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Virchows Archiv : An International... Jul 2023The heterogeneous group of B3 lesions in the breast harbors lesions with different malignant potential and progression risk. As several studies about B3 lesions have... (Review)
Review
The heterogeneous group of B3 lesions in the breast harbors lesions with different malignant potential and progression risk. As several studies about B3 lesions have been published since the last Consensus in 2018, the 3rd International Consensus Conference discussed the six most relevant B3 lesions (atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), radial scar (RS), papillary lesions (PL) without atypia, and phyllodes tumors (PT)) and made recommendations for diagnostic and therapeutic approaches. Following a presentation of current data of each B3 lesion, the international and interdisciplinary panel of 33 specialists and key opinion leaders voted on the recommendations for further management after core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). In case of B3 lesion diagnosis on CNB, OE was recommended in ADH and PT, whereas in the other B3 lesions, vacuum-assisted excision was considered an equivalent alternative to OE. In ADH, most panelists (76%) recommended an open excision (OE) after diagnosis on VAB, whereas observation after a complete VAB-removal on imaging was accepted by 34%. In LN, the majority of the panel (90%) preferred observation following complete VAB-removal. Results were similar in RS (82%), PL (100%), and FEA (100%). In benign PT, a slim majority (55%) also recommended an observation after a complete VAB-removal. VAB with subsequent active surveillance can replace an open surgical intervention for most B3 lesions (RS, FEA, PL, PT, and LN). Compared to previous recommendations, there is an increasing trend to a de-escalating strategy in classical LN. Due to the higher risk of upgrade into malignancy, OE remains the preferred approach after the diagnosis of ADH.
Topics: Humans; Female; Breast; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Mammography; Biopsy, Large-Core Needle; Precancerous Conditions; Phyllodes Tumor; Retrospective Studies
PubMed: 37330436
DOI: 10.1007/s00428-023-03566-x -
Medicine Jan 2024Breast cancer remains a complex and prevalent health concern affecting millions of individuals worldwide. This review paper presents a comprehensive analysis of the... (Review)
Review
Breast cancer remains a complex and prevalent health concern affecting millions of individuals worldwide. This review paper presents a comprehensive analysis of the multifaceted landscape of breast cancer, elucidating the diverse spectrum of risk factors contributing to its occurrence and exploring advancements in diagnostic methodologies. Through an extensive examination of current literature, various risk factors have been identified, encompassing genetic predispositions such as BRCA mutations, hormonal influences, lifestyle factors, and reproductive patterns. Age, family history, and environmental factors further contribute to the intricate tapestry of breast cancer etiology. Moreover, this review delineates the pivotal role of diagnostic tools in the early detection and management of breast cancer. Mammography, the cornerstone of breast cancer screening, is augmented by emerging technologies like magnetic resonance imaging and molecular testing, enabling improved sensitivity and specificity in diagnosing breast malignancies. Despite these advancements, challenges persist in ensuring widespread accessibility to screening programs, particularly in resource-limited settings. In conclusion, this review underscores the importance of understanding diverse risk factors in the development of breast cancer and emphasizes the critical role of evolving diagnostic modalities in enhancing early detection. The synthesis of current knowledge in this review aims to contribute to a deeper comprehension of breast cancer's multifactorial nature and inform future directions in research, screening strategies, and preventive interventions.
Topics: Humans; Female; Breast Neoplasms; Early Detection of Cancer; Mammography; Breast; Risk Factors
PubMed: 38241592
DOI: 10.1097/MD.0000000000036905 -
Nature Communications Nov 2023Biomarkers for early detection of breast cancer may complement population screening approaches to enable earlier and more precise treatment. The blood proteome is an...
Biomarkers for early detection of breast cancer may complement population screening approaches to enable earlier and more precise treatment. The blood proteome is an important source for biomarker discovery but so far, few proteins have been identified with breast cancer risk. Here, we measure 2929 unique proteins in plasma from 598 women selected from the Karolinska Mammography Project to explore the association between protein levels, clinical characteristics, and gene variants, and to identify proteins with a causal role in breast cancer. We present 812 cis-acting protein quantitative trait loci for 737 proteins which are used as instruments in Mendelian randomisation analyses of breast cancer risk. Of those, we present five proteins (CD160, DNPH1, LAYN, LRRC37A2 and TLR1) that show a potential causal role in breast cancer risk with confirmatory results in independent cohorts. Our study suggests that these proteins should be further explored as biomarkers and potential drug targets in breast cancer.
Topics: Humans; Female; Breast Neoplasms; Biomarkers; Mammography; Phenotype; Blood Proteins; Mendelian Randomization Analysis; Genome-Wide Association Study; Polymorphism, Single Nucleotide; Lectins, C-Type
PubMed: 37996402
DOI: 10.1038/s41467-023-43485-8 -
European Journal of Breast Health Oct 2023The landscape of breast imaging has transformed significantly since mammography's introduction in the 1960s, accelerated by ultrasound and imageguided biopsies in the... (Review)
Review
The landscape of breast imaging has transformed significantly since mammography's introduction in the 1960s, accelerated by ultrasound and imageguided biopsies in the 1990s. The emergence of magnetic resonance imaging (MRI) in the 2000s added a valuable dimension to advanced imaging. Multimodality and multiparametric imaging have firmly established breast radiology's pivotal role in managing breast disorders. A shift from conventional to digital radiology emerged in the late 20th and early 21st centuries, enabling advanced techniques like digital breast tomosynthesis, contrast-enhanced mammography, and artificial intelligence (AI) integration. AI's impending integration into breast radiology may enhance diagnostics and workflows. It involves computer-aided diagnosis (CAD) algorithms, workflow support algorithms, and data processing algorithms. CAD systems, developed since the 1980s, optimize cancer detection rates by addressing false positives and negatives. Radiologists' roles will evolve into specialized clinicians collaborating with AI for efficient patient care and utilizing advanced techniques with multiparametric imaging and radiomics. Wearable technologies, non-contrast MRI, and innovative modalities like photoacoustic imaging show potential to enhance diagnostics. Imaging-guided therapy, notably cryotherapy, and theranostics, gains traction. Theranostics, integrating therapy and diagnostics, holds potential for precise treatment. Advanced imaging, AI, and novel therapies will revolutionize breast radiology, offering refined diagnostics and personalized treatments. Personalized screening, AI's role, and imaging-guided therapies will shape the future of breast radiology.
PubMed: 37795010
DOI: 10.4274/ejbh.galenos.2023.2023-8-3 -
Ugeskrift For Laeger Aug 2023Lifetime risk of developing breast cancer for Danish women is approx. 9%. Diagnostics are done by mammography, biopsy, and examination. Breast-conserving surgery... (Review)
Review
Lifetime risk of developing breast cancer for Danish women is approx. 9%. Diagnostics are done by mammography, biopsy, and examination. Breast-conserving surgery followed by radiotherapy is standard for treatment of early-stage breast cancer. Studies report unsatisfying outcomes in up to one third of the patients. This review summarises the current surgical techniques. Oncoplastic breast surgery makes it possible to combine wide-margin oncological surgery with immediate partial breast reconstruction, thus improving cosmetic outcome. Techniques involve volume reduction, volume displacement and volume replacement, depending on breast size and tumour characteristics.
Topics: Humans; Female; Breast Neoplasms; Mammography; Mammaplasty; Mastectomy, Segmental; Biopsy
PubMed: 37622607
DOI: No ID Found -
Radiologia Brasileira 2023
PubMed: 37829579
DOI: 10.1590/0100-3984.2023.56.4e1-en -
Annals of Internal Medicine Sep 2023Overdiagnosis is increasingly recognized as a harm of breast cancer screening, particularly for older women.
BACKGROUND
Overdiagnosis is increasingly recognized as a harm of breast cancer screening, particularly for older women.
OBJECTIVE
To estimate overdiagnosis associated with breast cancer screening among older women by age.
DESIGN
Retrospective cohort study comparing the cumulative incidence of breast cancer among older women who continued screening in the next interval with those who did not. Analyses used competing risk models, stratified by age.
SETTING
Fee-for-service Medicare claims, linked to the SEER (Surveillance, Epidemiology, and End Results) program.
PATIENTS
Women 70 years and older who had been recently screened.
MEASUREMENTS
Breast cancer diagnoses and breast cancer death for up to 15 years of follow-up.
RESULTS
This study included 54 635 women. Among women aged 70 to 74 years, the adjusted cumulative incidence of breast cancer was 6.1 cases (95% CI, 5.7 to 6.4) per 100 screened women versus 4.2 cases (CI, 3.5 to 5.0) per 100 unscreened women. An estimated 31% of breast cancer among screened women were potentially overdiagnosed. For women aged 75 to 84 years, cumulative incidence was 4.9 (CI, 4.6 to 5.2) per 100 screened women versus 2.6 (CI, 2.2 to 3.0) per 100 unscreened women, with 47% of cases potentially overdiagnosed. For women aged 85 and older, the cumulative incidence was 2.8 (CI, 2.3 to 3.4) among screened women versus 1.3 (CI, 0.9 to 1.9) among those not, with up to 54% overdiagnosis. We did not see statistically significant reductions in breast cancer-specific death associated with screening.
LIMITATIONS
This study was designed to estimate overdiagnosis, limiting our ability to draw conclusions on all benefits and harms of screening. Unmeasured differences in risk for breast cancer and differential competing mortality between screened and unscreened women may confound results. Results were sensitive to model specifications and definition of a screening mammogram.
CONCLUSION
Continued breast cancer screening was associated with greater incidence of breast cancer, suggesting overdiagnosis may be common among older women who are diagnosed with breast cancer after screening. Whether harms of overdiagnosis are balanced by benefits and for whom remains an important question.
PRIMARY FUNDING SOURCE
National Cancer Institute.
Topics: Aged; Female; Humans; United States; Breast Neoplasms; Mammography; Overdiagnosis; Retrospective Studies; Early Detection of Cancer; Medicare; Mass Screening
PubMed: 37549389
DOI: 10.7326/M23-0133