Increased Incidence of Breast Cancer in Postmenopausal Women with High Body Mass Index at the Modena Screening Program.

PURPOSE: We conducted a study to evaluate the relationship between body mass index (BMI) and the risk of breast cancer (BC) and outcome in a population of 14,684 women aged 55 to 69 years eligible to participate in the Mammography Screening Program (MSP) in the Province of Modena, Italy. METHODS: The study population was drawn from women who underwent mammography screening between 2004 and 2006 in the Province of Modena. Women were subdivided into obese, overweight, and normal-weight categories according to BMI and followed until July 31, 2010, to evaluate the BC incidence. The clinicopathological characteristics of BC were also evaluated in different groups of patients classified according to BMI. After BC diagnosis, patients were followed for a median period of 65 (range, 2-104) months. Second events (recurrences and second tumors) were recorded, and the 5-year event-free survival (EFS) was calculated. RESULTS: After a period of 73 months, 366 cases of BC were diagnosed. Compared with normal-weight women, obese women had a significantly higher incidence of BC (relative risk [RR], 1.32; p=0.040) (RR=1), larger tumors (27% of tumors were larger than T2 size), and more nodal involvement (38.5% of tumors were node-positive). Furthermore, a significantly higher rate of total events was seen in obese women compared with overweight and normal-weight patients, respectively (17.9% vs. 11.4% vs. 10.8%, p=0.032). The 5-year EFS was 89.0%, 89.0%, and 80.0% for normal-weight, overweight, and obese patients, respectively. CONCLUSION: We observed a significantly higher risk of BC in obese women among those eligible to participate in the MSP in the Province of Modena. Finally, obese women had more second events and poorer EFS compared to nono bese women.

Physical and psychophysical characterization of a novel clinical system for digital mammography.

PURPOSE: In recent years, many approaches have been investigated on the development of full-field digital mammography detectors and implemented in practical clinical systems. Some of the most promising techniques are based on flat panel detectors, which, depending on the mechanism involved in the x-ray detection, can be grouped into direct and indirect flat panels. Direct detectors display a better spatial resolution due to the direct conversion of x rays into electron-hole pairs, which do not need an intermediate production of visible light. In these detectors the readout is usually achieved through arrays of thin film transistors (TFTs). However, TFT readout tends to display noise characteristics worse than those from indirect detectors. To address this problem, a novel clinical system for digital mammography has been recently marketed based on direct-conversion detector and optical readout. This unit, named AMULET and manufactured by FUJIFILM, is based on a dual layer of amorphous selenium that acts both as a converter of x rays (first layer) and as an optical switch for the readout of signals (second layer) powered by a line light source. The optical readout is expected to improve the noise characteristics of the detector. The aim is to obtain images with high resolution and low noise, thanks to the combination of optical switching technology and direct conversion with amorphous selenium. In this article, the authors present a characterization of an AMULET system. METHODS: The characterization was achieved in terms of physical figures as modulation transfer function (MTF), noise power spectra (NPS), detective quantum efficiency (DQE), and contrast-detail analysis. The clinical unit was tested by exposing it to two different beams: 28 kV Mo/Mo (namely, RQA-M2) and 28 kV W/Rh (namely, W/Rh). RESULTS: MTF values of the system are slightly worse than those recorded from other direct-conversion flat panels but still within the range of those from indirect flat panels: The MTF values of the AMULET system are about 45% and 15% at 5 and 8 lp/mm, respectively. On the other hand, however, AMULET NNPS results are consistently better than those from direct-conversion flat panels (up to two to three times lower) and flat panels based on scintillation phosphors. DQE results lie around 70% when RQA-M2 beams are used and approaches 80% in the case of W/Rh beams. Contrast-detail analysis, when performed by human observers on the AMULET system, results in values better than those published for other full-field digital mammography systems. CONCLUSIONS: The novel clinical unit based on direct-conversion detector and optical reading presents great results in terms of both physical and psychophysical characterizations. The good spatial resolution, combined with excellent noise properties, allows the achievement of very good DQE, better than those published for clinical FFDM systems. The psychophysical analysis confirms the excellent behavior of the AMULET unit.

Prognosis of screen-detected breast cancers: results of a population based study.

BACKGROUND: The reduced mortality rate from breast carcinoma among women offered screening mammography is demonstrated after 15-20 years of follow-up. However, the assessment of 5-year overall and event-free survival could represent an earlier measure of the efficacy of mammography screening program (MSP). METHODS: All cases of breast cancer diagnosed in the Province of Modena between years 1996 and 2000 in women aged 50 to 69 years, were identified through the Modena Cancer Registry (MCR). Stage of disease and treatment information were obtained from clinical records. All the events occurring up to June 30, 2003 were retrieved by experienced monitors. Five-year overall and event-free survival were the principal end-points of the study. RESULTS: During a 5-year period, 587 primary breast cancers were detected by the MSP and 471 primary breast cancers were diagnosed out of the MSP. The screen-detected breast cancers were smaller, more likely node negative, with low histological grade, low proliferative activity and positive receptors status. Furthermore, the breast cancer diagnosed through the MSP more frequently received a conservative surgery. The 5-year survival rate was 94% in the screen-detected group, versus 84% in the other group (p = 0.0001). The rate of 5-year event-free survival was 89% and 75% for the MSP participants and not participants, respectively (p = 0.0001). CONCLUSIONS: Our data confirm a favourable outcome of screen-detected breast cancers in terms of five-year overall and event-free survival, which reflect the good quality assurance parameters of the MSP. Finally, a cancer registry should be implemented in every area covered by screening programs.

Changes in breast cancer incidence and stage distribution in Modena, Italy: the effect of a mammographic screening program.

OBJECTIVE: Assessing changes in breast cancer (BC) incidence and stage distribution in the District of Modena, Italy, during the period 1992-1998, and their relationship to a mammographic screening program launched in 1995. METHODS: Demographic, clinical, and pathological data of all BC cases reported to the population-based Modena Cancer Registry between 1992 and 1998 were collected and linked to the screening database. RESULTS: A total of 3429 women were diagnosed with BC in the District of Modena between 1992 and 1998. In this period the incidence rate increased by 15.7% (from 134.3 in 1992 to 155.4 per 100,000 in 1998). The increase began in 1995 and exclusively included women aged 50-69; the incidence rose by 30.4%. Moreover, the rise was confined to early tumors, with more than half (54%) of all cases reported in 1998 diagnosed as stage 0 or I disease, compared with 42% in 1992. Screen-detected tumors were significantly smaller (13.2 mm) than other tumors diagnosed in women aged 50-69 (18.5 mm), with 46% of screen-detected tumors smaller than 10 mm. Overall, a decline in the average tumor diameter was shown (from 20.2 mm in 1992-1994 to 18 mm in 1996-1998). CONCLUSIONS: Our data confirm that mammographic screening leads to an increase in the incidence of early-stage BC cancers.