Showing papers on "Mammography published in 2011"

Breast cancer statistics, 2011†

Abstract: In this article, the American Cancer Society provides an overview of female breast cancer statistics in the United States, including trends in incidence, mortality, survival, and screening. Approximately 230,480 new cases of invasive breast cancer and 39,520 breast cancer deaths are expected to occur among US women in 2011. Breast cancer incidence rates were stable among all racial/ethnic groups from 2004 to 2008. Breast cancer death rates have been declining since the early 1990s for all women except American Indians/Alaska Natives, among whom rates have remained stable. Disparities in breast cancer death rates are evident by state, socioeconomic status, and race/ethnicity. While significant declines in mortality rates were observed for 36 states and the District of Columbia over the past 10 years, rates for 14 states remained level. Analyses by county-level poverty rates showed that the decrease in mortality rates began later and was slower among women residing in poor areas. As a result, the highest breast cancer death rates shifted from the affluent areas to the poor areas in the early 1990s. Screening rates continue to be lower in poor women compared with non-poor women, despite much progress in increasing mammography utilization. In 2008, 51.4% of poor women had undergone a screening mammogram in the past 2 years compared with 72.8% of non-poor women. Encouraging patients aged 40 years and older to have annual mammography and a clinical breast examination is the single most important step that clinicians can take to reduce suffering and death from breast cancer. Clinicians should also ensure that patients at high risk of breast cancer are identified and offered appropriate screening and follow-up. Continued progress in the control of breast cancer will require sustained and increased efforts to provide high-quality screening, diagnosis, and treatment to all segments of the population.

Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study.

Abstract: Background False-positive mammography results are common. Biennial screening may decrease the cumulative probability of false-positive results across many years of repeated screening but could also delay cancer diagnosis. Objective To compare the cumulative probability of false-positive results and the stage distribution of incident breast cancer after 10 years of annual or biennial screening mammography. Design Prospective cohort study. Setting 7 mammography registries in the National Cancer Institute-funded Breast Cancer Surveillance Consortium. Participants 169,456 women who underwent first screening mammography at age 40 to 59 years between 1994 and 2006 and 4492 women with incident invasive breast cancer diagnosed between 1996 and 2006. Measurements False-positive recalls and biopsy recommendations stage distribution of incident breast cancer. Results False-positive recall probability was 16.3% at first and 9.6% at subsequent mammography. Probability of false-positive biopsy recommendation was 2.5% at first and 1.0% at subsequent examinations. Availability of comparison mammograms halved the odds of a false-positive recall (adjusted odds ratio, 0.50 [95% CI, 0.45 to 0.56]). When screening began at age 40 years, the cumulative probability of a woman receiving at least 1 false-positive recall after 10 years was 61.3% (CI, 59.4% to 63.1%) with annual and 41.6% (CI, 40.6% to 42.5%) with biennial screening. Cumulative probability of false-positive biopsy recommendation was 7.0% (CI, 6.1% to 7.8%) with annual and 4.8% (CI, 4.4% to 5.2%) with biennial screening. Estimates were similar when screening began at age 50 years. A non-statistically significant increase in the proportion of late-stage cancers was observed with biennial compared with annual screening (absolute increases, 3.3 percentage points [CI, -1.1 to 7.8 percentage points] for women age 40 to 49 years and 2.3 percentage points [CI, -1.0 to 5.7 percentage points] for women age 50 to 59 years) among women with incident breast cancer. Limitations Few women underwent screening over the entire 10-year period. Radiologist characteristics influence recall rates and were unavailable. Most mammograms were film rather than digital. Incident cancer was analyzed in a small sample of women who developed cancer. Conclusion After 10 years of annual screening, more than half of women will receive at least 1 false-positive recall, and 7% to 9% will receive a false-positive biopsy recommendation. Biennial screening appears to reduce the cumulative probability of false-positive results after 10 years but may be associated with a small absolute increase in the probability of late-stage cancer diagnosis. Primary funding source National Cancer Institute.

Personalizing Mammography by Breast Density and Other Risk Factors for Breast Cancer: Analysis of Health Benefits and Cost-Effectiveness

Abstract: The optimal timing and frequency of screening mammography are controversial. This analysis found that the cost-effectiveness of screening mammography depended on a woman's age, breast density, fami...

Multicenter Surveillance of Women at High Genetic Breast Cancer Risk Using Mammography, Ultrasonography, and Contrast-Enhanced Magnetic Resonance Imaging (the High Breast Cancer Risk Italian 1 Study): Final Results

Abstract: Objectives:To prospectively compare clinical breast examination, mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (MRI) in a multicenter surveillance of high-risk women.Materials and Methods:We enrolled asymptomatic women aged ≥25: BRCA mutation carriers; first-degree r

The First Analysis and Clinical Evaluation of Native Breast Tissue Using Differential Phase-Contrast Mammography

Abstract: Objectives Phase-contrast and scattering-based x-ray imaging are known to provide additional and complementary information to conventional, absorption-based methods, and therefore have the potential to play a crucial role in medical diagnostics. We report on the first mammographic investigation of 5 native, that is, freshly dissected, breasts carried out with a grating interferometer and a conventional x-ray tube source. Four patients in this study had histopathologically proven invasive breast cancer. One male patient, without the presence of any malignant formations within the resected breast, was included as a control specimen. Materials and methods We used a Talbot-Lau grating setup installed on a conventional, low-brilliance x-ray source; the interferometer operated at the fifth Talbot distance, at a tube voltage of 40 kVp with mean energy of 28 keV, and at a current of 25 mA. The device simultaneously recorded absorption, differential phase and small-angle scattering signals from the native breast tissue. These quantities were then combined into novel color- and high-frequency-enhanced radiographic images. Presurgical images (conventional mammography, ultrasonography, and magnetic resonance imaging) supported the findings and clinical relevance was verified. Results Our approach yields complementary and otherwise inaccessible information on the electron density distribution and the small-angle scattering power of the sample at the microscopic scale. This information can be used to potentially answer clinically relevant, yet unresolved questions such as unequivocally discerning between malignant and premalignant changes and postoperative scars and distinguishing cancer-invaded regions within healthy tissue. Conclusions We present the first ex vivo images of fresh, native breast tissue obtained from mastectomy specimens using grating interferometry. This technique yields improved diagnostic capabilities when compared with conventional mammography, especially when discerning the type of malignant conversions and their breadth within normal breast tissue. These promising results advance us toward the ultimate goal, using grating interferometry in vivo on humans in a clinical setting.

Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: a comparison.

Abstract: OBJECTIVE. The purpose of this article is to compare the ability of digital breast tomosynthesis and full field digital mammography (FFDM) to detect and characterize calcifications.MATERIALS AND METHODS. One hundred paired examinations were performed utilizing FFDM and digital breast tomosynthesis. Twenty biopsy-proven cancers, 40 biopsy-proven benign calcifications, and 40 randomly selected negative screening studies were retrospectively reviewed by five radiologists in a crossed multireader multimodal observer performance study. Data collected included the presence of calcifications and forced BI-RADS scores. Receiver operator curve analysis using BI-RADS was performed.RESULTS. Overall calcification detection sensitivity was higher for FFDM (0.84% [95% CI, 0.79–0.88%]) than for digital breast tomosynthesis (0.75% [95% CI, 0.70–0.80%]). In the cancer cohort, 75 (76%) of 99 interpretations identified calcification in both modes. Of those, a BI-RADS score less than or equal to 2 was rendered in three (4%) ...

Comparative Effectiveness of Digital Versus Film-Screen Mammography in Community Practice in the United States: A Cohort Study

Abstract: Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice. In a large sample of women screened in community settings, digital and ...

Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging

Abstract: Purpose The sensitivity of magnetic resonance imaging (MRI) for breast cancer screening exceeds that of mammography. If MRI screening reduces mortality in women with a BRCA1 or BRCA2 mutation, it is expected that the incidence of advanced-stage breast cancers should be reduced in women undergoing MRI screening compared with those undergoing conventional screening. Patients and Methods We followed 1,275 women with a BRCA1 or BRCA2 mutation for a mean of 3.2 years. In total, 445 women were enrolled in an MRI screening trial in Toronto, Ontario, Canada, and 830 were in the comparison group. The cumulative incidences of ductal carcinoma in situ (DCIS), early-stage, and late-stage breast cancers were estimated at 6 years in the cohorts. Results There were 41 cases of breast cancer in the MRI-screened cohort (9.2%) and 76 cases in the comparison group (9.2%). The cumulative incidence of DCIS or stage I breast cancer at 6 years was 13.8% (95% CI, 9.1% to 18.5%) in the MRI-screened cohort and 7.2% (95% CI, 4.5% t...

Risk of Radiation-induced Breast Cancer from Mammographic Screening

Abstract: The predicted risk of radiation-induced breast cancer from mammographic screening is low in terms of the number of cancers induced, the number of potential deaths, and the number of woman-years of life lost.

Dual-energy contrast-enhanced digital mammography: initial clinical results

Abstract: Objective To assess the diagnostic accuracy of Dual-Energy Contrast-Enhanced Digital Mammography (CEDM) as an adjunct to mammography (MX) versus MX alone and versus mammography plus ultrasound (US).

Effectiveness of Population-Based Service Screening With Mammography for Women Ages 40 to 49 Years Evaluation of the Swedish Mammography Screening in Young Women (SCRY) Cohort

Abstract: BACKGROUND: The effectiveness of mammography screening for women ages 40 to 49 years still is questioned, and few studies of the effectiveness of service screening for this age group have been cond ...

Mammographic Breast Density and Subsequent Risk of Breast Cancer in Postmenopausal Women According to Tumor Characteristics

Abstract: Background Few studies that investigated the associations between breast density and subsequent breast cancer according to tumor characteristics have produced inconclusive findings. We aimed to determine whether the associations between breast density and subsequent breast cancer varied by tumor characteristics.

Mammography with synchrotron radiation: first clinical experience with phase-detection technique.

Abstract: Mammography with synchrotron radiation facilitates the potential for increased ability to diagnose true-negative imaging findings.

Interpreting Overdiagnosis Estimates in Population-based Mammography Screening

Abstract: Estimates of overdiagnosis in mammography screening range from 1% to 54%. This review explains such variations using gradual implementation of mammography screening in the Netherlands as an example. Breast cancer incidence without screening was predicted with a micro-simulation model. Observed breast cancer incidence (including ductal carcinoma in situ and invasive breast cancer) was modeled and compared with predicted incidence without screening during various phases of screening program implementation. Overdiagnosis was calculated as the difference between the modeled number of breast cancers with and the predicted number of breast cancers without screening. Estimating overdiagnosis annually between 1990 and 2006 illustrated the importance of the time at which overdiagnosis is measured. Overdiagnosis was also calculated using several estimators identified from the literature. The estimated overdiagnosis rate peaked during the implementation phase of screening, at 11.4% of all predicted cancers in women aged 0-100 years in the absence of screening. At steady-state screening, in 2006, this estimate had decreased to 2.8%. When different estimators were used, the overdiagnosis rate in 2006 ranged from 3.6% (screening age or older) to 9.7% (screening age only). The authors concluded that the estimated overdiagnosis rate in 2006 could vary by a factor of 3.5 when different denominators were used. Calculations based on earlier screening program phases may overestimate overdiagnosis by a factor 4. Sufficient follow-up and agreement regarding the chosen estimator are needed to obtain reliable estimates.

United States Preventive Services Task Force Screening Mammography Recommendations: Science Ignored

Abstract: OBJECTIVE. The purpose of this article is to examine the scientific evidence considered by the United States Preventive Services Task Force (USPSTF) in recommending against screening mammography in women 40–49 years old and against annual screening mammography in women 50 and older. We use evidence made available to the USPSTF to estimate the benefits and “harms” of screening mammography in women 40 years old and older. We use Cancer Intervention and Surveillance Modeling Network modeling to compare lives saved by different screening scenarios and the summary of evidence prepared for the USPSTF to estimate the frequency of harms of screening mammography by age.CONCLUSION. Averaged over the six Cancer Intervention and Surveillance Modeling Network models of benefit, screening mammography shows greatest benefit—a 39.6% mortality reduction—from annual screening of women 40–84 years old. This screening regimen saves 71% more lives than the USPSTF-recommended regimen of biennial screening of women 50–74 years ...

Breast Cancer: Comparative Effectiveness of Positron Emission Mammography and MR Imaging in Presurgical Planning for the Ipsilateral Breast

Abstract: Overall, 61 (16%) of 388 participants had an appropriate change in surgical management based on MR findings—more than the 41 (11%) participants with an appropriate change based on positron emission mammography (PEM) findings (P = .003) and fewer than the 71 (18%) participants with an appropriate change based on combined PEM and MR findings (P = .004 for comparison with MR imaging alone); 25 (6.4%) women had excessive excisions on the basis of MR findings compared with 19 (4.9%) women who had them on the basis of PEM findings (P = .26) and 32 (8.2%) women who had them after undergoing combined PEM and MR imaging (P = .023 for comparison with MR imaging alone).

Estimation of mean glandular dose for breast tomosynthesis: factors for use with the UK, European and IAEA breast dosimetry protocols.

Abstract: A formalism is proposed for the estimation of mean glandular dose for breast tomosynthesis, which is a simple extension of the UK, European and IAEA protocols for dosimetry in conventional projection mammography. The formalism introduces t-factors for the calculation of breast dose from a single projection and T-factors for a complete exposure series. Monte Carlo calculations of t-factors have been made for an imaging geometry with full-field irradiation of the breast for a wide range of x-ray spectra, breast sizes and glandularities. The t-factors show little dependence on breast glandularity and tables are provided as a function of projection angle and breast thickness, which may be used for all x-ray spectra simulated. The T-factors for this geometry depend upon the choice of projection angles and weights per projection, but various example calculations gave values in the range 0.93-1.00. T-factors are also provided for the Sectra tomosynthesis system, which employs a scanned narrow-beam imaging geometry. In this quite different configuration, the factor (denoted T(S)) shows an important dependence on breast thickness, varying between 0.98 and 0.76 for 20 and 110 mm thick breasts, respectively. Additional data are given to extend the current tabulations of g-, c- and s-factors used for dosimetry of conventional 2D mammography.

Volume of Mammographic Density and Risk of Breast Cancer

Abstract: Background: Assessing the volume of mammographic density might more accurately reflect the amount of breast volume at risk of malignant transformation and provide a stronger indication of risk of breast cancer than methods based on qualitative scores or dense breast area. Methods: We prospectively collected mammograms for women undergoing screening mammography. We determined the diagnosis of subsequent invasive or ductal carcinoma in situ (DCIS) for 275 cases, selected 825 controls matched for age, ethnicity, and mammography system, and assessed three measures of breast density: percent dense area, fibroglandular volume, and percent fibroglandular volume. Results: After adjustment for familial breast cancer history, body mass index, history of breast biopsy, and age at first live birth, the odds ratios for breast cancer risk in the highest versus lowest measurement quintiles were 2.5 (95% CI: 1.5, 4.3) for percent dense area, 2.9 (95% CI: 1.7, 4.9) for fibroglandular volume, and 4.1 (95% CI: 2.3, 7.2) for percent fibroglandular volume. Net reclassification indexes for density measures plus risk factors versus risk factors alone were 9.6% (P=0.07) for percent dense area, 21.1% (P=0.0001) for fibroglandular volume, and 14.8% (P=0.004) for percent fibroglandular volume. Fibroglandular volume improved the categorical risk classification of 1 in 5 women for both women with and without breast cancer. Conclusion: Volumetric measures of breast density are more accurate predictors of breast cancer risk than risk factors alone and than percent dense area. Impact: Risk models including dense fibroglandular volume may more accurately predict breast cancer risk than current risk models.

Effectiveness of Computer-Aided Detection in Community Mammography Practice

Abstract: Results Of 90 total facilities, 25 (27.8%) adopted CAD and used it for an average of 27.5 study months. In adjusted analyses, CAD use was associated with statistically significantly lower specificity (OR = 0.87, 95% confidence interval [CI] = 0.85 to 0.89, P < .001) and positive predictive value (OR = 0.89, 95% CI = 0.80 to 0.99, P = .03). A non-statistically significant increase in overall sensitivity with CAD (OR = 1.06, 95% CI = 0.84 to 1.33, P = .62) was attributed to increased sensitivity for ductal carcinoma in situ (OR = 1.55, 95% CI = 0.83 to 2.91; P = .17), although sensitivity for invasive cancer was similar with or without CAD (OR = 0.96, 95% CI = 0.75 to 1.24; P = .77). CAD was not associated with higher breast cancer detection rates or more favorable stage, size, or lymph node status of invasive breast cancer. Conclusion CAD use during film-screen screening mammography in the United States is associated with decreased specificity but not with improvement in the detection rate or prognostic characteristics of invasive breast cancer.

Expert system based on neuro-fuzzy rules for diagnosis breast cancer

Abstract: Research highlights? In this study, we have developed an expert system for diagnosing of breast cancer. ? Inference engine of Ex-DBC system includes neuro fuzzy rules. ? Ex-DBC system has 97% specificity, 96% positive and 81% negative predictive values. ? Ex-DBC can be used as a strong diagnostic tool for diagnosing of breast cancer. Recent advances in the field of artificial intelligence have led to the emergence of expert systems for medical applications. Moreover, in the last few decades computational tools have been designed to improve the experiences and abilities of physicians for making decisions about their patients.Breast cancer is the commonest cancer in women and is the second leading cause of cancer death (Jemal et al., 2003). Although it is curable when detected early, about one third of women with breast cancer die of the disease (Scheidhauer, Walter, & Seemann, 2004). In this study, we have developed an expert system that we called as an Ex-DBC (Expert system for Diagnosis of Breast Cancer), because differentiating between benign and malignant mammographic findings, however, is quite difficult. Only 15-30% of biopsies performed on nonpalpable but mammographically suspicious lesions prove malignant (Hall, Storella, Silverstone, & Wyshak, 1988). The golden standard for diagnosis of breast cancer is biopsy. But, biopsy can be a source of patient discomfort, bleeding and infection, and can burden the health care system with extra costs. Thus, to reduce unnecessary biopsy rate have acquired big importance.The fuzzy rules which will be use in inference engine of Ex-DBC system were found by using neuro-fuzzy method. Ex-DBC can be used as a strong diagnostic tool with 97% specificity, 76% sensitivity, 96% positive and 81% negative predictive values for diagnosing of breast cancer. That the developed system's positive predictive is high is very important. By means of this system can be prevented unnecessary biopsy. Beside it can be benefited from this system for training of students in medicine.

Accuracy of Clinical Examination, Digital Mammogram, Ultrasound, and MRI in Determining Postneoadjuvant Pathologic Tumor Response in Operable Breast Cancer Patients

Abstract: To determine the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of clinical examination and breast imaging techniques in determining pathologic complete response in patients with locally advanced breast cancer after neoadjuvant therapy. A retrospective review was performed of data collected from patients treated with either neoadjuvant hormonal or chemotherapy between January 2005 and September 2010. Patients were evaluated by one of three surgical breast oncologists before neoadjuvant therapy and within 1 month before surgery by clinical breast examination (CBE), digital mammogram, breast ultrasound, and/or magnetic resonance imaging (MRI). The accuracy, NPV, and PPV of each modality was calculated on the basis of the final pathologic report. Available data from the literature was synthesized. Sixty-two tumors in 61 patients with a mean age of 56 (range 34–87) years were evaluated. Overall accuracy ranged from 54% (CBE) to 80% (breast ultrasound). All modalities had a PPV greater than 75% for identifying the presence of residual disease. The PPV of each modality was generally higher in the younger patients. The NPV of all methods was less than 50%. The accuracy and NPV were compromised even further in younger patients. The combination of our own data with data available from the literature revealed MRI to be superior with regard to accuracy and PPV, but the NPV of MRIs remained poor at 65%. All measured tests are good at predicting the presence of disease on final pathology, but none are able to reliably predict a pathologic complete response.

Update on Mammography Trends: Comparisons of Rates in 2000, 2005, and 2008

Abstract: BACKGROUND Mammography screening allows early detection of breast cancer, which helps reduce mortality from breast cancer, especially in women aged 50–69. This paper updates a previous analysis of trends in mammography using newly-available data from the National Health Interview Survey (NHIS).

Breast imaging: A survey

Abstract: Breast cancer is the second leading cause of death in women. It occurs when cells in the breast start to grow out of proportion and invade neighboring tissues or spread throughout the body. Mammography is one of the most effective and popular modalities presently used for breast cancer screening and detection. Efforts have been made to improve the accuracy of breast cancer diagnosis using different imaging modalities. Ultrasound and magnetic resonance imaging have been used to detect breast cancers in high risk patients. Recently, electrical impedance imaging and nuclear medicine techniques are also being widely used for breast cancer screening and diagnosis. In this paper, we discuss the capabilities of various breast imaging modalities.

Increasingly strong reduction in breast cancer mortality due to screening

Abstract: Favourable outcomes of breast cancer screening trials in the 1970s and 1980s resulted in the launch of population-based service screening programmes in many Western countries. We investigated whether improvements in mammography and treatment modalities have had an influence on the effectiveness of breast cancer screening from 1975 to 2008. In Nijmegen, the Netherlands, 55 529 women received an invitation for screening between 1975 and 2008. We designed a case–referent study to evaluate the impact of mammographic screening on breast cancer mortality over time from 1975 to 2008. A total number of 282 breast cancer deaths were identified, and 1410 referents aged 50–69 were sampled from the population invited for screening. We estimated the effectiveness by calculating the odds ratio (OR) indicating the breast cancer death rate for screened vs unscreened women. The breast cancer death rate in the screened group over the complete period was 35% lower than in the unscreened group (OR=0.65; 95% CI=0.49–0.87). Analysis by calendar year showed an increasing effectiveness from a 28% reduction in breast cancer mortality in the period 1975–1991 (OR=0.72; 95% CI=0.47–1.09) to 65% in the period 1992–2008 (OR=0.35; 95% CI=0.19–0.64). Our results show an increasingly strong reduction in breast cancer mortality over time because of mammographic screening.

Detection of breast cancer cells using targeted magnetic nanoparticles and ultra-sensitive magnetic field sensors

Abstract: Introduction Breast cancer detection using mammography has improved clinical outcomes for many women, because mammography can detect very small (5 mm) tumors early in the course of the disease. However, mammography fails to detect 10 - 25% of tumors, and the results do not distinguish benign and malignant tumors. Reducing the false positive rate, even by a modest 10%, while improving the sensitivity, will lead to improved screening, and is a desirable and attainable goal. The emerging application of magnetic relaxometry, in particular using superconducting quantum interference device (SQUID) sensors, is fast and potentially more specific than mammography because it is designed to detect tumor-targeted iron oxide magnetic nanoparticles. Furthermore, magnetic relaxometry is theoretically more specific than MRI detection, because only target-bound nanoparticles are detected. Our group is developing antibody-conjugated magnetic nanoparticles targeted to breast cancer cells that can be detected using magnetic relaxometry.