Risk-based breast cancer screening that incorporates breast density saves more lives at acceptable cost

Abstract Background Breast cancer remains one of the leading causes of death in women over the age of 40 years. Breast cancer screening is used to identify women with asymptomatic cancer with the goal of enabling women to undergo less invasive treatments that lead to better outcomes, ideally at earlier stages and before the cancer progresses. Mammography is the best-studied breast cancer screening modality and the only recommended imaging tool for screening the general population of women. Objective to correlate the relation between ACR density of breast and breast cancer in screening program. Patients and Methods Our study included 40 women of breast cancer were depicted radiologically and histo-pathologically diagnosed after outreaching for screening by Digital Mammography by the Egyptian National Breast Cancer Screening Program in Ain Shams University Hospitals at period from January 2018 to October 2019.Their data were collected from the medical records of the program. Their age ranged between 40 and 65 years. Results According to the BI-RADS 5th edition 2013, cases were classified into four classes as follows: 6 were ACR-A (15.0%), 21 were ACR-B (52.5%), 12 were ACR-C (30.0%) and 1 were ACR-D (2.5%), So according to our study results dense breast shouldn’t be considered as a risk factor for breast cancer as we observed that the percentage of breast cancer in our study increases the most with average breast density ACR class B then increases with ACR class C and A respectively. Conclusion dense breast is not a risk factor for breast cancer, so further researches are needed to study the relationship between breast density and breast cancer in Egyptian population, to elucidate the role of breast density estimation in prediction of breast cancer considering the genotypical and phenotypical differences of the Egyptian population.

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The Divide Between Breast Density Notification Laws and Evidence-Based Guidelines for Breast Cancer Screening

JAMA Internal Medicine ◽

10.1001/jamainternmed.2015.3040 ◽

2015 ◽

Vol 175 (9) ◽

pp. 1439 ◽

Cited By ~ 24

Author(s):

Jennifer S. Haas ◽

Celia P. Kaplan

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Breast Density ◽

Evidence Based ◽

Evidence Based Guidelines

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Density and tailored breast cancer screening: practice and prediction – an overview

Acta Radiologica Open ◽

10.1177/2058460118791212 ◽

2018 ◽

Vol 7 (9) ◽

pp. 205846011879121 ◽

Cited By ~ 1

Author(s):

Georg J Wengert ◽

Thomas H Helbich ◽

Panagiotis Kapetas ◽

Pascal AT Baltzer ◽

Katja Pinker

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Breast Density ◽

Cancer Detection ◽

Public Awareness ◽

Breast Cancer Detection ◽

Screening Methods ◽

Average Risk ◽

Screening Practice

Mammography, as the primary screening modality, has facilitated a substantial decrease in breast cancer-related mortality in the general population. However, the sensitivity of mammography for breast cancer detection is decreased in women with higher breast densities, which is an independent risk factor for breast cancer. With increasing public awareness of the implications of a high breast density, there is an increasing demand for supplemental screening in these patients. Yet, improvements in breast cancer detection with supplemental screening methods come at the expense of increased false-positives, recall rates, patient anxiety, and costs. Therefore, breast cancer screening practice must change from a general one-size-fits-all approach to a more personalized, risk-based one that is tailored to the individual woman’s risk, personal beliefs, and preferences, while accounting for cost, potential harm, and benefits. This overview will provide an overview of the available breast density assessment modalities, the current breast density screening recommendations for women at average risk of breast cancer, and supplemental methods for breast cancer screening. In addition, we will provide a look at the possibilities for a risk-adapted breast cancer screening.

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The Effect of California’s Breast Density Notification Legislation on Breast Cancer Screening

Journal of Primary Care & Community Health ◽

10.1177/2150131916674889 ◽

2016 ◽

Vol 8 (2) ◽

pp. 55-62 ◽

Cited By ~ 13

Author(s):

Stephanie Lynn Chau ◽

Amy Alabaster ◽

Karin Luikart ◽

Leslie Manace Brenman ◽

Laurel A. Habel

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Breast Density ◽

Screening Mammography ◽

Median Income ◽

Cancer History ◽

Screening Guidelines ◽

Younger Women ◽

Dense Breasts

Purpose: Half of US states mandate women be notified if they have dense breasts on their mammogram, yet guidelines and data on supplemental screening modalities are limited. Breast density (BD) refers to the extent that breast tissue appears radiographically dense on mammograms. High BD reduces the sensitivity of screening mammography and increases breast cancer risk. The aim of this study was to determine the potential impact of California’s 2013 BD notification legislation on breast cancer screening patterns. Methods: We conducted a cohort study of women aged 40 to 74 years who were members of a large Northern California integrated health plan (approximately 3.9 million members) in 2011-2015. We calculated pre- and post-legislation rates of screening mammography and magnetic resonance imaging (MRI). We also examined whether women with dense breasts (defined as BI-RADS density c or d) had higher MRI rates than women with nondense breasts (defined as BI-RADS density a or b). Results: After adjustment for race/ethnicity, age, body mass index, medical facility, neighborhood median income, and cancer history, there was a relative 6.6% decrease (relative risk [RR] 0.934, confidence interval [CI] 0.92-0.95) in the rate of screening mammography, largely driven by a decrease among women <50 years. While infrequent, there was a relative 16% increase (RR 1.16, CI 1.07-1.25) in the rate of screening MRI, with the greatest increase among the youngest women. In the postlegislation period, women with extremely dense breasts (BI-RADS d) had 2.77 times (CI 1.93-3.95) the odds of a MRI within 9 months of a screening mammogram compared with women with nondense breasts (BI-RADS b). Conclusions: In this setting, MRI rates increased in the postlegislation period. In addition, women with higher BD were more likely to have supplementary MRI. The decrease in mammography rates seen primarily among younger women may have been due to changes in national screening guidelines.

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