The role of magnetic resonance imaging in screening women at high risk of breast cancer

Most women at very high risk of breast cancer because of a mutation in the genes BRCA1 or BRCA2, or a very strong family history of breast cancer, opt for intensive breast screening rather than bilateral prophylactic mastectomy. Annual screening mammography has low sensitivity in this population in part because of the greater breast density and faster tumor growth of younger women, resulting in cancers being detected at a suboptimal stage. In 11 prospective comparative studies, the addition of annual contrast-enhanced magnetic resonance imaging (MRI) of the breast to mammography demonstrated more than 90% sensitivity, more than twice that of mammography alone. False-positive rates were higher with the addition of MRI, but specificity improved on successive rounds of screening. Although survival data are not yet available, the stage distribution of these tumors predicts a significant reduction in breast cancer mortality rate compared with that of screening without MRI. Accordingly, annual MRI plus mammography is now the standard of care for screening women aged 30 years or older who are known or likely to have inherited a strong predisposition to breast cancer (based on the above evidence) and for women who received radiation therapy to the chest before the age of 30 years (based on expert opinion). Further research is necessary to define the optimal screening schedule for different subgroups. Formal studies of other high-risk populations (eg, biopsy showing lobular neoplasia or atypical ductal hyperplasia, dense breasts, and personal history of breast cancer at a young age) should be done before MRI screening is routinely adopted for these women.     

Breast cancer screening.

Breast cancer, as the second leading form of cancer death among women, causes significant morbidity and mortality. The primary care physician can help raise the survival rate of women with breast cancer by providing important screening procedures that will lead to early diagnosis and treatment. Screening mammography and regular breast physical examinations are the current screening procedures of choice. Although there is still considerable debate over the age and interval at which women should undergo screening (see Table 1 for recommendations from various organizations), the primary care physician's recommendation is the single most important factor and will certainly lead to a higher screening rate for women in the greater at-risk age groups. Judicious use of these screening procedures should allow primary care physicians to catch more breast cancers at an early, curable stage.     

The nurse's role in mammography screening

Black women in Dade Country have a substantially higher proportion of advanced breast cancer at diagnosis than white women. To shift the stage at diagnosis from later to earlier, a Cancer Early Detection Program was initiated in the fall of 1987. This program involves screening with low-cost mammography, physical breast examination, and instruction in self-breast examination as well as general cancer education about prevention, early detection, and health promotion. The educational programs are presented in conjunction with the local unit of the American Cancer Society. A mobile mammography van travels to Primary Health Care Centers to provide mammograms to a population with limited access to preventive health care. This article describes the development and implementation of the program. It focuses on the responsibilities of an oncology nurse who coordinates and directs the program. Recommendations are made for ways oncology nurses can assume expanded roles in cancer screening/early detection.     

Imaging of the breast: techniques and results

Procedures for imaging of the breast have increased in number substantially in the past 30 years. Mammography, currently the most important breast imaging technique, was introduced at the Mayo Clinic in 1961. In 1988, more than 36,000 mammographic procedures were done. Breast ultrasonography is also a valuable examination, particularly for determining whether mass lesions are cystic or solid. The use of mammography for screening is increasing. Screening mammography allows the detection of breast cancer before it is palpable and while it is still in a stage known as minimal breast cancer. Lesions metastatic to axillary lymph nodes are less common in women with nonpalpable breast cancers than in women with palpable lesions. Nondiagnostic mammography should not delay the biopsy of a mass that is suspicious on physical examination. A special breast imaging center for performance of screening studies and evaluation of breast problems has been established at the Mayo Clinic.     

1502名社区女性钼靶筛查行为现状及影响因素研究The status and influencing factors of mammography screening behavior for 1502 women in community 陈乐英 吴怡颖 郁骐襄 沈坤炜 方琼*

目的 调查社区女性实施乳腺钼靶筛查行为的现状,并分析影响其实施的相关因素。方法 2012年对上海16个社区共1502名女性进行问卷调查。结果 调查中≥40岁的女性中,有544人（占49.5%）从未做过乳腺钼靶检查,仅有284人（占25.8%）每年参与乳腺钼靶检查;乳腺疾病史、是否有机会参加乳腺健康检查、是否知道乳腺自我检查方法、医院是否有专业检查人员及设备是重要影响因素（F=34.427 P＜0.001 R2=0.468）。结论 目前社区女性参与乳腺钼靶筛查行为处于较低水平,医护人员需要从其影响因素着手,探索并研究如何提高女性参与乳腺癌早期筛查率的方法。     

Diagnosis of early stage of breast cancer by mammography

The incidence of small breast carcinoma especially of non-palpable lesion is increasing after introduction of mammography screening. The tumor of which diameter is less than 2 cm, non invasive carcinoma, and Paget's disease are included in early stage of breast cancer. This article introduces the rate of early stage breast cancer in the mammography screening and the feature of these mammographic findings. Furthermore, we are going to reevaluate mammographical findings, occurrence of invasion, and evaluation the size of the lesion by mammography which are thought to be important for the diagnosis of early stage of breast cancer.     

Comprehensive breast cancer screening. Programs now include individual risk assessment

A comprehensive breast cancer screening program needs to include risk assessment in addition to clinical breast examination and mammography. Women identified as being at increased risk should have an individualized schedule of screening mammography and a proven prevention program tailored to their level of risk. In this article, Drs Cardenas and Frisch review risk factors, screening methods, and individual risk assessment, then explain how to use them in conjunction to identify tumors at an earlier, more curable stage.     

Health Behavioural Theories and Their Application to Women's Participation in Mammography Screening

The most effective method of detecting breast cancer among asymptomatic women is by mammography screening. Most countries have this preventive measure in place for women within their society; however, most of these programs struggle with attendance. This article discusses four health behavioural theories and models in relation to mammography screening that may explain the factors affecting women's participation, including the health belief model, theory of planned behaviour, trans-theoretical model, and the theory of care seeking behaviour. In summary, analysis of these theories indicates that the theory of care seeking behaviour has value for exploring these factors because of its sensitivity to socioeconomic differences that exist among women in society and because it has a broader construct (such as habit and external factors) compared to the other health behavioural theories.     

Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals

Mammography is the standard for breast cancer screening. The sensitivity of mammography in identifying breast cancer, however, is reduced for women with dense breasts. Thirty-eight states have passed laws requiring that all women be notified of breast tissue density results in their mammogram report. The notification includes a statement that differs by state, encouraging women to discuss supplemental screening options with their health care professionals (HCPs). Several supplemental screening tests are available for women with dense breast tissue, but no established guidelines exist to direct HCPs in their recommendation of preferred supplemental screening test. Tailored screening, which takes into consideration the patient’s mammographic breast density and lifetime breast cancer risk, can guide breast cancer screening strategies that are more comprehensive. This review describes the benefits and limitations of the various available supplemental screening tests to guide HCPs and patients in choosing the appropriate breast cancer screening.     

Mail versus telephone surveys on mammography utilization among women 50-75 years old

Surveys are needed to monitor trends in mammography use and to evaluate intervention programs aimed at increasing breast cancer screening. In a community-based intervention project in Long Island (New York), estimated response rates were similar in separate random surveys of women 50-75 years old by mail and telephone. Respondents by mail (n = 2,368) and telephone (n = 1,011) were similar in distributions of age, marital status, and educational level, and mail respondents did not have higher income levels than telephone respondents. Reported utilization of breast cancer screening tests was similar by survey mode. A statistically significant positive association between mammography utilization and income level was evident in both mail and telephone surveys. These findings should promote the consideration of mail surveys in other studies of the utilization of breast cancer screening tests by various health care organizations.     

Early detection of breast cancer in women

Breast self-exam, clinical breast exam and mammography are the primary screening modalities for the early detection of breast cancer. In this article, we review the epidemiology of breast cancer and methodologic considerations in screening for breast cancer. For each screening modality, we assess the evidence for its effectiveness in reducing breast cancer mortality. For each modality we also discuss the limitations, cost/benefit considerations, utilization, and published recommendations for use. This article is intended to facilitate primary care providers in decision-making regarding the early detection of breast cancer.     

Multi-level Intervention to increase participation in mammography screening: ¡Fortaleza Latina! study design

BackgroundBreast cancer is the most common cancer and the leading cause of death among Latinas in the United States. The Multi-level Intervention to Increase Participation in Mammography Screening study (¡Fortaleza Latina!) is a partnership among research institutions, a Latino-serving community-based primary care clinic organization, and a cancer treatment center. The study will assess the efficacy of a clinic- and patient-level program to increase breast cancer screening among Latinas in Western Washington.Methods/designThe intervention is a multi-level breast cancer screening program in four participating primary care clinics. The study is a parallel randomized controlled trial of 600 Latino women aged 42–74 who are non-compliant with breast cancer screening guidelines. Participants will be randomized within clinic using block randomization to: (1) a control arm (usual care); and (2) a theory-based counseling program consisting of a ‘promotora’ or community health worker-led home-based intervention to encourage breast cancer screening. At the clinic-level, two clinics will offer additional mammography services provided by a mobile mammography unit operated by the Seattle Cancer Care Alliance. The primary endpoint is the rate of mammography uptake over the 1-year follow-up period.DiscussionThis multi-level intervention aims to raise rates of participation in breast cancer screening among Latino women. If effective, the program may improve rates of early detection of breast cancer in Latino women.Clinicaltrials.gov Registration Number: NCT02010008.     

Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients

The axillary node status is important in the prognosis of breast cancer. To evaluate the accuracy of various preoperative examination methods in detecting metastatic axillary lymph nodes, we compared the findings of clinical examination, axillary ultrasonography, and axillary mammography of 41 breast cancer patients who underwent axillary dissection and histological examination. The sensitivity was 72.7% for ultrasonography, 38.9% for axillary mammography, and 32.3% for clinical examination. Ultrasonography provides good information about the axillary nodal status. The specificity can be increased by fine-needle biopsy under ultrasound guidance.     

Breast imaging. A practical look at its capabilities and its limitations.

The film-screen technique is evolving as the standard for mammography. Sonography is the only other method that currently has a defined role in breast imaging. Mammography should be performed at facilities that have received American College of Radiology accreditation or its equivalent, because technical quality assurance is an important part of mammographic practice. Interpretive quality may be assured by outcome audits performed by mammography facilities. Primary care physicians are best suited to encouraging eligible women to undergo screening studies and should consider these recommendations: Refer patients for screening mammography to accredited facilities according to established guidelines. Educate patients about the need for regular screening. Provide annual breast physical examination. Refresh your knowledge on breast health and the techniques of physical examination if necessary. Teach patients breast self-examination techniques. Demand low-cost, high-quality screening mammography; be aware of local variability of charges and quality.     

Computerized analysis of images in the detection and diagnosis of breast cancer.

Improvements in mammographic acquisition techniques have resulted in making the early signs of breast cancer more apparent on mammograms. However, the accuracy of the overall mammographic examination depends on both the quality of the mammographic images and the ability of the radiologist to interpret those images. While mammography is the best screening method for the early detection of breast cancer, radiologists do miss lesions on mammograms. Use of output, however, from a computerized analysis of an image by a radiologist may help him/her in the detection or diagnostic tasks, and potentially improve the overall interpretation of breast images and the subsequent patient care. Computer-aided detection and diagnosis (CAD) involves the application of computer technology to the process of medical image interpretation. CAD can be defined as a diagnosis made by a radiologist, who uses the output from a computerized analysis of medical images as a "second opinion" in detecting and diagnosing lesions, with the final diagnosis being made by the radiologist. The computer output must be at a sufficient performance level, and in addition, the output must be displayed in a user-friendly format for effective and efficient use by the radiologist. This chapter reviews CAD in breast cancer detection and diagnosis, including examples of image analyses, multi-modality approaches (i.e., special-view diagnostic mammography, ultrasound, and MRI), and means of communicating the computer output to the human.     

Breast Cancer Screening in Premenopausal Women: Current Recommendations and Opportunities for Research

The American Cancer Society recommends periodic mammography, clinical breast examination and breast self-examination beginning at age 40 years for asymptomatic women at average risk of breast cancer. Although there is substantial evidence from meta-analyses and non-randomized studies to support these recommendations, individual randomized clinical trials of breast cancer screening have not demonstrated mortality reduction in women aged 40-49 years. The opportunity to study this issue further in the United States has been diminished by the high prevalence of screening already being conducted in that population of younger women. The International Union Against Cancer, the American Cancer Society and the National Cancer Institute of the United States have convened a series of workshops and planning meetings to consider the available data and outline plans for future research. Plans are being developed to conduct a randomized trial of mammography in women younger than 50 years in multiple European sites. Successful completion of this trial may provide critical data on efficacy of breast cancer screening in younger women.     

乳腺MRI检查对乳腺癌个体化治疗的作用

乳腺MRI具有极好的软组织分辨率和无射线辐射特点,对乳腺癌诊断和局部分期明显优于X线和超声检查,本文结合临床病例在四个方面重点阐述乳腺MRI检查对乳腺癌个体化治疗的作用.     

Facilitating adherence to ACS and NCI guidelines for breast cancer screening

1. Measures are needed to increase awareness of the incidence of breast cancer, and perhaps to increase the perception of susceptibility to breast cancer among all women. 2. Common reasons for noncompliance with the established guidelines include: fear of the carcinogenic effect of radiation, unfamiliarity with the guidelines, belief that mammography is ineffective, or fear that detection will necessitate mastectomy. 3. While cost, accessibility, and availability are critically important in enhancing public compliance, professional health care providers have a tremendous burden to obtain current information regarding the breast screening guidelines, and communicate the information to the public. 4. By helping to establish accessible and affordable breast screening programs, nurses have an excellent opportunity to play a role in the reduction of morbidity and mortality associated with breast cancer.     

早期乳腺癌的影像学诊断

目的：探讨早期乳腺癌的特点和结合计算机辅助检测（CAD）诊断乳腺癌的作用。材料与方法：260例疑有癌变者,经手术病理证实的乳腺癌100例,其中50例经X线、超声波和粗针吸取芯组织活检（LCB）,比较三种检查方法诊断的敏感性,计算CAD的检出率。结果：钼靶X线摄影对早期乳腺癌显像的敏感度约为38％,乳腺超声对〈0．5cm肿物难作定性诊断,LCB的敏感度74％-88％。CAD对于乳腺癌的检出率为78％,使用CAD后早期乳腺癌的检出率提高了16％,CAD后乳腺癌诊断的假阴性率下降16％。结论：针对性的多种检查手段检诊,对不能明确者放宽手术活检指征,是早期发现乳腺癌的可靠方法。CAD可提高早期乳腺癌的检出率,并降低乳腺癌诊断的假阴性率。