Breast Cancer Screening Modalities Research Articles

Performance of breast cancer screening methods and modality among Chinese women: a report from a society-based breast screening program (SBSP) in Shanghai

To evaluate the screening performance of individual and combined use of clinical breast examination, ultrasonography and mammography in Chinese women, we conducted a biennial breast cancer screening program among 14,464 women aged 35 to 74 years old who lived in Qibao County, Minhang district of Shanghai, China, between May 2008 and Sept 2012. All participants were submitted to clinical breast examination, and then women with positive results and all women at age of 45-69 years old were preformed breast ultrasonography and mammography. The examination results were compared against pathological findings as the gold standard of reference. A total of 66 women were diagnosed with breast cancer in the two rounds of the screening, yielding an incident rate of 194 per 100,000 person-years. The sensitivity of clinical breast examination, ultrasonography and mammography alone were 61.4%, 53.7% and 67.3%, respectively. While mammography performed better in elder age groups and hormone receptor positive disease groups, ultrasonography had a higher sensitivity in younger age group and did not differ in sensitivity by estrogen receptor or progesterone receptor status. Combined use of the two imaging examinations increased the sensitivity in almost all age groups, but had a higher sensitivity in hormone receptor positive cancers than in those negative. Our results suggest that the Qibao modality is an effective strategy for breast cancer screening among Chinese women, especially for early detection of elder and hormone receptor positive breast cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-276) contains supplementary material, which is available to authorized users.

Effects of Age, Breast Density and Volume on Breast Cancer Diagnosis: A Retrospective Comparison of Sensitivity of Mammography and Ultrasonography in China's Rural Areas

Mammography has been confirmed as the only effective mode to improve the prognosis of patients with breast cancer in Western developed countries, but might not be a good choice in other areas of the world. One of the major challenges in China is to determine an optimal imaging modality for breast cancer screening. This study was designed to clarify the sensitivity of ultrasonography compared with that of mammography in rural China. We retrospectively studied the sensitivity of mammography and ultrasonography based on 306 breast cancer patients detected by the program of "screening for cervical cancer and breast cancer" performed in Chinese rural areas between January 2009 and December 2011, and analyzed the effects of age, breast density and volume on the sensitivity. Stratified analysis showed that the sensitivity of breast ultrasonography was significantly higher than that of mammography in premenopausal patients (81.4% vs. 61.1%, p=0.02), in women ≤ 55 years of age (82.2% vs. 63.4%, p<0.01), in the high breast density group (American College of Radiology [ACR] levels 3-4) (85.9% vs. 60.6%, p<0.01) and in the small breast volume group (≤ 400 ml) (87.1% vs. 66.7%, p<0.01). Age had a significant effect on sensitivity of mammography (breast density and volume-adjusted odds ratio, 6.39; 95% confidence interval, 2.8-14.4 in age group > 55 compared to age group ≤ 45), but not that of ultrasonography. Neither breast density nor volume had significant effect on sensitivity of mammography or ultrasonography. Ultrasonography is more sensitive than mammography in detecting breast cancer in women under 55 year-old Chinese, especially in those with high-density and relatively small breasts.

Ductal carcinoma in situ : a ticking time bomb

85 ISSN 1758-1923 10.2217/BMT.12.69 © 2013 Future Medicine Ltd Breast Cancer Manage. (2013) 2(2), 85–88 The goal of screening is to detect cancer early and improve survival. Most screen-detected cancers should be treated effectively with fewer and less morbid therapies. Over the last decade, the quality of mammography and other imaging modalities for breast cancer screening has improved, resulting in a dramatic increase in the number of women diagnosed with noninvasive ductal carcinoma in situ (DCIS). In 2005, almost 60,000 cases of DCIS were recorded in the USA, representing nearly a quarter of all screen-detected cancers [1]. Evidence that earlier detection of DCIS improves diseasespecific survival is controversial, however, and many groups question the value of current breast-screening programs. Despite technological improvements in imaging, treatment for DCIS has not changed. Women with small foci of lowgrade DCIS are often treated with a onesize-fits-all barrage of surgery, radiotherapy and hormonal therapy. Analyses of trends over time show that, since 1998, both the mastectomy rate and the contralateral prophylactic mastectomy rate for DCIS have increased dramatically. DCIS is an independent risk factor for bilateral mastectomy in many studies, despite the results of the NSABP B-17 and B-24 trials, which demonstrate the safety of breastconserving surgery (BCS) for DCIS [2]. For those selecting BCS, there also appears to be a very high rate of intervention in the first decade after treatment [3], leading many to wonder if, from both a psychological and an economic standpoint, BCS is really worth it. Here, we present some current therapies and opportunities for future research regarding the treatment of DCIS.

Mass classification in breast DCE-MR images using an artificial neural network trained via a bee colony optimization algorithm

Breast cancer is becoming the leading cause of cancer deaths among women. The best way to reduce deaths due to breast cancer is early detection and treatment. Dynamic contrast enhanced (DCE) MRI has emerged as a promising new imaging modality for breast cancer screening. Currently, radiologists evaluate breast lesions based on a qualitative description of lesion morphology and contrast uptake profiles. The qualitative description of breast lesions from DCE-MRI introduces a high degree of inter-observer variability. In addition, the high sensitivity of MRI results in good specificity. A computer-assisted evaluation system that can automatically analyse lesion features to differentiate between malignant and benign lesions would be very useful. One of the major characteristics for mass classification is texture. Artificial neural networks exploit this important factor to classify the mass as benign or malignant. The selected texture features were used to classify the mass with a three-layered neural network to predict the outcome of a biopsy. The main objective of this proposed method is to increase the effectiveness, robustness, and efficiency of the classification process in an objective manner to reduce the numbers of false-positive results. The paper presents an intelligent computer assisted mass classification method for breast DCE-MR images. It uses the artificial bee colony algorithm to optimize the a neural network performing benign- malignant classification on the region of interest. A three-layer neural network with seven features was used for classifying the region of interest as benign or malignant. The network was trained and tested using the artificial bee colony algorithm and was found to yield a good diagnostic accuracy.

Effects of Digital Mammography Uptake on Downstream Breast-related Care Among Older Women

Digital mammography is the dominant modality for breast cancer screening in the United States. No previous studies have investigated as to how introducing digital mammography affects downstream breast-related care. Compare breast-related health care use after a screening mammogram before and after introduction of digital mammography. Longitudinal study of screening mammograms from 14 radiology facilities contributing data to the Breast Cancer Surveillance Consortium performed 1 year before and 4 years after each facility introduced digital mammography, along with linked Medicare claims. We included 30,211 mammograms for women aged 66 years and older without breast cancer. Rates of false-positive recall and short-interval follow-up were based on radiologists' assessments and recommendations; rates of follow-up mammography, ultrasound, and breast biopsy use were based on Medicare claims. False-positive recall rates increased after the introduction of digital mammography. Follow-up mammography use was significantly higher across all 4 years after a facility began using digital mammography compared with the year before [year 1 odds ratio (OR) = 1.7, 95% confidence interval (CI), 1.4-2.1]. Among women with false-positive mammography results, use of ultrasound decreased significantly in the second through fourth years after digital mammography began (year 2 OR = 0.4, 95% CI, 0.3-0.6). Introduction of a new technology led to changes in health care use that persisted for at least 4 years. Comparative effectiveness research on new technologies should consider not only diagnostic performance but also downstream utilization attributable to this apparent learning curve.

Optimizing Canadian breast cancer screening strategies: a perspective for action.

While controversies regarding optimal breast cancer screening modalities, screening start and end ages, and screening frequencies continue to exist, additional population-based randomized trials are unlikely to be initiated to examine these concerns. Simulation models have been used to evaluate the efficacy and effectiveness of various breast cancer screening strategies, however these models were all developed using US data. Currently, there is a need to examine the optimal screening and treatment policies in the Canadian context. In this commentary, we discuss the current controversies pertaining to breast cancer screening, and describe the fundamental components of a simulation model, which can be used to inform breast cancer screening and treatment policies.

OR Forum—A POMDP Approach to Personalize Mammography Screening Decisions

Breast cancer is the most common nonskin cancer and the second leading cause of cancer death in U.S. women. Although mammography is the most effective modality for breast cancer screening, it has several potential risks, including high false-positive rates. Therefore, the balance of benefits and risks, which depend on personal characteristics, is critical in designing a mammography screening schedule. In contrast to prior research and existing guidelines that consider population-based screening recommendations, we propose a personalized mammography screening policy based on the prior screening history and personal risk characteristics of women. We formulate a finite-horizon, partially observable Markov decision process (POMDP) model for this problem. Our POMDP model incorporates two methods of detection (self or screen), age-specific unobservable disease progression, and age-specific mammography test characteristics. We solve this POMDP optimally after setting transition probabilities to values estimated from a validated microsimulation model. Additional published data is used to specify other model inputs such as sensitivity and specificity of test results. Our results show that our proposed personalized screening schedules outperform the existing guidelines with respect to the total expected quality-adjusted life years, while significantly decreasing the number of mammograms and false-positives. We also report the lifetime risk of developing undetected invasive cancer associated with each screening scenario.

In This Issue

In This Issue

Why we need more breast cancer screening trials

Despite a high false-positive rate, screening mammography fails to detect one in five breast cancers and even fewer in women with dense breasts. New technologies have been developed to address...

Predictors of Breast Cancer Screening Uptake: A Pre Intervention Community Survey in Malaysia

Despite health education efforts to educate women on breast cancer and breast cancer screening modalities, the incidence of breast cancer and presentation at an advanced stage are still a problem in Malaysia. To determine factors associated with the uptake of breast cancer screening among women in the general population. This pre-intervention survey was conducted in a suburban district. All households were approached and women aged 20 to 60 years old were interviewed with pre-tested guided questionnaires. Variables collected included socio-demographic characteristics, knowledge on breast cancer and screening practice of breast cancer. Univariate and multivariate analysis were performed. 41.5% of a total of 381 respondents scored above average; the mean knowledge score on causes and risks factors of breast cancer was 3.41 out of 5 (SD1.609). 58.5% had ever practiced BSE with 32.5% performing it at regular monthly intervals. Uptake of CBE by nurses and by doctors was 40.7% and 37.3%, respectively. Mammogram uptake was 14.6%. Significant predictors of BSE were good knowledge of breast cancer (OR=2.654, 95% CI: 1.033-6.816), being married (OR=2.213, 95% CI: 1.201-4.076) and attending CBE (OR=1.729, 95% CI: 1.122-2.665). Significant predictors for CBE included being married (OR=2.161, 95% CI: 1.174-3.979), good knowledge of breast cancer (OR=2.286, 95% CI: 1.012-5.161), and social support for breast cancer screening (OR=2.312, 95% CI: 1.245-4.293). Women who had CBE were more likely to undergo mammographic screening of the breast (OR=5.744, 95% CI: 2.112-15.623), p<0.005. CBE attendance is a strong factor in promoting BSE and mammography, educating women on the importance of breast cancer screening and on how to conduct BSE. The currently opportunistic conduct of CBE should be extended to active calling of women for CBE.

Difficulties and Errors in Diagnosis of Breast Neoplasms

Many perceptual and interpretive factors influence the radiologic detection and assessment of breast neoplasms. Diagnostic problems can be divided into errors of detection and errors of assessment and management. Detection issues may relate to inherent features of the tumor or surrounding tissue, technical problems, or human error. Even when lesions are successfully detected, errors in assessment or management recommendations can cause diagnostic delays. Improper breast imaging-reporting and data system (BI-RADS) usage or failure to integrate mammographic, ultrasonography (US), and magnetic resonance imaging (MRI) findings with clinical findings, all lead to interpretive errors. This article reviews factors affecting the detection and diagnosis of breast cancer, to improve radiologic interpretation, benefit patients by earlier cancer detection, and lessen medicolegal exposure from a missed or delayed cancer diagnosis. Mammography is the primary imaging modality for population-based breast cancer screening, and it is also the usual initial examination performed for diagnostic evaluation of clinical or screen-detected breast abnormalities in women aged 40 years and older. Mammography is supplemented by breast US and/or breast MRI in some cases. This article will, therefore, focus on mammography in reviewing difficulties and errors in cancer diagnosis, with supplemental discussion of breast US and breast MRI.

Using Automated Breast Sonography as Part of a Multimodality Approach to Dense Breast Screening

Three-dimensional automated breast sonography is currently an investigational modality for breast cancer screening not yet accepted clinically in the United States. In this pilot study, a prospective study of 24 asymptomatic female patients with more than 50% breast density by digital screening mammography was performed using automated breast sonography and compared with 3D contrast breast magnetic resonance imaging (MRI) correlation (the gold standard). This study was performed as part of a multimodality approach to histologically proven breast lesions classified as categories 4 and 5 according to the American College of Radiology Breast Imaging, Reporting, and Data System (BI-RADS). Comparable diagnostic reliability (kappa values between 0.95 and 0.98) was observed between automated breast sonography and MRI in differentiating benign from malignant breast lesions based on similar morphologic criteria. This preliminary study offers automated breast sonography as a promising cost-effective adjunct diagnostic modality to MRI in the evaluation women with increased breast density by digital mammography.

Evaluation of Breast Disorders with Ultrasound

A 45-year-old nonlactating female presented to the emergency department (ED) fast-track area with a chief complaint of breast pain associated with redness. The symptoms occurred over a period of weeks. There were no constitutional symptoms of fever, chills, or weight loss. The patient had no known personal or family history of breast cancer. On physical examination, there was a 6- by 3-cm confluent area of erythema involving both lower quadrants of the breasts without dimpling. There were no palpable masses, areas of fluctuance, or discharge expressed from the areola. However, it was notable that the patient had large nonaugmented breasts that were difficult to examine. These findings were thought to be most consistent with infectious mastitis, and the patient was started on antibiotics for observation in the ED. On reexamination of the patient, given the difficulty of direct manual evaluation, ultrasound of the breast was performed with a high-frequency linear array ultrasound probe. A 4- by 4-cm complex structure with both solid and cystic components was visualized 1 cm below the area of erythema (see Movie Clip, online only). The patient was then admitted for evaluation of possible breast cancer versus deep tissue abscess. Initial fine-needle aspiration biopsy revealed diffuse lymphocytic invasion that was nonspecific. However, a later ultrasound-guided core-needle biopsy revealed infiltrating ductal carcinoma. Distinguishing between breast pathologies, such as simple infectious mastitis, breast abscess, or a malignant condition, can be quite challenging in the ED. A recent study of 127 adult mastitis complaints revealed that only 25% actually represented true simple infectious mastitis. Another 40% were found to be an abscess, and 6% represented a malignant condition.1 Currently, there is a growing body of literature that identifies ultrasound as being a more sensitive modality in identifying more complicated conditions, such as malignancy, from simple mastitis.2–3 Mammography, while more specific, is often difficult to obtain from the ED. Furthermore, the National Comprehensive Cancer Network endorses ultrasound alongside mammography as a class IIA screening modality for breast cancer with breast skin changes in their 2010 guidelines.4 This case demonstrates that the potential use of bedside ultrasound by emergency physicians can be a rapid and helpful diagnostic tool in differentiating an uncomplicated infectious condition, mastitis, from more complex pathology, such as breast cancer, that was ultimately diagnosed in this patient.

Optical mammography: Diffuse optical imaging of breast cancer

Existing imaging modalities for breast cancer screening, diagnosis and therapy monitoring, namely X-ray mammography and magnetic resonance imaging, have been proven to have limitations. Diffuse optical imaging is a set of non-invasive imaging modalities that use near-infrared light, which can be an alternative, if not replacement, to those existing modalities. This review covers the background knowledge, recent clinical outcome, and future outlook of this newly emerging medical imaging modality.

Ionizing radiation or mitomycin-induced micronuclei in lymphocytes of BRCA1 or BRCA2 mutation carriers

BRCA1 and BRCA2 genes are essential in preserving the integrity of genome, and it is not unambiguously clear whether the heterozygosity status may affect BRCA1 or BRCA2 functions. This may have implications for the clinical management of BRCA1 and BRCA2 mutation carriers both in breast cancer (BC) screening modality and in cancer treatment based on DNA-damaging or DNA-repair-inhibiting drugs. We investigated whether lymphocytes carrying BRCA1 or BRCA2 mutations displayed an increased sensitivity to radiation or mitomycin C (MMC) in vitro treatments. Peripheral blood from 21 BRCA1 mutation carriers (12 with BC and 9 healthy), 24 BRCA2 carriers (13 with BC and 11 healthy), 15 familial BC patients without detected mutation in BRCA1 or BRCA2 and 16 controls without familial history of cancer (5 with BC and 11 healthy) were irradiated or treated with MMC. Chromosomal damage was measured using the cytokinesis-block micronucleus assay. We evaluated micronuclei (MN) and nucleoplasmic bridges (NPBs). The BRCA2 mutation carriers and familial BC patients without detected mutation in BRCA1 or BRCA2 showed less basal NPB than BRCA1 carriers and controls. The BRCA1 (+/-) or BRCA2 (+/-) lymphocytes did not have increased frequencies of MN or NPB after irradiation. In contrast, BRCA2 (+/-) lymphocytes presented higher levels of MN after MMC exposure than BRCA1 carriers and controls. The monoallelic BRCA1 or BRCA2 pathogenic mutations seem not to be associated with an enhanced radiosensitivity. The mutation of one BRCA2 allele conferred an increased sensitivity to MMC, presumably because of the role of this gene in the repair of MMC-induced DNA damage. This finding indicates that the MMC-induced MN analysis could be useful in identifying functional deficiencies of BRCA2 or genes related to BRCA2. Since MMC can be used as an anti-cancer drug, these data may be relevant for the management and follow-up of BRCA2 mutation carriers.

WE‐B‐204C‐01: Postron Emission Mammography

Specialized positron emission tomography (PET) systems dedicated to imaging breast cancer have been proposed and developed since the mid‐1990s. The term positron emission mammography (PEM) has been applied to this specialized area of PET scanners and scanning.While progress has been made in reversing a long increasing trend of breast cancer deaths in the U.S. and elsewhere, there is still a relatively high incidence of breast cancer diagnosis and mortality: an estimated 192,000 cases, and 40,000 deaths in the U.S. in 2009. This is the second leading cause of cancer deaths in women in the U.S. Screening X‐ray mammography has played an important role in reversing the trend of increasing deaths, and is the primary imaging modality for breast cancer screening. A limitation of screening and diagnostic mammography is its lack of specificity to malignant disease, resulting in many false positives. A number of imaging methods are used to further investigate equivocal mammography findings, including ultrasound, magnetic resonance imaging (MRI), scintigraphy, and PEM.PET is a functional imaging modality used routinely in oncology to image hyper‐metabolic lesions, including breast cancers. However, the spatial resolution of whole‐body PET (WB‐PET) scanners limits their usefulness in early breast cancer because lesion sizes at diagnosis tend to be smaller than can be reliably imaged with WB‐PET. Dedicated PEM systems focus on improved spatial resolution for imaging early breast cancer, and its functional nature is seen to complement the morphological information provided by mammography. One proposed use of PEM is to improve specificity in diagnosing suspicious but equivocal findings in mammography. PEM has also been suggested for identifying multi‐focal, multi‐centric, or bilateral disease for purposes of planning surgical treatment, for guiding and monitoring therapies, and for better identification of ductal carcinoma in situ.This lecture will provide a brief history of PEM development, give the current status of PEM, compare PEM to WB‐PET and mammography, and discuss clinical applications and operations.Learning Objectives:1. At the end of this lecture, attendees should be able to2. Understand the differences between whole‐body PET and PEM3. Understand the differences between mammography and PEM4. List possible clinical applications/indications for PEM5. Describe clinical operation and requirements of PEM scanning

Cancer screening test

SCreening lest is Iimited to asymptomatic individuals and its purpose is to decrease mortality. Beyond the technical issues involved in study design, other requirements addressing implementation，analysis，and interpretation including biases, must be met to demonstrate that a screening test is useful. A positive screening test may lead to early intervention that could allow "cure'' of the disease but not be efficacious for a person's general health. There are effective screening modalities for breast cancer ‘colorectal cancers , and cervical cancers，whereas no compelling evidence exists for the value to screening for lung cancer. Over the past few years ‘there have been rapid developments applying new imaging and molecular diagnostic modalities for the purpose of cancer screenings. Appropriate methods for incorporating these new techniques into screening trials must be considered.

Routine Breast MRI as a Screening Modality for Occult Contralateral Breast Cancer: Where Do We Draw the Line?

The Breast JournalVolume 16, Issue 2 p. 115-117 Routine Breast MRI as a Screening Modality for Occult Contralateral Breast Cancer: Where Do We Draw the Line? Christine Dauphine MD, Christine Dauphine MD Departments of SurgerySearch for more papers by this authorIraj Khalkhali MD, Iraj Khalkhali MD Radiology, Harbor-UCLA Medical Center, 21840 S. Normandie Ave. Ste. 500, Torrance, CA 90502, USAe-mail: [email protected]Search for more papers by this author Christine Dauphine MD, Christine Dauphine MD Departments of SurgerySearch for more papers by this authorIraj Khalkhali MD, Iraj Khalkhali MD Radiology, Harbor-UCLA Medical Center, 21840 S. Normandie Ave. Ste. 500, Torrance, CA 90502, USAe-mail: [email protected]Search for more papers by this author First published: 12 March 2010 https://doi.org/10.1111/j.1524-4741.2009.00888.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume16, Issue2March/April 2010Pages 115-117 RelatedInformation

Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population. The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals. The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation) The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement) The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation) The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement).

Longitudinal analysis of domain-level breast cancer literacy among African-American women

Functional breast cancer literacy was assessed among African-American women and measured at the domain level over time. We used the Kin Keeper(SM) Cancer Prevention Intervention to educate 161 African-American women on three domains of breast cancer literacy: (i) cancer awareness, (ii) knowledge of breast cancer screening modalities and (iii) cancer prevention and control. A breast cancer literacy assessment was administered pre- and post-educational intervention at two time points followed by another assessment 12 months after the second intervention. Generalized estimating equations were specified to predict the probability of correctly answering questions in each domain over time. Domain-level literacy differentials exist; at baseline, women had higher test scores in the breast cancer prevention and control domain than the cancer awareness domain (odds ratio = 1.67, 95% confidence interval 1.19-2.34). After Kin Keeper(SM) Cancer Prevention Intervention, African-American women consistently improved their breast cancer literacy in all domains over the five time stages (P < 0.001) though at different rates for each domain. Differences in domain-level breast cancer literacy highlight the importance of assessing literacy at the domain level. Interventions to improve African-American women's breast cancer literacy should focus on knowledge of breast cancer screening modalities and cancer awareness domains.