Screening for breast cancer.

With the increase in breast cancer risk over the years, there are many factors estimated that lead to it. However, till date which factor is majorly involved in development of breast cancer or which factor accounts more is not clearly evident. Mammography technique accounting for 80-90% of cancer being detected is believed to be the best method of detection. While mammographic density is manifested by increased proliferation of fat, stoma, epithelium and connective tissue, it is considered to be a risk factor for development of breast cancer. The current study was thus conducted to find out whether the mammographic density is actually a risk factor for development of breast cancer and to find out the better detection tool available. For this, the methodology adopted was review of various journals and studies already published with respect to mammographic density and its risk on development of breast cancer. The conclusion of the current study as well as from another comparable study was that the frequency of screening might be dependent on breast density and in such cases diagnostic techniques such as “digital mammography, ultra sonography and magnetic resonance imaging” may prove to be better detection tools. Moreover, recent studies have also suggested that mammographic density as a marker for risk of developing breast cancer holds true however, this fact needs to be evaluated further. Article DOI:  https://dx.doi.org/10.20319/lijhls.2016.22.4854 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

Mammographic density and the risk and detection of breast cancer

The diagnosis and management of breast cancer are undergoing a paradigm shift from a one-size-fits-all approach to an era of personalized medicine. Sophisticated diagnostics, including molecular imaging and genomic expression profiles, enable improved tumor characterization. These diagnostics, combined with newer surgical techniques and radiation therapies, result in a collaborative multidisciplinary approach to minimizing recurrence and reducing treatment-associated morbidity. This article reviews the diagnosis and treatment of breast cancer, including screening, staging, and multidisciplinary management.

https://jnm.snmjournals.org/content/jnumed/57/Supplement_1/9S.full.pdf

Clinical Diagnosis and Management of Breast Cancer

Background: Controversy persists about optimal mammography screening strategies. Objective: To evaluate screening outcomes, taking into account advances in mammography and treatment of breast cancer. Design: Collaboration of 6 simulation models using national data on incidence, digital mammography performance, treatment effects, and other-cause mortality. Setting: United States. Patients: Average-risk U.S. female population and subgroups with varying risk, breast density, or comorbidity. Intervention: Eight strategies differing by age at which screening starts (40, 45, or 50 years) and screening interval (annual, biennial, and hybrid [annual for women in their 40s and biennial thereafter]). All strategies assumed 100% adherence and stopped at age 74 years. Measurements: Benefits (breast cancer-specific mortality reduction, breast cancer deaths averted, life-years, and qualityadjusted life-years); number of mammograms used; harms (false-positive results, benign biopsies, and overdiagnosis); and ratios of harms (or use) and benefits (efficiency) per 1000 screens. Results: Biennial strategies were consistently the most efficient for average-risk women. Biennial screening from age 50 to 74 years avoided a median of 7 breast cancer deaths versus no screening; annual screening from age 40 to 74 years avoided an additional 3 deaths, but yielded 1988 more false-positive results and 11 more overdiagnoses per 1000 women screened. Annual screening from age 50 to 74 years was inefficient (similar bene-fits, but more harms than other strategies). For groups with a 2-to 4-fold increased risk, annual screening from age 40 years had similar harms and benefits as screening average-risk women biennially from 50 to 74 years. For groups with moderate or severe comorbidity, screening could stop at age 66 to 68 years. Limitation: Other imaging technologies, polygenic risk, and nonadherence were not considered. Conclusion: Biennial screening for breast cancer is efficient for average-risk populations. Decisions about starting ages and intervals will depend on population characteristics and the decision makers' weight given to the harms and benefits of screening.

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Collaborative modeling of the benefits and harms associated with different U.S. Breast cancer screening strategies

OBJECTIVE. The purpose of this study was to assess the diagnostic performance of supplemental screening molecular breast imaging (MBI) in women with mammographically dense breasts after system modifications to permit radiation dose reduction. SUBJECTS AND METHODS. A total of 1651 asymptomatic women with mammographically dense breasts on prior mammography underwent screening mammography and adjunct MBI performed with 300-MBq 99mTc-sestamibi and a direct-conversion (cadmium zinc telluride) gamma camera, both interpreted independently. The cancer detection rate, sensitivity, specificity, and positive predictive value of biopsies performed (PPV3) were determined. RESULTS. In 1585 participants with a complete reference standard, 21 were diagnosed with cancer: two detected by mammography only, 14 by MBI only, three by both modalities, and two by neither. Of 14 participants with cancers detected only by MBI, 11 had invasive disease (median size, 0.9 cm; range, 0.5–4.1 cm). Nine of 11 (82%) were node negative, an...

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Journal club: molecular breast imaging at reduced radiation dose for supplemental screening in mammographically dense breasts.

OBJECTIVE. This article discusses breast ultrasound for the detection of breast cancer in the screening environment, as well as strategies for integrating screening breast ultrasound, including automated breast ultrasound. CONCLUSION. Breast density is an increasingly pertinent issue in breast cancer diagnosis. Breast density results in a decrease in the sensitivity of mammography for cancer detection, with a significant increase in the risk of breast cancer. Ultrasound detects additional cancers.

https://www.ajronline.org/doi/pdf/10.2214/AJR.13.12072

Screening Breast Ultrasound: Past, Present, and Future

OBJECTIVE. The purpose of this study was to evaluate the sensitivity of breast-specific gamma imaging (BSGI) for the detection of breast cancer in dense versus nondense breasts. MATERIALS AND METHODS. This was a retrospective study of 341 women with biopsy-proven breast cancer diagnosed from January 2004 to August 2009 who underwent BSGI before surgical excision. Patients with predominantly fatty replaced (BI-RADS density 1) or scattered fibroglandular tissue (BI-RADS density 2) breasts were classified as nondense, and those with heterogeneously dense (BI-RADS density 3) or extremely dense tissue (BIRADS density 4) were classified as dense. BSGI examinations exhibiting focal increased radiotracer uptake in the area of biopsy-proven cancer were classified as positive according to BSGI reports in the medical record. The sensitivity of BSGI was calculated using Microsoft Excel 2003. Between-group differences were evaluated statistically using the Student t test for continuous variables and the chi-square tes...

/pdf/breast-specific-gamma-imaging-for-the-detection-of-breast-lp5gz8lq54.pdf

Jennifer H. Lieberman

Papers

Screening Breast Ultrasound: Past, Present, and Future

Breast-Specific Gamma Imaging for the Detection of Breast Cancer in Dense Versus Nondense Breasts