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Kalan Farmanfarma K, Mahdavifar N, Kiasara SH, Hassanipour S, Salehiniya H. Determinants of mammography screening in Iranian women: A systematic review and meta-analysis. Breast Dis 2022; 41:279-294. [PMID: 35634841 DOI: 10.3233/bd-210037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Mammography is the most effective method for early detection of breast cancer (BC), however, it has performed in low-level. The aim of this study was to investigate the determinants of mammography in Iran. METHODS This study was a systematic review which was performed based on articles published in both Persian and English languages among Iranian patients in the period of 2000 to 2020 by using keywords of "Iran and mammography". Papers were selected from national databases including (SID, Magiran) and international database including (Scopus, PubMed and web of science), finally related articles to mammography were reviewed. RESULTS Findings indicated that 35-50% of breast cancer can be detected in the early stages by mammography, however, it is in low rate of performance among Iranian women. Age, age of menarche, occupation, family history, marital status, family support, number of pregnancies, physician recommendations, perceived sensibility and severity, self-efficacy and perceived benefits are the most important predictors of performing mammography in Iran. CONCLUSION Due to the growing trend of breast cancer cases in the country and low mammography rates in Iranian population, high risk groups such as women with BC family history, low income level, low education level, older age and people with history of breast complications were more emphasized for performing mammography through health centers. Therefore, appropriate planning to reduce the barriers of mammography could be helpful.
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Affiliation(s)
- Khadijeh Kalan Farmanfarma
- Department of Epidemiology & Biostatistics, Health Promotion Research Centre, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Neda Mahdavifar
- Department of Biostatistics and Epidemiology, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Trieu PD, Lewis SJ, Li T, Ho K, Tapia KA, Brennan PC. Reader characteristics and mammogram features associated with breast imaging reporting scores. Br J Radiol 2020; 93:20200363. [DOI: 10.1259/bjr.20200363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives: This study aims to explore the reading performances of radiologists in detecting cancers on mammograms using Tabar Breast Imaging Reporting and Data System (BIRADS) classification and identify factors related to breast imaging reporting scores. Methods: 117 readings of five different mammogram test sets with each set containing 20 cancer and 40 normal cases were performed by Australian radiologists. Each radiologist evaluated the mammograms using the BIRADS lexicon with category 1 - negative, category 2 - benign findings, category 3 - equivocal findings (Recall), category 4 - suspicious findings (Recall), and category 5 - highly suggestive of malignant findings (Recall). Performance metrics (true positive, false positive, true negative, and false negative) were calculated for each radiologist and the distribution of reporting categories was analyzed in reader-based and case-based groups. The association of reader characteristics and case features among categories was examined using Mann-Whitney U and Kruskal-Wallis tests. Results: 38% of cancer-containing mammograms were reported with category 3 which decreased to 32.3% with category 4 and 16.2% with category 5 while 16.6 and 10.3% of cancer cases were marked with categories 1 and 2. Female readers had less false-negative rates when using categories 1 and 2 for cancer cases than male readers (p < 0.01). A similar pattern as gender category was also found in Breast Screen readers and readers completed breast reading fellowships compared with non-Breast Screen and non-fellowship readers (p < 0.05). Radiologists with low number of cases read per week were more likely to record the cancer cases with category 4 while the ones with high number of cases were with category 3 (p < 0.01). Discrete mass and asymmetric density were the two types of abnormalities reported mostly as equivocal findings with category 3 (47–50%; p = 0.005) while spiculated mass or stellate lesions were mostly selected as highly suggestive of malignancy with category 5 (26%, p = 0.001). Conclusions: Most radiologists used category 3 when reporting cancer mammograms. Gender, working for BreastScreen, fellowship completion, and number of cases read per week were factors associated with scoring selection. Radiologists reported higher Tabar BIRADS category for specific types of abnormalities on mammograms than others. Advances in knowledge: The study identified factors associated with the decision of radiologists in assigning a BIRADS Tabar score for mammograms with abnormality. These findings will be useful for individual training programs to improve the confidence of radiologists in recognizing abnormal lesions on screening mammograms.
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Affiliation(s)
- Phuong Dung(Yun) Trieu
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health. The University of Sydney 75 East street, Lidcombe, New South Wales, Australia 2141
| | - Sarah J Lewis
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health. The University of Sydney 75 East street, Lidcombe, New South Wales, Australia 2141
| | - Tong Li
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health. The University of Sydney 75 East street, Lidcombe, New South Wales, Australia 2141
| | - Karen Ho
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health. The University of Sydney 75 East street, Lidcombe, New South Wales, Australia 2141
| | - Kriscia A Tapia
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health. The University of Sydney 75 East street, Lidcombe, New South Wales, Australia 2141
| | - Patrick C Brennan
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health. The University of Sydney 75 East street, Lidcombe, New South Wales, Australia 2141
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No Author. Chapitre 3 : Hormonothérapie ménopausique et cancer du sein. Journal of Obstetrics and Gynaecology Canada 2019; 41:S58-S67. [DOI: 10.1016/j.jogc.2019.02.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zheng B, Qiu Y, Aghaei F, Mirniaharikandehei S, Heidari M, Danala G. Developing global image feature analysis models to predict cancer risk and prognosis. Vis Comput Ind Biomed Art 2019; 2:17. [PMID: 32190407 DOI: 10.1186/s42492-019-0026-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022] Open
Abstract
In order to develop precision or personalized medicine, identifying new quantitative imaging markers and building machine learning models to predict cancer risk and prognosis has been attracting broad research interest recently. Most of these research approaches use the similar concepts of the conventional computer-aided detection schemes of medical images, which include steps in detecting and segmenting suspicious regions or tumors, followed by training machine learning models based on the fusion of multiple image features computed from the segmented regions or tumors. However, due to the heterogeneity and boundary fuzziness of the suspicious regions or tumors, segmenting subtle regions is often difficult and unreliable. Additionally, ignoring global and/or background parenchymal tissue characteristics may also be a limitation of the conventional approaches. In our recent studies, we investigated the feasibility of developing new computer-aided schemes implemented with the machine learning models that are trained by global image features to predict cancer risk and prognosis. We trained and tested several models using images obtained from full-field digital mammography, magnetic resonance imaging, and computed tomography of breast, lung, and ovarian cancers. Study results showed that many of these new models yielded higher performance than other approaches used in current clinical practice. Furthermore, the computed global image features also contain complementary information from the features computed from the segmented regions or tumors in predicting cancer prognosis. Therefore, the global image features can be used alone to develop new case-based prediction models or can be added to current tumor-based models to increase their discriminatory power.
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Danala G, Patel B, Aghaei F, Heidari M, Li J, Wu T, Zheng B. Classification of Breast Masses Using a Computer-Aided Diagnosis Scheme of Contrast Enhanced Digital Mammograms. Ann Biomed Eng 2018; 46:1419-31. [PMID: 29748869 DOI: 10.1007/s10439-018-2044-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/07/2018] [Indexed: 12/23/2022]
Abstract
Contrast-enhanced digital mammography (CEDM) is a promising imaging modality in breast cancer diagnosis. This study aims to investigate how to optimally develop a computer-aided diagnosis (CAD) scheme of CEDM images to classify breast masses. A CEDM dataset of 111 patients was assembled, which includes 33 benign and 78 malignant cases. Each CEDM includes two types of images namely, low energy (LE) and dual-energy subtracted (DES) images. A CAD scheme was applied to segment mass regions depicting on LE and DES images separately. Optimal segmentation results generated from DES images were also mapped to LE images or vice versa. After computing image features, multilayer perceptron based machine learning classifiers that integrate with a correlation-based feature subset evaluator and leave-one-case-out cross-validation method were built to classify mass regions. When applying CAD to DES and LE images with original segmentation, areas under ROC curves (AUC) were 0.759 ± 0.053 and 0.753 ± 0.047, respectively. After mapping the mass regions optimally segmented on DES images to LE images, AUC significantly increased to 0.848 ± 0.038 (p < 0.01). Study demonstrated that DES images eliminated overlapping effect of dense breast tissue, which helps improve mass segmentation accuracy. The study demonstrated that applying a novel approach to optimally map mass region segmented from DES images to LE images enabled CAD to yield significantly improved performance.
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Kim YJ, Lee EH, Jun JK, Shin DR, Park YM, Kim HW, Kim Y, Kim KW, Lim HS, Park JS, Kim HJ, Jo HM. Analysis of Participant Factors That Affect the Diagnostic Performance of Screening Mammography: A Report of the Alliance for Breast Cancer Screening in Korea. Korean J Radiol 2017; 18:624-631. [PMID: 28670157 PMCID: PMC5447638 DOI: 10.3348/kjr.2017.18.4.624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/27/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze participant factors that affect the diagnostic performance of screening mammography. MATERIALS AND METHODS We enrolled 128756 cases from 10 hospitals between 2005 and 2010. We analyzed recall rate, cancer detection rate (CDR) per 1000 examinations, positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and interval cancer rate (ICR) per 1000 negative examinations according to participant factors including age, breast density, and number of visit to the same institution, and adjusted for confounding variables. RESULTS Increasing age improved recall rates (27.4% in 40's, 17.5% in 50's, 11.1% in 60's, and 8.6% in 70's), CDR (2.7, 3.2, 2.0, and 2.4), PPV (1.0, 1.8, 1.8, and 2.8%), sensitivity (81.3, 88.8, 90.3, and 94.7%), specificity (72.7, 82.7, 89.0, and 91.7%), and FPR (27.3, 17.3, 11.0, and 8.4%) (p < 0.05). Higher breast density impaired recall rates (4.0% in P1, 9.0% in P2, 28.9% in P3, and 27.8% in P4), PPV (3.3, 2.3, 1.2, and 1.3%), specificity (96.1, 91.2, 71.4, and 72.5%), and FPR (3.9, 8.9, 28.6, and 27.6%) (p < 0.001). It also increased CDR (1.3, 2.1, 3.3, and 3.6) and ICR (0.2, 0.3, 0.6, and 1.6) (p < 0.05). Successive visits to the same institution improved recall rates (20.9% for one visit, 10.7% for two visits, 7.7% for more than three visits), PPV (1.6, 2.8, and 2.7%), specificity (79.4, 89.6, and 92.5%), and FPR (20.6, 10.4, and 7.5%) (p < 0.001). CONCLUSION Young age and dense breasts negatively affected diagnostic performance in mammography screening, whereas successive visits to the same institution had a positive effect. Examinee education for successive visits to the same institution would improve the diagnostic performance.
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Affiliation(s)
- Young Joong Kim
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon 35365, Korea
| | - Eun Hye Lee
- Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Korea
| | - Dong-Rock Shin
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea
| | - Young Mi Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Korea
| | - Hye-Won Kim
- Department of Radiology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan 54538, Korea
| | - Youme Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan 31116, Korea
| | - Keum Won Kim
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon 35365, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun 58128, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, Kyungpook National University College of Medicine, Daegu 41404, Korea
| | - Hye-Mi Jo
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Korea
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Abstract
The purpose of this study is to develop a new global mammographic image feature analysis based computer-aided detection (CAD) scheme and evaluate its performance in detecting positive screening mammography examinations. A dataset that includes images acquired from 1896 full-field digital mammography (FFDM) screening examinations was used in this study. Among them, 812 cases were positive for cancer and 1084 were negative or benign. After segmenting the breast area, a computerized scheme was applied to compute 92 global mammographic tissue density based features on each of four mammograms of the craniocaudal (CC) and mediolateral oblique (MLO) views. After adding three existing popular risk factors (woman's age, subjectively rated mammographic density, and family breast cancer history) into the initial feature pool, we applied a sequential forward floating selection feature selection algorithm to select relevant features from the bilateral CC and MLO view images separately. The selected CC and MLO view image features were used to train two artificial neural networks (ANNs). The results were then fused by a third ANN to build a two-stage classifier to predict the likelihood of the FFDM screening examination being positive. CAD performance was tested using a ten-fold cross-validation method. The computed area under the receiver operating characteristic curve was AUC = 0.779 ± 0.025 and the odds ratio monotonically increased from 1 to 31.55 as CAD-generated detection scores increased. The study demonstrated that this new global image feature based CAD scheme had a relatively higher discriminatory power to cue the FFDM examinations with high risk of being positive, which may provide a new CAD-cueing method to assist radiologists in reading and interpreting screening mammograms.
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Affiliation(s)
- Maxine Tan
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
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Choi WJ, Cha JH, Kim HH, Shin HJ, Chae EY. Analysis of prior mammography with negative result in women with interval breast cancer. Breast Cancer 2015; 23:583-9. [PMID: 25820217 DOI: 10.1007/s12282-015-0606-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/20/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of our study was to review mammographic findings which were previously negative in women with interval breast cancer and to analyze the histopathological features of the interval breast cancer. MATERIALS AND METHODS A total of 5521 women underwent surgery for breast cancer between January 2009 and December 2011. Among them, 240 women who had undergone available, previous mammography studies reported as normal or benign (mean interval between examinations, 9.7 months) were included in our study. We reviewed the previous mammographic features and categorized as true interval breast cancer, minimal sign, and missed interval breast cancer. Histopathological findings were also reviewed. RESULTS Of the 240 diagnosed cancers, 78 (32.5 %) were classified as true interval breast cancer, 78 (32.5 %) as minimal sign, and 84 (35 %) as missed interval breast cancer. True interval breast cancer occurred in a younger age and showed dense breast compared with missed breast cancer. The breast density of 169 patients (70.4 %) was dense. In the minimal sign group, the most common finding was normal appearing tissue (61/78), followed by benign-appearing calcification (17/78). There were no significant differences in the histopathological findings in each of the three groups and tended to have smaller tumor size, negative nodal status, a lower AJCC stage, and frequent luminal A subtype. CONCLUSION The majority of interval breast cancers was not detectable in patients with dense breast or showed subtle mammographic findings on previous mammography. Although the majority of breast cancers showed a low grade in the histopathological findings, a better understanding of the mammographic findings will influence the sensitivity of mammography.
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Affiliation(s)
- Woo Jung Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea
| | - Joo Hee Cha
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea.
| | - Hak Hee Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea
| | - Hee Jung Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea
| | - Eun Young Chae
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea
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Korpraphong P, Limsuwarn P, Tangcharoensathien W, Ansusingha T, Thephamongkhol K, Chuthapisith S. Improving breast cancer detection using ultrasonography in asymptomatic women with non-fatty breast density. Acta Radiol 2014; 55:903-8. [PMID: 24103915 DOI: 10.1177/0284185113507711] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mammography (MX) is a reliable modality for detection of breast cancer in asymptomatic women. Use of additional whole breast ultrasonography (US) for breast cancer screening is widely recognized, in particular in women with dense breast parenchyma. PURPOSE To determine the subgroup of women, according to breast density and age, who receive most benefit from US following MX for detection of breast cancer in an asymptomatic condition. MATERIAL AND METHODS The study was conducted in asymptomatic women who had non-fatty breast parenchyma using MX and US during January 2006 and December 2007. Mammographic breast density was classified as recommended by ACR BI-RADS lexicon. Non-fatty breast referred to D2, D3, and D4. US was performed by the same radiologists who interpreted MX with a handheld machine during the same visit. Data on demographics, cancer detection rate (CDR), and incremental cancer detection rate (ICDR) were analyzed using 95% confident interval (CI). RESULTS Of 14,483 breast cancer screenings in women who had non-fatty breast density, 115 cancers were documented. The mean age of cancer patients was 49.6 years. Of 115 cancers, 105 were evidenced on images (31 with MX alone, 19 with US alone, and 55 with both MX and US). Overall CDR was 7.9 per 1000 examination (95% CI, 6.5-9.5). CDR for MX only (MX-CDR) was 6.5 per 1000 examinations (95% CI, 5.2-7.9). Additional US could significantly improve CDR (P < 0.001; 95% CI, 0.9-2.2); US-ICDR was 1.4 per 1000 examinations. According to age group, the group of 40-59 years had statistically significant improvement of ICDR (P < 0.001). The ICDR was highest in D4 breast density (D4) (US-ICDR = 2.5 per 1000 examinations). CONCLUSION Use of US adjunct to MX for detection of breast cancer in asymptomatic non-fatty, average-risk women for detection of breast cancer is a promising diagnostic procedure. A significant benefit was documented, in particular, in women aged 40-59 years old, and in women with D4 breast density.
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Affiliation(s)
- Pornpim Korpraphong
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panida Limsuwarn
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Woranuj Tangcharoensathien
- Thanyarak Breast Imaging Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tamnit Ansusingha
- Thanyarak Breast Imaging Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kullathorn Thephamongkhol
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suebwong Chuthapisith
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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RETIRED: Managing Menopause Chapter 3 Menopausal Hormone Therapy and Breast Cancer. Journal of Obstetrics and Gynaecology Canada 2014; 36:S23-S30. [DOI: 10.1016/s1701-2163(15)30459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bernardi D, Ciatto S, Pellegrini M, Anesi V, Burlon S, Cauli E, Depaoli M, Larentis L, Malesani V, Targa L, Baldo P, Houssami N. Application of breast tomosynthesis in screening: incremental effect on mammography acquisition and reading time. Br J Radiol 2013; 85:e1174-8. [PMID: 23175484 DOI: 10.1259/bjr/19385909] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to supplement the paucity of information available on logistical aspects of the application of three-dimensional (3D) mammography in breast screening. METHODS We prospectively examined the effect on radiographers' and radiologists' workload of implementing 3D mammography in screening by comparing image acquisition time and screen-reading time for two-dimensional (2D) mammography with that of combined 2D+3D mammography. Radiologists' accuracy was also calculated. RESULTS Average acquisition time (measured from start of first-view breast positioning to compression release at completion of last view) for seven radiographers, based on 20 screening examinations, was longer for 2D+3D (4 min 3 s; range 3 min 53 s-4 min 18 s) than 2D mammography (3 min 13 s; range 3 min 0 s-3 min 26 s; p<0.01). Average radiologists' reading time per screening examination (three radiologists reading case-mix of 100 screens: 10 cancers, 90 controls) was longer for 2D+3D (77 s; range 60-90 s) than for 2D mammography (33 s; range 25-46 s; p<0.01). 2D+3D screen-reading was associated with detection of more cancers and with substantially fewer recalls than 2D mammography alone. CONCLUSION Relative to standard 2D mammography, combined 2D+3D mammography prolongs image acquisition time and screen-reading time (at initial implementation), and appears to be associated with improved screening accuracy. ADVANCES IN KNOWLEDGE These findings provide relevant information to guide larger trials of integrated 3D mammography (2D+3D) and its potential implementation into screening practice.
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Affiliation(s)
- D Bernardi
- U O Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy
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Ni XJ, Xia TS, Zhao YC, Ma JJ, Zhao J, Liu XA, Ding Q, Zha XM, Wang S. Postmenopausal Hormone Therapy is Associated with in Situ Breast Cancer Risk. Asian Pac J Cancer Prev 2012; 13:3917-25. [DOI: 10.7314/apjcp.2012.13.8.3917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bernardi D, Ciatto S, Pellegrini M, Tuttobene P, Fanto’ C, Valentini M, Michele SD, Peterlongo P, Houssami N. Prospective study of breast tomosynthesis as a triage to assessment in screening. Breast Cancer Res Treat 2012; 133:267-71. [DOI: 10.1007/s10549-012-1959-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 01/13/2012] [Indexed: 11/24/2022]
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Abstract
PURPOSE Substantial effort has been devoted to the clinical development of digital breast tomosynthesis (DBT). DBT is a three-dimensional (3D) x-ray imaging modality that reconstructs a number of thin image slices parallel to a stationary detector plane. Preliminary clinical studies have shown that the removal of overlapping breast tissue reduces image clutter and increases detectability of large, low contrast lesions. However, some studies, as well as anecdotal evidence, suggested decreased conspicuity of small, high contrast objects such as microcalcifications. Several investigators have proposed alternative imaging methods for improving microcalcification detection by delivering half of the total dose to the central view in addition to a separate DBT scan. Preliminary observer studies found possible improvement by either viewing the central projection alone or combining all views with a reconstruction algorithm. METHODS In this paper, we developed a generalized imaging theory based on a cascaded linear-system model for DBT to calculate the effect of variable angular dose distribution on the 3D modulation transfer function (MTF) and noise power spectrum (NPS). Using the ideal observer signal-to-noise ratio (SNR), d', as a figure-of-merit (FOM) for a signal embedded in a uniform background, we compared the detectability of objects with different sizes under different imaging conditions (e.g., angular dose distribution and reconstruction filters). Experimental investigation was conducted for three different angular dose schemes (ADS) using a Siemens Novation(TOMO) prototype unit. RESULTS Our results show excellent agreement between modeled and experimental measurements of 3D NPS with different angular dose distribution. The ideal observer detectability index for the detection of Gaussian objects with different angular dose distributions depends strongly on the applied reconstruction filter as well as the imaging task. For detection tasks of small calcifications with reconstruction filters used typically in a clinical setting, variable angular dose distribution with more dose delivered to the central views may lead to higher d' than a uniform angular dose distribution. CONCLUSIONS The conspicuity of the detection of small calcifications may be improved, under certain imaging conditions, by delivering higher dose toward the central views of a tomosynthesis scan, while also reducing the dose at peripheral angles to keep total administered radiation dose equivalent. The degree of improvement depends on the choice of reconstruction filters as well as the imaging task. The improvement is more substantial for high-frequency imaging tasks and when an aggressive slice-thickness (ST) filter is applied to reduced the high-frequency noise at peripheral angles.
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Affiliation(s)
- Yue-Houng Hu
- Department of Radiology, State University of New York at Stony Brook, L-4 120 Health Sciences Center, Stony Brook, New York 11794-8460, USA.
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Salas D, Ibáñez J, Román R, Cuevas D, Sala M, Ascunce N, Zubizarreta R, Castells X. Effect of start age of breast cancer screening mammography on the risk of false-positive results. Prev Med 2011; 53:76-81. [PMID: 21575653 DOI: 10.1016/j.ypmed.2011.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 04/19/2011] [Accepted: 04/25/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate the false-positive (FP) risk according to the start age of mammography screening (45-46 or 50-51 years). METHOD Data from eight regions of the Spanish breast cancer screening programme from 1990 to 2006 were included (1,565,364 women). Discrete time-hazard models were used to ascertain the effect of age and time-related, programme-related and personal variables on FP leading to any further procedure and to invasive procedures (FPI). In a subset we estimated the differential FP risk of starting screening at 45-46 years (175,656 women) or 50-51 (251,275). RESULTS A start age of 45-46 versus 50-51 years increased both FP (OR=1.20; 95%CI: 1.13-1.26) and FPI risks (OR=1.43 (95%CI: 1.18-1.73).Other factors increasing FP risk were premenopausal status (FP OR=1.26; 95%CI: 1.23-1.29 and FPI OR=1.22; 95%CI: 1.13-1.31), prior invasive procedures (FP OR=1.52; 95%CI: 1.47-1.57 and FPI (OR=2.08; 95%CI: 1.89-2.28) and family history (FP OR=1.16; 95%CI: 1.12-1.20 and FPI OR=1.26; 95%CI: 1.13-1.41). FP risk was increased by double reading (OR=1.36; 95%CI: 1.23-1.51) and FPI risk by double views (OR=1.34; 95%CI: 1.18-1.52). Both the cumulative FP and FPI risks were higher in women commencing screening at 45-46 years versus 50-51 years (33.30% versus 20.39% and 2.68% versus 1.76%). CONCLUSIONS Starting screening earlier increases the cumulative risk of FP and FPI.
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Affiliation(s)
- Dolores Salas
- General Directorate Public Health and Centre for Public Health Research (CSISP), Avda. Catalunya 21, Valencia, Spain.
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Abstract
OBJECTIVE Current users of hormone therapy (HT) are known to have a lower accuracy of mammography screening than do never users. We studied whether the risk of misclassification depends on type of hormone, administration, regimen, and dose of the therapy. METHODS We linked data from mammography screening registers with drug prescription registers from Fyn, Denmark to identify current and never HT users among screening participants. We compared false-positive risks and interval cancer proportions between current users of different HT preparations, taking women's age, breast density, screen number, and age of comparison mammogram into account. RESULTS Estrogen therapy users had a significantly higher false-positive risk when the administration was by injection instead of oral (relative risk [RR], 2.37; 95% CI, 1.37-4.09). Women using sequential estrogen plus progestogen therapy had a significantly higher false-positive risk (RR, 1.94; 95% CI, 1.16-3.26) and a nonsignificantly higher interval cancer proportion (RR, 4.29; 95% CI, 0.69-26.53) when the administration of both hormones was transdermal instead of oral. Using tibolone instead of comparable hormones gave a nonsignificantly lower false-positive risk and a nonsignificantly higher interval cancer proportion. CONCLUSIONS Our data showed increased risks of misclassification at mammography screening among women using estrogen injections or transdermal, sequential estrogen plus progestogen. Tibolone seems to offer no advantage regarding accuracy of screening mammography.
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Abstract
Diagnostic imaging modalities utilized in the care of cancer patients must fulfill several requirements: they must diagnose and characterize tumors with high accuracy, must reliably stage and restage the disease, and should allow for monitoring the effects of therapeutic interventions on the course of the disease. They should impact management by guiding treating physicians to appropriate individualized treatment strategies. There is ample evidence that positron emission tomography (PET) and PET-computed tomography (CT) imaging can meet these requirements. This chapter discusses the role and contributions of PET and PET-CT imaging using (18)F-fluorodeoxyglucose in diagnosing, staging, restaging, and treatment monitoring of breast cancer. Novel molecular imaging probes and devices that have been developed and translated into early clinical research protocols are also introduced.
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Affiliation(s)
- Johannes Czernin
- Ahmanson Biological Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA.
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Aiello Bowles EJ, Anderson ML, Reed SD, Newton KM, Fitzgibbons ED, Seger D, Buist DS. Mammographic Breast Density and Tolerance for Short-Term Postmenopausal Hormone Therapy Suspension. J Womens Health (Larchmt) 2010; 19:1467-74. [DOI: 10.1089/jwh.2009.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Melissa L. Anderson
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Susan D. Reed
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
- University of Washington, Department of Obstetrics and Gynecology, Seattle, Washington
| | - Katherine M. Newton
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - E. Dawn Fitzgibbons
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Deborah Seger
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Diana S.M. Buist
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
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Taplin SH, Abraham L, Geller BM, Yankaskas BC, Buist DSM, Smith-Bindman R, Lehman C, Weaver D, Carney PA, Barlow WE. Effect of previous benign breast biopsy on the interpretive performance of subsequent screening mammography. J Natl Cancer Inst 2010; 102:1040-51. [PMID: 20601590 PMCID: PMC2907407 DOI: 10.1093/jnci/djq233] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 05/22/2010] [Accepted: 05/26/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most breast biopsies will be negative for cancer. Benign breast biopsy can cause changes in the breast tissue, but whether such changes affect the interpretive performance of future screening mammography is not known. METHODS We prospectively evaluated whether self-reported benign breast biopsy was associated with reduced subsequent screening mammography performance using examination data from the mammography registries of the Breast Cancer Surveillance Consortium from January 2, 1996, through December 31, 2005. A positive interpretation was defined as a recommendation for any additional evaluation. Cancer was defined as any invasive breast cancer or ductal carcinoma in situ diagnosed within 1 year of mammography screening. Measures of mammography performance (sensitivity, specificity, and positive predictive value 1 [PPV1]) were compared both at woman level and breast level in the presence and absence of self-reported benign biopsy history. Referral to biopsy was considered a positive interpretation to calculate positive predictive value 2 (PPV2). Multivariable analysis of a correct interpretation on each performance measure was conducted after adjusting for registry, year of examination, patient characteristics, months since last mammogram, and availability of comparison film. Accuracy of the mammogram interpretation was measured using area under the receiver operating characteristic curve (AUC). All statistical tests were two-sided. RESULTS A total of 2,007,381 screening mammograms were identified among 799,613 women, of which 14.6% mammograms were associated with self-reported previous breast biopsy. Multivariable adjusted models for mammography performance showed reduced specificity (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.73 to 0.75, P < .001), PPV2 (OR = 0.85, 95% CI = 0.79 to 0.92, P < .001), and AUC (AUC 0.892 vs 0.925, P < .001) among women with self-reported benign biopsy. There was no difference in sensitivity or PPV1 in the same adjusted models, although unadjusted differences in both were found. Specificity was lowest among women with documented fine needle aspiration-the least invasive biopsy technique (OR = 0.58, 95% CI = 0.55 to 0.61, P < .001). Repeating the analysis among women with documented biopsy history, unilateral biopsy history, or restricted to invasive cancers did not change the results. CONCLUSIONS Self-reported benign breast biopsy history was associated with statistically significantly reduced mammography performance. The difference in performance was likely because of tissue characteristics rather than the biopsy itself.
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Affiliation(s)
- Stephen H Taplin
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
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Chlebowski RT, Anderson G, Manson JE, Pettinger M, Yasmeen S, Lane D, Langer RD, Hubbell FA, McTiernan A, Hendrix S, Schenken R, Stefanick ML. Estrogen alone in postmenopausal women and breast cancer detection by means of mammography and breast biopsy. J Clin Oncol 2010; 28:2690-7. [PMID: 20439627 DOI: 10.1200/jco.2009.24.8799] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE As the influence of estrogen alone on breast cancer detection is not established, we examined this issue in the Women's Health Initiative trial, which randomly assigned 10,739 postmenopausal women with prior hysterectomy to conjugated equine estrogen (CEE; 0.625 mg/d) or placebo. METHODS Screening mammography and breast exams were performed at baseline and annually. Breast biopsies were based on clinical findings. Effects of CEE alone on breast cancer detection were determined by using receiver operating characteristic (ROC) analyses of mammogram performance. RESULTS After a 7.1-year mean follow-up, fewer invasive breast cancers were diagnosed in the CEE than in the placebo group, but the difference was not statistically significant. Use of CEE alone increased mammograms with short-interval follow-up recommendations (cumulative, 39.2% v 29.6.3%; P < .001) but not abnormal mammograms (ie, those suggestive of or highly suggestive of malignancy; cumulative, 7.3% v 7.0%; P = .41). Breast biopsies were more frequent in the CEE group (cumulative, 12.5% v 10.7%; P = .004) and less commonly diagnosed as cancer (8.9% v 15.8%, respectively, with positive biopsies; P = .04). Mammographic breast cancer detection in the CEE group was significantly compromised only in the early years of use. CONCLUSION CEE alone use for 5 years results in approximately one in 11 and one in 50 women having otherwise avoidable mammograms with short-interval follow-up recommendations or breast biopsies, respectively. Although the breast biopsies on CEE were less commonly diagnosed as cancer, breast cancer detection was not substantially compromised. These findings differ from estrogen-plus-progestin use, for which significantly increased abnormal mammograms and a compromise in breast cancer detection are seen.
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Affiliation(s)
- Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, University of California-Los Angeles, 1124 W. Carson St., Torrance, CA 90502, USA.
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Speroff L. A tender subject. Menopause 2010; 17:445-449. [DOI: 10.1097/gme.0b013e3181d0edbb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Walsh JME, Beattie MS, Charney P. Update in women's health. J Gen Intern Med 2010; 25:363-8. [PMID: 20020220 PMCID: PMC2842556 DOI: 10.1007/s11606-009-1199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 10/06/2009] [Accepted: 11/11/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Judith M E Walsh
- Division of General Internal Medicine, Women's Health Clinical Research Center, University of California, San Francisco, CA 94115, USA.
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Reed SD, Buist DS, Anderson ML, Bowles EJ, Fitzgibbons D, Seger D, Newton KM. Short-term (1-2 mo) hormone therapy cessation before mammography. Menopause 2009; 16:1125-31. [PMID: 19455069 DOI: 10.1097/gme.0b013e3181a5ce60] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Some healthcare providers recommend hormone therapy (HT) cessation before mammography to improve performance. Our objective was to evaluate characteristics of women willing to consider HT cessation before screening mammography. METHODS We performed a randomized clinical trial, the Radiological Evaluation and Breast Density study, within an integrated health plan (2004-2007). Women aged 45 to 80 years who used HT at their most recent screening (index) mammogram, who were due for a screening (study) mammogram, and who were still using HT were invited to participate. Randomization groups were: (1) no, (2) 1-month, or (3) 2-month cessation. Women's willingness to participate was evaluated by age, race, ethnicity, education, hysterectomy, type of HT (unopposed estrogen and estrogen plus progestin), duration of HT use, body mass index, breast cancer risk, and breast density. RESULTS A total of 5,861 women were invited to participate; 2,999 refused. An additional 169 women agreed to participate but withdrew before data collection. Compared with women who participated (n = 1,535), nonparticipants (n = 3,168; 2,999 + 169; 54%) were older, were less educated, and had lower body mass index (all P < 0.05). Among nonparticipants, 1,876 (59.2%) were unwilling to stop HT. Among estrogen-plus-progestin users, women with a first-degree relative with a history of breast cancer had lower odds of refusal than women without a family history of breast cancer (adjusted odds ratio, 0.71; 95% CI, 0.54-0.93). CONCLUSIONS Most women were unwilling to stop HT, even for a short period, when the intent was to improve mammographic accuracy, and even when informed that they could restart HT at any time during the 2-month study. Some factors predicted willingness to stop HT; the magnitude of the differences may not be clinically meaningful.
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Lakhani P, Maidment ADA, Weinstein SP, Kung JW, Alavi A. Correlation between quantified breast densities from digital mammography and 18F-FDG PET uptake. Breast J 2009; 15:339-47. [PMID: 19601942 DOI: 10.1111/j.1524-4741.2009.00737.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To correlate breast density quantified from digital mammograms with mean and maximum standardized uptake values (SUVs) from positron emission tomography (PET). This was a prospective study that included 56 women with a history of suspicion of breast cancer (mean age 49.2 +/- 9.3 years), who underwent 18F-fluoro-2-deoxyglucose (FDG)-PET imaging of their breasts as well as digital mammography. A computer thresholding algorithm was applied to the contralateral nonmalignant breasts to quantitatively estimate the breast density on digital mammograms. The breasts were also classified into one of four Breast Imaging Reporting and Data System categories for density. Comparisons between SUV and breast density were made using linear regression and the Student's t-test. Linear regression of mean SUV versus average breast density showed a positive relationship with a Pearson's correlation coefficient of R(2) = 0.83. The quantified breast densities and mean SUVs were significantly greater for mammographically dense than nondense breasts (p < 0.0001 for both). The average quantified densities and mean SUVs of the breasts were significantly greater for premenopausal than postmenopausal patients (p < 0.05). 8/51 (16%) of the patients had maximum SUVs that equaled 1.6 or greater. There is a positive linear correlation between quantified breast density on digital mammography and FDG uptake on PET. Menopausal status affects the metabolic activity of normal breast tissue, resulting in higher SUVs in pre- versus postmenopausal patients.
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Affiliation(s)
- Paras Lakhani
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Pettersen PC, Raundahl J, Loog M, Nielsen M, Tankó LB, Christiansen C. Parallel assessment of the impact of different hormone replacement therapies on breast density by radiologist- and computer-based analyses of mammograms. Climacteric 2009; 11:135-43. [DOI: 10.1080/13697130801930385] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Njor SH, Pedersen AT, Schwartz W, Hallas J, Lynge E. Minimizing misclassification of hormone users at mammography screening. Int J Cancer 2009; 124:2159-65. [DOI: 10.1002/ijc.24181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hu YH, Zhao B, Zhao W. Image artifacts in digital breast tomosynthesis: investigation of the effects of system geometry and reconstruction parameters using a linear system approach. Med Phys 2009; 35:5242-52. [PMID: 19175083 DOI: 10.1118/1.2996110] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Digital breast tomosynthesis (DBT) is a three-dimensional (3D) x-ray imaging modality that reconstructs image slices parallel to the detector plane. Image acquisition is performed using a limited angular range (less than 50 degrees) and a limited number of projection views (less than 50 views). Due to incomplete data sampling, image artifacts are unavoidable in DBT. In this preliminary study, the image artifacts in DBT were investigated systematically using a linear system approximation. A cascaded linear system model of DBT was developed to calculate the 3D presampling modulation transfer function (MTF) with different image acquisition geometries and reconstruction filters using a filtered backprojection (FBP) algorithm. A thin, slanted tungsten (W) wire was used to measure the presampling MTF of the DBT system in the cross-sectional plane defined by the thickness (z-) and tube travel (x-) directions. The measurement was in excellent agreement with the calculation using the model. A small steel bead was used to calculate the artifact spread function (ASF) of the DBT system. The ASF was correlated with the convolution of the two-dimensional (2D) point spread function (PSF) of the system and the object function of the bead. The results showed that the cascaded linear system model can be used to predict the magnitude of image artifacts of small, high-contrast objects with different image acquisition geometry and reconstruction filters.
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Affiliation(s)
- Yue-Houng Hu
- Department of Radiology, State University of New York at Stony Brook, Health Sciences Center Stony Brook, New York 11794-8460, USA.
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Newcomb PA, Egan KM, Trentham-Dietz A, Titus-Ernstoff L, Baron JA, Hampton JM, Stampfer MJ, Willett WC. Prediagnostic use of hormone therapy and mortality after breast cancer. Cancer Epidemiol Biomarkers Prev 2008; 17:864-71. [PMID: 18381475 DOI: 10.1158/1055-9965.epi-07-0610] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A few studies have observed reduced breast cancer mortality in women who used hormone therapy before diagnosis. Due to the high prevalence of past and current hormone use, it is important to investigate whether these preparations are related to breast cancer mortality. METHODS To evaluate the influence of prediagnostic use of hormone therapy on breast cancer mortality, a prospective cohort of 12,269 women ages 50 years or more diagnosed with incident invasive breast cancer and residents of Wisconsin, Massachusetts, or New Hampshire were enrolled in three phases beginning in 1988. They were followed for death until December 31, 2005, using the National Death Index. Cumulative mortality and multivariable adjusted hazard rate ratios for breast cancer and other mortality causes were calculated for women according to any hormone therapy use, and for exclusive use of estrogen or estrogen-progestin (EP). RESULTS During an average 10.3 years of follow-up, 1,690 deaths from breast cancer were documented. Cumulative mortality from breast cancer was lower among hormone therapy users, specifically current users at the time of diagnosis, and EP users, compared with nonusers. Adjusted survival varied by type and duration of hormone therapy before diagnosis. A reduced risk of death from breast cancer was associated with EP preparations (hazard rate ratio, 0.73; 0.59-0.91) and with > or =5 years of EP use (0.60; 0.43-0.84). No association was observed for women who were former or current users of E-alone preparations. CONCLUSIONS Although use of combined EP preparations increases breast cancer risk, in this study, use of these hormones before diagnosis was associated with reduced risk of death after a breast cancer diagnosis. The better survival among users, particularly of EP, persisted after adjustment of screening, stage, and measured confounders.
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Affiliation(s)
- Polly A Newcomb
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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Weaver K, Kataoka M, Murray J, Muir B, Anderson E, Warren R, Warsi I, Highnam R, Glasier A. Does a short cessation of HRT decrease mammographic density? Maturitas 2008; 59:315-22. [DOI: 10.1016/j.maturitas.2008.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 12/30/2007] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
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Hur MH, Lee HK, Kang WN, Yoon CS, Ko SS, Lee YJ, Lee KS, Cho BJ, Kang SS. Breast Cancer Screening: A Medical Audit of the Screening Mammography Performed at One Institution for 10 Years. J Breast Cancer 2008. [DOI: 10.4048/jbc.2008.11.4.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Min Hee Hur
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Hae Kyung Lee
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Wan Nam Kang
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Chan Seok Yoon
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Seung Sang Ko
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Yu-Jin Lee
- Department of Radiology, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Kyung Sang Lee
- Department of Radiology, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Byung Jae Cho
- Department of Radiology, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Sung Soo Kang
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
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Cho KR, Seo BK, Lee J, Lee KY, Je BK, Kim BH, Cha SH, Oh YW, Kim S, Bae JW. A Comparative Study of Palpable and Nonpalpable Breast Cancers determined by Ultrasonography. J Breast Cancer 2008. [DOI: 10.4048/jbc.2008.11.2.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ki Yeol Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bo Kyung Je
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Yu Whan Oh
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seokjin Kim
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jeoung Won Bae
- Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Agostini V, Delsanto S, Molinari F, Knaflitz M. Evaluation of feature-based registration in dynamic infrared imaging for breast cancer diagnosis. Conf Proc IEEE Eng Med Biol Soc 2007; 2006:953-6. [PMID: 17946428 DOI: 10.1109/iembs.2006.260808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Dynamic infrared imaging has been proposed in literature as an interesting adjunctive technique to mammography in breast cancer diagnosis. For a correct analysis of the infrared image sequences, however, a preprocessing registration step may be fundamental. In this paper, we provide a first quantitative evaluation of the performances of registration on dynamic infrared images for this specific application. We propose an algorithm for the automatic control point localization and employ a feature-based piecewise linear registration approach. The quality of the image alignment is evaluated on a small sample of subjects, considering both alignment and localization errors. Results show that subject movement of up to five pixels is compensated, obtaining a subpixel error correction.
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Abstract
Gynecologic concerns in postmenopausal women are common. Although various conditions may affect all women in this age group, the prevalence of certain disorders, and also diagnostic approaches and treatment options, may vary significantly when considering very elderly women compared with those early in the sixth decade. The focus of this chapter is to address several commonly encountered gynecologic issues in postmenopausal women, with particular attention given to aspects that must be considered when caring for women in the geriatric age group.
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Affiliation(s)
- John W Moroney
- Division of Gynecologic Oncology, MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
Over the past decade, breast radiologists have been increasingly asked to fulfill a new dynamic role as medical directors of breast imaging centers. To our knowledge, there are no standardized job descriptions nor defined roles and responsibilities for this position. Job descriptions are usually crafted to fit unique institutional and individual situations. To be an effective medical director of a breast imaging center, breast imagers must be more than just film readers. In this article, the authors describe the diverse roles of contemporary medical directors of breast imaging centers.
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Affiliation(s)
- Jay Parikh
- Women's Diagnostic Imaging Center Swedish Cancer Institute, Seattle, WA 98104, USA.
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Abramson RG, Mavi A, Cermik T, Basu S, Wehrli NE, Houseni M, Mishra S, Udupa J, Lakhani P, Maidment ADA, Torigian DA, Alavi A. Age-Related Structural and Functional Changes in the Breast: Multimodality Correlation With Digital Mammography, Computed Tomography, Magnetic Resonance Imaging, and Positron Emission Tomography. Semin Nucl Med 2007; 37:146-53. [PMID: 17418148 DOI: 10.1053/j.semnuclmed.2007.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Preliminary results generated from digital mammography, computed tomography, magnetic resonance imaging, and (18)F-fluorodeoxyglucose positron emission tomography demonstrate concordant findings of decreasing glandular tissue and decreasing metabolic activity with increasing age. These results are presented in the context of a detailed literature review summarizing age-related changes in the breast, both from the histologic/physiologic and the imaging perspectives. We also discuss potential applications of this approach and emphasize the importance of new advanced imaging technologies to offer high levels of quantitative precision for tissue characterization for research and clinical purposes.
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Affiliation(s)
- Richard G Abramson
- Department of Radiology, Division of Nuclear Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4283, USA
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Seo BK, Pisano ED, Kuzmiak CM, Koomen M, Pavic D, McLelland R, Lee Y, Cole EB, Mattingly D, Lee J. The positive predictive value for diagnosis of breast cancer full-field digital mammography versus film-screen mammography in the diagnostic mammographic population. Acad Radiol 2006; 13:1229-35. [PMID: 16979072 DOI: 10.1016/j.acra.2006.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 07/12/2006] [Accepted: 07/12/2006] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Diagnostic mammography is performed on women with clinical symptoms that suggest breast cancer or women for whom further mammographic evaluation has been requested because of an abnormal screening mammography. We assessed whether the use of full-field digital mammography would improve the positive predictive value (PPV) for the diagnosis of breast cancer in a diagnostic population compared with film-screen mammography. MATERIALS AND METHODS From January 2002 to December 2003, 11,621 patients underwent diagnostic mammography at the University of North Carolina Hospital, Chapel Hill. Among these 11,621 patients, 1400 lesions in 1121 patients underwent biopsy. We included the biopsy-performed lesions, so PPV3 was used for comparison of PPVs between film-screen mammography and full-field digital mammography. Six breast radiologists interpreted the images using the Breast Imaging Reporting and Data System of the American College of Radiology. PPV3s were compared between film-screen and full-field digital mammography in the entire study cohort and in specified subgroups according to different radiologists, breast density, and lesion type on mammography. The chi(2) and Fisher's exact tests were used for comparison of PPV3s between two modalities of mammography with the Bonferroni procedure for subgroup analysis. RESULTS In the entire study cohort, PPV3s of full-field digital mammography and film-screen mammography were similar (difference in PPV3,-0.007; 95% confidence interval, -0.081 to 0.068; P = .8602). In predefined subgroups, there was no difference in PPV3 by the radiologist, breast density, or lesion type between two modalities of mammography (P > .005). CONCLUSION There is no improvement in PPV for the diagnosis of breast cancer with full-field digital mammography compared with film-screen mammography in a large diagnostic population.
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Affiliation(s)
- Bo Kyoung Seo
- Department of Diagnostic Radiology, Korea University School of Medicine, Ansan, Korea
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Chiarelli AM, Kirsh VA, Klar NS, Shumak R, Jong R, Fishell E, Yaffe MJ, Boyd NF. Influence of Patterns of Hormone Replacement Therapy Use and Mammographic Density on Breast Cancer Detection. Cancer Epidemiol Biomarkers Prev 2006; 15:1856-62. [PMID: 17035392 DOI: 10.1158/1055-9965.epi-06-0290] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is evidence that factors such as current hormone replacement therapy (HRT) use and mammographic density may each lower the sensitivity of mammography and are associated with a greater risk of developing an interval cancer. This study explores this relationship further by examining the influence of patterns of HRT use and the percentage of mammographic density on the detection of breast cancer by classification of interval cancer. METHODS This study uses a case-case design nested within a cohort of women screened by the Ontario Breast Screening Program between 1994 and 2002. Interval cancers, both those missed at screening but seen on retrospective review (n = 87) or true intervals without visible tumor signs at screening (n = 288) were matched to 450 screen-detected cancers. The association between the percentage of mammographic density, measured by radiologists and a computer-assisted method, and HRT use, ascertained from a mailed questionnaire, and the risk of being diagnosed with an interval cancer was estimated using conditional logistic regression. RESULTS A monotonic gradient of increasing risk for interval cancers was found for each 25% increase in mammographic density [odds ratio (OR), 1.77; 95% confidence intervals (95% CI), 1.07-2.95 for missed intervals and OR, 2.16; 95% CI, 1.59-2.94 for true intervals]. After adjusting for mammographic density, a significantly increased risk for true-interval cancers remained for women taking estrogen alone (OR, 1.75; 95% CI, 1.11-2.83) as well as for missed- (OR, 2.84; 95% CI, 1.32-6.13) and true-interval cancers (OR, 1.79; 95% CI, 1.10-2.90) for women taking combined HRT. CONCLUSIONS Information on mammographic density and HRT use should routinely be collected at the time of screening. Women at risk should be made aware of the lower sensitivity of mammography and offered alternative procedures for screening.
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Affiliation(s)
- Anna M Chiarelli
- Division of Preventive Oncology, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario, Canada M5G 2L7.
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Kavanagh AM, Davidson N, Jolley D, Heuzenroeder L, Chapman A, Evans J, Gertig DM, Amos A. Determinants of false positive recall in an Australian mammographic screening program. Breast 2006; 15:510-8. [PMID: 16278082 DOI: 10.1016/j.breast.2005.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2004] [Revised: 09/22/2005] [Accepted: 09/29/2005] [Indexed: 12/01/2022] Open
Abstract
We conducted a case-control study (n=30128) to assess the importance of clinical (e.g., family history, age, hormone replacement therapy (HRT) use and duration) and service-related characteristics (e.g., time since introduction of Kodak MINR2000 film, year of screen) for false positive (FP) recall at BreastScreen Victoria, Australia. There was an age-adjusted upward trend in FP recall rates with year of screen at first (odds ratio (OR) 1.11, 95% confidence interval (95% CI) 1.08-1.13) and subsequent rounds (OR 1.04, 95% CI 1.01-1.06). In the multivariate analysis, the upward trend only remained for first round and age and family history also remained statistically significant at first round. At subsequent rounds the time since introduction of MINR2000, age, strong family history of breast cancer, use of HRT, recall at previous screen and previous screen at more than 27 months were all important predictors of FP recall. The rise in FP rates with year of screen at first round screening is of concern and may require further training of radiologists to improve confidence when viewing films when there a no films for comparison.
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Affiliation(s)
- A M Kavanagh
- Key Centre for Women's Health in Society, University of Melbourne 3010, Australia.
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Christodoulakos GE, Lambrinoudaki IV, Vourtsi AD, Vlachou S, Creatsa M, Panoulis KPC, Botsis D. The effect of low dose hormone therapy on mammographic breast density. Maturitas 2006; 54:78-85. [PMID: 16198519 DOI: 10.1016/j.maturitas.2005.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 08/29/2005] [Accepted: 08/30/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the effect of two standard and one low dose continuous hormone therapy regimens on mammography. METHODS One hundred and thirty-two non-hysterectomized postmenopausal women were randomly allocated either to conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 5 mg (CEE/MPA, n=38), 17beta-estradiol 2 mg plus norethisterone acetate 1 mg (E2/NETA, n=44) or 17beta-estradiol 1 mg plus norethisterone acetate 0.5 mg (low E2/NETA, n=50). Treatment was continuous and the study period lasted 12 months. Main outcome measures were the changes according to Wolfe classification between baseline and 12-month mammograms. RESULTS Five (13.2%) women in the CEE/MPA group showed an increase in breast density. Fourteen (31.8%) women on E2/NETA and 6 (12.2%) on low E2/NETA treatment revealed an increase in breast density. No woman exhibited an involution of fibroglandular tissue. CONCLUSIONS Different hormone therapy regimens have a variable impact on breast density probably depending on the steroid used. Low dose hormone therapy associates with significantly lesser increase in breast density.
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Affiliation(s)
- George E Christodoulakos
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, 27, Themistokleous Street, Dionysos, GR-14578 Athens, Greece
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Boudreau DM, Buist DSM, Rutter CM, Fishman PA, Beverly KR, Taplin S. Impact of hormone therapy on false-positive recall and costs among women undergoing screening mammography. Med Care 2006; 44:62-9. [PMID: 16365614 DOI: 10.1097/01.mlr.0000188969.83608.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to evaluate the effects of hormone therapy (HT) on false-positive (FP) recall for additional breast evaluation and costs. DESIGN We undertook an observational cohort study of women ages 40-80 years with 2 mammography screenings in an integrated delivery system. MEASURES FP recall, defined as mammograms resulting in a radiologist's recommendation for additional imaging, ultrasound, or invasive procedures among disease-free women, was compared for nonusers, initiators, discontinuers, and continuers of HT. Differences in health care costs by HT were assessed for total, primary care, specialty, laboratory, radiology, inpatient, mental health, and pharmacy. RESULTS There was no association between HT and FP recall among women ages 40-49 years. Among women 50 years or older, current HT users, ie, initiators and continuers, had increased odds of FP recall (odds ratio; 95% confidence interval) compared with nonusers (1.2; 1.0-1.4 for women 50-59 years; 1.8; 1.5-2.2 for women 60-69; and 1.7; 1.4-2.0 for women 70-80 years). Among women 50-59 years, the odds of FP recall were attributed to opposed HT (ie, estrogen+progestin). Increases in FP recall among HT users 60 years and older was maintained for initiators, continuers, opposed, and unopposed (estrogen only). Increases in FP recall among HT users were for imaging and ultrasound but not invasive procedures. Costs for current HT users during the 12 months after screening were not higher than nonusers, except for pharmacy and outpatient mental health. CONCLUSION The relationship between HT use and FP recall is greatest among older women and does not result in a differential use of invasive procedures.
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Affiliation(s)
- Denise M Boudreau
- Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101-1448, USA.
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Marchesoni D, Driul L, Ianni A, Fabiani G, Della Martina M, Zuiani C, Bazzocchi M. Postmenopausal hormone therapy and mammographic breast density. Maturitas 2006; 53:59-64. [PMID: 15939560 DOI: 10.1016/j.maturitas.2005.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Revised: 02/06/2005] [Accepted: 02/09/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of different types of hormone replacement therapy (HRT) on mammographic density. MATERIALS AND METHODS In a prospective 1-year study, 103 postmenopausal women were randomized to receive tibolone 2.5 mg/die, continuous conjugated equine estrogens 0.625 mg/die plus medroxyprogesterone acetate (MPA) 5mg/die or placebo. Mammograms were performed at baseline and after 12 months of treatment. Mammographic density was quantified according to the Wolfe classification. RESULTS After 12 months of HRT 16 of the 35 patients (45.1%) receiving continuous combined hormonal therapy showed an increase of breast density change in the Wolfe classification. After treatment with tibolone, an up grading in breast density, according to Wolfe's classification, was found in 2 of the 43 patients (2.3%). No changes were recorded in the 25 patients of the control group. The difference between the group treated with continuous combined hormonal therapy and the control group was highly significant (p<0.001). The difference in breast density between patients in treatment with tibolone and the control group was not statistically significant (p=0.34). DISCUSSION Continuous combination HRT may be more commonly associated with an increase of mammography density than tibolone treatment.
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Affiliation(s)
- D Marchesoni
- Department of Surgical Sciences, Chair of Obstetrics and Gynecology, University of Udine, P.le Santa Maria della Misericordia, 33100 Udine, Italy.
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Banks E, Reeves G, Beral V, Bull D, Crossley B, Simmonds M, Hilton E, Bailey S, Barrett N, Briers P, English R, Jackson A, Kutt E, Lavelle J, Rockall L, Wallis MG, Wilson M, Patnick J. Hormone replacement therapy and false positive recall in the Million Women Study: patterns of use, hormonal constituents and consistency of effect. Breast Cancer Res 2005; 8:R8. [PMID: 16417651 PMCID: PMC1413983 DOI: 10.1186/bcr1364] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Revised: 11/02/2005] [Accepted: 11/08/2005] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Current and recent users of hormone replacement therapy (HRT) have an increased risk of being recalled to assessment at mammography without breast cancer being diagnosed ('false positive recall'), but there is limited information on the effects of different patterns of HRT use on this. The aim of this study is to investigate in detail the relationship between patterns of use of HRT and false positive recall. METHODS A total of 87,967 postmenopausal women aged 50 to 64 years attending routine breast cancer screening at 10 UK National Health Service Breast Screening Units from 1996 to 1998 joined the Million Women Study by completing a questionnaire before screening and were followed for their screening outcome. RESULTS Overall, 399 (0.5%) participants were diagnosed with breast cancer and 2,629 (3.0%) had false positive recall. Compared to never users of HRT, the adjusted relative risk (95% CI) of false positive recall was: 1.62 (1.43-1.83), 1.80 (1.62-2.01) and 0.76 (0.52-1.10) in current users of oestrogen-only HRT, oestrogen-progestagen HRT and tibolone, respectively (p (heterogeneity) < 0.0001); 1.65 (1.43-1.91), 1.49 (1.22-1.81) and 2.11 (1.45-3.07) for current HRT used orally, transdermally or via an implant, respectively (p (heterogeneity) = 0.2); and 1.84 (1.67-2.04) and 1.75 (1.49-2.06) for sequential and continuous oestrogen-progestagen HRT, respectively (p (heterogeneity) = 0.6). The relative risk of false positive recall among current users appeared to increase with increasing time since menopause, but did not vary significantly according to any other factors examined, including duration of use, hormonal constituents, dose, whether single- or two-view screening was used, or the woman's personal characteristics. CONCLUSION Current use of oestrogen-only and oestrogen-progestagen HRT, but not tibolone, increases the risk of false positive recall at screening.
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Affiliation(s)
- Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia
| | - Gillian Reeves
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Valerie Beral
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Diana Bull
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Barbara Crossley
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Moya Simmonds
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Elizabeth Hilton
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Stephen Bailey
- Breast Screening Service, Princess of Wales Community Hospital, Stourbridge Road, Bromsgrove B61 0BB, UK
| | - Nigel Barrett
- West of London Breast Screening Service, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Peter Briers
- Gloucestershire Breast Screening Service, Linton House, Thirlestaine Road, Cheltenham, Glos GL53 7AS, UK
| | - Ruth English
- The Breast Care Unit, Oxford Radcliffe Hospital NHS Trust, The Churchill Hospital, Old Road, Headington, Oxford OX3 7JH, UK
| | - Alan Jackson
- Patricia Massey Breast Screening Unit, Queen Alexandra Hospital, Cosham, Portsmouth, Hants PO6 3LY, UK
| | - Elizabeth Kutt
- Avon Breast Screening, Central Health Clinic, Tower Hill, Bristol BS2 0JD, UK
| | - Janet Lavelle
- North Lancashire Breast Screening Service, Royal Lancaster Infirmary, Ashton Court, Lancaster LA1 4GG, UK
| | - Linda Rockall
- The West Sussex Breast Screening Service, Worthing Hospital, Park Avenue, Worthing, West Sussex BN11 2DH, UK
| | - Matthew G Wallis
- Breast Screening Unit, Coventry and Warwick Hospital, Stoney Stanton Road, Coventry CV1 4FH, UK
| | - Mary Wilson
- Greater Manchester Breast Screening Service, The Nightingale Centre, Withington Hospital, Nell Lane, Manchester M20 0PT, UK
| | - Julietta Patnick
- National Health Service Cancer Screening Programmes, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK
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Kavanagh AM, Cawson J, Byrnes GB, Giles GG, Marr G, Tong B, Gertig DM, Hopper JL. Hormone replacement therapy, percent mammographic density, and sensitivity of mammography. Cancer Epidemiol Biomarkers Prev 2005; 14:1060-4. [PMID: 15894653 DOI: 10.1158/1055-9965.epi-04-0165] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We examine to what extent the lower mammographic sensitivity found in hormone replacement therapy (HRT) users can be explained by any association of HRT use with higher mammographic density and more difficult to detect cancers. METHODS We used logistic regression to estimate the odds of a false-negative screen (a breast cancer diagnosed in the 24 months after a negative screening examination) for HRT users and to estimate, and adjust for, mammographic density (measured on a continuous scale, blinded, using a reliable, computer-assisted method), tumor characteristics (size, grade, and morphology), and potential confounders (age, symptom status, family history, and prior screening) among women ages > or =55 years who attended BreastScreen Victoria for first round screening mammography in 1994 and 1995 (1,086 breast cancers) and for subsequent round screening (471 breast cancers) in 1995 and 1996. RESULTS After adjusting for confounders, HRT users were more likely to have a false-negative screen [first round: odds ratio (OR), 1.99; 95% confidence interval (95% CI), 1.4-2.9; subsequent round: OR, 2.29; 95% CI, 1.4-3.8]. This effect was modestly attenuated by adjusting for mammographic density (first round: OR, 1.54; 95% CI, 1.0-2.3; subsequent round: OR, 1.97; 95% CI, 1.2-3.3). Adjusting for tumor characteristics resulted in a modest increase in the odds of a false negative at first round but had no effect at subsequent round. CONCLUSIONS Mammographic density only partly explains the effect of HRT on sensitivity. Further research needs to clarify whether hyperemic breast tissue changes affect cancer detectability in HRT users as well as the possibility that the quality of mammography may be poor in some HRT users.
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Affiliation(s)
- Anne M Kavanagh
- Key Centre for Women's Health in Society, School of Population Health, University of Melbourne, Victoria 3010, Australia.
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Tromberg BJ, Cerussi A, Shah N, Compton M, Durkin A, Hsiang D, Butler J, Mehta R. Imaging in breast cancer: diffuse optics in breast cancer: detecting tumors in pre-menopausal women and monitoring neoadjuvant chemotherapy. Breast Cancer Res 2005; 7:279-85. [PMID: 16457705 PMCID: PMC1410753 DOI: 10.1186/bcr1358] [Citation(s) in RCA: 204] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Diffuse optical spectroscopy (DOS) and diffuse optical imaging (DOI) are non-invasive diagnostic techniques that employ near-infrared (NIR) light to quantitatively characterize the optical properties of centimeter-thick, multiple-scattering tissues. Although NIR was first applied to breast diaphanography more than 70 years ago, quantitative optical methods employing time- or frequency-domain 'photon migration' technologies have only recently been used for breast imaging. Because their performance is not limited by mammographic density, optical methods can provide new insight regarding tissue functional changes associated with the appearance, progression, and treatment of breast cancer, particularly for younger women and high-risk subjects who may not benefit from conventional imaging methods. This paper reviews the principles of diffuse optics and describes the development of broadband DOS for quantitatively measuring the optical and physiological properties of thick tissues. Clinical results are shown highlighting the sensitivity of diffuse optics to malignant breast tumors in 12 pre-menopausal subjects ranging in age from 30 to 39 years and a patient undergoing neoadjuvant chemotherapy for locally advanced breast cancer. Significant contrast was observed between normal and tumor regions of tissue for deoxy-hemoglobin (p = 0.005), oxy-hemoglobin (p = 0.002), water (p = 0.014), and lipids (p = 0.0003). Tissue hemoglobin saturation was not found to be a reliable parameter for distinguishing between tumor and normal tissues. Optical data were converted into a tissue optical index that decreased 50% within 1 week in response to neoadjuvant chemotherapy. These results suggest a potential role for diffuse optics as a bedside monitoring tool that could aid the development of new strategies for individualized patient care.
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Affiliation(s)
- Bruce J Tromberg
- Laser Microbeam and Medical Program, Beckman Laser Institute, University of California, Irvine, CA, USA.
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Cho KR, Seo BK, Lee JY, Pisano ED, Je BK, Lee JY, Choi EJ, Chung KB, Whan Oh Y. A comparative study of 2D and 3D ultrasonography for evaluation of solid breast masses. Eur J Radiol 2005; 54:365-70. [PMID: 15899337 DOI: 10.1016/j.ejrad.2004.07.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Revised: 07/06/2004] [Accepted: 07/08/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare image quality and diagnostic accuracy of 2D with 3D ultrasonography in solid breast masses. METHODS AND MATERIAL To rate image quality, two radiologists compared lesion contrast and characterization of 507 solid breast masses in 2D and 3D ultrasonography and then graded the 3D imaging in 3-point scale. To characterize the masses, the same radiologists rated the examination for clarity of margin, posterior acoustic feature, and clustered microcalcifications within a mass. In addition, the masses were assigned BI-RADS categories as proposed by the American College of Radiology, criteria using just ultrasonographic features. In the 202 pathologically confirmed cases, sensitivity, specificity, positive predictive value, negative predictive value, and false negative rate for diagnosis of breast cancer in 2D and 3D ultrasonography were assessed. Image quality and diagnostic accuracy were further evaluated according to the size of the masses. RESULTS Two observers rated 3D imaging superior to 2D imaging in terms of lesion contrast and characterization of the masses. Especially, superiority of 3D ultrasonography in terms of image quality was increasing in more than 10 mm sized masses. However, diagnostic accuracy including sensitivity, specificity, positive predictive value, negative predictive value, and false negative rate for diagnosis of breast cancer of 3D imaging was not different from 2D imaging. CONCLUSION In spite of superior image quality on 3D ultrasonography, it does not provide additional benefits to diagnostic accuracy for diagnosis of breast cancer.
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Affiliation(s)
- Kyu Ran Cho
- Department of Diagnostic Radiology, Korea University Hospital, Seoul, Korea
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