Breast Cancer In Asymptomatic Women Research Articles

Exploring enablers and barriers to breast self-examination among women in the North Shewa Zone, Oromia, Ethiopia: a qualitative study

Breast cancer (BC) is the leading cause of cancer death worldwide and the second most common cancer overall. Breast self-examination (BSE) is one of the cheapest methods used for the early detection of BC in asymptomatic women. More than 90% of cases of BC can be detected by women themselves. This reality stresses the importance of BSE as the key BC detection mechanism. However, in Ethiopia, most of the BE studies were not conducted among women in the general population. Therefore, this study aimed to explore enablers and barriers to breast self-examination among women in the North Shewa Zone, Oromia. A descriptive qualitative study design was conducted from August 1, 2022, to September 30, 2022. Five focus group discussions (FGDs) were conducted with 46 women from one selected district in the North Shewa Zone, Oromia. A Purposive sampling technique was used to select participants for FGD. The audio-recorded data were transcribed verbatim to “Afan Oromo”. Transcribed data were translated into English. The data were manually coded into themes and analyzed manually by using inductive thematic analysis. The findings of the study were discussed under five themes of enablers and three themes of barriers. The five themes of enablers were knowledge about BC, knowledge about BSE, experience of BSE practice, perceived susceptibility, and perceived benefit of BSE practice. The four themes of barriers were low knowledge of BSE practice, misconceptions about BSE practice, and fear of detecting BC. These findings suggest that targeted health education programs, collaboration between healthcare providers and local stakeholders, and the availability of support services can play a crucial role in overcoming barriers and encouraging BSE practice for early detection of breast abnormalities.

Abstract OT3-18-02: Clinical validation of “TriNetra™-Breast” test for breast cancer screening in a prospective, observational, case-cohort study

Abstract Introduction The Standard of Care for early detection of breast cancer in asymptomatic women is screening mammography, which has limitations such as radiation exposure and lower sensitivity to detect cancer in women with high breast density or invasive carcinomas. TriNetra™-Breast is a blood test for the detection of breast cancer associated circulating tumor cells in blood. Previously, this test has been used in a study for breast cancer detection in India, where it has shown a sensitivity of 92.5%. It has since been granted the United States Food and Drug Administration (USFDA) Breakthrough Device Designation, attesting its potential to provide for improved detection of breast cancer. This prospective, observational, case-cohort study will confirm the clinical performance characteristics of the technology in the US population. Patients and Methods The primary endpoint of this study will be to determine the sensitivity and specificity of the test for breast cancer screening, using mammography and histopathology confirmed diagnosis (when relevant) as the reference methods. Women ≥40 years, with no prior diagnosis of any cancer and undergoing screening mammography for breast cancer will be eligible for participation in this study. 700 women, representing the diverse ethnic US population, will be enrolled. Cohort A will have 500 women with BI-RADS score of 1, 2, or 3. Among these 500 participants, the age categories of 40-49 years, 50-74 years and >74 years will have 100, 300 and 100 women respectively. Cohort B will have 100 women with suspicion of DCIS (without a suspicion of simultaneous invasive carcinoma) and 50 women each with BI-RADS score of 4 or 5. These study population numbers will ensure optimal representation of in-situ carcinoma, malignant and benign cases. Blood samples will be collected from the enrolled women for TriNetra™-Breast, within sixty (60) days of the screening mammogram. If biopsy is indicated, sample collection will be required prior to the procedure. The lab investigators will be blinded to the clinical information of all participants, including mammography and histopathology results, while the participants and clinical investigators will be blinded to the TriNetra™-Breast test results. The results of TriNetra™-Breast will be compared with the results of mammography and/or histopathology for performance estimation of the test. Study participants will be followed for clinical outcomes for maximum duration of 2 years. Citation Format: Ulka Vaishampayan, Darshana Patil, Wahida Rahman, Stephanie Patterson, Emilija Mitrikeska, Joe Dib. Clinical validation of “TriNetra™-Breast” test for breast cancer screening in a prospective, observational, case-cohort study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-18-02.

Effectiveness of mammogram and ultra-sonogram in the diagnosis of breast cancer in asymptomatic women at Central Karnataka

Background: Breast cancer is one of the most common cancers among women around the world. Some occult breast cancers can be missed when using ultrasound or mammogram alone. Considering this background, the study was performed to highlight the improved diagnostic efficacy of identifying breast cancer when using both ultrasound and mammogram as a combined modality.Methods: A total of 150 cases of suspected breast cancer were studied over a period of 2 years. Ultrasonography, and mammography were done by two independent radiologists and the results were analyzed. The patients were tested for BRCA1/2 gene mutations. Histopathology was done finally to confirm the diagnoses.Results: The 39 cases out of 150 asymptomatic women screened for breast cancer showed that they were positive for breast cancer by histopathology and 38 were positive by mammogram and ultra-sonogram. Cancer was prominently diagnosed in the age group of more than 40 years (92.3%) and 82.1% of women were in premenopausal stage. High BMI had a statistically significant correlation with breast cancer. The 71.7% of breast cancer cases were obese and 25.6% were overweight individuals. 89.7% of breast cancer cases were from the urban population. Detection of mutation in the BRCA gene showed 28 cases with a mutation in the BRCA-1 gene and 4 cases with a mutation in the BRCA-2 gene.Conclusions: The study confirms that mammography in addition to ultrasonography improves the sensitivity of detection of occult breast cancer in asymptomatic women.

Evidence and assessment of parenchymal patterns of ultrasonography for breast cancer detection among Chinese women: a cross-sectional study

BackgroundScreening 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.MethodsBreast 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).ResultsHeterogeneous (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).ConclusionsBreast cancer risk in Chinese asymptomatic women differ according to the ultrasonographic breast parenchymal pattern.Level of Evidence: III.Technical efficacy stage: 2.

The value of clinical breast examination in a breast cancer surveillance program for women with germline BRCA1 or BRCA2 mutations.

To assess the sensitivity and specificity of clinical breast examination for detecting breast cancer in asymptomatic women with predisposing germline mutations enrolled in a cancer risk management program that includes radiologic screening. Retrospective, longitudinal cohort study of women with BRCA1/2 mutations who attended the Breast and Ovarian Cancer Risk Management Clinic at the Peter MacCallum Cancer Centre, a tertiary referral centre in Melbourne, during 1 September 2001 - 31 December 2019. Consecutive women with BRCA1/2 mutations who did not have personal histories of cancer and had not undergone bilateral risk-reducing mastectomy, and who had visited the clinic at least twice during the study period. Participants had generally undergone breast examination at 6- or 12-month intervals, and annual breast imaging (mammography; and magnetic resonance imaging [MRI] for women aged 50 years or younger). Sensitivity (proportion of all biopsy-confirmed breast cancers detected by breast examination alone) and specificity of breast examination for detecting breast cancer. Of 414 eligible women (mean age, 35.5 years; SD, 11.2 years), 35 were diagnosed with breast cancer during 1761 woman-years of follow-up. Only two were diagnosed based on breast examination alone (ie, without radiologic evidence), neither of whom was undergoing MRI screening. The sensitivity of breast examination was 6% (95% CI, 1-19%), the specificity 97% (95% CI, 95-98%); the positive predictive value was 14% (95% CI, 2-43%), the negative predictive value 92% (95% CI, 89-94%). Clinical breast examination did not increase the number of breast cancers detected in MRI-screened women with BRCA1/2 mutations. Removing breast examination from surveillance programs that include MRI may be reasonable for these women.

Breast Self-Examination Practice and Associated Factors Among Women Attending Family Planning Service in Modjo Public Health Facilities Southwest Ethiopia.

PurposeBreast cancer is the leading cause of cancer death worldwide and the second common cancer overall. Breast self-examination is one of the cheapest methods used for the early detection of breast cancer in asymptomatic women. However, the practice of breast self-examination remains low in Ethiopia. Therefore, this study aimed to assess breast self-examination practice and associated factors among women attending family planning services in Modjo public health facilities in southwest Ethiopia.Patient and MethodsFacility-based cross-sectional study was conducted in Modjo public health facilities from October 01, 2020, to October 30, 2020. Data were collected from 420 women by using an interviewer-administered structured questionnaire. Variables with a P-value ≤0.2 in the bivariate analysis were included in the multivariable logistic regression model. Results of regression analysis were shown as odds ratio (OR) and confidence intervals (95% CI).ResultsOverall 86 (20.5%) of the participants had ever performed breast self-examination. The odds of breast self-examination practice among women with tertiary level of education were 2.14 [AOR: 2.14; 95% CI: (1.45, 6.74)] times higher compared to those with secondary education. Women who knew breast self-examination were 4.32 [AOR: 4.32; 95% CI: (1.81, 10.81)] times higher odds of breast self-examination practice compared to their counterparts. The odds of breast self-examination practice among women who had a positive attitude were 2.7 [AOR: 2.7; 95% CI: (1.03, 6.91)] times higher compared to women with a negative attitude towards breast self-examination.ConclusionBreast self-examination practice was low within the study area. Tertiary level of education, having Knowledge on breast self-examination and a positive attitude towards breast self-examination were found to have a significant association with breast self-examination practice. Breast self-examination should be promoted by improving awareness and providing special health education for women that had low educational level.

A cue-to-action pilot project to increase screening mammography.

Screening mammography is a preventive exam used to detect breast cancer in asymptomatic women. This cue-to-action pilot project sought to determine if outreach, education, and incentive would increase uptake of screening mammography among women aged 52 to 74 years who are members of a community-based health insurance plan. Cohort study design with retrospective and prospective components. Women were eligible to participate in accordance with the CMS Quality Rating System technical specification for breast cancer screening. Eligible women with no documented screening for a mammogram from January 1, 2016, through November 7, 2017, were invited to participate in a campaign that included outreach about screening mammography as a no-cost covered benefit, education about screening mammography to detect asymptomatic disease, and a gift card to a local grocery merchant if the member obtained screening mammography by December 31, 2017. During December 2017, 20.8% (27/130) of eligible women obtained a screening mammogram compared with 7.8% (5/64) of eligible women during the nonintervention reference period of December 2016. Mammography screening increased by 170% during the study period in comparison with the reference period of a year earlier (prevalence ratio [PR], 2.7; 95% CI, 1.1-6.6; P = .02). A one-time, time-limited cue-to-action pilot project consisting of outreach, education, and incentive increased uptake of screening mammography by women enrolled in a community health insurance plan providing health insurance coverage as part of the Affordable Care Act. This increase is statistically significant in the intervention period compared with the reference period (PR, 2.7; 95% CI, 1.1-6.6; P = .02). Despite a small sample size, the magnitude of the effect for this pilot study is encouraging and warrants future studies in a larger population.

Knowledge and Practice of Breast Self-examination and Associated Factors among Women Students in West Arsi Zone, Southeast Ethiopia

Background: Breast cancer is the leading cause for maternal mortality globally, especially in developing countries like Ethiopia. The incidence is increasing specially in developing regions. Regular breast self-examination is one of the most cost-effective methods for early detection of breast cancer in asymptomatic women. Objective: The aim of the study is to assess the level of knowledge and breast self-examination practice, and its associated factors among students in private universities at west Arsi zone, south east Ethiopia. Methods: A facility based cross-sectional study design was conducted from April 1 to 30, 2018. A total of 355 undergraduate female students were participated in the study. Simple random sampling technique was used to select the study participants. Binary and multivariate logistics regression analyses was applied using backward step wise method with p 0.25 criteria to enter and exit from the model respectively. Odds ratios with 95% confidence intervals were computed and significance of all tests was determined at p ≤ 0.05. Results: From all participants 84(23.7%) were knowledgeable about breast self-examination and 148(41.7%) and 65(18.3%) of them have knowledge about sign and risk of breast cancer respectively. Only 112(31.5%) ever practiced breast self-examination, from those 79(22.3) of them practice breast self-examination monthly and most them started breast self-examination between age of 20-30 years. After adjusting for possible confounders; Field of study, knowledge of breast cancer risk and sign were significantly associated with knowledge of breast self-examination. Knowledge about breast self-examination and from constructs of health belief model perceived susceptibility and perceived barriers were significantly associated with breast self-examination practice. Conclusion: knowledge and practice of breast self-examination of undergraduate female students was low as a National guideline of Ethiopia FMOH that states all female age above 20 years should practice BSE. Therefore, the health sector should design strategies to improve female students’ knowledge and practice of breast self-examination.

Breast pain and cancer: should we continue to work-up isolated breast pain?

To assess the cancer detection rate (CDR) in patients presenting with isolated breast pain. A retrospective review was performed of consecutive patients presenting to a large tertiary care academic center or an affiliated hospital with isolated breast pain from October 1, 2013 to September 30, 2015. Medical records were reviewed for patient demographics, pain characteristics, imaging findings, and outcome. The study cohort was comprised of 971 exams in 953 patients, with a median age of 50years. A total of 62.5% (607/971) of the cases were assessed by mammography and ultrasound, 24.4% (237/971) by ultrasound only, and 13.1% (127/971) by mammography only. Including the abnormalities detected in the asymptomatic breast, 88.7% (861/971) of the cases were negative or had benign findings (BI-RADS 1 and 2), 6.8% (66/971) were probably benign (BI-RADS 3), 3.9% (38/971) were suspicious (BI-RADS 4), and 0.6% (6/971) were highly suggestive of malignancy (BI-RADS 5). CDR on initial work-up was 0.8% (8/953), of which 0.6% (4/690) was in average-risk patients while 1.5% (4/263) was in higher-than-average risk patients. CDR in patients presenting with isolated breast pain overall was low, comparable to the expected incidence of breast cancer in asymptomatic women. Work-up for isolated breast pain may therefore be unnecessary and lead to overutilization of healthcare resources. Routine screening mammography should be encouraged and higher-than-average risk patients may benefit from additional tests.

Mammographic screening patterns in Sokoto, Northwestern Nigeria

Background: Screening mammography is a radiographic examination of the breast performed for early detection of breast cancer in asymptomatic women. The American College of Radiology recommends that women should have mammography at the age of 40 years and annually thereafter. However, those who are at increased risk of breast cancer should start screening mammography earlier. These include patients with a strong family history of breast cancer or those who had radiotherapy to the chest wall. Objective: This study is aimed at evaluating the mammographic outcomes among 77 Nigerian females who had screening mammographic breast examination. Materials and Methods: From December 2010 and November 2012, 77 females had routine screening mammography in the department with the general electric alpha-RT machine with model number MGF-101 (manufactured 2010). All the participants had to fill a mammographic form consisting of variables such as age, sex, occupation, family history of breast cancer, tribe, contraception, parity and caffeine consumption, history of surgical intervention (lumpectomy, biopsy, and/or mastectomy), previous mammography, and last childbirth. Mediolateral-oblique and cranial-caudal views were done for the breast examination though additional were occasionally employed. Results: Seventy-seven females had screening mammography. The minimum age recruited was 40 years. The mammographic outcome for those who had screening was normal in 51 (66.2%) and abnormal in 26 (33.8%) participants. The abnormal mammographic outcomes were architectural distortion in either or both breasts in 13 (16.9%) participants, masses in either or both breast in 11 (14.3%) participants, while isolated calcification in either or both breast among 2 (2.6%) participants. Two (18.2%) of the subjects with masses had associated macrocalcification. No masses with malignant features were seen. Conclusion: Screening mammography was found out to be useful in detecting various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions. Screening mammography is, therefore, advised yearly and routinely for women age 40 years and above.

PO-498 Spliced RNA panels from tumor-educated platelets (TEP) enable detection of early breast cancer

IntroductionDetection of early-stage breast cancer from blood is a highly desirable screening application of liquid biopsies. Tumor-educated platelets (TEP) contain distinct spliced RNA repertoires and can function as a blood-based biosource for the detection of cancer (Best et al. Cancer Cell 2015). Here, we investigated the potential of TEP RNA profiles as an early breast cancer diagnostics algorithm.Material and methodsWe sequenced platelets of women with stage I-III breast cancer (n=134) and asymptomatic non-cancer females (n=121). Samples were divided over a training, evaluation and validation set. We developed a TEP RNA-based classification algorithm, which was tailored towards two clinically relevant diagnostic applications. The first application is to rule out breast cancer in women with an abnormal mammography. The second application is to rule in breast cancer in asymptomatic women carrying an elevated baseline breast cancer risk. We examined if classifications depended on patient age, tumour stage, subtype, BRCA mutation status, and breast density. In addition, we tested if the algorithm was breast cancer specific by testing our algorithm in a pan-cancer cohort (n=192).Results and discussionsIn the evaluation cohort (n=48 of which n=24 early breast cancer cases) the TEP RNA-based breast cancer classification had an accuracy of 90% with an AUC of 0.96 (95% confidence interval (CI) 0.92–1.00; p<0.001). In the validation cohort, the TEP RNA-based classification algorithm reached an overall accuracy of 86% and an AUC of 0.93 (95% CI 0.89–0.98, p<0.001). Most important, the accuracy was 91% in stage I/II disease. In a confirmatory rule-out application (positive mammography) sensitivity would be 94% with a specificity of 67%; whereas in a screening setting sensitivity would be 80% with a specificity of 93%. The classifier performance is consistent across subgroups based on patient age, tumour stage, subtype, tissue density, or BRCA1/2-status. The breast cancer TEP profiles were distinct from those of women with other tumour types (n=192, accuracy: 87%, AUC: 0.91, 95% CI 0.87–0.96, p<0.001). Although results look promising, sensitivity and specificity should be improved for clinical implementation. Follow-up studies should, among others, require sample collection in actual screening and confirmatory settings.ConclusionWe show that platelet RNA signatures may enable blood-based screening for early breast cancer, and warrant validation in a confirmatory and screening setting.

Role of elastography for downgrading BI-RADS category 4a breast lesions according to risk factors.

Elastography has been introduced as an additional diagnostic tool to ultrasonography (US) which helps clinicians decide whether or not to perform biopsy on US-detected lesions. To evaluate the role of strain elastography in downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4a breast lesions according to personal risk factors for breast cancer in asymptomatic women. Strain elastography features of a total of 255 asymptomatic category 4a lesions were classified as soft and not soft (intermediate and hard). Malignancy was confirmed by surgery or biopsy, and benignity was confirmed by surgery or biopsy with no change on US for at least six months. Malignancy rates of lesions with soft and not soft elastography were calculated according to the presence of risk factors. Of 255 lesions, 25 (9.8%) were malignant and 230 (90.2%) were benign. Of 195 lesions in average-risk women, the malignancy rate of lesions with soft elastography was 1.5% (1/68), which was significantly lower than the 14.2% (18/127) of lesions with not soft elastography ( P = 0.004). Of 60 lesions in increased-risk women, the malignancy rate of lesions with soft elastography was 15.0% (3/20), which was not significantly different from the 7.5% (3/40) of lesions with not soft elastography ( P = 0.390). In average-risk women, category 4a lesions with soft elastography could be followed up with US because of a low malignancy rate of 1.5%.

The Value of Quality-Assured Magnetic Resonance Imaging of the Breast for the Early Detection of Breast Cancer in Asymptomatic Women.

The aim of this study was to evaluate the exclusive performance of quality-assured high-resolution breast magnetic resonance imaging (MRI) for early detection of breast cancer in a population of asymptomatic women. A total of 1189 MRI examinations performed in 789 asymptomatic women (mean age, 51.1 years) were evaluated. All examinations were performed using open bilateral surface coil, dedicated compression device, and high spatial resolution (matrix, 512 × 512). Digital mammography was available for all participants. Assessment included density types, artifact level, and Breast Imaging Reporting and Data System classification. Evaluation was performed by 2 readers. In addition, a computer-assisted diagnosis (CAD) system was used for image assessment. Breast MRI showed density types I and II in 87.6% and artifacts categories III and IV in 3.1%. Study included 32 carcinomas (8 ductal carcinoma in situ, 24 invasive tumors). Both readers detected 29 of 32 correctly (sensitivity 90.6%). The variation between the readers was low (reader 1: specificity, 94.4% and positive predictive value (PPV), 25.7%; reader 2: specificity, 97.6% and PPV, 34.1%). Sensitivity of CAD was 62.5% (specificity, 84.4%; PPV, 5.2%). Digital mammography detected 13 of 32 carcinomas (sensitivity, 56.3%; specificity, 98.4%; PPV, 32.1%). The exclusive use of quality-assured breast MRI allows the early detection of breast cancer with a high sensitivity and specificity. The CAD analysis of MRI does not give additional information but shows results comparable with digital mammography.

English

Breast cancer is the leading cause of cancer mortality worldwide. Breast cancer incidence is increasing both in developed and developing regions. Regular breast self-examination (BSE) is one of the most cost effective methods for early detection of breast cancer in asymptomatic women. The aim of this study is to assess the magnitude of BSE practice and its associated factors among female health professionals working in public health facilities in Western Ethiopia. The study applied is health facility based cross-sectional study design. Simple random sampling technique was used to recruit a total of 390 female health professionals. The study was conducted from January to March, 2015. Bivariate and multivariable logistic regression model was used, odds ratios with 95% confidence intervals were computed and significance of all tests was decided at p-value of 0.05. From the total respondents, 77% had ever practiced BSE and only one third (33.7%) of them practiced regularly. Not experiencing breast problem (12.7%) was the main reason for not practicing regular BSE. After adjusting for possible confounders; personal history of breast cancer (AOR=4.7, 95%CI: 1.32-17.07), having knowledge of BSE (AOR=4.1, 95%CI: 1.36-5.65), positive attitude (AOR, 3.8, 95%CI: 2.10-9.17) and ever taught BSE to a client (AOR=5.2, 95%CI: 2.35-8.14) were found to be statistically significant predictors of BSE. Even though the life time BSE practice in this study was high, the regular BSE practice was low. Thus, trainings on BSE practice will be important to improve the practice level of health professionals and their counseling skill for the clients.&nbsp; &nbsp;&nbsp; &nbsp; Key words: Breast self-examination, health professionals, practice, females.

Use of Imaging for Staging of Localized Breast Cancer in Two Integrated Health Care Systems: Adherence to a Choosing Wisely Recommendation

Background/Aims: The initial American Society of Clinical Oncology “Top 5” list, created as part of the Choosing Wisely campaign, recommends against use of imaging for staging of localized breast cancer in asymptomatic women at low risk for metastasis. The objective of this study was to measure and compare use of imaging for staging in two large integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH). We also sought to distinguish whether imaging was used for routine staging or for diagnostic purposes.

Use of imaging for staging of early breast cancer in two integrated health care systems.

184 Background: The initial ASCO “Top 5” list, created as part of the Choosing Wisely campaign, recommends against use of imaging for staging of early stage breast cancer in asymptomatic women at low risk for metastasis. The objective of this study was to measure and compare use of imaging for staging in two large integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH). We also sought to distinguish whether imaging was used for routine staging or for diagnostic purposes. Methods: We identified stage 0-IIB breast cancer patients diagnosed between January 1, 2010 and December 31, 2012 with first primary malignancy from tumor registries in three KP regions (Southern California, Northwest, and Mid-Atlantic) and IH. Using the KP and IH electronic health records, we identified use of imaging tests (PET, CT, bone scan) during the staging window (30 days prior to diagnosis up to initial surgery). We performed chart abstraction on a random sample of patients who received an imaging test to identify indication. Results: For the total sample of 10,014, mean age at diagnosis was 60 (range 22-99); with 21% stage 0, 47% stage I, 32% stage II. Overall, 8% of patients (792 patients) received at least one imaging test during the staging window, including 8% at KP and 6% at IH (p=0.0005). Chart abstraction (N=129) revealed that overall, almost half of all imaging tests (48%) were performed to evaluate a symptom, sign or prior imaging finding, including 55% at KP and 32% at IH. Conclusions: Use of imaging for staging of low-risk breast cancer was very low in both health care systems, with clinically trivial differences between them. Approximately half of imaging services were in response to a sign or symptom. Strategies to reduce use of imaging at staging for early stage breast cancer patients within these health care systems are unlikely to yield meaningful improvement. [Table: see text]

Improving breast cancer detection using ultrasonography in asymptomatic women with non-fatty breast density

Mammography (MX) is a reliable modality for detection of breast cancer in asymptomatic women. Use of additional whole breast ultrasonography (US) for breast cancer screening is widely recognized, in particular in women with dense breast parenchyma. To determine the subgroup of women, according to breast density and age, who receive most benefit from US following MX for detection of breast cancer in an asymptomatic condition. The study was conducted in asymptomatic women who had non-fatty breast parenchyma using MX and US during January 2006 and December 2007. Mammographic breast density was classified as recommended by ACR BI-RADS lexicon. Non-fatty breast referred to D2, D3, and D4. US was performed by the same radiologists who interpreted MX with a handheld machine during the same visit. Data on demographics, cancer detection rate (CDR), and incremental cancer detection rate (ICDR) were analyzed using 95% confident interval (CI). Of 14,483 breast cancer screenings in women who had non-fatty breast density, 115 cancers were documented. The mean age of cancer patients was 49.6 years. Of 115 cancers, 105 were evidenced on images (31 with MX alone, 19 with US alone, and 55 with both MX and US). Overall CDR was 7.9 per 1000 examination (95% CI, 6.5-9.5). CDR for MX only (MX-CDR) was 6.5 per 1000 examinations (95% CI, 5.2-7.9). Additional US could significantly improve CDR (P < 0.001; 95% CI, 0.9-2.2); US-ICDR was 1.4 per 1000 examinations. According to age group, the group of 40-59 years had statistically significant improvement of ICDR (P < 0.001). The ICDR was highest in D4 breast density (D4) (US-ICDR = 2.5 per 1000 examinations). Use of US adjunct to MX for detection of breast cancer in asymptomatic non-fatty, average-risk women for detection of breast cancer is a promising diagnostic procedure. A significant benefit was documented, in particular, in women aged 40-59 years old, and in women with D4 breast density.

Breast-cancer screening with trained volunteers in a rural area of Sudan: a pilot study

Breast cancer has a low cure rate in low-income and middle-income countries because patients often present with late-stage disease that has metastasised to other organs. We assessed whether the implementation of a cancer awareness and breast examination programme that uses local, volunteer women could increase the early detection of breast cancer in a rural area of sub-Saharan Africa. We did this pilot study in two counties in Gezira State, Sudan. We chose Keremet (56 villages) as the experimental county and Abugota (79 villages) as the control county. Female volunteers from villages in Keremet were trained in the detection of breast abnormalities. When trained, volunteers visited households in their village and screened women aged 18 years or older for breast abnormalities, referring women with suspected breast cancer for medical diagnosis and, if necessary, treatment at the district hospital. We also ran a cancer awareness programme for both men and women in study villages. Villages in the control population received no intervention. This study is ongoing. Between Jan 1, 2010, and Oct 10, 2012, 10 309 (70%) of 14 788 women in Keremet were screened. 138 women were identified as having breast abnormalities and were referred to the district hospital for diagnosis and treatment. 20 of these women did not report to the hospital. Of the 118 women who did report, 101 were diagnosed with benign lesions, eight with carcinoma in situ, and nine had malignant disease. After treatment, 12 of the 17 women with either carcinoma in situ or malignant disease (four had early breast cancer and eight had ductal carcinoma in situ) were disease-free and had a good prognosis. In the control villages, only four women reported to the centre: one was found to have a benign lesion while three were diagnosed with advanced disease. Our findings show that a screening programme using local volunteers can increase the detection of breast cancer in asymptomatic women in low-income rural communities. These findings can inform policy-makers' decisions in the design of cancer control programmes in Sudan and other similar areas in sub-Saharan Africa. Sudan National Cancer Institute.

Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer

This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low (3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1unanticipated secondary operation. Bilateral prophylactic mastectomy is safe and efficacious in reducing future breast cancer in asymptomatic women at high risk. Unanticipated reoperations are common. Given the small number of patients centralization seems justified.

Genome-Based Prediction of Breast Cancer Risk in the General Population: A Modeling Study Based on Meta-Analyses of Genetic Associations

Genome-wide association studies identified novel breast cancer susceptibility variants that could be used to predict breast cancer in asymptomatic women. This review and modeling study aimed to investigate the current and potential predictive performance of genetic risk models. Genotypes and disease status were simulated for a population of 10,000 women. Genetic risk models were constructed from polymorphisms from meta-analysis including, in separate scenarios, all polymorphisms or statistically significant polymorphisms only. We additionally investigated the magnitude of the odds ratios (OR) for 1 to 100 hypothetical polymorphisms that would be needed to achieve similar discriminative accuracy as available prediction models [modeled range of area under the receiver operating characteristic curve (AUC) 0.70-0.80]. Of the 96 polymorphisms that had been investigated in meta-analyses, 41 showed significant associations. AUC was 0.68 for the genetic risk model based on all 96 polymorphisms and 0.67 for the 41 significant polymorphisms. Addition of 50 additional variants, each with risk allele frequencies of 0.30, requires per-allele ORs of 1.2 to increase this AUC to 0.70, 1.3 to increase AUC to 0.75, and 1.5 to increase AUC to 0.80. To achieve AUC of 0.80, even 100 additional variants would need per-allele ORs of 1.3 to 1.7, depending on risk allele frequencies. The predictive ability of genetic risk models in breast cancer has the potential to become comparable to that of current breast cancer risk models. Risk prediction based on low susceptibility variants becomes a realistic tool in prevention of nonfamilial breast cancer.