Does computer-aided detection (CAD) contribute to the performance of digital mammography in a self-referred population?

Background Recent evidence suggests that computer-aided detection (CAD) may have a negative impact on the interpretation of mammography-this necessitates timely evaluation of CAD in practice. We report a retrospective study of the incremental effect of CAD on the accuracy of full-field digital mammography (DM) as applied prospectively in breast assessment. Methods: Subjects were all consecutive women attending a self-referral breast centre in Florence between September 2005 and January 2007 (N = 3,425). DM was reported without, then with, CAD according to a standard protocol; all mammograms recalled on the basis of either the radiologist's reading alone, or the radiologist's reading after viewing CAD, were recalled to assessment. Results Overall recall rate (RR) was 13.1% and 107 cancers were diagnosed (90 invasive cancers, 8 DCIS, 9 malignant on cytology). The use of CAD allowed the additional detection of 5 cancers (three invasive cancers, one DCIS, one malignant on cytology) and caused one additional benign surgical biopsy, with a relative RR of 4.9%, and an incremental RR of 1.17%. The cancer detection rate (CDR) of DM interpreted with the use of CAD was 3.12% and did not significantly differ from the CDR of 2.9% based on DM without CAD (chi(2) = 3.2, P = 0.07). Conclusion While the increase in CDR with the use of CAD only approached statistical significance, representing modest gains in absolute terms, the incremental number of cancers detected justifies the incremental recall and benign surgical biopsy attributable to CAD use. In our clinical setting, these data suggest more benefit than harm in using CAD with DM, and we will continue the use of CAD with ongoing monitoring of patient outcomes.     

What proportion of breast cancers are detected by mammography in the United States?

BACKGROUND: None of the recent national studies has ascertained how women's breast cancer was detected in the United States. To rectify this gap, questions were added to the leading national health survey. Mammography was of special interest because it is widely used in the US and has evidence of a mortality benefit. METHODS: We used the 2003 National Health Interview Survey (NHIS), to ascertain the self-reported modalities used to detect breast cancer in the non-institutionalized US population. The study included 345 women 40-84 years of age who, in 2003, reported a personal history of breast cancer. We examined the frequency of self-reported characteristics and tested for association with mammography-detected breast cancer using logistic regression. RESULTS: Among the survivors in 2003, the percentage of breast cancers detected by mammography was much higher after 2001 (59%) than before 1993 (29%). Breast cancer survivors with less than high school education or less than US$ 20,000 household income were less likely to report detection by mammography. CONCLUSIONS: Women reported mammography-detected breast cancer at a slightly higher rate than published studies of mammography sensitivity and use would suggest. Lower rates of mammography-detected breast cancers among survivors with low income or low education raise the question whether mammography is underutilized as a diagnostic tool, especially for underserved women.     

Predictors of mammography use in older women with disability: the patients’ perspectives

To determine the factors associated with mammography use among Medicare beneficiaries and reasons for nonuse. Cohort of 4610 community-dwelling Medicare beneficiaries ≥65 years included in the 2004–2005 Medicare Current Beneficiary Survey. Regression models evaluated the association of disability with mammography use. Reasons for underuse are described. Women with disability were more likely than women with no disability to report lower mammography use (unadjusted, moderate disability OR = 0.76; 95% CI = 0.64, 0.91; severe disability OR = 0.46; 95% CI = 0.40, 0.54). Lower use was significant for women with severe disability (adjusted, OR = 0.67; 95% CI = 0.54, 0.83) and women with fair-poor self-rated health, no HMO enrollment and ≥3 comorbidities. No physician recommendation, no need, dislike/pain during the test and forget it were reasons for underutilization. Mammography use decreases with increasing level of disability. Common reasons for underutilization are no physician recommendation, no need, dislike/pain during the test and forgot it. Screening guidelines should be used to target women with disabilities who can benefit from mammography.     

Sociodemographic predictors of non-attendance at invitational mammography screening – a population-based register study (Sweden)

Objective: To investigate the role of sociodemographic factors in predicting mammography uptake in an outreach screening program. Methods: Linkage of data from a regional population-based mammography program with four Swedish nationwide registers: the Population and Housing Census of 1990, the Fertility Register, the Cancer Register, and the Cause of Death Register. We computed odds ratios (OR) and 95% confidence intervals (CI) for non-attendance by sociodemographic factors. Non-attendance was defined as failure to attend in response to the two most recent invitations. Results: Multivariate analyses among 4198 non-attenders and 38,972 attenders revealed that both childless and high-parity women were more likely to be non-attenders (OR = 1.8, 95% CI: 1.6–2.0 and OR = 2.2, 95% CI: 1.8–2.7, respectively). Women living without a partner were less likely to attend (OR = 1.7, 95% CI: 1.5–1.9), as were non-employed women (OR = 2.1, 95% CI: 1.9–2.3). Those renting an apartment were more likely to be non-attenders compared with home-owners (OR = 1.8, 95% CI: 1.6–2.0), and immigrants from non-Nordic countries were more than twice as likely to be non-attenders compared with Swedish-born women (OR = 2.4, 95% CI: 2.0–2.8). Conclusions: There are identifiable subgroups in which mammography utilization can be increased. Special attention should be paid to women who have never attended, childless women, and non-Nordic immigrants.     

The clinical impact of breast scintigraphy acquired with a breast specific γ-camera (BSGC) in the diagnosis of breast cancer: incremental value versus mammography

We investigated the clinical impact of breast scintigraphy acquired with a breast specific γ-camera (BSGC) in the diagnosis of breast cancer (BC) and assessed its incremental value over mammography (Mx). A consecutive series of 467 patients underwent BSGC scintigraphy for different indications: suspicious lesions on physical examination and/or on US/MRI negative at Mx (BI-RADS 1 or 3), characterization of lesions suspicious at Mx (BI-RADS 4), preoperative staging in lesions highly suggestive of malignancy at Mx (BI-RADS 5). Definitive histopathological findings were obtained in all cases after scintigraphy: 420/467 patients had BC, while 47/467 patients had benign lesions. The scintigraphic data were correlated to Mx BI-RADS category findings and to histology. The incremental value of scintigraphy over Mx was calculated. Scintigraphy was true-positive in 97.1% BC patients, detecting 96.2% of overall tumor foci, including 91.5% of carcinomas ≤10 mm, and it was true-negative in 85.1% of patients with benign lesions. Scintigraphy gave an additional value over Mx in 141/467 cases (30.2%). In particular, scintigraphy ascertained BC missed at Mx in 31 patients with BI-RADS 1 or 3, including 26 patients with heterogeneously/high dense breast (19/26 with tumors ≤10 mm) and detected additional clinically occult ipsilateral or controlateral tumor foci (all <10 mm) or the in situ component sited around invasive tumors in 77 BC patients with BI-RADS 4 or 5, changing surgical management in 18.2% of these cases; moreover, scintigraphy ruled out malignancy in 33 patients with BI-RADS 4. BSGC scintigraphy proved a highly sensitive diagnostic tool, even in small size carcinoma detection, while maintaining a high specificity. The procedure increased both the sensitivity of Mx, especially in dense breast and in multifocal/multicentric disease, and the specificity as well as it better defined local tumor extension, thus guiding the surgeon to a more appropriate surgical treatment.     

Association between radiologists’ and facilities’ characteristics and mammography screening detection of ductal carcinoma in situ

Breast Cancer Research and Treatment - The aim of our study was, first, to measure association between radiologists and facilities characteristics and DCIS detection. Second, to assess whether...     

Trends in stage-specific breast cancer incidence in New South Wales,Australia: insights into the effects of 25 years of screening mammography

Purpose

Screening mammography aims to improve breast cancer (BC) prognosis by increasing the incidence of early-stage tumours in order to decrease the incidence of late-stage cancer, but no reports have investigated these potential effects in an Australian population. Therefore we aimed to identify temporal trends in stage-specific BC in New South Wales (NSW), Australia, between 1972 and 2012.

Methods

An observational study of women who received a diagnosis of BC from 1972–2012 as recorded in the NSW Cancer Registry, a population-based registry with almost complete coverage and high rates of histological verification. We analysed trends in stage-specific incidence before screening and compared them to periods after screening began. Our primary group of interest was women in the target age range of 50–69 years, though trends in women outside the target age were also assessed.

Results

Screening was not associated with lower incidence of late-stage BC at diagnosis. Incidence for all stages remained higher than prescreening levels. In women aged 50–69 years, the incidence of carcinoma in situ (CIS), localised and regional BC has more than doubled compared to the prescreening era, with incidence rate ratios ranging from 2.0 for regional (95% CI 1.95–2.13) to 121.8 for CIS (95% CI 82.58–179.72). Before the introduction of screening, there was a downward trend in distant metastatic BC incidence, and after the introduction of screening there was an increase (IRR 1.8; 95% CI 1.62–2.00). In women too young to screen the incidence of late-stage BC at diagnosis also increased, whereas localised disease was stable.

Conclusions

The incidence of all stages of BC has increased over the past 40 years, with the greatest rise seen during the established screening period for women aged 50–69 years. Our findings suggest that some of the expected benefits of screening may not have been realised and are consistent with overdiagnosis.

     

Health-related quality of life in survivors of tumours of the central nervous system in childhood—a preference-based approach to measurement in a cross-sectional study

There is an evident need to measure the comprehensive burden of morbidity experienced by survivors of brain tumours in childhood. To this end, a questionnaire based on the Health Utilities Index mark 2 (HUI2) and mark 3 (HUI3) systems was completed independently for a cohort of such children by their parents, by a nurse, by physicians and by a selected group of the children themselves. Each of the HUI2 and HUI3 systems consists of a multi-attribute health status classification scheme linked to a preference function which provides utility scores for levels within single attributes (domains of health) and for global health states. All eligible families (n=44) participated. Even cognitively impaired children of at least 9.5 years of age could complete the questionnaire. The greatest burden of morbidity, occurring in two-thirds of children, was in the attribute of cognition. Surprisingly, almost one-third of children experienced pain. Global health status was lowest in children who underwent radiotherapy before the age of 5 years and the corresponding utility scores were related inversely to the volume irradiated. Children with demonstrable disease had lower scores than those in whom disease was not evident. There was a high level of agreement (intraclass correlation coefficients >0.5) on formal assessment of inter-rater reliability for global health-related quality of life utility scores. The usefulness of measures of health status and health-related quality of life, in children surviving brain tumours, has been demonstrated by this study.     

Clinical Research of a Modified Midfacial Degloving in a Maxillectomy （with a Report of a Typical Case）

OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation.The tumors were classified according to the 2002 AJCC system.The TNM staging of the cases was as follows:1 T4aN0M0,2 T3N0M0 and 5 T2N0M0.Of the 8 cases,1 patient underwent extended maxillectomy;exenteration of the orbit;tumorectomy of the sphenomaxillary and infratemporal fossae.Two patients received a total maxillectomy,and 5 a partial resection of the maxilla. Postoperative pathological report:4 well-di?erentiated squamous carcinoma,2 moderately-differentiated squamous carcinoma,1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma. RESULTS A modified midfacial degloving operation can sufficiently expose a field of operation,resect the tumor within a safe margin,and leave no facial cicatricles.One patient died of intracranial metastasis 8 months a er operation.We observed no recurrences or metastasis in other patients during the period of follow-up. CONCLUSION The major advantages of employing the modified midfacial degloving in maxillectomy is that a facial incision can be avoided.It has an advantage of minimal invasive surgery.     

Protection of mammography screening against death from breast cancer in women aged 40–64 years

OBJECTIVE: This study assessed the efficacy of community-based screening mammography in protecting against breast cancer death, asking whether age differences in efficacy persisted in the 1990s. METHODS: In a case-control study with follow-up, odds ratios (OR) were used to estimate the relative mortality rates from invasive breast cancer among women with at least one screening mammogram in the two years prior to a baseline reference date compared to non-screened women, adjusting for potential confounding. The multicenter population-based study included 553 black and white women diagnosed during 1994-1998 who died in the following five years, and 4016 controls without breast cancer. RESULTS: Efficacy for reducing the rate of breast cancer death within five years after diagnosis was greater at ages 50-64 years (OR = 0.47, 95% confidence interval (CI) 0.35-0.63) than at ages 40-49 (OR = 0.89, 95% CI 0.65-1.23), and greater among postmenopausal (OR = 0.45, 95% CI 0.33-0.62) than premenopausal women (OR = 0.74, 95% CI 0.53-1.04). Estimates of efficacy were conservative, as shown by sensitivity analyses addressing whether cancer was discovered by a screening mammogram, age at which screening was received, the length of the screening observation window, and years of follow-up after diagnosis. CONCLUSIONS: Despite the persistence of age differences in efficacy of mammography screening, with greater observed benefit for women aged 50-64 years, these findings support current screening recommendations for women 40-64 years old.     

Methods of early detection： would clinical breastexamination and breast ultrasonography be a good alternative to mammography？

Breast cancer is one of the leading causes of cancer deaths among women[1].In the past 40 years,breast cancer incidence has doubled or even tripled in developed countries such as South Korea and Japan; whereas it is about 20% to 30% in China and India in the past decade[2-4]. An increasing incidence rate of 3%     

Was the drop in mammography rates in 2005 associated with the drop in hormone therapy use?

BACKGROUND:

In 2005, mammography rates in the United States dropped nationally for the first time among age‐eligible women. An increased risk of breast cancer related to hormone therapy (HT) use reported in 2002 led to a dramatic drop in its use by 2005. Because current users of HT also tend to have higher mammography rates, the authors examined whether concurrent drops in HT and mammography use were associated.

METHODS:

Multivariate logistic regression was used to test for an interaction between HT use and survey year, controlling for a range of measurable factors in data from the 2000 and 2005 National Health Interview Surveys (NHIS).

RESULTS:

Women ages 50 to 64 years were more likely to report a recent mammogram if they also reported more education, a usual source of care, private health insurance, any race except non‐Hispanic Asian, talking with an obstetrician/gynecologist or other physician in the past 12 months, or were currently taking HT. Women aged ≥65 years were more likely to report a recent mammogram if they also reported younger age (ages 65‐74 years), more education, a usual source of care, having Medicare Part B or other supplemental Medicare insurance, excellent health, any race except non‐Hispanic Asian, talking with an obstetrician/gynecologist or other physician in the past 12 months, or were currently taking HT.

CONCLUSIONS:

The change in HT use was associated with the drop in mammography use for women ages 50 to 64 years but not for women aged ≥65 years. NHIS data explained 70% to 80% of the change in mammography use. Cancer 2011;. © 2011 American Cancer Society.     

The beginning of a decline in breast cancer incidence in Italy?

The incidence of invasive breast cancer in Turin, Italy, showed a statistically significant decrease during 1999-2003 overall (estimated annual percent change -2.6; 95% CL -8.52; -0.78) and in women aged over 50, similar to the recently documented trend in American data. This represents the first demonstration of a decline in breast cancer incidence in the early years of this decade outside the United States. In our population, the drop in the usage of hormone replacement therapy which occurred after 2002 is unlikely to be at the origin of this declining incidence trend, which is largely explained by a screening effect. This observation may be relevant to other geographical areas where organized or spontaneous screening reached a plateau after an increase in the preceding years.     

Experimental Study of Ultrasound on MDR in a Human Tumor in Vivo

OBJECTIVE To evaluate the potential efficacy of low-intensity ultrasound(US)in combination with anticancer drugs to reverse multidrug resistance(MDR)in nude mice. METHODS A total of 40 male and female athymic nude mice were inoculated subcutaneously with 5x106 HepG 2 /ADM and HepG 2 cells.Ultrasound with pulsed irradiation at an average intensity of 0.5 W/cm2 was given to the tumor area 10 min after administration of adriamycin(ADM).The tumor 3 dimensional diameters were measured by calipers before and after treatment, and the tumor growth indexes(TGI)calculated.RT-PCR was used to detect the gene levels of the HepG 2 /ADM cells.Immunohistochemical analyses for MDR proteins were conducted on the tumor tissues. RESULTS The ultrasonic treatment resulted in an average reduction in the tumor volume of 62%one month later.The relative mRNA levels of MDR1 and MRP were significantly different among the folowing 4 groups: untreated group as control,ADM treated;US treated;and ADM plus US treated.The mRNA levels of mdr1 and mrp were down-regulated in the US groups compared to those of the non-ultrasound groups by multiple com- parisons.The relative mRNA levels of lrp expression were not significantly changed.The results of immunohistochemistry indicated that tumor tissue from animals treated with US had remarkably low mdr1 and mrp expression. CONCLUSION The results showed that low-intensity US can effectively reduce the size of adriamycin-resistant human hepotacarcinoma in a nude mouse model,and support the efficacy of US to overcome multiple mechanisms of drug resistance.