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Breast Cancer Research : BCR May 2015Mammography screening for breast cancer is widely available in many countries. Initially praised as a universal achievement to improve women's health and to reduce the... (Review)
Review
Mammography screening for breast cancer is widely available in many countries. Initially praised as a universal achievement to improve women's health and to reduce the burden of breast cancer, the benefits and harms of mammography screening have been debated heatedly in the past years. This review discusses the benefits and harms of mammography screening in light of findings from randomized trials and from more recent observational studies performed in the era of modern diagnostics and treatment. The main benefit of mammography screening is reduction of breast-cancer related death. Relative reductions vary from about 15 to 25% in randomized trials to more recent estimates of 13 to 17% in meta-analyses of observational studies. Using UK population data of 2007, for 1,000 women invited to biennial mammography screening for 20 years from age 50, 2 to 3 women are prevented from dying of breast cancer. All-cause mortality is unchanged. Overdiagnosis of breast cancer is the main harm of mammography screening. Based on recent estimates from the United States, the relative amount of overdiagnosis (including ductal carcinoma in situ and invasive cancer) is 31%. This results in 15 women overdiagnosed for every 1,000 women invited to biennial mammography screening for 20 years from age 50. Women should be unpassionately informed about the benefits and harms of mammography screening using absolute effect sizes in a comprehensible fashion. In an era of limited health care resources, screening services need to be scrutinized and compared with each other with regard to effectiveness, cost-effectiveness and harms.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Mortality; Sensitivity and Specificity
PubMed: 25928287
DOI: 10.1186/s13058-015-0525-z -
Radiology Jul 2019Digital breast tomosynthesis (DBT) is emerging as the standard of care for breast imaging based on improvements in both screening and diagnostic imaging outcomes. The... (Review)
Review
Digital breast tomosynthesis (DBT) is emerging as the standard of care for breast imaging based on improvements in both screening and diagnostic imaging outcomes. The additional information obtained from the tomosynthesis acquisition decreases the confounding effect of overlapping tissue, allowing for improved lesion detection, characterization, and localization. In addition, the quasi three-dimensional information obtained from the reconstructed DBT data set allows a more efficient imaging work-up than imaging with two-dimensional full-field digital mammography alone. Herein, the authors review the benefits of DBT imaging in screening and diagnostic breast imaging.
Topics: Breast; Breast Neoplasms; Female; Humans; Mammography
PubMed: 31084476
DOI: 10.1148/radiol.2019180760 -
Journal of the National Cancer Institute Sep 2019Artificial intelligence (AI) systems performing at radiologist-like levels in the evaluation of digital mammography (DM) would improve breast cancer screening accuracy...
BACKGROUND
Artificial intelligence (AI) systems performing at radiologist-like levels in the evaluation of digital mammography (DM) would improve breast cancer screening accuracy and efficiency. We aimed to compare the stand-alone performance of an AI system to that of radiologists in detecting breast cancer in DM.
METHODS
Nine multi-reader, multi-case study datasets previously used for different research purposes in seven countries were collected. Each dataset consisted of DM exams acquired with systems from four different vendors, multiple radiologists' assessments per exam, and ground truth verified by histopathological analysis or follow-up, yielding a total of 2652 exams (653 malignant) and interpretations by 101 radiologists (28 296 independent interpretations). An AI system analyzed these exams yielding a level of suspicion of cancer present between 1 and 10. The detection performance between the radiologists and the AI system was compared using a noninferiority null hypothesis at a margin of 0.05.
RESULTS
The performance of the AI system was statistically noninferior to that of the average of the 101 radiologists. The AI system had a 0.840 (95% confidence interval [CI] = 0.820 to 0.860) area under the ROC curve and the average of the radiologists was 0.814 (95% CI = 0.787 to 0.841) (difference 95% CI = -0.003 to 0.055). The AI system had an AUC higher than 61.4% of the radiologists.
CONCLUSIONS
The evaluated AI system achieved a cancer detection accuracy comparable to an average breast radiologist in this retrospective setting. Although promising, the performance and impact of such a system in a screening setting needs further investigation.
Topics: Algorithms; Area Under Curve; Artificial Intelligence; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Image Processing, Computer-Assisted; Mammography; ROC Curve; Radiologists; Reproducibility of Results
PubMed: 30834436
DOI: 10.1093/jnci/djy222 -
Missouri Medicine 2014Screening for breast cancer with mammography has been shown in multiple randomized control trials to decrease breast cancer mortality. Despite this, there are ongoing... (Review)
Review
Screening for breast cancer with mammography has been shown in multiple randomized control trials to decrease breast cancer mortality. Despite this, there are ongoing controversies regarding the benefits and risks of mammographic screening. Different professional groups have published conflicting guidelines regarding when to start screening, how often to screen, and when to stop screening which have added to the confusion. In this article we describe the evidence supporting and challenging the efficacy of mammography and review our real world approach to breast cancer screening.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Middle Aged; Predictive Value of Tests; Randomized Controlled Trials as Topic; Reproducibility of Results
PubMed: 25438368
DOI: No ID Found -
Journal of Medical Radiation Sciences Sep 2020To investigate compliance to the '30% rule' and key factors which may influence visualisation of the pectoralis major muscle (PMM) on the craniocaudal (CC) view of the...
INTRODUCTION
To investigate compliance to the '30% rule' and key factors which may influence visualisation of the pectoralis major muscle (PMM) on the craniocaudal (CC) view of the breast.
METHODS
A retrospective review of 2688 paired full-field digital mammography (FFDM) CC view mammograms of women attending BreastScreen NSW between August and October 2015 was undertaken. PMM visualisation and measurements of PMM width and length, compressed breast thickness, the posterior nipple line (PNL) and age were recorded. Statistical analysis was performed using descriptive and inferential statistics to investigate associations between key breast measurements, age and PMM visualisation.
RESULTS
PMM visualisation was reported in 10.4% of images unilaterally (one breast, left or right only), 14.1% bilaterally (both left and right breasts) and 24.5% overall (unilateral and bilateral combined). There was little or no correlations between PMM length or width and age, breast compressed thickness or PNL. Multiple logistic regression analysis found that up to 15% of the variance in visualisation of the PMM was accounted for by the predictors overall. While some predictors provided a statistically significant contribution to the model, the contribution was small and the odds ratio for all predictors approximated 1.
CONCLUSION
This research could not replicate the '30% rule', and visualisation of the PMM was determined not to be influenced by the variables investigated. The significance of the 'rule' itself must be challenged where the vast majority of images (70-85%) do not comply, and there is no requirement for repeat imaging if the 'rule' is not met. Further research should be undertaken to validate this study including analysis of diagnostic images for comparison.
Topics: Breast; Humans; Image Processing, Computer-Assisted; Mammography; Pectoralis Muscles; Practice Guidelines as Topic
PubMed: 32567806
DOI: 10.1002/jmrs.404 -
Sao Paulo Medical Journal = Revista... 2011Mammography is the best method for breast-cancer screening and is capable of reducing mortality rates. Studies that have assessed the clinical impact of mammography have... (Comparative Study)
Comparative Study Meta-Analysis Review
CONTEXT AND OBJECTIVE
Mammography is the best method for breast-cancer screening and is capable of reducing mortality rates. Studies that have assessed the clinical impact of mammography have been carried out using film mammography. Digital mammography has been proposed as a substitute for film mammography given the benefits inherent to digital technology. The aim of this study was to compare the performance of digital and film mammography.
DESIGN
Systematic review and meta-analysis.
METHOD
The Medline, Scopus, Embase and Lilacs databases were searched looking for paired studies, cohorts and randomized controlled trials published up to 2009 that compared the performance of digital and film mammography, with regard to cancer detection, recall rates and tumor characteristics. The reference lists of included studies were checked for any relevant citations.
RESULTS
A total of 11 studies involving 190,322 digital and 638,348 film mammography images were included. The cancer detection rates were significantly higher for digital mammography than for film mammography (risk relative, RR = 1.17; 95% confidence interval, CI = 1.06-1.29; I² = 19%). The advantage of digital mammography seemed greatest among patients between 50 and 60 years of age. There were no significant differences between the two methods regarding patient recall rates or the characteristics of the tumors detected.
CONCLUSION
The cancer detection rates using digital mammography are slightly higher than the rates using film mammography. There are no significant differences in recall rates between film and digital mammography. The characteristics of the tumors are similar in patients undergoing the two methods.
Topics: Breast Neoplasms; Female; Humans; Mammography; Middle Aged; X-Ray Film
PubMed: 21971901
DOI: 10.1590/s1516-31802011000400009 -
Journal of Digital Imaging Oct 2018After years of development, the RadLex terminology contains a large set of controlled terms for the radiology domain, but gaps still exist. We developed a data-driven...
After years of development, the RadLex terminology contains a large set of controlled terms for the radiology domain, but gaps still exist. We developed a data-driven approach to discover new terms for RadLex by mining a large corpus of radiology reports using natural language processing (NLP) methods. Our system, developed for mammography, discovers new candidate terms by analyzing noun phrases in free-text reports to extend the mammography part of RadLex. Our NLP system extracts noun phrases from free-text mammography reports and classifies these noun phrases as "Has Candidate RadLex Term" or "Does Not Have Candidate RadLex Term." We tested the performance of our algorithm using 100 free-text mammography reports. An expert radiologist determined the true positive and true negative RadLex candidate terms. We calculated precision/positive predictive value and recall/sensitivity metrics to judge the system's performance. Finally, to identify new candidate terms for enhancing RadLex, we applied our NLP method to 270,540 free-text mammography reports obtained from three academic institutions. Our method demonstrated precision/positive predictive value of 0.77 (159/206 terms) and a recall/sensitivity of 0.94 (159/170 terms). The overall accuracy of the system is 0.80 (235/293 terms). When we ran our system on the set of 270,540 reports, it found 31,800 unique noun phrases that are potential candidates for RadLex. Our data-driven approach to mining radiology reports can identify new candidate terms for expanding the breast imaging lexicon portion of RadLex and may be a useful approach for discovering new candidate terms from other radiology domains.
Topics: Female; Humans; Mammography; Natural Language Processing; Radiology Information Systems; Research Report; Vocabulary, Controlled
PubMed: 29560542
DOI: 10.1007/s10278-018-0064-0 -
The Oncologist Feb 2014Solid evidence shows that screening mammography contributes to a substantial reduction in mortality from breast cancer, but it is far from a perfect test. Estimates of...
Solid evidence shows that screening mammography contributes to a substantial reduction in mortality from breast cancer, but it is far from a perfect test. Estimates of overdetection of breast cancer, based on extrapolation of SEER data, may suffer from considerable uncertainty because of major assumptions required in such calculations and the difficulty in correcting for confounding factors such as lead time and demographic variations. Some of the charged language used and the extreme positions taken in the discussion of screening distract from coherent communication of the complex issues surrounding this topic. More balanced discussion would better serve the public.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography
PubMed: 24536050
DOI: 10.1634/theoncologist.2014-0036 -
Radiologia 2019Breast tomosynthesis is a continually improving tool for diagnostic radiologists. This update about tomosynthesis reviews the advantages of the technique both in... (Review)
Review
Breast tomosynthesis is a continually improving tool for diagnostic radiologists. This update about tomosynthesis reviews the advantages of the technique both in patients with suspected or known disease and in screening, as well as its limitations, of which the dose of radiation is the most important. The more recent advent of synthesized mammography, computer-assisted detection, and tomosynthesis-guided biopsy have helped to reduce the dose of radiation used and have improved the diagnostic performance of tomosynthesis, so they are also discussed in this review.
Topics: Breast Neoplasms; Female; Humans; Mammography
PubMed: 30808510
DOI: 10.1016/j.rx.2019.01.002 -
Technology in Cancer Research &... Aug 2004Interest in digital radiography was stimulated by the enthusiastic acceptance of computed tomography in the early 1970s. It quickly became apparent to the medical... (Review)
Review
Interest in digital radiography was stimulated by the enthusiastic acceptance of computed tomography in the early 1970s. It quickly became apparent to the medical community that images with improved information content, whose display characteristics could be manipulated by the viewer, provided many advantages. Subsequently, digital systems for subtraction angiography and later for conventional projection radiography and fluoroscopy were developed. The timing of the introduction of these systems was highly dependent on the readiness of certain key component technologies to meet the requirements of each of these applications. These components are the x-ray detectors, analog to digital converters, computers, data storage systems and high-resolution electronic displays and printers used in image acquisition, storage and display. Mammography represents one of the most demanding radiographic applications, simultaneously requiring excellent contrast sensitivity, high spatial resolution, and wide dynamic range at as low as radiation dose to the breast as is reasonably achievable while meeting the other requirements. For this reason, it is one of the last radiographic procedures to "go digital". Here, some of the considerations related to the detector technology for digital mammography will be discussed and systems currently available will be described.
Topics: Breast; Humans; Image Processing, Computer-Assisted; Mammography; Models, Statistical; Phosphorus; Radiographic Image Enhancement; Sensitivity and Specificity; Statistics as Topic; X-Ray Intensifying Screens
PubMed: 15270582
DOI: 10.1177/153303460400300401