Abnormal Mammographic Findings with Short-Interval Follow-up Recommendation
Department of Medicine, Division of Medical Oncology and Hematology, Los Angeles BioMedical Research Institute and Harbor-University of California Los Angeles Medical Center, Torrance, CA 90502, USA. Clinical Breast Cancer
(Impact Factor: 2.11).
09/2005; 6(3):235-9. DOI: 10.3816/CBC.2005.n.025
An abnormal Breast Imaging and Reporting Data System (BIRADS) category 3 mammogram with a short interval follow-up recommendation is a common finding seen in approximately 40% of women for each decade of screening. Factors associated with category 3 mammograms include mammography examination features, tendencies of the interpreting physician, and features of the country's health care system and the screened population including age, family history, previous biopsies, obesity, and menopausal hormone therapy. Recently, the degree to which a BIRADS category 3 mammographic result provides differential breast cancer risk compared with normal mammographic categories (BIRADS category 1 or 2) has been questioned. The yield of category 3 mammographic results could potentially be increased by more uniform performance of additional imaging workup (additional views and/or ultrasonography). In addition, other strategies to more accurately characterize the risk of breast cancer in women with category 3 mammographic results are under evaluation and including magnetic resonance imaging, computer-aided classification systems, and digital tomosynthesis. Given the potential psychologic impact of abnormal mammographic results, studies attempting to more accurately relate screening mammography findings to breast cancer risk are a priority.
Available from: Martine Berliere
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ABSTRACT: Our purpose was to determine the contribution of mammography followed by sonography for the detection of nonpalpable breast cancers in Breast Imaging Reporting and Data System (BI-RADS) density grades 1-4 breasts, in grades 1 and 2 breasts, and in grades 3 and 4 breasts.
The results of physical, mammographic, and sonographic examinations performed in 4236 patients were reviewed to determine the sensitivities of mammography and sonography for the detection of nonpalpable breast cancers and to calculate the relative risk for detecting nonpalpable breast cancers using sonography in comparison with mammography in density grades 1-4, grades 1 and 2, and grades 3 and 4 breasts. Sonography was performed after mammographic interpretation.
Sensitivities of mammography and subsequent sonography for the detection of nonpalpable breast cancers were 69% and 88% in grades 1-4, 80% and 88% in grades 1 and 2, and 56% and 88% in grades 3 and 4 breasts, respectively. The relative risk for detecting nonpalpable breast cancers using sonography was statistically significantly greater than that for detecting nonpalpable breast cancers using mammography in grades 1-4 (relative risk, 1.29; p = 0.024) and in grades 3 and 4 (relative risk, 1.57; p = 0.013) but not in grades 1 and 2 (relative risk, 1.1; p = 0.445) breasts.
Sonography is a useful adjunct after mammography for the detection of nonpalpable breast cancer, particularly in the dense breast.
Available from: Assaf Annlouise
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ABSTRACT: The Women's Health Initiative Estrogen-Aone trial comparing conjugated equine estrogens (CEE) with placebo was stopped early because of an increased stroke incidence and no reduction in risk of coronary heart disease. Preliminary results suggesting possible reduction in breast cancers warranted more detailed analysis.
To determine the effects of CEE on breast cancers and mammographic findings.
Following breast cancer risk assessment, 10,739 postmenopausal women aged 50 to 79 years with prior hysterectomy were randomized to CEE or placebo at 40 US clinical centers from 1993 through 1998. Mammography screenings and clinical breast examinations were performed at baseline and annually. All breast cancers diagnosed through February 29, 2004, are included.
A dose of 0.625 mg/d of CEE or an identical-appearing placebo.
Breast cancer incidence, tumor characteristics, and mammogram findings.
After a mean (SD) follow-up of 7.1 (1.6) years, the invasive breast cancer hazard ratio (HR) for women assigned to CEE vs placebo was 0.80 (95% confidence interval [CI], 0.62-1.04; P = .09) with annualized rates of 0.28% (104 cases in the CEE group) and 0.34% (133 cases in the placebo group). In exploratory analyses, ductal carcinomas (HR, 0.71; 95% CI, 0.52-0.99) were reduced in the CEE group vs placebo group; however, the test for interaction by tumor type was not significant (P = .054). At 1 year, 9.2% of women in the CEE group had mammograms with abnormalities requiring follow-up vs 5.5% in the placebo group (P<.001), a pattern that continued through the trial to reach a cumulative percentage of 36.2% vs 28.1%, respectively (P<.001); however, this difference was primarily in assessments requiring short interval follow-up.
Treatment with CEE alone for 7.1 years does not increase breast cancer incidence in postmenopausal women with prior hysterectomy. However, treatment with CEE increases the frequency of mammography screening requiring short interval follow-up. Initiation of CEE should be based on consideration of the individual woman's potential risks and benefits.
clinicaltrials.gov Identifier: NCT00000611.
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ABSTRACT: The new techniques of three-dimensional visualization of the breast that have been developed in recent years have the potential
to markedly improve diagnostic breast imaging. Many experts even expect the new 3D techniques such as digital breast tomosynthesis
(DBT) or breast CT to completely replace “conventional” digital mammography in the intermediate term as they have definitive
advantages over 2D mammography. Various approaches are theoretically conceivable and have to be evaluated in the clinical
setting, including the use of different reconstruction algorithms, the use of different DBT angles, slit-scan DBT vs. flat-panel
DBT vs. breast CT, different dose settings, and DBT in one plane vs. two planes. Finally, DBT might also have advantages in
combination with other tools for improving the diagnostic accuracy of breast imaging such as computer-aided diagnosis and
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