Risk assessment, screening and prevention of breast cancer: A look at cost-effectiveness

Risk assessment, screening and prevention of breast cancer: A look at cost-effectiveness
Gail S. Lebovic, Alan Hollingsworth, Stephen A. Feig
The Breast 2010. 19;4:260-267
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Following consideration of the above review, it is clear that the cost-effectiveness surrounding the many clinical areas as they relate to breast cancer are difficult, if not impossible to fully assess. However, within the literature we begin to see an important framework for the future. This includes the importance of risk assessment for stratification of women of various ages, preventive measures including lifestyle, chemoprevention and surgery, as well as the continued support for the essential component of mammographic screening according to present guidelines. It is these measures taken together as a whole that ultimately will save lives with the most effective, efficient and most cost-effective approach to breast cancer throughout the world

The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications

The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications
Ki Seok Choo, Hee Suk Kwak, Young Tae Bae, Jee-Yeon Lee, Seung Ju Lee, Hyoung Il Seo, Su Bong Nam
The Breast 17 (2008) 611 - 616

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Purpose: to introduce and evaluate the usefulness of the combination of wire localization and ultrasound (US)-guided, vacuum-assisted breast biopsy (VAB) to histologically diagnose mammographically detected clustered microcalcifications in the absence of sonographic and clinically palpable masses. Appears to be an accurate and useful method for diagnosing mammographically detected, clustered microcalcifications

Lower recurrence risk through mammographic screening reduces breast cancer treatment costs

Lower recurrence risk through mammographic screening reduces breast cancer treatment costs
Lea Kauhava, Pirjo Immonen-Räihä, Ilmo Parvinen, Kaija Holli, Liisa Pylkkänen, Anne Kaljonen, Hans Helenius, Pauliina Kronqvist, Pekka J. Klemi
The Breast 17 (2008) 550–554

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The high risk and high costs of breast cancer recurrence are reasons why interventions should be developed that can prevent or delay disease recurrence and reduce the costs of breast cancer care. The present study showed that screening saves costs by early detection of breast cancer with reduced risk of recurrence

Breast screening: Axillary lymph node status of interval cancers by interval year

Breast screening: Axillary lymph node status of interval cancers by interval year
Lauro Bucchi, Donella Puliti, Alessandra Ravaioli, Laura Cortesi, Vincenzo De Lisi, Fabio Falcini, Stefano Ferretti, Alfonso Frigerio, Lucia Mangone, Marco Petrella, Chiara Petrucci, Priscilla Sassoli de Bianchi, Adele Traina, Rosario Tumino, Roberto Zanetti, Manuel Zorzi, Eugenio Paci
The Breast 17 (2008) 477 - 483

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We can confirm the hypothesis that there exists a relationship between the time since last negative screen and the biological aggressiveness of interval-surfacing cancers. The second interval year, but not the first, was associated with an excess risk of lymph node metastases that was independent from tumour size and grade. The results of this study improve the understanding of the screening process, particularly the interplay between mammography sensitivity and the natural history of breast cancer.

Surveillance mammography after breast conservation therapy in Hong Kong: Effectiveness and feasibility of risk-adapted approach

T.K. Yau, H. Sze, I.S. Soong, W. Wong, K. Chan, A. Chang, K.Y. Lau and A. Lee
The Breast 17, 2, April 2008, Pages 132-137

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Annual surveillance mammography is commonly recommended after breast conservation therapy (BCT). We retrospectively reviewed its effectiveness on 511 invasive and non-invasive breast cancers treated with BCT between 1994 and 2003. The median follow-up was 5.9 years. The 5-year actuarial ipsilateral breast tumour recurrence (IBTR) rate was 4.5% and contralateral breast cancer (CBC) rate was 2.0% (representing eight times increase in risk). IBTR of 43% and 62% CBC were first detected by surveillance mammography. The IBTR detection rates per 1000 mammograms were 5.2 for patients (n=349) with one or more IBTR risk factors (age 45, positive/close margins or histological grade 3) and 0.6 for patients (n=162) without. No survival difference was observed between different modes of IBTR detection (p=0.342).

In conclusion, a risk-adapted approach of limiting ipsilateral surveillance to patients with IBTR risk is possible but its implementation will be complicated by the continued need of contralateral surveillance.

Performance of radiographers in mammogram interpretation: A systematic review

F.J.H.M. van den Biggelaar, P.J. Nelemans and K. Flobbe
The Breast Volume 17, Issue 1, February 2008, Pages 85-90
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This systematic literature review focuses on the performance of radiographers (also referring to technologists and physician assistants) compared with radiologists in the interpretation of mammograms; the effect of training; and the question whether there are any studies evaluating the effects of involving radiographers in the interpretation of diagnostic mammograms in daily clinical practice on the sensitivity and specificity of cancer detection in breast imaging.

Six studies met the inclusion criteria (primary aim of the study has to be the evaluation of the performance of radiographers, sensitivity and specificity have to be reported or calculable and there has to be a sufficient gold standard). The results showed that, in a screening setting, radiographers scored higher false positive rates with a similar sensitivity in the detection of malignancies, compared with radiologists. Furthermore, results suggested that training could improve their performance. No studies were reported assessing the performance of radiographers interpreting diagnostic mammograms in a consecutive patient population in a daily clinical setting.

This indicates a need for a well-designed diagnostic study using an adequate gold standard, in order to evaluate the feasibility of deploying radiographers in the interpretation of diagnostic mammograms in a clinical setting.

The acceptance and feasibility of breast cancer screening in the East

Ava Kwong, Polly S.Y. Cheung, Ada Y.W. Wong, Gloria T.Y. Hung, Gladys Lo, Marion Tsao, Edith W.K. Chan, Ting Wong and Michael Ma
The Breast Volume 17, Issue 1, February 2008, Pages 42-50
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-4PHJGMR-1&_user=4430&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=6b73ef38c616738fb79e6473b687d629

An overall malignancy detection rate of 2.3 per 1000 screens and a recall rate of 9.2% were found. Despite culture differences and differences in breast characteristics (denser and smaller breasts), breast screening is feasible and acceptable in the East