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Posts Tagged ‘Mammography’

Mammography is less effective in breast cancer detection in women in their forties, concluded a recent study published recently in The Journal of the National Cancer Institute.

It is already known that mammography screening outcomes in women less than 50yrs is poorer when compared to older women and the main suggested attributes are lesser mammogram sensitivity in younger women due to dense breast tissue and faster tumor growth in younger women.

Sylvia K. Plevritis and colleagues from the of the Department of Radiology at the Stanford University School of Medicine investigated to determine which factor contributes most to the poor mammography outcomes. They used a computer simulated model to estimate and compare the relative effect of biology and technology on mammograms of women in their forties with those in fifties and sixties.

The researchers found that from their simulation model (Breast Cancer Screening Simulator) that lowered mammographic tumor detectability accounted for 79% and faster tumor volume doubling time accounted for 21% of the poorer sensitivity in mammography screening among younger women, compared with older women.

“The age-specific differences in mammographic tumor detection contribute more than age-specific differences in tumor growth rates to the lowered performance of mammography screening in younger women,” according to the authors.

The latest Texas MD Anderson Cancer Center research reveal that,PEM scanners with high-resolution breast PET systems are able to assess early Neoadjuvant Chemotherapy signs. The research work was produced at the American Association of Cancer Research Annual Meeting in Washington, DC, by the University of Texas MD Anderson Cancer Center.

Positron Emission Mammography ( PEM ) scanners containing high-resolution breast PET systems, are capable of identifying the location and the metabolic phase of a lesion. The report is cruicial in evaluating a lesion’s malignancy and its effect on the process of patient care. Unfortunately, Mammography and ultrasound imaging systems are only confined to projection of their location and not the metabolic phase.

Dr. Wei Yang, Associate Professor of Radiology at the University of Texas MD Anderson Cancer Center in Houston and her team of researchers discovered that, PEM or Positron Emission Mammography capacitates medical practitioners to detect a patient’s reaction to neoadjuvant medical therapy, at an early stage. Neoadjuvant Chemotherapy is commonly a cancer treatment where the patient is medicated with a drug for the reduction of the size of a tumor before the surgery is conducted.

9 patients with HER2 over-expressing Inflammatory Breast Cancer (IBC) in a Phase II neoadjuvant trial of lapatinib were absorbed in the study over a period of 14 days with chemotherapy following suit. Baseline tumor measurements on mammography, sonography, PEM and PET/CT scans with serial biopsies were taken. The PEM and biopsies were again conducted on the 14 the day. Standardized uptake value (SUV) and Quantification of tumor activity known as PEM uptake value (PUV) were compared for PET/CT pre- and post-lapatinib and correlated with tumor size and proliferation marker Ki67.

The outcome of the study said, critical early recede in PUV as a functional reaction to targeted therapy makes PEM as an early evaluator of patient response of the Neoadjuvant Cancer treatment therapy. Look forward to further peer-reviews as and when the surgical results of the patients are published.

“The high spatial resolution of PEM combined with functional quantification tools has the potential to assess tumor response early in the course of treatment,” said Dr. Yang, lead author on the study. “The ability to perform correlative studies that may help discover early on if targeted therapy is working or not will potentially save a patient from enduring the wrong type of neoadjuvant chemotherapy and enable a timely switch to the right one.”

A study finds that surgeons specially trained to perform breast cancer surgeries can interpret a mammogram as good as a trained breast radiologist and they provide an excellent alternative to meet the shortage of radiologists.

The findings of the study, titled ‘Surgeon-Read Screening Mammography: An Analysis of 10 020 Examinations,’ was presented at the 11th Annual Meeting of the American Society of Breast Surgeons.

The objective of the study was to determine whether the reading performance of breast surgeons can be compared to that of mammography radiologists.

The prospective research involved 13 622 mammograms read at a dedicated, surgeon-run breast health centre between January 2003 and June 2009.

Mammograms were conducted according to conventional mammography guidelines by certified technicians on state of the art film-screen and from July 2006 on full-field digital equipment.

All the mammograms were double read by two experienced breast surgeons and the findings were catagorised according to BIRADS.

The study concluded that the findings of the breast surgeons were equivalent to that in organized national screening programs run by specialized breast radiologists in Europe and Australia. With fewer recalls, a lower biopsy rate with a higher malignancy rate of biopsy and a high cancer detection rate, they were better than highly skilled radiologists in the United States.

This study provide a first benchmark for surgeon-read screening mammography.

“These findings suggest that the ability to precisely analyze breast images is enhanced by both ongoing experience and specialized training,” comments Justus Apffelstaedt, MD, FCS (SA), Associate Professor of Surgery and Head: Breast Clinic, University of Stellenbosch, chief author of the study, who practices at the South African site. He added that, ‘Breast surgeons review large numbers of breast images as part of their ongoing treatment planning and delivery.  Now, this study shows that with appropriate training, they prove to be highly accurate primary mammography interpreters.’

Women with higher density on a mammogram has higher risk (four to five times) of developing breast cancer, opined the researchers who presented data regarding this during the Annual Meeting of the American Association for Cancer Research.

The presentation included data from three studies on latest research regarding mammographic density. The following two studies in the presentation indicate that mammographic breast density is an indicator of breast cancer risk.

1. Longitudinal breast density and risk of breast cancer: The study was conducted at the Mayo Clinic, Rochester,  and lead by Celine M. Vachon, Ph.D., associate professor of epidemiology in the College of Medicine and colleagues. They evaluated from data collected for Mayo Mammography Health Study, which included 19,924 women who had a mammogram at the Mayo Clinic between 2003 and 2006; the women were above 35 years and didnt have a history of breast cancer. The researchers evaluated whether change in breast density is associated with breast cancer and found that women who had an increase in breast density over six years has a higher risk (28 percent) of developing breast cancer. And it is likely that women with decreasing density has lower risk.

2. Change in mammographic density with estrogen and progestin therapy: A measure of breast cancer risk in the Women’s Health Initiative : Celia Byrne, Ph.D.and colleagues at the Lombardi Comprehensive Cancer Center at Georgetown University found that Change in mammographic density may be a useful intermediate marker to explain the increased breast cancer risk among postmenopausal women using estrogen and progestin therapy (EPT). The case-control study was conducted within the Women’s Health Initiative (WHI) randomized trial of EPT.

Mammography, which is basically an x-ray of the breast, is the gold standard for breast cancer screening and the American Cancer Society recommends yearly screening mammograms for all women aged above 40yrs of age. The new research has added a new dimension in the advantages of a mammogram, ie not just early breast cancer detection but also identification of potential risk of developing breast cancer later.

A new study finds that women who does not undergo annual mammographic screening have higher rate of detection of breast cancer as palpable breast tumors, which are at an advanced stage when compared to cancers detected by mammography screening.

The study supports the benefits of yearly screening mammographyas well as clinical breast examination (CBE) and breast self-examinationat in early detection of breast cancer. Thus it contradicts the new U.S Preventative Services Task Force (USPSTF) recommendations – biennial mammography screening starting at 50yrs, discouraging teaching breast self examination and that current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE).

“Presentation as a palpable mass was more frequent in those women who had not had a mammogram in the prior 12 months. This finding is even more concerning when you consider the recent recommendations for decreasing the use of mammography because it would result in an even greater proportion of breast cancers being detected by palpation and therefore at more advanced stages.”said Judy Boughey, MD, FACS, assistant professor of surgery, Mayo Clinic, Rochester, MN, and a co-investigator of the study.

The study investigator is Dr. Amy C. Degnim, MD, FACS, associate professor of surgery, Mayo Clinic and the findings of the study are published in the March issue of the Journal of the American College of Surgeons.