The P.I.N.K. Study Approach for Supporting Personalized Risk Assessment and Early Diagnosis of Breast Cancer.

Michela Franchini,Brunella Di Nubila,Stefania Pieroni,Cosimo Di Maggio,On Behalf Of The Pink Consortium ,Edgardo Montrucchio,Sabrina Molinaro,Jacopo Nori Cucchiari,Gian Giuseppetti,Gianfranco Scaperrotta,Paolo Belli,Sonia Santicchia,Alberto Nicolucci,Enrico Cassano

doi:10.3390/ijerph18052456

Abstract

Breast cancer is a clear example of excellent survival when it is detected and properly treated in the early stage. Currently, screening of this cancer relies on mammography, which may be integrated by new imaging techniques for more exhaustive evaluation. The Personalized, Integrated, Network, Knowledge (P.I.N.K.) study is a longitudinal multicentric study involving several diagnostic centres across Italy, co-ordinated by the Italian National Research Council and co-funded by the Umberto Veronesi Foundation. Aim of the study is to evaluate the increased diagnostic accuracy in detecting cancers obtained with different combinations of imaging technologies, and find the most effective diagnostic pathway matching the characteristics of an individual patient. The study foresees the enrolment of 50,000 women over the age of 40 years presenting for breast examination and providing informed consent to data handling. So far, the 15 participating centres across Italy have recruited a total of 22,848 patients. Based on the analyses of the first 175 histopathological-proven breast cancers, mammographic sensitivity was estimated to be 61.7% (n = 108 cancers), whereas diagnostic accuracy increased by 35.5% (n = 44 cancers) when mammography was integrated with other imaging modalities (ultrasound and/or digital breast tomosynthesis). Increase was mainly determined by ultrasound alone. Given the ongoing data collection and recruitment, the number of cancers detected is too low to allow any further in-depth analysis to explore links to patient characteristics. Past studies show that the uniform approach of population screening guidelines should be revised in favour of more personalised regimens, where known standards are integrated by imaging techniques most suitable for the individual’s characteristics. With the ultimate goal of identifying early breast cancer detection strategies, our preliminary results suggest that integrated diagnostic approach could lead to a paradigm shift from an age-based regimen toward more specific and effective risk-based personalised screening regimens, in order to reduce mortality from breast cancer.

Highlights

Breast cancer (BC) treated in the early stage is a clear example of excellent survival and closely relies on early screening [1].Traditional BC screening is based on the mammography technique, used since the1960s [2]
The overall sensitivity of mammography for BC detection is 75–85%, which can decrease to 30–50% in women with dense breast tissue [3]
The trials of mammographic screening provide evidence about its effects on reduction in BC mortality [4,5], mammograms have their limits and newer diagnostic techniques have been introduced to increase the diagnosis of early cancer in those patients for whom mammography is less sensitive

Summary

Introduction

Breast cancer (BC) treated in the early stage is a clear example of excellent survival and closely relies on early screening [1].Traditional BC screening is based on the mammography technique, used since the1960s [2]. Traditional BC screening is based on the mammography technique, used since the. The overall sensitivity of mammography for BC detection is 75–85%, which can decrease to 30–50% in women with dense breast tissue [3]. The trials of mammographic screening provide evidence about its effects on reduction in BC mortality [4,5], mammograms have their limits and newer diagnostic techniques have been introduced to increase the diagnosis of early cancer in those patients for whom mammography is less sensitive. Ultrasound scan (US) introduced in the 1970s, digital breast tomosynthesis (DBT) and magnetic resonance imaging (MRI) in the 1990s have greatly improved the ability to recognise very early carcinomas [2]. Detected cancers are most often invasive tumours, and their detection will not increase the rate of ductal carcinoma in situ (DCIS) seen at mammography

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Conclusion