiHee Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Zayar Soe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Alice W Lee
- Department of Public Health, California State University, Fullerton, Fullerton, CA, 92831, USA
| | - Cam Van Doan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Dennis Deapen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | | | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
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Jo HM, Lee EH, Ko K, Kang BJ, Cha JH, Yi A, Jung HK, Jun JK. Prevalence of Women with Dense Breasts in Korea: Results from a Nationwide Cross-sectional Study. Cancer Res Treat 2019; 51:1295-1301. [PMID: 30699499 PMCID: PMC6790853 DOI: 10.4143/crt.2018.297] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/27/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose Women with dense breast are known to be at high risk for breast cancer, but their prevalence and number of Korean women are unknown. The current study was to investigate the distribution of mammographic breast density by age of women undergoing screening mammography, and to estimate the prevalence of Korean women with dense breasts, quantitatively. Materials and Methods For obtaining a nationwide representative sample, 6,481 mammograms were collected from 86 screening units participated in the National Cancer Screening Program for breast cancer. Based on the American College of Radiology Breast Imaging Reporting and Data System classification, breast density was evaluated by six breast radiologists, qualitatively. We applied these breast density distributions to age-specific counts of the Korean women population derived to mid-year 2017 to estimate the number of Korean women with dense breasts. Results Overall, 54.4% (95% confidence interval [CI], 52.9% to 55.8%) of women 40 to 69 years of age had heterogeneously or extremely dense breasts, and this proportion was inversely associated with age. Based on the age distribution of Korean women, we estimated that 6,083,000 women (95% CI, 5,919,600 to 6,245,600) age 40-69 years in Korean have dense breasts. Women aged 40-49 years (n=3,450,000) accounted for 56.7% of this group. Conclusion More than half of Korean women aged 40 and over have dense breasts. To prevent breast cancer effectively and efficiently, it is necessary to develop a new personalized prevention strategy considering her status of breast density.
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Affiliation(s)
- Hye-Mi Jo
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kyungran Ko
- Center for Breast Cancer, National Cancer Center Hospital, National Cancer Center, Goyang, Korea
| | - Bong Joo Kang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hee Cha
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ann Yi
- Department of Radiology, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Hae Kyoung Jung
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Bond-Smith D, Stone J. Methodological Challenges and Updated Findings from a Meta-analysis of the Association between Mammographic Density and Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 28:22-31. [DOI: 10.1158/1055-9965.epi-17-1175] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/11/2018] [Accepted: 09/05/2018] [Indexed: 11/16/2022] Open
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Golemis EA, Scheet P, Beck TN, Scolnick EM, Hunter DJ, Hawk E, Hopkins N. Molecular mechanisms of the preventable causes of cancer in the United States. Genes Dev 2018; 32:868-902. [PMID: 29945886 PMCID: PMC6075032 DOI: 10.1101/gad.314849.118] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Annually, there are 1.6 million new cases of cancer and nearly 600,000 cancer deaths in the United States alone. The public health burden associated with these numbers has motivated enormous research efforts into understanding the root causes of cancer. These efforts have led to the recognition that between 40% and 45% of cancers are associated with preventable risk factors and, importantly, have identified specific molecular mechanisms by which these exposures modify human physiology to induce or promote cancer. The increasingly refined knowledge of these mechanisms, which we summarize here, emphasizes the need for greater efforts toward primary cancer prevention through mitigation of modifiable risk factors. It also suggests exploitable avenues for improved secondary prevention (which includes the development of therapeutics designed for cancer interception and enhanced techniques for noninvasive screening and early detection) based on detailed knowledge of early neoplastic pathobiology. Such efforts would complement the current emphasis on the development of therapeutic approaches to treat established cancers and are likely to result in far greater gains in reducing morbidity and mortality.
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Affiliation(s)
- Erica A Golemis
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
| | - Paul Scheet
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
| | - Tim N Beck
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
- Molecular and Cell Biology and Genetics Program, Drexel University College of Medicine, Philadelphia, Pennsylvania 19129, USA
| | - Eward M Scolnick
- Eli and Edythe L. Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts 02142, USA
| | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Medical Sciences Division, Oxford OX3 7LF, United Kingdom
| | - Ernest Hawk
- Division of Cancer Prevention and Population Sciences, University of Texas M.D. Anderson Cancer Center, Houston Texas 77030, USA
| | - Nancy Hopkins
- Koch Institute for Integrative Cancer Research, Biology Department, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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