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Waaijer L, Filipe MD, Simons J, van der Pol CC, de Boorder T, van Diest PJ, Witkamp AJ. Detection of breast cancer precursor lesions by autofluorescence ductoscopy. Breast Cancer 2020; 28:119-129. [PMID: 32725533 PMCID: PMC7796885 DOI: 10.1007/s12282-020-01136-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/03/2020] [Accepted: 07/16/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Autofluorescence is an image enhancement technique used for the detection of cancer precursor lesions in pulmonary and gastrointestinal endoscopy. This study evaluated the feasibility of addition of autofluorescence to ductoscopy for the detection of intraductal breast cancer precursor lesions. METHODS An autofluorescence imaging system, producing real-time computed images combining fluorescence intensities, was coupled to a conventional white light ductoscopy system. Prior to surgery, ductoscopy with white light and autofluorescence was evaluated under general anaesthesia in women scheduled for therapeutic or prophylactic mastectomy. Endoscopic findings in both modes were compared, marked and correlated with histology of the surgical specimen. RESULTS Four breast cancer patients and five high-risk women, with a median age of 47 years (range 23-62) were included. In autofluorescence mode, two intraductal lesions were seen in two breast cancer patients, which had an increase in the red-to-green fluorescence intensity compared with the surrounding tissue. One lesion had initially been missed by white light ductoscopy but was clearly visible in subsequent autofluorescence mode. One endoscopic finding was classified as suspicious by white light, but was negative in autofluorescence mode and showed normal histology. CONCLUSIONS This study demonstrates for the first time the in vivo feasibility of autofluorescence ductoscopy to detect pathologically confirmed breast cancer precursor lesions in both breast cancer patients and high-risk women that were occult under white light.
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Affiliation(s)
- Laurien Waaijer
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Mando D Filipe
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Janine Simons
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Carmen C van der Pol
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tjeerd de Boorder
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Arjen Joost Witkamp
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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2
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Chaveepojnkamjorn W, Pichainarong N, Thotong R, Sativipawee P, Pitikultang S. Relationship between Breast Cancer and Oral Contraceptive
Use among Thai Premenopausal Women: a Case-Control Study. Asian Pac J Cancer Prev 2017; 18:1429-1433. [PMID: 28612598 PMCID: PMC5555558 DOI: 10.22034/apjcp.2017.18.5.1429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Breast cancer (BC) is an important issue both in medicine and public health as it is the leading malignancy with high incidence and mortality among women worldwide. The objective of this research was to determine the associations of BC with oral contraceptive (OC) use among Thai premenopausal women (TPW). Materials and Methods: A case-control study was conducted among TPW attending the National Cancer Institute, with 257 cases and 257 controls in 2013-2014. Cases and controls were matched by age (± 5 years), residential area and duration of attendance. Data were collected with a questionnaire that comprised 2 sections: part 1 socio-demographic characteristics, and part 2 health risk behavior and reproductive factors. The obtained data were analyzed using descriptive and analytic statistics with a computerized statistical package. Results: The study participants were mainly 40-44 years old (60 %) with an average age of 39 years. The major BC type was invasive ductal carcinoma (91.8%). Multiple unconditional logistic regression analysis, controlling for possible confounding factors, revealed that TPW with OC use increased the risk of BC by a factor of over 3 times (ORadj=3.39, 95%CI =1.99-5.75). In addition, the greater the duration of OC, the greater the risk (ORadj 6-10 yrs=3.91, 95%CI = 1.99-7.64, ORadj >10 yrs=4.23, 95%CI = 2.05-8.71). Conclusions: From our findings, a surveillance system of cancer risk with OC use should be conducted, accompanied by an exercise promotion campaign among risk groups, providing information and counseling for physical exercise and physical activities, weight control and basic adjustment for a healthy lifestyle to reduce BC.
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Affiliation(s)
- Wisit Chaveepojnkamjorn
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Ratchathewi, Bangkok, Thailand.
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3
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Abstract
As our knowledge of the mechanisms underlying cancer development and progression has increased, so too have more effective, less toxic, and targeted therapies begun to reach the clinic. However, the full impact of these clinical advances and the practical success of the emerging field of precision medicine are dependent on the discovery and validation of sensitive and accurate biomarkers that can enable appropriate and rigorous sample type and patient selection, reliable longitudinal monitoring of therapeutic efficacy, and even risk assessment and early detection. Within the context of this review, we examine state-of-the-art approaches to the discovery and validation of noninvasive cancer biomarkers, with a specific emphasis on those that are protein or protein-associated ones. We also review sample selection strategies, currently utilized proteomic approaches for both discovery and validation requirements, and data analysis standards. Finally, we provide examples of these elements of biomarker discovery and validation from our own biomarker research.
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4
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Albert M, Schnabel F, Chun J, Schwartz S, Lee J, Klautau Leite AP, Moy L. The relationship of breast density in mammography and magnetic resonance imaging in high-risk women and women with breast cancer. Clin Imaging 2015; 39:987-92. [PMID: 26351036 DOI: 10.1016/j.clinimag.2015.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/03/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the relationship between mammographic breast density (MBD), background parenchymal enhancement (BPE), and fibroglandular tissue (FGT) in women with breast cancer (BC) and at high risk for developing BC. METHODS Our institutional database was queried for patients who underwent mammography and MRI. RESULTS Four hundred three (85%) had BC and 72 (15%) were at high risk. MBD (P=.0005), BPE (P<.0001), and FGT (P=.02) were all higher in high-risk women compared to the BC group. CONCLUSIONS Higher levels of MBD, BPE and FGT are seen in women at higher risk for developing BC when compared to women with BC.
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Affiliation(s)
- Marissa Albert
- Department of Radiology, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Freya Schnabel
- Department of Surgery, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Jennifer Chun
- Department of Surgery, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Shira Schwartz
- Department of Surgery, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Jiyon Lee
- Department of Radiology, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Ana Paula Klautau Leite
- Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil 05024-000 SP
| | - Linda Moy
- Department of Radiology, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA.
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5
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van Harten W, Stanta G, Bussolati G, Riegman P, Hoefler G, Becker K, Folprecht G, Truini M, Haybaeck J, Buiga R, Dono M, Bagg A, López Guerrero J, Zupo S, Lemare F, de Lorenzo F, Goedbloed N, Razavi D, Lövey J, Cadariu P, Rollandi G, Paparo F, Pierotti M, Ciuleanu T, De Paoli P, Weiner G, Saghatchian M, Lombardo C. Report from the OECI Oncology Days 2014. Ecancermedicalscience 2014; 8:496. [PMID: 25624877 PMCID: PMC4303612 DOI: 10.3332/ecancer.2014.496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Indexed: 11/06/2022] Open
Abstract
The 2014 OECI Oncology Days was held at the 'Prof. Dr. Ion Chiricuta' Oncology Institute in Cluj, Romania, from 12 to 13 June. The focus of this year's gathering was on developments in personalised medicine and other treatment advances which have made the cost of cancer care too high for many regions throughout Europe.
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Affiliation(s)
- Wh van Harten
- The Netherlands Cancer Institute, Amsterdam,The Netherlands
| | - G Stanta
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - G Bussolati
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - P Riegman
- Erasmus Medical Centre, Rotterdam, The Netherlands
| | - G Hoefler
- Johannes Haybaeck, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Kf Becker
- Institute of Pathology, Technische Universität München, München, Germany
| | - G Folprecht
- University Cancer Centre, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M Truini
- IRCCS AOU San Martino/IST National Cancer Institute of Genoa, Genoa, Italy
| | - J Haybaeck
- Johannes Haybaeck, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - R Buiga
- The Oncology Institute "Prof. Dr. Ion Chircuţă", Cluj-Napoca, Romania
| | - M Dono
- IRCCS AOU San Martino/IST, National Cancer Institute of Genoa, Italy
| | - A Bagg
- Hematology, University of Pennsylvania, PA, USA
| | | | - S Zupo
- IRCCS AOU San Martino/IST, National Cancer Institute of Genoa, Italy
| | - F Lemare
- Clinical Pharmacy Department, Gustave Roussy Comprehensive Cancer Centre, Villejuif, France
| | - F de Lorenzo
- European Cancer Patient Coalition, Brussels, Belgium
| | - N Goedbloed
- The Netherlands Cancer Institute, Amsterdam,The Netherlands
| | - D Razavi
- Institut Jules Bordet et Université Libre de Bruxelles, Clinique de Psycho-Oncologie et des Soins Supportifs, Brussels, Belgium
| | - J Lövey
- National Institute of Oncology, Budapest, Hungary
| | - Pa Cadariu
- The Oncology Institute "Prof. Dr. Ion Chircuţă", Cluj-Napoca, Romania
| | - Ga Rollandi
- Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine, Genoa, Italy
| | - F Paparo
- Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine, Genoa, Italy
| | - M Pierotti
- IRCCS Fondazione Istituto Nazionale Tumori Milan, Milan, Italy
| | - T Ciuleanu
- The Oncology Institute "Prof. Dr. Ion Chircuţă", Cluj-Napoca, Romania
| | - P De Paoli
- Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | | | - M Saghatchian
- Medical Oncology Department, Gustave Roussy Comprehensive Cancer Centre, Villejuif, France
| | - Claudio Lombardo
- Organisation of the European Cancer Institutes, C/o SOS Europe, Genoa, Italy
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6
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Mastoraki A, Kazani A, Mastoraki S, Konstantiadou I, Kokoropoulos P, Smyrniotis V, Arkadopoulos N. Breast-Cancer Subtyping in Clinical Practice: Clinicopathologic Features and Outcomes. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2014.0022] [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: 12/31/2022] Open
Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Aikaterini Kazani
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Sotiria Mastoraki
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Ioanna Konstantiadou
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Panagiotis Kokoropoulos
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Vasilios Smyrniotis
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
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Abstract
Today breast cancer remains a major public health problem, although reducing its risk is now an achievable medical objective. Risk-assessment models may be used in estimating a woman's risk for developing breast cancer and to direct suitable candidates for preventive therapy. Researchers are attempting to enhance individualized risk assessment through incorporation of phenotypic biomarkers. Individual selective estrogen receptor modulators have been approved for breast cancer risk reduction, and other drug categories are being studied. It is critical that obstetrician-gynecologists be familiar with the evolving science of the risk assessment of breast cancer as well as interventional and surveillance strategies.
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Affiliation(s)
- Victoria L Green
- Department of Obstetrics and Gynecology, Gynecology Breast Clinic, Avon Comprehensive Breast Center, Winship Cancer Institute, Emory University at Grady Memorial Hospital, 69 Jesse Hill Jr Drive, Atlanta, GA 30303, USA.
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8
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West JG, Hollingsworth A. Screening for breast cancer risk in the obstetric/gynecological setting: a breast surgeon’s perspective. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.3.1.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Hollingsworth AB. Risk Assessment. Breast Cancer 2014. [DOI: 10.1007/978-1-4614-8063-1_1] [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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10
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Sarica O, Ozturk E, Demirkurek HC, Uluc F. Comparison of ductoscopy, galactography, and imaging modalities for the evaluation of intraductal lesions: a critical review. Breast Care (Basel) 2013; 8:348-54. [PMID: 24415988 PMCID: PMC3862052 DOI: 10.1159/000355833] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 12/14/2022] Open
Abstract
BACKGROUND Today, in cases of nipple discharge of unclear origin, the abundance of diagnostic procedures - a, diagnostic dilemma' - becomes apparent, because unequivocal indications and a current, standardized examination sequence are presently not available. The diagnostic workup of patients with nipple discharge usually includes the clinical history, physical examination, mammography, ultrasonography, galactography, and nipple discharge cytology, but not ductoscopy. METHODS In this review we analyze and discuss the possible role of ductoscopy in evaluating intraductal pathologies and its combined use with diagnostic imaging modalities. For this purpose, we reviewed and compared the results of the radiological, pathological, and surgical studies independently. CONCLUSIONS Currently, there is no solitary accurate modality to reach our definitive purpose. Being aware of the capability of each diagnostic modality may take us closer to our target. Therefore, adjunct and appropriate use of multiple imaging modalities and ductoscopy is necessary to evaluate patients with nipple discharge.
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Affiliation(s)
- Ozgur Sarica
- Department of Radiology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Enis Ozturk
- Department of Radiology, Bakirkoy Education and Research Hospital, Istanbul, Turkey
| | - Huseyin C. Demirkurek
- Department of Nuclear Medicine, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Fatih Uluc
- Department of Radiology, Taksim Education and Research Hospital, Istanbul, Turkey
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11
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Konstandiadou I, Mastoraki A, Kotsilianou O, Karakitsos P, Athanasas G, Smyrniotis V, Arkadopoulos N. Does ductal lavage assert its role as a noninvasive diagnostic modality to identify women at low risk of breast cancer development? J Gynecol Oncol 2012; 23:110-4. [PMID: 22523627 PMCID: PMC3325344 DOI: 10.3802/jgo.2012.23.2.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/25/2011] [Revised: 12/20/2011] [Accepted: 02/01/2012] [Indexed: 11/30/2022] Open
Abstract
Objective Ductal lavage (DL) involves evaluation of the ductal system of the breast for detection of intra-ductal carcinomas and precursor lesions by collecting breast epithelial cells using a small-gauge catheter inserted into a ductal orifice on the nipple. The aim of this survey was to analyze cytologic features of samples obtained from low-risk women with DL and to elucidate the efficacy of this diagnostic modality in evaluating fluid production, cannulating and determining atypical breast epithelial cells. Methods Into this prospective study were consecutively registered 80 women between ages 28 to 67. Nipple aspiration was performed to identify all fluid-yielding ducts. According to the grading of specific features the interpretation of the sample included: normal/benign (category, 0), mild atypical (category, I), markedly atypical (category, II) or malignant (category, III) disorders. Results Ninety five percent (316/334) of the nipple aspirate fluid samples were classified as category 0, 4.8% (16/334) as category I and 0.2% (2/334) as category II changes. Category III disorders were not detected. Therefore, in 80% of the women examined results were within normal limits while 17.5% of the participants presented mild atypical and 2.5% markedly atypical rates. Conclusion DL collection procedure proved to be rapid as well as acceptable by the women studied. It retains the advantage over other methods of nipple aspirate fluid in that it is easy to perform, thereby removing most clinician variability. It also helped low risk women to discriminate those with breast disorders that require additional investigation, further follow-up or administration of preventive medication.
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Affiliation(s)
- Ioanna Konstandiadou
- 4th Department of Surgery, Attikon University Hospital, Athens University Medical School, Athens, Greece
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12
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Abstract
Women with a germline BRCA1 or BRCA2 mutation or a hereditary predisposition for breast and ovarian cancer have substantial risk of breast or ovarian cancer relative to the general US population. Health care professionals can be instrumental in identifying women at increased risk through obtaining a comprehensive family history and becoming familiar with family history characteristics associated with hereditary predisposition for breast and ovarian cancer. BRCA carriers and women at very high risk benefit from multidisciplinary, individualized medical evaluation and risk management. We conducted a search of MEDLINE from 1989 through 2010 for the terms BRCA1, BRCA2, breast cancer, ovarian cancer, risk assessment, and genetic testing. We reviewed abstracts and relevant randomized and prospective studies that included very high-risk patient groups and BRCA mutation carriers. Herein, we review the role of genetic consultation and BRCA testing and the comprehensive, multisystem recommendations for risk management. A multidisciplinary approach offers the ability to educate those at very high risk about cancer prevention, reduce cancer risk, maximize early detection of breast and ovarian cancer, and improve survival.
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Affiliation(s)
- Sandhya Pruthi
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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13
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Abstract
Recent suggestions by the United States Preventive Task Force to change the longstanding guidelines for screening mammography have raised the issue of cost-effectiveness in regards to breast cancer detection. Given the enormous number of women who have had, or who will be diagnosed with breast cancer, it is essential to maintain the quality of care that has been achieved here in the United States while utilizing a cost-effective approach. The following review attempts a close examination of current methods available for risk assessment, screening and prevention programs. These programs must be carefully considered and analyzed prior to implementing cost-saving changes to current clinical standards that have proven successful in decreasing the mortality from breast cancer throughout the world.
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Affiliation(s)
- Gail S Lebovic
- American Society of Breast Disease, Frisco, TX 75034, United States.
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14
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Elsheikh TM. Does the new automated "HALO" nipple aspiration fluid system really deliver as promised? The answer is "No, but...": A literature review of the role of breast fluid cytology in cancer risk assessment. Diagn Cytopathol 2009; 37:699-704. [PMID: 19530102 DOI: 10.1002/dc.21124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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]
Abstract
The HALO breast Pap test is a new automated nipple aspiration fluid (NAF) system that was recently introduced into the market. In an extensive marketing campaign directed principally toward OB/GYN practices, including endorsements from few local news media, HALO has been promoted as the "new Pap screening test for breast." Physicians are encouraged to perform this test on all women, as part of their annual examination, with claims that HALO will detect breast cancers as early as 10 years before mammography. These arguments are made more appealing to physician's offices by highlighting the potential positive financial impact on their practices, without consuming physician time, as medical assistants or technicians can perform this test. As a result of this directed campaign, cytology laboratories are increasingly confronted with implementing the HALO system and clinicians are increasingly soliciting pathologist's input regarding its validity. Yet, there is no data available regarding this new system, outside rare reports sponsored by the manufacturer. In this discussion, I examine the pros and cons of this new NAF system, including literature review of breast fluid cytology, and how it relates to breast cancer risk assessment.
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15
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Li Y, Brown PH. Strategies of hormonal prevention. Cancer Treat Res 2009; 147:1-35. [PMID: 21461832 DOI: 10.1007/978-0-387-09463-2_10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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16
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Pories SE, Zurakowski D, Roy R, Lamb CC, Raza S, Exarhopoulos A, Scheib RG, Schumer S, Lenahan C, Borges V, Louis GW, Anand A, Isakovich N, Hirshfield-Bartek J, Wewer U, Lotz MM, Moses MA. Urinary metalloproteinases: noninvasive biomarkers for breast cancer risk assessment. Cancer Epidemiol Biomarkers Prev 2008; 17:1034-42. [PMID: 18483323 DOI: 10.1158/1055-9965.epi-07-0365] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Matrix metalloproteinases (MMP) and a disintegrin and metalloprotease 12 (ADAM 12) can be detected in the urine of breast cancer patients and provide independent prediction of disease status. To evaluate the potential of urinary metalloproteinases as biomarkers to predict breast cancer risk status, urine samples from women with known risk marker lesions, atypical hyperplasia and lobular carcinoma in situ (LCIS), were analyzed. Urine samples were obtained from 148 women: 44 women with atypical hyperplasia, 24 women with LCIS, and 80 healthy controls. MMP analysis was done using gelatin zymography and ADAM 12 analysis was done via immunoblotting with monospecific antibodies and subsequent densitometric measurement. Positive urinary MMP-9 levels indicated a 5-fold risk of atypical hyperplasia and >13-fold risk of LCIS compared with normal controls. Urinary ADAM 12 levels were significantly elevated in women with atypical hyperplasia and LCIS from normal controls, with receiver operating characteristic curve analysis showing an area under the curve of 0.914 and 0.950, respectively. To assess clinical applicability, a predictive index was developed using ADAM 12 in conjunction with Gail risk scores for women with atypia. Scores above 2.8 on this ADAM 12-Gail risk prediction index score are predictive of atypical hyperplasia (sensitivity, 0.976; specificity, 0.977). Our data suggest that the noninvasive detection and analysis of urinary ADAM 12 and MMP-9 provide important clinical information for use as biomarkers in the identification of women at increased risk of developing breast cancer.
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Affiliation(s)
- Susan E Pories
- Department of Surgery, Beth Israel Deaconess Medical Center and Mount Auburn Hospital, Boston, MA, USA
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18
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Pruthi S, Brandt KR, Degnim AC, Goetz MP, Perez EA, Reynolds CA, Schomberg PJ, Dy GK, Ingle JN. A multidisciplinary approach to the management of breast cancer, part 1: prevention and diagnosis. Mayo Clin Proc 2007; 82:999-1012. [PMID: 17673070 DOI: 10.4065/82.8.999] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [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] [Indexed: 01/11/2023]
Abstract
Breast cancer is the most common cancer among women in the United States, with an estimated 200,000 new cases diagnosed annually. A multidisciplinary focus that entails prevention, diagnosis, and treatment has led to significant strides in the reduction of breast cancer incidence and mortality. Additionally, breast cancer management has become increasingly complex, requiring comprehensive assessment and review of multiple issues that include the role of genetic testing, imaging and breast magnetic resonance imaging, surgical and reconstructive options, and a variety of new adjuvant therapies. It has become more evident that a multidisciplinary team approach that involves a spectrum of breast experts is necessary to provide optimal care to patients. This team includes medical oncologists, breast radiologists, breast pathologists, surgical breast specialists, radiation oncologists, geneticists, and primary care physicians. Furthermore, patient knowledge has increased use of the Internet, and more patients are seeking a multidisciplinary approach to treatment. This review considers information for health care professionals who will facilitate optimal patient care for women at increased risk for or presenting with a new diagnosis of breast cancer. The multidisciplinary team of authors, representing the different disciplines, has selected important state-of-the-art issues that arise in their daily practices for consideration, rather than summarizing what is already available in textbooks.
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Affiliation(s)
- Sandhya Pruthi
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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19
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Byun WS, Park CH, Cho SJ, Ahn HG, Nam ES, Cha HJ, Kim KS. Loss of Heterozygosity of Major Tumor Suppressor Genes in Invasive Ductal Carcinomas. J Breast Cancer 2007. [DOI: 10.4048/jbc.2007.10.1.68] [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: 11/30/2022] Open
Affiliation(s)
- Woo Seok Byun
- Department of Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Chan Heun Park
- Department of Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Seong Jin Cho
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| | - Hye Gyung Ahn
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| | - Eun Sook Nam
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| | - Hee Jung Cha
- Department of Pathology and Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Jeong DH, Jeong JC, Park CH, Kwon MJ, Cho SJ, Nam ES, Shin HS, Kim KS. Microsatellite Instability in Invasive Ductal Carcinomas. J Breast Cancer 2007. [DOI: 10.4048/jbc.2007.10.1.77] [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: 11/30/2022] Open
Affiliation(s)
- Duck Hyoun Jeong
- Department of Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jin Cheol Jeong
- Department of Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Chan Heun Park
- Department of Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| | - Seong Jin Cho
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| | - Eun Sook Nam
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| | - Hyung Sik Shin
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
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Cazzaniga M, Severi G, Casadio C, Chiapparini L, Veronesi U, Decensi A. Atypia and Ki-67 expression from ductal lavage in women at different risk for breast cancer. Cancer Epidemiol Biomarkers Prev 2006; 15:1311-5. [PMID: 16835329 DOI: 10.1158/1055-9965.epi-05-0810] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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
PURPOSE Ductal lavage provides adequate material and detects atypical cells from ducts in women at increased risk of breast cancer, but the clinical significance of this finding is unclear. We studied the prevalence and predictors of atypia in addition to the proliferation-associated antigen Ki-67 expression in ductal lavage done in women at different risk of breast cancer. RESULTS Ductal lavage was attempted in 202 women at increased risk and in 16 at average risk. Lavage could not be done in 20 women at increased risk because of anatomic impediments. Seven average-risk women (44%) had samples with inadequate cytology versus 30 women at higher risk (16%; P = 0.014). Atypia was observed in two average-risk women [22%; 95% confidence interval (95% CI), 3-60%]. The prevalence of atypia was 33% in women with a 5-year risk of > or =1.3% according to the Gail model (25 of 75; 95% CI, 23-45%), 36% in women with an increased probability of or ascertained BRCA mutation (9 of 25; 95% CI, 18-57%), and 52% in women with contralateral breast cancer (27 of 52; 95% CI, 38-66%). Ki-67 expression measured in a consecutive series of 80 women at increased risk was higher in atypical samples (P = 0.0001) and was positively associated with total cell count per slide (P = 0.002). CONCLUSIONS Atypia is frequent in women at increased risk of breast cancer but it can also be found in average-risk women. Ki-67 expression is associated with atypia and cell yield and it might be assessed as a surrogate biomarker in early-phase chemoprevention trials.
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22
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Abstract
Selective estrogen receptor modulators (SERMs) are used for the treatment of invasive breast cancer. Chemoprevention is the use of specific natural or synthetic chemical agents to reverse, suppress, or prevent the progression of premalignant lesions to invasive carcinoma. The finding of a decrease in contralateral breast cancer incidence following tamoxifen administration for adjuvant therapy led to its use in breast cancer prevention. Four large trials have used tamoxifen, the prototypical SERM, as a breast cancer chemopreventive agent with differing results. In the National Surgical Adjuvant Breast and Bowel Project's (NSABP) Breast Cancer Prevention Trial (BCPT), tamoxifen reduced the risk of invasive breast cancer by 49%. Tamoxifen also reduced the incidence of benign breast disease as well as the number of breast biopsies in the treated women. Three other randomized prevention trials comparing tamoxifen with placebo have been reported and show a reduction in breast cancer incidence of 38%. Serum levels of estrone sulfate and testosterone are significantly associated with breast cancer risk, and estradiol appears to be more strongly associated with breast cancer in high-risk women. Raloxifene is comparable to tamoxifen in its ability to reduce the risk of breast cancer in postmenopausal, high-risk women and has fewer side effects, as shown in the study of tamoxifen and raloxifene. Several ongoing and planned studies will evaluate the ability of aromatase inhibitors to reduce the risk of breast cancer in women at increased risk.
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Affiliation(s)
- Victor G Vogel
- Department of Medicine, University of Pittsburgh Cancer Institute Magee-Womens Hospital, 300 Halket Street, Room 3524, Pittsburgh, PA 15213, USA.
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Al Sarakbi W, Salhab M, Mokbel K. Does mammary ductoscopy have a role in clinical practice? Int Semin Surg Oncol 2006; 3:16. [PMID: 16808852 PMCID: PMC1524964 DOI: 10.1186/1477-7800-3-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 06/30/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mammary ductoscopy (MD) is a newly developed endoscopic technique that allows direct visualisation of the mammary ductal epithelium using sub-millimetre fiberoptic microendoscopes inserted through the ductal opening onto the nipple surface. These scopes also provide working channels for insufflation, irrigation, ductal lavage, and possible therapeutic intervention. MD can be performed under local anaesthesia in the office setting. The objective of this study is to assess the technical feasibility of mammary ductoscopy, and examine its role in guiding ductal excision surgery and the early diagnosis of malignancy. METHODS Mammary ductoscopy (MD) was performed using a 1 mm fiberoptic microendoscope (Mastascope TM) in 26 patients (age range: 14-73 years): 13 patients undergoing mastectomy (n = 12) or lumpectomy (n = 1) for ductal carcinoma (including 12 cases of DCIS and one case of infiltrating ductal carcinoma) and 13 patients with pathological nipple discharge (PND) and benign breast imaging and simple discharge cytology. Of the latter group: 10 procedures were performed under local anaesthesia (LA) in the office setting and 3 procedures were carried out under general anaesthesia (GA) to guide duct excision surgery. The ductoscopic appearances in this group were graded between 0 and 5 (D0-D5) according to the degree of suspicion. RESULTS Intraoperative MD was accomplished in 11 (84.6%) of 13 patients undergoing surgery for DCIS. MD was unsuccessful in 2 cases: one patient (aged 73 years) had sclerosis of the nipple and one patient had preoperative vital blue injection in the subareolar region as part of the sentinel node biopsy thus resulting in inadequate visualisation. Intraductal pathology was visualised in 8 (80%) of the 10 cases undergoing mastectomy but ductoscopic cytology was positive for malignancy in only 2 cases (sensitivity = 16%, specificity = 100%). In the office setting, MD was accomplished in 9 (90%) out of 10 patients with PND and was well tolerated (mean pain score = 3.8 out of 10: range 0-7). Of these 10 patients; MD was inadequate (D0) in one patient due to complete occlusion of lumen by the lesion, showed a papilloma in 3 patients (D3), duct ectasia (D2) in 3 patients, irregular thickening of the lumen suspicious of DCIS (D4) in one patient and non-specific benign findings (D2) in 2 patients. Three women with benign ductoscopy and ductoscopy-assisted cytology were reassured and treated conservatively. The remaining 7 patients had ductoscopy-guided duct excision which revealed DCIS in one, papilloma in 4 and benign breast disease in 2 patients. Adequate cellular yield was obtained in 7 (70%) out of 10 cases (benign cytology). The three patients who had MD under GA during microdochectomy had benign endoscopic appearances and final histology (one papilloma and 2 cases of duct ectasia). CONCLUSION MD is technically feasible in most patients and has a potential in the early detection of breast cancer. The procedure can be performed safely in the office setting and should be considered in all patients presenting with a single duct PND. MD has the potential to reduce the number of duct excision procedures and minimise the extent of surgical resection. Ductoscopic cytology is not sufficiently sensitive for the diagnosis of malignancy and the development of a biopsy tool that obtains tissue under direct visualisation is required.
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Affiliation(s)
- W Al Sarakbi
- The Breast Care Centre, St. George's & The Princess Grace Hospitals, London, UK
| | - M Salhab
- The Breast Care Centre, St. George's & The Princess Grace Hospitals, London, UK
| | - K Mokbel
- The Breast Care Centre, St. George's & The Princess Grace Hospitals, London, UK
- Consultant Breast & Endocrine Surgeon, St. George's Hospital, Blackshaw Rd, London SW17 0QT, UK
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24
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Abstract
Options for breast cancer prevention, used in combination with screening and surveillance, include lifestyle modifications, chemoprevention with tamoxifen, and prophylactic surgery. Preventive health decisions are often preference driven: patients typically must choose whether to initiate effective treatments that hold the possibility of side effects that can negatively impact quality of life. This situation demands that patients be well informed and have a full understanding of the risks associated with each option. Investigators have developed a comprehensive decision-making framework designed to support breast cancer prevention consultations within a shared decision-making setting. The framework integrates predictive information from current risk models within the context of a woman's general health to appropriately frame breast cancer risk management consultations and outlines the application of available treatments and emerging biomarker information to individual patient decisions. Using an evidence-based approach, specialized risk-benefit projections can be provided in the clinical setting. A more comprehensive individualized risk profile allows for tailored medical management plans and can better prepare patients to make informed decisions. The framework is intended to encourage a shared decision-making approach to prevention consultations, a method for researchers to increase accrual to trials, and to more quickly incorporate new findings into the routine of practice.
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Affiliation(s)
- Elissa M Ozanne
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Lee SH, Kim SR, Park CH, Cho SJ, Choi YH. Loss of Heterozygosity of Chromosome 17p13 and p53 Expression in Invasive Ductal Carcinomas. J Breast Cancer 2006. [DOI: 10.4048/jbc.2006.9.4.309] [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: 11/30/2022] Open
Affiliation(s)
- Sook Hyun Lee
- Department of Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Seong Rae Kim
- Department of Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Chan Heun Park
- Department of Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Seong Jin Cho
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| | - Young Hee Choi
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
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Proctor KAS, Rowe LR, Bentz JS. Cytologic features of nipple aspirate fluid using an automated non-invasive collection device: a prospective observational study. BMC Womens Health 2005; 5:10. [PMID: 16078997 PMCID: PMC1198234 DOI: 10.1186/1472-6874-5-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 08/03/2005] [Indexed: 11/24/2022]
Abstract
Background Detection of cytologic atypia in nipple aspirate fluid (NAF) has been shown to be a predictor of risk for development of breast carcinoma. Manual collection of NAF for cytologic evaluation varies widely in terms of efficacy, ease of use, and patient acceptance. We investigated a new automated device for the non-invasive collection of NAF in the office setting. Methods A multi-center prospective observational clinical trial involving asymptomatic women designed to assess fluid production, adequacy, safety and patient acceptance of the HALO NAF Collection System (NeoMatrix, Irvine, CA). Cytologic evaluation of all NAF samples was performed using previously described classification categories. Results 500 healthy women were successfully enrolled. Thirty-eight percent (190/500) produced fluid and 187 were available for cytologic analysis. Cytologic classification of fluid producers showed 50% (93/187) Category 0 (insufficient cellular material), 38% (71/187) Category I (benign non-hyperplastic ductal epithelial cells), 10% (18/187) Category II (benign hyperplastic ductal epithelial cells), 3% (5/187) Category III (atypical ductal epithelial cells) and none were Category IV (unequivocal malignancy). Overall, 19% of the subjects produced NAF with adequate cellularity and 1% were found to have cytologic atypia. Conclusion The HALO system is a simple, safe, rapid, automated method for standardized collection of NAF which is acceptable to patients. Cytologic assessment of HALO-collected NAF showed the ability to detect benign and pre-neoplastic ductal epithelial cells from asymptomatic volunteers.
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Affiliation(s)
- Kerry AS Proctor
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Leslie R Rowe
- Institute for Clinical and Experimental Pathology, Associated Regional and University Pathologists (ARUP) Laboratories Inc., Salt Lake City, Utah, USA
| | - Joel S Bentz
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
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Abstract
BACKGROUND Mammary ductoscopy (MD) allows direct visualisation of the mammary ducts using sub-millimetre fiberoptic microendoscopes inserted through the ductal opening onto the nipple surface. The sharp clear magnified images are viewed on a video monitor. Such scopes have working channels that allow irrigation and ductal lavage for cytological analysis. MD can be performed under local anaesthesia in the office setting. This article reviews the evolving role of MD in the diagnosis and treatment of intraductal breast disease. METHODS A literature search was carried out from Pubmed for indexed articles published over the last 30 years using the keywords 'mammary ductoscopy' and 'breast ductoscopy'. RESULTS The search yielded 27 indexed published articles and reports. Important major reports and studies were reviewed, screened and tracked for other relevant publications. The most important articles were analysed and discussed. The review also includes our published and unpublished original work in the field of MD. CONCLUSIONS MD is a useful diagnostic adjunct in patients with pathological nipple discharge (PND). Furthermore, it can reduce the number and extent of duct excision operations for PND. However, its potential use in the early detection of breast cancer, guiding breast conserving surgery (BCS) for cancer, therapeutic ablation of intraductal disease, and guiding risk-reducing strategies among high risk women requires further research and evaluation. Future developments include the development of a biopsy kit, combining MD with molecular diagnostic markers and real-time optical biopsy system for the diagnosis of pre-malignant and early malignant disease and radiofrequency for curative ablation of intraductal lesions.
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Affiliation(s)
- Kefah Mokbel
- St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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28
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Abstract
Abstract
Objective: Assess the effectiveness and cost-effectiveness of using biomarkers and risk assessment tools to stratify women for breast cancer preventive interventions.
Methods: A Markov model was developed to compare risk management strategies for high-risk women considering chemoprevention. Annual screening is compared to the use of chemoprevention for all women and the use of risk assessment technologies to stratify patients for chemoprevention. The biomarker atypia was used to stratify women by risk. Random fine-needle aspiration (rFNA) and ductal lavage (DL) were evaluated and compared as the risk assessment tools used to discover atypia. Sensitivity analyses explore assumptions regarding the prognostic and predictive characteristics of atypia, both the relative breast cancer risk and benefit from chemoprevention women with atypia incur.
Results: Risk assessment strategies using rFNA or DL in combination with chemoprevention are found to be cost-effective (<$50,000 per life year saved) in high-risk groups under most scenarios. Both strategies were more effective and less costly in younger cohorts. Effectiveness of the risk assessment strategies increased when higher risk and increased benefit from chemoprevention were associated with atypia. Within the scenarios tested, rFNA is less costly than DL.
Conclusion: rFNA and DL appear to be cost-effective in high-risk women, assuming women with detected atypia choose tamoxifen. The tools are largely effective for women who are not motivated to take tamoxifen but would be if atypia were found. As biomarker risk assessment tools better predict the risk of breast cancer and or benefit of interventions, their cost-effectiveness increases.
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Affiliation(s)
- Elissa M. Ozanne
- 1Institute for Technology Assessment at Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, Massachusetts; and
| | - Laura J. Esserman
- 2Carol Franc Breast Care Center, Department of Surgery, University of California San Francisco Medical Center, San Francisco, California
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