Breast Screening Modalities Research Articles

Imaging Preferences in Women With a History of Breast Cancer Receiving Contrast-Enhanced Mammography.

There is interest in contrast-enhanced mammography (CEM) to screen breast cancer survivors, yet it is unclear whether they would accept CEM as their annual exam. The purpose of this study was to understand patient preferences to guide CEM implementation for screening. Consecutive women with breast cancer history who had CEM as their annual mammogram from July 2020 to August 2021 at a single academic institution completed an 18-question survey regarding prior contrast imaging, CEM experience, and comparison to other breast imaging exams. Response proportions were calculated, and chi-square or Fisher's exact test were used to evaluate associations of demographics with responses. A total of 78% (104/133) of women undergoing CEM provided results. Most were satisfied with CEM (99%, 103/104), had nothing to complain about (87%, 90/104), did not find CEM anxiety provoking (69%, 72/104), felt comfortable having contrast for annual imaging (94%, 98/104), were willing to accept the small risk of a contrast reaction if CEM would find their cancer (93%, 97/104), and would like to have CEM for their exam next year (95%, 99/104). Compared with mammography, 23% (24/104) reported CEM was a better experience, and 63% (66/104) reported CEM was about the same. Of those who had prior MRI, the majority reported CEM was better (53%, 29/55) and would prefer CEM if both MRI and CEM had an equal chance of detecting cancer (73%, 41/56). Most preferences did not differ significantly according to demographics. Most women surveyed considered CEM to be satisfactory and preferred compared to other breast screening modalities.

MLO Mammogram Pectoral Masking with Ensemble of MSER and Slope Edge Detection and Extensive Pre-Processing

Breast Cancer is a fatal disease. Several people are losing their lives as a result of Breast Cancer. Mammography is the most often used Breast screening modality where we can see both mass and microcalcifications and both are the two major indicators of Breast Cancer. We can see Pectoral muscle also on MLO Mammograms. Digital Image Processing based computer aided diagnosis systems are being used widely to help the radiologist in detecting mass and microcalcifications in MLO Mammograms. However, because the intensity levels of the Pectoral muscle are similar to masses, in computer aided diagnosis system, Pectoral presence in the Mammogram has a detrimental effect on identifying mass. Therefore, in computer aided diagnosis system, Pectoral muscle masking substantially enhances lesion detection. This study suggests a novel ensemble computer aided diagnosis system strategy that combines the MSER based and SlopeEdgeDetection methods with extensive pre-processing to identify and cover Pectoral muscle from MLO Mammograms. The results demonstrate that the new procedure is straightforward and improves the precision of Pectoral region covering. Compared to the average accuracy of the state-of-the-art solutions which is 94%, the suggested technique achieves an accuracy of 99%. Performance analysis makes use of the Mini-MIAS database.

Factors associated with the uptake of clinical breast examination among women of reproductive age in Lesotho: analysis of a national survey

BackgroundIn low-resource settings with weak health systems, the WHO recommends clinical breast examination (CBE) as the most cost-effective breast screening modality for women. Evidence shows that biennial CBE leads to significant downstaging of breast cancer in all women. Breast cancer is the second most common cancer among women in Lesotho with a weaker healthcare system and a low breast cancer screening rate. This study investigated the prevalence and factors associated with the uptake of CBE among women of reproductive age in Lesotho.MethodsThis study used cross-sectional data from the 2014 Lesotho Demographic and Health Survey. A sample of 6584 reproductive-age women was included in this study. We conducted both descriptive and multivariable logistic regression analyses. The study results were presented in frequencies, percentages, and adjusted odds ratios (aOR) with their corresponding confidence intervals (CIs).ResultsThe prevalence of CBE uptake was 9.73% (95% CI: 8.91, 10.61). Women who were covered by health insurance (aOR = 2.31, 95% CI [1.37, 3.88]), those who were pregnant (aOR = 2.34, 95% CI [1.64, 3.35]), those who had one to three children (aOR = 1.81, 95% CI [1.29,2.52]), and women who frequently read newspapers or magazines (aOR = 1.33, 95% CI [1.02,1.72]) were more likely to undergo CBE than their counterparts. Women who were aware of breast cancer (aOR = 2.54, 95% CI [1.63,3.97]), those who have ever had breast self-examination (BSE) within the last 12 months prior to the study (aOR = 5.30, 95% CI [4.35,6.46]), and those who visited the health facility in the last 12 months prior to the study (aOR = 1.57, 95% CI [1.27,1.95]) were also more likely to undergo CBE than their counterparts. Women residing in the Qacha’s-nek region (aOR = 0.42, 95% CI [0.26,0.67]) were less likely to undergo CBE than those in the Botha-bothe region.ConclusionThe study found a low prevalence of CBE uptake among reproductive-age women in Lesotho. Factors associated with CBE uptake include health insurance coverage, being pregnant, those who had one to three children, exposure to media, breast cancer awareness, ever had BSE, and those who visited a health facility. To increase CBE uptake, these factors should be considered when designing cancer screening interventions and policies in order to help reduce the burden of breast cancer in Lesotho.

Critical Assessment of Mammography Accuracy

Mammography is currently considered the gold standard for breast screening, despite painful breast compression, invasive radiation exposure and excessive infrastructure and personnel requirements, contributing to its inequity. Furthermore, sensitivity and specificity of mammog-raphy are often overstated by studies utilising flawed methodology. This paper critically reviews the literature reporting on methods used to calculate diagnostic accuracy of mammography. Values for sensitivity, specificity and receiver operator characteristic (ROC) curve area (AUC) are presented by averaging results from studies inclusive of a comparison to another breast screening modality. The result is mammography sensitivity of 60%, specificity of 80%, AUC of 0.73. These values should be used when assessing diagnostic performance of other breast screening technologies.

135 (PB-048) Poster - Finding patient-reported deterrents to adjunct Breast Cancer screening among patients with dense breast tissues. A cross sectional study in Pakistan

Background: Women with dense breast tissues are at a greater risk of developing cancer because of reduced sensitivity of mammography. In order to address this issue, there’s need to incorporate adjunct screening modalities for this particular population. We aim to identify patient’s characteristics such as age, socioeconomic status, personal risk of breast cancer etc associated with patient cited concerns about adjunct breast screening modalities.

Preferences and Attitudes Regarding Adjunct Breast Cancer Screening Among Patients with Dense Breasts.

New breast screening modalities are being investigated to address the need for more sensitive breast cancer screening in women with dense breasts. We investigated the preferences and attitudes of these patients regarding adjunct screening modalities to help evaluate the acceptability of these exams. In this institutional review board-approved prospective study, patients with dense breasts on their prior mammogram were invited to complete a survey. Patients were asked to estimate their personal breast cancer risk compared with peers, indicate their level of concern related to screening callbacks, radiation exposure, and intravenous (IV) contrast allergies, and identify which factors might deter them from getting adjunct screening exams. Five hundred eight patients with dense breasts presenting for screening mammography completed surveys. While most patients (304/508, 59.9%) felt it was likely or very likely that cancer could be missed on their mammogram, only 8.9% (45/508) had undergone adjunct screening exams in the past 3 years. The most commonly cited deterrents to adjunct screening were cost (340/508, 66.9%), pain (173/508, 34.1%), and concern that adjunct screening could lead to additional procedures (158/508, 31.1%). When asked to select among three hypothetical breast cancer screening modalities, patients strongly preferred the more sensitive examination, even if this involved greater cost (162/508, 31.9%) or IV-contrast administration (315/508, 62.0%). Our data suggest that patients with dense breasts prefer adjunct screening exams that are both sensitive and inexpensive, although an increase in sensitivity could outweigh additional cost or even IV-line placement.

Let's Get Real about Molecular Breast Imaging and Radiation Risk.

Let's Get Real about Molecular Breast Imaging and Radiation Risk.

NF1 Patients Receiving Breast Cancer Screening: Insights from The Ontario High Risk Breast Screening Program.

Neurofibromatosis Type I (NF1) is caused by variants in neurofibromin (NF1). NF1 predisposes to a variety of benign and malignant tumor types, including breast cancer. Women with NF1 <50 years of age possess an up to five-fold increased risk of developing breast cancer compared with the general population. Impaired emotional functioning is reported as a comorbidity that may influence the participation of NF1 patients in regular clinical surveillance despite their increased risk of breast and other cancers. Despite emphasis on breast cancer surveillance in women with NF1, the uptake and feasibility of high-risk screening programs in this population remains unclear. A retrospective chart review between 2014–2018 of female NF1 patients seen at the Elizabeth Raab Neurofibromatosis Clinic (ERNC) in Ontario was conducted to examine the uptake of high-risk breast cancer screening, radiologic findings, and breast cancer characteristics. 61 women with pathogenic variants in NF1 enrolled in the high-risk Ontario breast screening program (HR-OBSP); 95% completed at least one high-risk breast screening modality, and four were diagnosed with invasive breast cancer. Our findings support the integration of a formal breast screening programs in clinical management of NF1 patients.

Knowledge and Attitude to Breast Cancer Screening and Risk Factors Among Women in Southwest Nigeria

Background: Breast cancer is the commonest cancer among women in Nigeria. There are several reasons why over 60% of breast cancer patients present with advanced disease. Some of which are lack of awareness and poor uptake of cancer screening methods. Aim: This study aims to assess the knowledge of breast cancer risk factors and practice of screening modalities among a cross-section of women in 5 different local government areas in Lagos. Methods: This is a descriptive and cross-sectional study conducted among women during a breast cancer awareness and screening program in 5 local government areas of Lagos. A self-administered questionnaire was administered to assess the knowledge of breast cancer risk factors and practice of screening methods. Results were analyzed with SPSS version 21. Results: A total of 1113 respondents were surveyed across various communities. Distributions among semi-urban communities include: 29.7% from Mushin, 22.4% from Somolu, 18.2% from Ikeja, 15.8% from Kosofe and 13.8% from Idi-Araba. Mean age ± SD of respondents was 43.6 ± 12.6 years. Even though 78.5% have heard about breast cancer and screening only 29.3% had been screened. Breast screening modalities used were clinical breast examination (19.9%), mammogram (5.8%) and breast ultrasound (3.6%). Conclusion: This study shows that there is a low uptake of breast cancer screening practices and the high knowledge of screening methods did not translate to higher screening practices among the studied population. There is a need to create more awareness on the risk factors identification and emphasize the importance of regular screening for breast cancer as essentials for early diagnosis and survival.

Review of breast screening: Toward clinical realization of microwave imaging.

Microwave imaging (MI) technology has come a long way to introduce a noninvasive, inexpensive, fast, convenient, and safe screening tool for clinical breast monitoring. However, there is a niche between the existing understanding of MI by engineers versus clinicians. Our manuscript targets that niche and highlights the state of the art in MI technology compared to the existing breast cancer detection modalities (mammography, ultrasound, molecular imaging, and magnetic resonance). The significance of our review article is in consolidation of up-to-date breast clinician views with the practical needs and engineering challenges of a novel breast screening modality. We summarize breast tissue abnormalities and highlight the benefits as well as potential drawbacks of the MI as a cancer detection methodology. Our goal is to present an article that MI researchers as well as practitioners in the field can use to assess the viability of the MI technology as a competing or complementary modality to the existing means of breast cancer screening.

Screening Breast Ultrasound: Where Are We Today?

In this article, we will review the current recommendations for screening breast ultrasound along with its role as an adjunct to mammography and as a primary screening tool. We will discuss the most recent literature pertaining to breast ultrasound screening in high-risk, intermediate-risk, and average-risk women and compare it with other breast screening modalities including breast MRI, tomosynthesis or 3D mammography, and automated breast ultrasound. The current obstacles to screening breast ultrasound’s more widespread implementation will also be covered in our discussion. These will include ultrasound’s high false positive rate when compared to mammography, overdiagnosis, and cost-effectiveness. Our target audience encompasses breast surgeons, oncologists, and breast radiologists with an interest in screening breast ultrasound.

Potentialities of steady-state and transient thermography in breast tumour depth detection: A numerical study

Breast thermography still has inherent limitations that prevent it from being fully accepted as a breast screening modality in medicine. The main challenges of breast thermography are to reduce false positive results and to increase the sensitivity of a thermogram. Further, it is still difficult to obtain information about tumour parameters such as metabolic heat, tumour depth and diameter from a thermogram. However, infrared technology and image processing have advanced significantly and recent clinical studies have shown increased sensitivity of thermography in cancer diagnosis. The aim of this paper is to study numerically the possibilities of extracting information about the tumour depth from steady state thermography and transient thermography after cold stress with no need to use any specific inversion technique. Both methods are based on the numerical solution of Pennes bioheat equation for a simple three-dimensional breast model. The effectiveness of two approaches used for depth detection from steady state thermography is assessed. The effect of breast density on the steady state thermal contrast has also been studied. The use of a cold stress test and the recording of transient contrasts during rewarming were found to be potentially suitable for tumour depth detection during the rewarming process. Sensitivity to parameters such as cold stress temperature and cooling time is investigated using the numerical model and simulation results reveal two prominent depth-related characteristic times which do not strongly depend on the temperature of the cold stress or on the cooling period.

CONTRAST ENHANCED BEAMFORMING FOR BREAST CANCER DETECTION

The early identiflcation of malignant tissue is one of the most signiflcant factors in the successful treatment of breast cancer. Microwave imaging is an emerging breast screening modality based on the dielectric contrast between normal and cancerous tissues at microwave frequencies. When the breast is illuminated with an Ultrawideband (UWB) microwave pulse, the dielectric contrast between normal and cancerous tissues generates electromagnetic re∞ections. These re∞ected signals, containing tumor backscatter, are spatially focused using a beamformer which can compensate for attenuation and phase efiects as the signal propagates through the breast. However, recent studies have shown the breast to be a dielectrically heterogeneous entity. High levels of heterogeneity reduce the dielectric contrast between normal and cancerous tissue, limiting the efiectiveness of beamforming algorithms. One possible method to assist in the diagnoses of cancer in a heterogeneously dense breast is the use of contrast agents. Contrast agents modify the dielectric properties of a malignant tumor site in order to increase the dielectric contrast with flbroglandular tissue. In this paper, a number of beamforming algorithms are applied to MRI-derived models with endogenous and contrast enhanced malignant tissue properties. Two contrast agents are applied to heterogeneously dense breast phantoms and simulations are carried out prior and post contrast agent delivery. A range of tumor diameters are simulated and a number of beamforming algorithms are applied to the simulated data. The resulting difierential scans are then compared across a range of appropriate metrics.

X-ray tomosynthesis: a review of its use for breast and chest imaging

Tomosynthesis is a three-dimensional imaging technique based on the reconstruction of several planar radiographs. During the image acquisition in tomosynthesis, the X-ray tube moves around the detector which is often stationary, and a number of projection images are taken from different angles. Individual slices from the reconstructed volume can be studied. With the effective reduction of the visibility of the overlapping normal tissue, the detection of pathological lesions is improved when compared with projection radiography. Up to now, tomosynthesis has mainly been used for breast and chest examinations and, to some extent, also for orthopaedic, angiographic and dental investigations. For chest, tomosynthesis is used as an alternative to computed tomography with significantly lower cost and radiation dose to the patient. Breast tomosynthesis has, in several studies, proved to be an effective tool for improving detection of breast lesions. As tomosynthesis has many properties that make it suitable as a modality for screening, including good diagnostic performance, short examination time and low radiation dose, it is a strong competitor to the current gold standard breast screening modality, i.e. mammography. In this paper, the principles of tomosynthesis will be presented as well as a few clinical studies showing the potential role of tomosynthesis in clinical routine examinations.

Commentary - Evidence Against Breast Self Examination is not Conclusive: What Policymakers and Health Professionals Need to Know

Breast cancer is a serious health concern and a disease that is not well understood. Early detection remains the best way to prevent debilitation and death. Traditionally, mammography, clinical breast examination (CBE), and breast self examination (BSE) have been accepted as legitimate breast screening modalities. Over the past 5 years, academics, health professionals, and policymakers have seriously questioned the usefulness of BSE after influential organizations such as the Canadian Task Force on Preventive Health Care downgraded their BSE recommendation citing fair evidence of no benefit and good evidence of harm. We briefly review the three large BSE trials, highlighting methodological weaknesses limiting their ability to evaluate its effectiveness, as well as critique the 2001 Canadian Task Force on Preventive Health Care report on BSE. We argue that it is premature to conclude that BSE is ineffective. Given that most women find their own breast cancer, this article cautions policymakers and health professionals that a prudent approach to BSE promotion should be taken.

BREAST CANCER SCREENING METHODS: A REVIEW OF THE EVIDENCE

Breast cancer remains a major health problem among Canadian women. Efforts directed at primary prevention of the disease are limited. Secondary prevention through screening appears to be the most promising intervention available in controlling the disease. In recent years, there have been ongoing debates over the effectiveness of available breast screening modalities (breast self-examination [BSE], clinical breast examination [CBE], and screening mammography). In this article I provide an overview of evidence related to each of the three breast screening modalities. The evidence shows that screening mammography and proper examination of breasts can be useful in reducing breast cancer mortality.

Infiltrating breast carcinoma smaller than 0.5 centimeters

Saiz et al.1 pose an interesting question regarding the management of small invasive breast carcinomas; this is especially relevant with the more frequent detection of small tumors due to breast screening by mammography and the promise of future three-dimensional breast screening modalities.2 Saiz et al. performed careful assessment of banked pathologic materials for 117 tumors that measured ≤ 1.0 cm, 24 of which measured ≤ 0.5 cm; the workup included an attribution for the size of multiple foci through the summation of maximum dimensions of invasive tumor. The conclusion was that it might not be necessary for patients with T1a tumors to undergo axillary lymph node (LN) dissection because there were no observed LN metastases for this group of patients. Women's College Hospital of the University of Toronto has used mammography routinely for more than 30 years. In a full cohort of primary invasive breast carcinoma patients accrued between 1971–1990 and followed until 1996,3 we attributed tumor sizes by the standard maximum dimension (for the largest focus, when the disease was multifocal), the sum of the greatest dimensions (as in the article by Saiz et al.1), and the surface area or volume (for all foci). We reported that there were 112 patients with tumors measuring ≤ 1 cm by the standard maximum dimension and 108 patients with tumors equivalent to ≤ 1 cm tumors by summed tumor size/surface area/volume. The article by Saiz et al.1 prompted us to reexamine our data, dividing the patients into those with T1a and T1b tumors; we report the results for standard (and summed) tumor sizes. The summed size is comparable to the article by Saiz et al. and in our patients was equivalent to surface area or volume for tumors measuring ≤ 1 cm. We found that patients with T1a and T1b tumors had similar LN involvement; 5 of 16 T1a patients (31%) were LN positive compared with 17 of 47 T1b patients (36%) (P = 0.72 by the Pearson chi-square test [respectively, by summed tumor dimensions, 5 of 16 (31%), 15 of 44 (34%); P = 0.84]). In addition, we compared survival from breast carcinoma for our T1a patients who were histologically LN negative, clinically LN negative (no axillary LN dissection performed), and LN positive, using a Wilcoxon (Peto-Prentice) test statistic. None of the 11 histologically LN negative patients, 2 of 17 of the clinically LN negative patients (12%), and 1 of 5 of the LN positive patients (20%) had died from breast carcinoma at last follow-up (P = 0.28). Saiz et al. provide an interesting literature review of LN status for T1a and T1b tumors in Table 1 of their article. Only 2 of 11 articles reported no LN involvement for T1a patients; including the article by Saiz et al., this would increase to 3 of 12 articles, or 25% of the articles in the reviewed literature. From these 12 studies, 178 of 1149 T1a patients (15%) were LN positive; a simple two-sided normal test of the hypothesis that T1a patients are expected to be LN negative is strongly rejected (P < 0.001). The 31% rate of LN involvement for our T1a patients marginally exceeded the highest report of 28% by Nemoto et al.4 The overall data undermine the conclusion reached by Saiz et al. that patients with T1a tumors generally might be spared an axillary LN dissection. Previous investigations with our full cohort of 678 patients with invasive breast carcinoma indicated that women age ≥ 65 years were more likely to die from another cause of death than those women age < 65 years.5 Furthermore, not performing an axillary LN dissection in elderly patients when they were clinically LN negative after a thorough clinical examination did not appear to have a detrimental effect on breast carcinoma mortality. Only 3 of the 90 clinically LN negative patients age ≥ 65 years had tumors measuring ≤ 0.5 cm. The article by Saiz et al.1 raises the question of appropriate therapeutic modalities for small invasive breast carcinoma that we anticipate will become an increasingly important issue to address. Some elderly patients who clinically are LN negative after a thorough examination, and who possibly have other major concomitant health problems, might be candidates for close follow-up with potentially delayed axillary LN dissection; however, caution is needed in patients age < 65 years because our experience5 has shown that the majority of deaths in these women were from breast carcinoma. Judith-Anne W. Chapman Ph.D.*, Richard Gordon Ph.D. , Marilyn A. Link*, Edward B. Fish M.D.*, * Henrietta Banting Breast Centre, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada, Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada