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.     

Determinants of Participation in a Breast Cancer Screening Trial in Trivandrum District,India

Background: Conspicuous differences in participation rates for breast self-examination (BSE), clinical breastexamination (CBE), and referral for further investigations have been observed indicating involvement of anumber of different factors. This study analysed determinants for participation in different levels of the breastcancer screening process in Indian females. Materials and Methods: An intervention group of 52,011 womenwas interviewed in a breast cancer screening trial in Trivandrum district, India. In order to assess demographic,socio-economic, reproductive, and cancer-related determinants of participation in BSE, CBE, and referral,uni- and multi-variate logistic regression was employed. Results: Of the interviewed women, 23.2% reportedpracticing BSE, 96.8% had attended CBE, and 49.1% of 2,880 screen-positives attended referral. Results showedan influence of various determinants on participation; women who were currently not married or who had nofamily history of cancer were significantly less likely to attend the screening process at any level. Conclusions:Increasing awareness about breast cancer, early detection methods, and the advantages of early diagnosesamong women, and their families, as well as health care workers offering social support, could help to increaseparticipation over the entire screening process in India.     

Comparison of False Negative Rates among Breast Cancer Screening Modalities with or without Mammography: Miyagi Trial

False negative rates were compared in two screening modalities, physical examination with or without mammography, in an intervention study for women aged over 50 in Miyagi Prefecture. Thirty-five breast cancers were detected in 12,515 subjects who participated in the trial consisting of physical examination and mammography, whereas 44 breast cancers were detected in 50,105 subjects who received physical examination alone, so that the detection rates were 0.28% and 0.09%, respectively. Among 50,061 subjects who received physical examination alone, 8 women were diagnosed as having breast cancer within 12 months after the screening, while only one of 12,480 screenees receiving the combined modality was so diagnosed, implying false negative rates of 15.4% and 2.8%, respectively. When the screening sensitivity in the combined system was analyzed according to each single modality, the false negative rate provided by physical examination with mammography turned out to be 2.8%, significantly lower than that (33.3%) by the physical examination alone. Minimal breast cancers represented 25.7% of all screen-detected cancers in the combined modality, compared with 9.1% in the modality without mammography. The trial thus indicates that physical examination combined with mammography may be an appropriate modality for breast cancer screening in women aged over 50 on the basis of screening sensitivity.     

乳腺癌的普查研究的现状及其评价

乳腺癌二级预防是提高患者生存率、降低死亡率的重要手段之一,防癌普查是其中重要的组成部分.综述了恶性肿瘤的分级预防、乳腺癌普查的现状、不同观点的比较和普查的利弊分析,以及正确开展乳腺癌普查及评估工作等.     

Breast Cancer Screening with Mammography

There has been a great deal of controversy regarding the change in breast cancer screening recommendations released by the US Preventive Services Task Force in November 2009. Despite limited new data, the Task Force changed their previous recommendations delaying initial screening of asymptomatic women from age 40 to age 50 and recommending biennial rather than annual breast cancer screening. It is important to fully understand the nuances of the analysis and modeling upon which the revisions were based in order to accurately inform patients of the risks and benefits of breast cancer screening. Several new studies as well as additional guidelines have also been released over the past year which further inform the debate, and a number of commentaries have helped to place the risks and benefit in clinical and societal context.     

The Total Incidence of Loco-Regional Recurrence in a Randomized Trial of Breast Cancer Tnm Stage Ii the South Sweden Breast Cancer Trial

We studied loco-regional recurrence during follow-up (median observation time 8 years) in 1153 patients, who underwent modified mastectomy and were randomly assigned to one of the following postoperative treatments; Premenopausal patients: radiotherapy, cyclophosphamide, or both; Postmenopausal patients: radiotherapy, tamoxifen, or both. Recurrence occurred in a total of 419 patients, 123 of whom had loco-regional recurrence with or without distant metastasis. the loco-regional recurrence rate was 7% in the irradiated subgroups and 17% in the non-irradiated subgroups, the corresponding cure rates being 43% and 58%. Complete remission of all local recurrence was obtained after the first treatment in 67% of the cases, and was persistent in 67% of them (44% overall). Complete remission was obtained in all patients with local recurrence who received local treatment only, and was persistent in 65%. of local recurrences treated with a combination of surgery, radiotherapy and hormone therapy, complete response was obtained in 94% of the patients, and was persistent in 94% of them (88% overall). Complete remission of all regional recurrence was obtained after the first treatment in 58% of the patients and was persistent in 67% of them (39% overall). Postoperative radiotherapy reduced not only the total number of loco-regional recurrences but also the number of uncontrolled loco-regional recurrences. Aggressive local treatment would appear to yield both satisfactory initial control and, when combined with the hormone therapy, a high rate of persistent loco-regional control.     

A Review of Breast Density Implications and Breast Cancer Screening

Breast density is an independent risk factor for breast cancer and significantly decreases the sensitivity of mammography. Assessing a woman’s risk of developing breast cancer is becoming increasingly important for establishing individual screening recommendations and preventive strategies. This article reviews the factors influencing mammographic density (MD), the available methods of MD assessment, and its effect on breast cancer. Finally, we discuss the supplemental screening methods for women with dense breast tissue.     

乳腺癌筛查的思考

乳腺癌筛查虽在西方世界获得降低死亡率的实效,但有关其利弊之争迄今未息。本文结合中国的实际,就筛查年龄段的取舍、城乡发病的考虑、筛检方法的选择,以及组织形式与筛查方案等进行了讨论,提出了增利减弊的建议。     

Screening for Distress in Breast Cancer

Distress is a common and clinically relevant complication of breast cancer which can occur at any time. Several organizations have recommended systematic screening for distress but, because there is still a debate about its effectiveness, uptake has been slow. Screening research can be divided into studies of diagnostic validity that test the accuracy of particular tools and studies involving screening implementation that test the clinical success of screening. Despite many cross-sectional validation studies, few have specifically studied breast cancer patients. Only one short tool, the distress thermometer (DT), and a longer tool, the hospital anxiety and depression scale (HADS) have been evaluated in both types of study in more than one centre. Multidomain tools, for example the Edmonton symptom assessment system (ESAS) and the Emotion Thermometer (ET), are promising, and are currently under evaluation. Current evidence suggests that for any mental disorder (including adjustment disorder) the DT has sensitivity of 84 % and specificity of 63 % and the HADS has sensitivity of 65 % and specificity of 77 %. Evidence to date suggests that the DT and HADS are moderately accurate when helping identify distress, performing best in screening (initial assessment), but only slightly increase referrals for psychosocial care. However, their effect can be magnified by combining screening with mandatory follow-up.     

Prediction of higher mortality reduction for the UK Breast Screening Frequency Trial: a model-based approach on screening intervals

Background:

The optimal interval between two consecutive mammograms is uncertain. The UK Frequency Trial did not show a significant difference in breast cancer mortality between screening every year (study group) and screening every 3 years (control group). In this study, the trial is simulated in order to gain insight into the results of the trial and to predict the effect of different screening intervals on breast cancer mortality.

Methods:

UK incidence, life tables and information from the trial were used in the microsimulation model MISCAN–Fadia to simulate the trial and predict the number of breast cancer deaths in each group. To be able to replicate the trial, a relatively low sensitivity had to be assumed.

Results:

The model simulated a larger difference in tumour size distribution between the two groups than observed and a relative risk (RR) of 0.83 of dying from breast cancer in the study group compared with the control group. The predicted RR is lower than that reported from the trial (RR 0.93), but within its 95% confidence interval (0.63–1.37).

Conclusion:

The present study suggests that there is benefit of shortening the screening interval, although the benefit is probably not large enough to start annual screening.     

The Breast Cancer Screening and Timing of Breast MRI—Experience in a Genetic High-Risk Screening Clinic in a Comprehensive Cancer Center

For women with genetic risk of breast cancer, the addition of screening breast MRI to mammography has become a standard. The order and interval of annual imaging can be variable among providers. To evaluate the clinical implications related to the timing, we conducted a chart review on a cohort of women (N = 276) with high-risk (BRCA1, BRCA2, CDH1, PTEN and TP53) and moderate high-risk (ATM and CHEK2) predisposition to breast cancer in a 48-month follow up. The estimated MRI detection rate in the entire group is 1.75% (18 per 1000 MRI tests). For the high-risk group, the estimated rate is 2.98% (30 per 1000 MRI tests). Many women discovered their genetic risk at an age much older (average age of the high-risk group was 48 years) than the age recommended to initiate enhanced screening (age 20 to 25 years). In total, 4 of the 11 primary breast cancers detected were identified by screening MRI within the first month after initial visit, which were not detected by previous mammography, suggesting the benefit of initiating MRI immediately after the discovery of genetic risk. Breast screening findings for women with Lynch syndrome and neurofibromatosis type 1 were also included in this report.