Screening Mammography In Women Research Articles

Health benefits and harms of mammography screening in older women (75+ years)—a systematic review

BackgroundThere is little evidence on the balance between potential benefits and harms of mammography screening in women 75 years and older. The aim of this systematic review was to synthesise the evidence on the outcomes of mammography screening in women aged 75 years and older.MethodsA systematic review of mammography screening studies in women aged 75 years and over.ResultsThirty-six studies were included in this review: 27 observational studies and 9 modelling studies. Many of the included studies used no or uninformative comparison groups resulting in a potential bias towards the benefits of screening. Despite this, there was mixed evidence about the benefits and harms of continuing mammography screening beyond the age of 75 years. Some studies showed a beneficial effect on breast cancer mortality, and other studies showed no effect on mortality. Some studies showed some harms (false positive tests and recalls) being comparable to those in younger age-groups, with other studies showing increase in false positive screens and biopsies in older age-group. Although reported in fewer studies, there was consistent evidence of increased overdiagnosis in older age-groups.ConclusionThere is limited evidence available to make a recommendation for/against continuing breast screening beyond the age of 75 years. Future studies should use more informative comparisons and should estimate overdiagnosis given potentially substantial harm in this age-group due to competing causes of death.This review was prospectively registered with PROSPERO (CRD42020203131).

Benefits and Harms of Mammography Screening in 75 + Women to Inform Shared Decision-making: a Simulation Modeling Study.

Guidelines recommend shared decision-making (SDM) around mammography screening for women ≥ 75years old. To use microsimulation modeling to estimate the lifetime benefits and harms of screening women aged 75, 80, and 85years based on their individual risk factors (family history, breast density, prior biopsy) and comorbidity level to support SDM in clinical practice. We adapted two established Cancer Intervention and Surveillance Modeling Network (CISNET) models to evaluate the remaining lifetime benefits and harms of screening U.S. women born in 1940, at decision ages 75, 80, and 85years considering their individual risk factors and comorbidity levels. Results were summarized for average- and higher-risk women (defined as having breast cancer family history, heterogeneously dense breasts, and no prior biopsy, 5% of the population). Remaining lifetime breast cancers detected, deaths (breast cancer/other causes), false positives, and overdiagnoses for average- and higher-risk women by age and comorbidity level for screening (one or five screens) vs. no screening per 1000 women. Compared to stopping, one additional screen at 75years old resulted in six and eight more breast cancers detected (10% overdiagnoses), one and two fewer breast cancer deaths, and 52 and 59 false positives per 1000 average- and higher-risk women without comorbidities, respectively. Five additional screens over 10years led to 23 and 31 additional breast cancer cases (29-31% overdiagnoses), four and 15 breast cancer deaths avoided, and 238 and 268 false positives per 1000 average- and higher-risk screened women without comorbidities, respectively. Screening women at older ages (80 and 85years old) and high comorbidity levels led to fewer breast cancer deaths and a higher percentage of overdiagnoses. Simulation models show that continuing screening in women ≥ 75 years old results in fewer breast cancer deaths but more false positive tests and overdiagnoses. Together, clinicians and 75 + women may use model output to weigh the benefits and harms of continued screening.

Screening mammographic performance by race and age in the National Mammography Database: 29,479,665 screening mammograms from 13,181,241 women.

There are insufficient large-scale studies comparing the performance of screening mammography in women of different races. This study aims to compare the screening performance metrics across racial and age groups in the National Mammography Database (NMD). All screening mammograms performed between January 1, 2008, and December 31, 2021, in women aged 30-100years from 746 mammography facilities in 46 U.S. states in the NMD were included. Patients were stratified by 10-year age intervals and 5 racial groups (African American, American Indian, Asian, White, unknown). Incidence of risk factors (breast density, personal history, family history of breast cancer, age), and time since prior exams were compared. Five screening mammography metrics were calculated: recall rate (RR), cancer detection rate (CDR), positive predictive values for recalls (PPV1), biopsy recommended (PPV2) and biopsy performed (PPV3). 29,479,655 screening mammograms performed in 13,181,241 women between January 1, 2008, and December 31, 2021, from the NMD were analyzed. The overall mean performance metrics were RR 10.00% (95% CI 9.99-10.02), CDR 4.18/1000 (4.16-4.21), PPV1 4.18% (4.16-4.20), PPV2 25.84% (25.72-25.97), PPV3 25.78% (25.66-25.91). With advancing age, RR significantly decreases, while CDR, PPV1, PPV2, and PPV3 significantly increase. Incidence of personal/family history of breast cancer, breast density, age, prior mammogram availability, and time since prior mammogram were mostly similar across all races. Compared to White women, African American women had significantly higher RR, but lower CDR, PPV1, PPV2 and PPV3. Benefits of screening mammography increase with age, including for women age > 70 and across all races. Screening mammography is effective; with lower RR and higher CDR, PPV2, and PPV3 with advancing age. African American women have poorer outcomes from screening mammography (higher RR and lower CDR), compared to White and all women in the NMD. Racial disparity can be partly explained by higher rate of African American women lost to follow up.

AI Risk Score on Screening Mammograms Preceding Breast Cancer Diagnosis.

Background Few studies have evaluated the role of artificial intelligence (AI) in prior screening mammography. Purpose To examine AI risk scores assigned to screening mammography in women who were later diagnosed with breast cancer. Materials and Methods Image data and screening information of examinations performed from January 2004 to December 2019 as part of BreastScreen Norway were used in this retrospective study. Prior screening examinations from women who were later diagnosed with cancer were assigned an AI risk score by a commercially available AI system (scores of 1-7, low risk of malignancy; 8-9, intermediate risk; and 10, high risk of malignancy). Mammographic features of the cancers based on the AI score were also assessed. The association between AI score and mammographic features was tested with a bivariate test. Results A total of 2787 prior screening examinations from 1602 women (mean age, 59 years ± 5.1 [SD]) with screen-detected (n = 1016) or interval (n = 586) cancers showed an AI risk score of 10 for 389 (38.3%) and 231 (39.4%) cancers, respectively, on the mammograms in the screening round prior to diagnosis. Among the screen-detected cancers with AI scores available two screening rounds (4 years) before diagnosis, 23.0% (122 of 531) had a score of 10. Mammographic features were associated with AI score for invasive screen-detected cancers (P < .001). Density with calcifications was registered for 13.6% (43 of 317) of screen-detected cases with a score of 10 and 4.6% (15 of 322) for those with a score of 1-7. Conclusion More than one in three cases of screen-detected and interval cancers had the highest AI risk score at prior screening, suggesting that the use of AI in mammography screening may lead to earlier detection of breast cancers. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Mehta in this issue.

Women 75 Years Old or Older: To Screen or Not to Screen?

Breast cancer is the most common cancer in women, with the incidence rising substantially with age. Older women are a vulnerable population at increased risk of developing and dying from breast cancer. However, women aged 75 years and older were excluded from all randomized controlled screening trials, so the best available data regarding screening benefits and risks in this age group are from observational studies and modeling predictions. Benefits of screening in older women are the same as those in younger women: early detection of smaller lower-stage cancers, resulting in less invasive treatment and lower morbidity and mortality. Mammography performs significantly better in older women with higher sensitivity, specificity, cancer detection rate, and positive predictive values, accompanied by lower recall rates and false positives. The overdiagnosis rate is low, with benefits outweighing risks until age 90 years. Although there are conflicting national and international guidelines about whether to continue screening mammography in women beyond age 74 years, clinicians can use shared decision making to help women make decisions about screening and fully engage them in the screening process. For women aged 75 years and older in good health, continuing annual screening mammography will save the most lives. An informed discussion of the benefits and risks of screening mammography in older women needs to include each woman's individual values, overall health status, and comorbidities. This article will review the benefits, risks, and controversies surrounding screening mammography in women 75 years old and older and compare the current recommendations for screening this population from national and international professional organizations. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.

Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: a systematic review

ObjectiveTo systematically identify interventions that increase the use of mammography screening in women living in low-income and middle-income countries (LMICs).DesignSystematic review.Data sourcesMEDLINE, Embase, Global Health, CINAHL, PsycINFO, Web of Science,...

New recommendations on mammography screening for women over 70 years

The new recommendations of the European Council (December 2022) indicate to the Member States to implement mammography screening programs for women aged 45 to 74 and make explicit reference to the European guidelines produced by the ECIBC (European Commission Initiative on Breast Cancer) for operational indications. For women aged 70-74, the ECIBC suggests a three-year interval, rather than two years, and the process of adaptation and adoption of the guidelines in Italy has taken this recommendation as it is. Previous indications for Italian screening programs proposed a two-year interval for all women over 50 years of age. The intervention analyzes the rationale and interpretation of the evidence that led to the formulation of the different recommendations. It discusses whether the new recommendations fit into the perspective of risk-stratified screening that is under evaluation by several studies. it analyzes some of the critical issues of the methodology for developing recommendations in defining the characteristics of complex interventions, in particular the difficulties that the formulation of dichotomous questions finds in answering questions such as what is the best age to stop screening and what is the best interval at any age, which require an analysis of a continuous variable as age or interval duration. Finally, the opportunities and limitations in producing evidence regarding the best interval to adopt in mammography screening are discussed.

EE112 Cost-Effectiveness of Digital Breast Tomosynthesis in Mammography Screening in Women With High Breast Density From a Czech Perspective

Women with high breast density have a higher risk of breast cancer and a lower likelihood of detecting a lesion with standard mammography screening. Digital breast tomosynthesis is a three-dimensional imaging modality that offers superior diagnostic performance compared with two-dimensional digital mammography in women with high breast density. The study objective was to evaluate the cost-effectiveness of digital breast tomosynthesis in mammography screening in women with high breast density from Czech payers’ perspective.

Performance analysis of screening mammography in Asian women under 40years.

Screening mammography performance among young women remains uncertain in East Asia, where the proportion of young breast cancer patients is higher than that in Western countries. Thus, we analyzed the performance of screening mammography in women under 40years in comparison with older age groups. This retrospective study comprised 95,431 Asian women with 197,525 screening mammograms. The reference standard was determined by linkage to the national cancer registry data and the 12-month follow-up outcomes after the index mammogram. The performance metrics included sensitivity, specificity, cancer detection rate (CDR), positive predictive value (PPV), recall rate, and areas under the receiver operating characteristic curve (AUCs), with comparisons across age groups (30s, 40s, and ≥ 50s). For young women aged < 40years, sensitivity and AUC (95% confidence interval [CI]) of screening mammography were 60.4% (50.4-69.7) and 0.73 (0.68-0.77), respectively, with no significant difference compared to women in their 40s (sensitivity: 64.0% [95% CI: 57.8-69.8], P = 0.52; AUC: 0.75 [95% CI: 0.73-0.78], P = 0.35). The CDR (95% CI) was 0.8 (0.6-1.1) per 1,000 mammograms for young women, poorer than 1.8 (1.6-2.1) per 1,000 mammograms for women in their 40s (P < 0.001). The PPV and recall rate (95% CI) for young women were 0.6% (0.4-0.7) and 14.9% (14.6-15.1), poorer than 1.4% (1.2-1.6) and 13.3% (13.1-13.5) for women in their 40s (P < 0.001), respectively. The accuracy of screening mammography for young women in their 30s was not significantly different from that for women in their 40s, but the cancer detection and recall rates were poorer.

Effectiveness of mammography screening for women aged 40–49

The aim of the work was to review randomized controlled trials regarding the efficacy of screening mammography in women aged 40–49 years.Google Scholar and PubMed databases were searched for English-language publications for randomized controlled trials. Inclusion criteria were studies evaluating the possible benefit/harm of mammographic screening in women 40–49 years old, a follow-up period of at least 10 years, primary breast cancer, regarding as primary outcomes reduction of breast cancer mortality, and side effects screening mammography.A search for the specified keywords found 2453 sources in electronic databases, of which only 83 studies were published as articles. After analyzing these studies, only 5 studies met the inclusion criteria. An analysis of these studies according to the inclusion criteria is subsequently presented in the article.Based on the available data from randomized trials, no definitive conclusion about the effectiveness of mammographic screening in women 40–49 years of age can yet be drawn. Therefore, it is too early to draw a line in the debate about the appropriateness of mammography in the 40–49 age group.

Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey

While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group. Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements. 1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: "No reason/never thought about it" 744/1948 (38.2%), "Put it off" 343/1948 (17.6%), "Didn't need it" 331/1948 (16.9%), "Doctor didn't order it" 162/1948 (8.3%), and "I'm too young" 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001). Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.

Racial disparities in the screening mammography continuum within a diverse healthcare system.

e18580 Background: Racial disparities in breast cancer have been extensively characterized in the literature. Access to screening mammography is a significant contributor to breast cancer disparities. Decreased access to mammography translates into disparities in breast cancer through delayed presentation to care. The USPSTF recommends biannual screening mammography of women 50-74 with average risk for breast cancer. Methods: We conducted a cross-sectional analysis of encounter-level data for Black and white female primary care patients aged 50-74 in the University of Washington Medicine system who were due for mammogram in 2019. Completion of steps of the mammography continuum (referral, scheduling, and completion of mammogram) were compared among Black and white women. Multivariable logistic regression was used to explore race and mammogram completion, adjusting for age, language, referral, insurance, clinical site, wellness visit utilization, and history of prior mammogram. Results: The study population comprised 18,156 women of whom 2,059 (11.3%) were Black and 16,097 (88.7%) were white. Among Black women, 26.8% were referred to screening mammogram, 12.9% self-referred, 39.3% were scheduled, and 21.4% completed their mammogram, compared to 21.1%, 20.6%, 41.4%, and 26.9% among white women respectively. The greatest attrition among Black women was in the step of completing a mammogram after it was scheduled, which was higher seen in white women at the same step. Adjusted analyses demonstrated an association between Black race and lower rates of screening mammography completion (OR 0.85, [95% CI 0.78-0.98], p = 0.02). Conclusions: Our analysis assessed racial disparities in steps of the screening mammography continuum in a large, diverse health system. Black race was associated with lower screening mammography completion after adjustment for several covariates. Provider-initiated referral was higher for Black women, while self-referral was higher for white women. Both Black and white women experienced highest attrition from no-show rates for scheduled mammograms, though attrition was greater for Black women. These findings have systems implications for future interventions, such as patient navigators or system-driven nudges, to mitigate disparities in breast cancer screening. [Table: see text]

An Evidence-based and Inclusive Breast Cancer Screening Strategy: Summary of Current Guidelines from the American College of Radiology and Society of Breast Imaging.

HomeRadiology: Imaging CancerVol. 4, No. 2 PreviousNext Research HighlightsFree AccessAn Evidence-based and Inclusive Breast Cancer Screening Strategy: Summary of Current Guidelines from the American College of Radiology and Society of Breast ImagingDevan Diwanji, Bonnie JoeDevan Diwanji, Bonnie JoeDevan DiwanjiBonnie JoePublished Online:Mar 18 2022https://doi.org/10.1148/rycan.229003MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: For persons at average risk, initiating annual screening mammography at age 40 years confers the greatest reduction in breast cancer mortality with diagnosis at earlier stages and better options for surgery and chemotherapy.■ Key Result: Screening should continue past age 74 years without upper age limit unless significant comorbidities limit life expectancy.■ Impact: Breast cancer risk assessment should be performed by age 30 years, especially in Black, Asian, and Hispanic women, to appropriately define risk category for each person.Breast cancer is the most common nonskin cancer and the second leading cause of cancer death in women. Although advances in treatments have significantly improved survival, they alone cannot overcome the disadvantage of a late-stage cancer diagnosis. Regular breast cancer screening with mammography reduces mortality by approximately 40% for women age 40 years and older. Experts from the American College of Radiology (ACR) and Society of Breast Imaging (SBI) reviewed data from numerous trials and imaging studies to offer evidence-based recommendations for screening mammography. Recommendations focused on reducing morbidity and mortality while addressing screening disparities and risks of screening versus not screening.The ACR and SBI recommend annual screening mammography starting at age 40 years for individuals at average risk. Starting at age 40 years versus 45 or 50 years helps detect cancer at earlier stages in which smaller tumor burdens and less metastatic potential broaden effective therapeutic options. Annual screening helps identify cancers with potential to grow and metastasize during longer screening interval periods. More than one-third of breast cancer deaths and nearly half for women age 40–49 years manifested in the 2nd year after mammography with negative findings. Because one in five breast cancers occur in women age 75 years and older, the ACR and SBI recommend screening past 75 years of age with consideration for comorbidities that limit life expectancy. More frequent screening increases benign-outcome recalls and biopsies but should be balanced against benefits of gained life-years and fewer deaths from breast cancer. Overdiagnosis from mammography screening occurs in less than 1% of women younger than 60 years of age, independent of screening interval or age to begin screening. A single mammography examination provides minimal radiation, equivalent to 6 weeks of natural background radiation. The ratio of lives saved by mammography compared with the theoretical possibility of lives lost from increased radiation exposure is 50–75 to one. Both benefits and risks should be considered to help individuals make informed choices regarding screening.The ACR and SBI recommendations address racial disparities associated with less frequent or delayed screening. Racial and ethnic minority women younger than 50 years old are 72% more likely to be diagnosed with invasive breast cancer than non-Hispanic White women. One-third of breast cancers in Black, Asian, and Hispanic women are diagnosed before 50 years of age. Biological factors, including higher incidences of mutations in BRCA1 and BRCA2 and aggressive triple-negative disease in racial and ethnic minority women, as well as systemic inequities in access to screening mammography may contribute to these discrepancies. Earlier or more frequent screening may detect cancers earlier in racial and ethnic minority women and mitigate some differences.Highlighted ArticleMonticciolo DL, Malak SF, Friedewald SM, et al. Breast cancer screening recommendations inclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021; 18(9):1280–1288. doi: https://doi.org/10.1016/j.jacr.2021.04.021Highlighted ArticleMonticciolo DL, Malak SF, Friedewald SM, et al. Breast cancer screening recommendations inclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021;18(9):1280–1288. doi:https://doi.org/10.1016/j.jacr.2021.04.021 Crossref, Medline, Google ScholarArticle HistoryPublished online: Mar 18 2022 FiguresReferencesRelatedDetailsRecommended Articles Age-based versus Risk-based Mammography Screening in Women 40–49 Years Old: A Cross-sectional StudyRadiology2019Volume: 292Issue: 2pp. 321-328Sustainable Benefits of Digital Breast Tomosynthesis ScreeningRadiology2020Volume: 298Issue: 1pp. 58-59Non-BRCA Early-Onset Breast Cancer in Young WomenRadioGraphics2022Volume: 42Issue: 1pp. 5-22Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007–2016Radiology2021Volume: 300Issue: 2pp. 290-300Invited Commentary: The Challenges of Early-Onset Breast CancerRadioGraphics2022Volume: 42Issue: 1pp. E16-E17See More RSNA Education Exhibits How to Identify Women Who Are Above Average Risk for Developing Breast Cancer: Retrospective Review of our Institution's First Year Experience After Implementing a Breast Cancer Risk Assessment Program in Breast ImagingDigital Posters2018High Risk Breast Cancer Screening  Digital Posters2020Non-Contrast-Enhanced Breast MR Screening for Women with Dense BreastsDigital Posters2019 RSNA Case Collection Multifocal breast cancerRSNA Case Collection2020Male invasive Ductal Carcinoma RSNA Case Collection2022Invasive ductal carcinoma of the breastRSNA Case Collection2020 Vol. 4, No. 2 Metrics Altmetric Score PDF download

Benefits and harms of annual, biennial, or triennial breast cancer mammography screening for women at average risk of breast cancer: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

BackgroundAlthough mammography screening is recommended in most European countries, the balance between the benefits and harms of different screening intervals is still a matter of debate. This review informed the European Commission Initiative on Breast Cancer (BC) recommendations.MethodsWe searched PubMed, EMBASE, and the Cochrane Library to identify RCTs, observational or modelling studies, comparing desirable (BC deaths averted, QALYs, BC stage, interval cancer) and undesirable (overdiagnosis, false positive related, radiation related) effects from annual, biennial, or triennial mammography screening in women of average risk for BC. We assessed the certainty of the evidence using the GRADE approach.ResultsWe included one RCT, 13 observational, and 11 modelling studies. In women 50–69, annual compared to biennial screening may have small additional benefits but an important increase in false positive results; triennial compared to biennial screening may have smaller benefits while avoiding some harms. In younger women (aged 45–49), annual compared to biennial screening had a smaller gain in benefits and larger harms, showing a less favourable balance in this age group than in women 50–69. In women 70–74, there were fewer additional harms and similar benefits with shorter screening intervals. The overall certainty of the evidence for each of these comparisons was very low.ConclusionsIn women of average BC risk, screening intervals have different trade-offs for each age group. The balance probably favours biennial screening in women 50–69. In younger women, annual screening may have a less favourable balance, while in women aged 70–74 years longer screening intervals may be more favourable.

Automated Breast Density Measurement in Mammography for Cancer Risk Stratification

HomeRadiology: Imaging CancerVol. 3, No. 6 PreviousNext Research HighlightsFree AccessAutomated Breast Density Measurement in Mammography for Cancer Risk StratificationSurrin DeenSurrin DeenSurrin DeenPublished Online:Nov 26 2021https://doi.org/10.1148/rycan.2021219025MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: Breast density (BD) was quantified using automated software and compared with subjective radiologist rating of BD.■ Key Result: Automated software improved discrimination of cancer type and of interval cancers compared with visual assessment by a radiologist.■ Impact: Automated BD measurements from mammograms have the potential to stratify patients undergoing breast cancer screening, reducing false-positive rates and the frequency of unnecessary further tests such as MRI or biopsy.Stratified or risk-based breast cancer screening aims to select the most suitable personalized screening regimen for individual patients by estimating the likelihood of developing cancer and balancing this against the negative impact of unnecessary tests. Risk-based stratification algorithms incorporate BD classified subjectively by a radiologist in Breast Imaging Reporting and Data System.In the retrospective case-control study highlighted here, the authors used a U.K.-based population database, the OPTIMAM Database, to identify screening mammograms with cancer in women aged 47EN_DASH73 years. Cancer-free controls (n = 605) were identified and matched to cancer cases (n = 599) on the basis of age and the imaging equipment used. Automated software (Volpara, version 1.5.1; Volpara Health Technologies) calculated fibroglandular volume (FGV), volumetric BD (VBD), and density grade (DG). This was compared to BD assessed by a blinded radiologist using a visual analogue scale (VAS) from 0 to 100.The relative discriminative ability of FGV, both overall and for individual cancer subtypes, was found to be either equivalent to or greater than that of VAS or VBD, whether using statistical analyses based on logistic regression, receiver operating characteristic curves, or number of cancers included in the highest risk category (highest quartile). FGV provided the steepest risk gradient for all cancers, with an odds ratio (OR) for the highest quartile compared to the lowest quartile of 3.7 (95% CI: 2.5, 5.6). FGV quartile, VBD quartile, and DG also predicted node-positive cancers, and FGV quartile demonstrated the steepest risk gradient for interval (OR, 5.3; CI: 3.1, 9.1; P < .01), node-positive (OR, 4.7; CI: 2.5, 9.0; P < .01), and combined cancers (OR, 4.7; CI: 2.9, 7.8; P < .01).This study suggests that automated FGV may provide a good foundation for stratified breast cancer screening. However, information on several covariates was not collected in this study, necessitating further work to confirm this finding.Highlighted ArticleBurnside ES, Warren LM, Myles J, et al. Quantitative breast density analysis to predict interval and node-positive cancers in pursuit of improved screening protocols: a case-control study. Br J Cancer 2021;125(6):884–892. doi: https://doi.org/10.1038/s41416-021-01466-yHighlighted ArticleBurnside ES, Warren LM, Myles J, et al. Quantitative breast density analysis to predict interval and node-positive cancers in pursuit of improved screening protocols: a case-control study. Br J Cancer 2021;125(6):884–892. doi: https://doi.org/10.1038/s41416-021-01466-y Crossref, Medline, Google ScholarArticle HistoryPublished online: Nov 26 2021 FiguresReferencesRelatedDetailsRecommended Articles Impact of New Technology Adoption on Breast Cancer ScreeningRadiology2018Volume: 290Issue: 3pp. 638-639Age-based versus Risk-based Mammography Screening in Women 40–49 Years Old: A Cross-sectional StudyRadiology2019Volume: 292Issue: 2pp. 321-328MRI Screening Interval in Women with a History of Breast CancerRadiology2021Volume: 300Issue: 2pp. 312-313Fully Automated Volumetric Breast Density Estimation from Digital Breast TomosynthesisRadiology2021Volume: 301Issue: 3pp. 561-568Deep Learning Predicts Interval and Screening-detected Cancer from Screening Mammograms: A Case-Case-Control Study in 6369 WomenRadiology2021Volume: 301Issue: 3pp. 550-558See More RSNA Education Exhibits Let’s Talk about Next-Generation Breast Cancer Screening Programs: How Should We Do? What Should We Use?Digital Posters2020The Impact of New Genetic Mutations Associated with Breast Cancer on Breast MRI ScreeningDigital Posters2020Dense Breast: Is It Really Looking for a Needle in the Haystack? Digital Posters2020 RSNA Case Collection Malignancy on abbreviated screening breast MRIRSNA Case Collection2020Multifocal breast cancerRSNA Case Collection2020Breast density change with hormone replacement RSNA Case Collection2021 Vol. 3, No. 6 Metrics Altmetric Score PDF download

Breast Density, Risk of Breast Cancer, and Screening Mammography in Women 75 Years and Older

Breast Density, Risk of Breast Cancer, and Screening Mammography in Women 75 Years and Older

Abstract PS2-41: Supplemental contrast enhanced mammography screening of women with elevated risk of breast cancer

Abstract Objective and Rationale: To investigate the utility of screening Contrast Enhanced Mammography (CEM) imaging as a supplemental screening tool in women at elevated risk for breast cancer. Materials and Methods: This prospective, single institution, IRB approved observational study was conducted in asymptomatic women 35 years of age or older who were deemed at elevated risk of breast cancer, defined as IBIS v.8.0 lifetime risk of breast cancer score &amp;gt;15% or a prior personal history of breast cancer. Enrollment started in January 2019 and is on-going. An interim data analysis was performed. Women were invited to undergo supplemental CEM screening within 180 days of negative (BI-RADS 1 or 2) conventional 2D/3D screening mammography (MG). Patients with prior screening MBI, ultrasound or MR imaging within 12 months were excluded from study participation. Outcome measures were supplemental cancer detection rates, sensitivity, specificity, positive predictive value, and negative predictive value of CEM, along with their 95% confidence intervals, as well as the biologic profiles of MG-occult, CEM detected cancers. Results: A total of 351 women were enrolled in this prospective study over a 20-month period. To date, we have 1 year follow up on 106 cases with negative follow-up MG. Average age of the participants was 56 years ± 9.44 (standard deviation); 11 patients had screening 2D MG, 333 had combined 3-D and 2-D screening MG; 309 dense and 37 non-dense breasts based on ACR BI-RADS categories. CEM depicted 8 additional breast cancers (table 1), which were otherwise MG occult, for an overall supplemental cancer detection rate of 22.7 per 1000 patients, 95% CI (9.9, 44.3). 1 false negative cancer on CEM imaging which was further detected on MR imaging only. Biopsy revealed 16 benign changes (16/28=57%), 4 high-risk lesions (4/28=14%), and 8 breast cancers (8/28=29%) (table 2). CEM imaging screening offered high specificity (0.942, 95% CI (0.917, 0.967), high NPV 0.997, 95% CI (0.991, 1.000) and moderate PPV (0.286, 95% CI (0.118, 0.453) and sensitivity (0.889, 95% CI (0.684, 1.000)). Size of CEM detected cancers ranged from 7 to 57 mm. Conclusion: This pilot trial demonstrates a supplemental cancer detection rate of 22.7 per 1000 during prevalence round of CEM screening in women at an elevated risk for breast cancer. These initial results are comparable to results reported for high-risk surveillance MR imaging. Larger, multi-institutional high-risk CEM trials are needed for those patients who are not otherwise undergoing regular supplemental surveillance MR imaging. Citation Format: Bhavika K. Patel, Victor Pizzitola, Donald Northfelt, Karen Anderson, Marina Giurescu, Gina Mazza, Roxanne Lorans, William Eversman, Richard Sharpe, Juliana Kling, Denise Millstine, Ernst Brenda, Patricia Cronin, Heidi Apsey, Jennifer Palmieri, Barbara Pockaj, Michele Halyard. Supplemental contrast enhanced mammography screening of women with elevated risk of breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS2-41.

Routine Breast Cancer Screening in Average-Risk Women Younger Than 50 Years: Current Paradigms Based on National Guidelines.

Breast cancer poses a large health care burden. More than 270,000 women are diagnosed with breast cancer every year in the United States alone, and more than 40,000 women will die from the disease over the same period. Advances in routine screening and curative treatment options have led to mean 5-year survival rates for localized and regional disease of 98.9% and 85.7%, respectively. Diagnosis at an early stage, often due to routine screening, represents one of the most important prognostic factors for survival. Routine mammography screening in average-risk women 50 years and older has reduced the age-adjusted mortality rate from breast cancer by 34% just over the past 20 years.2,3 While there is consensus among national health organizations regarding the benefits of routine mammographic screening in women 50 years and older, screening recommendations for average-risk women aged between 40 and 49 years vary. Differences in screening recommendations among national organizations largely reflect variations in assessment of the benefit-to-harm ratio of screening women aged between 40 and 49 years who are less likely to develop breast cancer, compared with older women. Women who do develop breast cancer in this age group, however, are more likely to develop more aggressive disease.4,5 Over the past decade, this has become an increasingly important topic of discussion as breast cancer shifts to a younger age of onset.1 In this review, we examine the risks and benefits of routine breast cancer screening starting at age 40 at the individual level, followed by an evaluation of the role of advanced imaging techniques in screening women on a population level.

Update of international guidelines for breast cancer screening

In the last decade, the number of breast cancer cases has increased by 35% worldwide. The screening mammography clearly reduces the relative risk of breast cancer mortality in women between 50 and 59 years old, the decrease being more important for the age range 60-69 years old. The United States of America together with international specialized groups recommend mammographic screening in women between 50 and 74 years old every 1-2 years, depending on the individual risk factors and on the patient’s desire. Japan’s position is that of recommending mammographic screening without clinical examination of the breasts for women between the ages of 40 and 74. In the European Union, population screening by mammography in women aged 50-69 has been recognized as a priority, along with the screening for cervical and colon cancer, since 2003. Romania presents a major delay in the implementation of organized screening of the population for breast cancer compared to other EU members, although the number of cases is increasing.

Recommendations for breast cancer screening – Author's reply

László Tabár and Peter Dean, Martin Yaffe and colleagues, and Daniel B Kopans have used my commentary 1 Miller AB Final results of the UK Age trial on breast cancer screening age. Lancet Oncol. 2020; 21: 1125-1126 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar on the UK Age trial as a means to comment adversely on the Canadian National Breast Screening Study. Tabár and Dean rely on the International Agency for Research on Cancer 2016 evaluation of breast screening 2 International Agency for Research on Cancer Working Group on the Evaluation of Cancer Preventive StrategiesBreast Cancer Screening IARC Handbooks of Cancer Prevention. Volume 15. International Agency for Research on Cancer, Lyon2016: 254 Google Scholar to support their arguments, yet that evaluation did not consider the Canadian National Breast Screening Study. Yaffe and colleagues were impressed with the 25% reduction in breast cancer mortality at 10 years of follow-up in the UK Age trial (relative rate 0·75 [95% CI 0·58–0·97]), but acknowledge that this was attenuated on longer follow-up (0·98 [0·79–1·22]). They dismiss our determination of overdiagnosis in the Canadian National Breast Screening Study, casting doubt on the efficiency of our follow-up, which was in fact based on record linkage with the Canadian cancer and death registries. Only Kopans refers to the UK Age trial 3 Duffy SW Vulkan D Cuckle H et al. Effect of mammographic screening from age 40 years on breast cancer mortality (UK Age trial): final results of a randomised, controlled trial. Lancet Oncol. 2020; 21: 1165-1172 Summary Full Text Full Text PDF PubMed Scopus (26) Google Scholar and suggests that the absence of a benefit from initiating mammography screening at age 40–41 years could be because single-view mammography was used in the trial. This suggestion is ironic, as single-view mammography was used in Tabár and colleagues' Two-County Swedish trial, 4 Tabár L Vitak B Chen TH et al. Swedish Two-County trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology. 2011; 260: 658-663 Crossref PubMed Scopus (490) Google Scholar where a benefit of mammography screening in women from age 40 years was reported. Final results of the UK Age trial on breast cancer screening ageIn The Lancet Oncology, the findings from a 23-year follow-up of the UK Age trial are presented by Stephen Duffy and colleagues.1 No difference in mortality from breast cancer was found between the group that began yearly mammography screening at age 39–41 years until they entered the National Health Service (NHS) Breast Screening Programme at age 50–52 years, and a group that did not begin mammography screening until they entered the NHS Breast Screening Programme (126 deaths vs 255 deaths occurring after more than 10 years of follow-up; relative rate 0·98 [95% CI 0·79–1·22]; p=0·86). Full-Text PDF Open AccessRecommendations for breast cancer screeningDespite evidence confirming the benefits of detecting breast cancer before it becomes palpable, in his Comment, Anthony Miller1 advocates that women should not have mammography screening, but instead could wait until their breast cancers have grown large enough to become palpable. Contrary to his closing statement, Miller's argument against earlier diagnosis of breast cancer through mammography screening is not supported by the WHO recommendations, which review various methodologies available to bring care to patients as early as possible. Full-Text PDF Recommendations for breast cancer screeningIn his Comment on the UK Age trial, Anthony Miller1 stated that it could be argued that breast cancer screening with mammography should not be initiated at any age. We disagree with this assertion, given the overwhelming evidence from multiple randomised trials and observational studies showing the lifesaving benefits of mammography screening—benefits that have been acknowledged by guideline-setting bodies in several countries.2 Furthermore, recent publications have shown a reduced need for mastectomy, chemotherapy, and axillary dissection when breast cancers are detected by mammography screening. Full-Text PDF Recommendations for breast cancer screeningIn his Comment, Anthony Miller1 asserted that his trials showed “comparability of the study groups”. Although Miller states that women were randomly assigned in the Canadian National Breast Screening Studies, he did not mention that all women had a clinical breast examination before allocation and study coordinators with this information could assign women out of random order. Significantly more women with palpable, advanced cancers were allocated to the screening group than to the control group of the Canadian National Breast Screening Study-1. Full-Text PDF