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mammography - Top 30 Publications

Imaging Features of Inflammatory Breast Disorders: A Pictorial Essay.

Inflammatory breast disorders include a wide array of underlying causes, ranging from common benign infection, non-infectious inflammation and inflammation resulting from underlying breast malignancy. Because it is at times difficult to distinguish mastitis and breast cancer based on clinical features, awareness of detailed imaging features may be helpful for better management of inflammatory breast disorders. Therefore, this pictorial essay intends to demonstrate radiologic findings of a variety of inflammatory breast disorders, using selected cases with mammography, ultrasound and magnetic resonance images.

Surveillance for cancer recurrence in long-term young breast cancer survivors randomly selected from a statewide cancer registry.

This study examined clinical breast exam (CBE) and mammography surveillance in long-term young breast cancer survivors (YBCS) and identified barriers and facilitators to cancer surveillance practices.

Determinants of breast size in Asian women.

Breast size as a risk factor of breast cancer has been studied extensively with inconclusive results. Here we examined the associations between breast size and breast cancer risk factors in 24,353 Asian women aged 50 to 64 years old enrolled in a nationwide mammography screening project conducted between October 1994 and February 1997. Information on demographic and reproductive factors was obtained via a questionnaire. Breast size was ascertained as bust line measured at study recruitment and total breast area measured from a mammogram. The average bust line and total breast area was 91.2 cm and 102.3 cm2, respectively. The two breast measurements were moderately correlated (Spearman correlation coefficient = 0.65). Age, BMI, marital and working status were independently associated with bust line and total breast area. In the multivariable analyses, the most pronounced effects were observed for BMI (24.2 cm difference in bust line and 39.4 cm2 in breast area comparing women with BMI ≥30 kg/m2 to BMI <20 kg/m2). Ethnicity was a positive predictor for total breast area, but not bust line.

Is DCIS Overrated?

Ductal carcinoma in situ (DCIS), the noninvasive form of breast cancer (BC), comprises just over 20% of breast cancer cases diagnosed each year in the USA. Most patients are treated with local excision of the disease followed by whole breast radiation therapy. Total mastectomy is not an uncommon approach, and total mastectomy with a contralateral risk-reducing mastectomy has been on the rise in the past decade. In estrogen receptor-positive disease, patients are often offered endocrine ablative therapy with a selective estrogen receptor modulator or an aromatase inhibitor as both treatment and prevention. Local regional treatment options have no impact upon ultimate overall survival. Long-term survival rates are higher in patients with DCIS than with any other form of the disease. Are these strikingly high success rates a testament to effective treatment strategies or is there a significant subset of DCIS that was unlikely to ever progress to invasive ductal carcinoma? DCIS was not seen in the US prior to the advent of screening mammography. When compared to other countries, the USA has the highest utilization of screening mammography and the incidence rate of DCIS. Other lines of evidence include autopsy series examining the breast tissue of women who died of other causes, missed-diagnosis series and current retrospective reviews of DCIS, all align in support of the concept of DCIS as indolent in the majority of cases [3-14]. The evidence suggests that both patient and physician misconceptions about DCIS have led to overdiagnosis and over-treatment of DCIS. Recently, a gene expression profiling tool (12 gene assay, Oncotype DCIS) has emerged that shows considerable promise in predicting class in DCIS patients.

Breast Cancer Screening: The Debate that Never Ends.

Screening mammography has been shown to decrease breast cancer deaths through randomized controlled trials. However, there remains significant debate surrounding the most appropriate time to commence screening and the optimal screening interval. Several national organizations have recently updated their guidelines by reanalyzing the published data. Interestingly, each organization has come to different conclusions regarding their recommendation for breast cancer screening in the average risk woman. Three of the main organizations that issue guidelines for breast cancer screening in the United States are reviewd in this chapter.

Dense Breast Notification Laws: Impact on Downstream Imaging After Screening Mammography.

Dense breast tissue is a common finding that decreases the sensitivity of mammography in detecting cancer. Many states have recently enacted dense breast notification (DBN) laws to provide patients with information to help them make better-informed decisions about their health. To test whether DBN legislation affected the probability of screening mammography follow-up by ultrasound and magnetic resonance imaging (MRI), we examined the proportion of times screening mammography was followed by ultrasound or MRI for a series of months pre- and post-legislation. The subjects were women aged 40 to 64 years, covered by private health insurance, undergoing screening mammography from 2007 to 2014. Except for Hawaii, Maryland, and New York, DBN legislation significantly increased the probability of ultrasound follow-up in all states that implemented DBN legislation before December 2014. It also increased the probability of MRI follow-up in California, North Carolina, Pennsylvania, and Texas. The financial and access consequences merit further study.

High Participation Rate in Mammography Screening: Experience from Croatia.

The aim of the study was to analyse the results of three cycles of mammography screening (MS) in the Croatian National Programme (CNP) for Early Breast Cancer Detection for women aged 50–69 years in the Bjelovar-Bilogora County (BBC) from 2006–2014.

Evaluation of nipple aspirate fluid as a diagnostic tool for early detection of breast cancer.

There has been tremendous progress in detection of breast cancer in postmenopausal women, resulting in two-thirds of women surviving more than 20 years after treatment. However, breast cancer remains the leading cause of cancer-related deaths in premenopausal women. Breast cancer is increasing in younger women due to changes in life-style as well as those at high risk as carriers of mutations in high-penetrance genes. Premenopausal women with breast cancer are more likely to be diagnosed with aggressive tumours and therefore have a lower survival rate. Mammography plays an important role in detecting breast cancer in postmenopausal women, but is considerably less sensitive in younger women. Imaging techniques, such as contrast-enhanced MRI improve sensitivity, but as with all imaging approaches, cannot differentiate between benign and malignant growths. Hence, current well-established detection methods are falling short of providing adequate safety, convenience, sensitivity and specificity for premenopausal women on a global level, necessitating the exploration of new methods. In order to detect and prevent the disease in high risk women as early as possible, methods that require more frequent monitoring need to be developed. The emergence of "omics" strategies over the last 20 years, enabling the characterisation and understanding of breast cancer at the molecular level, are providing the potential for long term, longitudinal monitoring of the disease. Tissue and serum biomarkers for breast cancer stratification, diagnosis and predictive outcome have emerged, but have not successfully translated into clinical screening for early detection of the disease. The use of breast-specific liquid biopsies, such as nipple aspirate fluid (NAF), a natural secretion produced by breast epithelial cells, can be collected non-invasively for biomarker profiling. As we move towards an age of active surveillance, home-based liquid biopsy collection kits are increasingly being applied and these could provide a paradigm shift where NAF biomarker profiling is used for routine breast health monitoring. The current status of established and newly emerging imaging techniques for early detection of breast cancer and the potential for alternative biomarker screening of liquid biopsies, particularly those applied to high-risk, premenopausal women, will be reviewed.

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans.

The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography.


To characterise the mean glandular dose (MGD) in a sample of healthcare providers for digital mammography in Portugal. To compare the achieved values with European references. The MGD was measured on a poly-methyl-methacrylate phantom (45 mm) for each system using dosimeters. In addition, MGD was estimated using exposure settings collected from mammography exams in clinical context. Data were collected from 25 computed-radiography systems (CR) and 13 integrated digital (DR). For both measurements (phantom and clinical exposures), the average MGD for CR was higher compared to the DR. For CR the mean MGD was 1.85 mGy (CC projection) and 2.10 mGy (MLO projection). For DR systems the corresponding values were 1.54 mGy (CC) and 1.68 mGy (MLO). The average MGD obtained using both methods and for both technologies is within the acceptable reference range proposed by European guidelines (<2.5 mGy). Dose Reference Levels implementation should be the next step to optimise mammography practice in Portugal.

Underutilization of Supplemental Magnetic Resonance Imaging Screening Among Patients at High Breast Cancer Risk.

Women at high lifetime breast cancer risk may benefit from supplemental breast magnetic resonance imaging (MRI) screening, in addition to routine mammography screening for earlier cancer detection.

Family History and Risk of Second Primary Breast Cancer after In Situ Breast Carcinoma.

Incidence rates of in situ breast carcinomas have increased due to widespread adoption of mammography. Very little is known about why some women with in situ breast cancer later develop second primary breast cancers.

Primary Care Provider Experience with Breast Density Legislation in Massachusetts.

Dense breasts on mammography independently increases breast cancer risk and decreases mammography sensitivity. Thirty-two states have adopted notification laws to raise awareness among women with dense breasts about supplemental screening. Little is known about these policies' impact on clinical practice among primary care providers (PCPs).

The role of screening mammography in the era of modern breast cancer treatment.

The evidence is reviewed on the efficacy and effectiveness of mammography screening derived from randomized screening trials and from the surveillance of populations where mammography screening for breast cancer has been introduced. Nearly all the trials were performed in the era before modern adjuvant therapy for breast cancer was introduced, apart from the Canadian National Breast Screening Study and the UK Age trial. The former found no benefit from annual mammography screening for 5 years in women age 40-59 years, the latter, a non-significant benefit from screening women by annual mammography for 7 years from ages 39 to 41 years. The evidence from population-based surveillance is mixed, most such studies having failed to consider the benefit gained from improved therapy. It is concluded that we have reached the point of negligible benefit from mammography screening for breast cancer in women at average risk, and that we should concentrate on early diagnosis of breast cancer and the application of modern therapy according to clearly defined sub-types of breast cancer.

Retroareolar masses and intraductal abnormalities detected on screening ultrasound: can biopsy be avoided?

To investigate the malignancy rate of retroareolar masses and intraductal abnormalities discovered in asymptomatic women during screening whole breast ultrasound (US-S) and determine if biopsy can be avoided.

The impact of compression force and pressure at prevalent screening on subsequent re-attendance in a national screening program.

Adherence to screening may indirectly help assess whether a prior screening examination deters women from returning for a subsequent examination. We investigated whether compression force and pressure in mammography were associated with re-attendance among prevalently screened women in the organized breast cancer screening program in Norway. Data on compression force (kg) and pressure (kPa) from women's first screening examination in the program (prevalent screening) and subsequent re-attendance were available for 31,225 women aged 50-68, screened during 2007-2013. Crude re-attendance rates and log-binomial regression models estimating the prevalence ratio of re-attendance were used to identify the association between compression force or pressure and re-attendance two-years later. Age and year at prevalent screening, county of residence, screening result (negative or false positive), breast volume, and breast density were included in analyses. Overall, 27,197 (87.1%) women re-attended the program. Re-attendance was highest for women who received a compression force of 10.0-13.9 kg (87.5%) or pressure of 9.0-17.9 kPa (87.8%) and lowest for those who received a compression force of <10.0 kg (85.0%) or pressure of <9.0 kPa (84.7%). The adjusted prevalence of re-attendance was 3% lower for women who received low compression force (<10.0 kg) and 2% lower for women who received low compression pressure (<9.0 kPa) relative to the reference groups (10.0-13.9 kg and 9.0-17.9 kPa, respectively). Future research related to re-attendance should also include information about women's experience of pain, anxiety and stress, as well as image quality.

Case Report: Synchronous primary malignancy including the breast and endometrium.

Breast and endometrial cancer are the most common types of female cancers, but the incidence of both of these malignancies in a single patient is a rare event. Multiple primary malignancy has been increasingly reported over the past decade, and double primary cancer is considered as the most common type.  In this study, we present a 53-year-old woman with synchronous primary malignancy of breast and endometrium. This patient had a history of breast and endometrial cancer in her family. Mammography and chest CT of the patient revealed a mass in the right breast and left supraclavicular region. However, the patient did not want to initiate treatment. Subsequently, the patient returned with a chief complaint of persistent abnormal vaginal bleeding. Abdominopelvic CT scan of the patient revealed a huge soft tissue mass in the pelvic cavity. She underwent hysterectomy, and pathology revealed endometrioid carcinoma, which had invaded the full thickness of uterine wall. Since this type of malignancy is rare and several risk factors are associated with it, it is worth being considered by clinicians when making decisions about screening or strategy for prevention.

Women's satisfaction with mammography and predictors of participation in an organized breast cancer screening program: Perspectives of a Local Health Unit in Rome.

The aims of the study were to evaluate satisfaction with the mammography service of the Local Health Unit RMA (Rome, Lazio Region) among women who have attended the program and to identify the predictors of participation.

Breast cancer screening: Where have we been and where are we going? A personal perspective based on history, data and experience.

It is important to understand the history of breast cancer screening to better understand the continuing effort to reduce access to screening. Since the randomized, controlled trials have shown a statistically significant mortality reduction for women ages 40-74, the appropriate threshold for initiating screening is age 40 with no data to support the use of the age of 50 as a threshold for screening. All women are at risk for developing breast cancer and all women should have access to screening.

Systematic Review of Mammography Screening Educational Interventions for Hispanic Women in the United States.

In the United States (U.S.), Hispanics experience breast cancer disparities. Breast cancer is the leading cause of cancer-related death among Hispanic women, and Hispanic women receive mammography screening at lower rates than some other ethnic groups. This low rate of screening mammography is associated with increased risk for possible late-stage diagnosis and lower survival rates. Educational interventions could play a role in increasing screening mammography rates among Hispanic women. This systematic review synthesized the current literature on educational interventions to increase mammography screening among Hispanic women. The review included studies published between May 2003 and September 2017 with experimental and quasi-experimental interventions to increase mammography screening among Hispanics in the U.S. Five studies out of an initial 269 studies met inclusion criteria for the review. All studies employed an interpersonal intervention strategy with community health workers, or promotoras, to deliver the mammography screening intervention. For each study, odds ratios (OR) were calculated to estimate intervention effectiveness based on similar follow-up time periods. The study ORs resulted in a narrow range between 1.02 and 2.18, indicating a low to moderate intervention effect for these types of interpersonal cancer education interventions. The summary OR for the random effects model was 1.67 (CI 1.24-2.26). Hispanics exhibit lower levels of adherence to screening mammography than non-Hispanic whites. Interpersonal cancer education interventions such as the use of promotoras may help to mediate the impact of barriers to receiving a mammogram such as low health literacy, deficits in knowledge about the benefits of screening, and low awareness of the availability of screening services.

Automatic Information Extraction from Unstructured Mammography Reports Using Distributed Semantics.

To date, the methods developed for automated extraction of information from radiology reports are mainly rule-based or dictionary-based, and, therefore, require substantial manual effort to build these systems. Recent efforts to develop automated systems for entity detection have been undertaken, but little work has been done to automatically extract relations and their associated named entities in narrative radiology reports that have comparable accuracy to rule-based methods. Our goal is to extract relations in a unsupervised way from radiology reports without specifying prior domain knowledge. We propose a hybrid approach for information extraction that combines dependency-based parse tree with distributed semantics for generating structured information frames about particular findings/abnormalities from the free-text mammography reports. The proposed IE system obtains a F1-score of 0.94 in terms of completeness of the content in the information frames, which outperforms a state-of-the-art rule-based system in this domain by a significant margin. The proposed system can be leveraged in a variety of applications, such as decision support and information retrieval, and may also easily scale to other radiology domains, since there is no need to tune the system with hand-crafted information extraction rules.

Interval breast cancers in the 'screening with tomosynthesis or standard mammography' (STORM) population-based trial.

The prospective 'screening with tomosynthesis or standard mammography' (STORM) trial recruited women participating in biennial breast screening in Italy (2011-2012), and compared sequential screen-readings based on 2D-mammography alone or based on tomosynthesis (integrated 2D/3D-mammography). The STORM trial showed that tomosynthesis screen-reading significantly increased breast cancer detection compared to 2D-mammography alone. The present study completes reporting of the trial by examining interval breast cancers ascertained at two year follow-up.

Social determinants of health related to adhesion to mammography screening.

To identify proximal, intermediary and individual social determinants related to mammography adherence, according to the Social Determinants of Health model proposed by Dahlgren and Whitehead. Method: Correlational cross-sectional study, carried out with a sociodemographic and clinical data questionnaire and the Champion's Health Belief Model Scale, translated and adapted for use in Brazil. Data analyzed by multiple linear regression, from the domains scale, and sociodemographic and clinical variables were used as predictors.

Cost-effectiveness and comparative effectiveness of cancer risk management strategies in BRCA1/2 mutation carriers: a systematic review.

PurposeTo review the evidence for the effectiveness and cost-effectiveness of cancer risk management interventions for BRCA carriers.MethodsComparative effectiveness and cost-effectiveness analyses were identified by searching scientific and health economic databases. Eligible studies modeled the impact of a cancer risk management intervention in BRCA carriers on life expectancy (LE), cancer incidence, or quality-adjusted life years (QALYs), with or without costs.ResultsTwenty-six economic evaluations and eight comparative effectiveness analyses were included. Combined risk-reducing salpingo-oophorectomy and prophylactic mastectomy resulted in the greatest LE and was cost-effective in most analyses. Despite leading to increased LE and QALYs, combined mammography and breast magnetic resonance imaging (MRI) was less likely to be cost-effective than either mammography or MRI alone, particularly for women over 50 and BRCA2 carriers. Variation in patient compliance to risk management interventions was incorporated in 11/34 studies with the remaining analyses assuming 100% adherence.ConclusionProphylactic surgery and intensive breast screening are effective and cost-effective in models of BRCA carrier risk management. Findings were based predominantly on assuming perfect adherence to recommendations without assessment of the health-care resource use and costs related to engaging patients and maximizing compliance, meaning the real-world impact on clinical outcomes and resource use remains unclear.GENETICS in MEDICINE advance online publication, 11 January 2018; doi:10.1038/gim.2017.255.

Insights Into Breast Cancer Screening: A Computer Simulation of Two Contemporary Screening Strategies.

The debate over the value of screening mammography is rekindled with each new published study or guideline. Central to the discussion are the uncertainties about screening benefits and harms and the criteria used to assess them. Today, the magnitude of benefits for a population is less certain, and the evolving concept of harm has come to encompass false-positives (FPs), unnecessary biopsies, overdiagnosis, and overtreatment. This study uses a Monte Carlo computer simulation to study the balance of benefits and harms of mammographic breast cancer screening for average-risk women.

Construction of mammographic examination process ontology using bottom-up hierarchical task analysis.

Describing complex mammography examination processes is important for improving the quality of mammograms. It is often difficult for experienced radiologic technologists to explain the process because their techniques depend on their experience and intuition. In our previous study, we analyzed the process using a new bottom-up hierarchical task analysis and identified key components of the process. Leveraging the results of the previous study, the purpose of this study was to construct a mammographic examination process ontology to formally describe the relationships between the process and image evaluation criteria to improve the quality of mammograms. First, we identified and created root classes: task, plan, and clinical image evaluation (CIE). Second, we described an "is-a" relation referring to the result of the previous study and the structure of the CIE. Third, the procedural steps in the ontology were described using the new properties: "isPerformedBefore," "isPerformedAfter," and "isPerformedAfterIfNecessary." Finally, the relationships between tasks and CIEs were described using the "isAffectedBy" property to represent the influence of the process on image quality. In total, there were 219 classes in the ontology. By introducing new properties related to the process flow, a sophisticated mammography examination process could be visualized. In relationships between tasks and CIEs, it became clear that the tasks affecting the evaluation criteria related to positioning were greater in number than those for image quality. We developed a mammographic examination process ontology that makes knowledge explicit for a comprehensive mammography process. Our research will support education and help promote knowledge sharing about mammography examination expertise.

Silicone Granuloma Associated with Pectoral Muscle Involvement after Ruptured Breast Implant: a Novel case report.

In this study, an unusual case of a patient who was previously operated on a ruptured breast implant following silicone granuloma associated with pectoral muscle involvement is reported. A 72-year-old woman had undergone breast augmentation surgery when she was 52-year-old and silicone implant rupture 10 years later. After 10 years of ruptured silicone implant, her mammography showed diffuse, multiple high-density nodules in the left breast. The pectoral muscle was significantly hypertrophic. The magnetic resonance imaging showed that the pectoral muscle was quite hypertrophic and had heterogeneous enhancement. In clinical consideration and the presence of the suspected malignancy, a biopsy was performed. The histological analysis identified pectoral muscle and breast tissue, which had been mainly replaced by giant cells, along with an apparent foreign body response. Silicone granuloma can present itself as a soft tissue mass. Malignancy is the most important differential diagnosis. Meticulous follow-up is recommended for these patients.

MR Imaging Features of Tubular Carcinoma: Preliminary Experience in Twelve Masses.

We retrospectively analyzed the magnetic resonance (MR) imaging features and diffusion-weighted imaging findings of the 12 masses of 10 patients with tubular carcinoma (TC), including mammography and sonography findings.

Efficiency of Imaging Modalities in Male Breast Disease: Can Ultrasound Give Additional Information for Assessment of Gynecomastia Evolution?

The purpose of this study is to present mammography and ultrasound findings of male breast lesions and to investigate the ability of diagnostic modalities in estimating the evolution of gynecomastia.

Breast Cancer Screening Behaviors of First Degree Relatives of Women Receiving Breast Cancer Treatment and the Affecting Factors.

First-degree relatives of women with breast cancer are under higher risk when compared with the general population. The aim of this study is to evaluate breast cancer screening behaviors of women who are first-degree relatives of women with breast cancer and factors affecting these behaviors.