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
Link to Journal
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
Wednesday, 28 October 2009
Wednesday, 10 June 2009
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
Link to Journal
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
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
Link to Journal
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
Friday, 20 March 2009
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
Link to Journal
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.
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
Link to Journal
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.
Monday, 10 November 2008
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
Link to Journal
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
O M Ginsburg, L J Martin & N F Boyd
Br J Cancer 2008 99: 1369-1374
Link to Journal
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
Friday, 4 April 2008
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
Link to article
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.
British Journal of Cancer (2008) 98, 1182-1190
Link to article
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.
Thursday, 6 March 2008
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
Journal Link
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.
British Journal of Cancer (2008) 98, 870-874
Journal Link
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.
Tuesday, 19 February 2008
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
Link
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.
British Journal of Cancer (2008) 98, 734-741
Link
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.
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