tag:blogger.com,1999:blog-37987608910983873822024-02-18T21:14:48.062-05:00Letter From AmericaDr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comBlogger54125tag:blogger.com,1999:blog-3798760891098387382.post-80618060328907975212011-04-19T15:39:00.000-04:002011-04-19T15:39:05.751-04:00Thyroid Sheilds and the Dr Oz saga continuesIn the US, there is currently a major scare triggered by a spot on the Dr Oz show where he (a well known and respected cardiothoracic surgeon) took on the imaging community with regards to dental x-rays and mammograms and the rising risk of thyroid cancer. Following his programme, <span><span class="maBody">women across the U.S. have been asking for the protection after an email went viral in March based on advice Dr. Mehmet Oz gave in his show that originally aired last year.</span></span><br />
<br />
<span><span class="maBody">The background for this controversy is the rising incidence of thyroid cancer, which has increased fourfold since the 1970s. The original episode in 2010 said that some of the increase could be due to radiation exposure from dental x-rays and mammograms, and advised the use of thyroid shields to reduce risk.</span></span><br />
<br />
<div id="beacon_64113d66e6" style="left: 0px; position: absolute; top: 0px; visibility: hidden;"><img alt="" height="0" src="http://cdn.trimedmedia.com/cdn/_a/www/delivery/lg.php?bannerid=823&campaignid=412&zoneid=6&loc=1&referer=http%3A%2F%2Fwww.healthimaging.com%2Findex.php%3Foption%3Dcom_articles%26article%3D27109&cb=64113d66e6" style="height: 0px; width: 0px;" width="0" /></div><div class="ad_s"> <div id="beacon_b3ec4a548c" style="left: 0px; position: absolute; top: 0px; visibility: hidden;"><img alt="" height="0" src="http://cdn.trimedmedia.com/cdn/_a/www/delivery/lg.php?bannerid=897&campaignid=447&zoneid=7&loc=1&referer=http%3A%2F%2Fwww.healthimaging.com%2Findex.php%3Foption%3Dcom_articles%26article%3D27109&cb=b3ec4a548c" style="height: 0px; width: 0px;" width="0" /></div></div><div style="float: right;"> <div class="ad_r"> <a href="http://ad.doubleclick.net/click;h=v8/3aee/14/70/%2a/t;239471083;0-0;0;62336230;4307-300/250;41516610/41534397/1;;%7Esscs=%3fhttp://cdn.trimedmedia.com/cdn/_a/www/delivery/ck.php?oaparams=2__bannerid=960__zoneid=1__cb=028e5df69b__oadest=http://blog.carestreamhealth.com/category/videos/" target="_blank"><br />
</a> <div id="beacon_028e5df69b" style="left: 0px; position: absolute; top: 0px; visibility: hidden;"><img alt="" height="0" src="http://cdn.trimedmedia.com/cdn/_a/www/delivery/lg.php?bannerid=960&campaignid=467&zoneid=1&loc=1&referer=http%3A%2F%2Fwww.healthimaging.com%2Findex.php%3Foption%3Dcom_articles%26article%3D27109&cb=028e5df69b" style="height: 0px; width: 0px;" width="0" /></div></div><div class="ad_r"> <a href="http://cdn.trimedmedia.com/cdn/_a/www/delivery/ck.php?oaparams=2__bannerid=848__zoneid=2__cb=9f25a13067__oadest=http%3A%2F%2Fwww.ndssi.com%2Fproducts%2Fdome%2Fex-grayscale%2Fs10.php" target="_Blank"><br />
</a><div id="beacon_9f25a13067" style="left: 0px; position: absolute; top: 0px; visibility: hidden;"><img alt="" height="0" src="http://cdn.trimedmedia.com/cdn/_a/www/delivery/lg.php?bannerid=848&campaignid=419&zoneid=2&loc=http%3A%2F%2Fwww.healthimaging.com%2Findex.php%3Foption%3Dcom_articles%26article%3D27109&cb=9f25a13067" style="height: 0px; width: 0px;" width="0" /></div></div><div class="ad_r"> <div id="beacon_817916ae7f" style="left: 0px; position: absolute; top: 0px; visibility: hidden;"><img alt="" height="0" src="http://cdn.trimedmedia.com/cdn/_a/www/delivery/lg.php?bannerid=851&campaignid=422&zoneid=3&loc=http%3A%2F%2Fwww.healthimaging.com%2Findex.php%3Foption%3Dcom_articles%26article%3D27109&cb=817916ae7f" style="height: 0px; width: 0px;" width="0" /></div></div><div class="ad_r"> </div><div class="ad_r"> </div><div class="ad_r"> </div><br />
</div>In response to this erroneous message, the <a class="hasTip" href="http://www.acr.org/">American College of Radiology</a> (ACR) and the <a class="hasTip" href="http://www.sbi-online.org/">Society of Breast Imaging</a> (SBI) released a joint statement urging patients to disregard trumped up risks of thyroid cancer due to mammography-induced radiation<br />
<a href="http://www.mammographysaveslives.org/Documents/ACR-SBI%20Thyroid%20CA%20Statement.pdf"><span><span class="maBody">ACR-SBI statement on the use of thyroid shields (PDF FILE)</span></span></a><br />
<br />
The associations put the estimated x-ray scatter delivered to the thyroid at less than 0.005 mGy, equivalent to 30 minutes of natural background radiation and resulting in a cancer risk of less than one in 17 million. ACR and SBI further cautioned patients against using thyroid shields, which the organizations said could interfere with optimal breast positioning and create artifacts, thereby potentially compromising diagnosis<span><span class="maBody"> </span></span><br />
<span><span class="maBody"><br />
</span></span><br />
<span><span class="maBody">A follow up programme was aired on April 14, but appeared to be deliberately engineered as a lecture to professionals on listening to what women want. </span></span><span><span class="maBody">This week's episode was ostensibly intended to set the record straight, with Oz, inviting experts from dentistry and radiology to comment on the email controversy and the pros and cons of thyroid shielding.</span></span><br />
<span><span class="maBody">Radiology experts included Dan Kopans, Phil Evans and </span></span><span><span class="maBody">Jocelyn Rapelyea who tried to objectively answer the criticism.</span></span><br />
<span><span class="maBody">Dan Kopans talked about the radiation dose being tiny to the thyroid and about cumulative dose. Phil Evans explained about how thyroid shields obscure much breast tissue, and the mammograms may need repeating. </span></span><span><span class="maBody"></span></span><span><span class="maBody">Jocelyn Rapelyea also explained that certain body habitus can prevent women from successfully wearing thyroid shields which of course are a fixed size.</span></span><br />
<br />
<span><span class="maBody">Either way, the programme just muddied the waters, and the fact that the basis of the claim about thyroid cancer risk and mammography screening is unsubstantiated, was never addressed, means that women are more concerned than ever.</span></span><br />
<br />
<span><span class="maBody">We have thyroid shields available at Moffitt Cancer Center for women who wish to wear them, but we, as most other centers do not offer them routinely, as they degrade the quality of the subsequent mammograms in many women.</span></span><span><span class="maBody"> </span></span><br />
<br />
<span><span class="maBody"> </span></span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-22544017464177071452010-08-07T08:48:00.000-04:002010-08-07T08:49:54.260-04:00Is Mammographic Breast Density a Breast Cancer Risk Factor in Women With BRCA Mutations?In a paper from Sunnybrook in Toronto, Canada in this month's Journal of Clinical Oncology, researchers found that women with increased breast density who were also BRCA gene mutation carriers did not have an increased risk of breast cancer.<br />
<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://www.rcrbreastgroup.com/images/Covers/JCOcover.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://www.rcrbreastgroup.com/images/Covers/JCOcover.jpg" /></a></div><br />
<br />
Is Mammographic Breast Density a Breast Cancer Risk Factor in Women With BRCA Mutations?<br />
Kavitha Passaperuma, Ellen Warner, Kimberley A. Hill, Anoma Gunasekara, Martin J. Yaffe<br />
Journal of Clinical Oncology, Vol 28, No 23 (August 10), 2010: pp. 3779-3783<br />
<br />
<a href="http://jco.ascopubs.org/cgi/content/abstract/28/23/3779?cmpid=jco_etoc_10August2010">Link to Journal </a> - <br />
<br />
Their purpose of the study was based on the knowledge that Increased mammographic breast density is a well recognized as a breast cancer risk factor in the general population. However, it is unclear whether it is a risk factor in women with BRCA mutations. They present the results of a nested case-control screening study investigating the relationship between breast density and breast cancer incidence in this population.<br />
<br />
Between November 1997 and March 2008, 462 women (mean age, 44 years; 245 BRCA1 and 217 BRCA2) were screened and 50 breast cancers were diagnosed (38 invasive, 12 ductal carcinoma in situ [DCIS]). Density was not measured in 40 women of whom four developed cancer (three invasive, one DCIS). Mean PD (± standard deviation [SD]) for 376 women who did not develop breast cancer was 34% (23) compared with 31% (21) for 46 women with cancer (P = .51). Logistic regression model of breast cancer incidence and PD revealed an odds ratio of 0.99 (± 0.01 SD) for a one-unit increase in PD (P = .44). Results remained nonsignificant in multivariate analysis, as well as when women with pure DCIS were excluded.<br />
<br />
Their conclusion was that ncreased mammographic breast density in "two-dimensional" breast imaging is not associated with higher breast cancer incidence in women with BRCA mutations.<br />
<br />
On the basis of these findings, density should not be considered a factor for these women in decision making regarding prophylactic surgery or chemoprevention.<br />
<br />
Some pointers they make are that what they call 3D breast imaging like Digital mammography and MRI may give a better reflection of true breast density (compared with conventional mammography (SFM) which tends to over-estimate breast density, may give different results, therefore the study should be repeated with current mammographic techniques using FFDM or using MRI.Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-70832272970130725932010-07-22T23:32:00.000-04:002010-07-22T23:36:11.494-04:00Revised RECIST Guideline Version 1.1: What Oncologists Want to Know and What Radiologists Need to Know<div class="separator" style="clear: both; text-align: center;"><a href="http://www.rcrbreastgroup.com/images/Covers/AJR.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://www.rcrbreastgroup.com/images/Covers/AJR.gif" /></a></div><br />
<br />
Mizuki Nishino, Jyothi P. Jagannathan, Nikhil H. Ramaiya, and Annick D. Van den Abbeele<br />
<i><b>AJR 2010;195:281-289</b></i><br />
<br />
<a href="http://www.ajronline.org/cgi/content/abstract/195/2/281">Link to Journal</a><br />
<br />
<i>The original RECIST guideline, version 1.0, provided definitions for "measurable lesion" and "nonmeasurable lesion". Measurable lesions must have a longest diameter of ≥ 10 mm on CT with a slice thickness of ≤ 5 mm (or a longest diameter of ≥ 20 mm on nonhelical CT with a slice thickness of > 10 mm) or a longest diameter of ≥ 20 mm on chest radiography<br />
<br />
RECIST assigns four categories of response: complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Assessment of overall response is based on the evaluations of target and nontarget lesions at each follow-up time point. The measurements and response assessment are often recorded using tumor measurement tables.<br />
<br />
Major changes in RECIST 1.1 related to imaging include the following: first, the number of target lesions; second, assessment of pathologic lymph nodes; third, clarification of disease progression; fourth, clarification of unequivocal progression of nontarget lesions; and, fifth, inclusion of 18F-FDG PET in the detection of new lesions. The number of target lesions to be assessed was reduced from five per organ to two per organ and from a maximum of 10 target lesions total to a maximum of five total.<br />
<br />
In RECIST 1.0, there was no clear guideline for lymph node measurement. In RECIST 1.1, detailed instructions about how to measure and assess lymph nodes are provided. Lymph nodes with a short axis of ≥ 15 mm are considered measurable and assessable as target lesions, and the short-axis measurement should be included in the sum of target lesion measurements in the calculation of tumor response as opposed to the longest axis used for measurements of other target lesions<br />
<br />
<b>CONCLUSION:</b><br />
Familiarity with the revised RECIST is essential in day-to-day oncologic imaging practice to provide up-to-date service to oncologists and their patients. Some of the changes in the revised RECIST affect how radiologists select, measure, and report target lesions</i>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-54245692092183603292010-06-29T11:22:00.000-04:002010-06-29T11:22:11.565-04:00New guidelines published for scintimammography from the Socety of Nucelar Medicine<div class="separator" style="clear: both; text-align: center;"><a href="http://www.rcrbreastgroup.com/images/logos/SNMlogo.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://www.rcrbreastgroup.com/images/logos/SNMlogo.gif" /></a></div><br />
For those of you who perform scintimammography in difficult cases, the <a href="http://www.snm.org/">Society of Nuclear Medicine </a>has issued <a href="http://interactive.snm.org/docs/Breast_v2.0.pdf">guidelines</a> to assist breast imaging practitioners in patient selection, performance, interpretation and reporting for breast scintigraphy with 99mTc-sestamibi breast-specific gamma imaging.<br />
<br />
The guidelines indicate the use of breast scintigraphy in:<br />
• Patients with recently detected breast malignancy;<br />
• Patients at high risk for breast malignancy;<br />
• Patients with indeterminate breast abnormalities and remaining diagnostic concerns;<br />
• Patients with technically difficult breast imaging;<br />
• Patients for whom breast MRI would be indicated; and<br />
• Monitoring neoadjuvant tumor response in patients undergoing preoperative chemotherapy.<br />
<br />
Approximately 925 MBq [25 mCi] of the radiopharmaceutical should be administered using an indwelling venous catheter or butterfly needle followed by 10 ml of saline to flush the vein, according to the guidelines.<br />
<br />
The guidelines suggest that the sensitivity, specificity and accuracy of the test depend upon several factors, including the size of the breast neoplasm being imaged. While the sensitivity of this test for subcentimeter tumors approaches 95 percent, sensitivity decreases with lesion size.<br />
<br />
The report to the referring physician should indicate the most likely diagnosis and should recommend appropriate follow-up as with any breast imaging study, using Breast Imaging-Reporting and Data System (BIRADS) classificationDr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-67983936529069133262010-04-01T10:29:00.000-04:002010-04-01T10:29:15.589-04:00Absolute numbers of lives saved and overdiagnosis in breast cancer screening, from a randomized trial and from the Breast Screening Programme in England<b>Absolute numbers of lives saved and overdiagnosis in breast cancer screening, from a randomized trial and from the Breast Screening Programme in England</b><br />
Duffy SW, Tabar L, Olsen AH, Vitak B et al<br />
J Med Screen 2010;17:25-30 <br />
<br />
<a href="http://jms.rsmjournals.com/cgi/content/full/17/1/25">Link to Journal</a><br />
<b><br />
Objectives:</b> To estimate the absolute numbers of breast cancer deaths prevented and the absolute numbers of tumours over-diagnosed in mammographic screening for breast cancer at ages 50–69 years<br />
<br />
<b>Setting:</b> The Swedish Two-County randomized trial of mammographic screening for breast cancer, and the UK Breast Screening Programme in England, ages 50–69 years<br />
<br />
<b>Methods:</b> We estimated the absolute numbers of deaths avoided and additional cases diagnosed in the study group (active study population) of the Swedish Two-County Trial, by comparison with the control group (passive study population). We estimated the same quantities for the mortality and incidence rates in England (1974–2004 and 1974–2003, respectively). We used Poisson regression for statistical inference<br />
<br />
<b>Results:</b> A substantial and significant reduction in breast cancer mortality was associated with screening in both the Two-County Trial (P < 0.001) and the screening programme in England (P < 0.001). The absolute benefits were estimated as 8.8 and 5.7 breast cancer deaths prevented per 1000 women screened for 20 years starting at age 50 from the Two-County Trial and screening programme in England, respectively. The corresponding estimated numbers of cases overdiagnosed per 1000 women screened for 20 years were, respectively, 4.3 and 2.3 per 1000.<br />
<br />
<b>Conclusions:</b> The benefit of mammographic screening in terms of lives saved is greater in absolute terms than the harm in terms of overdiagnosis. Between 2 and 2.5 lives are saved for every overdiagnosed caseDr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-40751340001655061272010-03-26T12:47:00.000-04:002010-03-26T15:34:41.325-04:00New Gotzsche paper dismissing screening - this time in DenmarkIn a paper published in the Research section of the BMJ today, Peter Gotzsche once again lines up the guns against organized screening programs, targeting in this instance the Danish Screening Program.<br />
<a href="http://www.bmj.com/cgi/content/full/340/mar23_1/c1241">http://www.bmj.com/cgi/content/full/340/mar23_1/c1241</a><br />
<br />
His conclusions are -<br />
"We were unable to find an effect of the Danish screening programme on breast cancer mortality. The reductions in breast cancer mortality we observed in screening regions were similar or less than those in non-screened areas and in age groups too young to benefit from screening, and are more likely explained by changes in risk factors and improved treatment than by screening mammography<br />
We believe it is time to question whether screening has delivered the promised effect on breast cancer mortality."<br />
<br />
As this may hit mainstream news media, I have gathered some responses so far -<br />
Danish and Swedish experts have replied saying that -<br />
They claim that mammography screening in Denmark had no impact on breast cancer mortality. This claim is unsubstantiated, firstly because the authors used very crude data, and secondly because the analysis was not geared to answer the question.<br />
<br />
Firstly, breast cancer screening can only possibly have an effect on women not already diagnosed with breast cancer prior to screening. Therefore the so-called “refined mortality” should be used in evaluation of screening. Jørgensen et al did not used refined mortality. Furthermore, they merge data from three screening areas starting screening at different points in time, and used age groups instead of cohorts. Together this gave quite “polluted” data.<br />
<br />
Secondly, they calculated “annual change in the relative risk of breast cancer death” by time period and areas excluding 1992-1996. The relevant outcome measure is, however, the change in breast cancer mortality in the screening area controlled for the change in breast cancer mortality in the non-screening area.<br />
<br />
Even using these “polluted” data, the relative breast cancer mortality decreased for women aged 55-74 covered by screening, while the relative breast cancer mortality did not decrease for women aged 35-54 largely uncovered by screening, and the relative breast cancer mortality was slightly but statistically non-significantly decreased for women aged 75-84 where the majority, but not all, of the person years were uncovered by screening. Although this pattern in the data is actually visible in Figure 1 in the paper by Jørgensen et al, it was missed in their analysis among other things because they excluded data from the period 1992-1996.<br />
<br />
As we have reported previously, the measured impact of mammography screening on breast cancer mortality is highly dependent on the data set used for the analysis. Use of “polluted” data leads to biased estimates (2). Using cohort based refined mortality, we found a 25% decrease in breast cancer mortality in the municipality of Copenhagen during the first 10 years following the introduction of mammography screening in April 1991 (3). We deliberately did not include data from Funen and Frederiksberg in that analysis, as cause of death data were not available at that time for the first 10 years of these two screening programmes.<br />
Other commentators also note -<br />
<br />
<br />
The analysis of population trends in breast cancer mortality in the presence of screening is complicated by the inability to measure exposure to screening, and the long period of follow-up required. Studies such as this one by Jørgensen et al obscure whatever benefit may be present with crude, insensitive methodology. While we expect to see a range of benefits from mammography, some small and some large, based on the design and quality of the screening program, its duration, and the participation rate of the target population, to argue that there is no benefit from modern mammography on the basis of such flawed methods means this paper contributes nothing of substance to the on-going debateDr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-28414505535195746812010-03-16T15:18:00.000-04:002010-03-26T15:38:06.321-04:00The US Preventive Services Task Force recommendations on Screening Mammography flawed<span class="textfirstpara" style="font-weight: bold;">Guidelines for mammography screening published by the U.S. Preventive Services Task Force (USPSTF) in November not only are based on flawed methodology, they also fail to address current breast imaging practice and data, making them obsolete, </span><span class="textfirstpara" style="font-style: italic;">according to a critique published in this month's Journal of Diagnostic Medical Sonography<br />
<br />
</span><span class="textfirstpara">Author Kevin Evans, Ph.D., evaluated the USPSTF's report methodology and found that it did not meet established standards for systematic reviews (JDMS, January/February 2010, Vol. 26:1, pp. 19-23). Evans is chair of the radiologic sciences division in the School of Allied Medical Professions at Ohio State University in Columbus.<br />
<br />
Evans used two resources to evaluate the USPSTF's report: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a 27-point checklist, and the Assessment of Multiple Systematic Reviews (AMSTAR), an 11-point checklist.<br />
<br />
The task force's report scored 7 out of 27 on the PRISMA checklist and 1 out of 11 on the AMSTAR list. These low methodological scores put in question the rigor used in developing the report, limiting it to a review of literature instead of a formal systematic review and reducing its overall scientific impact to a much lower level in the hierarchy of evidence, according to Evans.<br />
<br />
"I picked two of the most well-known methods to evaluate systematic reviews and applied them to the report," he told AuntMinnie.com. "It's possible that USPSTF met these standards but failed to provide their methodology in the report. This becomes problematic in reading their guidelines."<br />
<br />
The USPSTF's intention was to update its 2002 report by using other systematic reviews, meta-analyses, recently published literature, and data from the Breast Cancer Surveillance Consortium from 2000 to 2005. In its guidelines, it proposed the following, according to Evans:<br />
<br />
</span><br />
<ul><li><span class="textfirstpara">Routine screening mammography in women ages 40 to 49 years should not be conducted; rather, this process should be biennial at ages 50 to 74 years.</span></li>
<li><span class="textfirstpara">A lack of published evidence currently exists to provide a guideline for screening mammography for women older than 75 years of age.</span></li>
<li><span class="textfirstpara">A lack of evidence exists for assessing the benefits and harms of using clinical breast examinations for women 40 years and older.</span></li>
<li><span class="textfirstpara">Self breast examination is not recommended to be taught to women by clinicians, as it is not a sensitive technique and raises a woman's level of anxiety.</span></li>
<li><span class="textfirstpara">A lack of published evidence currently exists to provide a guideline about benefits and harms associated with digital mammography or MRI instead of film-screen mammography.</span></li>
</ul><span class="textfirstpara"><br />
USPSTF used data from film-screen mammography in its report, rather than taking into consideration that digital mammography was developed to address film-screen's limitations and is in widespread use, according to Evans. In fact, one of the puzzling things about the USPSTF report is its lack of any reference to the American College of Radiology Imaging Network (ACRIN) Digital Mammographic Imaging Screening Trial (DMIST), conducted in 2005.<br />
<br />
"USPSTF didn't make specific mention of DMIST," he said. "And yet they claim that more evidence is needed to provide a guideline about benefits and harms associated with digital mammography, instead of film-screen mammography."<br />
<br />
"Other U.S. Preventive Services Task Force reports are routinely high quality," Evans said. "It's possible that the breast cancer screening task force did a good job but didn't spell out their methods. In any case, their report has created confusion for everyone, as well as our government officials."<br />
<br />
If the U.S. Department of Health and Human Services had addressed the guidelines point by point, this confusion might have been put to rest earlier, Evans said.<br />
<br />
"[After the guidelines were released], the Department of Health and Human Services responded by telling the public not to pay attention," he said. "They should have asked the USPSTF to provide an addendum with additional details on their review."<br />
<br />
In the aftermath of the report's publication, USPSTF should take several steps to clear up the confusion, Evans wrote: It needs to provide an addendum that details its methodology, and if a systematic review as outlined by PRISMA or AMSTAR has not been conducted, it needs to be done.<br />
<br />
"A revised set of guidelines is needed to assist patients in making the best decision about participating in screening breast examinations," he concluded.</span><span class="textfirstpara" style="font-style: italic;"><br />
</span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-50164223550675516092009-11-16T20:39:00.000-05:002010-03-26T15:39:22.111-04:00Breast Cancer Screening Guidelines Changing again<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFUf8VUfX42osIdk1xAZXY-DU48xDZk7Wb_Lbc6nDLPTkYKifis4nMlFpPfwgZL-vuH4_Sa2GeODhHSjyVFq7F6eMSw9LZP2ntMVrUXF_917xsKIgqTAOvj1ue92Tde_qGR5r2qhkMGtw/s1600/AnnalsIMcover.gif" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5404882614675270434" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFUf8VUfX42osIdk1xAZXY-DU48xDZk7Wb_Lbc6nDLPTkYKifis4nMlFpPfwgZL-vuH4_Sa2GeODhHSjyVFq7F6eMSw9LZP2ntMVrUXF_917xsKIgqTAOvj1ue92Tde_qGR5r2qhkMGtw/s320/AnnalsIMcover.gif" style="cursor: pointer; float: left; height: 255px; margin: 0pt 10px 10px 0pt; width: 195px;" /></a><br />
Furore in the colleges and societies, as the <a href="http://www.ahrq.gov/clinic/uspstfab.htm">US preventive services task force</a> releases it's new breast cancer screening guidelines, following the release of a paper in the Annals of Internal Medicine today<br />
<br />
Their recommendations for starting screening at 50 (for women without a family history of breast cancer) with mammograms every 2 years, and ending at 74 years, more closely mimics the recommendations for screening in European countries, and broadly similar to the <a href="http://www.blogger.com/The%20task%20force%20is%20an%20independent%20panel%20of%20experts%20in%20prevention%20and%20primary%20care%20appointed%20by%20the%20federal%20Department%20of%20Health%20and%20Human%20Services.">UK NHSBSP</a>.<br />
<br />
The task force is an independent panel of experts in prevention and primary care appointed by the federal <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/h/health_and_human_services_department/index.html?inline=nyt-org" title="More articles about Health and Human Services Department, U.S.">Department of Health and Human Services</a>.<br />
<br />
The guidelines were published in today's (Nov 16, 2009) edition of the <a href="http://www.annals.org/">Annals of Internal Medicine</a><br />
<br />
In order to formulate its guidelines, the task force used new data from mammography studies in England and Sweden and also commissioned six groups to make statistical models to analyze the aggregate data. The models were the only way to answer questions like how much extra benefit do women get if they are screened every year<br />
<br />
Dr. Karla Kerlikowske, a professor in the department of medicine, epidemiology and biostatistics at the University of California, San Francisco said "The message for most women is to forgo routine mammograms if they are in their 40s.<br />
<br />
Starting at age 50, Dr. Kerlikowske said, “the message is to get 10 mammograms in a lifetime, one every two years.” That way they get the most benefit and the least harm from the test. If women are healthy, she added, they might consider having mammograms every two years until age 74.<br />
<br />
Nearly two-thirds of all women in their 40s had mammograms within the last two years, as did 72 percent of women age 50 to 65, according to an editorial by Dr. Kerlikowske that accompanies the report.<br />
<br />
The Society of Breast Imaging and the American College of Radiology, the American Cancer Society, and many other respected professional organizations, have voiced strong opposition to the changes proposed in the articles.<br />
<br />
It is the opinion of the SBI leadership that adopting these guidelines would result in a major step backward in women's healthcare and increased deaths from breast cancer.<br />
<br />
Immediately, they provided a number of guidance documents and statements as follows (which is a model for speedy response to crises) -<br />
<br />
<span style="text-decoration: underline;"><span style="font-weight: bold;"><br />
</span><a href="http://www.sbi-online.org/associations/8199/files/STATEMENT%20FROM%20THE%20AMERICAN%20COLLEGE%20OF%20RADIOLOGY%20AND%20THE%20SOCIETY%20OF%20BREAST%20IMAGING.pdf">STATEMENT FROM THE AMERICAN COLLEGE OF RADIOLOGY AND THE SOCIETY OF BREAST IMAGING:<br />
USPSTF Mammography Recommendations Will Result in Unnecessary Breast Cancer Deaths Each Year</a><span style="font-weight: bold;"><br />
<a href="http://www.sbi-online.org/associations/8199/files/SOCIETY%20OF%20BREAST%20IMAGING%20TALKING%20POINTS.pdf"><br />
</a></span><a href="http://www.sbi-online.org/associations/8199/files/SOCIETY%20OF%20BREAST%20IMAGING%20TALKING%20POINTS.pdf">Talking Points in response to USPSTF Statement</a><br />
<a href="http://www.sbi-online.org/associations/8199/files%20USPSTF_breast_cancer_screening_analysis.pdf"><br />
Detailed ACR Statement on Ill Advised and Dangerous USPSTF Mammography Recommendations</a><a href="http://www.sbi-online.org/associations/8199/files%20USPSTF_breast_cancer_screening_analysis.pdf">: Mammography Screening References</a><br />
<br />
<a href="http://www.sbi-online.org/associations/8199/files/ACS%20Statement%20from%20Otis%20W%20Brawley.pdf">American Cancer Society Statement</a><br />
<a href="http://www.sbi-online.org/associations/8199/files/KOMEN%20Screening%20Statement%2011%2016%2009.pdf"><br />
Komen Screening Statement 11-16-09</a><br />
<a href="http://www.cancer.gov/newscenter/pressreleases/BreastScreen2009"><br />
NCI Statement</a></span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-81307906623840812082009-10-22T11:27:00.000-04:002009-10-22T14:22:56.009-04:00Rethinking strategies for breast and prostate cancer screening<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjg1BwsAALg4LwoEX-q17CbV-LLKb2zOLRgg3uYJi4TAxkro7suKhZmvmbpwAWi1Lne1U6dJCQ72o5aYJ7b0_8L40sOpJmcD0kCYvIyfPKYnCokqymsira6ZNzWtchMYQKOahh04AYXq8E/s1600-h/JAMAcover.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 184px; height: 248px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjg1BwsAALg4LwoEX-q17CbV-LLKb2zOLRgg3uYJi4TAxkro7suKhZmvmbpwAWi1Lne1U6dJCQ72o5aYJ7b0_8L40sOpJmcD0kCYvIyfPKYnCokqymsira6ZNzWtchMYQKOahh04AYXq8E/s400/JAMAcover.jpg" alt="" id="BLOGGER_PHOTO_ID_5395447082411549858" border="0" /></a><br />Twenty years of screening for breast and prostate cancer—the most diagnosed cancers for women and men—have not brought the anticipated decline in deaths from these diseases, argue experts in an opinion piece published Wednesday in the Journal of the American Medical Association<br /><br />In an article published yesterday (Oct 21, 2009) in JAMA, Laura Esserman et al, one of our UCSF breast surgeons, and leader of the ATHENA project in the University of California, discuss whether we should be reconsidering looking at our screening tools for both breast and prostate cancer, and be more intelligent in their use.<br /><br /><br />"Screening does provide some benefit, but the problem is that the benefit is not nearly as much as we hoped and comes at the cost of over-diagnosis and over-treatment," said <a class="hasTip" title="More news about::Laura Esserman" href="http://www.ucsfbreastcarecenter.org/aboutindex2.html">Laura Esserman</a>, MD, professor of surgery and radiology, director of the <a class="hasTip" title="More news about::University of California, San Francisco" href="http://www.ucsf.edu/">University of California, San Francisco</a> (UCSF) <a class="hasTip" title="More news about::Carol Franc Buck Breast Care Center" href="http://www.blogger.com/www.ucsfbreastcarecenter.org">Carol Franc Buck Breast Care Center</a>.<br /><br />We acknowledge that screening is not perfect, as there are a proportion of women who are screened but would never die of the disease (lead time bias). Also there are the group of women who present as interval cancers due to their very different biology. These women still get their mammograms at the proscribed times, but tend to develop cancer between their screening tests.<br /><br />"We need to focus on developing new tools to identify men and women at risk for the most aggressive cancers, to identify at the time of diagnosis those who have indolent or 'idle' tumors that are not life-threatening,"<br /><br />Periodic screening may find some tumors early, but patients may not be screened often enough for lethal tumors to be detected in time to prevent death, leading the authors to conclude: "Without the ability to distinguish cancers that pose minimal risk from those posing substantial risk and with highly sensitive screening tests, there is an increased risk that the population will be over-treated."<br /><br />The authors suggested that to improve screening, "a new focus is recommended for research and care to identify markers that discriminate minimal-risk from high-risk disease (and) identify less aggressive interventions for minimal-risk disease to reduce treatment burden for patients and society."<br /><br />The authors made the following recommendations for early cancer detection and prevention:<br /><ul><li>Develop tests to distinguish between low-risk and lethal cancers. </li><li>Reduce treatment for low-risk disease. “Diagnosing cancers that don't kill the patient has led to treatment that may do more harm than good,” they wrote. </li><li>Develop tools for physicians and patients to help them make informed decisions about prevention, screening, biopsy and treatment. </li><li>Offer treatments individually tailored to a patient's tumor. </li><li>Work to identify the people at highest risk for cancer and use proven preventive interventions. </li></ul>As part of the <a href="https://bighealth.nci.nih.gov/index.php/Athena_Breast_Health_Network#Presentation">ATHENA project</a> we are looking at these aspects across the whole of the University of California medical centers (UCSF, UCLA, UC Irvine, UC Davis and UC San Diego).<br />This is a mix of researcher and clinicians who are trying to put research to clinical use (bench to bedside medicine)<br /><br />Targeting screening tests to the at risk population may give better outcomes with fewer so called "false positives" from screening, thereby benefiting the screened women the most. It will also save us from overtreating some of the lower risk/indolent cancers that occur.<br /><br />NCI commentary is available <a href="http://www.cancer.gov/ncicancerbulletin/102009/page6">in their bulletin</a>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-55189954161596708322009-09-29T14:52:00.000-04:002010-04-10T19:15:55.586-04:00CAD and Screening Mammography: ready for prime time?In this months RADIOLOGY, Robyn Birdwell and Liane Philpotts share their different viewpoints on CAD and screening mammography. Both are well known mammographers in the North East, with Robyn being a guest of the RCR Breast Group at November's Annual Scientific Meeting<br />
<br />
In the first of the two articles, Robyn Birdwell talks about the various CAD studies, and how the proponderance of data supports the use of CAD in screening mammography, and that "Having a system to aid the human eye that does nottake vacations, is not vulnerable to fatigue or environmental distractions, is without, emotion, and is designed specifically to assist the very human eye to "look over here" seems like a good idea"<br />
<span style="font-weight: bold;">The Preponderance of Evidence Supports Computer-aided Detection for Screening Mammography</span><br />
<span style="font-weight: bold;">Robyn L. Birdwell</span><br />
Radiology 2009;253 9-16<br />
<a href="http://radiology.rsna.org/cgi/content/full/253/1/9?etoc">http://radiology.rsna.org/cgi/content/full/253/1/9?etoc</a><br />
<br />
In the second editorial article, Liane Philpotts points out that recalling patients from screening is sometimes more of an art than a science, and I am sure that many experienced radiologists would share her view.<br />
<br />
One of the main issues with CAD is the necessary high false-positive rate of CAD prompts which subsequently means that the specificity is low, and we have the distracting factor of many false calls, while also knowing that not all cancers are picked up by CAD<br />
<br />
Understanding of the limitations of computer-aided detection is important for those interpreting mammograms; this cautious approach to the use of computer-aided detection should help optimize this presently imperfect system and minimize the possible detrimental effects<br />
<br />
<span style="font-weight: bold;">Can Computer-aided Detection Be Detrimental to Mammographic Interpretation?</span><br />
<span style="font-weight: bold;">Liane E. Philpotts</span><br />
Radiology 2009;253 17-22<br />
<a href="http://radiology.rsna.org/cgi/content/full/253/1/17?etoc">http://radiology.rsna.org/cgi/content/full/253/1/17?etoc </a>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-49296863362862473282009-09-14T12:18:00.001-04:002009-09-14T12:33:06.731-04:00Informing patients about breast cancer screening - risks of overdiagnosisA recent posting on the NHS National Prescribing Centre website blog addresses the issues of possible overdiagnosis of inconsequential cancers found as part of routine screening.<br /><br /><a href="http://www.npci.org.uk/blog/?p=417">Blog link here</a><br /><br />It is estimated that approximately 30% of breast cancers found at screening are of low grade and metastatic potential (low oncotype score) which may never kill the patient, and are therefore counted as being overdiagnosis.<br /><br />Various tools are available to help primary care providers and others wishing to assist women to make informed decisions about whether to have screening or not.<br /><br />Patient decision aids may help to guide women make the decision alongside the literature from the NHSBSPDr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-51253716187244655472009-09-13T19:55:00.000-04:002009-09-13T19:59:00.905-04:00Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUs0fceqWia23UWgVN2H3aMy3P67MGNyDBlhIw-8maqC7Ea_LeH2mUIbl2Bkypc8s5DbNblxSmtyk4tlLd_ilUmLuiACtVzmrLgsWLrj2AtOS3BrbauXcwbGdt01X7Z-eq7o04zhogfaE/s1600-h/JCOcover.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 145px; height: 192px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUs0fceqWia23UWgVN2H3aMy3P67MGNyDBlhIw-8maqC7Ea_LeH2mUIbl2Bkypc8s5DbNblxSmtyk4tlLd_ilUmLuiACtVzmrLgsWLrj2AtOS3BrbauXcwbGdt01X7Z-eq7o04zhogfaE/s400/JCOcover.jpg" alt="" id="BLOGGER_PHOTO_ID_5381105533557430242" border="0" /></a><br /><span style="font-weight: bold;">Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes</span><br />Marie L. De Bruin, Judith Sparidans, Mars B. van't Veer, Evert M. Noordijk, Marieke W.J. Louwman, Josée M. Zijlstra, Hendrik van den Berg, Nicola S. Russell, Annegien Broeks, Margreet H.A. Baaijens, Berthe M.P. Aleman, and Flora E. van Leeuwen<br />Journal of Clinical Oncology, Vol 27, No 26 (September 10), 2009: pp. 4239-4246<br /><br /><a href="http://jco.ascopubs.org/cgi/content/abstract/27/26/4239">Link to Journal</a><br /><br /><span style="font-style: italic;">Some good signs for the future in this article from the Netherlands on the breast cancer risk reduction following the reduction in radiation volumes for Hodgkin's disease sufferers.<br /><br />Reduction of radiation volume appears to decrease the risk for Breast Cancer after Hodgkin's Lymphoma. </span> <span style="font-style: italic;">In addition, shorter duration of intact ovarian function after irradiation is associated with a significant reduction of the risk for Breast Cancer</span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-40242476974060159762009-08-11T11:33:00.000-04:002009-08-11T13:16:01.366-04:00Image display contrast variation negates consistent mammo readingsSo it seems that much of the effects found by the DMIST Study were due to image contrast, inherent with digital imaging.................<br /><br />A report in Radiology from the DMIST investigators in the August edition -<br /><cite><abbr title="Radiology" class="site-title">Radiology</abbr> <span class="cit-print-date">August 2009 </span><span class="cit-vol">252<span class="cit-sep cit-sep-after-article-vol">:</span></span><span class="cit-pages"><span class="cit-first-page">348</span><span class="cit-sep">-</span><span class="cit-last-page">357<br /><br /><a href="http://radiology.rsna.org/content/252/2/348.abstract">Link to Journal</a><br /><br /></span></span></cite><span style="font-style: italic;">Readers most frequently attributed differences in DMIST cancer visibility to variations in image contrast—not differences in positioning or compression—between digital and screen-film mammography.<br /><br />For women with both fatty and dense breasts, the most frequent reason given for the difference in visibility between film-screen and digital mammography was contrast differences between the two modalities. For women with dense breasts, contrast differences accounted for 70 of the 378 reasons given by the readers for better visibility. Positioning, compression, and technique differences accounted for only 37 of the reasons given for improved visibility<br /><br />The odds of a cancer being more visible on a digital mammogram—rather than being equally visible on digital and screen-film mammograms—were significantly greater for women with dense breasts than for women with non-dense breasts, even with the data adjusted for patient age, lesion type, and mammography system (odds ratio, 2.28; </span><em style="font-style: italic;">P</em><span style="font-style: italic;"> < .0001).<br /><br />The odds of a cancer being more visible at digital mammography—rather than being equally visible at digital and screen-film mammography—were significantly greater for lesions imaged with the General Electric digital mammography system than for lesions imaged with the Fischer (</span><em style="font-style: italic;">P</em><span style="font-style: italic;"> = .0070) and Fuji (</span><em style="font-style: italic;">P</em><span style="font-style: italic;"> = .0070) devices.</span> No comment was made about Hologic<br /><cite><span class="cit-pages"><span class="cit-last-page"><br /></span></span></cite><span style="font-style: italic;">The significantly better diagnostic accuracy of digital mammography, as compared with screen-film mammography, in women with dense breasts demonstrated in the DMIST was most likely attributable to differences in image contrast, which were most likely due to the inherent system performance improvements that are available with digital mammography. The authors conclude that the DMIST results were attributable primarily to differences in the display and acquisition characteristics of the mammography devices rather than to reader variability.</span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-42294965262551443072009-06-26T18:16:00.000-04:002009-06-26T18:37:37.274-04:00JNCI response to latest attack on screening by Grotzche et al<span style="font-weight: bold;">JNCI response to latest attack on screening by Grotzche et al</span><br /><br />In a very balanced editorial in today's JNCI, Liz Savage writes about the recent letter to The Times of London, and the claim that up to 50% of cancers are diagnosed unnecessarily by the NHS Breast Screening Programme (NHS BSP), but primarily the attack was again on the content of invitation leaflets sent to women at each invitation. These were changed or amended after their last attack in the media a few years ago.<br /><br />Although some of their criticism remains valid, their wild claims that 50% of cancers detected by screening would never kill women remains unsubstantiated.<br />While it is clear, that some women have an exceptionally good prognosis, and probably would never have had disease that would have killed them, the majority (or even if it was just the 50%) would definitely have been helped.<br /><br />Newer genomic typing of tumors may assist at an early stage of diagnosis (perhaps at initial core biopsy) which group of risk she is in, then if low, she may not need any treatment, or just hormone therapy instead of the current more invasive procedures.<br /><br />Typing, such as that used by mammaprint (nl), may be able to distinguish between three separate groups, with minimal overlap. Laura Vantveer, on sabatical with UCSF from Holland is developing this technique on all our cancers treated at UCSF. The middle group of women with less aggressive subtyping and the ones most likely to be helped by screening, the high risk women showed marked aggressivity at any size, and appear to need everything (including the kitched sink) thrown at them, to get a response (CPR - complete pathological response)<br /><br />Women with the least aggressive subtype, may be represented by this group who never progress to a 'killer' cancer, and may be overtreated by being offered chemotherapy, radiotherapy or even surgery. If these cancers NEVER kill anyone, maybe a different term - other than carcinoma - may need to be used to indicate that these are a different disease compared with the real cancers.<br /><br />These are interesting times, and allow us to start thinking more intelligently about screening, and the outcomes from screening. In the meanwhile.... let's get back to ensuring that women are adequately informed about the benefits and risks at their invitation.Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-27894633837441250542009-03-25T11:17:00.000-04:002009-03-25T11:25:19.181-04:00Triple negative breast cancers are increased in black women regardless of age or body mass indexMore on Triple Negative Breast Cancer amongst Black Women - OF ANY AGE<br /><b><span class="hiddenlink"><span class="xcitationtitle"><b>Triple negative breast cancers are increased in black women regardless of age or body mass index</b></span></span></b><br /><span class="smalltext">Lesley Stead, Timothy L Lash, Jerome Sobieraj, Dorcas Chi, Jennifer Westrup, Marjory Charlot, Rita Blanchard, John-cho Lee, Thomas King, Carol L Rosenberg</span><br /><p><em>Breast Cancer Research</em> 2009, <strong>11</strong><strong>:</strong>R18<span class="pseudotab">doi:10.1186/bcr2242</span></p><a style="font-style: italic;" href="http://breast-cancer-research.com/content/11/2/R18">Reported online</a><span style="font-style: italic;">, on the breast cancer research website. black women are three times more likely than other women to develop an aggressive form of breast cancer characterised by "triple negative tumours. The findings held true even when other risk factors such as lifestyle, age and weight were taken into account. In the United States, where the study was conducted, the overall incidence of breast cancer is lower in black women than in white women. But when black women do get breast cancer, it tends to be more advanced when diagnosed, has a higher risk of recurring, and a less favourable outcome.</span> <span style="font-style: italic;"><br /><br /></span><span style="font-weight: bold; font-style: italic;">Black women of diverse background have 3-fold more Tneg tumours than non-black women, regardless of age and BMI.</span><br /><span style="font-style: italic;"><br />Researchers led by Carol Rosenberg of Boston University analysed 415 breast cancer cases and noted the number of "triple negative" tumours, so called because three critical proteins -- estrogen and progesterone receptors, and the HER2 gene -- malfunction.</span> <span style="font-style: italic;"><br /><br />"The odds of having a triple-negative tumour were three times higher for black women than for non-black women," said Rosenberg</span> <span style="font-style: italic;"><br /><br />It had been known that pre-menopausal black women were disproportionately affected by this deadly form of cancer, but the new study showed that these tumours were just as common in black women diagnosed before or after age 50, obese or not.</span> <span style="font-style: italic;"><br /><br />The higher prevalence of triple negative breast tumours in black women in all age and weight categories likely contributes to black women's unfavourable breast cancer prognosis</span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-62749864648148820002009-03-25T11:08:00.000-04:002009-03-25T11:14:48.775-04:00Early detection of second breast cancers improves prognosis in breast cancer survivors<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVQM2DXfEY1S-rrRBhFneIs4AIegVveuLpfzpRxUZ4EmSkmbha3gVuqlPjxlix4kMMWSGXKV2UtH0cTMCBma2VIKoADq3hLuLL_dj2TUw3cmrbprWrjkrGHKBA8QeLza5I0o2gKiMQWpI/s1600-h/AnnalsofOncology.gif"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 134px; height: 175px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVQM2DXfEY1S-rrRBhFneIs4AIegVveuLpfzpRxUZ4EmSkmbha3gVuqlPjxlix4kMMWSGXKV2UtH0cTMCBma2VIKoADq3hLuLL_dj2TUw3cmrbprWrjkrGHKBA8QeLza5I0o2gKiMQWpI/s400/AnnalsofOncology.gif" alt="" id="BLOGGER_PHOTO_ID_5317142741753610642" border="0" /></a><br /><span style="font-weight: bold;">Early detection of second breast cancers improves prognosis in breast cancer survivors<br /></span>N. Houssami, S. Ciatto, F. Martinelli, R. Bonardi, and S. W. Duffy<br /><span><a href="http://annonc.oxfordjournals.org/papbyrecent.dtl">Advanced access</a> to the publication</span><span> of this paper, published online March 19, 2009 <span style="font-weight: bold;"><br /></span><span style="font-style: italic;"> The impact of early detection of second breast cancers in women who have survived a primary breast cancer is unknown.</span><br /><span style="font-style: italic;">The researchers looked at information on 1,044 women who were seen at a medical center in Florence, Italy, between 1980 and 2005 and who had developed a second breast cancer -- 455 with cancer in the same breast (ipsilateral) and 589 with cancer in the opposite breast (contralateral). Of the second breast cancers, 67 percent were asymptomatic, and 33 percent were symptomatic.</span><br /><br /><span style="font-style: italic;">The study found that chances of survival improved between 27 percent and 47 percent if the second breast cancer was detected in the early, asymptomatic stage rather than at a later stage when women started to experience symptoms.</span><br /><br /><span style="font-style: italic;">The researchers also found that mammography</span><br /><span style="font-style: italic;">was more sensitive than clinical examination for detecting second breast cancers -- 86 percent vs. 57 percent. However, 14 percent of the cancers were detected only by clinical examination.</span><br /><br /><span style="font-style: italic;">Asymptomatic cancers were smaller than symptomatic cancers, and early-stage cancers were more common in asymptomatic women (58 percent) than in symptomatic women (23 percent). Fewer women with asymptomatic than symptomatic contralateral cancer had node metastases, an indication the cancer may have spread.</span><br /><br /><span style="font-weight: bold;">Take home message:<br />Early detection of second breast cancers can reduce the risk of death by as much as half</span><span style="font-weight: bold;"><br /></span></span><span style="font-weight: bold;"><br /></span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-30524723280192728112009-03-19T10:51:00.000-04:002009-03-23T21:35:42.802-04:00First Report of a Necrotising Fasciitis of the Breast Following a Core Needle Biopsy<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtBG4ygp-1irxQ09beWcuZbKgTxyu37h0hM4w4NqSJYFW5fjVkfBeML9rSYq8C9b-pd0hcnvnld1ZrDOovk8mP9_i6wlpFV71tjc2y1hCb6N7V7QjW-vy6nErYJ7jpyNy9zhmMxkssFfI/s1600-h/TheBreastJournalblogHeader.gif"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 400px; height: 92px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtBG4ygp-1irxQ09beWcuZbKgTxyu37h0hM4w4NqSJYFW5fjVkfBeML9rSYq8C9b-pd0hcnvnld1ZrDOovk8mP9_i6wlpFV71tjc2y1hCb6N7V7QjW-vy6nErYJ7jpyNy9zhmMxkssFfI/s400/TheBreastJournalblogHeader.gif" alt="" id="BLOGGER_PHOTO_ID_5314912347517255218" border="0" /></a><br /><br /><br /><br /><br /><br />The first report of the aggressive infection, necrotising fasciitis following core biopsy of the breast has been reported by researchers in France.<br /><br />In a paper published in <a href="http://www3.interscience.wiley.com/journal/122249668/abstract">The Breast Journal</a> this month, the department of OB/GYN in Montpelier, France, describe the case of a 50 year old woman one week after a 14g stereotactic core biopsy for a BIRADS 4 - suspicious lesion.<br /><br />This is an aggressive infection with a beta-hemolytic streptococcus, which requires aggressive surgery to clear (debride) the infected tissue. Previously only described following mastectomy or breast reduction, this has now occurred following a simple routine core biopsy.<br /><br />When consenting a patient for a core biopsy, we routinely describe the complication of infection, along with bruising and non-removal of the target lesion. Based on this case, our management should not change, but it remains a salutary lesson, that the most aggressive type of infection can occur in patients attending for a routine biopsy.<br /><br />Continued attention to hand hygiene, and an aseptic field during biopsy remain important. Interestingly, the staff performing the biopsy did not have their skin tested for whether they were carriers of the B-Hemolytic strep, so we wil never know whether this was a factorDr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-74796699604970157162009-02-25T18:05:00.000-05:002009-03-23T21:40:03.134-04:00Moderate Alcohol Intake and Cancer Incidence in Women<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2kID1O8BueiUNyMSqBcMT6bvfTvvKSrxxuz_ktSvJkHYuwxkE0X8zJw9Vqj9o-QxYWJMgjea8p4zzvpYx7ZpV3gxN1BEka62xVst3JhvkTrY-7n1bWs9OA_BPcLG7VsL4baf9lfejGX4/s1600-h/JNCIcover.gif"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 134px; height: 175px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2kID1O8BueiUNyMSqBcMT6bvfTvvKSrxxuz_ktSvJkHYuwxkE0X8zJw9Vqj9o-QxYWJMgjea8p4zzvpYx7ZpV3gxN1BEka62xVst3JhvkTrY-7n1bWs9OA_BPcLG7VsL4baf9lfejGX4/s400/JNCIcover.gif" alt="" id="BLOGGER_PHOTO_ID_5306877589151583378" border="0" /></a><br /><br />Published this week in the Journal of the National Cancer Institute, and available to members on the RCRBG website, is the revelation from the Million Women Study, that any alcohol is 'bad' alcohol, as regards breast cancer risk.<br /><br />Valerie Beral's team at Oxford demonstrated that increasing but moderate alcohol consumption in women was determined to be associated with an increased risk of cancers of the oral cavity and pharynx, esophagus, larynx, rectum, breast, and liver, and with a decreased risk for thyroid cancer, non–Hodgkin lymphoma, and renal cell carcinoma. No differences in cancer risks were observed between drinkers of wine only and other consumers of alcohol<br /><br />As ever, this could be seen as a scare story, but has to be taken in context with some of the other proven beneficial effects - eg a glass of red wine and its protective effects against heart disease.<br />If you are a woman who is at increased risk already from family history or a prior biopsy of atypia, maybe you are the one who needs to be aware of this finding and consider modifying your lifestyle.<br /><br />In the greater scheme of things, everything has risks and benefits - look at HRT use itself, which was the original target of this researchDr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-22114071648197320222009-01-27T17:37:00.000-05:002009-01-27T17:57:27.341-05:00RECIST criteria for tumour volume measurement for trialsThe first, formal revision of specific guidelines, known as RECIST (Response Evaluation Criteria in Solid Tumours), used by clinicians to measure tumour size and response to treatment, has been published January 20 in a special issue of the European Journal of Cancer<br /><a href="http://www.sciencedirect.com/science/journal/09598049"><b>European Journal of Cancer</b></a><br /><a href="http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%235024%232009%23999549997%23790193%23FLA%23&_cdi=5024&_pubType=J&view=c&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1517432643c911a999374022937a13a7"> Volume 45, Issue 2</a>, January 2009<br /><br />The only proven way of measuring tumour response is by measuring size on imaging. This of course is subject to measurement error, and so criteria have been published that allow measurement of response in even small tumours (5mm)<br /><br />When it comes to clinical trials of therapeutic agents, tumour shrinkage (objective response) and time to the development of disease progression are both important endpoints in trials, and, increasingly in recent years, trials have been using time to progression (or progression-free survival) as their main endpoint on which to base conclusions about the efficacy of a drug.<br /><br />The new RECIST (RECIST 1.1 to distinguish them from the original RECIST) answer some of the questions and issues that have arisen since 2000 as a result of changing methodologies and available treatments<br /><br /><p>Key changes in RECIST 1.1 that will simplify, optimise and standardise the assessment of tumour burden in clinical trials are as follows:</p> <ol><li>A reduction in the number of lesions to be assessed for response from a maximum of ten to five, and from five to a maximum of two per organ</li><li>New guidance on making robust measurements of lymph node involvement</li><li>Confirmation of response is required for trials with objective response as a primary endpoint, but is no longer required for randomised studies, since the control arm of these studies provides appropriate means for interpreting results of the experimental arm</li><li>The definition of disease progression has been refined so that it not only includes a 20% increase in the size of the lesion, but also a 5 mm absolute increase as well, so that changes of just a few mms in very small tumours, which may be within the range of measurement error, are not unnecessarily described as disease progression</li><li>Guidance on imaging, including its use in the detection of new lesions and the interpretation of FDG-PET scan assessment</li></ol>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-15201947207956967592009-01-07T10:46:00.000-05:002009-01-07T10:51:27.892-05:00Rising incidence of cancer in survivors<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeJiEFD8AN2I43tiSQVC5H2aLBZFpb2Sr3qQ8mJRbpF0VqXStIeZksqS-wFy0_75-1bEdPmqh8ZtL7QWAckKslkiEKIPIkFGXF3A0_9BSObcoy1gcYll4ODb2fU5HqpcMeG6dr7tCAe1k/s1600-h/bjccover.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 139px; height: 187px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeJiEFD8AN2I43tiSQVC5H2aLBZFpb2Sr3qQ8mJRbpF0VqXStIeZksqS-wFy0_75-1bEdPmqh8ZtL7QWAckKslkiEKIPIkFGXF3A0_9BSObcoy1gcYll4ODb2fU5HqpcMeG6dr7tCAe1k/s400/bjccover.jpg" alt="" id="BLOGGER_PHOTO_ID_5288579602234967906" border="0" /></a><br /><span style="font-weight: bold;">Rising incidence of breast cancer among female cancer survivors: implications for surveillance</span><br />Paper in this months British Journal of Cancer, British Journal of Cancer (2009) 100, 77 – 81 from the Netherlands, showing a marked rise in breast cancer incidence among female cancer survivors.<br /><br />There are certainly questions raised from this study, in contradistinction to recent papers suggesting that most patients who are not in trials or undergoing adjuvant therapy can be discharged after surgery.<br /><br />What implications will it have on your Cancer Centre's policy?Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-31013112517152761852008-11-25T11:31:00.000-05:002009-05-30T21:22:17.126-04:00Do some screen-detected breast cancers spontaneously regress?<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYdj5esyKy4uNx8dzDYgC_jcY9EFDOeLwnleXG5aiZsxtKPiSckrrP7b5gZ7bS_J8tACfqzebOS5W4K8bAXgN1CABRGtE16WZXeUkl31zcC6oSDRbFsl4VpgUAxpKmd2bbh96tEEYcXkQ/s1600-h/ArchIntMedCover.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 184px; height: 242px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYdj5esyKy4uNx8dzDYgC_jcY9EFDOeLwnleXG5aiZsxtKPiSckrrP7b5gZ7bS_J8tACfqzebOS5W4K8bAXgN1CABRGtE16WZXeUkl31zcC6oSDRbFsl4VpgUAxpKmd2bbh96tEEYcXkQ/s400/ArchIntMedCover.jpg" alt="" id="BLOGGER_PHOTO_ID_5272633967070710834" border="0" /></a><br />An article in this weeks <a href="http://archinte.ama-assn.org/cgi/content/abstract/168/21/2311">Archives of Internal Medicine</a> from the Norwegian Screening Programme, discuss how there is an excess of cancers in the screened population, and how some of these regress spontaneously<br /><br /><span style=";font-family:verdana,arial,helvetica,sans-serif;font-size:85%;" ><em>Arch Intern Med.</em> 2008;168(21):2311-2316<br /><br />it appears that some breast cancers detected by repeated mammographic screening would not persist to be detectable by a single mammogram at the end of 6 years. This raises the possibility that the natural course of some screen-detected invasive breast cancers is to spontaneously regress<br /></span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-11059234339219037932008-10-07T22:07:00.000-04:002008-10-07T22:20:02.364-04:00News from the Fall meeting of ACRIN at the Pentagon<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwC1xo5SFAAMkHlYkyiv8aHPE0DE4k_zPlO6snCyh0cBxy1brSZmYoJcNssZlW2pIPav8eClGZ2_AGxSWpw62yoCACgF7FWyQhAAySiWUBSGIMKX6vjO1-1iiV-oQ0v-aLB0aE2y5lbV4/s1600-h/Picture+2-1.png"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwC1xo5SFAAMkHlYkyiv8aHPE0DE4k_zPlO6snCyh0cBxy1brSZmYoJcNssZlW2pIPav8eClGZ2_AGxSWpw62yoCACgF7FWyQhAAySiWUBSGIMKX6vjO1-1iiV-oQ0v-aLB0aE2y5lbV4/s400/Picture+2-1.png" alt="" id="BLOGGER_PHOTO_ID_5254600192505641218" border="0" /></a><br />The Fall meeting of ACRIN was held last week at Pentagon City in DC.<br /><br /><br /><br />Of note was the report from UCSF-led ACRIN study, on the use of breast MRI in the assessment of neoadjuvant chemotherapy -<br /><span class="text"><span class="textfirstpara"><b><br />"MRI is superior to mammography for evaluating the response to neoadjuvant chemotherapy for breast cancer, according to the early results of a trial from the University of California, San Francisco (UCSF) and nine other academic centers in the U.S. The results were presented at last week's American College of Radiology Imaging Network (ACRIN) fall meeting".</b><br /><br /></span></span><span class="text">The study was developed under ACRIN's protocol 6657, representing the imaging side of the larger I-SPY (Investigation of Serial Studies to Predict Your Therapeutic Response With Imaging and Molecular Analysis) trial aimed at gauging breast cancer treatment response. Sponsored by the Cancer and Leukemia Group B Foundation (CALGB), the I-SPY trial is "testing imaging and tissue-based biomarkers in combination, predicting neoadjuvant response to standard chemotherapy," explained Nola Hylton, Ph.D., a principal investigator from UCSF who discussed the results.<br /><br /></span><span class="text">Participants were scanned four times during chemotherapy, including once pretherapeutically, once after the first cycle of chemotherapy, and a third time between the anthracycline and Taxol agents. A fourth scan prior to surgery was intended to detect residual disease and evaluate the post-treatment sensitivity and specificity of MRI. Mammography scans were acquired to coincide with the first and last MRI scans<br /><br /></span><span class="text">MRI measurements included morpholgic measurements of the tumors classified according to BI-RADS criteria for breast MRI, including tumor diameter measurements. "We're also measuring by computer the volume of the tumor and the microvascular parameters of the tumor, PE [percent enhancement] and SER [signal enhancement ratio]," used to distinguish malignant tissue</span>, said Hylton.<br /><br /><span class="text">he investigational software assesses tumor volume quantitatively based on functional rather than anatomic criteria, she explained. "We are measuring something that is based on how these tumors enhance, and assigning [volume] based on an algorithm calling it part of the tumor or not. So it's really a virtual volume [that defines] areas of the image based on function, in this case how the tumors enhance."<br /><br /></span><span class="text">The investigators acquired one T1-weighted precontrast and two T2-weighted postcontrast scans, "and from that we looked at the early ratio of enhancement from the early time point to the late time point," she said. This calculation yields the signal enhancement ratio, which distinguishes tumor from nontumor. Another protocol ensures that the direction of diameter measurements remains constant over the course of multiple imaging exams<br /><br /></span><span class="text">At the end of surgery, 43% of the patients were complete responders, 38% were partial responders, and 10% demonstrated stable disease. "There were a larger portion of complete responders among those who also received Taxol," she said. "And there were a total of 82 pathologic complete responders, meaning that there was no invasive disease left at pathology. Sixty percent of patients had a complete solid lesion, and 32% had two identifiable lesions in the breast.<br /><br /></span><span class="text">Compliance with the study was surprisingly good, especially considering the complexity of the protocol, requiring both biopsy and multiple imaging exams in addition to treatment, she said. In addition, lesion morphology was very similar to a pilot study. There were 36 single masses; 65 multilobulated masses with well-defined margins; 66 lesions with area enhancement, irregular margins, and nodularity; 30 of the same without nodularity; and 19 patients with septal spread.<br /><br /></span><span class="text">Once the analysis has been completed, more precise data will be presented at the 2008 RSNA meeting in Chicago. </span><br /><span class="text"><span class="textfirstpara"><b><br /></b></span></span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-37981501180274771302008-08-29T12:20:00.000-04:002008-08-29T12:33:04.137-04:00Researchers Are Investigating Two New Potential Tools for Diagnosing Breast Cancer<span style="font-style: italic;">Researchers at Jefferson Medical College of Thomas Jefferson University in Philadelphia are investigating contrast-enhanced subharmonic ultrasound as a noninvasive exam that could help physicians make a diagnosis. In subharmonic imaging, pulses are transmitted at one frequency, but only echoes at half that frequency are received</span><br /><br /><span style="font-style: italic;">In a study reported in the <a href="http://radiology.rsna.org/cgi/content/abstract/244/3/718">September 2007 issue of Radiology</a>, researchers tested their technique on 14 women ranging in age from 37 to 66 who had 16 biopsy-proven lesions. The researchers used a GE Logiq 9 ultrasound machine that was modified to perform grayscale subharmonic imaging, transmitting at 4.4 megahertz and receiving at 2.2 megahertz. The women underwent precontrast imaging and imaging using contrast</span><br /><br /><span style="font-style: italic;">The researchers’ results using subharmonic imaging were better than conventional ultrasound and mammography. Of the 16 lesions, four were malignant. Mammography had 100% sensitivity and 20% specificity for these lesions. Subharmonic imaging had 75% sensitivity and 83% specificity for the same lesions.</span><br /><br /><span style="font-style: italic;">The other tool - </span><br /><span style="font-style: italic;">Researchers at Duke University in North Carolina have developed a new scanner that they believe is better at finding early cancers in women than conventional mammography, and it can also be used for diagnosis and monitoring of therapeutic response(s). It is a hybrid between a SPECT and a CT scanner they are collectively calling mammotomography</span><br /><br /><span style="font-style: italic;">The researchers have done imaging observer studies using phantoms to compare x-ray digital mammography with CT. “We have been able to show a significant statistical improvement using CT compared to mammography,” Tornai says. “In mammography, you lose a lot of information because you have only a 2D image. With the 3D image that the SPECT/CT scanner produces, lesions become more conspicuous because overlapping tissues are removed. In contrast to x-ray tomosynthesis, a pseudo-3D x-ray imaging modality, the SPECT/CT system produces a uniform 3D image and does not require any breast compression.”</span><br /><br /><span style="font-style: italic;">The hybrid scanner that the researchers have built from novel configurations of conventional equipment circles the breast as the patient lies on a specially built table.</span><br /><br /><span style="font-style: italic;">The scanner is also able to see areas, including the chest wall, that traditional mammograms may not. They have tested the hybrid scanner extensively with phantoms and has begun successfully scanning subjects with known cancer.</span><br /><br /><span style="font-style: italic;">Because SPECT requires IV injection of imaging agents, the SPECT portion of the scanner would not likely be broadly used for routine screening mammography. However, if it proves to be more effective, the hybrid SPECT/CT system might be especially helpful for women who are at high risk for developing breast cancer because of familial history or a genetic predisposition.</span><br /><br /><span style="font-style: italic;">Breast SPECT/CT also could be used for women with dense breasts or implants because mammography is known to miss up to 25% of cancers in these women, Tornai says. The scanner and associated imaging procedure also should be less costly to employ than MRI</span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-88209037465960829342008-08-26T22:28:00.000-04:002009-02-26T14:49:11.484-05:00Potential mechanisms of breast cancer risk associated with mammographic density: hypotheses based on epidemiological evidenceLisa J Martin; Norman F Boyd<br />An interesting paper published online in Breast Cancer Res. 2008;10(1) by the above authors<span style="font-weight: bold;"><br /></span><span style=";font-family:times new roman;font-size:100%;" >This is reported in a <a href="http://www.medscape.com/viewarticle/577947?src=mp&spon=35&uac=50862MJ">Medline</a> article this week</span><br /><br /><span style="font-style: italic;">There is now extensive evidence that mammographic density is a risk factor for breast cancer, independent of other risk factors, and is associated with large relative and attributable risks for the disease. The hypotheses that we have developed from the observations described above are summarized here</span><br /><br /><span style="font-weight: bold; font-style: italic;">Cumulative Exposure to Mammographic Density and Breast Cancer Risk</span><br /><br /><span style="font-style: italic;">Mammographic density reflects variations in the tissue composition of the breast, and is associated positively with collagen and epithelial and nonepithelial cells, and negatively with fat. Increasing age, parity, and menopause are all associated with reductions in the epithelial and stromal tissues in the breast, and with an increase in fat. These histological changes are reflected in the radiological appearance of the breast, and are consistent with mammographic density being a marker of susceptibility to breast cancer, in a manner similar to the concept of 'breast tissue age' described in the Pike model. Like breast tissue age, variations in mammographic density may reflect the mitotic activity of breast cells and differences in susceptibility to genetic damage, and cumulative exposure to density may have an important influence on breast cancer incidence.</span><br /><br /><span style="font-weight: bold; font-style: italic;">Mitogens, Mutagens and Mammographic Density</span><br /><br /><span style="font-style: italic;">Mammographic density is influenced by some hormones and growth factors, as well as by several hormonal interventions, and is associated with urinary levels of a mutagen. We postulate that the combined effects of cell proliferation (mitogenesis) and genetic damage to proliferating cells by mutagens (mutagenesis) may underlie the increased risk for breast cancer associated with extensive mammographic density. As described above under 'Relationship of mitogenesis and mutagenesis', mitogenesis and mutagenesis are not independent processes. Increased cell proliferation can increase lipid peroxidation, and the products of lipid peroxidation can increase cell proliferation</span><br /><br /><span style="font-style: italic;">Potential areas for genetic influence include variation in the regulation of the hormones and growth factors that act on the breast, the response and modelling of breast tissue to these stimuli, and the processes that are involved in oxidative stress and the generation of mutagens.</span>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.comtag:blogger.com,1999:blog-3798760891098387382.post-62809460623195671002008-08-18T11:55:00.000-04:002008-08-18T17:15:59.010-04:00Use of Lidocaine gel pre-mammo may help to reduce discomfort<span id="article"><span style="font-weight: bold;"><br /><span style="font-style: italic;">Compression and the occasional discomfort and pain it brings in the breasts lead many women to avoid mammograms altogether.</span></span><br /><br /></span>However, results from a recent study from Boise, to be published in <a href="http://radiology.rsnajnls.org/cgi/content/abstract/248/3/765?etoc">September 08 edition of Radiology</a>, showed that application of lidocaine gel prior to a mammogram significantly reduced the degree of discomfort experienced.<br /><span id="article"><p> Lambertz and colleagues recruited 418 women ages 32 to 89 who expected significant discomfort with screening mammography. Fifty-four of the women reported that they had probably or definitely delayed their mammograms due to concern over possible discomfort. </p><p> The women were randomized to receive placebos or premedication with acetaminophen, ibuprofen, and/or a local anesthetic gel followed by mammography screening. The gel was applied to the skin of the breasts and chest wall and then removed 30 to 65 minutes before mammography. The gel had no effect on subsequent image quality. </p><p>Results showed that oral medication produced no significant differences in breast discomfort, nor did other factors such as breast density. Women who received a topical application of 4% lidocaine gel, however, reported significantly less breast discomfort during mammography.<br /></p></span><p> Eighty-eight percent of study participants indicated they would definitely get a mammogram the following year, and 10% said they would probably get a mammogram the following year. </p><p>"Women can now take charge of the situation," Lambertz said. "They can schedule a mammography appointment for a time in their cycle when their breasts are least tender, apply the gel at home, and travel to the appointment knowing they have taken steps toward a positive experience with this potentially life-saving procedure</p>Dr Chris Flowershttp://www.blogger.com/profile/13312249870856064707noreply@blogger.com