Mammography In Women Research Articles

Time for a re-evaluation of mammography in the young? Results of an audit of mammography in women younger than 40 in a resource restricted environment

Mammography in younger women is considered to be of limited value. In a resource restricted environment without access to magnetic resonance imaging (MRI) and with a high incidence of breast cancer in the young, mammography remains an important diagnostic tool. Recent technical advances and better regulation of mammography make a reassessment of its value in these conditions necessary. Data of all the mammograms performed at a tertiary hospital and private breast clinic between January 2003 and July 2009 in women less than 40years of age were collected. Indications were the presence of a mass, follow-up after primary cancer therapy, and screening for patients perceived at high risk due to a family history or the presence of atypical hyperplasia. Data acquired were as follows: Demographics, prior breast surgery, indication for mammography, outcome of mammography, diagnostic procedures, and their results. Of 2,167 mammograms, 393 were performed for a palpable mass, diagnostic mammography. In these, the overall cancer detection rate was 40%. If the mammography was reported as breast imaging reporting and data system (BIRADS(®)) 5 versus BIRADS(®) 3 and 4 versus BIRADS(®) 1 and 2, a final diagnosis of malignancy was established in 96, 48, and 5%, respectively. Of 367 mammograms done for the follow-up after primary treatment of breast cancer, seven cancers were diagnosed for a detection rate of 1.9%. Of 1,312 mammograms performed for screening, the recall rate was 4%; the biopsy rate 2%, and the cancer diagnosis rate 3/1,000 examinations. In contrast to past series, this series has shown that recent advances in mammography have made it a useful tool in the management of breast problems in young women, notably in a resource-restricted environment. Women for screening should be selected carefully.

MO‐D‐211‐01: Low Dose Molecular Breast Imaging

Background: Several new nuclear medicine‐based breast imaging techniques have emerged over the last few years. These include Positron Emission Mammography (PEM), Breast Specific Gamma Imaging (BSGI) and Molecular Breast Imaging (MBI). These techniques usually employ doses of ∼ 10 mCi F‐18 FDG in the case of PEM, or 20–30 mCi Tc‐99m sestamibi in the cases of BSGI or MBI. In addition to their potential value as adjunct diagnostic tools, these techniques hold promise as potential adjuncts to screening mammography particularly for women with dense breast tissue where the sensitivity of mammography is known to be reduced. A previous study has shown MBI to have 2–3 times the sensitivity and equivalent specificity to screening mammography in women with dense breasts. However, the current administered doses employed in these techniques deliver effective radiation doses that are ∼10 times higher than mammography.From the BEIR VII tables, the lifetime associated risks from PEM, BSGI and MBI can be calculated and compared to that of screening mammography. These estimates indicate that in order to achieve a comparable radiation burden to mammography, the administered doses of F‐ 18 FDG and Tc‐99m sestamibi need to be reduced to less than 2 mCi F‐18 FDG and 4 mCi Tc‐99m sestamibi.This presentation will briefly review the clinical literature demonstrating the value of these new techniques in both diagnostic and screening applications, and will review the dosimetry and estimated lifetime associated risks from these technologies. It will then focus on one of these technologies — MBI, and will illustrate how we can optimize the physics of the collimation and detector to achieve a 5‐fold reduction in the required dose of Tc‐99m sestamibi for clinical studies. We will also review possible post‐acquisition processing techniques that may enable further reduction in dose, along with alternative radiopharmaceuticals that deliver low doses due to their biodistribution.A total of 4 dose reduction schemes will be discussed — a) development of optimized collimation for single‐photon imaging, b) improved utilization of the energy spectral characteristics of the gamma cameras, c) implementation of noise reduction and resolution recovery algorithms, and d) use of adaptive geometric mean algorithms for combination of images from opposing detectors. In addition we will consider alternative radiopharmaceuticals, such as Tc‐99m MDP that deliver a lower radiation burden than Tc‐99m sestamibi.We will demonstrate that image quality obtained with low‐dose MBI performed with 4 mCi Tc‐99m sestamibi matches that of standard MBI performed with 20 mCi dose. Low‐dose MBI presents radiation risks to the patient comparable to that of digital screening mammography, allowing its safe implementation as a screening technique.

Prevalencia de patología maligna de seno en mujeres mayores de 14 años Servicio de cirugía general, Hospital de San José, Bogotá D.C., 2009

Estudio descriptivo de corte transversal para determinar la prevalencia de patología maligna en mujeres mayores de 14 años que consultaron por masa sólida palpable en mama al servicio de cirugía general del Hospital de San José, de Bogotá D.C. durante el período marzo 2009 a febrero de 2010. Esta prevalencia fue de 18,1%. El promedio de edad fue 60.1 años, el de la menopausia 50 años, la edad del primer parto 25.8 años y el promedio de hijos 1.7. El tiempo de lactancia materna fue 103 meses, no había antecedentes personales de cáncer de mama y sólo 13,3% presentaron antecedente familiar de esta malignidad. El 78,3% (65) de las masas sólidas palpables fueron detectadas por autoexamen de seno. El tiempo de aparición fue en promedio de 14.1 meses (DE: 17 meses) y como manifestación clínica asociada se reportó dolor en la mayoría. La clasificación de BIRADS predominante para ecografía y mamografía en mujeres con patología maligna fue el tipo 4. Entre los diagnósticos por biopsia predominó el carcinoma ductal infiltrante (80%) y en patología benigna el fibroadenoma (56%). El tratamiento más frecuente fue quirúrgico.

Early detection of breast cancer the second time around: mammography in women with a personal history of breast cancer

Australian and US collaborators provide evidence on outcomes of mammographic screening in previously affected women.

Accuracy and Outcomes of Screening Mammography in Women With a Personal History of Early-Stage Breast Cancer

Women with a personal history of breast cancer (PHBC) are at risk of developing another breast cancer and are recommended for screening mammography. Few high-quality data exist on screening performance in PHBC women. To examine the accuracy and outcomes of mammography screening in PHBC women relative to screening of similar women without PHBC. Cohort of PHBC women, mammogram matched to non-PHBC women, screened through facilities (1996-2007) affiliated with the Breast Cancer Surveillance Consortium. There were 58,870 screening mammograms in 19,078 women with a history of early-stage (in situ or stage I-II invasive) breast cancer and 58,870 matched (breast density, age group, mammography year, and registry) screening mammograms in 55,315 non-PHBC women. Mammography accuracy based on final assessment, cancer detection rate, interval cancer rate, and stage at diagnosis. Within 1 year after screening, 655 cancers were observed in PHBC women (499 invasive, 156 in situ) and 342 cancers (285 invasive, 57 in situ) in non-PHBC women. Screening accuracy and outcomes in PHBC relative to non-PHBC women were cancer rates of 10.5 per 1000 screens (95% CI, 9.7-11.3) vs 5.8 per 1000 screens (95% CI, 5.2-6.4), cancer detection rate of 6.8 per 1000 screens (95% CI, 6.2-7.5) vs 4.4 per 1000 screens (95% CI, 3.9-5.0), interval cancer rate of 3.6 per 1000 screens (95% CI, 3.2-4.1) vs 1.4 per 1000 screens (95% CI, 1.1-1.7), sensitivity 65.4% (95% CI, 61.5%-69.0%) vs 76.5% (95% CI, 71.7%-80.7%), specificity 98.3% (95% CI, 98.2%-98.4%) vs 99.0% (95% CI, 98.9%-99.1%), abnormal mammogram results in 2.3% (95% CI, 2.2%-2.5%) vs 1.4% (95% CI, 1.3%-1.5%) (all comparisons P < .001). Screening sensitivity in PHBC women was higher for detection of in situ cancer (78.7%; 95% CI, 71.4%-84.5%) than invasive cancer (61.1%; 95% CI, 56.6%-65.4%), P < .001; lower in the initial 5 years (60.2%; 95% CI, 54.7%-65.5%) than after 5 years from first cancer (70.8%; 95% CI, 65.4%-75.6%), P = .006; and was similar for detection of ipsilateral cancer (66.3%; 95% CI, 60.3%-71.8%) and contralateral cancer (66.1%; 95% CI, 60.9%-70.9%), P = .96. Screen-detected and interval cancers in women with and without PHBC were predominantly early stage. Mammography screening in PHBC women detects early-stage second breast cancers but has lower sensitivity and higher interval cancer rate, despite more evaluation and higher underlying cancer rate, relative to that in non-PHBC women.

United States Preventive Services Task Force Screening Mammography Recommendations: Science Ignored

The purpose of this article is to examine the scientific evidence considered by the United States Preventive Services Task Force (USPSTF) in recommending against screening mammography in women 40-49 years old and against annual screening mammography in women 50 and older. We use evidence made available to the USPSTF to estimate the benefits and "harms" of screening mammography in women 40 years old and older. We use Cancer Intervention and Surveillance Modeling Network modeling to compare lives saved by different screening scenarios and the summary of evidence prepared for the USPSTF to estimate the frequency of harms of screening mammography by age. Averaged over the six Cancer Intervention and Surveillance Modeling Network models of benefit, screening mammography shows greatest benefit--a 39.6% mortality reduction--from annual screening of women 40-84 years old. This screening regimen saves 71% more lives than the USPSTF-recommended regimen of biennial screening of women 50-74 years old, which had a 23.2% mortality reduction. For U.S. women currently 30-39 years old, annual screening mammography from ages 40-84 years would save 99,829 more lives than USPSTF recommendations if all women comply, and 64,889 more lives with the current 65% compliance rate. The potential harms of a screening examination in women 40-49 years old, on average, consist of the risk of a recall for diagnostic workup every 12 years, a negative biopsy every 149 years, a missed breast cancer every 1,000 years, and a fatal radiation-induced breast cancer every 76,000-97,000 years. Evidence made available to the USPSTF strongly supports the mortality benefit of annual screening mammography beginning at age 40 years, whereas potential harms of screening with this regimen are minor.

Women with chance of familial cancer likely to benefit from screening.

Annual mammography in women with a medium familial risk of breast cancer is likely to prevent deaths from the disease.

Accuracy and Outcomes of Screening Mammography in Women With a Personal History of Early-Stage Breast Cancer

Accuracy and Outcomes of Screening Mammography in Women With a Personal History of Early-Stage Breast Cancer

Abstract S4-7: Compliance with Mammographic Screening Guidelines from an Administrative Claims Database

Abstract BACKGROUND: Guidelines for breast cancer screening using mammography vary in terms of monitoring frequency and age at which screening should be performed. In November 2009, the US Preventive Services Task Force (USPSTF) modified their recommendations for women at average risk for breast cancer, now supporting first mammographic screening at age 50, with repeat mammograms every two years. The American Cancer Society and the Mayo Clinic continue to support yearly mammograms beginning at age 40. In two separate surveys performed after the USPSTF recommendations became public, 71% and 84% of women indicated an intention to undergo or continue mammographic testing during their 40's (Annals of Internal Medicine 2010; 152:531-532; USA Today 11/24/2009), but few studies have looked at actual screening frequency among women of different age groups. This study was performed to determine current pattern of testing as derived from an administrative medical claims database. METHOD: De-identified medical claims were reviewed from a 12-million member medical claims database at Medco Health Solutions, Inc. Claims for mammography for women 40 years of age and older eligible from January 2006 through December 2009 were reviewed. All women through age 64 had employer or health-plan based insurance coverage. Those 65 and older were covered through either an employer based retiree plan, or Medicare. Testing within each calendar year is reported. Annual testing was determined for women continuously eligible over the 4-year period. RESULTS: Among women 40-85 years old in any given year, 41-50% had a medical claim for a mammogram. Over the 4-year study (2006-2009), mean annual mammography rates were 41% (40-49 years old), 50.0% (50-64 years old), and 44% (65-85 years old). The percentage of women who were continuously eligible over the 4-year study period with any mammogram and with 1, 2, 3, or 4 or more mammograms over the 4-year study period are shown in the table below. CONCLUSIONS: Although surveys indicate that over 70% of women support mammographic screening between ages 40-49, these data suggest that even among an insured population, many women do not have claims evidence of even one mammogram in 4 years and almost half of women do not receive biannual or more frequent mammography. These data also indicate that additional efforts are needed to reach the HealthyPeople 2010 goal of at least 70% of women aged 40 years or older having a mammogram in the past two years. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr S4-7.

Perspective on prostate cancer screening

Cancer screening has become an obligatory appendix to all periodic and continuity care of adults. It is ritualistic and seldom questioned. It is discrete and modular and so easily audited for 'quality'. Its impact on actual health ranges from slightly helpful to slightly harmful, and even these conclusions are usually more than slightly speculative. While, in some cases, the existing data includes the probability of an occasional life saved, all screening programmes increase many-fold the lifetime chance of confronting a false alarm and thus becoming, for a time, a cancer patient.

An assessment of American Indian women's mammography experiences.

BackgroundMortality from breast cancer has increased among American Indian/Alaskan Native (AI/AN) women. Despite this alarming reality, AI/AN women have some of the lowest breast cancer screening rates. Only 37% of eligible AI/AN women report a mammogram within the last year and 52% report a mammogram within the last two years compared to 57% and 72% for White women. The experiences and satisfaction surrounding mammography for AI/AN women likely are different from that of women of other racial/ethnic groups, due to cultural differences and limited access to Indian Health Service sponsored mammography units. The overall goals of this study are to identify and understand the mammography experiences and experiential elements that relate to satisfaction or dissatisfaction with mammography services in an AI/AN population and to develop a culturally-tailored AI/AN mammography satisfaction survey.Methods and DesignThe three project aims that will be used to guide this work are: 1) To compare the mammography experiences and satisfaction with mammography services of Native American/Alaska Native women with that of Non-Hispanic White, Hispanic, and Black women, 2) To develop and validate the psychometric properties of an American Indian Mammography Survey, and 3) To assess variation among AI/AN women's assessments of their mammography experiences and mammography service satisfaction. Evaluations of racial/ethnic differences in mammography patient satisfaction have received little study, particularly among AI/AN women. As such, qualitative study is uniquely suited for an initial examination of their experiences because it will allow for a rich and in-depth identification and exploration of satisfaction elements.DiscussionThis formative research is an essential step in the development of a validated and culturally tailored AI/AN mammography satisfaction assessment. Results from this project will provide a springboard from which a maximally effective breast cancer screening program to benefit AI/AN population will be developed and tested in an effort to alter the current breast cancer-related morbidity and mortality trajectory among AI/AN women.

Mammographic surveillance in women younger than 50 years who have a family history of breast cancer: tumour characteristics and projected effect on mortality in the prospective, single-arm, FH01 study

Evidence supports a reduction in mortality from breast cancer with mammographic screening in the general population of women aged 40-49 years, but the effect of family history is not clear. We aimed to establish whether screening affects the disease stage and projected mortality of women younger than 50 years who have a clinically significant family history of breast cancer. In the single-arm FH01 study, women at intermediate familial risk who were younger than 50 years were enrolled from 76 centres in the UK, and received yearly mammography. Women with BRCA mutations were not explicitly excluded, but would be rare in this group. To compare the FH01 cohort with women not receiving screening, two external comparison groups were used: the control group of the UK Age Trial (106,971 women aged 40-42 years at recruitment, from the general population [ie, average risk], followed up for 10 years), and a Dutch study of women with a family history of breast cancer (cancer cases aged 25-77 years, diagnosed 1980-2004). Study endpoints were size, node status, and histological grade of invasive tumours, and estimated mortality calculated from the Nottingham prognostic index (NPI) score, and adjusted for differences in underlying risk between the FH01 cohort and the control group of the UK Age Trial. This study is registered with the National Research Register, number N0484114809. 6710 women were enrolled between Jan 16, 2003, and Feb 28, 2007, and received yearly mammography for a mean of 4 years (SD 2) up until Nov 30, 2009; surveillance and reporting of cancers is still underway. 136 women were diagnosed with breast cancer: 105 (77%) at screening, 28 (21%) symptomatically in the interval between screening events, and three (2%) symptomatically after failing to attend their latest mammogram. Invasive tumours in the FH01 study were significantly smaller (p=0·0094), less likely to be node positive (p=0·0083), and of more favourable grade (p=0·0072) than were those in the control group of the UK Age Trial, and were significantly less likely to be node positive than were tumours in the Dutch study (p=0·012). Mean NPI score was significantly lower in the FH01 cohort than in the control group of the UK Age Trial (p=0·00079) or the Dutch study (p<0·0001). After adjustment for underlying risk, predicted 10-year mortality was significantly lower in the FH01 cohort (1·10%) than in the control group of the UK Age Trial (1·38%), with relative risk of 0·80 (95% CI 0·66-0·96; p=0·022). Yearly mammography in women with a medium familial risk of breast cancer is likely to be effective in prevention of deaths from breast cancer.

Abstract B103: Time for a change in breast cancer screening? A survey of female physicians’ perception of 2009 USPSTF guidelines on breast cancer screening

Abstract Objective: To explore the attitudes and compliance of female physicians to the 2009 USPSTF guidelines and its influencing factors. Methods: An anonymous cross-sectional survey was conducted on the SurveyMonkey website with a self-designed questionnaire. Email invitations were sent to the presidents of various organizations including American Medical Association (AMA) to explain the purpose of this survey and to recruit participates. Of the 111 female physicians participated in the survey, 109 completed the questionnaire, resulting in an effective response rate of 98.2%. Results: Mammography (71.7%) and clinical breast examination (67.3%) are the most preferred screening tests of female physicians for women aged 40 to 49 years. Consistent with the results, mammography was considered as “very effective” in reducing breast cancer mortality in women aged 40 to 49 years by 66.7% of respondents, compared with breast self examination (23.4%) and clinical breast examination (24.8%) (P &amp;lt; 0.0001). Logistic regression analysis results showed that the following items “Recommend not to begin routine screening mammography in women aged 40 to 49 years”, “Recommend biennial screening mammography in women aged 50 to 74 years”, and the female physicians’ age would significantly influence the female physicians’ decision on whether or not to follow the 2009 USPSTF guidelines. Conclusion: Our survey reveals that most female physician's unwillingness to follow the 2009 USPSTF guidelines is primarily associated with their opposition to the 2009 USPSTF guidelines not to begin routine screening mammography in women aged 40 to 49 years and to start biennial screening mammography in women aged 50 to 74 years. The concerns about the false positive rate and the cost-effectiveness of breast cancer screening, particularly the routine screening mammography for women aged 40 to 49 years, did not significantly influence the female physicians to follow the 2009 USPSTF guidelines. Based on these findings, we propose the following: 1. Inform women about the harms and benefits of mammography as a component of informed decision making and continue annual screening mammography starting at age 40; 2. Educate the public about breast cancer and the importance of early screening remains a high priority. Personalized risk assessment and screening tailored to risks are our future goals. Although there remains some debate about the optimal age at which to begin screening and the optimal frequency of screening, as more robust evidence and improved technical advances are more readily available, the USPSTF guidelines will be updated. The art and science of medicine continue to be intertwined as physicians attempt to balance their current knowledge with the needs and concerns of their individual patients. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B103.

Integrating Tools for Breast Cancer Risk Assessment, Risk Reduction, and Early Detection

Commentary on Graubard et al., [p. 2430][1] In 2010, it is projected that there will be 207,090 diagnoses and 39,840 deaths from breast cancer among women in the United States. Approximately 10,300 will be diagnosed before the age of 40 ([1][2]), the age when the American Cancer Society ([2][3])

Abstract B21: Patient health literacy may affect use of screening mammography in an underinsured patient population

Abstract Purpose of Study: Physician-patient communication is critical to patient decisions. In underinsured and racial/ethnic minority patients, the disparity in comprehension may be greater than among insured or non-Hispanic white populations. Previous studies have demonstrated that mammography is underutilized by disadvantaged populations. Previous studies have also demonstrated that minority patients are dissatisfied with the amount of information they receive from physicians. One potential explanation for both the seeming non-compliance by patients and the dissatisfaction experienced by patients may be lack of awareness by the physicians of limited health literacy. The current study examined the feasibility of assessing health literacy in a busy surgical practice in a teaching institution and evaluated the influence of patient health literacy on their use of screening mammography. Experimental Procedures: Maricopa Medical Center, the county safety net hospital in Phoenix, Arizona, serves a patient base which is 34.5% non-English speaking. All patients who were seen at least once at the Maricopa Medical Center Breast Clinic from January 14, 2010 to June 17, 2010 were included. Using the Newest Vital Sign (NVS) instrument to assess health literacy, participants were classified into 3 groups: 1) high likelihood of limited health literacy (NVS score 0 or 1); 2) Possible limited health literacy (NVS score 2 or 3); and 3) adequate health literacy (NVS score 4-6). Data Summary: After exclusions, 504 of 505 patients underwent health literacy assessment as part of the routine history and physical examination during their clinic visit. The majority of the participants were classified as having a high likelihood of limited health literacy (59.9%), while 21.8% and 18.3% were classified as having possible limited health literacy and adequate health literacy, respectively. The vast majority of respondents (97.6%) were underinsured or uninsured. Compared to women with adequate health literacy, those with limited literacy were more likely to be Hispanic (p&amp;lt;0.001) and of lower educational level (p&amp;lt;0.0o1). Although nearly half (49%) of the patients had less than a high school education, limited health literacy was not explained solely by education level. Fifty six percent (56%) of limited health literacy patients had graduated from high school and 30% of these had at least some college education. Among patients who were 40 years or older, only 47% had undergone screening mammography and among those 50 years of age and older, 54% had participated in screening mammography. Among women 40 years of and older, mammography screening was significantly associated with higher level of health literacy; 42%, 39%, and 70% had undergone screening mammography among those with limited health literacy, possible health literacy, and high health literacy, respectively (p&amp;lt;0.0001). The prevalence of screening mammography for women 50 years of age and older also increased with level of health literacy; however, the results were not statistically significant (p=0.15). Conclusions: Assessment of health literacy is feasible in a busy surgical practice at a teaching hospital. Although overall use of screening mammography was suboptimal in this underinsured population, health literacy assessment can help identify patients at increased risk for underutilization of this important screening tool. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B21.

Screening for tumours in paraneoplastic syndromes: report of an EFNS Task Force

paraneoplastic neurological syndromes (PNS) almost invariably predate detection of the malignancy. Screening for tumours is important in PNS as the tumour directly affects prognosis and treatment and should be performed as soon as possible. an overview of the screening of tumours related to classical PNS is given. Small cell lung cancer, thymoma, breast cancer, ovarian carcinoma and teratoma and testicular tumours are described in relation to paraneoplastic limbic encephalitis, subacute sensory neuronopathy, subacute autonomic neuropathy, paraneoplastic cerebellar degeneration, paraneoplastic opsoclonus-myoclonus, Lambert-Eaton myasthenic syndrome (LEMS), myasthenia gravis and paraneoplastic peripheral nerve hyperexcitability. many studies with class IV evidence were available; one study reached level III evidence. No evidence-based recommendations grade A-C were possible, but good practice points were agreed by consensus. the nature of antibody, and to a lesser extent the clinical syndrome, determines the risk and type of an underlying malignancy. For screening of the thoracic region, a CT-thorax is recommended, which if negative is followed by fluorodeoxyglucose-positron emission tomography (FDG-PET). Breast cancer is screened for by mammography, followed by MRI. For the pelvic region, ultrasound (US) is the investigation of first choice followed by CT. Dermatomyositis patients should have CT-thorax/abdomen, US of the pelvic region and mammography in women, US of testes in men under 50 years and colonoscopy in men and women over 50. If primary screening is negative, repeat screening after 3-6 months and screen every 6 months up till 4 years. In LEMS, screening for 2 years is sufficient. In syndromes where only a subgroup of patients have a malignancy, tumour markers have additional value to predict a probable malignancy.

Performance of Mammography in Women Aged under 40 Years

Evaluation of: Yankaskas BC, Haneuse S, Kapp JM, Kerlikowske K, Geller B, Buist DSM; For the Breast Cancer Surveillance Consortium: Performance of first mammography examination in women younger than 40 years. J. Natl Cancer Inst. 102(10), 692–700 (2010). By using pooled data from six mammography registries across the USA, 117,737 women aged 18–39 years were identified who had received their first mammography in the period 1995–2005. A distinction was made between diagnostic mammography for women who presented with a breast problem (n = 30,956), and screening mammography (n = 86,781). The age-adjusted positive predictive value of screening mammography was 1.3% (95% CI: 1.1–1.5%), as compared with 14.6% (95% CI: 13.3–15.8%) for diagnostic mammography. Considering the high recall rates, the high number of false-positive test results and the low cancer detection rate, the appropriateness of mammography for women younger than 40 without symptoms is questionable.

The accuracy of digital infrared imaging for breast cancer detection in women undergoing breast biopsy

Background Mammography has a lower sensitivity for breast cancer detection in younger women and those with dense breasts. Recent improvements in digital infrared breast imaging suggest there may be a role for this technology and we have studied its performance in 100 women prior to breast needle core biopsy (CB). Methods All patients were imaged using a digital infrared breast (DIB) scan (Sentinel BreastScan™) prior to breast biopsy. Analysis of the infrared scans was performed, blinded to biopsy results, in four different ways: Sentinel screening report, Sentinel artificial intelligence (neural network), expert manual review and NoTouch BreastScan a novel artificial intelligence programme. Results Of 106 biopsies performed in 100 women, 65 were malignant and 41 were benign. Sensitivity of Sentinel screening (53%) and Sentinel neural network (48%) was low but analysis with NoTouch software (70%) was much closer to expert manual review (78%). Sensitivity (78%) and specificity (75%) using NoTouch BreastScan were higher in women under 50 and the combination of mammography and DIB, with NoTouch interpretation, in this age group resulted in a sensitivity of 89%. Conclusion DIB using NoTouch is an effective adjunctive test for breast cancer detection in women under 70 and appears to be particularly effective in women under 50 where maximal sensitivity (78%) and specificity (75%) were observed. The combined sensitivity of NoTouch BreastScan and mammography in women under 50 was encouraging at 89%, suggesting a potential way forward for a dual imaging approach in this younger age group.

The role of preoperative mammography in women considering reduction mammoplasty: a single institution review of 207 patients

Background Standard use of preoperative mammography is controversial in patients considering reduction mammoplasty. The aim of this study was to determine the utility of mammography before breast reduction. Methods The authors conducted a single-center, retrospective chart review examining preoperative mammography in reduction mammoplasty candidates. Results Between 2001 and 2005, 207 women with recent screening mammography were evaluated for reduction mammoplasty. Thirty-two patients (16%) were found to have abnormal preoperative mammographic results, all of which were false-positives. Previously, reported risk factors including body mass index, decreasing age, previous breast procedure, and lack of comparative mammogram did not predict abnormal mammographic findings. Abnormal imaging results did not influence the decision to proceed with surgery but did have a trend toward delaying surgery. Conclusions Mammography before reduction mammoplasty can result in a high number of false-positive results, and surgeons should counsel their patients as to the possibility of subsequent studies.

Screening Mammography for Women 40–49 Years Old

Screening Mammography for Women 40–49 Years Old