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JAMA Network Open Apr 2022Increasing use of screening breast magnetic resonance imaging (MRI), including among women at low or average risk of breast cancer, raises concerns about resulting...
IMPORTANCE
Increasing use of screening breast magnetic resonance imaging (MRI), including among women at low or average risk of breast cancer, raises concerns about resulting mammary and extramammary cascades (downstream services and new diagnoses) of uncertain value.
OBJECTIVE
To estimate rates of cascade events (ie, laboratory tests, imaging tests, procedures, visits, hospitalizations, and new diagnoses) and associated spending following screening breast MRI vs mammography among commercially insured US women.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used 2016 to 2018 data from the MarketScan research database (IBM Corporation), which includes claims and administrative data from large US employers and commercial payers. Participants included commercially insured women aged 40 to 64 years without prior breast cancer who received an index bilateral screening breast MRI or mammogram between January 1, 2017, and June 30, 2018. We used propensity scores based on sociodemographic, clinical, and utilization variables to match MRI recipients to mammogram recipients in each month of index service use. Data were analyzed from October 8, 2020, to October 28, 2021.
EXPOSURES
Breast MRI vs mammography.
MAIN OUTCOMES AND MEASURES
Mammary and extramammary cascade event rates and associated total and patient out-of-pocket spending in the 6 months following the index test.
RESULTS
In this study, 9208 women receiving breast MRI were matched with 9208 women receiving mammography (mean [SD] age, 51.4 [6.7] years). Compared with mammogram recipients, breast MRI recipients had 39.0 additional mammary cascade events per 100 women (95% CI, 33.7-44.2), including 5.0 additional imaging tests (95% CI, 3.8-6.2), 17.3 additional procedures (95% CI, 15.5-19.0), 13.0 additional visits (95% CI, 9.4-17.2), 0.34 additional hospitalizations (95% CI, 0.18-0.50), and 3.0 additional new diagnoses (95% CI, 2.5-3.6). For extramammary cascades, breast MRI recipients had 19.6 additional events per 100 women (95% CI, 8.6-30.7) including 15.8 additional visits (95% CI, 10.2-21.4) and no statistically significant differences in other events. Breast MRI recipients had higher total spending for mammary events ($564 more per woman; 95% CI, $532-$596), extramammary events ($42 more per woman; 95% CI, $16-$69), and overall ($1404 more per woman; 95% CI, $1172-$1636). They also had higher overall out-of-pocket spending ($31 more per woman; 95% CI, $6-$55).
CONCLUSIONS AND RELEVANCE
In this cohort study of commercially insured women, breast MRI was associated with more mammary and extramammary cascade events and spending relative to mammography. These findings can inform cost-benefit assessments and coverage policies to ensure breast MRI is reserved for patients for whom benefits outweigh harms.
Topics: Breast; Breast Neoplasms; Cohort Studies; Female; Humans; Magnetic Resonance Imaging; Mammography; Middle Aged
PubMed: 35416989
DOI: 10.1001/jamanetworkopen.2022.7234 -
Radiology Feb 2022
Topics: Humans; Mammography
PubMed: 34751621
DOI: 10.1148/radiol.2021212092 -
American Journal of Surgery Aug 2019From its inception, screening mammography has enjoyed a perceived level of sensitivity that is inconsistent with available evidence. The original data that imparted... (Review)
Review
From its inception, screening mammography has enjoyed a perceived level of sensitivity that is inconsistent with available evidence. The original data that imparted erroneous beliefs about sensitivity were based on a variety of misleading definitions and approaches, such as the inclusion of palpable tumors, using the inverse of interval cancer rates (often tied to an arbitrary 12 month interval), and quoting prevalence screen sensitivity wherein tumors are larger than those found on incidence screens. This review addresses the background for the overestimation of mammographic sensitivity, and how a major adjustment in our thinking is overdue now that multi-modality imaging allows us to determine real time mammographic sensitivity. Although a single value for mammographic sensitivity is disingenuous, given the wide range based on background density, it is important to realize that a sensitivity gap between belief and reality still exists in the early detection of breast cancer using mammography alone, in spite of technologic advances. Failure to recognize this gap diminishes the acceptance of adjunct methods of breast imaging that greatly complement detection rates.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Follow-Up Studies; Humans; Mammography; Multimodal Imaging; Sensitivity and Specificity
PubMed: 30739738
DOI: 10.1016/j.amjsurg.2019.01.039 -
British Journal of Cancer Nov 2022The associations between mammographic radiomics and breast cancer clinical endpoints are unclear. We aimed to identify mammographic radiomics features associated with...
BACKGROUND
The associations between mammographic radiomics and breast cancer clinical endpoints are unclear. We aimed to identify mammographic radiomics features associated with breast cancer prognosis.
METHODS
Nested from a large breast cancer cohort in our institution, we conducted an extreme case-control study consisting of 207 cases with any invasive disease-free survival (iDFS) endpoint <5 years and 207 molecular subtype-matched controls with >5-year iDFS. A total of 632 radiomics features in craniocaudal (CC) and mediolateral oblique (MLO) views were extracted from pre-treatment mammography. Logistic regression was used to identify iDFS-associated features with multiple testing corrections (Benjamini-Hochberg method). In a subsample with RNA-seq data (n = 96), gene set enrichment analysis was employed to identify pathways associated with lead features.
RESULTS
We identified 15 iDFS-associated features from CC-view yet none from MLO-view. S(1,-1)SumAverg and WavEnLL_s-6 were the lead ones and associated with favourable (OR 0.64, 95% CI 0.42-0.87, P = 0.01) and poor iDFS (OR 1.53, 95% CI 1.31-1.76, P = 0.01), respectively. Both features were associated with eight pathways (primarily involving cell cycle regulation) in tumour but not adjacent normal tissues.
CONCLUSION
Our findings suggest mammographic radiomics features are associated with breast cancer iDFS, potentially through pathways involving cell cycle regulation.
Topics: Humans; Female; Breast Neoplasms; Progression-Free Survival; Case-Control Studies; Mammography; Breast
PubMed: 36050449
DOI: 10.1038/s41416-022-01958-5 -
BMC Cancer Dec 2021The debate continues among medical professionals regarding the frequency, starting age, and stopping age for mammography screening. Some experts suggest tailoring...
BACKGROUND
The debate continues among medical professionals regarding the frequency, starting age, and stopping age for mammography screening. Some experts suggest tailoring recommendations based on individuals' personal breast cancer risk. Previous studies have not compared the impact of annual versus biennial mammography stratified by age group and risk category. The purpose of this study was to examine the relationship between mammography frequency and mortality by age group and risk category in the California Teachers Study.
METHODS
Using data from study questionnaires from 93,438 women between the ages of 40 and 85 and linkages to the California Cancer Registry and other indices, overall and breast cancer-specific mortality by mammography frequency were estimated using multivariable Cox proportional hazards models, stratified by age group and risk category at baseline as determined by the Gail breast cancer risk model.
RESULTS
During the follow-up period of 20 years, overall mortality risk was lower in women who had annual or biennial mammography compared to less frequent or no mammography in all age groups. Annual mammography was associated with lower overall mortality risk compared to biennial mammography among women age 50-85. This difference was especially apparent in women age 60-74, regardless of estimated Gail risk category at baseline. Breast cancer-specific mortality was lower among women who had annual mammography compared to biennial or less frequent mammography among women age 60-74, regardless of their baseline risk.
CONCLUSIONS
Our findings suggest that at least biennial mammography is beneficial to most women age 40-85 and that annual mammography is more beneficial than biennial mammography to most women age 50-85 in terms of overall mortality.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Breast; Breast Neoplasms; California; Early Detection of Cancer; Female; Follow-Up Studies; Humans; Longitudinal Studies; Mammography; Middle Aged; Practice Guidelines as Topic; Prospective Studies; Risk Assessment; Time Factors
PubMed: 34922473
DOI: 10.1186/s12885-021-09071-1 -
Scientific Reports Feb 2022Comorbidity substantially affects breast cancer risk and prognosis. However, women with chronic conditions are less likely to participate in mammography screening. Few...
Comorbidity substantially affects breast cancer risk and prognosis. However, women with chronic conditions are less likely to participate in mammography screening. Few studies have examined potential benefits of mammography in women with chronic conditions. This study investigated the moderation effects of mammography screening on early stage breast cancer and all-cause mortality among women aged 50-69 years with chronic conditions in Taiwan. We used a matched cohort design with four nationwide population databases, and an exact matching approach to match groups with different chronic conditions. Women population aged 50-69 years in 2010 in Taiwan were studied. A generic Charlson comorbidity index (CCI) measure was used to identify chronic illness burden. The sample sizes of each paired matched group with CCI scores of 0, 1, 2, or 3+ were 170,979 using a 1-to-1 exact matching. Conditional logistic regressions with interaction terms were used to test moderation effect, and adjusted predicted probabilities and marginal effects to quantify average and incremental chronic conditions associated with outcome measures. Statistical analyses were conducted in 2020-2021. Women with more chronic conditions were less likely to participate in mammography screening or to receive early breast cancer diagnoses, but were at greater risk of mortality. However, mammography participation increased the likelihood of early breast cancer diagnosis (OR 1.48, 95% CI 1.36-1.60) and decreased risk of all-cause mortality (HR 0.53, 95% CI 0.51-0.55). The interaction terms of CCI and mammography participation indicated significantly increased benefits of early breast cancer diagnosis and decreased risk of all-cause mortality as chronic illness increased. Mammography participation significantly moderated the link between comorbidity and outcome measures among women with chronic conditions. Hence, it is important for public health policy to promote mammography participation for women with multiple chronic conditions.
Topics: Age Factors; Aged; Breast Neoplasms; Cause of Death; Early Detection of Cancer; Female; Health Promotion; Humans; Logistic Models; Mammography; Middle Aged; Multiple Chronic Conditions; Taiwan; Women's Health Services
PubMed: 35145157
DOI: 10.1038/s41598-022-06187-7 -
Canadian Association of Radiologists... Feb 2022Digital breast tomosynthesis (DBT) is gradually being implemented in routine clinical breast imaging practice. The technique of image acquisition reduces the confounding... (Review)
Review
Digital breast tomosynthesis (DBT) is gradually being implemented in routine clinical breast imaging practice. The technique of image acquisition reduces the confounding effect of overlapping breast tissue, which substantially affects cancer detection, abnormal recall, and interval cancer rates in a screening/ surveillance setting. In a diagnostic setting, tomosynthesis also allows for improved lesion localization and characterization over conventional imaging, which potentially improves the accuracy and improved workflow efficiency. To optimize the utility of tomosynthesis, imagers should be aware of the pertinent aspects of image acquisition as it relates to interpretation, the appearance of benign and malignant pathologies, and sources of possible misinterpretation. This article aims to provide a practical knowledge base of DBT and demonstrate its potential benefits when incorporated into routine clinical practice.
Topics: Breast; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography
PubMed: 34229477
DOI: 10.1177/08465371211025229 -
European Journal of Medical Research Sep 2023High mammographic density (MD) is a risk factor for the development of breast cancer (BC). Changes in MD are influenced by multiple factors such as age, BMI, number of...
BACKGROUND
High mammographic density (MD) is a risk factor for the development of breast cancer (BC). Changes in MD are influenced by multiple factors such as age, BMI, number of full-term pregnancies and lactating periods. To learn more about MD, it is important to establish non-radiation-based, alternative examination methods to mammography such as ultrasound assessments.
METHODS
We analyzed data from 168 patients who underwent standard-of-care mammography and performed additional ultrasound assessment of the breast using a high-frequency (12 MHz) linear probe of the VOLUSON 730 Expert system (GE Medical Systems Kretztechnik GmbH & Co OHG, Austria). Gray level bins were calculated from ultrasound images to characterize mammographic density. Percentage mammographic density (PMD) was predicted by gray level bins using various regression models.
RESULTS
Gray level bins and PMD correlated to a certain extent. Spearman's ρ ranged from - 0.18 to 0.32. The random forest model turned out to be the most accurate prediction model (cross-validated R, 0.255). Overall, ultrasound images from the VOLUSON 730 Expert device in this study showed limited predictive power for PMD when correlated with the corresponding mammograms.
CONCLUSIONS
In our present work, no reliable prediction of PMD using ultrasound imaging could be observed. As previous studies showed a reasonable correlation, predictive power seems to be highly dependent on the device used. Identifying feasible non-radiation imaging methods of the breast and their predictive power remains an important topic and warrants further evaluation. Trial registration 325-19 B (Ethics Committee of the medical faculty at Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany).
Topics: Female; Pregnancy; Humans; Breast Density; Lactation; Breast Neoplasms; Mammography; Risk Factors; Transducers
PubMed: 37770952
DOI: 10.1186/s40001-023-01327-9 -
Seminars in Roentgenology Apr 2022Molecular breast imaging (MBI) is a nuclear medicine study performed with dedicated gamma camera systems optimized to image the uptake of Tc-99m sestamibi in the breast....
Molecular breast imaging (MBI) is a nuclear medicine study performed with dedicated gamma camera systems optimized to image the uptake of Tc-99m sestamibi in the breast. MBI provides a relatively low-cost and simple functional breast imaging method that can identify breast cancers obscured by dense fibroglandular tissue on mammography. Recent studies have also found that background levels of uptake in benign dense tissue may provide breast cancer risk information. This article discusses the latest updates in MBI technology, recent evidence supporting its clinical use, and work in progress that may aid in wider adoption of MBI.
Topics: Breast; Breast Neoplasms; Female; Gamma Cameras; Humans; Mammography; Molecular Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi
PubMed: 35523526
DOI: 10.1053/j.ro.2021.12.006 -
Journal of Medical Radiation Sciences Mar 2022To report for the first time the image quality of mammograms performed in Papua New Guinea (PNG) using the Perfect, Good, Moderate, Inadequate (PGMI) image evaluation... (Review)
Review
INTRODUCTION
To report for the first time the image quality of mammograms performed in Papua New Guinea (PNG) using the Perfect, Good, Moderate, Inadequate (PGMI) image evaluation system (IES); and to benchmark the image quality against BreastScreen Australia (BSA) National Accreditation Standards (NAS).
METHODS
A retrospective image quality analysis of the de-identified mammograms of 102 women imaged at the Port Moresby General Hospital (PMGH) was undertaken using the PGMI IES. Each craniocaudal (CC) and mediolateral oblique (MLO) image was assigned a grade and the reasons for the grade recorded. Age was recorded in years. Simple frequency analysis was undertaken and comparison with BSA NAS 2.4 was made.
RESULTS
Women were aged between 25 and 74 years. There were 111 CC views and 109 MLO views. The most frequent individual grade for the CC view was G (83.8%) and for the MLO view M (72.48%); and for a routine series (four images), P and G combined (14.8%). Non-visualisation of the IMA (28%), nipple not in profile (26%) and short length of pectoral muscle (12%) were the most cited reasons for assigning an M grade.
CONCLUSION
The reported image quality is not commensurate with that required by BSA (P and G > 50%) and while common positioning errors can be rectified through education and training, it is also important to recognise the complex challenges faced by PNG radiographers in obtaining mammographic images that extend beyond education and training and reflect the emerging nature of the modality as well as wider health, economic and other issues. This work raises the need for national standards, dedicated equipment, and radiographer education to best serve the women of PNG.
Topics: Adult; Aged; Australia; Breast Neoplasms; Female; Humans; Mammography; Middle Aged; Papua New Guinea; Pectoralis Muscles; Retrospective Studies
PubMed: 34418330
DOI: 10.1002/jmrs.538