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2.
Ann Surg Oncol ; 28(12): 7421-7429, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34043094

RESUMO

BACKGROUND: Some subgroups of breast cancer patients receiving neoadjuvant chemotherapy (NACT) show high rates of pathologic complete response (pCR) in the breast, proposing the possibility of omitting surgery. Prediction of pCR is dependent on accurate imaging methods. This study investigated whether magnetic resonance imaging (MRI) is better than ultrasound (US) in predicting pCR in breast cancer patients receiving NACT. METHODS: This institutional, retrospective study enrolled breast cancer patients receiving NACT who were examined by either MRI or combined US and mammography before surgery from 2016 to 2019. Imaging findings were compared with pathologic response evaluation of the tumor. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for prediction of pCR were calculated and compared between MRI and US. RESULTS: Among 307 patients, 151 were examined by MRI and 156 by US. In the MRI group, 37 patients (24.5 %) had a pCR compared with 51 patients (32.7 %) in the US group. Radiologic complete response (rCR) was found in 35 patients (23.2 %) in the MRI group and 26 patients (16.7 %) in the US group. In the MRI and US groups, estimates were calculated respectively for sensitivity (87.7 % vs 91.4 %), specificity (56.8 % vs 33.3 %), PPV (86.2 % vs 73.8 %), NPV (60.0 % vs 65.4 %), and accuracy (80.1 % vs 72.4 %). CONCLUSIONS: In predicting pCR, MRI was more specific than US, but not sufficiently specific enough to be a valid predictor of pCR for omission of surgery. As an imaging method, MRI should be preferred when future studies investigating prediction of pCR in NACT patients are planned.


Assuntos
Neoplasias da Mama , Terapia Neoadjuvante , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante , Feminino , Humanos , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
3.
Sci Rep ; 11(1): 2259, 2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500440

RESUMO

Axillary lymph node status is an important prognostic factor for breast cancer patients and sentinel lymph node biopsy (SLNB) is a less invasive surgical proxy. We examined if consecutively derived molecular subtypes from primary breast cancers provide additional predictive value for SLNB status. 1556 patients with a breast cancer > 10 mm underwent primary surgical procedure including SLNB and tumor specimens were assigned with a transcriptomics-based molecular subtype. 1020 patients had a negative sentinel node (SN) and 536 a positive. A significant association between tumor size and SN status (p < 0.0001) was found across all samples, but no association between size and SN status (p = 0.14) was found for BasL tumors. A BasL subtype was a predictor of an SN-negative status (p = 0.001, OR 0.58, 95% CI 0.38;0.90) and among the BasL, postmenopausal status was a predictor for SN-negative status (p = 0.01). Overall survival was significantly lower (p = 0.02) in patients with BasL tumors and a positive SN. Interestingly, we identified a significant correlation between hormone receptor activity and SN status within the BasL subtype. Taken together, molecular subtypes and hormone receptor activity of breast cancers add predictive value for SLNB status.


Assuntos
Neoplasias da Mama/classificação , Neoplasias da Mama/patologia , Linfonodo Sentinela/patologia , Proteína BRCA1/metabolismo , Proteína BRCA2/metabolismo , Neoplasias da Mama/metabolismo , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Menopausa , Análise de Componente Principal , Receptores de Estrogênio/metabolismo , Análise de Sobrevida , Carga Tumoral
4.
Breast ; 54: 31-36, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32898786

RESUMO

The aim of this study was to analyse if breast cancer survivors without other breast imaging surveillance attend population-based screening differently than women not previously diagnosed with breast cancer. Further, to analyse if any differences depended on the women's age and years since previous cancer diagnosis. The study was a register-based retrospective cohort study of all women invited to participate in the national breast cancer screening programme in 2015-2016. Participation rates were calculated for breast cancer survivors without breast imaging within 21 months (2-4 years, 4-6 years, 6-10 years and more than 10 years after diagnosis) and for women without previous breast cancer. Relative differences in participation rates between the two groups were calculated. A total of 679,990 women were included in the study (2.6% breast cancer survivors). For breast cancer survivors, participation rates increased with increasing number of years since the previous cancer diagnosis peaking at 80.3% if the cancer diagnosis was more than 10 years ago. For women with no previous breast cancer, participation rate was 80.3%. The relative difference in participation was highest close to the breast cancer diagnosis and for the youngest women participation rates remained lower among breast cancer survivors even more than 10 years after the diagnosis. In conclusion, regardless of age and years since previous breast cancer diagnosis, breast cancer survivors had lower or similar participation rates than women with no previous cancer diagnosis. This indicated that as many as one fifth of the breast cancer survivors are at risk of inadequate surveillance.


Assuntos
Neoplasias da Mama/diagnóstico , Sobreviventes de Câncer/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Recidiva Local de Neoplasia/diagnóstico , Vigilância da População , Idoso , Dinamarca , Feminino , Humanos , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos
5.
Breast Cancer Res Treat ; 184(3): 891-899, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32862304

RESUMO

INTRODUCTION: Service breast cancer screening is difficult to evaluate because there is no unscreened control group. Due to a natural experiment, where 20% of women were offered screening in two regions up to 17 years before other women, Denmark is in a unique position. We utilized this opportunity to assess outcome of service screening. MATERIALS AND METHODS: Screening was offered in Copenhagen from 1991 and Funen from 1993 to women aged 50-69 years. We used difference-in-differences methodology with a study group offered screening; a historical control group; a regional control group; and a regional-historical control group, comparing breast cancer mortality and incidence, including ductal carcinoma in situ, between study and historical control group adjusted for changes in other regions, and calculating ratios of rate ratios (RRR) with 95% confidence intervals (CI). Data came from Central Population Register; mammography screening databases; Cause of Death Register; and Danish Cancer Register. RESULTS: For breast cancer mortality, the study group accumulated 1,551,465 person-years and 911 deaths. Long-term breast cancer mortality in Copenhagen was 20% below expected in absence of screening; RRR 0.80 (95% CI 0.71-0.90), and in Funen 22% below; RRR 0.78 (95% CI 0.68-0.89). Combined, cumulative breast cancer incidence in women followed 8+ years post-screening was 2.3% above expected in absence of screening; RRR 1.023 (95% CI 0.97-1.08). DISCUSSION: Benefit-to-harm ratio of the two Danish screening programs was 2.6 saved breast cancer deaths per overdiagnosed case. Screening can affect only breast cancers diagnosed in screening age. Due to high breast cancer incidence after age 70, only one-third of breast cancer deaths after age 50 could potentially be affected by screening. Increasing upper age limit could be considered, but might affect benefit-to-harm ratio negatively.


Assuntos
Neoplasias da Mama , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Dinamarca/epidemiologia , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Mamografia , Programas de Rastreamento , Sobremedicalização , Pessoa de Meia-Idade
6.
Cancer Med ; 9(16): 6042-6050, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32608178

RESUMO

BACKGROUND: Breast cancer survivors are increasing followed for new breast cancers / recurrences by mammography screening only. We aimed at assessing how often breast cancer survivors get a false positive or false negative result at mammography screening. METHODS: All mammography screenings performed between 2007 and 2017 in the Danish national mammography screening programme were included. Screenings in women with a breast cancer diagnosis prior to invitation were included in the "breast cancer survivors" group, while remaining screenings were included in the "no previous breast cancer" group. We compared the proportion of false positive screenings and the proportion of breast cancers detected at screening among breast cancer survivors and women without previous breast cancer. The analyses were further stratified according to whether the women had a diagnostic breast imaging in the 21 months prior to the screening. RESULTS: At initial screenings, breast cancer survivors had a significant lower false positive risk than other women, while the risk was similar at subsequent screenings. Breast cancer survivors had a significant lower proportion of breast cancers detected at screening compared to other women. This was true both for women who had a diagnostic breast imaging in the 21 months prior to screening and those who did not. CONCLUSION: This study shows that breast cancers survivors have a smaller amount of their new breast cancers detected at mammography screening, when compare to the amount of new breast cancers detected at mammography screening among women without previous breast cancer. The lower sensitivity does not seem to be due to different behavior among breast cancer survivors.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Sobreviventes de Câncer , Mamografia , Recidiva Local de Neoplasia/diagnóstico por imagem , Segunda Neoplasia Primária/diagnóstico por imagem , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Sobreviventes de Câncer/estatística & dados numéricos , Dinamarca/epidemiologia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Risco , Sensibilidade e Especificidade , Fatores de Tempo
7.
Clin Epidemiol ; 12: 509-518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32547242

RESUMO

Purpose: In this cross-sectional study, we evaluated the association between morbidity and participation in the prevalence round of the Danish national mammography screening program. Patients and Methods: Morbidity was assessed by the Charlson Comorbidity Index (CCI) score (0, 1-2, and ≥3) and by 19 individual diagnoses. We retrieved data on participation from The Danish Quality Database of Mammography Screening and on diagnoses from The Danish National Patient Registry. We estimated prevalence proportion ratios (PR) with 95% confidence intervals (CI). Results: In total, 519,009 (79.8%) women participated in the first national breast cancer screening round. Relative to women with a CCI score of 0, the adjusted PRs were 0.96 (95% CI: 0.95-0.96) for a CCI score of 1-2 and 0.80 (95% CI: 0.79-0.81) for a CCI score of ≥3. Compared with no disease, the PRs for a diagnosis of the most prevalent, but less severe diseases, chronic pulmonary disease, cerebrovascular disease, diabetes I and II were 0.93 (95% CI: 0.93-0.94), 0.96 (95% CI: 0.94-0.96), and 0.96 (95% CI: 0.95-0.97), respectively. Among women with low prevalent, but most severe diseases, the PRs were 0.69 (95% CI: 0.60-0.81) for AIDS and 0.73 (95% CI: 0.70-0.76) for metastatic solid tumor. Conclusion: Women with a high CCI score or one severe chronic condition are less likely to participate in breast cancer screening compared to women without disease. However, these women account for a small proportion of all non-participating women. Thus, it might be most beneficial to maximize breast cancer screening participation in women with less severe although more common morbidities.

8.
Eur J Radiol ; 127: 109019, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32361308

RESUMO

PURPOSE: Assessment of a woman's risk of breast cancer is essential when moving towards personalized screening. Breast density is a well-known risk factor and has the potential to improve accuracy of risk prediction models. In this study we reviewed the impact on model performance of adding breast density to clinical breast cancer risk prediction models. METHODS: We conducted a systematic review using a pre-specified search strategy for PubMed, EMBASE, Web of Science, and Cochrane Library from January 2007 until November 2019. Studies were screened using the Covidence software. Eligible studies developed or modified existing breast cancer risk prediction models applicable to the general population of women by adding breast density to the model. Improvement in discriminatory accuracy was measured as an increase in the Area Under the Curve or concordance statistics. RESULTS: Eleven eligible studies were identified by the search and one by reference check. Four studies modified the Gail model, four modified the Tyrer-Cuzick model, and five studies developed new models. Several methods were used to measure breast density, including visual, semi- and fully automated methods. Eleven studies reported discriminatory accuracy and one study reported calibration. Seven studies found a statistically significantly increased discriminatory accuracy when including density in the model. The increase in AUC ranged 0.03 to 0.14. Four studies did not report on statistical significance, but reported an increased AUC ranging from 0.01 to 0.06. CONCLUSION: Including mammographic breast density has the potential to improve breast cancer risk prediction models. However, all models demonstrated limited discrimination accuracy.


Assuntos
Densidade da Mama , Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Idoso , Mama/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Medição de Risco/métodos
9.
Cancer Med ; 9(11): 3995-4003, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32253821

RESUMO

BACKGROUND: Although breast cancer screening reduces breast cancer mortality at the population level, subgroups of women may benefit differently. We investigated the impact of health status on the effect of breast cancer screening. METHODS: The study included 181 299 women invited in two population-based screening programs in Denmark and 1 526 446 control subjects, followed from April 1981 to December 2014. Poisson regressions were used to compare the observed breast cancer mortality rate in women invited to screening with the expected rate in the absence of screening among women with and without chronic diseases. Chronic diseases were defined as any diagnosis in the Charlson Comorbidity Index during 4 years before the first invitation to screening. RESULTS: Almost 10% of women had chronic diseases before first invitation to screening. Whereas we observed a reduction in breast cancer mortality following invitation to screening of 28% (95% CI, 20% to 35%) among women without chronic diseases, only a 7% (95% CI, -39% to 37%) reduction was seen for women with chronic diseases (P-value for interaction = .22). For participants, the reduction, corrected for selection bias, was 35% (95% CI 16% to 49%) for women without, and 4% (95% CI -146% to 62%) for women with chronic diseases (P-value for interaction = .43). CONCLUSION: Our data indicate a marginal effect of mammography screening on breast cancer mortality in women with chronic diseases. If our results are confirmed in other populations, the presence of chronic diseases will be an important factor to take into consideration in personalized screening.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/métodos , Nível de Saúde , Mamografia/métodos , Idoso , Estudos de Casos e Controles , Doença Crônica , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida
10.
Acta Radiol ; 61(10): 1335-1342, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31979977

RESUMO

BACKGROUND: Recently, a new mammography system to perform contrast-enhanced mammography has become available in the market. For the high-energy acquisition, it uses a titanium filter instead of a copper one, reducing the tube load while maintaining image quality. PURPOSE: To retrospectively evaluate the accuracy of contrast-enhanced mammography with a titanium filter (TiCEM) in three readers with different grades of experience. MATERIAL AND METHODS: IRB-approved retrospective multicentric lesion by lesion study with 200 lesions, all of them initially classified as BI-RADS categories 0/3/4/5 on mammography and/or ultrasound and with pathological confirmation, in 135 patients. Three readers with different levels of experience (expert, resident, intermediate) blinded to the final diagnosis, retrospectively evaluated the low-energy (LE) images and the combination of LE and recombined (subtracted) images and classified the lesions according to the BI-RADS categories. Reader 1 also categorized the breast density. ROC curves were performed for each reader. RESULTS: Out of the 200 lesions, 82 were benign and 118 malignant (20 DCIS, 10 ILC, 88 IDC). The AUCs of LE versus TiCEM for were: Reader 1: 0.7 vs. 0.88, P < 0.001; Reader 2: 0.63 vs. 0.83, P < 0.001; and Reader 3: 0.63 vs. 0.84, P < 0.001. For the three readers, the AUCs of LE versus TiCEM were significantly superior in both dense and non-dense breasts (P < 0.001). Comparing the AUC of LE for Reader 1 (expert) versus the AUC of TiCEM for Reader 2 (resident) there were significant differences (0.7 vs. 0.83, P < 0.001). CONCLUSION: The accuracy of TiCEM was significantly better for all the readers, in both dense and non-dense breasts. The accuracy of a resident reading a TiCEM study was better than the accuracy of an expert radiologist reading LE images.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/instrumentação , Titânio/química , Idoso , Neoplasias da Mama/patologia , Meios de Contraste , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
J Clin Med ; 8(11)2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31752353

RESUMO

BACKGROUND: Attention in the 2000s on the importance of mammographic density led us to study screening sensitivity, breast cancer incidence, and associations with risk factors by mammographic density in Danish breast cancer screening programs. Here, we summarise our approaches and findings. METHODS: Dichotomized density codes: fatty, equal to BI-RADS density code 1 and part of 2, and other mixed/dense data from the 1990s-were available from two counties, and BI-RADS density codes from one region were available from 2012/13. Density data were linked with data on vital status, incident breast cancer, and potential risk factors. We calculated screening sensitivity by combining data on screen-detected and interval cancers. We used cohorts to study high density as a predictor of breast cancer risk; cross-sectional data to study the association between life style factors and density, adjusting for age and body mass index (BMI); and time trends to study the prevalence of high density across birth cohorts. RESULTS: Sensitivity decreased with increasing density from 78% in women with BI-RADS 1 to 47% in those with BI-RADS 4. For women with mixed/dense compared with those with fatty breasts, the rate ratio of incident breast cancer was 2.45 (95% CI 2.14-2.81). The percentage of women with mixed/dense breasts decreased with age, but at a higher rate the later the women were born. Among users of postmenopausal hormone therapy, the percentage of women with mixed/dense breasts was higher than in non-users, but the patterns across birth cohorts were similar. The occurrence of mixed/dense breast at screening age decreased by a z-score unit of BMI at age 13-odds ratio (OR) 0.56 (95% CI 0.53-0.58)-and so did breast cancer risk and hazard ratio (HR) 0.92 (95% CI 0.84-1.00), but it changed to HR 1.01 (95% CI 0.93-1.11) when controlled for density. Age and BMI adjusted associations between life style factors and density were largely close to unity; physical activity OR 1.06 (95% CI 0.93-1.21); alcohol consumption OR 1.01 (95% CI 0.81-1.27); air pollution OR 0.96 (95% 0.93-1.01) per 20 µg/m3; and traffic noise OR 0.94 (95% CI 0.86-1.03) per 10 dB. Weak negative associations were seen for diabetes OR 0.61 (95% CI 0.40-0.92) and cigarette smoking OR 0.86 (95% CI 0.75-0.99), and a positive association was found with hormone therapy OR 1.24 (95% 1.14-1.35). CONCLUSION: Our data indicate that breast tissue in middle-aged women is highly dependent on childhood body constitution while adult life-style plays a modest role, underlying the need for a long-term perspective in primary prevention of breast cancer.

12.
Breast Cancer Res ; 21(1): 111, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623646

RESUMO

BACKGROUND: Screening mammography works better in fatty than in dense breast tissue. Computerized assessment of parenchymal texture is a non-subjective method to obtain a refined description of breast tissue, potentially valuable in addition to breast density scoring for the identification of women in need of supplementary imaging. We studied the sensitivity of screening mammography by a combination of radiologist-assessed Breast Imaging Reporting and Data System (BI-RADS) density score and computer-assessed parenchymal texture marker, mammography texture resemblance (MTR), in a population-based screening program. METHODS: Breast density was coded according to the fourth edition of the BI-RADS density code, and MTR marker was divided into quartiles from 1 to 4. Screening data were followed up for the identification of screen-detected and interval cancers. We calculated sensitivity and specificity with 95% confidence intervals (CI) by BI-RADS density score, MTR marker, and combination hereof. RESULTS: Density and texture were strongly correlated, but the combination led to the identification of subgroups with different sensitivity. Sensitivity was high, about 80%, in women with BI-RADS density score 1 and MTR markers 1 or 2. Sensitivity was low, 67%, in women with BI-RADS density score 2 and MTR marker 4. For women with BI-RADS density scores 3 and 4, the already low sensitivity was further decreased for women with MTR marker 4. Specificity was 97-99% in all subgroups. CONCLUSION: Our study showed that women with low density constituted a heterogenous group. Classifying women for extra imaging based on density only might be a too crude approach. Screening sensitivity was systematically high in women with fatty and homogenous breast tissue.


Assuntos
Densidade da Mama , Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/métodos , Mamografia/métodos , Programas de Rastreamento/métodos , Vigilância da População/métodos , Idoso , Estudos de Coortes , Dinamarca , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
13.
Int J Cancer ; 145(11): 2954-2962, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30762225

RESUMO

High mammographic density is a well-known risk factor for breast cancer. This study aimed to search for a possible birth cohort effect on mammographic density, which might contribute to explain the increasing breast cancer incidence. We separately analyzed left and right breast density of Dutch women from a 13-year period (2003-2016) in the breast cancer screening programme. First, we analyzed age-specific changes in average percent dense volume (PDV) across birth cohorts. A linear regression analysis (PDV vs. year of birth) indicated a small but statistically significant increase in women of: 1) age 50 and born from 1952 to 1966 (left, slope = 0.04, p = 0.003; right, slope = 0.09, p < 0.0001); 2) age 55 and born from 1948 to 1961 (right, slope = 0.04, p = 0.01); and 3) age 70 and born from 1933 to 1946 (right, slope = 0.05, p = 0.002). A decrease of total breast volume seemed to explain the increase in PDV. Second, we compared proportion of women with dense breast in women born in 1946-1953 and 1959-1966, and observed a statistical significant increase of proportion of highly dense breast in later born women, in the 51 to 55 age-groups for the left breast (around a 20% increase in each age-group), and in the 50 to 56 age-groups for the right breast (increase ranging from 27% to 48%). The study indicated a slight increase in mammography density across birth cohorts, most pronounced for women in their early 50s, and more marked for the right than for the left breast.


Assuntos
Densidade da Mama , Neoplasias da Mama/epidemiologia , Mama/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Idoso , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Países Baixos , Análise de Regressão
14.
Acta Radiol ; 60(1): 13-18, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29665706

RESUMO

BACKGROUND: Early detection of breast cancer (BC) is crucial in lowering the mortality. PURPOSE: To present an overview of studies concerning computer-aided detection (CAD) in screening mammography for early detection of BC and compare diagnostic accuracy and recall rates (RR) of single reading (SR) with SR + CAD and double reading (DR) with SR + CAD. MATERIAL AND METHODS: PRISMA guidelines were used as a review protocol. Articles on clinical trials concerning CAD for detection of BC in a screening population were included. The literature search resulted in 1522 records. A total of 1491 records were excluded by abstract and 18 were excluded by full text reading. A total of 13 articles were included. RESULTS: All but two studies from the SR vs. SR + CAD group showed an increased sensitivity and/or cancer detection rate (CDR) when adding CAD. The DR vs. SR + CAD group showed no significant differences in sensitivity and CDR. Adding CAD to SR increased the RR and decreased the specificity in all but one study. For the DR vs. SR + CAD group only one study reported a significant difference in RR. CONCLUSION: All but two studies showed an increase in RR, sensitivity and CDR when adding CAD to SR. Compared to DR no statistically significant differences in sensitivity or CDR were reported. Additional studies based on organized population-based screening programs, with longer follow-up time, high-volume readers, and digital mammography are needed to evaluate the efficacy of CAD.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Mamografia/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Mama/diagnóstico por imagem , Feminino , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
15.
J Clin Oncol ; 36(30): 2988-2994, 2018 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-30179570

RESUMO

PURPOSE: Randomized, controlled trials showed that screening reduces breast cancer mortality rates, but some recent observational studies have concluded that programmatic screening has had minor effect on breast cancer mortality rates. This apparent contradiction might be explained by the use of aggregated data in observational studies. We assessed the long-term effect of screening using individual-level data. MATERIALS AND METHODS: Using data from mammography screening in the Copenhagen and Danish national registers, we compared the observed breast cancer mortality rate in women invited to screening with the expected rate in absence of screening. The effect was examined using the "naïve model," which included all breast cancer deaths; the "follow-up model," which counted only breast cancer deaths in women diagnosed after their first invitation to screening; and the "evaluation model," which is similar to the follow-up model during screening age, but after screening age, which counted only breast cancer deaths and person-years in women diagnosed during screening age. RESULTS: We included 18,781,292 person-years, 976,743 of which were from women invited to screening. The naïve and follow-up models showed, respectively, 10% and 11% reduction in breast cancer mortality after invitation to screening. However, many breast cancer deaths occurred in women whose cancer was diagnosed when they were no longer eligible for screening. Accounting for this dilution, the evaluation model showed a 20% (95% CI, 10% to 29%) reduction in breast cancer mortality after invitation to screening. CONCLUSION: Screening had a clear long-term beneficial effect with a 20% reduction in breast cancer-associated mortality in the invited population. However, this effect was, by nature, restricted to breast cancer deaths in women who could potentially benefit from screening. Our study highlights the complexity in evaluating the long-term effect of breast cancer screening from observational data.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/mortalidade , Detecção Precoce de Câncer/mortalidade , Programas de Rastreamento/mortalidade , Idoso , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade
16.
Cancer Causes Control ; 29(11): 1015-1025, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30194548

RESUMO

PURPOSE: Physical activity is a modifiable lifestyle risk factor in prevention of breast cancer. Mammographic density (MD) is a strong risk factor for breast cancer. We investigate the association of regular physical activity with MD. METHODS: For 5,703 women who participated in the Danish Diet, Cancer and Health cohort (1993-1997) and attended mammographic screening in Copenhagen (1993-2001), MD was assessed at the first screening after cohort entry. MD was defined as a binary measure equivalent to Breast Imaging Report and Data System (BI-RADS) to either mixed/dense or fatty. Participation and duration in physical activities (hours/week) and confounders were assessed by questionnaire at cohort baseline. Logistic regression was used to estimate associations [odds ratios (OR), 95% confidence intervals (CI)] between physical activities and MD. RESULTS: 56.3% of women had mixed/dense MD and 47.6% participated in sports. We found a significant positive association between participation in sports (OR 1.15; 95% CI 1.03-1.28) and do-it-yourself work (1.17; 1.05-1.31) and odds of having mixed/dense MD, which attenuated (1.08; 0.96-1.22 and 1.11; 0.98-1.25, respectively) in a fully adjusted model. No associations were found for time spent on physical activities or total metabolic equivalent of task scores with MD, in fully adjusted models. There was no effect modification of association between any physical activities and MD by obesity (BMI ≥ 30 kg/m2) and menopause status. CONCLUSIONS: Physical activity is not a determinant of MD.


Assuntos
Densidade da Mama , Exercício Físico , Mamografia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Estudos de Coortes , Dieta , Feminino , Humanos , Modelos Logísticos , Menopausa , Pessoa de Meia-Idade , Obesidade/epidemiologia , Razão de Chances , Fatores de Risco
17.
Ugeskr Laeger ; 180(33)2018 Aug 13.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30084348

RESUMO

Prostate artery embolisation (PAE) is a new minimally in-vasive treatment for prostate disease. Recent studies have shown, that PAE may be an alternative to transurethral resection of the prostate (TURP), and it reduces the prostate volume by 40%. The reduction in symptom score is com-parable to that of TURP, and only few major complications have been reported. The purpose of this narrative review is to provide a brief overview of the current literature on PAE.


Assuntos
Embolização Terapêutica/métodos , Hiperplasia Prostática/terapia , Angiografia Digital , Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Próstata/irrigação sanguínea , Próstata/diagnóstico por imagem , Hiperplasia Prostática/diagnóstico por imagem
18.
Breast Cancer Res Treat ; 171(3): 767-776, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29974357

RESUMO

PURPOSE: The currently recommended double reading of all screening mammography examinations is an economic burden for screening programs. The sensitivity of screening is higher for women with low breast density than for women with high density. One may therefore ask whether single reading could replace double reading at least for women with low density. We addressed this question using data from a screening program where the radiologists coded their readings independently. METHODS: Data include all screening mammography examinations in the Capital Region of Denmark from 1 November 2012 to 31 December 2013. Outcome of screening was assessed by linkage to the Danish Pathology Register. We calculated sensitivity, specificity, number of interval cancers, and false positive-tests per 1000 screened women by both single reader and consensus BI-RADS density code. RESULTS: In total 54,808 women were included. The overall sensitivity of double reading was 72%, specificity was 97.6%, 3 women per 1000 screened experienced an interval cancer, and 24 a false-positive test. Across all BI-RADS density codes, single reading consistently decreased sensitivity as compared with consensus reading. The same was true for specificity, apart from results across BI-RADS density codes set by reader 2. CONCLUSIONS: Single reading decreased sensitivity as compared with double reading across all BI-RADS density codes. This included results based on consensus BI-RADS density codes. This means that replacement of double with single reading would have negative consequences for the screened women, even if density could be assessed automatically calibrated to the usual consensus level.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer , Mamografia , Idoso , Densidade da Mama/fisiologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Dinamarca/epidemiologia , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade
19.
Breast ; 40: 177-180, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29906740

RESUMO

Papillomas of the female breast is a relatively frequent lesion, and the majority are benign when excised. However, some may host malignant or premalignant areas. Consequently, it is a worldwide accepted principle to excise the lesion whenever diagnosed. However, this leads to a large number of patients having an unnecessary operation. The present study was designed to investigate whether we could find clinical, radiological and pathological factors in the preoperative, diagnostic setting that could identify patients hosting a benign papilloma in order to avoid operation. The patient material consisted of 260 patients, all with a preoperative diagnosis of a papillomatous process in core biopsy. The lesion was excised, and 71% had a benign lesion. The rest had lesions ranging from premalignant to malignant. In the clinical, radiological and histopathological investigations conducted, we were not able to identify factors that statistically significant could predict whether the lesion was benign or malignant. However, our data showed a higher prevalence of malignant and premalignant lesions for older patient, larger lesions, and lesions found at a longer distance from the papilla. We conclude that, since almost 30% of the patients in our study ended up with a premalignant or malignant diagnosis, where no statistically significant preoperative factors could indicate a benign outcome, operation is warranted in all patients with a preoperative diagnosis of a papillomatous lesion.


Assuntos
Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Papiloma/diagnóstico , Adulto , Fatores Etários , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/patologia , Dinamarca , Feminino , Humanos , Pessoa de Meia-Idade , Papiloma/patologia , Sistema de Registros , Fatores de Risco
20.
Cancer Causes Control ; 29(6): 495-505, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29671181

RESUMO

PURPOSE: Hormone replacement therapy (HRT) use increases breast cancer risk and mammographic density (MD). We examine whether MD mediates or modifies the association of HRT with the breast cancer. METHODS: For the 4,501 participants in the Danish diet, cancer and health cohort (1993-1997) who attended mammographic screening in Copenhagen (1993-2001), MD (mixed/dense or fatty) was assessed at the first screening after cohort entry. HRT use was assessed by questionnaire and breast cancer diagnoses until 2012 obtained from the Danish cancer registry. The associations of HRT with MD and with breast cancer were analyzed separately using Cox's regression. Mediation analyses were used to estimate proportion [with 95% confidence intervals (CI)] of an association between HRT and breast cancer mediated by MD. RESULTS: 2,444 (54.3%) women had mixed/dense breasts, 229 (5.4%) developed breast cancer, and 35.9% were current HRT users at enrollment. Compared to never users, current HRT use was statistically significantly associated with having mixed/dense breasts (relative risk and 95% CI 1.24; 1.14-1.35), and higher risk of breast cancer (hazard ratio 1.87; 1.40-2.48). Association between current HRT use and breast cancer risk was partially mediated by MD (percent mediated = 10%; 95% CI 4-22%). The current HRT use-related breast cancer risk was higher in women with mixed/dense (1.94; 1.37-3.87) than fatty (1.37; 0.80-2.35) breasts (p value for interaction = 0.15). CONCLUSIONS: MD partially mediates some of the association between HRT and breast cancer risk. The association between HRT and breast cancer seems to be stronger in women with dense breasts.


Assuntos
Densidade da Mama , Neoplasias da Mama/diagnóstico , Terapia de Reposição Hormonal/efeitos adversos , Mamografia/métodos , Idoso , Mama/patologia , Estudos de Coortes , Dieta , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários
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