Systematic Mammography Research Articles

First site of recurrence after breast cancer adjuvant treatment in the era of multimodality therapy: which imaging for which patient during follow-up?

We evaluated the relation between first site of recurrence of early breast cancer and disease profile at presentation and reported survival results, suggesting a personalized diagnostic imaging guidance during follow up. Among 1400 early breast cancer treated from 2000 to 2010, 324 relapses were divided into 4 groups according to first site: A-locoregional, B-bone, C-Brain and D-visceral. We analyzed redictive factors of each group compared to a control group of 100 non relapsing patients and the remaining groups matched. In group A, patients were more likely to have histological tumor size above >2cm, grade 1-2, HR positive and 0-3 involved lymph nodes. In group B, patients had more commonly grade 2-3, 1-3 positive lymph nodes and HR positive tumors. In group C, patients were more frequently young, with large tumor size, grade3, positive lymph nodes and HER2 positive tumors. In group D, patients were more likely to have tumors>2cm in size, with nodal involvement, grade3, HR negative and HER2 positive tumors. Annual recurrence rate in group A, was stable ranging between 15%-18%, within the first 3 years and peaked at 19.4% in the interval [1-2]year in groupB. Median survival was 46 months in group A, 43 months in group B, with no significant difference. Outcome of loco-regional and bone relapses was good, suggesting that both systematic mammography and bone-scan/CT scan for high risk patients (N+, gradeIII) during the first 2-3years may represent a tailored relevant follow-up protocol for breast cancer patients.

From facts to arguments: A study of the 2014 Swiss controversy over systematic mammography screening

ObjectiveThe Swiss Medical Board (SMB) has recently revived the controversy over mammography screening by recommending to stop the introduction of new systematic mammography screening programs. This study aimed to examine the Swiss media coverage of the release of the SMB report. MethodsThe dataset consisted of 25 newspaper and “medical magazine” articles, and TV/radio interviews. The analytic approach was based on argumentation theory. ResultsAuthority and community arguments were the most frequent types of arguments. With respect to authority arguments, stakeholders for instance challenged or supported the expertise of the SMB by referring to the competence of external figures of authority. Community arguments were based on common values such as life (saved thanks to systematic mammography screening) and money (costs associated with unnecessary care induced by systematic mammography screening). ConclusionThe efficiency of mammography screening which was the key issue of the debate appeared to be largely eluded, and the question of what women should do endures. Practice implicationsWhile interpersonal and interprofessional communication has become a major topic of interest in the medical community, it appears that media communication on mammography screening is still rather ineffective. We call in particular for a more fact-based discussion.

Could Patients Older than 75 Years Benefit from a Systematic Breast Cancer Screening Program?

To assess prognosis of women aged 75 and older according to breast cancer (BC) diagnosis circumstances. A retrospective cohort study was conducted in the Amiens, France, regional oncologic referral center between 2005 and 2015. Two groups were formed depending on whether the patients followed clinical manifestations (CM) or a prescribed systematic mammography (SM). Three hundred and ninenty-three patients were selected. CM and SM represented 72% and 14.5% of BC diagnosis circumstances, respectively. In the SM group statistically significant differences included: earlier stage cancer diagnosis (tumor stages 0 and 1 accounted for 6.3% and 61.4% of cases, respectively), less lymph node invasions (35.7% and 8.8%) and metastases (19.1% and 0%), more frequent possibility of conservative surgery (25.6% and 74.5%), improved global and disease-free survival rates (by 14.2 and 18.4 months). Screening seems to improve prognosis of older BC patients; this constitutes a strong argument for reconsidering age limits of national BC screening programs.

Knowledge, barriers and attitudes towards breast cancer mammography screening in jordan.

Breast cancer is the most common type of cancer in Jordan. Current efforts are focused on annual campaigns aimed at increasing awareness about breast cancer and encouraging women to conduct mammogram screening. In the absence of regular systematic screening for breast cancer in Jordan, there is a need to evaluate current mammography screening uptake and its predictors, assess women's knowledge and attitudes towards breast cancer and screening mammograms and to identify barriers to this preventive service. This cross-sectional study was conducted in six governorates in Jordan through face- to-face interviews on a random sample of women aged 40 to 69 years. A total of 507 participants with mean age of 46.8±7.8 years were interviewed. There was low participation rate in early detection of breast cancer practices. Breast self-examination, doctor examination and periodic mammography screening were reported by 34.9%, 16.8% and 8.6% of study participants, respectively. Additionally 3.8% underwent breast cancer screening at least once but not periodically, while 87.6% had never undergone mammography screening. Reported reasons for conducting the screening were: perceived benefit (50%); family history of breast cancer (23.1%); perceived severity (21.2%); and advice from friend or family member (5.8%). City residents have shown higher probability of undergoing mammogram than those who live in towns or villages. Results revealed negative perceptions and limited knowledge of study participants on breast cancer and breast cancer screening. The most commonly reported barriers for women who never underwent screening were: fear of results (63.8%); no support from surrounding environment (59.7); cost of the test (53.4%); and religious belief, i.e. Qadaa Wa Qadar (51.1%). In the absence of regular systematic screening for breast cancer in Jordan, the uptake of this preventive service is very low. It is essential for the country of Jordan to work on applying regular systematic mammography screening for breast cancer. Additionally, there is a need for improvement in the current health promotion programmes targeting breast cancer screening. Other areas that could be targeted in future initiatives in this field include access to screening in rural areas and removal of current barriers.

Development and implementation of guidelines for quality assurance in breast cancer screening: The European experience

In Europe, as in many other regions of the world, breast cancer is a major cause of suffering and death. Early detection of breast cancer by systematic mammography screening can find lesions for which treatment is more effective and generally more favourable for quality of life. Comprehensive quality assurance guidelines for breast cancer screening based on mammography have been developed in the Europe Against Cancer programme with the aim of maximising screening benefits while minimising adverse effects, such as unnecessary examination or treatment resulting from false-positive screening tests. The present report provides an overview of the European experience in developing and implementing quality assurance guidelines for breast cancer screening. It highlights implications relevant to those regions of the world in which the burden of breast cancer in the coming years will make population-based screening an option for cancer control.

Registered and potential indications of FDG PET/CT in breast carcinoma

The indication of 18F-fluorodeoxyglucose (FDG) imaging has been more disputed in breast carcinoma than in many other primary cancers (e.g. lung, head and neck, colorectal, lymphoma...) due to a limited sensitivity to detect the primary tumours in case of lobular or in situ forms or small sized tumours detected on systematic mammography, and to identify minimal node invasion in the axilla. Nevertheless dedicated PET machines are now proposed to characterise breast lesions. For staging locally advanced or restaging recurrent or metastatic breast cancer, FDG PET/CT has a good diagnostic performance. As a functional whole-body imaging modality, it is able to detect extra-axilar metastatic lymph nodes, distant metastases including in the skeleton, where it outperforms bone scintigraphy or SPECT except in case of osteoblastic lesions, or to discover second primary cancers (around 2% of cases). A potential indication is monitoring response to chemotherapy, to early detect disease resistance or progression. To summarise published results and our own experience, the breast tumour SUVmax decreases with the number of cycles in most patients, including those who will show residual disease on pathology. It is therefore best to perform FDG PET/CT at baseline and after 1 cycle of chemotherapy; the criterion for prediction of an incomplete pathologic response would be a SUVmax reduction <50%. In case of adjuvant chemotherapy, the visual interpretation of FDG PET/CT performed after 5 months may be sufficient to predict disease-free survival; the response to chemotherapy evaluated by FDG PET is a better predictor of recurrence-free survival than pathologic response.

THE PREVALENCE OF BREAST CANCER IN SLOVAKIA

Background: Breast cancer is one of the most serious diseases in terms of epidemiological indicators on the whole world. In the last fifty years the incidence of disease has increased continuously. Currently such disease threatens every tenth woman and in this way it also endangers the lives of thousands. One of the reasons of high mortality is late diagnosis of the disease. Prevention is the most essential. Mammography screening for breast cancer presents the most effective method. By systematic mammography screening it is possible to reduce mortality up to 30%, mainly in the age group 50-69. Material and methods: In the work we focused on the statistics of mammography screening in the Slovak republic. The analysis compares mammography, examinations provided and estimation of the required number of preventive mammography examinations. Results: The largest number of mammography examinations is provided in Bratislava (23.95%), Košice (16.41%) and the region of Banska Bystrica (14.57%), the least in the region of Trnava (5.63%). Women from the age 40 are invited to a regular preventive mammogram every two years. This group becomes greater from year to year (by 1.78%). Evaluating the calculations according to individual regions it may be concluded that the number of conducted examinations are below the claimed number of preventive - the required examinations. Conclusion: Improving the availability of mammography screening in SR depends not only on increasing the state of medical instrumentation techniques, but also on the organization of work, eddification, information about the claims for preventive examinations and limition of the performance by health insurance organizations.

The debate over mass mammography: is it beneficial for women?

The authors discuss the controversy about mass screening for breast cancer in order to assess the soundness of a nationwide expansion of such programmes. Mass screening is second best because of the failure of prevention, therapeutic progress or ability to target high risk populations, but its efficacy reducing mortality is not clearly demonstrated and the chances of one woman being saved from participating are very low. Detrimental side-effects such as anxiety, false alarms, unnecessary biopsies, overdiagnosis and overtreatment and deficiency of psychological approach are reported. On the other hand, mass screening may save lives and if no recent study can provide absolute proof of efficacy, inefficacy of systematic mammography cannot be proven either, even concerning 40–49 years old women. Moreover, screening trials have allowed an improvement in medical practice, especially concerning quality and dose in mammography and radiographer's performance. Many questions remain unanswered about mass screening for breast cancer and the best way to achieve it.

Cancer risks and cancer prevention in Sweden.

Sweden has had cancer and population registers since 1958, indicating an increasing total age-adjusted cancer incidence. The incidence of liver, prostate and urinary tract cancer, as well as of melanoma and lymphoma, is increasing, whereas that of stomach cancer and Hodgkin's lymphoma is decreasing. National public recommendations by the nutrition and exercise committee of the National Board of Health and Welfare to reduce fat, salt, energy and sugar intake and to increase fiber intake and exercise have existed for 20 yr. The purpose was initially to prevent cardiovascular diseases, later also to prevent breast and prostatic cancer. Since the 1970s, Swedish women have been offered systematic gynecological health checks, resulting in a reduced incidence and mortality of cervix carcinoma. Local Swedish studies suggest that systematic mammography, which is now recommended on a national basis, can reduce breast cancer mortality by 30%. It is estimated that between 300 and 1100 cases of bronchopulmonary carcinoma are partly caused by a dwelling environment with over 400 Bq radon m-3. General rebuilding of the 40,000 houses concerned is at present being considered.