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Corsi F, Bossi D, Sartani A, Papadopoulou O, Amadori R, Scoccia E, Trifirò G, Albasini S, Truffi M, Bonizzi A, Sorrentino L. Radio-guided and clip-guided preoperative localization for malignant microcalcifications offer similar performances in breast-conserving surgery. Breast J 2019; 25:865-873. [PMID: 31187568 DOI: 10.1111/tbj.13354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/30/2022]
Abstract
Obtaining a tailored breast resection is challenging in microcalcifications detected on screening mammography, and an accurate localization is required. The aim of this study was to compare the efficacy of radio-guided localization (ROLL) versus ultrasound localization of a titanium clip with collagen (TCC) in terms of clear margins, re-intervention rates, excess of resected breast tissue, and operative times in pure malignant microcalcifications detected on screening mammography. Two hundred and twenty-one consecutive patients with malignant microcalcifications detected on screening mammography from a tertiary breast unit were reviewed: 177 patients were localized by TCC and 44 patients by stereotactic ROLL. A propensity score-matched analysis was performed, followed by a logistic regression model, to avoid selection bias. Adequacy of resection was expressed as the calculated resection ratio considering lesion size. No differences were found in clear margins with ROLL versus TCC (77.3% vs 81.8%, adjusted OR 2, P = 0.27). Re-operation rates were similar, being 11.3% with ROLL and 7.4% with TCC (P = 0.627). Mean resection volume was 46.2 cm3 with ROLL versus 54.2 cm3 with TCC (P = 0.222). Adjusted mean calculated resection ratio was 1.8 with ROLL and 2.1 with TCC (P = 0.38). Surgery time was longer with TCC compared to ROLL (69.6 vs 52.7 minutes, P < 0.0001). ROLL and TCC are equally effective to excise malignant microcalcifications with clear margins, providing similar re-intervention rates and resection volumes.
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Affiliation(s)
- Fabio Corsi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.,Breast Unit, Surgery Department, ICS Maugeri S.p.A. SB, Pavia, Italy
| | - Daniela Bossi
- Breast Unit, Surgery Department, ICS Maugeri S.p.A. SB, Pavia, Italy
| | - Alessandra Sartani
- Surgery Division, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milano, Italy
| | | | | | | | | | - Sara Albasini
- Breast Unit, Surgery Department, ICS Maugeri S.p.A. SB, Pavia, Italy
| | - Marta Truffi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Arianna Bonizzi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Luca Sorrentino
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
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Corsi F, Bossi D, Combi F, Papadopoulou O, Amadori R, Regolo L, Trifirò G, Albasini S, Mazzucchelli S, Sorrentino L. Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study. J Surg Oncol 2019; 119:916-924. [DOI: 10.1002/jso.25409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Fabio Corsi
- Department of Biomedical and Clinical Sciences “Luigi Sacco”University of MilanMilan Italy
- Surgery DepartmentBreast Unit, Istituti Clinici Scientifici Maugeri IRCCSPavia Italy
| | - Daniela Bossi
- Surgery DepartmentBreast Unit, Istituti Clinici Scientifici Maugeri IRCCSPavia Italy
| | - Francesca Combi
- Surgery DepartmentBreast Unit, Istituti Clinici Scientifici Maugeri IRCCSPavia Italy
| | - Ourania Papadopoulou
- Service of Breast Radiology, Department of RadiologyIstituti Clinici Scientifici Maugeri IRCCSPavia Italy
| | - Rosella Amadori
- Breast Radiology Unit, Department of RadiologyIstituti Clinici Scientifici Maugeri IRCCSMilan Italy
| | - Lea Regolo
- Surgery DepartmentBreast Unit, Istituti Clinici Scientifici Maugeri IRCCSPavia Italy
| | - Giuseppe Trifirò
- Department of Nuclear MedicineIstituti Clinici Scientifici Maugeri IRCCSPavia Italy
| | - Sara Albasini
- Surgery DepartmentBreast Unit, Istituti Clinici Scientifici Maugeri IRCCSPavia Italy
| | - Serena Mazzucchelli
- Department of Biomedical and Clinical Sciences “Luigi Sacco”University of MilanMilan Italy
| | - Luca Sorrentino
- Department of Biomedical and Clinical Sciences “Luigi Sacco”University of MilanMilan Italy
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Reduction in rate of node metastases with breast screening: consistency of association with tumor size. Breast Cancer Res Treat 2012; 137:653-63. [DOI: 10.1007/s10549-012-2384-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
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Lehtimäki T, Lundin M, Linder N, Sihto H, Holli K, Turpeenniemi-Hujanen T, Kataja V, Isola J, Joensuu H, Lundin J. Long-term prognosis of breast cancer detected by mammography screening or other methods. Breast Cancer Res 2011; 13:R134. [PMID: 22204661 PMCID: PMC3326576 DOI: 10.1186/bcr3080] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 12/22/2011] [Accepted: 12/28/2011] [Indexed: 12/04/2022] Open
Abstract
Introduction Previous studies of breast cancer have shown that patients whose tumors are detected by mammography screening have a more favorable survival. Little is known, however, about the long-term prognostic impact of screen detection. The purpose of the current study was to compare breast cancer-specific long-term survival of patients whose tumors were detected in mammography screening compared with those whose tumors were detected by other methods. Methods Breast cancer patients diagnosed within five specified geographical areas in Finland in 1991 and 1992 were identified (N = 2,936). Detailed clinical, treatment and outcome data, as well as tissue samples, were collected. Women with in situ carcinoma, distant metastases at the time of primary diagnosis and women who were not treated surgically were excluded. The main analyses were performed after excluding patients with other malignancy or contralateral breast cancer, followed by sensitivity analyses with different exclusion criteria. Median follow-up time was 15.4 years. Univariate and multivariate analyses of breast cancer-specific survival were performed. Results Of patients included in the main analyses (n = 1,884), 22% (n = 408) of cancers were screen-detected and 78% (n = 1,476) were detected by other methods. Breast cancer-specific 15-year survival was 86% for patients with screen-detected cancer and 66% for patients diagnosed using other methods (P < 0.0001, HR = 2.91). Similar differences in survival were observed in women at screening age (50 to 69 years), as well as in clinically important subgroups, such as patients with small tumors (≤ 1 cm in diameter) and without nodal involvement (N0). Women with breast cancer diagnosed on the basis of screening mammography had a more favorable prognosis than those diagnosed outside screening programs, following adjustments according to patient age, tumor size, axillary lymph node status, histological grade and hormone receptor status. Significant differences in the risk of having future contralateral breast cancer according to method of detection were not observed. Conclusions Breast cancer detected by mammography screening is an independent prognostic factor in breast cancer and is associated with a more favorable survival rate as well as in long-term follow-up.
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Affiliation(s)
- Tiina Lehtimäki
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Biomedicum Helsinki 2U, Tukholmankatu 8, PO Box 20, FI-00014 Helsinki, Finland.
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Jochelson MS, Morris EA. An imaging approach to high-risk screening for breast cancer. Semin Roentgenol 2011; 46:68-75. [PMID: 21134530 DOI: 10.1053/j.ro.2010.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maxine S Jochelson
- Memorial Sloan-Kettering Cancer Center, Weill College of Medicine at Cornell University, New York, NY, USA.
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Wai ES, D'yachkova Y, Olivotto IA, Tyldesley S, Phillips N, Warren LJ, Coldman AJ. Comparison of 1- and 2-year screening intervals for women undergoing screening mammography. Br J Cancer 2005; 92:961-6. [PMID: 15714210 PMCID: PMC2361910 DOI: 10.1038/sj.bjc.6602393] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We compared the long-term impact of 1- and 2-year screening mammography intervals using prognostic, screening, and outcome information for women aged 50–74 years obtained from the Screening Mammography Program of British Columbia in two time periods, prior to 1997 (policy of annual mammography) and after 1997 (biennial mammography). Survival was estimated for both periods using a prognostic model and the expected rate of interval and screen-detected cancers. The likelihood of a screen-detected cancer with annual screening was 2.32 per thousand screens and with biennial screening was 3.32 per thousand screens. The prognostic profile of screen-detected cancers was better than that of interval cancers. Among both screen-detected and interval cancers, the prognostic profiles with annual and biennial screening were similar. The estimated breast cancer-specific survival rates for women undergoing annual and biennial screening mammography were 95.2 and 94.6% at 5 years, and 90.4 and 89.2% at 10 years, respectively. Annual compared to biennial mammography was associated with a 1.2% increase in the estimated 10-year breast cancer-specific survival for women aged 50–74 years, diagnosed with invasive breast cancer after screening programme attendance.
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Affiliation(s)
- E S Wai
- Radiation Therapy Program, BC Cancer Agency, Vancouver Island Centre, 2410 Lee Ave, Victoria, BC, Canada V8R 6V5.
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Sharp PC, Michielutte R, Spangler JG, Cunningham L, Freimanis R. Primary care providers' concerns and recommendations regarding mammography screening for older women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2005; 20:34-8. [PMID: 15876180 DOI: 10.1207/s15430154jce2001_11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Morbidity and mortality from breast cancer increase with age; however, mammography screening does not reflect this increased risk for older women. Lack of provider recommendation is a major barrier to screening. METHODS This is a descriptive study of mammography screening recommendations of community primary care providers in North Carolina (N = 96) participating in a National Cancer Institute funded research project. Providers self-reported screening recommendations for typical patients of different ages and issues and concerns that might influence the decision. Chart reviews compared actual practices with policies stated. RESULTS Of the providers, 51% recommended biannual, 45% annual for women ages 50 through 74; 4% recommended biannual, 80% annual, 5% did not recommend screening, and 10% had no general policy for women over 75. Cost, inconsistent guidelines, comorbidity, functional status, value of mammography, and patient resistance influenced screening recommendations. Chart review showed even lower rates of recommendation than self-reported figures. CONCLUSIONS Although the use of screening mammography has increased over the past decade, older women are one of the last subgroups to derive benefit from this screening test. Our survey revealed lower rates for mammography referral in older women. The primary care provider appears to be essential to increasing participation for these older women in breast cancer screening.
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Affiliation(s)
- Penny C Sharp
- Wake Forest University School of Medicine, Department of Family & Community Medicine, Winston-Salem, NC 27157-1084, USA.
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Taplin SH, Ichikawa L, Yood MU, Manos MM, Geiger AM, Weinmann S, Gilbert J, Mouchawar J, Leyden WA, Altaras R, Beverly RK, Casso D, Westbrook EO, Bischoff K, Zapka JG, Barlow WE. Reason for late-stage breast cancer: absence of screening or detection, or breakdown in follow-up? J Natl Cancer Inst 2004; 96:1518-27. [PMID: 15494602 DOI: 10.1093/jnci/djh284] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mammography screening increases the detection of early-stage breast cancers. Therefore, implementing screening should reduce the percentage of women who are diagnosed with late-stage disease. However, despite high national mammography screening rates, late-stage breast cancers still occur, possibly because of failures in screening implementation. METHODS Using data from seven health care plans that included 1.5 million women aged 50 years or older, we conducted retrospective reviews of chart and automated data for 3 years before 1995-1999 diagnoses of late-stage (metastatic and/or tumor size > or =3 cm; case subjects, n = 1347) and early-stage breast cancers (control subjects, n = 1347). We categorized the earliest screening mammogram during the period 13-36 months before diagnosis as none (absence of screening), negative (absence of detection), or positive (potential breakdown in follow-up). We compared the proportion of case and control subjects in each category of screening implementation and estimated the likelihood (odds ratio [OR] with 95% confidence intervals [CIs]) of late-stage breast cancer. We also evaluated demographic characteristics associated with absence of screening in women with late-stage disease. All statistical tests were two-sided. RESULTS Absence of screening, absence of detection, and potential breakdown in follow-up were distributed differently among case (52.1%, 39.5%, and 8.4%, respectively) and control subjects (34.4%, 56.9%, and 8.8%, respectively) (P = .03). Among all women, the odds of having late-stage cancer were higher among women with an absence of screening (OR = 2.17, 95% CI = 1.84 to 2.56; P<.001). Among case patients, women were more likely to be in the absence-of-screening group if they were aged 75 years or older (OR = 2.77, 95% CI = 2.10 to 3.65), unmarried (OR = 1.78, 95% CI = 1.41 to 2.24), or without a family history of breast cancer (OR = 1.84, 95% CI = 1.45 to 2.34). A higher proportion of women from census blocks with less education (58.5% versus 49.4%; P = .003) or lower median annual income (54.4% versus 42.9%; P = .004) were in the absence-of-screening category compared with the proportion for the other two categories combined. CONCLUSIONS To reduce late-stage breast cancer occurrence, reaching unscreened women, including elderly, unmarried, low-income, and less educated women, should be made a top priority for screening implementation.
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David P. Valeur primordiale de l’échographie en aval de la mammographie de dépistage du cancer du sein. IMAGERIE DE LA FEMME 2004. [DOI: 10.1016/s1776-9817(04)94831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
As the population ages, preventive gerontology has been advocated to promote good personal health practices for a healthier longevity. While detection and management of high blood pressure, elevated serum glycemic and cholesterol levels, have been routine in the care of older persons, approaches to osteoporosis identification and management are more complex and less widely practiced. This article reviews aspects of osteoporosis detection and intervention in this patient population, with recommendations for meeting the needs of 'bone health' in an aging society.
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Affiliation(s)
- D Hamerman
- Department of Medicine and Resnick Gerontology Center, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, 10467, Bronx, NY, USA
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Williams JC, Helvie MA. Recommendations for mammographic screening of elderly women. AJR Am J Roentgenol 2000; 175:1182-3. [PMID: 11000187 DOI: 10.2214/ajr.175.4.1751182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Breast cancer is the most common malignancy among women in the United States; however, recent data demonstrates a decline in the mortality rate, which may be attributed to early detection from screening programs combined with effective therapies for early stage disease. As a result of the prevalence of breast cancer and its association with highly emotional issues, screening recommendations have aroused debate in the scientific, public, and legislative domains. A general consensus supports breast cancer screening among women between the ages of 50 and 70; however, much controversy exists regarding screening for women age 40 to 49 or above age 70. This article explores the issues involved in determining breast cancer screening recommendations among asymptomatic women with average risk in the United States.
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Affiliation(s)
- B Overmoyer
- Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve School of Medicine, Ohio, USA
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