Mammography Results Research Articles

Combining metabolomics and machine learning to discover biomarkers for early-stage breast cancer diagnosis.

There is an urgent need for better biomarkers for the detection of early-stage breast cancer. Utilizing untargeted metabolomics and lipidomics in conjunction with advanced data mining approaches for metabolism-centric biomarker discovery and validation may enhance the identification and validation of novel biomarkers for breast cancer screening. In this study, we employed a multimodal omics approach to identify and validate potential biomarkers capable of differentiating between patients with breast cancer and those with benign tumors. Our findings indicated that ether-linked phosphatidylcholine exhibited a significant difference between invasive ductal carcinoma and benign tumors, including cases with inconsistent mammography results. We observed alterations in numerous lipid species, including sphingomyelin, triacylglycerol, and free fatty acids, in the breast cancer group. Furthermore, we identified several dysregulated hydrophilic metabolites in breast cancer, such as glutamate, glycochenodeoxycholate, and dimethyluric acid. Through robust multivariate receiver operating characteristic analysis utilizing machine learning models, either linear support vector machines or random forest models, we successfully distinguished between cancerous and benign cases with promising outcomes. These results emphasize the potential of metabolic biomarkers to complement other criteria in breast cancer screening. Future studies are essential to further validate the metabolic biomarkers identified in our study and to develop assays for clinical applications.

Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort.

False-positive results on screening mammography may affect women's willingness to return for future screening. To evaluate the association between screening mammography results and the probability of subsequent screening. Cohort study. 177 facilities participating in the Breast Cancer Surveillance Consortium (BCSC). 3 529 825 screening mammograms (3 184 482 true negatives and 345 343 false positives) performed from 2005 to 2017 among 1 053 672 women aged 40 to 73 years without a breast cancer diagnosis. Mammography results (true-negative result or false-positive recall with a recommendation for immediate additional imaging only, short-interval follow-up, or biopsy) from 1 or 2 screening mammograms. Absolute differences in the probability of returning for screening within 9 to 30 months of false-positive versus true-negative screening results were estimated, adjusting for race, ethnicity, age, time since last mammogram, BCSC registry, and clustering within women and facilities. Women were more likely to return after a true-negative result (76.9% [95% CI, 75.1% to 78.6%]) than after a false-positive recall for additional imaging only (adjusted absolute difference, -1.9 percentage points [CI, -3.1 to -0.7 percentage points]), short-interval follow-up (-15.9 percentage points [CI, -19.7 to -12.0 percentage points]), or biopsy (-10.0 percentage points [CI, -14.2 to -5.9 percentage points]). Asian and Hispanic/Latinx women had the largest decreases in the probability of returning after a false positive with a recommendation for short-interval follow-up (-20 to -25 percentage points) or biopsy (-13 to -14 percentage points) versus a true negative. Among women with 2 screening mammograms within 5 years, a false-positive result on the second was associated with a decreased probability of returning for a third regardless of the first screening result. Women could receive care at non-BCSC facilities. Women were less likely to return to screening after false-positive mammography results, especially with recommendations for short-interval follow-up or biopsy, raising concerns about continued participation in routine screening among these women at increased breast cancer risk. National Cancer Institute.

Evaluating the Impact of a Clinical Breast Examination Screening Program within the IraPEN Project.

Breast cancer is a prevalent global cancer and a leading cause of mortality in developed countries. In 2015, Iran introduced the Package of Essential Noncommunicable Diseases (IraPEN) as a pilot project to tackle prevalent noncommunicable diseases, including breast cancer. However, there is limited research evaluating the implementation, costs, and outcomes of breast cancer screening within IraPEN. Therefore, this study aims to investigate the costs and outcomes of the clinical breast examination screening program in Isfahan from 2017 to 2020. This descriptive cost-outcome study utilized data from 450,876 individuals aged 30 to 69 who participated in clinical breast examination screening. The outcomes assessed in this program encompassed the number of participants, the number of individuals identified with symptoms, referrals to the next level of examination, the number of individuals undergoing mammography, recorded mammography results, and the number of cases of breast cancer identified. Direct costs were estimated, including personnel, infrastructure, equipment, and other related expenses. ‌The findings revealed that the direct costs of the breast cancer screening program in Isfahan between 2017 and 2020 were 310,514,608,558 Rials, equivalent to approximately 15,470,633 PPP$. These expenses led to the identification of 134,508 individuals with symptoms, referrals of 258,599 individuals to the subsequent level of examination, and approximately 55,974 individuals undergoing mammography tests. This study demonstrates that the breast cancer screening program provides a significant number of women in the target age group with breast self-examination education while raising public awareness about this disease.

Magnetic resonance imaging of the breast: Could it be used as a screening test?

To investigate whether magnetic resonance imaging (MRI) best detects early malignancy in high-risk women. A retrospective, cross-sectional study, carried out at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, included 419 female breast cancer patients aged 16-84 years (mean age of 49). Data were collected from the radiological department's database to compare the MRI, ultrasound (US), and mammography results, with or without tissue biopsy. In diagnosing benign versus malignant lesions, MRI showed significant agreement with tissue biopsy, with high sensitivity (70%) and specificity (87%); its positive predictive value (PPV) was 92% and negative predictive value (NPV) was 56%. While US has a PPV of 84% and NPV of 63%; with a sensitivity (79%) and specificity (71%). In patients without tissue biopsy, there was little difference between mammography and US compared with MRI results. Magnetic resonance imaging is more effective than US and mammography for early detection of BC. It showed high sensitivity in detecting breast lesions and high specificity in characterizing their nature when correlated with pathological results. Ultrasound screening followed by MRI is suggested for undetected or suspected lesions. This will increase the breast lesion detection rate, reduce unneeded tissue biopsies, and enhance the disease's survival rate.

Breast Arterial Calcifications on Mammography: Awareness and Reporting Preferences Amongst Referring Physicians in Canada.

Purpose: Breast arterial calcifications (BAC) on mammography have been correlated with increased cardiovascular risk. The Canadian Society of Breast Imaging released a position statement on BAC reporting in January 2023. This study evaluates the awareness of the clinical significance of BAC and reporting preferences of referring physicians in Canada. Methods: A 15-question survey was distributed to Canadian physicians who may review mammography results via regional and subspecialty associations and on social media following local institutional ethical approval. Responses were collected over 10 weeks from February to April 2023. Results: Seventy-two complete responses were obtained. We are unable to determine the response rate, given the means of distribution. Only 17% (12/72) of responding physicians were previously aware of the association between BAC and increased cardiovascular risk, and 51% (37/72) preferred the inclusion of BAC in the mammography report. Fifty-six percent (40/72) indicated that BAC reporting would prompt further investigation, and 63% (45/72) would inform patients that their mammogram showed evidence of BAC. Sixty-nine percent (50/72) would find grading of BAC beneficial and 71% (51/72) agreed that there is a need for national guidelines. Conclusion: Less than a quarter of responding Canadian referring physicians were previously aware of the association between BAC and cardiovascular risk, although half of respondents indicated a preference for BAC reporting on mammography. Most participating physicians would inform their patients of the presence of BAC and consider further cardiovascular risk management. There was consensus that a national BAC grading system and clinical management guidelines would be beneficial.

Screening Outcomes of Mammography with AI in Dense Breasts: A Comparative Study with Supplemental Screening US.

Background Comparative performance between artificial intelligence (AI) and breast US for women with dense breasts undergoing screening mammography remains unclear. Purpose To compare the performance of mammography alone, mammography with AI, and mammography plus supplemental US for screening women with dense breasts, and to investigate the characteristics of the detected cancers. Materials and Methods A retrospective database search identified consecutive asymptomatic women (≥40 years of age) with dense breasts who underwent mammography plus supplemental whole-breast handheld US from January 2017 to December 2018 at a primary health care center. Sequential reading for mammography alone and mammography with the aid of an AI system was conducted by five breast radiologists, and their recall decisions were recorded. Results of the combined mammography and US examinations were collected from the database. A dedicated breast radiologist reviewed marks for mammography alone or with AI to confirm lesion identification. The reference standard was histologic examination and 1-year follow-up data. The cancer detection rate (CDR) per 1000 screening examinations, sensitivity, specificity, and abnormal interpretation rate (AIR) of mammography alone, mammography with AI, and mammography plus US were compared. Results Among 5707 asymptomatic women (mean age, 52.4 years ± 7.9 [SD]), 33 (0.6%) had cancer (median lesion size, 0.7 cm). Mammography with AI had a higher specificity (95.3% [95% CI: 94.7, 95.8], P = .003) and lower AIR (5.0% [95% CI: 4.5, 5.6], P = .004) than mammography alone (94.3% [95% CI: 93.6, 94.8] and 6.0% [95% CI: 5.4, 6.7], respectively). Mammography plus US had a higher CDR (5.6 vs 3.5 per 1000 examinations, P = .002) and sensitivity (97.0% vs 60.6%, P = .002) but lower specificity (77.6% vs 95.3%, P < .001) and higher AIR (22.9% vs 5.0%, P < .001) than mammography with AI. Supplemental US alone helped detect 12 cancers, mostly stage 0 and I (92%, 11 of 12). Conclusion Although AI improved the specificity of mammography interpretation, mammography plus supplemental US helped detect more node-negative early breast cancers that were undetected using mammography with AI. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Whitman and Destounis in this issue.

Correlation of Ultrasound to Mammogram in Breast Lesions by BIRADS Category

Background: Breast cancer is the most common female cancer and the second leading cause of death worldwide. The gold standard tool for screening breast cancer, mammography has limitations in some instances, such as patients with dense breast tissue. This study evaluates the correlation of Ultrasound (US) to mammography in breast lesions in BI-RADS. Methods: This prospective cross-sectional study was conducted at a tertiary hospital during 2019-2021. Women who referred to the radiology department for mammography with abnormalities appearing in their mammograms, with a minimum age of 40 and older, underwent ultrasonography. The results of mammography and US evaluations compared according to BI-RADS category. Statistical software SPSS was used to analyze the form data. Results: In this study, 156 women with a mean age of 48/9 years registered. The US reports were equivalent to mammographic BI-RADS category 2 in 23 cases. All the 26 patients with mammographic BI-RADS category were categorized into BI-RADS 2 by US. Among 43 lesions with BI-RADS category 4 and 21 with BI-RADS category 5, 90/6% and 95/2% of sonography reports were similar to mammography findings. Based on the Pearson correlation coefficient of 0/68, there is a correlation between the results of US and mammography in this study. Conclusion: This study reveals that US can be an excellent complement to mammography, particularly in identifying early-stage breast cancer in mammographic BI-RADS category 0 lesions. The mammographic-sonographic correlation should lead to more accurate diagnoses and better patient care.

Role of Tomosynthesis in Determining the BI-RADS Score of Individuals with Indeterminate Mammography Results

Background: Tomosynthesis, despite its potential to produce superior images compared to mammography for Breast Imaging-Reporting and Data System (BI-RADS) scoring, has not yet been widely adopted. This is likely due to a combination of insufficient data and a scarcity of expertise in this area. Objectives: In this study, we aimed to evaluate the potential benefits of tomosynthesis for patients with indeterminate BI-RADS results from full-field digital mammography (FFDM). Specifically, we sought to determine whether this method could clarify ambiguous BI-RADS scores. Patients and Methods: This cross-sectional study involved 386 female patients, with an average age of 44.7 ± 7.9 years. The study included all patients who were admitted to a referral center for breast radiology during 2019 - 2020 and underwent both FFDM and tomosynthesis within a short interval. The purpose of performing tomosynthesis was to assess its additional benefits over FFDM. The collected data was input into SPSS version 20 for analysis. A P-value of less than 0.05 was deemed statistically significant. Results: Out of 152 patients who initially had indeterminate findings in mammography (BI-RADS score of 0), only one patient (0.7%) remained indeterminate after tomosynthesis. This implies that tomosynthesis was able to clarify the BI-RADS scores for 99.3% of patients with previously indeterminate scores. Specifically, out of these 151 patients, 81 were scored as BI-RADS 2, 45 as BI-RADS 3, 19 as BI-RADS 4, and six as BI-RADS 5. Conclusion: Tomosynthesis has the capability to clarify unclear FFDM BI-RADS scores in over 99% of cases. This suggests that it could serve as the primary supplementary imaging technique for cases with indeterminate BI-RADS scores.

Role of Tomosynthesis in Determining the BI-RADS Score of Individuals with Indeterminate Mammography Results

Background: Tomosynthesis, despite its potential to produce superior images compared to mammography for Breast Imaging-Reporting and Data System (BI-RADS) scoring, has not yet been widely adopted. This is likely due to a combination of insufficient data and a scarcity of expertise in this area. Objectives: In this study, we aimed to evaluate the potential benefits of tomosynthesis for patients with indeterminate BI-RADS results from full-field digital mammography (FFDM). Specifically, we sought to determine whether this method could clarify ambiguous BI-RADS scores. Patients and Methods: This cross-sectional study involved 386 female patients, with an average age of 44.7 ± 7.9 years. The study included all patients who were admitted to a referral center for breast radiology during 2019 - 2020 and underwent both FFDM and tomosynthesis within a short interval. The purpose of performing tomosynthesis was to assess its additional benefits over FFDM. The collected data was input into SPSS version 20 for analysis. A P-value of less than 0.05 was deemed statistically significant. Results: Out of 152 patients who initially had indeterminate findings in mammography (BI-RADS score of 0), only one patient (0.7%) remained indeterminate after tomosynthesis. This implies that tomosynthesis was able to clarify the BI-RADS scores for 99.3% of patients with previously indeterminate scores. Specifically, out of these 151 patients, 81 were scored as BI-RADS 2, 45 as BI-RADS 3, 19 as BI-RADS 4, and six as BI-RADS 5. Conclusion: Tomosynthesis has the capability to clarify unclear FFDM BI-RADS scores in over 99% of cases. This suggests that it could serve as the primary supplementary imaging technique for cases with indeterminate BI-RADS scores.

Can We Do Breast-Conserving Surgery Without Intraoperative Frozen Section of Margin?

PurposeThis study was a retrospective and nonrandomized study to assess the safety and reliability of identifying the surgical margin in breast cancer breast-conserving surgery (BCS) by using intraoperative ultrasonic location and specimen mammography instead of traditional intraoperative frozen pathological section. MethodsAmong the patients who underwent BCS from May 2019 to October 2021, according to the different methods of evaluating the intraoperative margin, 104 breast cancer patients were included in the frozen edge group, 53 breast cancer patients were included in the freeze-free group, and the surgeon judged whether extended resection was needed based on the results of pathological section or evaluation of intraoperative ultrasound and mammography. The surgical margins of the two groups were judged by postoperative pathological results as the gold standard. ResultsThe median waiting pathology results time in the frozen edge group was 64 minutes, while the waiting time in the freeze-free group was 30 minutes, and the difference was statistically significant (P < .0001). The postoperative pathological results showed that the positive rate of the surgical margin in the frozen edge group was 0.96%. The coincidence rate of intraoperative frozen and postoperative pathological results was 99.04%. The coincidence rate between intraoperative mammography and postoperative pathological results was 100%. ConclusionsIn BCS, the method of using intraoperative staining markers combined with mammography to evaluate the resection margin is highly accurate, reliable, economical and convenient, and at the same time reduces the waiting time of the operator during the operation. However, this was not a randomized controlled study, and there was patient selection bias, and its safety needs to be confirmed by long-term follow-up. In the future, it is expected to become the mainstream means of evaluating.

Evaluating the features of breast lesions identified by bimodal breast examination: a real-world study.

Several image-based diagnostic methods have been developed to examine the features of breast lesions among women, while the value of combining palpation imaging and ultrasound by a bimodal breast examination system is still unknown. A real-world study was conducted among 424 patients who visited Fujian Maternal and Child Health Hospital and Fujian Obstetrics and Gynecology Hospital, and used the Bimodal Breast Exam (BBE) systems which combines palpation imaging and ultrasound imaging. Among them, 97 patients had additional ultrasound, mammogram, or pathological examination. These patients were used to evaluate the consistency and efficacy of the BBE in interpreting the features of breast lesions as compared to results of ultrasound, mammogram, and pathological examinations. The BBE system detected 1517 lesions with palpation imaging, 1126 lesions with ultrasound examination (950 solid lesions and 176 cysts), and 391 non mass lesions. Among them, 404 patients were diagnosed as benign and 20 were diagnosed as malignant tumor. However, 12, 9 and 4 cases were diagnosed as malignant tumors by ultrasound, mammogram and pathological examination, respectively. Compared with the integrative results of ultrasound, mammogram and pathology, the sensitivity of BBE is 55.6%, and the specificity is 90.9%, with a kappa coefficient of 0.387 (0.110, 0.665), indicating moderate consistency. In clinical practice, BBE can be used to evaluate features of breast lesions with a high specificity. The diagnostic efficacy is comparable to the integrative results of ultrasound, mammography, and pathological examination.

An Analysis of the k-Nearest Neighbor Classifier to Predict Benign and Malignant Breast Cancer Tumors

Because of Breast Cancer's high mortality rate and being a leading cause of death among women worldwide, there has been importance given to machine learning (ML) algorithms to detect early signs of benign and malignant tumors effectively. Assistance from ML classifiers allows for a more efficient evaluation of mammographic results, surpassing the capabilities of radiologists who manually classify extensive patient data. This study aims to evaluate the effectiveness of the k-Nearest Neighbor (kNN) classifier in characterizing cancer tumor stages based on concavity, texture, area, perimeter, and smoothness. We employ scatterplots to differentiate between benign and malignant classes using the Breast Cancer Wisconsin Dataset (WBCD) from the University of California at Irvine Machine Learning Repository. Employing the k-Fold Cross Validation (k-FCV) technique, we determine the optimal value for k to assign anonymous data to their respective categories. The analysis conducted in this study finds that the most favorable value for the hyperparameter k is 12, resulting in a highly effective diagnostic outcome from administering four distinct tests. Given the absence of a predefined value for the k parameter, guesswork could lead to accuracy errors and misdiagnosis; therefore, employing k-FCV provides a more precise approach to determining the optimal class for unknown tumor attributes. Additionally, preprocessing of this dataset and measuring how different data splits impact accuracy are used to organize the data effectively and achieve reliable results. Recognizing that early detection is essential in preventing Breast Cancer-related deaths, ML techniques like kNN can greatly reduce mortality rates associated with the disease.

Sociodemographic Variations in Women’s Reports of Discussions With Clinicians About Breast Density

Breast density notifications advise women to discuss breast density with their clinicians, yet little is known about such discussions. To examine the content of women's reports of breast density discussions with clinicians and identify variations by women's sociodemographic characteristics (age, income, state legislation status, race and ethnicity, and literacy level). This US nationwide, population-based, random-digit dial telephone survey study was conducted from July 1, 2019, to April 30, 2020, among 2306 women aged 40 to 76 years with no history of breast cancer who underwent mammography in the prior 2 years and had heard the term dense breasts or breast density. Results were analyzed from a subsample of 770 women reporting a conversation about breast density with their clinician after their last mammographic screening. Statistical analysis was conducted in April and July 2023. Survey questions inquired whether women's clinicians had asked about breast cancer risk or their worries or concerns about breast density, had discussed mammography results or other options for breast cancer screening or their future risk of breast cancer, as well as the extent to which the clinician answered questions about breast density. Of the 770 women (358 [47%] aged 50-64 years; 47 Asian [6%], 125 Hispanic [16%], 204 non-Hispanic Black [27%], 317 non-Hispanic White [41%], and 77 other race and ethnicity [10%]) whose results were analyzed, most reported that their clinicians asked questions about breast cancer risk (88% [670 of 766]), discussed mammography results (94% [724 of 768]), and answered patient questions about breast density (81% [614 of 761]); fewer women reported that clinicians had asked about worries or concerns about breast density (69% [524 of 764]), future risk of breast cancer (64% [489 of 764]), or other options for breast cancer screening (61% [459 of 756]). Women's reports of conversations varied significantly by race and ethnicity; non-Hispanic Black women reported being asked questions about breast cancer risk more often than non-Hispanic White women (odds ratio [OR], 2.08 [95% CI, 1.05-4.10]; P = .04). Asian women less often reported being asked about their worries or concerns (OR, 0.42 [95% CI, 0.20-0.86]; P = .02), and Hispanic and Asian women less often reported having their questions about breast density answered completely or mostly (Asian: OR, 0.28 [95% CI, 0.13-0.62]; P = .002; Hispanic: OR, 0.48 [95% CI, 0.27-0.87]; P = .02). Women with low literacy were less likely than women with high literacy to report being asked about worries or concerns about breast density (OR, 0.64 [95% CI, 0.43-0.96]; P = .03), that mammography results were discussed with them (OR, 0.32 [95% CI, 0.16-0.63]; P = .001), or that their questions about breast density were answered completely or mostly (OR, 0.51 [95% CI, 0.32-0.81]; P = .004). In this survey study, although most women reported that their clinicians counselled them about breast density, the unaddressed worries or concerns and unanswered questions, especially among Hispanic and Asian women and those with low literacy, highlighted areas where discussions could be improved.

Application of Artificial Intelligence in the Mammographic Detection of Breast Cancer in Saudi Arabian Women

Background: Breast cancer has a 14.8% incidence rate and an 8.5% fatality rate in Saudi Arabia. Mammography is useful for the early detection of breast cancer. Researchers have been developing artificial intelligence (AI) algorithms for early breast cancer diagnosis and reducing false-positive mammography results. The aim of this study was to examine the performance and accuracy of an AI system in breast cancer screening among Saudi women. Materials and Methods: This is a retrospective cross-sectional study that included 378 mammograms collected from 2017 to 2021 from government hospitals in Jeddah, Saudi Arabia. The patients’ demographic and clinical information were collected from files and electronic medical records. The radiologists’ assessments of the mammograms were based on Breast Imaging Reporting and Data System (BIRADS) scores. Follow-up or biopsy reports verified the radiologists’ findings. The MammoScreen system was the AI tool used in this study. Data were analyzed using SPSS Version 25. Results: The patients’ mean age was 50.31 years. Most patients had breast density B (42.3%) followed by A (27.2%) and C (25.9%). Most malignant cases were invasive ductal carcinomas (37.3%). Of the 181 cancer cases, 36.9% were BIRADS category V. The area under the curve for the AI detection (0.923; 95% confidence interval [CI], 0.893–0.954) was greater than that for the radiologists’ interpretation (0.838; 95% CI, 0.796–0.881). The AI detection agreed with the histopathological result in 167 positive (91.3%) and 182 negative cases (93.3%). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the AI system were 92.8%, 91.9%, 91.3%, 93.3%, and 92.3%, respectively. The radiologist’s interpretation agreed with the pathology report in 180 positive (73.8%) and 134 negative cases (100%). Its sensitivity, specificity, PPV, NPV, and accuracy were 100%, 67.7%, 73.8%, 100%, and 83.1%, respectively. Conclusions: The AI system tested in this study had better accuracy and diagnostic performance than the radiologists and thus could be used as a support diagnostic tool for breast cancer detection in clinical practice and to reduce false-positive recalls.

Breast Cancer Incidence After a False-Positive Mammography Result

False-positive mammography results are common. However, long-term outcomes after a false-positive result remain unclear. To examine long-term outcomes after a false-positive mammography result and to investigate whether the association of a false-positive mammography result with cancer differs by baseline characteristics, tumor characteristics, and time since the false-positive result. This population-based, matched cohort study was conducted in Sweden from January 1, 1991, to March 31, 2020. It included 45 213 women who received a first false-positive mammography result between 1991 and 2017 and 452 130 controls matched on age, calendar year of mammography, and screening history (no previous false-positive result). The study also included 1113 women with a false-positive result and 11 130 matched controls with information on mammographic breast density from the Karolinska Mammography Project for Risk Prediction of Breast Cancer study. Statistical analysis was performed from April 2022 to February 2023. A false-positive mammography result. Breast cancer incidence and mortality. The study cohort included 497 343 women (median age, 52 years [IQR, 42-59 years]). The 20-year cumulative incidence of breast cancer was 11.3% (95% CI, 10.7%-11.9%) among women with a false-positive result vs 7.3% (95% CI, 7.2%-7.5%) among those without, with an adjusted hazard ratio (HR) of 1.61 (95% CI, 1.54-1.68). The corresponding HRs were higher among women aged 60 to 75 years at the examination (HR, 2.02; 95% CI, 1.80-2.26) and those with lower mammographic breast density (HR, 4.65; 95% CI, 2.61-8.29). In addition, breast cancer risk was higher for women who underwent a biopsy at the recall (HR, 1.77; 95% CI, 1.63-1.92) than for those without a biopsy (HR, 1.51; 95% CI, 1.43-1.60). Cancers after a false-positive result were more likely to be detected on the ipsilateral side of the false-positive result (HR, 1.92; 95% CI, 1.81-2.04) and were more common during the first 4 years of follow-up (HR, 2.57; 95% CI, 2.33-2.85 during the first 2 years; HR, 1.93; 95% CI, 1.76-2.12 at >2 to 4 years). No statistical difference was found for different tumor characteristics (except for larger tumor size). Furthermore, associated with the increased risk of breast cancer, women with a false-positive result had an 84% higher rate of breast cancer death than those without (HR, 1.84; 95% CI, 1.57-2.15). This study suggests that the risk of developing breast cancer after a false-positive mammography result differs by individual characteristics and follow-up. These findings can be used to develop individualized risk-based breast cancer screening after a false-positive result.

Association of CYP1A2 gene polymorphism (rs762551) with the risk &#x0D; of breast cancer and miscarriage of the first pregnancy

Introduction. Missed pregnancy, as a rule, is caused by a combination of several factors. Exogenous factors can have a teratogenic effect, leading to the occurrence of mutations of varying severity. In such case at the early stages of embryogenesis, serious disturbances occur, leading to a halt in the pregnancy development. The system of their biotransformation is responsible for the elimination of xenobiotics from the body, the inadequate functioning of which increases the activity of mutagenesis, which may raise the risk of breast cancer.&#x0D; Materials and methods. One hundred thirty four women were examined. The first group included 63 women, 28 of them were diagnosed with fetal egg death in primigravida young women, in 35 women the first pregnancy ended with physiological childbirth. The second group included 71 woman, 33 of them were diagnosed with a malignant breast neoplasm, 38 had no suspicion of breast cancer (BC) according to the results of mammography. Polymorphisms of the CYP1A2*1F gene of the xenobiotic biotransformation system in these groups were determined by polymerase chain reaction.&#x0D; Results. In the group of women with a missed first pregnancy, a statistically reliable association of a high risk of the fetal egg death with the A/A CYP1A2*1F genotype and resistance to this pathology in the case of the C/A CYP1A2*1F polymorphism was revealed. In the group of BC women, the association of a high risk of developing a malignant neoplasm with the A/A CYP1A2*1F genotype and resistance to the development of the disease in the presence of C/A CYP1A2*1F polymorphism was shown.&#x0D; Limitations. The study was limited by the number of samples, there is no data on polymorphisms of the BRCA-1, BRCA-2 genes.&#x0D; Conclusion. The results obtained will allow not only adjusting the tactics of pregnancy management in women with a high risk of the fetal egg death or the selection of pharmacological drugs in the treatment of BC under the conditions of serious environmental stress, but also developing preventive measures to reduce the risk of these pathologies.

Efficacy and safety of non-hormonal agents for vasomotor symptoms of menopause: A prospective, double-blind, placebo-controlled study

Aim. To assess the safety and efficacy of non-hormonal agents for mild vasomotor symptoms of menopause.&#x0D; Materials and methods. The study included 173 females aged 4855 with mild vasomotor symptoms during the early postmenopausal period. Patients in the study cohort were stratified into two groups by the double-blind method. In group 1 (study), the patients took the homeopathic agent Neoclimsal 1 tablet 4 times a day sublingually until completely dissolved for 4 weeks (n=86). In group 2 (n=87), the patient received a placebo (30 mg of microcrystalline cellulose) in a regimen mimicking the study treatment. Twenty-three patients withdrew from the study due to protocol violation or revoked their consents for reasons not related to medication. At the end of the study, 75 patients remained in both groups. The therapeutic efficacy was assessed based on the Greene and MENQOL scores change. The SF-36 questionnaire was used to evaluate patients' quality of life, and the average rate of falling asleep was calculated to assess the change in sleep disturbance. The change of M-echo and mammography results were reviewed using the BI-RADS scale 12 months after the start of the treatment to assess the agent's safety. Study design: A prospective, double-blind, placebo-controlled study.&#x0D; Results. The course of Neoclimsal, sublingual tablets, reduced the severity of vasomotor symptoms by 2.3 times, the severity of depression by half (p0.001), and at the end of treatment after 12 weeks of observation, the therapeutic effect not only persisted but tended to increase (p0.001). Improvement in the quality of life of patients treated with Neoclimsal was confirmed by an improvement in the MENQOL score by 1.4 times a month after the start of therapy while maintaining the achieved result after 12 weeks of observation (p0.001). The drug's safety is confirmed by the absence of adverse side effects and allergic reactions, the absence of endometrial thickness change within 3 months after the start of treatment, and mammography results using the BI-RADS scale at 12 months.&#x0D; Conclusion. The results indicate the effectiveness of non-hormonal therapy in relieving vasomotor symptoms of mild postmenopause with a high safety profile. The drug has a beneficial effect on sleep disorders, reducing the severity of mental distress and improving the general quality of life.

What Women Want: Real Time Results for Screening Mammography in the Era of Value-Based Care | A Single Institution Experience During the COVID-19 SARS-COV2 Pandemic

Objective: Direct radiologist to patient communication has been linked to higher levels of patient satisfaction, compliance, and overall treatment outcomes. Recent studies examining patient expectations in breast imaging indicate that 90% of women prefer result communication and review of imaging directly from their radiologist. Though the primary components of diagnostic breast imaging are patient centered, supplemental data suggests that screening mammography result consultation may represent an additional opportunity for engagement in the new era of patient-experience driven care. The primary aim of our study was to examine patient preferences for receiving real time screening mammography result communication (RTRC) and characteristics that may influence their willingness to participate. Material and Methods: This quality-improvement based, IRB-approved, study was performed at three community-based academic breast radiology centers in a large metropolitan area between October 5, 2020, and January 2, 2021. Female patients presenting for screening mammography were invited to opt in for RTRC and/or participate in an electronic, HIPAA-compliant, simple survey that could be completed on the personal subject’s phone or tablet. Subjects opting in for RTRC were invited to wait in a consultation room during staff radiologist review. Once interpreted, the radiologist would discuss the results and next step recommendations with the patient. Self-reported patient demographic characteristics and RTRC preferences by age, race, ethnicity, level of education, household income, prior personal or family history of breast cancer, active (non-breast) cancer history and prior history of abnormal mammogram were assessed by categorical variable analysis using Chi-squared tests. A p-value &lt;0.05 was determined to be statistically significant. Results: 1714 screening mammograms were performed across our three community-based breast imaging centers and 11% (186/1714) of women completed the survey during the study timeframe. White women (92%) were statistically more likely to opt in for RTRC when compared with non-white (80%) counterparts (p=.026). Patients with a personal history (p=0.001) or family history (p=0.006) of breast cancer were statistically more likely to opt in for RTRC when compared with other cohorts. A positive correlation was observed between prior history of abnormal mammogram and preference for receiving RTRC (93%) but did not achieve statistical significance (p=.082). There was no correlation observed between RTRC preference and an active (non-breast) cancer diagnosis (p=0.415). Conclusion: Our study confirms previous data suggesting that patients vastly prefer direct verbal communication ahead of written letter result notification. Our study also suggests that screening mammography RTRC may be of particular interest in patients with higher (personal or familial) risk for developing breast cancer. While this service may operationally add demand on radiologist-patient face time and cost to care delivery, an awareness of patient preferences and cohorts that may find value in this service option can be prioritized to optimize both patient experience and clinical workflow. Additional studies are warranted to further validate which practice models would achieve most benefit from this tailored service offering.

Artificial intelligence-based diagnosis of breast cancer by mammography microcalcification

Mammography is the mainstream imaging modality used for breast cancer screening. Identification of microcalcifications associated with malignancy may result in early diagnosis of breast cancer and aid in reducing the morbidity and mortality associated with the disease. Computer-aided diagnosis (CAD) is a promising technique due to its efficiency and accuracy. Here, we demonstrated that an automated deep-learning pipeline for microcalcification detection and classification on mammography can facilitate early diagnosis of breast cancer. This technique can not only provide the classification results of mammography, but also annotate specific calcification regions. A large mammography dataset was collected, including 4,810 mammograms with 6,663 microcalcification lesions based on biopsy results, of which 3,301 were malignant and 3,362 were benign. The system was developed and tested using images from multiple centers. The overall classification accuracy values for discriminating between benign and malignant breasts were 0.8124 for the training set and 0.7237 for the test set. The sensitivity values of malignant breast cancer prediction were 0.8891 for the training set and 0.7778 for the test set. In addition, we collected information regarding pathological sub-type (pathotype) and estrogen receptor (ER) status, and we subsequently explored the effectiveness of deep learning-based pathotype and ER classification. Automated artificial intelligence (AI) systems may assist clinicians in making judgments and improve their efficiency in breast cancer screening, diagnosis, and treatment.

Women’s Willingness to Pay for Mammography Screening under Two Medical Information Scenarios

Objective. Secondary prevention of breast cancer (BC) helps diagnose the disease in the early stages and prevent disease progression. World Health Organization and the American Cancer Society consider early diagnosis as the best way to control BC. Mammography screening is the most sensitive and specific test that can be conducted along with the clinical examination for the early diagnosis of BC. However, like other tests, mammography is not a perfect test. The purpose of the present study is to measure willingness to pay (WTP) for mammography among a sample of women by providing each of them one of two scenarios describing medical information on the test. Methods. 450 women aged 35–55 years were assigned randomly into two groups of equal numbers in a quasi-experimental study conducted in Tabriz city, Iran. Each group was presented with one of the two designed scenarios. First scenario described the basic medical information on mammography as a good test of BC screening. The alternative scenario described some information on potential diagnostic errors of the mammography result alongside basic medical information about this test. The double bounded dichotomous choice method was used to extract women’s WTP for mammography under each scenario. Results. Based on the official currency exchange rate of 37000 IRR/USD, the mean WTP for BC screening with mammography was estimated as 30.5$ in the group receiving basic medical information and 26.8$ in the other group. However, the result of regression analysis revealed receiving information on potential diagnostic errors of mammography result did not lead to significant higher WTP for the test. The WTP for mammography raised significantly among older women, employed women, and those with higher level of education. Conclusion. The result of our study suggests that providing women with information about the potential diagnostic errors of mammography may not be correlated to economic value they give to this test. However, women with different individual status may reveal different economic value on mammography.