Lifting the fog of confusion about breast cancer screening guidelines: Surprise - it's about the money!

Large amounts of misinformation denigrating the benefits of breast cancer screening have been published over the past 50 years and continue to be published. Each effort to reduce breast cancer screening has been refuted, scientifically, but the efforts continue. The motivation has been unclear until the recent guidelines issued by the American Society of Breast Surgeons who support annual screening starting at the age of 40 contrasted with the American College of Physicians who advocated delaying screening until the age of 50 and then biennially. An analysis of the facts can only lead to the conclusion that delayed screening has been chosen to save money rather than lives.

Mammography: review of the controversy, health disparities, and impact on young african american women

BACKGROUND

Ongoing debate about mammography screening for women in their 40s has brought awareness to the opportunities and challenges for achieving optimal breast health in young African American women and in battling health inequities that place them at greater risk for mortality from breast cancer. Despite the screening controversy, a need exists to understand the complex issues related to mammography knowledge, attitudes, and behaviors of young minority women, while empowering them to take an active role in their breast health care.

OBJECTIVES

The purpose of this article is to describe the complicated issues related to screening in young African American women within the context of the uncertainty about the evidence surrounding screening practices.

METHODS

Literature was reviewed to garner a comprehensive update of the mammography screening controversy and its impact on mammography practices.

FINDINGS

Nurses should be aware of the mammography screening controversy and breast cancer risk assessment and how they affect young women's participation in mammography screening. Mammography screening should be a shared decision between the patient and healthcare provider. A better understanding of breast health and its effect on young minority women is needed. Nurses have a prominent role to advocate for, empower, and educate patients as they face the task of deciding whether to begin or continue mammography in their 40s.

Associated factors with mammographic changes in women undergoing breast cancer screening

Objective:

To evaluate association of sociodemographic, anthropometric, and epidemiological factors with result of mammogram in women undergoing breast cancer screening.

Methods:

This is a cross-sectional study with data obtained through interviews, anthropometric measurements, and mammography of 600 women aged 40 to 69 years at the Preventive Medicine Department of Hospital de Câncer de Barretos, Brazil, in 2014. The results of these examinations in the BI-RADS categories 1 and 2 were grouped and classified in this study as normal mammogram outcome, and those of BI-RADS categories 3, 4A, 4B, 4C, and 5 were grouped and classified as altered mammogram outcome. The statistical analysis included the Student's t-test to compare means, as well as odds ratios (OR), with their corresponding 95% confidence intervals (95%CI), to verify an association by means of the multivariate analysis.

Results:

Of 600 women evaluated, 45% belonged to the age group of 40–49 years-old and 60.2% were classified as BI-RADS category 2. The multivariate analysis showed that women with blood hypertension (OR: 2.64; 95%CI: 1.07–6.49; p<0.05) were more likely to present changes in the mammography, while physical activity was associated with lower chances (OR: 0.30; 95%CI: 0.11–0.81; p<0.05).

Conclusion:

Hypertensive women undergoing screening mammography are more likely to present mammographic changes, whereas women practicing physical activity have lower chances (70%) of presenting changes in the breast compared with sedentary individuals.

The impact of mammographic screening on the surgical management of breast cancer

BACKGROUND AND OBJECTIVES

Mammographic screening has been shown to result in downward stage migration, reflected by smaller tumor sizes and less extensive nodal involvement. National guidelines restrict screening recommendations in women age 40-49. The purpose of this study is to evaluate the specific impact of mammographic screening patterns on the surgical management of breast cancer in women aged 40-49.

METHODS

The study is a population-based retrospective review of the Vermont Breast Cancer Surveillance System of women aged 40-49 with a diagnosis of breast cancer. Tumor stage and related characteristics at the time of diagnosis, as well as the type of surgical intervention performed were recorded for women presenting with screen-detected versus non-screen-detected breast cancer.

RESULTS

Screen-detected breast cancers in women aged 40-49 were associated with a greater incidence of DCIS, smaller invasive tumor size, fewer cases of positive nodes, and higher rates of breast conservation compared to non-screened women presenting with symptomatic disease.

CONCLUSIONS

Mammographic screening is associated with less aggressive surgical treatment of breast cancer including higher rates of breast conservation. The observed changes in surgical management should factor into individual decision-making regarding screening mammography. J. Surg. Oncol. 2016;113:496-500. © 2016 Wiley Periodicals, Inc.

The Potential Impact of Risk-Based Screening Mammography in Women 40-49 Years Old

OBJECTIVE

The purpose of this study was to determine the prevalence of very strong family history and extremely dense tissue in women 40-49 years old with breast cancer detected on screening mammography.

MATERIALS AND METHODS

All cancers detected by screening mammography at our institution between January 1997 and November 2012 in 40- to 49-year-old women were retrospectively identified. Those with a personal history of breast cancer were excluded. Family history, breast density, type of malignancy, hormone receptor status, and lymph node status were recorded.

RESULTS

One hundred thirty-six cases of breast cancer were identified on screening mammography in 40- to 49-year-old women; 50% were invasive cancers, and 50%, ductal carcinoma in situ. Very strong family history was absent in 88%, and extremely dense breast tissue was absent in 86%. Seventy-six percent of patients had neither very strong family history nor extremely dense breasts, including 79% of the cases of invasive cancers, of which 25% had axillary nodal involvement and 89% were estrogen receptor positive.

CONCLUSION

Very strong family history and extremely dense breast tissue were absent in most 40- to 49-year-old women with breast cancer detected at screening mammography. These cancers were frequently invasive (often with nodal metastases) and treatable (hormone receptor positive). Reducing the number of women to be screened in this age group by using this risk-based approach would reduce the number of screen-detected cancers by more than 75%, thereby precluding the benefit of mortality reduction. Even using a risk-based strategy with an expanded definition of high risk that included any first-degree family history, extremely dense tissue, or both, 66% of malignancies would still be missed.

Beyond the mammography debate: a moderate perspective

After some decades of contention, one can almost despair and conclude that (paraphrasing) "the mammography debate you will have with you always." Against that sentiment, in this review I argue, after reflecting on some of the major themes of this long-standing debate, that we must begin to move beyond the narrow borders of claim and counterclaim to seek consensus on what the balance of methodologically sound and critically appraised evidence demonstrates, and also to find overlooked underlying convergences; after acknowledging the reality of some residual and non-trivial harms from mammography, to promote effective strategies for harm mitigation; and to encourage deployment of new screening modalities that will render many of the issues and concerns in the debate obsolete. To these ends, I provide a sketch of what this looking forward and beyond the current debate might look like, leveraging advantages from abbreviated breast magnetic resonance imaging technologies (such as the ultrafast and twist protocols) and from digital breast tomosynthesis-also known as three-dimensional mammography. I also locate the debate within the broader context of mammography in the real world as it plays out not for the disputants, but for the stakeholders themselves: the screening-eligible patients and the physicians in the front lines who are charged with enabling both the acts of screening and the facts of screening at their maximally objective and patient-accessible levels to facilitate informed decisions.

Hook Wire Localization Procedure and Early Detection of Breast Cancer - Our Experience

AIM:

The purpose of this study is to describe our experience with needle localization technique in diagnosing small breast cancers.

MATERIAL AND METHODS:

This retrospective study included a hundred and twenty patients’ with impalpable breast lesions and they underwent wire localization. All patients had mammography, ultrasound exam and pathohystological results. We use Mammomat Inspiration Siemens digital unit for diagnosing mammography, machine - Lorad Affinity with fenestrated compressive pad for wire localization and ultrasound machine Acuson X300 with linear array probe 10 MhZ. We use two types of wire: Bard hook wire and Kopans breast lesion localization needle, Cook. Comparative radiologic and pathologic data were collected and analyzed.

RESULTS:

In 120 asymptomatic women, 68 malignancies and 52 benign findings were detected with mammography and ultrasound. The mean age for patients with malignancy was 58.6 years. According BI-RADS classification for mammography the distribution is our group was: BI-RADS 3 was presented in 6 (8.82%) patients, BI-RADS 4 was presented in 56 (82.35%) patients and BI-RADS 5 was present in 6 (8.82%) of the patients. Most wire localizations were performed under mammographic guidance in 58 from 68 patients with malignant lesions (85.29%) and with ultrasound in 10 (14.7%). According the mammographic findings patients with mass on mammograms were 29 (42.65%), mass with calcifications 9 (13.23%), calcifications 20 (29.41%) and architectural distortions or asymmetry 10 (14.71%).

CONCLUSION:

Wire localization is a well established technique for the management of impalpable breast lesions.

The clinical use of a P63/cytokeratin7/18/cytokeratin5/14 antibody cocktail in diagnostic breast pathology

An antibody cocktail directed against p63, cytokeratin (CK)5/14, and CK7/18 is reported to be useful in distinguishing noninvasive from invasive breast lesions and for the characterization of intraductal epithelial proliferations. However, limited studies evaluate its use in clinical practice. A retrospective review of breast material at a university medical center identified cases that were immunostained with the above antibody cocktail. Additional p63 immunostaining alone was performed to further determine the utility of the antibody cocktail in the evaluation of invasion. Of 50 breast cases identified, the antibody cocktail was used to confirm or exclude invasion in 44 (88%). Twenty-two (50%) of these had easily identifiable p63/CK5/14-positive myoepithelial cells, whereas the remainder lacked such staining, confirming the diagnosis of invasive carcinoma. In 27 cases with available diagnostic material for additional p63 immunostaining, the cocktail better highlighted myoepithelial cells by staining nuclei and cytoplasm. Easier identification of invasion was also facilitated by CK7/18 expression in invasive foci, especially those composed of single cells. Ten cases were immunostained to help determine the nature of an intraductal proliferation. The cocktail demonstrated a mosaic staining pattern of both CK7/18- and CK5/14-positive epithelial cells in 3 (30%) cases consistent with usual hyperplasia; homogenous CK7/18 expression in the remaining cases supported the diagnosis of atypical ductal hyperplasia or carcinoma in situ. In summary, the p63/CK7/18/CK5/14 cocktail stain appears to be a useful tool in diagnostic breast pathology, in the evaluation of possible invasion, particularly in the setting of minute foci of invasion as well as in epithelial proliferations.