Saturday, 17 May 2008

MRI increases mastectomy rate

Two interesting stories hit the headlines this week. The first concerned breast density, and the fact that passing through the menopause can greatly affect the rate at which a woman's mammographic (breast) density changes over time.
This was a report from the American Journal of Epidemiology
Am. J. Epidemiol. 2008 167: 1027-1036

The researchers retrieved and digitized 5698 mammograms from 1689 women who were imaged in 1990-2003 to evaluate PD in the Minnesota Breast Cancer Family cohort. The women completed two questionnaires, the first in 1990-1996 and the second in 2001, which provided extensive risk factor data. Postmenopausal women showed a decline in PD of 1.0% over a mean of 6.2 years, while premenopausal women showed a decline in PD of 1.8% over a mean of 4.0 years.

Further analysis showed that, before the age of 50 years, postmenopausal women who never used hormones had a higher PD compared with former and current users. After the age of 50 years, women who never used hormones had larger declines in PD than current or former users.

Higher BMI was associated with lower PD among postmenopausal women at any age after adjusting for covariates. And women in the 95th (highest) percentile for baseline PD showed greater declines in PD over time than women in the 5th (lowest) percentile.

You can get a FREE PDF of the paper from - here

The other story was widely reported in the NEW YORK TIMES this Friday. Thanks to press releases, details about the study which will be presented in Chicago at the annual meeting of the American Society of Clinical Oncology, which begins May 30 has got into the media.

The study revealed that "the percentage of women opting for mastectomy rather than lumpectomy began rising sharply after 2003." A possible explanation for the increase is that MRI "detects more possibly cancerous growths than mammography," which "could be causing patients and doctors to conclude that a lumpectomy, which removes just the part of the breast containing the primary tumor, may not be sufficient."

We certainly are doing far more MRIs, but in our case at UCSF, many of these patients are in trials. Wait until we start following the American Cancer Society Guidelines for women at high risk of breast cancer, with the increase in false positives we get, plus the increased anxiety because of family history...........

Wednesday, 14 May 2008

Ultrasound screening in HIGH RISK WOMEN - article in JAMA May 2008

Wendy Berg and her ACRIN group published the results of Combined Screening With Ultrasound and Mammography vs Mammography Alone in high risk women in JAMA.

The ACRIN study in full is listed here

The JAMA abstract is here

Conclusions Adding a single screening ultrasound to mammography will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but it will also substantially increase the number of false positives.

Thursday, 1 May 2008

Breast cancer risk and aspirin use - report from the National Cancer Institute

Nonsteroidal anti-inflammatory drugs and breast cancer risk in the National Institutes of Health-AARP Diet and Health Study

Gretchen L Gierach, James V Lacey Jr, Arthur Schatzkin, Michael F Leitzmann, Douglas Richesson, Albert R Hollenbeck, Louise A Brinton
Breast Cancer Research 2008, 10:R38 (30 April 2008)
Available online through breast cancer research


Breast cancer risk was not significantly associated with NSAID use, but daily aspirin use was associated with a modest reduction in ER-positive breast cancer. Our results provide support for further evaluating relationships by NSAID type and breast cancer subtype.

This story hit the headlines in the USA last night, with several analyses on NBC news. Overall the reaction and advice was sensible, but yet again we will have more questions to answer when we see our patients this week