Diagnostic Mammography for Post-Lumpectomy Surveillance in Women with Breast Cancer: Annual Frequencies of Additional Imaging and Recurrent Cancer

The effectiveness of routine outpatient follow up in detecting recurrent disease after ‘curative’ surgery for breast cancer has been evaluated in a retrospective study of 148 patients. In all, 32 patients developed recurrent cancer. In 3 cases, asymptomatic disease was discovered by routine X-rays. In 25 cases, the patient noticed local disease or complained of symptoms due to distant spread, and over half of these returned to the clinic before the next routine appointment. In only 4 cases was routine examination by a doctor solely responsible for the discovery of recurrent disease. It is concluded that routine follow up made little contribution to the welfare of these patients.

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Effect of female-dominant support networks on end-of-life decision making among women with advanced or recurrent cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6590 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6590-6590

Author(s):

Katina Robison ◽

Ashley Stuckey ◽

Don S. Dizon ◽

Michelle Rogers ◽

Miles Ott ◽

...

Keyword(s):

Breast Cancer ◽

End Of Life ◽

Support Networks ◽

Health Care Proxy ◽

End Of Life Decisions ◽

Recurrent Cancer ◽

Support Person ◽

Advance Care ◽

End Of Life Decision ◽

Life Decision

6590 Background: Improved understanding of the factors that influence a woman’s end of life (EOL) decisions while confronting cancer is needed. The objective of this study was to determine if the composition of one’s social network was associated with advance care planning (ACP) among women with metastatic or recurrent gynecologic or breast cancer. Methods: Women were recruited from a program in women’s oncology in the northeast. Women with an established diagnosis of recurrent or metastatic cancer for ≥3 months duration were eligible. We asked women with advanced or recurrent cancer about their support networks and end-of-life decisions. Interviews were conducted by research staff. Clinical characteristics and documentation of EOL decisions of enrolled women were obtained through chart reviews. Multivariable logistic models were computed. The study protocol was approved by the hospital and university Institutional Review Boards. Results: 200 women were enrolled in the study. The majority had gynecologic malignancies (65.5%). Older age was associated with having an advanced directive (AD) (p<.0001) and a health care proxy (HCP) (p=0.002). Additionally, having more females than males in one’s support network was associated with an AD (p=0.005) and a HCP (p=0.012). Women with gynecologic cancer were more likely to self-report a HCP compared to those with breast cancer (p=0.040).A female support person was 1.57 times more likely to be trusted to make a medical decision (p=0.002) and a female support person was 1.33 times more likely to be someone a woman spoke with about her end of life decision than a male support person (p=0.037). Neither naming a HCP or having an AD were associated with number of support persons named, total number of female support persons, number of friends, number of children, or presence of an intimate partner. Conclusions: Women with more females than males in their social network were more likely to have an advance care directive or health care proxy. In addition, women were more likely to trust and talk with a female support person about end of life decisions than a male support person. However, the composition of the network was not associated with the likelihood of having completed ACP.

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The role of oncologic health care providers in end of life discussions for women with recurrent gynecologic or breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20543 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20543-e20543

Author(s):

Ashley Stuckey ◽

Katina Robison ◽

Don S. Dizon ◽

Michelle Rogers ◽

Miles Ott ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

End Of Life ◽

Health Care Providers ◽

Institutional Review Boards ◽

Care Providers ◽

Provider Type ◽

Health Care Proxy ◽

Recurrent Cancer ◽

And Gender

e20543 Background: Advance care planning (ACP) is an important topic for women with metastatic or recurrent cancer. Unfortunately, data suggest ACP is often not discussed at health care visits. Because patients with metastatic or recurrent cancer are incurable, the issue of end of life (EOL) is one faced by patients and providers. This study evaluates how often oncologic health care providers initiate EOL conversations with their patients. Methods: Eligible patients included women with metastatic or recurrent gynecologic or breast cancer of ≥3 month’s duration in an academic women’s oncology program. Interviews were conducted by research staff. Clinical characteristics and documentation of EOL decisions were obtained through chart reviews. Data were analyzed using SAS v.9.3. Multivariate logistic regression was used to model the association of EOL discussions with ACP. The study was approved by the hospital and university Institutional Review Boards. Results: 200 women were enrolled; 64% had stage III-IV cancer at diagnosis. The majority was white (91%) with a mean age of 60 (range 35-82). A total of 638 providers were identified (mean: 3.2 providers per patient; 57% female). Health care provider type and gender were not associated with EOL discussions. Only 49 women (25%) recalled an EOL conversation with at least one provider which appeared to correspond to the low proportion of people with documented ACP. Only 42 (22%) had an advanced directive (AD) and 29 (15%) a health care proxy (HCP) in the chart. Having an EOL conversation with at least one provider was not associated with a chart-documented AD (OR=1.6, 95% CI=0.7-3.6) or HCP (OR=1.8, 95% CI=0.7-4.5). The time since recurrence was shorter for those reporting EOL conversations (1.7 vs. 3.1 years, p=.0274). Conclusions: In this study, oncologic health care providers infrequently initiated EOL discussions with their patients with metastatic or recurrent cancer. More concerning, patient recollection of an EOL discussion with a provider was not associated with chart-documented ACP. Further studies evaluating the factors limiting EOL discussions as well as studies testing interventions to improve provider documentation of the ACP are warranted.

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Breast Density and Breast Cancer Incidence in the Lebanese Population: Results from a Retrospective Multicenter Study

BioMed Research International ◽

10.1155/2017/7594953 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Christine Salem ◽

David Atallah ◽

Joelle Safi ◽

Georges Chahine ◽

Antoine Haddad ◽

...

Keyword(s):

Breast Cancer ◽

Breast Density ◽

Breast Cancer Incidence ◽

Menopausal Status ◽

Western Society ◽

Dense Breasts ◽

Menopausal Women ◽

Diagnostic Mammography ◽

History Of ◽

Retrospective Multicenter Study

Purpose. To study the distribution of breast mammogram density in Lebanese women and correlate it with breast cancer (BC) incidence.Methods. Data from 1,049 women who had screening or diagnostic mammography were retrospectively reviewed. Age, menopausal status, contraceptives or hormonal replacement therapy (HRT), parity, breastfeeding, history of BC, breast mammogram density, and final BI-RADS assessment were collected. Breast density was analyzed in each age category and compared according to factors that could influence breast density and BC incidence.Results. 120 (11.4%) patients had BC personal history with radiation and/or chemotherapy; 66 patients were postmenopausal under HRT. Mean age was52.58±11.90years. 76.4% of the patients (30–39 years) had dense breasts. Parity, age, and menopausal status were correlated to breast density whereas breastfeeding and personal/family history of BC and HRT were not. In multivariate analysis, it was shown that the risk of breast cancer significantly increases 3.3% with age (P=0.005), 2.5 times in case of menopause (P=0.004), and 1.4 times when breast density increases (P=0.014).Conclusion. Breast density distribution in Lebanon is similar to the western society. Similarly to other studies, it was shown that high breast density was statistically related to breast cancer, especially in older and menopausal women.

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Posterior breast cancer: Mammographic and ultrasonographic features

Vojnosanitetski pregled ◽

10.2298/vsp120726032j ◽

2013 ◽

Vol 70 (11) ◽

pp. 1034-1038

Author(s):

Ana Jankovic ◽

Mirjan Nadrljanski ◽

Vesna Plesinac-Karapandzic ◽

Nebojsa Ivanovic ◽

Zoran Radojicic ◽

...

Keyword(s):

Breast Cancer ◽

Breast Imaging ◽

Color Doppler ◽

Lobular Carcinoma ◽

Architectural Distortion ◽

Breast Cancers ◽

Significant Difference ◽

Diagnostic Mammography ◽

Anatomical Localization ◽

Mass Lesions

Background/Aim. Posterior breast cancers are located in the prepectoral region of the breast. Owing to this distinctive anatomical localization, physical examination and mammographic or ultrasonographic evaluation can be difficult. The purpose of the study was to assess possibilities of diagnostic mammography and breast ultrasonography in detection and differentiation of posterior breast cancers. Methods. The study included 40 women with palpable, histopathological confirmed posterior breast cancer. Mammographic and ultrasonographic features were defined according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Results. Based on standard two-view mammography 87.5%, of the cases were classified as BI-RADS 4 and 5 categories, while after additional mammographic views all the cases were defined as BIRADS 4 and 5 categories. Among 96 mammographic descriptors, the most frequent were: spiculated mass (24.0%), architectural distortion (16.7%), clustered microcalcifications (12.6%) and focal asymmetric density (12.6%). The differentiation of the spiculated mass was significantly associated with the possibility to visualize the lesion at two-view mammography (p = 0.009), without the association with lesion diameter (p = 0.083) or histopathological type (p = 0.055). Mammographic signs of invasive lobular carcinoma were significantly different from other histopathological types (architectural distortion, p = 0.003; focal asymmetric density, p = 0.019; association of four or five subtle signs of malignancy, p = 0.006). All cancers were detectable by ultrasonography. Mass lesions were found in 82.0% of the cases. Among 153 ultrasonographic descriptors, the most frequent were: irregular mass (15.7%), lobulated mass (7.2%), abnormal color Doppler signals (20.3%), posterior acoustic attenuation (18.3%). Ultrasonographic BI-RADS 4 and 5 categories were defined in 72.5% of the cases, without a significant difference among various histopathological types (p = 0.109). Conclusion. Standard two-view mammography followed by additional mammographic projections is an effective way to demonstrate the spiculated mass and to classify the prepectoral lesion as category BI-RADS 4 or 5. Additional ultrasonography can overcome the mimicry of invasive lobular breast carcinoma at mammography.

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The PROCEM study protocol: Added value of preoperative contrast-enhanced mammography in staging of malignant breast lesions - a prospective randomized multicenter study

BMC Cancer ◽

10.1186/s12885-021-08832-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kristina Åhsberg ◽

Anna Gardfjell ◽

Emma Nimeus ◽

Lisa Ryden ◽

Sophia Zackrisson

Keyword(s):

Breast Cancer ◽

Randomized Study ◽

Preoperative Staging ◽

Added Value ◽

Breast Cancer Surgery ◽

Imaging Method ◽

Link Type ◽

Contrast Enhanced ◽

Patient Reported ◽

Additional Imaging

Abstract Background Correct preoperative estimation of the malignant extent is crucial for optimal planning of breast cancer surgery. The sensitivity of mammography is lower in dense breasts, and additional imaging techniques are sometimes warranted. Contrast-enhanced mammography (CEM) has shown similar sensitivity and in some cases better specificity, than magnetic resonance imaging (MRI) in small, observational studies. CEM may be more cost-effective than MRI, and may provide better identification of the tumor extent, however, no randomized trials have been performed to date to investigate the added value of CEM. In a feasibility study, we found that the treatment was changed in 10/47 (21%) cases after additional CEM. The purpose of the present study is to evaluate the added value of CEM in preoperative staging of breast cancer in a randomized study. Method This prospective randomized study will include 440 patients with strongly suspected or established diagnosis of breast malignancy, based on assessment with mammography, ultrasound and core biopsy/cytology, and for whom primary surgery is planned. Patients will be randomized 1:1 using a web-based randomization tool to additional investigation with CEM or no further imaging. The CEM findings will be taken into consideration, which may lead to changes in primary treatment, which is the primary endpoint of this study. Secondary endpoints include rate of reoperation and number of avoidable mastectomies, as well as a cost-benefit analysis of additional CEM. Patient-reported health-related quality of life will be investigated at 1 year with the validated Breast-Q™ questionnaire. The rate of local recurrence or new cancer ipsi- or contralaterally within 5 years will be assessed from medical records and pathology reports. Discussion The aim of this trial is to explore the added value of CEM in preoperative staging of breast cancer. The results obtained from this study will contribute to our knowledge on CEM as an additional imaging method to standard investigation with digital mammography and ultrasound. The findings may also provide additional information on which patient groups would benefit from CEM, and on the economic aspects of CEM in standard preoperative practice. Trial registration This trial is registered at clinicaltrials.gov, registration no: NCT04437602, date of registration: June 18, 2020.

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Breast Cancer Screening in Average-Risk Women

10.1093/med/9780190223700.003.0038 ◽

2016 ◽

Author(s):

Christoph I. Lee

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Meta Analysis ◽

Screening Mammography ◽

Average Risk ◽

Additional Information ◽

Additional Imaging ◽

Study Methodology ◽

Benign Biopsy

This chapter, found in the cancer screening and management section of the book, provides a succinct synopsis of a key meta-analysis regarding the efficacy of mammography for breast cancer screening among younger and older average-risk women. This summary outlines study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. Meta-analysis of available trial data demonstrates a 15% mortality reduction among women aged 39 to 49 years with routine screening mammography. This age group has the highest rates of additional imaging but lowest rates of benign biopsy. In addition to outlining the most salient features of the analysis, a clinical vignette and imaging example are included in order to provide relevant clinical context.

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Implementation of a direct patient callback system improves compliance for additional breast imaging and early breast cancer detection

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.6073 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 6073-6073

Author(s):

D. Richard-Kowalski ◽

D. Termeulen ◽

M. Reed ◽

R. Reyes ◽

M. Kuliga ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Cancer Detection ◽

Breast Imaging ◽

Recall Rate ◽

Screening Mammography ◽

Breast Cancer Detection ◽

Detection Methods ◽

Diagnose Breast Cancer ◽

Additional Imaging

6073 Background: Existing patient recall systems usually involve contacting the referring physician who then notifies the patient to schedule a return visit for further imaging. We set out to determine whether a direct patient callback system would improve patient compliance in returning for additional imaging including magnification, spot compression, and ultrasound, and whether that would translate to an improvement in early breast cancer detection. Methods: Beginning on 4/1/2004, we prospectively identified all patients whose screening mammograms were read as having an incomplete assessment that required additional imaging (ACR BIRADS 0). Those patients were contacted directly via telephone to return for additional views. Results: Between 11/1/2002 and 3/31/3004, 1142 patients with incomplete screening mammography were identified and the referring physicians were contacted. 956 of 1142 (84%) patients returned and underwent additional breast imaging. Between 4/1/2004 and 12/31/2005, 1,336 patients with incomplete screening mammography were contacted directly to return for additional imaging. 1,307 of 1,336 (98%) patients returned and underwent additional breast imaging. (p < 0.0001, Fisher’s exact test). 125 of the 1,307 (8.5%) of the subsequent exams were found to be suspicious and biopsy was recommended (ACR BIRADS 4 or 5). Conclusions: Our new system of contacting patients with incomplete mammography has significantly increased our recall rate. Implementation of this system has enabled us to identify those patients whose mammograms are suspicious and ultimately diagnose breast cancer earlier. Direct patient callback has become standard policy and we are recommending this system for all radiology recall examinations. No significant financial relationships to disclose.

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Dysphagia and Neck Swelling in a Case of Undiagnosed Lhermitte-Duclos Disease and Cowden Syndrome

Case Reports in Oncological Medicine ◽

10.1155/2015/546297 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Zishuo Ian Hu ◽

Lev Bangiyev ◽

Roberta J. Seidman ◽

Jules A. Cohen

Keyword(s):

Breast Cancer ◽

Genetic Testing ◽

Thyroid Disease ◽

Thyroid Nodules ◽

Cowden Syndrome ◽

Breast Cancers ◽

Neck Swelling ◽

Mri Scan ◽

Additional Imaging

We report a case of a 37-year-old woman presenting with dysphagia and thyroid masses who was subsequently diagnosed with Lhermitte-Duclos disease (LDD) based on MRI scan and histopathology. Additional imaging subsequently revealed the presence of thyroid nodules and bilateral breast cancers. Genetic testing later confirmed the diagnosis of Cowden syndrome. This case illustrates the importance of the overlap between LDD, Cowden syndrome, thyroid disease, and breast cancer.

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