Breast Cancer Screening in Asian Women with Dense Breast by Mammography: A Cross-Sectional Observational Study

Objective: Mammography density of Asian women is known to be higher than Western women. After 2009, the Korean National Cancer Screening Program (NCSP) has started to notify mammography density (MD). To investigate the effect of MD notification, we integrated screening results with national health insurance claim data from 2009 to 2013. Patients and Methods: We performed a cross-sectional observational study which investigated the crude detection rate (CDR), positive predictive value (PPV), and incidence rate of Interval Cancer (IC). IC was defined as breast cancer, where the interval between the screening date and date of diagnosis was more than 12 months and less than 24 months among participants with previous normal results. Results: CDR and PPV per 100,000 results increased from 510.9 to 756.2 and from 1842.5 to 3364.9, respectively. The incidence rate of IC per 100,000 negative results increased from 623.3 to 676.2. Women younger than 50 years had a high incidence of ICs. Conclusion: After notifying MD, the incidence rate of IC less increased comparing with CDR or PPV. Screening mammography could be more useful to Asian women when reporting MD.     

Breast imaging: A survey

Breast cancer is the second leading cause of death in women. It occurs when cells in the breast start to grow out of proportion and invade neighboring tissues or spread throughout the body. Mammography is one of the most effective and popular modalities presently used for breast cancer screening and detection. Efforts have been made to improve the accuracy of breast cancer diagnosis using different imaging modalities. Ultrasound and magnetic resonance imaging have been used to detect breast cancers in high risk patients. Recently, electrical impedance imaging and nuclear medicine techniques are also being widely used for breast cancer screening and diagnosis. In this paper, we discuss the capabilities of various breast imaging modalities.     

Risk of Breast Cancer among Young Women and Importance of Early Screening

Background: Breast cancer is the most common type of cancer in women throughout the world. However, in comparison with Western women, it presents relatively early in women of Asian ethnicity. Early menarche, late menopause, use of OCP’s, family history of benign or malignant breast disease, exposure to radiation and BMI in the under-weight range are well known risk factors for the development of breast cancer in premenopausal women. Early detection with the use of breast self-examination (BSE) and breast cancer screening programs can lead to a reduction in the mortality rates due to breast cancer. The aim of our study was to assess the risk factors for breast cancer among young women and to emphasize the importance of early screening among them. Materials and Methods: We conducted a cross-sectional study among women aged 18 to 25 using a selfadministered questionnaire. Data was collected over a period of 6 months from June to December, 2014. A total of 300 young women selected randomly from Dow Medical College and various departments of Karachi University successfully completed the survey. Results: Respondents were 18-25 years of age (mean age=21.5). Out of the 300 young females, 90 (30%) had at least one risk factor, 90 (30%) had two, 40 (13%) had three, 8 (2.7%) had four, 2 (0.7%) had five while one female was found to have six positive risk factors for breast cancer. Some 66 women (22%) experienced symptoms of breast cancer such as non-cyclical pain and lumps. While 222 women (74%) had never performed breast self-examination, 22 (7.3%) had had a breast examination done by a health professional while 32 (10.7%) had participated in breast screening programs. A total of 223 (74.3%) women considered breast cancer screening important for young women. Conclusions: The percentage of young women with risk factors for breast cancer was found to be alarmingly high. Therefore, screening for breast cancer should start at an early age especially in high risk groups. Awareness about breast self-examination should be emphasized. Moreover, screening programs should be started to ensure early detection and reduction of mortality rates caused by breast cancer also in young Pakistani females.     

The Impact of Breast Density on Breast Cancer Risk and Breast Screening

Whether measured by qualitative assessment of the parenchyma pattern or quantitatively by percent mammographic density, breast density is consistently a strong and independent risk factor for breast cancer (BC). Density is also a relatively common risk factor, and therefore an important contributor to BC risk at a population level. Including density (with other risk factors) in risk prediction models improves predictive accuracy; however, better standardization and/or automation of density measures will make the integration of breast density into risk assessment, and its application in tailored screening and primary prevention, more feasible. High breast density reduces screening sensitivity and is associated with risk of interval BC in screening; it is also associated with cancers that have poorer prognostic features. Non-randomized studies of adjunct ultrasound screening in women with mammography-negative dense breasts have provided evidence on incremental detection of BC with adjunct ultrasound and high false-positives but have not examined impact on clinical end-points, mortality, or balance of potential benefits versus harms.     

江西省10254例乳腺癌普查资料分析

目的调查江西省乳腺癌的发病率,乳腺癌发生的危险因素及普查对乳腺癌早期发现的作用。方法采用调查表、体检、乳腺钼靶X线、乳腺多普勒超对江西省10254名妇女进行乳腺癌普查,比较普查发现乳腺癌与门诊发现的乳腺癌的临床病理特点。结果体检、乳腺钼靶X线和多普勒超声联合方法进行乳腺癌普查具有较高的准确性,普查组发现13例乳腺癌（检出率为126.8/10万）,好发年龄段为40～49岁,乳腺癌的高危因素还包括乳腺癌家族史、未生育、月经初潮小于12岁、未哺乳、高脂饮食、饮酒、乳腺疾病史。普查发现的乳腺癌早期比率显著高于门诊组。结论体检、乳腺钼靶X线和多普勒超声联合方法是乳腺癌普查的有效手段,普查可以发现更多的早期乳腺癌,对高危因素进行干预可能减少乳腺癌发生。     

An overview of mammographic density and its association with breast cancer

In 2017, breast cancer became the most commonly diagnosed cancer among women in the US. After lung cancer, breast cancer is the leading cause of cancer-related mortality in women. The breast consists of several components, including milk storage glands, milk ducts made of epithelial cells, adipose tissue, and stromal tissue. Mammographic density (MD) is based on the proportion of stromal, epithelial, and adipose tissue. Women with high MD have more stromal and epithelial cells and less fatty adipose tissue, and are more likely to develop breast cancer in their lifetime compared to women with low MD. Because of this correlation, high MD is an independent risk factor for breast cancer. Further, mammographic screening is less effective in detecting suspicious lesions in dense breast tissue, which can lead to late-stage diagnosis. Molecular differences between dense and non-dense breast tissues explain the underlying biological reasons for why women with dense breasts are at a higher risk for developing breast cancer. The goal of this review is to highlight the current molecular understanding of MD, its association with breast cancer risk, the demographics pertaining to MD, and the environmental factors that modulate MD. Finally, we will review the current legislation regarding the disclosure of MD on a traditional screening mammogram and the supplemental screening options available to women with dense breast tissue.     

Breast Density of Mammography is Correlated with Reproductive Risk Factors Regardless of Menopausal Status: A Cross-Sectional Study of the Korean National Screening Program

Objective: To clarify the limitations of mammography screening for women with dense breasts, we examined breast density and its effects on screening results. Patients and Methods: We performed a cross-sectional, observational study on women who underwent mammography. Data from the National Cancer Screening Program(NCSP) from 2009 to 2013 were used. The study population consisted of participants with high breast density. We used a logistic regression analysis to evaluate the relationships between breast density and reproductive factors and screening results according to menopause status. Results: High breast density was reported for 57.5% of all participants (3,417,319 participants). Screening results indicated breast density of <25%, 25-50%, 51-75%, and ≥76% for 16.4%, 26.3%, 37.8%, and 19.5%, respectively, of participants. According to the screening results, high breast density was correlated with high deferment and recall rates. Reproductive factors, especially parity, breastfeeding, and use of oral contraceptives, had consistent effects on screening results of premenopausal and postmenopausal women. Regardless of menopausal status, age, early onset of menarche (15 years or younger), fewer live births (≤1 birth), and previous benign breast disease were correlated with increased breast density. In postmenopausal women, early-onset menopause and longer-term hormone replacement therapy (≥2 years) also independently increased breast density. Conclusion: Breast density influenced screening results, which could increase the rate of recall. Breast density was also influenced by reproductive factors, with patterns similar to those of breast cancer risk, regardless of menopausal status. We need to identify high-risk women with high density who would probably benefit from supplemental breast cancer screening.     

Breast Density and the Importance of Supplemental Screening

Purpose of Review

Mammographically dense breast tissue raises the risk of developing breast cancer and makes detection of breast cancer more difficult using standard of care mammography. This paper seeks to outline the evidence behind these risks and highlight the importance of informing patients, and their clinicians, of their density status. Solutions are also offered for improved detection in cancer screening in this population.

Recent Findings

Many states now require density information be conveyed to the patient. When performed in addition to screening mammography, supplemental screening methods (including tomosynthesis, ultrasound, and especially MRI) have demonstrated markedly improved rates of cancer detection in the dense screening population. However, only six states mandate insurance coverage for supplemental screening.

Summary

Increased breast density inherently raises the risk of breast cancer and reduces mammographic sensitivity. It is essential that women with dense breasts are notified of these hazards and provided with additional screening methods to aid in early detection.

     

Risk Factors for Benign Breast Disease according to Histopathological Type: Comparisons with Risk Factors for Breast Cancer

We evaluated risk factors for benign breast disease by using a case-control study method. The series was taken from participants in breast cancer screening programs during 1978–1986 in Miyagi Prefecture, Japan. All benign breast lesions diagnosed during this period were reviewed and reclassified into proliferative and non-proliferative types based on the Dupont and Page classification. Data on 382 benign breast disease cases (130 proliferative-type cases and 252 non-proliferative-type cases) and 1,489 screening year-, age- and screening area-matched normal controls were used for analysis. Nulliparity or low parity and family history of breast cancer in mother or sisters were significantly associated with an increased risk of proliferative type. Premenopausal status was significantly associated with an increased risk of non-proliferative type. No significant association with history of lactation for the last child was observed in either type, but the risk of proliferative type increased with increasing duration of lactation ( P =0.08). A comparison between the present findings and the risk factors for breast cancer indicated epidemiologic similarities between proliferative benign and malignant breast lesions in general. The associations of these two lesions with lactation patterns were, however, dissimilar.     

Breast cancer screening and early diagnosis in Chinese women

Breast cancer is the most common malignant tumor in Chinese women, and its incidence is increasing. Regular screening is an effective method for early tumor detection and improving patient prognosis. In this review, we analyze the epidemiological changes and risk factors associated with breast cancer in China and describe the establishment of a screening strategy suitable for Chinese women. Chinese patients with breast cancer tend to be younger than Western patients and to have denser breasts. Therefore, the age of initial screening in Chinese women should be earlier, and the importance of screening with a combination of ultrasound and mammography is stressed. Moreover, Chinese patients with breast cancers have several ancestry-specific genetic features, and aiding in the determination of genetic screening strategies for identifying high-risk populations. On the basis of current studies, we summarize the development of risk-stratified breast cancer screening guidelines for Chinese women and describe the significant improvement in the prognosis of patients with breast cancer in China.     

Five-Year Overall Survival of Interval Breast Cancers is Better than Non- Interval Cancers from Korean Breast Cancer Registry

Objective: Interval breast cancer (IC) is a limitation of breast cancer screening. We investigated data from alarge scaled breast cancer dataset of patients with breast cancer who underwent breast cancer screening in order torecapitulate the overall survival (OS) of patients with ICs compared to those with non-ICs. Methods: A total of 27,141patients in the Korean breast cancer registry with breast cancer who had ever participated in biannual national breastcancer screening programs between 2009 and 2013 were enrolled. We compared the social, pregnancy-associated, andpathologic characteristics between the IC and non-IC groups and identified the significant prognostic factors for OS.Results: The proportion of ICs was 1.3% (370/27,141) in this study population. ICs were correlated with age 45-55years at diagnosis, higher levels of education, early menopause (provinces (Kangwon, Kyungnam, Jeju, and Dae-jeon), and family history of breast cancer. Low-to-intermediate nucleargrade, early stage (stage 0-I), and low Ki-67 level were also correlated with IC proportion. Non-ICs were associatedwith an increased risk of five-year mortality (hazard ratio [HR] 7.4; 95% confidence interval [CI]:1.85-29.66; p = 0.005)compared to ICs. Lymph node metastasis, residence (Kyung-nam province), low education status, high histologic grade,and asymptomatic cancers increased the HR of five-year OS. Conclusion: ICs occurred unequally in specific provinceand relatively high-educated women in Korea. They were also diagnosed with early-stage breast cancer with a favorablerecurrence risk, and their outcome was better than those of patients with other breast cancers in breast cancer screening.     

Risk of Breast Cancer in Japanese Women with Benign Breast Disease

To investigate the risk of breast cancer development in women with benign breast disease (BBD), 387 screen-detected BBD women and 1,489 normal women, taken from participants in the breast cancer screening program during 1978–1986, were followed through 1991. While 2,811 person-years in the BBD group and 11,018 person-years in the normal group were accumulated, 5 women in the BBD group and 6 women in the normal group developed breast cancer. Using the Mantel-Haenszel method, relative risks (RR) were estimated for all women with BBD and women in some BBD types. Significantly elevated risk of breast cancer was observed in all women with BBD (RR=3.26, 95% confidence interval (CI) 1.08−9.83). Women with proliferative BBD were at high risk of breast cancer (RR=8.48, 95%CI 2.99−24.10), but no increased risk was observed for women with non-proliferative BBD (RR=0.93, 95%CI 0.11−7.66). These results are consistent with those in high-risk countries for breast cancer. In the management of women with BBD, histopathological diagnosis of the breast lesion is essential and women with proliferative BBD should be followed up carefully.     

Breast Cancer Knowledge and Screening Behaviour among Women with a Positive Family History: A Cross Sectional Study

Background: Breast cancer is the commonest type of cancer among women, and in Malaysia 50-60% of thenew cases are being detected at late stages. Do age, education level, income, ethnicity, relationship with breastcancer patients and knowledge of breast cancer risk factors influence breast screening practices? This studyrevealed interesting but significant differences. Objectives: To assess the knowledge of breast cancer risk factorsand early detection measures among women in a high risk group. Materials and Methods: A cross sectionalsurvey of one hundred and thirty one women relatives of breast cancer patients was carried out. Participantswere selected through purposive sampling, during hospital visits. A self-administered questionnaire was used fordata collection. Results: The majority of the respondents (71%) had poor knowledge of the risk factors for breastcancer. Income, relationship with a patient and practise of breast cancer screening predicted performance ofmammography, R2=0.467, F=12.568, p<0.0001. Conclusions: The finding shows inadequate knowledge of breastcancer risk factors and poor cancer screening practise among women with family history of breast cancer. Poorknowledge and practise of breast screening are likely to lead to late stage presentation of breast cancer disease.Some important predictors of breast cancer screening behaviour among women with positive family historyof breast cancer were identified. An understanding of the strengths and significance of the association betweenthese factors and breast screening behaviour is vital for developing more targeted breast health promotion.     

Clinical Risk Factor Analysis for Breast Cancer: 568,000 Subjects Undergoing Breast Cancer Screening in Beijing, 2009

Objectives: Although there are many reports about the risk of breast cancer, few have reported clinicalfactors including history of breast-related or other diseases that affect the prevalence of breast cancer. This studyexplores these risk factors for breast cancer cases reported in Beijing in 2009. Materials and Methods: Datawere derived from a Beijing breast cancer screening performed in 2009, of 568,000 women, from 16 districts ofBeijing, all aged between 40 and 60 years. In this study, multilevel statistical modeling was used to identify clinicalfactors that affect the prevalence of breast cancer and to provide more reliable evidence for clinical diagnosticsby using screening data. Results and Conclusion: Those women who had organ transplants, compared withthose with none, were associated with breast cancer with an odds ratio (OR) = 65.352 [95% confidence interval(CI): 8.488-503.165] and those with solid breast mass compared with none had OR = 1.384 (95% CI: 1.022-1.873). Malignant tendency was strongly associated with increased risk of breast cancer, OR = 207.999(95%CI: 151.950-284.721). The risk of breast cancer increased with age, OR1 = 2.759 (95% CI: 1.837-4.144, 56-60 vs.40-45), OR2 = 2.047 (95% CI: 1.394-3.077, 51-55 vs. 40-45), OR3 = 1.668 (95% CI: 1.145-2.431). Normal resultsof B ultrasonic examination show a lower risk among participants, OR= 0.136 (95% CI: 0.085-0.218). Thosewomen with ductal papilloma compared with none were associated with breast cancer, OR=6.524 (95% CI:1.871-22.746). Therefore, this study suggests that clinical doctors should pay attention to these high-risk factors.     

Determinants of Breast Cancer Screening Practice among Women in Indonesia: A Nationwide Study

Background: Breast cancer remains the leading cause of death for women globally, including in Indonesia. Breast cancer screening plays a vital role in reducing deaths caused by breast cancer. However, breast cancer screening rate is still low and studies on determinants for breast cancer screening is limited in Indonesia. This study aimed to identify the determinants of breast cancer screening among women in Indonesia. Methods: This population-based study was conducted among 827 women who lived in either rural and urban areas, using a stratified sampling design where were based on province and locality combinations. Data were analysed using a binary logistic regression model to assess the associations between independent and dependent variables. Results: As many as 827 women with an average age of 29.91 (± 11.14) years old participated in this study. The overall breast cancer screening among women was 18.74%. Knowledge of breast cancer risk factors, signs, and symptoms (adj.OR = 1.75, 95%CI: 1.20 – 2.56), age of 35 to 39 years old (adj.OR. = 1.52, 95% CI: 1.02 – 2.26), and household income of ≥6,000,000 IDR (≥457 USD) (adj.OR. = 5.19, 95%CI: 1.43–18.84) were associated with breast cancer screening attendance. In contrast, Christian women had a significantly lower breast cancer screening rate that women from other religions (adj. OR. = 0.45, 95%CI: 0.24 – 0.85). Conclusion: The overall breast cancer screening attendance was poor among Indonesian women population. Age, household income, religion, and knowledge of breast cancer risk factors were identified as the determinant factors for breast cancer screening.     

江西省宜春市3672例乳腺癌普查流行病学报告

目的调查江西省宜春市妇女乳腺疾病状况及乳腺癌发生的危险因素。方法采用调查表、体检、乳腺。,超声、钼靶X线检查对宜春市3672名妇女进行乳腺普查。结果乳腺增生检出率为51．6％。乳腺纤维腺瘤检出率为0．95％。乳腺癌5例,检出率为136．2／10万,40～59岁为乳腺发病高峰年龄段。乳腺癌的发生与患者年龄、乳腺癌家族史、月经初潮年龄〈12岁、未哺乳、高脂饮食、乳腺增生病史等因素有关（P均〈0．05）。结论乳腺普查是发现乳腺疾病的有效手段。早期发现、早期治疗乳腺增生和乳腺纤维腺,并倡导健康生活方式,可能减少乳腺癌的发生。     

Breast density and risk of breast cancer

Early studies reported a 4- to 6-fold risk of breast cancer between women with extremely dense and fatty breasts. As most early studies were case-control studies, we took advantage of a population-based screening program to study density and breast cancer incidence in a cohort design. In the Capital Region, Denmark, women aged 50 to 69 are invited to screening biennially. Women screened November 2012 to December 2017 were included, and classified by BI-RADS density code, version 4, at first screen after recruitment. Women were followed up for incident breast cancer, including ductal carcinoma in situ (DCIS), to 2020 in nationwide pathology data. Rate ratios (RRs) and 95% confidence intervals (CI) were compared across density groups using Poisson-regression. We included 189 609 women; 1 067 282 person-years; and 4110 incident breast cancers/DCIS. Thirty-three percent of women had BI-RADS density code 1; 38% code 2; 24% code 3; 4.7% code 4; and missing 0.3%. Using women with BI-RADS density code 1 as baseline; women with code 2 had RR 1.69 (95% CI 1.56-1.84); women with code 3, RR 2.06 (95% CI 1.89-2.25); and women with code 4, RR 2.37 (95% CI 1.05-2.74). Results differed between observations accumulated during screening and above screening age. Our results indicated less difference in breast cancer risk across level of breast density than normally stated. Translated into absolute risk of breast cancer after age 50, we found a 6.2% risk for the one-third of women with lowest density, and 14.7% for the 5% of women with highest density.