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Screening tests using automated software showed higher recall and biopsy rates, as well as a higher probability of breast cancers detected by screening and interval, in women with dense breasts compared to breasts. unsuitable, according to the results of a retrospective study.
"The chances of breast cancer detected by screening and interval were substantially higher in women with mammographically dense breasts vs fat in BreastScreen Norway" Solveig Hofvind, PhD, of the faculty of health sciences at the Metropolitan University of Oslo, Norway, said in a press release. "We also found significantly higher rates of boosts and biopsies in women with dense mammary breast tissue."
The results may indicate how automated categorization of volumetric density will impact performance and population-based screening results by using an objective paradigm for measuring breast density, according to the researchers.
Studies have reported that women with mammographically dense breasts have increased risks of breast cancer and missed cancers than women with nonsense breasts.
Studies on mammographic density have focused on the association between subjective assessments of density and risk of breast cancer. However, few studies have used objective density measures for risk estimation and few have evaluated the quantitative measurement of breast density with respect to screening performance.
Since there is no standard for the determination of breast density, the most common classification for mammographic density is based on a subjective interpretation using the system's data and imaging data system. within the American College of Radiology.
In various parts of the United States, legislation requires women to be informed of their breast density or that additional imaging could be beneficial; however, additional screening for women with dense breasts is not recommended by larger companies or medical organizations.
Hofvind and colleagues sought to determine recall and biopsy rates, cancer detection rates, positive predictive values, sensitivity, specificity, histopathological features of the tumor,
the chances of breast cancer and the expected number of breast cancer cases according to the volumetric breast density categories.
"We hypothesized that screening tests for women with high volumetric breast density were associated with less favorable screening outcomes than those with low breast density," the researchers wrote in the report. ;study.
Researchers used automated software to categorize the mammographic density of 107,949 women aged 50 to 69 (mean age 58.7 years) enrolled in BreastScreen Norway – a national program that provides women with breast screening every 2 years. Each woman underwent an average of 2.8 screening tests during the study period, which represented 307,015 exams.
The researchers used Senographe DS or Senographe Essential (GE Medical Systems SCS) for full-field digital mammography and Volpara, version 1.5.1 (Volpara Solutions) to measure absolute density, breast volume, and volumetric breast density.
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Twenty-eight percent (n = 87,021) of the review classified dense breasts.
A greater proportion of women with dense breasts had recalls (3.6% vs. 2.7%) and needle biopsies due to abnormal screening (1.4% vs. 1%). , 1%; P <.0001 for both) that women with nonsense breasts.
The researchers reported an on-screen cancer rate of 5.5 per 1,000 exams (n = 1,210) in women with nonsense breasts and 6.7 per 1,000 exams (n = 581) in women with dense breasts (P <0.001).
The breast cancer rate per interval was 1.2 per 1,000 exams (n = 199 out of 165,324) among women with unsusceptible breasts compared to 2.8 per 1,000 exams (n = 185 66 674) in women with dense breasts (P <0.001).
The researchers reported a sensitivity of 82% in nonsense breasts and 71% in dense breasts, while the specificity was 98% and 97% (P <.0001 for both).
Among cancers detected by screening, mean tumor diameter was higher in women with dense breasts (16.6 mm vs. 15.1 mm; P = 0.009). In addition, a higher proportion of women with dense breasts had positive lymph node disease (24% versus 18%; P = 0.023) and HER-2-positive luminal B-type tumors (11% vs 7%; P = 0.007).
The researchers did not observe any significant differences in the tumor characteristics of breast cancer in women with an average tumor diameter (25.3 mm vs 24.1 mm), lymph node involvement (41% vs 44%) and a triple negative status (17% vs. 15%).
Overall, women with dense breasts had a 1.37-fold higher probability (95% CI, 1.19-1.59) of breast cancer detected by screening and 2.93 times (CI to 95%, 2.16-3.97) a higher probability of breast cancer.
"We need well-planned and high-quality studies that can prove the cost-effectiveness of more frequent screening, other screening tools like tomosynthesis and / or the use of 39; additional screening tools like MRI and ultrasound for women's breasts, "said Hofvind." In addition, we need studies on automated measurement tools for mammographic density in order to ensure their validity. "
This study is important because it validates that an automated means of density classification can correctly identify women with dense tissue, and because it shows that screening mammography has a lower performance for women having a dense tissue, Liane E. Philpotts, MD, FACR, Head of breast imaging and professor of radiology and biomedical imaging at Yale School of Medicine, wrote in an accompanying editorial.
"Breast cancer density is here to stay, and it is in everyone's interest to embrace the understanding and optimization of breast imaging practice to best meet the needs of breast imaging. needs of women with dense tissue, "Philpotts writes. – by Melinda Stevens
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Disclosure
s
: Hofvind is head of BreastScreen Norway. Please see the full study for a list of relevant financial disclosures from all other authors. HemOnc today could not confirm the relevant financial information of Philpotts at the time of publication.
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