Breast Cancer Screening Among Medically Underserved Women in New Mexico: Potential for Lower Recall Rates with Digital Breast Tomosynthesis.

Introduction: Digital breast tomosynthesis (DBT) may decrease recall rates (RRs) and improve positive predictive values (PPVs) and cancer detection rates (CDRs) versus full-field digital mammography (FFDM). The value of DBT has not been assessed in New Mexico's rural and minority population. Objectives of this study were to compare RRs, CDRs, and PPVs using FFDM+DBT versus FFDM in screening mammograms at the University of New Mexico between 2013 and 2016 and to qualitatively evaluate patient decision-making regarding DBT. Materials and Methods: RRs, CDRs, and PPVs with 95% confidence intervals and relative risk were calculated from 35,147 mammograms. The association between relative risk and mammography approach was tested using Pearson's chi-square test. Twenty women undergoing screening were interviewed for qualitative evaluation of decision-making. Results: From 2013 to 2016, RRs were 8.4% and 11.1% for FFDM+DBT and FFDM, respectively. The difference in RRs became more pronounced with time. No significant difference was observed in PPVs or CDRs. Qualitative interviews revealed that the majority had limited prior knowledge of DBT and relied on provider recommendations. Conclusion: In New Mexico women undergoing screening mammography, a 30% relative risk reduction in RRs was observed with FFDM+DBT. Qualitative interviews suggest that women are aware of and receptive to DBT, assuming adequate educational support. Clinical Trials.gov ID: NCT03979729.

Resection of giant pseudoangiomatous stromal hyperplasia: Expectant observation and avoidance of complex breast surgery.

INTRODUCTION: Pseudoangiomatous stromal hyperplasia (PASH) is a benign tumor of the breast that can achieve large, or even giant, dimensions. Resection of giant tumors can pose cosmetic challenges. CASE PRESENTATION: We report the prospective cosmetic outcome of a 31-year old female with a 21-cm PASH tumor of the right breast using simple excision through an inframammary approach. The patient was followed for 6 months before final cosmesis was established. Breast cosmesis was considered very good by both patient and physician. Mild external rotation of the nipple and mild contour changes involving the lateral aspect of the breast persisted at 6 months. DISCUSSION: Avoidance of more complex alternatives such as reduction mammoplasty and/or mastopexy was achieved by allowing the skin envelope to undergo natural involution over a period of six months. CONCLUSION: Inframammary simple excision of a giant PASH tumor is appropriate in select patients.