Importance Many established breast cancer risk factors are used in clinical risk prediction models, although the proportion of breast cancers explained by these factors is unknown. Objective To determine the population-attributable risk proportion (PARP) for breast cancer associated with clinical breast cancer risk factors among premenopausal and postmenopausal women. Design, Setting, and Participants Case-control study with 1:10 matching on age, year of risk factor assessment, and Breast Cancer Surveillance Consortium (BCSC) registry. Risk factor data were collected prospectively from January 1, 1996, through October 31, 2012, from BCSC community-based breast imaging facilities. A total of 18 437 women with invasive breast cancer or ductal carcinoma in situ were enrolled as cases and matched to 184 309 women without breast cancer, with a total of 58 146 premenopausal and 144 600 postmenopausal women enrolled in the study. Exposures Breast Imaging Reporting and Data System (BI-RADS) breast density (heterogeneously or extremely dense vs scattered fibroglandular densities), first-degree family history of breast cancer, body mass index (>25 vs 18.5-25), history of benign breast biopsy, and nulliparity or age at first birth (≥30 years vs Main Outcomes and Measures Population-attributable risk proportion of breast cancer. Results Of the 18 437 women with breast cancer, the mean (SD) age was 46.3 (3.7) years among premenopausal women and 61.7 (7.2) years among the postmenopausal women. Overall, 4747 (89.8%) premenopausal and 12 502 (95.1%) postmenopausal women with breast cancer had at least 1 breast cancer risk factor. The combined PARP of all risk factors was 44.3% (95% CI, 40.8%-47.8%) among premenopausal women and 43.2% (95% CI, 41.0%-45.5%) among postmenopausal women. High breast density was one of the most prevalent risk factors for both premenopausal and postmenopausal women and had the largest effect on the PARP; 28.9% (95% CI, 25.3%-32.5%) of premenopausal and 14.4% (95% CI, 12.6%-16.0%) of postmenopausal breast cancers could potentially be averted if all women with heterogeneously or extremely dense breasts shifted to scattered fibroglandular breast density. Among postmenopausal women, 16.4% (95% CI, 14.4%-18.4%) of breast cancers could potentially be averted if all overweight and obese women attained a body mass index of less than 25. Conclusions and Relevance Most women with breast cancer have at least 1 breast cancer risk factor routinely documented at the time of mammography, and more than 40% of premenopausal and postmenopausal breast cancers are explained by these factors. These easily assessed risk factors should be incorporated into risk prediction models to stratify breast cancer risk and promote risk-based screening and targeted prevention efforts.

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Population-Attributable Risk Proportion of Clinical Risk Factors for Breast Cancer.

Background The Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) has been in use since 2015; while interreader reproducibility has been studied, there has been a paucity of studies investigating the intrareader reproducibility of PI-RADSv2. Purpose To evaluate both intra- and interreader reproducibility of PI-RADSv2 in the assessment of intraprostatic lesions using multiparametric magnetic resonance imaging (mpMRI). Study type Retrospective. Population/subjects In all, 102 consecutive biopsy-naive patients who underwent prostate MRI and subsequent MR/transrectal ultrasonography (MR/TRUS)-guided biopsy. Field strength/sequences Prostate mpMRI at 3T using endorectal with phased array surface coils (TW MRI, DW MRI with ADC maps and b2000 DW MRI, DCE MRI). Assessment Previously detected and biopsied lesions were scored by four readers from four different institutions using PI-RADSv2. Readers scored lesions during two readout rounds with a 4-week washout period. Statistical tests Kappa (κ) statistics and specific agreement (Po ) were calculated to quantify intra- and interreader reproducibility of PI-RADSv2 scoring. Lesion measurement agreement was calculated using the intraclass correlation coefficient (ICC). Results Overall intrareader reproducibility was moderate to substantial (κ = 0.43-0.67, Po = 0.60-0.77), while overall interreader reproducibility was poor to moderate (κ = 0.24, Po = 46). Readers with more experience showed greater interreader reproducibility than readers with intermediate experience in the whole prostate (P = 0.026) and peripheral zone (P = 0.002). Sequence-specific interreader agreement for all readers was similar to the overall PI-RADSv2 score, with κ = 0.24, 0.24, and 0.23 and Po = 0.47, 0.44, and 0.54 in T2 -weighted, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE), respectively. Overall intrareader and interreader ICC for lesion measurement was 0.82 and 0.71, respectively. Data conclusion PI-RADSv2 provides moderate intrareader reproducibility, poor interreader reproducibility, and moderate interreader lesion measurement reproducibility. These findings suggest a need for more standardized reader training in prostate MRI. Level of evidence 2 Technical Efficacy: Stage 2.

/pdf/intra-and-interreader-reproducibility-of-pi-radsv2-a-152ftwyld7.pdf

Intra‐ and interreader reproducibility of PI‐RADSv2: A multireader study

The Breast Imaging Reporting and Data System (BI-RADS) density categories, estimated subjectively by radiologists, are the standard for reporting breast density in the United States. Variation in t...

/pdf/automated-and-clinical-breast-imaging-reporting-and-data-2dgyagllun.pdf

Automated and Clinical Breast Imaging Reporting and Data System Density Measures Predict Risk for Screen-Detected and Interval Cancers: A Case-Control Study.

Inter-reader Variability in the Use of BI-RADS Descriptors for Suspicious Findings on Diagnostic Mammography: A Multi-institution Study of 10 Academic Radiologists.

Mammography has been the frontline screening tool for breast cancer for decades. However, high error rates in the form of false negatives (FNs) and false positives (FPs) have persisted despite technological improvements. Radiologists still miss between 10% and 30% of cancers while 80% of woman recalled for additional views have normal outcomes, with 40% of biopsied lesions being benign. Research show that the majority of cancers missed is actually visible and looked at, but either go unnoticed or are deemed to be benign. Causal agents for these errors include human related characteristics resulting in contributory search, perception and decision-making behaviours. Technical, patient and lesion factors are also important relating to positioning, compression, patient size, breast density and presence of breast implants as well as the nature and subtype of the cancer itself, where features such as architectural distortion and triple-negative cancers remain challenging to detect on screening. A better understanding of these causal agents as well as the adoption of technological and educational interventions, which audits reader performance and provide immediate perceptual feedback, should help. This paper reviews the current status of our knowledge around error rates in mammography and explores the factors impacting it. It also presents potential solutions for maximizing diagnostic efficacy thus benefiting the millions of women who undergo this procedure each year.

http://journal.waocp.org/article_55154_b69fdaa8fe977345e4ba0e9076419be6.pdf

Errors in Mammography Cannot be Solved Through Technology Alone

Objective The objective of the present study was to assess interradiologist agreement regarding mammographic breast density assessment performed using the rating scale outlined in the fifth edition of the BI-RADS atlas of the American College of Radiology. Materials and methods Breast density assessments of 1000 cases were conducted by five radiologists from the same institution who together had recently undergone retraining in mammographic breast density classification based on the fifth edition of BI-RADS. The readers assigned breast density grades (A-D) on the basis of the BI-RADS classification scheme. Repeat assessment of 100 cases was performed by all readers 1 month after the initial assessment. A weighted kappa was used to calculate intrareader and interreader agreement. Results Intrareader agreement ranged from a kappa value of 0.86 (95% CI, 0.77-0.93) to 0.89 (95% CI, 0.81-0.95) on a four-category scale (categories A-D) and from 0.89 (95% CI, 0.86-0.92) to 0.94 (95% CI, 0.89-0.97) on a two-category scale (category A-B vs category C-D). Interreader agreement ranged from substantial (κ = 0.76; 95% CI, 0.73-0.78) to almost perfect (κ = 0.87; 95% CI, 0.86-0.89) on a four-category scale, and the overall weighted kappa value was substantial (0.79; 95% CI, 0.78-0.83). Interreader agreement on a two-category scale ranged from a kappa value of 0.85 (95% CI, 0.83-0.86) to 0.91 (95% CI, 0.90-0.92), and the overall weighted kappa was 0.88 (95% CI, 0.87-0.89). Conclusion Overall, with regard to mammographic breast density classification, radiologists had substantial interreader agreement when a four-category scale was used and almost perfect interreader agreement when a dichotomous scale was used.

https://www.ajronline.org/doi/pdf/10.2214/AJR.15.15049

Assessment of Interradiologist Agreement Regarding Mammographic Breast Density Classification Using the Fifth Edition of the BI-RADS Atlas

The aim of this study was to examine the impact of kolaviron on cyclooxygenase, thromboxane A2 activity, lipid peroxidation and lactate dehydrogenase level in dexamethasone treated Wistar rats. Twenty (20) male Wistar rats weighing between 150 g and 200 g were randomly selected into four groups containing five rats each. Control rats received standard feed and water. Group two received 3 mg/kg body weight of dexamethasone intraperitoneally every two days for 9 days. Group 3 received 3 mg/kg body weight of dexamethasone intraperitoneally every two days for 9 days plus daily oral administration of 100 mg/kg of kolaviron for 30 days. Results showed that there was no effect of dexamethasone and kolaviron on COX and THX-A2 in all the groups. Dexamethasone increased MDA concentration, TG, VLDL, LDL, urea and creatinine but decreased serum LDH and HDL without altering the total cholesterol(TC) and superoxide dismutase (SOD) enzyme, decreased catalase activity and distorted cellular integrity of the liver, kidney and aorta. Treatment with kolaviron positively reversed the distorted lipid profile and peroxidation and improved catalase and SOD activity. Lactate dehydrogenase activity was significantly (p

Ujong Peter Ujong

Papers

Assessment of Interradiologist Agreement Regarding Mammographic Breast Density Classification Using the Fifth Edition of the BI-RADS Atlas

Impact of kolaviron(a biflavonoid) on lipid peroxidation, thromboxane and cyclooxygenase activity in dexamethasone treated ats