Digital Breast Tomosynthesis + Synthetic 2D Mammography Detects More Breast Cancers

MedicalResearch.com Interview with:
Dr. Solveig Hofvind, Dr. Philos.
Cancer Registry of Norway
Majorstuen, Oslo

MedicalResearch.com: What is the background for this study?

Response: To test out Digital Breast Tomosynthesis (DBT) in combination with synthethic images (SM) as a screening tool for breast cancer.

We screened the women in Oslo with DBT+SM using equipment from Hologic, while women in the neighboring counties were screened with Digital Mammography.

MedicalResearch.com: What are the main findings? 

Response: We found a 50% higher rate of screen-detected breast cancer among women screened with DBT+SM compared with  Digital Mammography

Both the rate of invasive breast cancer and ductal carcinoma in situ was higher. Tumors detected with DBT+SM were smaller and less aggressive compared to those detected with Digital Mammography.
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We found no differences in recall rates between the two groups.

MedicalResearch.com: What should readers take away from your report?

Response: Screening with Digital Breast Tomosynthesis and Synthetic 2D Mammography detects more breast cancer as Digital Mammography. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We need to follow the women for interval breast cancer, but also the rate of screen-detected breast cancer and the characteristics of the tumors in the next screening round. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The pro and cons of implementing Digital Breast Tomosynthesis and Synthetic 2D Mammography in a screening setting need further investigation, according to cost-effectiveness, also in a financial perspective. 

Citations: 

Radiology. 2018 Mar 1:171361. doi: 10.1148/radiol.2018171361. [Epub ahead of print]

Digital Breast Tomosynthesis and Synthetic 2D Mammography versus Digital Mammography: Evaluation in a Population-based Screening Program.

Hofvind S1, Hovda T1, Holen ÅS1, Lee CI1, Albertsen J1, Bjørndal H1, Brandal SHB1, Gullien R1, Lømo J1, Park D1, Romundstad L1, Suhrke P1, Vigeland E1, Skaane P1. 

 

 

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Mammograms Reduce Mortality From Higher Grade Breast Cancers

MedicalResearch.com Interview with:

Prof-Stephen-Duffy.jpg

Prof. Duffy

Stephen W. Duffy
Professor of Cancer Screening
Wolfson Institute of Preventive Medicine,
Barts and The London School of Medicine and Dentistry
Queen Mary University of London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The phenomenon of length bias, whereby screening has more chance of detecting slow growing tumours, has been known about for some years. This has led some colleagues to speculate that breast cancer screening only benefits those with slow-growing, less aggressive cancers, and does not reduce deaths from more aggressive, rapidly progressing cancers.

In this study, we addressed this question directly using data from a randomised trial of mammographic screening. We calculated the reduction in mortality from grade 1 (less aggressive), grade 2 (intermediate) and grade 3 (most aggressive) cancers, as a result of screening. We found that the greatest reduction in breast cancer mortality was from the aggressive, fast-growing grade 3 cancers, contrary to what had been suspected.  Continue reading

Machine Learning Applied To Predicting High-Risk Breast Lesions May Reduce Unnecessary Surgeries

MedicalResearch.com Interview with:

Manisha Bahl, MD, MPH Director, Breast Imaging Fellowship Program, Massachusetts General Hospital Assistant Professor of Radiology, Harvard Medical School

Dr. Bahl

Manisha Bahl, MD, MPH
Director, Breast Imaging Fellowship Program,
Massachusetts General Hospital
Assistant Professor of Radiology,
Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Image-guided biopsies that we perform based on suspicious findings on mammography can yield one of three pathology results: cancer, high-risk, or benign. Most high-risk breast lesions are noncancerous, but surgical excision is typically recommended because some high-risk lesions can be upgraded to cancer at surgery. Currently, there are no imaging or other features that reliably allow us to distinguish between high-risk lesions that warrant surgery from those that can be safely followed, which has led to unnecessary surgery of high-risk lesions that are not associated with cancer.

We decided to apply machine learning algorithms to help us with this challenging clinical scenario: to distinguish between high-risk lesions that warrant surgery from those that can be safely followed. Machine learning allows us to incorporate the full spectrum of diverse and complex data that we have available, such as patient risk factors and imaging features, in order to predict which high-risk lesions are likely to be upgraded to cancer and, ultimately, to help our patients make more informed decisions about surgery versus surveillance.

We developed the machine learning model with almost 700 high-risk lesions, then tested it with more than 300 high-risk lesions. Instead of surgical excision of all high-risk lesions, if those categorized with the model to be at low risk for upgrade were surveilled and the remainder were excised, then 97.4% malignancies would have been diagnosed at surgery, and 30.6% of surgeries of benign lesions could have been avoided.

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No Magic Age To Stop Performing Screening Mammograms

MedicalResearch.com Interview with:
Cindy S. Lee, MD

Department of Radiology and Biomedical Imaging
University of California, San Francisco, San Francisco
Now with Department of Radiology
NYU Langone Medical Center, Garden City, New York

MedicalResearch.com: What led you and colleagues to conduct this study?

Response: I am a breast imager. I see patients who come in for their screening mammograms and I get asked, a lot, if patients aged 75 years and older should continue screening, because of their age. There is not enough evidence out there to determine how breast cancer screening benefits women older than 75. In fact, all previously randomized trials of screening mammography excluded people older than 75 years.

Unfortunately, age is the biggest risk factor for breast cancer, so as patients get older, they have higher risks of developing breast cancer. It is therefore important to know how well screening mammography works in these patients.

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Doctors Continue To Order Mammograms Outside of Current Age Guidelines

MedicalResearch.com Interview with:
Archana Radhakrishnan MD MHS
Division of General Internal Medicine
Johns Hopkins University
Baltimore, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We were interested in understanding the current practice trends in breast cancer screening recommendations by doctors in light of the guideline changes.  We performed a national survey of primary care providers and gynecologists asking about their breast cancer screening practices.

We found that a large number of doctors recommend breast cancer screening to younger and older women—upwards of 80% of doctors recommend it for younger women (ages 40-44) and almost 70% for women 75 and older.  But this varies by the type of doctor that a woman see.  Gynecologists were, in general, more likely to recommend routine mammograms.

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False Positive Mammograms Can Lead Women To Delay or Skip Next Exam

MedicalResearch.com Interview with:

Mammogram showing small lesion - Wikipedia

Mammogram showing small lesion
– Wikipedia

Firas Dabbous, PhD
Manager, Patient Centered Outcomes Research
Russell Institute for Research & Innovation
Advocate Lutheran General Hospital
Park Ridge, IL 

MedicalResearch.com: What is the background for this study?

Response: When women are told that there is something abnormal on their screening mammogram that can cause stress and worry while undergoing additional testing, even when they are later told that there is nothing wrong. We wanted to know if receiving a false positive screening mammogram would cause women to think twice before getting their next screening mammogram, and maybe delay coming back for their next screen. This is important because patients who have a false positive experience may have higher chance to develop breast cancer at a later point in time. Therefore, it is important to understand their screening patterns to better educate and inform them about the importance of adhering to mammography guidelines and emphasize the importance of returning on schedule for their next screens.

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ACA: Screening Disparities Fall For Mammograms But Not Colonoscopies

MedicalResearch.com Interview with:

Dr. Gregory Cooper, MD Program Director, Gastroenterology, UH Cleveland Medical Center Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center Professor, Medicine, CWRU School of Medicine Co-Program Leader for Cancer Prevention and Control UH Seidman Cancer Center

Dr. Gregory Cooper

Dr. Gregory Cooper, MD
Program Director, Gastroenterology
UH Cleveland Medical Center
Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center
Professor, Medicine, CWRU School of Medicine
Co-Program Leader for Cancer Prevention and Control
UH Seidman Cancer Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Affordable Care Act, among other features, removed out of pocket expenses for approved preventive services, and this may have served as a barrier to cancer screening in socioeconomically disadvantaged individuals. If so, then the gap in screening between socioeconomic groups should narrow following the ACA.

The main findings of the study were that although in the pre-ACA era, there were disparities in screening, they narrowed only for mammography and not colonoscopy.

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Image-Guided Biopsies May Reduce Need For Surgery in Breast Cancer Patients Who Respond to Chemotherapy

MedicalResearch.com Interview with:

Henry M. Kuerer, MD, PhD, FACS</strong> Executive Director, Breast Network Programs MD Anderson Cancer Network PH and Fay Etta Robinson Distinguished Professor in Research Department of Breast Surgical Oncology Director, Breast Surgical Oncology Training Program

Dr. Henry M. Kuerer

Henry M. Kuerer, MD, PhD, FACS
Executive Director, Breast Network Programs
MD Anderson Cancer Network
PH and Fay Etta Robinson Distinguished Professor in Research
Department of Breast Surgical Oncology
Director, Breast Surgical Oncology Training Program

MedicalResearch.com: What is the background for this study?

Response: Worldwide, triple negative and HER2 positive breast cancers, combined, account for about 370,000 women diagnosed annually. With recent advances in neoadjuvant systemic therapy (NST, chemotherapy and targeted therapy given before surgery) for both subsets, the pCR (pathologic complete response- when no residual cancer is found) rates found at the time of surgery in these populations can be as high as 60 percent. This high rate of pCR naturally raises the question of whether surgery is required for all patients, particularly those who will receive adjuvant radiation.

We believe surgery may potentially be redundant – at least for these two subtypes of breast cancer – because of such a high chance for no evidence of disease at the time of pathological review. If there’s no cancer left after the patient has received chemotherapy and the patient is going to receive local radiation therapy, is surgery actually needed?

The challenge has been that standard breast imaging methods cannot accurately predict residual disease after NST. However, by doing the same image-guided percutaneous needle biopsies after neoadjuvant systemic therapy that we do at time of diagnosis, our preliminary research reveals that we may be able to accurately predict which women will have cancer or not.

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No Clear Cut-Off Age To Stop Screening Mammograms

MedicalResearch.com Interview with:
Cindy Lee, MD

Assistant Professor
Department of Radiology and Biomedical Imaging
University of California San Francisco
San Francisco, CA

MedicalResearch.com: What’s new about the research? How is it different than what’s come before?

• The largest study on the topic, including national data from 31 states in the United States. Including 5.7 million screening mammograms with follow up.
• All exams using digital techniques, up to date data, more representative of community practices in the U.S.

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How Can Radiologists Detect Cancer In a Fraction of a Second?

MedicalResearch.com Interview with:

Karla K. Evans, Ph.D. Lecturer, Department of Psychology The University of York Heslington, York UK

Dr. Karla Evans

Karla K. Evans, Ph.D.
Lecturer, Department of Psychology
The University of York
Heslington, York UK

MedicalResearch.com: What is the background for this study?

Response: This research started after initially talking to radiologists and pathologists about how they search a radiograph or micrograph for abnormalities. They talked about being able to tell at the first glance if the image had something bad about it. Jokingly, they talked about “having the force” to see the bad. We wanted to know whether this hunch after the brief initial viewing was real and to systematically test it. We collected radiographic and micrographic images, half of them that had signs of cancer in them and half of them that didn’t, and we briefly presented them (250 millisecond to 2000 milliseconds) to radiologists or pathologistsrespectively. They simply had to report whether they would recall the patient or not and try localize on the outline the location of the abnormality. We first reported these finding in the following paper.

Evans et al. (2013) The Gist of the Abnormal: Above chance medical decision making in the blink of an eye. Psychonomic Bulletin & Review (DOI) 10.3758/s13423-013-0459-3
In addition to finding that radiologists and pathologists can indeed detect subtle cancers in a quarter of a second we also found that they did not know where it was in the image leading us to conclude that the signal that they were picking up must be a global signal (i.e. the global image statistic or the texture of the breast as a whole) rather than the result of a local saliency. This led me to start further exploring this signal in order to characterize it when I moved to University or York, UK to establish my own lab.
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