The views of older women towards mammographic screening: a qualitative and quantitative study

The views of older women towards mammographic screening: a qualitative and quantitative study
K Collins, M Winslow, M W Reed, S J Walters, T Robinson, J Madan, T Green, H Cocker and L Wyld
Br J Cancer 2010 102: 1461-1467

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There is a lack of knowledge about screening in older women. The majority felt that invitation to screening should be extended to the older age group regardless of age or health. The current under-utilised system of voluntary self-referral is not supported by older women

Cancer screening and preventative care among long-term cancer survivors in the United Kingdom

Cancer screening and preventative care among long-term cancer survivors in the United Kingdom
N F Khan, L Carpenter, E Watson and P W Rose
Br J Cancer 2010 102: 1085-1090

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Results: The cancer survivors’ cohort consisted of 18,612 breast, 5764 colorectal and 4868 prostate cancer survivors. Most cancer survivors receive cancer screening at the same levels as controls, except for breast cancer survivors who were less likely to receive a mammogram than controls (OR=0.78, 95% CI: 0.66–0.92). Long-term cancer survivors received comparable levels of influenza vaccinations and cholesterol tests, but breast (OR 0.81, 95% CI: 0.74–0.87) and prostate cancer survivors (OR=0.70, 95% CI: 0.57–0.87) were less likely to receive a blood pressure test. All survivors were more likely to receive bone densitometry.

Conclusion: The provision and uptake of preventive care in a primary care setting in the United Kingdom is comparable between the survivors of three common cancers and those who have not had cancer. However, long-term breast cancer survivors in this cohort were less likely to receive a mammogram

Long-term outcomes of breast cancer in women aged 30 years or younger, based on family history, pathology and BRCA1/BRCA2/TP53 status

Long-term outcomes of breast cancer in women aged 30 years or younger, based on family history, pathology and BRCA1/BRCA2/TP53 status
D G R Evans, A Moran, R Hartley, J Dawson, B Bulman, F Knox, A Howell and F Lalloo
Br J Cancer 2010 102:1091-1098

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Results: Survival analysis of all 288 patients showed poor overall survival, although this improved from a 15-year survival of only 46% in those diagnosed between 1980 and 1989 to 58% in those diagnosed between 1990 and 1997 (P=0.05). Contralateral breast cancer rates were at a steady rate of 0.6 per 1000, although the rates in mutation carriers were ~2 per 1000. Altogether, 16 BRCA1, 9 BRCA2 and 6 TP53 mutations have now been found among the 115 cases on whom DNA analysis has been performed. BRCAPRO accurately predicted the number of carriers for BRCA1 and BRCA2 and was sensitive and specific at the 10 and 20% threshold, respectively. However, BRCAPRO did not seem to give any weight to DCIS, which accounted for two BRCA1 carriers and three TP53 carriers and overpredicted mutations at the high end of the spectrum, with only 6 of 11 (54%) with a >90% probability having identifiable BRCA1/2 mutations

Conclusion: Rates of new primaries are predicted to some extent by mutation status. BRCAPRO is useful at determining those patients aged less than or equal to30 years to be tested

Assessment of residual tumour by FDG-PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced b

Assessment of residual tumour by FDG-PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced breast cancer
J Dose-Schwarz, R Tiling, S Avril-Sassen, S Mahner, A Lebeau, C Weber, M Schwaiger, F Jänicke, M Untch and N Avril
Br J Cancer 2010 102: 35-41

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FDG-PET does not provide an accurate assessment of residual tumour after primary chemotherapy of breast cancer. Magnetic resonance imaging offers the highest sensitivity, but all imaging modalities have distinct limitations in the assessment of residual tumour tissue when compared with histopathology

Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast

Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane Project
J Thomas, A Evans, J Macartney, S E Pinder, A Hanby, I Ellis, O Kearins, T Roberts, K Clements, G Lawrence and H Bishop on behalf of the Sloane Project Steering Group
Br J Cancer 2010 102: 285-293

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In a large series of screen-detected DCIS, we have shown that current approaches to preoperative imaging undersize the extent of disease in patients selected for BCS in up to 30% of cases, with the consequence of failed primary conservation surgery.
Further improvements in preoperative assessment should include detailed discussion between surgeon, radiologist and pathologist about radiological – pathological size correlation, particularly the extent of colocation of microcalcification and DCIS. Our data suggest that such discussion should be particularly targeted at intermediate and low-grade disease

Radiological staging in breast cancer: which asymptomatic patients to image and how

Radiological staging in breast cancer: which asymptomatic patients to image and how
T Barrett, D J Bowden, D C Greenberg, C H Brown, G C Wishart and P D Britton
Br J Cancer 2009 101: 1522-1528

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The findings from this Cambridge audit, prompted new local guidelines for staging asymptomatic breast cancer patients:

Only clinical stage III or IV patients require baseline investigation

The high specificity and convenience of computed tomography (chest, abdomen and pelvis including proximal femur) led us to recommend this as the investigation of choice in breast cancer patients requiring radiological staging

One-stop diagnostic breast clinics: how often are breast cancers missed?

One-stop diagnostic breast clinics: how often are breast cancers missed?
Britton, S W Duffy, R Sinnatamby, M G Wallis, S Barter, M Gaskarth, A O'Neill, C Caldas, J D Brenton, P Forouhi & G C Wishart
British Journal of Cancer (2009) 100, 1873 – 1878

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The aim of this study was to estimate the number of patients discharged from a symptomatic breast clinic who subsequently develop breast cancer and to determine how many of these cancers had been ‘missed’ at initial assessment. Over a 3-year period, 7004 patients were discharged with a nonmalignant diagnosis. Twenty-nine patients were subsequently diagnosed with breast cancer over the next 36 months. This equates to a symptomatic ‘interval’ cancer rate of 4.1 per 1000 women in the 36 months after initial assessment (0.9 per 1000 women within 12 months, 2.6 per 1000 women within 24 months). The lowest sensitivity of initial assessment was seen in patients of 40 – 49 years of age, and these patients present the greatest imaging and diagnostic challenge.

Following multidisciplinary review, a consensus was reached on whether a cancer had been missed or not. No delay occurred in 10 patients (35%) and probably no delay in 7 patients (24%). Possible delay occurred in three patients (10%) and definite delay in diagnosis (i.e., a ‘missed’ cancer) occurred in only nine patients (31%). The overall diagnostic accuracy of ‘triple’ assessment is 99.6% and the ‘missed’ cancer rate is 1.7 per 1000 women discharged

Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome

Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome
L E M Duijm, M W J Louwman, J H Groenewoud, L V van de Poll-Franse, J Fracheboud & J W Coebergh
Br J Cancer 2009 100: 901-907

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Twenty-one screening mammography radiographers and eight screening radiologists participated. A total of 106 093 screening mammograms were double-read by two radiographers and, in turn, by two radiologists. Initially, radiologists were blinded to the referral opinion of the radiographers. A woman was referred if she was considered positive at radiologist double-reading with consensus interpretation or referred after radiologist review of positive cases at radiographer double-reading.

We conclude that screener performance significantly varied at single-reading. Double-reading increased sensitivity by a relative 7.3%. When there is a shortage of screening radiologists, triple reading by one radiologist and two radiographers may replace radiologist double-reading.

Mammographic density, lobular involution, and risk of breast cancer

Mammographic density, lobular involution, and risk of breast cancer
O M Ginsburg, L J Martin & N F Boyd
Br J Cancer 2008 99: 1369-1374

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In this review, we propose that age-related changes in mammographic density and breast tissue involution are closely related phenomena, and consider their potential relevance to the aetiology of breast cancer. We propose that the reduction in mammographic density that occurs with increasing age, parity and menopause reflects the involution of breast tissue.

We further propose that age-related changes in both mammographic density and breast tissue composition are observable and measurable phenomena that resemble Pike's theoretical construct of 'breast tissue ageing'.

Extensive mammographic density and delayed breast involution are both associated with an increased risk of breast cancer and are consistent with the hypothesis of the Pike model that cumulative exposure of breast tissue to hormones and growth factors that stimulate cell division, as well as the accumulation of genetic damage in breast cells, are major determinants of breast cancer incidence

Assessment of 1183 screen-detected, category 3B, circumscribed masses by cytology and core biopsy with long-term follow up data

G Farshid, P Downey, P G Gill & S Pieterse
British Journal of Cancer (2008) 98, 1182-1190

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Discrete masses are commonly detected during mammographic screening and most such lesions are benign. For lesions without pathognomonically benign imaging features that are still regarded likely to be non-malignant (Tabar grade 3) reliable biopsy results would be a clinically useful alternative to mammographic surveillance.

The stepwise approach to the use of FNAB and core biopsy would reduce substantially the proportion of cases requiring surgical diagnostic biopsy. Given the low probability of malignancy and the imperative to limit the morbidity associated with cancer screening, the demonstration of the reliability of FNAB as a minimally invasive but highly accurate test for this particular subset of screen-detected lesions has significant clinical utility.

Second malignancies after breast cancer: the impact of different treatment modalities

Y M Kirova, Y De Rycke, L Gambotti, J-Y Pierga, B Asselain & A Fourquet for the Institut Curie Breast Cancer Study Group
British Journal of Cancer (2008) 98, 870-874

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Treatment for non-metastatic breast cancer (BC) may be the cause of second malignancies in long-term survivors. Our aim was to investigate whether survivors present a higher risk of malignancy than the general population according to treatment received.

We calculated age-standardized incidence ratios (SIRs) for each malignancy, using data for the general French population from five regional registries. At a median follow-up 10.5 years, 709 patients had developed a second malignancy. The greatest increases in risk were for leukaemia (SIR: 2.07 (1.52-2.75)), ovarian cancer (SIR: 1.6 (1.27-2.04)) and gynaecological (cervical/endometrial) cancer (SIR: 1.6 (1.34-1.89); P<0.0001). face="symbol">-0.95; P<0.007).

The increase in leukaemia was most strongly related to chemotherapy and that in gynaecological cancers to hormone therapy. Radiotherapy alone also had a significant, although lesser, effect on leukaemia and gynaecological cancer incidence. The increased risk of sarcomas and lung cancer was attributed to radiotherapy. No increased risk was observed for malignant melanoma, lymphoma, genitourinary, thyroid or head and neck cancer. There is a significantly increased risk of several kinds of second malignancy in women treated for BC, compared with the general population. This increase may be related to adjuvant treatment in some cases. However, the absolute risk is small.

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

M A Bollet, A Savignoni, J-Y Pierga, M Lae, V Fourchotte, Y M Kirova, R Dendale, F Campana, B Sigal-Zafrani, R Salmon, A Fourquet & A Vincent-Salomon
British Journal of Cancer (2008) 98, 734-741

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The literature reports low rates of breast conservation after neoadjuvant chemotherapy for operable breast cancers not amenable to initial breast-conserving surgery.

Clinical response to primary chemotherapy was significantly worse for lobular than for ductal carcinomas (47 vs 60%; P=0.04), but only histological grade remained predictive in multivariate analysis. Breast conservation was high for both ductal and lobular carcinomas (65 and 54%; P=0.07), due, in part, to the use of radiotherapy, either exclusive or preoperative, for respectively 26 and 40% of patients. The lobular type had no adverse effect, neither on locoregional control nor on overall survival, even in the group of patients treated with breast conservation.

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

M Bhattacharyya, D Ryan, R Carpenter, S Vinnicombe & C J Gallagher
British Journal of Cancer (2008) 98, 289-293
http://www.nature.com/bjc/journal/v98/n2/full/6604171a.html

Contrast-enhanced magnetic resonance imaging (MRI) was used to monitor the response of patients undergoing neoadjuvant chemotherapy for breast cancer with the aim of undergoing breast-conserving surgery (BCS). Magnetic resonance imaging appears to be superior to conventional methods for assessing pathological response and the low rate of re-operation for positive margins indicates a valuable role in aiding the decision to undergo BCS or mastectomy.

Early onset of breast cancer in a group of British black women

R L Bowen, S W Duffy, D A Ryan, I R Hart & J L Jones
British Journal of Cancer (2008) 98, 277-281
http://www.nature.com/bjc/journal/v98/n2/abs/6604174a.html

Black women had a higher frequency of grade 3 tumours, lymph node-positive disease, negative oestrogen receptor and progesterone receptor status and basal-like (triple negative status) tumours. There were no differences in stage at presentation; however, for tumours of 2 cm, black patients had poorer survival than white patients (HR=2.90, 95% CI 0.98-8.60, P=0.05). Black women presented, on average, 21 years younger than white women. Tumours in younger women were considerably more aggressive in the black population, more likely to be basal-like, and among women with smaller tumours, black women were more than twice as likely to die of their disease. There were no disparities in socioeconomic status or treatment received. Our findings could have major implications for the biology of breast cancer and the detection and treatment of the disease in black women