Showing papers by "Nehmat Houssami published in 2016"

Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma In Situ

Abstract: BackgroundControversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation (WBRT).MethodsA multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7883 patients and other published literature as the evidence base for consensus.ResultsNegative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2 mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2 mm margins. Negative margins less than 2 mm alone are not an indication for mastectomy, and factors known to impact rates of IBTR should be considered in determining the need for re-excision.ConclusionThe use of a 2 mm margin as the standard for an adequate margin in DCIS treated with WBRT is associated with low rates ...

Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ

Abstract: Purpose Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation.

Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study

Abstract: Summary Background Breast tomosynthesis (pseudo-3D mammography) improves breast cancer detection when added to 2D mammography. In this study, we examined whether integrating 3D mammography with either standard 2D mammography acquisitions or with synthetic 2D images (reconstructed from 3D mammography) would detect more cases of breast cancer than 2D mammography alone, to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions. Methods The Screening with Tomosynthesis Or standard Mammography-2 (STORM-2) study was a prospective population-based screening study comparing integrated 3D mammography (dual-acquisition 2D–3D mammography or 2D synthetic–3D mammography) with 2D mammography alone. Asymptomatic women aged 49 years or older who attended population-based screening in Trento, Italy were recruited for the study. All participants underwent digital mammography with 2D and 3D mammography acquisitions, with the use of software that allowed synthetic 2D mammographic images to be reconstructed from 3D acquisitions. Mammography screen-reading was done in two parallel double-readings conducted sequentially for 2D acquisitions followed by integrated acquisitions. Recall based on a positive mammography result was defined as recall at any screen read. Primary outcome measures were a comparison between integrated (2D–3D or 2D synthetic–3D) mammography and 2D mammography alone of the number of cases of screen-detected breast cancer, the cancer detection rate per 1000 screens, the incremental cancer detection rate, and the number and percentage of false-positive recalls. Findings Between May 31, 2013, and May 29, 2015, 10 255 women were invited to participate, of whom 9672 agreed to participate and were screened. In these 9672 participants (median age 58 years [IQR 53–63]), screening detected 90 cases of breast cancer, including 74 invasive breast cancers, in 85 women (five women had bilateral breast cancer). To account for these bilateral cancers in cancer detection rate estimates, the number of screens used for analysis was 9677. Both 2D–3D mammography (cancer detection rate 8·5 per 1000 screens [82 cancers detected in 9677 screens]; 95% CI 6·7–10·5) and 2D synthetic–3D mammography (8·8 per 1000 [85 in 9677]; 7·0–10·8) had significantly higher rates of breast cancer detection than 2D mammography alone (6·3 per 1000 [61 in 9677], 4·8–8·1; p Interpretation Integration of 3D mammography (2D–3D or 2D synthetic–3D) detected more cases of breast cancer than 2D mammography alone, but increased the percentage of false-positive recalls in sequential screen-reading. These results should be considered in the context of the trade-off between benefits and harms inherent in population breast cancer screening, including that significantly increased breast cancer detection from integrating 3D mammography into screening has the potential to augment screening benefit and also possibly contribute to overdiagnosis. Funding None.

Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial

Abstract: PurposeDebate on adjunct screening in women with dense breasts has followed legislation requiring that women be informed about their mammographic density and related adjunct imaging. Ultrasound or tomosynthesis can detect breast cancer (BC) in mammography-negative dense breasts, but these modalities have not been directly compared in prospective trials. We conducted a trial of adjunct screening to compare, within the same participants, incremental BC detection by tomosynthesis and ultrasound in mammography-negative dense breasts.Patients and MethodsAdjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts is a prospective multicenter study recruiting asymptomatic women with mammography-negative screens and dense breasts. Eligible women had tomosynthesis and physician-performed ultrasound with independent interpretation of adjunct imaging. Outcome measures included cancer detection rate (CDR), number of false-positive (FP) recalls, and incremental CDR for each moda...

The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis.

Abstract: Purpose There is no consensus on adequate negative margins in breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). We systematically reviewed the evidence on margins in BCS for DCIS.

Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis

Abstract: Background:We investigated the additional contribution of mammography to screening accuracy in BRCA1/2 mutation carriers screened with MRI at different ages using individual patient data from six high-risk screening trials.Methods:Sensitivity and specificity of MRI, mammography and the combination of these tests were compared stratified for BRCA mutation and age using generalised linear mixed models with random effect for studies. Number of screens needed (NSN) for additional mammography-only detected cancer was estimated.Results:In BRCA1/2 mutation carriers of all ages (BRCA1=1219 and BRCA2=732), adding mammography to MRI did not significantly increase screening sensitivity (increased by 3.9% in BRCA1 and 12.6% in BRCA2 mutation carriers, P>0.05). However, in women with BRCA2 mutation younger than 40 years, one-third of breast cancers were detected by mammography only. Number of screens needed for mammography to detect one breast cancer not detected by MRI was much higher for BRCA1 compared with BRCA2 mutation carriers at initial and repeat screening.Conclusions:Additional screening sensitivity from mammography above that from MRI is limited in BRCA1 mutation carriers, whereas mammography contributes to screening sensitivity in BRCA2 mutation carriers, especially those ≤40 years. The evidence from our work highlights that a differential screening schedule by BRCA status is worth considering.

The association of surgical margins and local recurrence in women with ductal carcinoma in situ treated with breast-conserving therapy: A meta-analysis.

Abstract: 1020Background: There is no consensus on what constitutes adequate negative margins in breast-conserving surgery (BCS) for ductal carcinoma in-situ(DCIS). We systematically review the evidence on s...

Margins in Breast-Conserving Surgery for Early Breast Cancer: How Much is Good Enough?

Abstract: Breast-conserving therapy (breast-conserving surgery (BCS) and radiation therapy) is an effective treatment for early-stage breast cancer (BC). Whilst there is consensus that risk of local recurrence (LR) following BCS is increased if the surgical margins are positive (‘ink on tumour’), consensus on what constitutes adequate negative margins has been elusive despite studies spanning decades. Recent SSO–ASTRO guidelines have recommended ‘no ink on tumour’ as the standard for negative margins in BCS for invasive BC. These were underpinned by study-level meta-analysis reporting that a minimally defined negative margin width be adopted for BCS in invasive BC and showing that wider (than a minimum >1 mm) negative margins do not significantly reduce LR risk. Recommendations on a minimum margin width for ductal carcinoma in situ (DCIS) vary substantially from >1 to 10 mm or wider; evidence-based guidelines are being developed and are expected to address ‘how much is enough’ for margin width in DCIS.

The importance of enabling informed decision making for women considering breast cancer screening

Abstract: Sasieni et al. have commented on our Lancet report of a randomised controlled trial of a breast screening decision aid. We disagree with the authors on several points. While the majority of women who received the intervention decision aid found it to be either completely balanced (43%) or slanted towards screening (21%), some considered it a little (30%) or clearly (6%) slanted away from screening. Women’s attitudes to breast screening tend to be strongly favourable, having been shaped by decades of promotional campaigns designed to persuade them of the benefits of screening, without explaining the risk of overdetection. Because women are accustomed to receiving positive messages about screening that strongly endorse participation, it is not surprising that some perceived the decision aid, which aimed to present a more balanced and complete picture, as slanted away from screening. As a participant in our decision aid piloting interviews explained:

Evolution of Mammography Screening: From Film Screen to Digital Breast Tomosynthesis

Abstract: Mammography population screening has been implemented based on evidence of efficacy from randomized controlled trials (RCTs). Substantial technical developments have witnessed an evolution from screen-film mammography (SFM) to full-field digital mammography (FFDM), and more recently to digital breast tomosynthesis as a potential screening modality. Mammography's technical evolution calls for consideration of the evidence required on the performance and effect of new screening technologies before these could be broadly recommended for screening. This chapter provides an overview of the technical background of the different mammography screening modalities, and an overview of the trials and studies that form the evidence-base for screening with FFDM and potentially for tomosynthesis. The transition to FFDM was underpinned by observational studies and an RCT showing (respectively) similar or higher cancer detection for FFDM compared to SFM. The evidence on screen-detection measures using tomosynthesis is emerging rapidly but there is limited data on whether this extends screening benefit. (Less)

Digital breast tomosynthesis (3D-mammography) for screening women with dense breasts

Abstract: There is growing interest in breast density-tailored screening for breast cancer (BC)[1]. For decades, it has been known that breast tissue density is a predictor of BC risk [2–4]: pooled analyses ...

Imaging Surveillance of Women With a Personal History of Breast Cancer

Abstract: Advances in our understanding of breast cancer development, detection, and treatment are enabling women to survive their initial treatment and live longer, healthier lives. Current guidelines are consistent in supporting regular mammography in women following treatment for primary breast cancer. Surveillance imaging beyond mammography, including digital breast tomosynthesis, breast ultrasound, and magnetic resonance imaging, is being studied for its potential to further extend survival and improve outcomes. Improvements in understanding of tumor biology, and specifically in the classification of tumors by gene expression profiles or “molecular subtypes,” are also providing independent prognostic information to guide breast cancer treatment. Clinical care increasingly focuses on patient centered outcomes beyond survival, such as quality of life, costs of care, and shared decision making based on patient preferences and values. Closing critical knowledge gaps in technology evaluation, risk assessment, and shared decision making will enable evidence-based selection of tailored imaging surveillance regimens to improve individual and population-level outcomes.