Showing papers on "Mammography published in 2005"
TL;DR: Seven statistical models showed that both screening mammography and treatment have helped reduce the rate of death from breast cancer in the United States.
Abstract: BACKGROUND We used modeling techniques to assess the relative and absolute contributions of screening mammography and adjuvant treatment to the reduction in breast-cancer mortality in the United States from 1975 to 2000. METHODS A consortium of investigators developed seven independent statistical models of breast-cancer incidence and mortality. All seven groups used the same sources to obtain data on the use of screening mammography, adjuvant treatment, and benefits of treatment with respect to the rate of death from breast cancer. RESULTS The proportion of the total reduction in the rate of death from breast cancer attributed to screening varied in the seven models from 28 to 65 percent (median, 46 percent), with adjuvant treatment contributing the rest. The variability across models in the absolute contribution of screening was larger than it was for treatment, reflecting the greater uncertainty associated with estimating the benefit of screening. CONCLUSIONS Seven statistical models showed that both screening mammography and treatment have helped reduce the rate of death from breast cancer in the United States.
2,105 citations
TL;DR: The overall diagnostic accuracy of digital and film mammography as a means of screening for breast cancer is similar, but digital mammography is more accurate in women under the age of 50 years, women with radiographically dense breasts, and premenopausal or perimenopausal women.
Abstract: background Film mammography has limited sensitivity for the detection of breast cancer in women with radiographically dense breasts. We assessed whether the use of digital mammography would avoid some of these limitations. methods A total of 49,528 asymptomatic women presenting for screening mammography at 33 sites in the United States and Canada underwent both digital and film mammography. All relevant information was available for 42,760 of these women (86.3 percent). Mammograms were interpreted independently by two radiologists. Breast-cancer status was ascertained on the basis of a breast biopsy done within 15 months after study entry or a follow-up mammogram obtained at least 10 months after study entry. Receiver-operating-characteristic (ROC) analysis was used to evaluate the results. results In the entire population, the diagnostic accuracy of digital and film mammography was similar (difference between methods in the area under the ROC curve, 0.03; 95 percent confidence interval, i0.02 to 0.08; P=0.18). However, the accuracy of digital mammography was significantly higher than that of film mammography among women under the age of 50 years (difference in the area under the curve, 0.15; 95 percent confidence interval, 0.05 to 0.25; P=0.002), women with heterogeneously dense or extremely dense breasts on mammography (difference, 0.11; 95 percent confidence interval, 0.04 to 0.18; P=0.003), and premenopausal or perimenopausal women (difference, 0.15; 95 percent confidence interval, 0.05 to 0.24; P=0.002). conclusions The overall diagnostic accuracy of digital and film mammography as a means of screening for breast cancer is similar, but digital mammography is more accurate in women under the age of 50 years, women with radiographically dense breasts, and premenopausal or perimenopausal women. (clinicaltrials.gov number, NCT00008346.)
1,685 citations
TL;DR: M mammography alone, and also mammography combined with breast ultrasound, seems insufficient for early diagnosis of breast cancer in women who are at increased familial risk with or without documented BRCA mutation, but if MRI is used for surveillance, diagnosis of intraductal and invasive familial or hereditary cancer is achieved with a significantly higher sensitivity and at a more favorable stage.
Abstract: Purpose To compare the effectiveness of mammography, breast ultrasound, and magnetic resonance imaging (MRI) for surveillance of women at increased familial risk for breast cancer (lifetime risk of 20% or more). Patients and Methods We conducted a surveillance cohort study of 529 asymptomatic women who, based on their family history and/or mutational analysis, were suspected or proven to carry a breast cancer susceptibility gene (BRCA). A total of 1,542 annual surveillance rounds were completed with a mean follow-up of 5.3 years. Diagnostic accuracies of the three imaging modalities used alone or in different combinations were compared. Results Forty-three breast cancers were identified in the total cohort (34 invasive, nine ductal carcinoma-in-situ). Overall sensitivity of diagnostic imaging was 93% (40 of 43 breast cancers); overall node-positive rate was 16%, and one interval cancer occurred (one of 43 cancers, or 2%). In the analysis by modality, sensitivity was low for mammography (33%) and ultrasoun...
1,050 citations
TL;DR: In this paper, the authors compared contrast enhanced magnetic resonance imaging (CE MRI) with mammography for screening of women genetically predisposed to breast cancer and found that CE MRI is more sensitive than mammography.
1,023 citations
TL;DR: In the community, mammography remains the main screening tool while the effectiveness of clinical breast examination and self-examination are less, and new screening modalities are unlikely to replace mammography in the near future for screening the general population.
Abstract: ContextBreast cancer screening in community practices may be different from
that in randomized controlled trials. New screening modalities are becoming
available.ObjectivesTo review breast cancer screening, especially in the community and to
examine evidence about new screening modalities.Data Sources and Study SelectionEnglish-language articles of randomized controlled trials assessing
effectiveness of breast cancer screening were reviewed, as well as meta-analyses,
systematic reviews, studies of breast cancer screening in the community, and
guidelines. Also, studies of newer screening modalities were assessed.Data SynthesisAll major US medical organizations recommend screening mammography for
women aged 40 years and older. Screening mammography reduces breast cancer
mortality by about 20% to 35% in women aged 50 to 69 years and slightly less
in women aged 40 to 49 years at 14 years of follow-up. Approximately 95% of
women with abnormalities on screening mammograms do not have breast cancer
with variability based on such factors as age of the woman and assessment
category assigned by the radiologist. Studies comparing full-field digital
mammography to screen film have not shown statistically significant differences
in cancer detection while the impact on recall rates (percentage of screening
mammograms considered to have positive results) was unclear. One study suggested
that computer-aided detection increases cancer detection rates and recall
rates while a second larger study did not find any significant differences.
Screening clinical breast examination detects some cancers missed by mammography,
but the sensitivity reported in the community is lower (28% to 36%) than in
randomized trials (about 54%). Breast self-examination has not been shown
to be effective in reducing breast cancer mortality, but it does increase
the number of breast biopsies performed because of false-positives. Magnetic
resonance imaging and ultrasound are being studied for screening women at
high risk for breast cancer but are not recommended for screening the general
population. Sensitivity of magnetic resonance imaging in high-risk women has
been found to be much higher than that of mammography but specificity is generally
lower. Effect of the magnetic resonance imaging on breast cancer mortality
is not known. A balanced discussion of possible benefits and harms of screening
should be undertaken with each woman.ConclusionsIn the community, mammography remains the main screening tool while
the effectiveness of clinical breast examination and self-examination are
less. New screening modalities are unlikely to replace mammography in the
near future for screening the general population.
990 citations
TL;DR: Evidence is presented that mammographic density is a strong risk factor for breast cancer, and that risk of breast cancer is four to five times greater in women with density in more than 75% of the breast than in Women with little or no density in the breast.
Abstract: The amount of radiologically dense breast-tissue appearing on a mammogram varies between women because of differences in the composition of breast tissue, and is referred to here as mammographic density. This review presents evidence that mammographic density is a strong risk factor for breast cancer, and that risk of breast cancer is four to five times greater in women with density in more than 75% of the breast than in women with little or no density in the breast. Density in more than 50% of the breast could account for about a third of breast cancers. The epidemiology of mammographic density is consistent with its being a marker of susceptibility to breast cancer. Twin studies have shown that the proportion of the breast occupied by density, at a given age, is highly heritable, and inherited factors explain 63% of the variance. Mammographic breast density has the characteristics of a quantitative trait and might be determined by genes that are easier to identify than those for breast cancer itself. The genes that determine breast density might also be associated with risk of breast cancer, and their identification is also likely to provide insights into the biology of the breast and identify potential targets for preventive strategies.
581 citations
TL;DR: The authors compared the performance of screening mammography versus magnetic resonance imaging in women at genetically high risk for breast cancer and found the former to be more accurate and efficient.
Abstract: BACKGROUND
The authors compared the performance of screening mammography versus magnetic resonance imaging (MRI) in women at genetically high risk for breast cancer.
METHODS
The authors conducted an international prospective study of screening mammography and MRI in asymptomatic, genetically high-risk women age ≥ 25 years. Women with a history of breast cancer were eligible for a contralateral screening if they had been diagnosed within 5 years or a bilateral screening if they had been diagnosed > 5 years previously. All examinations (MRI, mammography, and clinical breast examination [CBE]) were performed within 90 days of each other.
RESULTS
In total, 390 eligible women were enrolled by 13 sites, and 367 women completed all study examinations. Imaging evaluations recommended 38 biopsies, and 27 biopsies were performed, resulting in 4 cancers diagnosed for an overall 1.1% cancer yield (95% confidence interval [95%CI], 0.3–2.8%). MRI detected all four cancers, whereas mammography detected one cancer. The diagnostic yield of mammography was 0.3% (95%CI, 0.01–1.5%). The yield of cancer by MRI alone was 0.8% (95%CI, − 0.3–2.0%). The biopsy recommendation rates for MRI and mammography were 8.5% (95%CI, 5.8–11.8%) and 2.2% (95%CI, 0.1–4.3%).
CONCLUSIONS
Screening MRI in high-risk women was capable of detecting mammographically and clinically occult breast cancer. Screening MRI resulted in 22 of 367 of women (6%) who had negative mammogram and negative CBE examinations undergoing biopsy, resulting in 3 additional cancers detected. MRI also resulted in 19 (5%) false-positive outcomes, which resulted in benign biopsies. Cancer 2005. © 2005 American Cancer Society.
381 citations
TL;DR: MRI appears to provide the best correlation with pathology-better than physical examination, mammography, and sonography-in patients undergoing neoadjuvant chemotherapy, however, MRI may overestimate or underestimate residual disease in approximately 29% of the patients (95% confidence interval, 14-48%).
Abstract: OBJECTIVE. The objective of our study was to determine the relative accuracy of mammography, sonography, and MRI in predicting residual tumor after neoadjuvant chemotherapy for breast cancer as compared with the gold standards of physical examination and pathology.SUBJECTS AND METHODS. Forty-one women with stage IIB–III palpable breast cancer were prospectively enrolled in a study investigating the effects of sequential single-agent chemotherapy (doxorubicin followed by paclitaxel or vice versa) on tumor imaging. The study cohort consisted of the first 31 patients (age range, 31–65 years; mean, 45 years) who completed the protocol. All underwent physical examination, mammography, sonography, and MRI before and after receiving each neoadjuvant chemotherapeutic drug. Imaging studies were reviewed by two radiologists using conventional lexicons for lesion analysis, and the findings were compared with clinical response and pathology results.RESULTS. Complete, partial, and stable clinical response as defined b...
378 citations
TL;DR: All risk factors for breast cancer must ultimately exert their influence by an effect on the breast, and these findings suggest that, for some risk factors, this influence includes an effect for some cells and the quantity of collagen.
Abstract: Background: We have examined the relationships between the measured properties of breast tissue and mammographic density and other risk factors for breast cancer, using breast tissue obtained at forensic autopsy and not selected for the presence of abnormalities.
Methods: We used randomly selected tissue blocks taken from breast tissue slices obtained by s.c. mastectomy at the time of forensic autopsy to measure histologic features using quantitative microscopy. The proportions of the biopsy occupied by cells (estimated by nuclear area), glandular structures, and collagen were determined. These measurements were examined in relation to the percent density in the faxitron image of the tissue slice from which the biopsy was taken and other risk factors for breast cancer.
Results: The percent mammographic density was associated with the proportion of the area of the biopsy occupied by nuclei, both epithelial and nonepithelial, and by collagen and the area of glandular structures. Several other risk factors for breast cancer, notably body weight, parity, and number of births, and menopausal status, that are associated with variations in mammographic density, were also associated with differences in one or more of these tissue features.
Conclusion: All risk factors for breast cancer must ultimately exert their influence by an effect on the breast, and these findings suggest that, for some risk factors, this influence includes an effect on the number of cells and the quantity of collagen.
312 citations
01 Dec 2005
308 citations
TL;DR: There was an apparent survival benefit beyond stage shift for patients with screen-detected breast cancers compared with patients with breast cancers detected otherwise, and method of detection appears to be an important prognostic factor, even after adjusting for known tumor characteristics.
Abstract: BACKGROUND Screening mammography detects breast cancers earlier than those detected symptomatically, and so mammographically detected breast cancers tend to have better prognoses. The so-called stage shift that results from screen detection is subject to lead-time and length biases, and so earlier detection may not translate into longer survival. We used data from three large breast cancer screening trials--Health Insurance Plan (HIP) of New York and two Canadian National Breast Cancer Screening Studies (CNBSS)--to investigate survival benefits of breast cancer screening beyond stage shift. We also address whether method of detection is an independent prognostic factor in breast cancer. METHODS The HIP trial randomly assigned approximately 62,000 women to screening and control groups. The two CNBSS trial cohorts CNBSS-1 and CNBSS-2 included a total of 44,970 women in the screening group and 44,961 in the control group. After adjusting for stage and other tumor characteristics in a Cox proportional hazards model, survival distributions were compared by method of breast cancer detection with both univariate and multivariable analyses. All P values are two-sided. RESULTS Breast cancers detected by screening mammography had a shift in stage distribution to earlier stages (for HIP, P < .001; for CNBSS-1, P = .03; and for CNBSS-2, P < .001). After adjusting for tumor size, lymph node status, and disease stage in a Cox proportional hazards model, method of detection was a statistically significant independent predictor of disease-specific survival. Patients with interval cancers had a 53% (95% confidence interval [CI] = 17% to 100%) greater hazard of death from breast cancer than patients with screen-detected cancers, and patients with cancer in the control groups had a 36% (95% CI = 10% to 68%) greater hazard of death than patients with screen-detected cancer. CONCLUSION There was an apparent survival benefit beyond stage shift for patients with screen-detected breast cancers compared with patients with breast cancers detected otherwise. Method of detection appears to be an important prognostic factor, even after adjusting for known tumor characteristics. This finding suggests that clinical trialists should routinely collect information about method of detection.
TL;DR: Routine mammographic screening of the contralateral breasts of patients with unilateral disease increased the rate of detection of simultaneous bilateral cancers, and the risk of a nonsimultaneous second cancer was strongly correlated with age at first primary.
Abstract: A prospective study was carried out, between January 1980 and March 1982, of all women who presented to the Breast Cancer Unit, Guy's Hospital, with a second primary breast cancer. The percentage of new simultaneous tumours detected clinically or by mammography was approximately 3 per cent. Routine mammographic screening of the contralateral breasts of patients with unilateral disease increased the rate of detection, fivefold, of simultaneous bilateral cancers. The incidence of nonsimultaneous bilateral disease was 7.6 second cancers per thousand patients at risk per year. The annual rate of occurrence of second primary cancers was a constant event and showed no trend either to increase or to decrease with follow-up. However, the risk of a nonsimultaneous second cancer was strongly correlated with age at first primary. Women who developed their first breast cancers under the age of 40 years had three times the risk of developing a second breast cancer compared with those who developed their first cancer after the age of 40. The risk of a second nonsimultaneous primary was 5.9 times that of the risk of occurrence of cancer in the first breast in the general female population.
TL;DR: The addition of breast density measured by BI-RADS categories minimally improved the predictive accuracy of the Gail model, and a model based on breast density alone adjusted for age and ethnicity was as accurate as the Gails model.
Abstract: Background. Estimating an individual woman’s absolute risk for breast cancer is essential for decision making about screening and preventive recommendations. Although the current standard, the Gail model, is well calibrated in populations, it performs poorly for individuals. Mammographic breast density (BD) may improve the predictive accuracy of the Gail model.
TL;DR: MRI was significantly more sensitive than mammography in DCIS detection and may have an important role to play in assessing the extent of disease in the breast in women with known or suspected DCIS.
Abstract: The purpose of this study was to compare the ability of magnetic resonance imaging (MRI) and mammography to determine the presence and extent of ductal carcinoma in situ (DCIS). Retrospective review of medical records of women who underwent MRI and mammographic examination during a 23-month period revealed 39 sites of pure DCIS in 33 breasts of 32 women. No invasive or microinvasive tumor was found. Women ranged in age from 34 to 79 years (mean age 53 years). In these 33 breasts, both MRI and mammography were done before surgery. Reports and images of mammography and MRI were reviewed to determine if each study was positive for the presence of single or multiple sites of DCIS and the imaging patterns associated with these sites. Of 33 breasts involved, DCIS was discovered by MRI alone in 21 (64%), by both MRI and mammography in 8 (24%), and by mammography alone in 1 (3%); in 3 breasts (9%), DCIS was found at mastectomy without findings on mammography or MRI. MRI had significantly higher sensitivity than mammography for DCIS detection (29/33=88% versus 9/33=27%, p<0.00001). Multiple sites of disease were present in five breasts; these were better demonstrated with MRI in three, mammography in one, and equally by both in one. The predominant enhancement pattern of DCIS on MRI was linear/ductal in 18 of 29 breasts (62%); mammography found calcifications associated with DCIS in 8 of 9 (89%). The nuclear grade of DCIS found with MRI and mammography was similar; size of lesions was larger on MRI; breast density did not impact results. In this study, MRI was significantly more sensitive than mammography in DCIS detection. In women with known or suspected DCIS, MRI may have an important role to play in assessing the extent of disease in the breast.
TL;DR: Prospectively assessing the effect of computer-aided detection on screening mammogram interpretation in an academic medical center to determine if the outcome is different than that previously reported for community practices found a 7.4% increase in cancers detected.
Abstract: PURPOSE: To prospectively assess the effect of computer-aided detection (CAD) on screening mammogram interpretation in an academic medical center to determine if the outcome is different than that previously reported for community practices. MATERIALS AND METHODS: Institutional review board approval was granted, and informed consent was waived. During a 19-month period, 8682 women (median age, 54 years; range, 33–95 years) underwent screening mammography. Each mammogram was interpreted by one of seven radiologists, followed by immediate re-evaluation of the mammogram with CAD information. Each recalled case was classified as follows: radiologist perceived the finding and CAD marked it, radiologist perceived the finding and CAD did not mark it, or CAD prompted the radiologist to perceive the finding and recall the patient. Lesion type was also recorded. Recalled patients were tracked to determine the effect of CAD on recall and biopsy recommendation rates, positive predictive value (PPV) of biopsy, and can...
TL;DR: In the Copenhagen programme, breast cancer mortality was reduced without severe negative side effects for the participants and compared with what the authors would expect in the absence of screening.
Abstract: Objectives To evaluate the effect on breast cancer mortality during the first 10 years of the mammography service screening programme that was introduced in Copenhagen in 1991. Design Cohort study. Setting The mammography service screening programme in Copenhagen, Denmark. Participants All women ever invited to mammography screening in the first 10 years of the programme. Historical, national, and historical national control groups were used. Main outcome measures The main outcome measure was breast cancer mortality. We compared breast cancer mortality in the study group with rates in the control groups, adjusting for age, time period, and region. Results Breast cancer mortality in the screening period was reduced by 25% (relative risk 0.75, 95% confidence interval 0.63 to 0.89) compared with what we would expect in the absence of screening. For women actually participating in screening, breast cancer mortality was reduced by 37%. Conclusions In the Copenhagen programme, breast cancer mortality was reduced without severe negative side effects for the participants.
TL;DR: The presented BCSC outcomes data and performance benchmarks may be used by mammography facilities and individual radiologists to evaluate their own performance for diagnostic mammography as determined by means of periodic comprehensive audits.
Abstract: PURPOSE: To evaluate a range of performance parameters pertinent to the comprehensive auditing of diagnostic mammography examinations, and to derive performance benchmarks therefrom, by pooling data collected from large numbers of patients and radiologists that are likely to be representative of mammography practice in the United States MATERIALS AND METHODS: Institutional review board approval was met, informed consent was not required, and this study was Health Insurance Portability and Accountability Act compliant Six mammography registries contributed data to the Breast Cancer Surveillance Consortium (BCSC), providing patient demographic and clinical information, mammogram interpretation data, and biopsy results from defined population-based catchment areas The study involved 151 mammography facilities and 646 interpreting radiologists The study population included women 18 years of age or older who underwent at least one diagnostic mammography examination between 1996 and 2001 Collected data wer
TL;DR: Granulomatous mastitis is a rare breast disease that mimics cancer in terms of clinical findings and surgical treatment in patients with GM is the treatment of choice.
Abstract: Granulomatous mastitis (GM) is a rare inflammatory breast disease of unknown etiology. Although it usually presents with sinus formation and abscesses, it may mimic the clinical characteristics of breast cancer. The aim of this study was to identify the clinical, radiologic, and pathologic characteristics of patients with GM and to show the results of surgical treatment in these patients. A chart review was performed for patients that were treated with a diagnosis of GM at the Breast Unit, Department of Surgery, Istanbul Medical Faculty, University of Istanbul, between September 1998 and January 2003. Eighteen patients were eligible for this study. The median age was 41.5 years (range 16–80 years). Seventeen patients were evaluated by both ultrasonography and mammography; whereas one young patient only had ultrasonography. Three patients were further examined with color Doppler ultrasonography and magnetic resonance imaging (MRI). Fourteen patients (78%) presented with a mass as the chief symptom, with a median size of 3.9 cm (range 1–8 cm), whereas four patients presented with fistula in their breasts. None of the radiologic techniques distinguished benign disease from cancer in any of the 14 patients that presented with a mass except one patient with normal mammography findings. Ultrasonography was only helpful to localize the abscess associated with a fistula tract in one patient. Therefore fine-needle aspiration biopsy (FNAB) was performed in six patients, followed by surgical excisional biopsy. The remaining eight patients with a clinical suspicion of malignancy underwent wide surgical excision with frozen section analysis under general anesthesia. All of the FNAB and frozen section evaluations revealed benign findings. All of the 18 patients underwent a wide excisional biopsy and had a definitive histopathologic diagnosis of GM. The median follow-up was 36 months (range 6–60 months). Only one patient had a recurrent disease, which was diagnosed at 12 months. GM is a rare breast disease that mimics cancer in terms of clinical findings. Preoperative radiologic diagnosis might be difficult. Complete surgical excision is the treatment of choice.
TL;DR: A simple, economical breast cancer detector has achieved high patient compliance and a high ROC/AUC score for a population which involved a range of tumors down to and including those of 0.8–1 cm in diameter.
TL;DR: It is concluded that a combination of clinical examination and mammography, with fine needle aspiration cytology performed by committed individuals with aptitude for the technique and interpreted by experienced pathologists, can identify all patients with breast cancer before surgery.
Abstract: The accuracy of clinical examination, mammography and fine needle aspiration cytology in identifying malignancy has been assessed in 1655 breast masses from two time periods. Clinical examination and mammography remained consistent at identifying malignancy but 9 per cent of all breast carcinomas were considered benign by both techniques (sensitivity 91 per cent). Fine needle aspiration cytology, when performed by multiple aspirators in the first study period, had a sensitivity of only 66 per cent for malignancy. During the second period of study, when all aspirates were performed by a single aspirator, sensitivity rose to 99 per cent. The two patients with false negative cytology in this latter period had both clinical and mammographic evidence of malignancy. No patient with malignant cytology was subsequently shown to have benign disease. It is concluded that a combination of clinical examination and mammography, with fine needle aspiration cytology performed by committed individuals with aptitude for the technique and interpreted by experienced pathologists, can identify all patients with breast cancer before surgery.
TL;DR: Preliminary data suggest that benign and malignant tumors can potentially be noninvasively differentiated with optical imaging, and the sensitivity of optical techniques to the composition of the breast is illustrated.
07 Jun 2005
TL;DR: This paper reviews most of the relevant work on breast tissue identification and abnormalities detection from 80's to nowadays and presents an automated technique for segmenting a digital mammogram into breast region and background, with pectoral muscle suppression.
Abstract: Previous works on breast tissue identification and abnormalities detection notice that the feature extraction process is affected if the region processed is not well focused. Thereby, it is important to split the mammogram into interesting regions to achieve optimal breast parenchyma measurements, breast registration or to put into focus a technique when we search for abnormalities. In this paper, we review most of the relevant work that has been presented from 80's to nowadays. Secondly, an automated technique for segmenting a digital mammogram into breast region and background, with pectoral muscle suppression is presented.
TL;DR: Two techniques are proposed based on wavelet analysis and fuzzy-neural approaches that can be very helpful for radiologist in detection and diagnosing abnormalities earlier and faster than traditional screening programs.
Abstract: The high incidence of breast cancer in women has increased significantly in the recent years. The most familiar breast tumors types are mass and microcalcification. Mammograms-breast X-ray-are considered the most reliable method in early detection of breast cancer. Computer-aided diagnosis system can be very helpful for radiologist in detection and diagnosing abnormalities earlier and faster than traditional screening programs. Several techniques can be used to accomplish this task. In this paper, two techniques are proposed based on wavelet analysis and fuzzy-neural approaches. These techniques are mammography classifier based on globally processed image and mammography classifier based on locally processed image (region of interest). The system is classified normal from abnormal, mass for microcalcification and abnormal severity (benign or malignant). The evaluation of the system is carried out on Mammography Image Analysis Society (MIAS) dataset. The accuracy achieved is satisfied.
TL;DR: The hypothesis that screening with CAD significantly improves detection of the specific cancer morphologies that CAD algorithms were designed to detect is supported.
Abstract: OBJECTIVE. This study was conducted to prospectively assess the effect of computer-aided detection (CAD) on screening outcomes in a regional mammography program.MATERIALS AND METHODS. Between January 1, 1998, and December 31, 2000, 27,274 consecutive screenings were performed. Radiologists' performance before CAD (n = 7,872) and with CAD (n = 19,402) was determined by annual audits. All positive biopsy results were reviewed; histopathology was reviewed and confirmed. Outcomes (recall, biopsy, and cancer detection rates) with CAD (1999, 2000) were compared with historical control data (1998).RESULTS. With CAD, increases were seen in recall rate (8.1%, from 7.7% to 8.3%), biopsy rate (6.7%, from 1.4% to 1.5%), and cancer detection rate (16.1%, from 3.7 per 1,000 to 4.3 per 1,000). Detection rate of invasive cancers of 1.0 cm or less increased 164% (from 0.508 to 1.34 per 1,000 screens; p = 0.069). Detection rate of in situ cancers declined 6.7% (from 1.27 to 1.19 per 1,000; p = 0.849). In multivariable anal...
University of Pennsylvania1, Brown University2, Johns Hopkins University3, University of Virginia4, University of California, Los Angeles5, University of Arkansas for Medical Sciences6, Technische Universität München7, University of California, San Francisco8, University of Bonn9, University of North Carolina at Chapel Hill10, University of Toronto11, Harvard University12, University of Texas MD Anderson Cancer Center13, University of Washington14, University of Texas Southwestern Medical Center15
TL;DR: The rate of MRI and mammography detection of foci of distinct incidental cancer in a prospective, multi center trial involving 426 women with confirmed breast cancer at 15 institutions in the US, Canada, and Germany is reported on.
Abstract: Background: Prior single institution studies suggest MRI may improve the assessment of the extent of cancer within the breast, and thus reduce the risk of leaving macroscopic disease in the breast following breast conservation therapy. We report on the rate of MRI and mammography detection of foci of distinct incidental cancer in a prospective, multi center trial involving426 women with confirmed breast cancer at 15 institutions in the US, Canada, and Germany. Methods: Women underwent mammography and MRI prior to biopsy of the suspicious index lesion. Additional incidental lesions (IL) greater than 2 cm from the index lesion that were detected by mammography and MRI were noted and characterized. Biopsy recommendations were associated with ILs given an assessment of suspicious or highly suspicous (BiRads 4 and 5). These assessments were considered a positive test. Results: MRI had a significantly higher yield of confirmed cancer ILs than mammography (0.18 (95%CI: 0.142‐0.214) for MRI versus 0.072 (95%CI: 0.050‐ 0.100) for mammography). The cancer ILs detected by MRI alone appeared to be similar to those detected by mammography with respect to size and histology. The percentage of biopsies of ILs that resulted in a cancer diagnosis was similar between
TL;DR: Blood flow contrast between tumor and normal tissues in patients with malignant and benign breast cancer was measured by diffuse optical correlation methods and introduces a new optical contrast for diffuse optical mammography.
Abstract: Blood flow contrast between tumor and normal tissues in patients with malignant and benign breast cancer was measured by diffuse optical correlation methods. The measurements were carried out with a hand-held optical probe that was manually scanned over the tumor-bearing breast. Increased blood flow was observed in tumor regions relative to healthy tissue, and control subjects did not exhibit significant blood flow heterogeneity. The measurements introduce a new optical contrast for diffuse optical mammography.
TL;DR: The mammography self-efficacy scale evidenced content and construct validity and Construct validity was measured using confirmatory factor analysis and logistic regression and Bandura's model guided item development.
Abstract: Mammography screening has been demonstrated to decrease mortality from breast cancer. Although adherence rates have increased, there is still a need to increase annual screening. Self-efficacy is a construct that has been found useful in predicting behaviors. Measurement of self- efficacy needs to be specific to the behavior and to have good validity and reliability. The purpose of this study is to describe development of a self- efficacy instrument to measure confidence in obtaining a mammogram. Bandura's model guided item development. Construct validity was measured using confirmatory factor analysis and logistic regression. Cronbach alpha was used to test internal consistency reliability. A Cronbach alpha coefficient of .87 was obtained. The mammography self-efficacy scale evidenced content and construct validity. 2005 Wiley Periodicals, Inc. Res Nurs Health 28:329-336, 2005
TL;DR: Higher overall accuracy was associated with more experience and with a higher focus on screening mammography, and raising the annual volume requirements in the Mammography Quality Standards Act might improve the overall quality of screening Mammography in the United States.
Abstract: Background: The association between physician experience and the accuracy of screening mammography in community practice is not well studied. We identified characteristics of U.S. physicians associated with the accuracy of screening mammography. Methods: Data were obtained from the Breast Cancer Surveillance Consortium and the American Medical Association Master File. Unadjusted mammography sensitivity and specificity were calculated according to physician characteristics. We modeled mammography sensitivity and specificity by multivariable logistic regression as a function of patient and physician characteristics. All statistical tests were two-sided. Results: We studied 209 physicians who interpreted 1220046 screening mammograms from January 1, 1995, through December 31, 2000, of which 7143 (5.9 per 1000 mammograms) were associated with breast cancer within 12 months of screening. Each physician interpreted a mean of 6011 screening mammograms (95% confidence interval [CI] = 4998 to 6677), including a mean of 34 (95% CI = 28 to 40) from women diagnosed with breast cancer. The mean sensitivity was 77% (range = 29%-97%), and the mean false-positive rate was 10% (range = 1%-29%). After adjustment for the patient characteristics of those whose mammograms they interpreted, physician characteristics were strongly associated with specificity. Higher specificity was associated with at least 25 years (versus less than 10 years) since receipt of a medical degree (for physicians practicing for 25-29 years, odds ratio [OR] = 1.54, 95% CI = 1.14 to 2.08; P = .006), interpretation of 2500-4000 (versus 481-750) screening mammograms annually (OR = 1.30, 95% CI = 1.06 to 1.59; P= .011) and a high focus on screening mammography compared with diagnostic mammography (OR = 1.59, 95% CI = 1.37 to 1.82; P<.001). Higher overall accuracy was associated with more experience and with a higher focus on screening mammography. Compared with physicians who interpret 481-750 mammograms annually and had a low screening focus, physicians who interpret 2500-4000 mammograms annually and had a high screening focus had approximately 50% fewer false-positive examinations and detected a few less cancers. Conclusion: Raising the annual volume requirements in the Mammography Quality Standards Act might improve the overall quality of screening mammography in the United States.
TL;DR: Tumor size, lymph node status, and lymphatic or vascular invasion were positively associated with breast density among screen-detected cancers and Histologic grade and mitotic index were negatively associated with Breast density in women diagnosed with an interval cancer.
Abstract: Objective: Few studies have examined the association between breast density and breast cancer tumor characteristics. We examined the association between hormonal, proliferative, and histologic tumor characteristics and mammographic breast density in women with breast cancer.
Methods: We conducted a cross-sectional analysis in 546 women diagnosed with invasive breast cancer to evaluate the associations between breast density and tumor size, lymph node status, lymphatic or vascular invasion, histologic grade, nuclear grade, tumor differentiation, mitotic index, tumor necrosis, Ki-67 proliferation, estrogen receptor, progesterone receptor, p53, p27, cyclin E, Bcl-2, and C-erb-B2 invasion. Breast density was classified as fatty (Breast Imaging Reporting and Data System code 1 or 2; n = 373) or dense (Breast Imaging Reporting and Data System code 3 or 4; n = 173) for the cancer-free breast. A single pathologist measured all tumor markers. We examined whether the relationships were modified by interval cancer or screen-detected cancer.
Results: Women with a tumor size >1.0 cm were more likely to have dense breasts compared with women with a tumor size ≤1.0 cm after adjusting for confounders (odds ratio, 2.0; 95% confidence interval, 1.2-3.4 for tumor sizes 1.1-2.0 cm; odds ratio, 2.3; 95% confidence interval, 1.3-4.4 for tumor sizes 2.1-10 cm). Tumor size, lymph node status, and lymphatic or vascular invasion were positively associated with breast density among screen-detected cancers. Histologic grade and mitotic index were negatively associated with breast density in women diagnosed with an interval cancer.
Conclusions: These results suggest that breast density is related to tumor size, lymph node status, and lymphatic or vascular invasion in screen-detected cancers. Additional studies are needed to address whether these associations are due to density masking the detection of some tumors, a biological relationship, or both.
TL;DR: Quantitative estimates of the benefits and harms of screening mammography are relatively finely balanced and can be used to support individual informed choices about screening.
Abstract: Objective To provide easy to use estimates of the benefits and harms of biennial screening mammography for women aged 40, 50, 60, and 70 years. Design Markov process model, with data from BreastScreen Australia, the Australian Institute of Health and Welfare, and the Australian Bureau of Statistics. Main outcome measure Age specific outcomes expressed per 1000 women over 10 years. Results For every 1000 women screened over 10 years, 167-251 (depending on age) receive an abnormal result; 56-64 of these women undergo at least one biopsy, 9-26 have an invasive cancer detected by screening, and 3-6 have ductal carcinoma in situ (DCIS) detected by screening. More breast cancers (both invasive and DCIS) are diagnosed among screened than unscreened women. For example, among 1000 women aged 50 who have five biennial screens, 33 breast cancers are diagnosed: 28 invasive cancers (18 detected at screening and 10 interval cancers) and five DCIS (all detected at screening). By comparison, among 1000 women aged 50 who decline screening, 20 cancers are diagnosed over 10 years. There are about 0.5, 2, 3, and 2 fewer deaths from breast cancer over 10 years per 1000 women aged 40, 50, 60, and 70, respectively, who choose to be screened compared with women who decline screening at times determined by relevant policy. Conclusion Benefits and harms of screening mammography are relatively finely balanced. Quantitative estimates such as these can be used to support individual informed choices about screening.