NCCN Guidelines® Insights: Breast Cancer Screening and Diagnosis, Version 1.2023.

The NCCN Guidelines for Breast Cancer Screening and Diagnosis provide health care providers with a practical, consistent framework for screening and evaluating a spectrum of clinical presentations and breast lesions. The NCCN Breast Cancer Screening and Diagnosis Panel is composed of a multidisciplinary team of experts in the field, including representation from medical oncology, gynecologic oncology, surgical oncology, internal medicine, family practice, preventive medicine, pathology, diagnostic and interventional radiology, as well as patient advocacy. The NCCN Breast Cancer Screening and Diagnosis Panel meets at least annually to review emerging data and comments from reviewers within their institutions to guide updates to existing recommendations. These NCCN Guidelines Insights summarize the panel's decision-making and discussion surrounding the most recent updates to the guideline's screening recommendations.

Outcome of long term active surveillance for estrogen receptor-positive ductal carcinoma in situ.

INTRODUCTION: An option for active surveillance is not currently offered to patients with ductal carcinoma in situ (DCIS); however a small number of women decline standard surgical treatment for noninvasive cancer. The purpose of this study was to assess outcomes in a cohort of 14 well-informed women who elected non-surgical active surveillance with endocrine treatment alone for estrogen receptor-positive DCIS. METHODS: Retrospective review of 14 women, 12 of whom were enrolled in an IRB-approved single-arm study of 3 months of neoadjuvant endocrine therapy prior to definitive surgical management. The patients in this report withdrew from the parent study opting instead for active surveillance with endocrine treatment and imaging. RESULTS: 8 women had surgery at a median follow up of 28.3 months (range 10.1-70 months), 5 had stage I IDC at surgical excision, and 3 had DCIS alone. 6 women remain on surveillance without evidence of invasive disease for a median of 31.8 months (range 11.8-80.8 months). CONCLUSION: Long-term active surveillance for DCIS is feasible in a well-informed patient population, but is associated with risk of invasive cancer at surgical excision.

Performance parameters for screening and diagnostic mammography: specialist and general radiologists.

PURPOSE: To evaluate performance parameters for radiologists in a practice of breast imaging specialists and general diagnostic radiologists who interpret a large series of consecutive screening and diagnostic mammographic studies. MATERIALS AND METHODS: Data (ie, patient age; family history of breast cancer; availability of previous mammograms for comparison; and abnormal interpretation, cancer detection, and stage 0-I cancer detection rates) were derived from review of mammographic studies obtained from January 1997 through August 2001. The breast imaging specialists have substantially more initial training in mammography and at least six times more continuing education in mammography, and they interpret 10 times more mammographic studies per year than the general radiologists. Differences between specialist and general radiologist performances at both screening and diagnostic examinations were assessed for significance by using Student t and chi(2) tests. RESULTS: The study involved 47,798 screening and 13,286 diagnostic mammographic examinations. Abnormal interpretation rates for screening mammography (ie, recall rate) were 4.9% for specialists and 7.1% for generalists (P <.001); and for diagnostic mammography (ie, recommended biopsy rate), 15.8% and 9.9%, respectively (P <.001). Cancer detection rates at screening mammography were 6.0 cancer cases per 1,000 examinations for specialists and 3.4 per 1,000 for generalists (P =.007); and at diagnostic mammography, 59.0 per 1,000 and 36.6 per 1,000, respectively (P <.001). Stage 0-I cancer detection rates at screening mammography were 5.3 cancer cases per 1,000 examinations for specialists and 3.0 per 1,000 for generalists (P =.012); and at diagnostic mammography, 43.9 per 1,000 and 27.0 per 1,000, respectively (P <.001). CONCLUSION: Specialist radiologists detect more cancers and more early-stage cancers, recommend more biopsies, and have lower recall rates than general radiologists.

Computerized analysis of digitized mammograms of BRCA1 and BRCA2 gene mutation carriers.

PURPOSE: To evaluate, by using computer image analysis, the mammographic density patterns of women with germ-line mutations in BRCA1 and BRCA2 genes in comparison with those of women at low risk of developing breast cancer. MATERIALS AND METHODS: Mammograms from 30 carriers of BRCA1 and BRCA2 mutations and from 142 low-risk women were collected retrospectively and digitized. In addition, 60 of the 142 low-risk women were randomly selected and age matched at 5-year intervals with the 30 mutation carriers. Mammographic features were extracted from the central regions of the breast images to characterize the mammographic density and heterogeneity of dense portions of the breast. These features were then merged into a single value related to the risk of breast cancer by using linear discriminant analysis. The applicability of these computer-extracted features and the output from linear discriminant analysis to differentiate between the carriers of BRCA1 and BRCA2 mutations and the low-risk women in the entire database and in an age-matched group were evaluated by using receiver operating characteristic analysis. RESULTS: Quantitative analysis of mammograms demonstrated that carriers of BRCA1 and BRCA2 mutations tended to have dense breast tissue, and their mammographic patterns tended to be low in contrast, with a coarse texture. Linear discriminant analysis resulted in values of the areas under the receiver operating characteristic curve of 0.91 and 0.92 in distinguishing between the BRCA1 and BRCA2 mutation carriers and the low-risk women in the entire database and the age-matched group, respectively. CONCLUSION: The computerized analysis of mammograms suggests that mammographic patterns in carriers of BRCA1 and BRCA2 mutations differ from those of women at low risk for breast cancer. Our computer-extracted features may be useful as radiographic markers for identifying women at high risk for breast cancer.