Trends in breast cancer screening and diagnosis

Abstract

Screening mammography is the single most effective method of early breast cancer detection and is recommended on an annual basis beginning at age 40 for women at average risk of breast cancer. In addition to traditional film-screen mammograms, digital mammograms now offer digital enhancement to aid interpretation, which is especially helpful in women with dense breast tissue. Useful emerging adjuncts to mammography include ultrasonography, which is particularly helpful for further assessment of known areas of interest, and magnetic resonance imaging, which shows promise for use in high-risk populations. Imageguided biopsy⎯directed by ultrasonograpy or stereotactic mammography views⎯plays a critical role in histologic confirmation of suspected breast cancer. E arly detection of breast cancer is vital to reducing the morbidity and mortality associated with this disease. After a brief overview of breast cancer epidemiology and risk assessment, this article describes screening and diagnostic imaging techniques as they are currently practiced to promote early breast cancer detection. We conclude with a review of image-guided needle biopsy techniques and a recommended approach to breast cancer screening in the general population. ■ EPIDEMIOLOGY OF BREAST CANCER: DAUNTING BUT SLOWLY IMPROVING After nonmelanoma skin cancers, breast cancer is the most common form of cancer in women today, accounting for more than 1 in 4 cancers diagnosed in US women. 1 If the current incidence of breast cancer remains constant, US females born today have an average risk of 12.7% of being diagnosed with breast cancer during their lifetime (ie, 1-in-8 lifetime risk), based on National Cancer Institute statistics. 2,3 The American Cancer Society estimated that 178,480 new cases of invasive breast cancer and 62,030 new cases of in situ breast cancer would be diagnosed in the United States in 2007, and that 40,460 US women would die from breast cancer that year. 1 Only lung cancer accounts for more cancer deaths in women. The role of race and ethnicity Breast cancer risk varies by race and ethnicity in the United States. After age 40 years, white women have a higher incidence of breast cancer compared with African American women; conversely, before age 40, African American women have a higher incidence compared with white women. African American women are more likely than their white counterparts to die from their breast cancer at any age. Incidence and death rates from breast cancer are lower among Asian American, American Indian, and Hispanic women compared with both white and African American women. 1 Recent hopeful trends Despite the daunting incidence numbers reviewed above, recent years have seen encouraging trends in US breast cancer epidemiology. For invasive breast cancer, the growth in incidence rates slowed during the 1990s, and rates actually declined by 3.5% per year during the period 2001-2004. 1 These changes are likely attributable to multiple factors, including variations in rates of mammography screening and decreased use of ...

Diagnostic accuracy of fused positron emission tomography/magnetic resonance mammography: initial results

“…Magnetic resonance mammography (MRM) is a valuable adjunct to conventional imaging methods, such as X-ray mammography and ultrasound, to determine the local operative treatment strategy for a primary breast cancer lesion [1,2]. It is well established that MRM is superior to X-ray mammography with and without concomitant ultrasound to define the local extent of breast cancer [3]; it is used both for the detection of breast cancer lesions that are occult on other imaging modalities [4,5] and for differential diagnosis of breast findings [6].…”

“…Hence, MRM has increasingly been used in clinical routine [7]. Notably, in contrast to its high sensitivity for the detection of breast cancer lesions and its high negative predictive value (NPV), MRM has been found to have a substantial rate of false-positive findings in breast cancer patients resulting in an only moderate specificity of approximately 65% [2,8]. These falsepositive findings, however, may lead to overtreatment in patients falsely characterised as multicentric or multifocal by MRI [3,9].…”

“…As a consequence, pre-operative biopsies are required in most cases to minimise the risk of overtreatment. Improving the specificity of MRM scans in the detection of breast cancer lesions would spare the patient the additional trauma of pre-operative invasive procedures [2,10].…”

Nachweis von Mikrokalk durch hochauflösende B-Mode-Sonographie bei BI-RADS-4a-Patientinnen

“…Derzeit ist die Röntgenmammographie zum Nachweis von Mikrokalk die einzig akzeptierte bildgebende Methode [20] . Seit Einführung der hochauflösenden B-Mode-Sonographie hat sich allerdings -bedingt durch die Anwendung einer höheren Ultraschallfrequenz und verschiedener Softwareverbesserungen -die Qualität der Mammasonographie enorm verbessert [21] .…”

Diagnostic power of diffuse reflectance spectroscopy for targeted detection of breast lesions with microcalcifications

“…X-ray mammography represents the current gold standard for screening methodologies and is extensively used to detect breast cancer at an early stage (prominently in women who are asymptomatic), where treatment is more effective and a cure is more probable (3,4). One of the primary features of diagnostic significance in mammograms is the presence of microcalcifications, which are tiny mineral deposits within the breast tissue and appear as small white spots on the X-ray film.…”