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1.
Univ. salud ; 22(1): 41-51, ene.-abr. 2020. tab
Article in Spanish | LILACS (Americas), COLNAL | ID: biblio-1094578

ABSTRACT

Introducción: La prevalencia del cáncer es un problema que vas más allá de la preocupación médica, por cuanto involucra aspectos subjetivos y sociales en la vida de quienes lo padecen o están en riesgo. Por esto, es de gran importancia detectarlo tempranamente, especialmente entre mujeres debido a su exposición a los factores de riesgo de cáncer de mama y cérvix. Objetivo: Analizar la abstención femenina en Chile a la Mamografía y Papanicolaou. Materiales y métodos: Se realizó un análisis multivariado de regresión logística binomial, de los datos disponibles en el Módulo de Salud de la Encuesta de Caracterización Socioeconómica Nacional (CASEN) en su edición del año 2015. Resultados: Se expone una generalizada abstención a la acción preventiva entre mujeres, aun cuando la prevalencia de ambos tipos de cáncer es alta. Los motivos personales aparecen como los más comunes para omitir Mamografía y/o Papanicolaou, especialmente la subvaloración de su importancia. Los factores que aumentan la probabilidad de abstención son la baja escolaridad, la ausencia de afiliación médica y la presencia de pareja. Conclusiones: Se plantea la necesidad de aumentar igualmente la cobertura del servicio preventivo, focalizar los recursos hacia la población vulnerable y mejorar las estrategias de incentivo hacia estos exámenes.


Introduction: The prevalence of cancer is a problem that goes beyond medical concern since it involves subjective and social aspects that affect the lives of those who either suffer from cancer or are at risk for it. Therefore, it is important to detect it early, especially among women due to their exposure to risk factors for breast and cervical cancer. Objective: To analyze women's abstention from mammography and Papanicolaou screening in Chile. Materials and methods: A multivariate binomial logistic regression analysis was conducted with available data from the Health Module of the National Socioeconomic Characterization Survey (NSCS) from 2015. Results: Even though there is a high prevalence of both types of cancer, there is a generalized female abstention from preventive actions. Personal reasons are the most common justifications given for avoidance of mammography and/or Papanicolaou test, especially undervaluing their importance. Factors that increase the probability of abstention include low education level, lack of medical affiliation, and presence of a partner. Conclusions: It is important to increase the coverage of preventive services, focus resources towards vulnerable populations, and create incentive strategies for women to take these exams.


Subject(s)
Female , Breast Neoplasms , Papanicolaou Test , Mammography , Uterine Cervical Neoplasms , Disease Prevention
2.
Rev. argent. mastología ; 39(141): 47-115, mar. 2020. ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1104372

ABSTRACT

La práctica de la imagenología mamaria ha experimentado gran variedad de avances tecnológicos desde los primeros tiempos hasta nuestros días. La técnica de la mamografía se estableció desde un comienzo como el gold standart para el estudio de la mama, pasando desde la mamografía de película de exposición directa a la mamografía digital y tomosíntesis actual. Junto con estos progresos tecnológicos, se han propuesto regulaciones basadas en la calidad de los estudios mamográficos y el desarrollo unificado de informes con la intención de estandarizar el lenguaje y el informe mamográfico, para facilitar el entendimiento entre los diferentes especialistas implicados en el manejo de la patología mamaria y como herramienta de mejora continua en la calidad. A partir del desarrollo de la ecografía y de la resonancia mamaria como complementos de la mamografía, surgen algoritmos adicionales para el diagnóstico y la selección de subgrupos de riesgo. Este acelerado avance en la detección por imágenes de la patología mamaria y de las técnicas intervencionistas las ha transformado en herramientas fundamentales no solo para el diagnóstico del cáncer de mama sino también por la utilización de esa información con vistas a guiar los futuros tratamientos. En esta presentación, se propone una descripción de la historia y evolución de las imágenes de mamografía desde su creación hasta la actualidad, entendiendo que el conocimiento del pasado ayuda a comprender mejor los debates y controversias actuales


The practice of breast imaging has undergone a variety of technological advances from the earliest times to the present day. The mammography technique was established from the beginning as the gold standard for the study of the breast, from the mammography of direct exposure film to digital mammography and current tomosynthesis. Together with these technological advances, regulations based on the quality of mammographic studies and the unified development of reports are proposed, with the intention of standardizing the language and mammographic report, to facilitate understanding between the different specialists involved in the management of breast pathology and as a tool for continuous improvement in quality. From the development of ultrasound and breast resonance, as complements of mammography, additional algorithms arise for the diagnosis and selection of risk subgroups. This accelerated progress in the detection of breast disease along with interventional techniques have been fundamental tools, not only for diagnosing breast cancer, but also for the use of this information to guide future treatments. A description of the history and evolution of mammography images from its creation to the present is proposed in this presentation, understanding that knowledge about the past helps to better understand current debates and controversies


Subject(s)
Breast Diseases , Mammography , Technological Development , Ultrasonography , History
3.
Article in English | WPRIM (Western Pacific) | ID: wprim-782173

ABSTRACT

Mammography is the primary screening method for breast cancers. However, the sensitivity of mammographic screening is lower for dense breasts, which are an independent risk factor for breast cancers. Automated breast ultrasound (ABUS) is used as an adjunct to mammography for screening breast cancers in asymptomatic women with dense breasts. It is an effective screening modality with diagnostic accuracy comparable to that of handheld ultrasound (HHUS). Radiologists should be familiar with the unique display mode, imaging features, and artifacts in ABUS, which differ from those in HHUS. The purpose of this study was to provide a comprehensive review of the clinical significance of dense breasts and ABUS screening, describe the unique features of ABUS, and introduce the method of use and interpretation of ABUS.


Subject(s)
Artifacts , Breast Neoplasms , Breast , Early Detection of Cancer , Female , Humans , Mammography , Mass Screening , Methods , Risk Factors , Ultrasonography
5.
Evid. actual. práct. ambul ; 22(3): e002023, nov. 2019.
Article in Spanish | LILACS (Americas) | ID: biblio-1046944

ABSTRACT

Al igual en otras partes del mundo, en Argentina la mortalidad específica por cáncer mamario disminuyó de forma sostenida entre 1996 y 2017. Es probable que en la actualidad la mamografía sea la herramienta más importante para detectar precozmente, evaluar y llevar un seguimiento de las personas con esta patología. Sin embargo existe mucha controversia acerca de los beneficios del tamizaje poblacional y de la realización de diagnósticos precoces de cáncer de mama. El propósito de esta revisión narrativa es brindar una mirada contraintuitiva, cuestionadora de los beneficios de esta práctica,ponderando también sus riesgos, escasamente visibilizados por las estrategias comunicacionales concordantes con el modelo deprevenir es mejor que curar y la lucha contra la historia natural del cáncer. (AU)


As in other parts of the world, in Argentina, breast cancer specific mortality declined steadily between 1996 and 2017. Mammography is currently the most important tool for early detection, evaluation and follow-up of people suffering fromthis disease. However, there is a controversy about the benefits of population screening and early diagnosis of breastcancer. The aim of this narrative review is to provide a counterintuitive, questioning view of the benefits of this practice, also weighing its risks, poorly visible through communication strategies consistent with the model of prevention is betterthan cureand the fight against the natural history of cancer. (AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Breast Neoplasms/diagnostic imaging , Mammography/adverse effects , Mass Screening/adverse effects , Argentina/epidemiology , Breast Neoplasms/diagnosis , Breast Neoplasms/mortality , Breast Neoplasms/prevention & control , Breast Neoplasms/therapy , Mammography/mortality , Mammography/trends , Public Health , Decision Making
6.
Evid. actual. práct. ambul ; 22(3): e002018, nov. 2019. ilus.
Article in Spanish | LILACS (Americas) | ID: biblio-1046953

ABSTRACT

En este comentario editorial, la autora repasa la controversia sobre la promoción del rastreo mamográfico del cáncer de mama en el contexto de las campañas de des-información durante el octubre rosa. (AU)


In this editorial comment, the author reviews the controversy over the promotion of mammographic screening of breastcancer in the context of misinformation campaigns during the pink October. (AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Breast Neoplasms/prevention & control , Mammography/adverse effects , Mass Screening/adverse effects , Health Communication/methods , Preventive Health Services/trends , Health Communication/trends , Health Promotion/trends
7.
Rev. argent. mastología ; 38(139): 80-98, oct. 2019. graf
Article in Spanish | LILACS (Americas) | ID: biblio-1116524

ABSTRACT

Introducción En los departamentos de Bariloche y Cushamen se encuentra una importante concentración de pueblos originarios de Sudamérica. Algunos de estos grupos poblacionales siguen con sus costumbres y, ante cualquier problema de salud, consultan con el curandero (figura médica mapuche) quien, con diferentes hierbas y métodos, trata dichos problemas en su comunidad. Por otro lado, muchos de esos pobladores se han integrado a nuestro sistema y son tratados en nuestros hospitales; pero, dada la falta de conocimiento de esta etnia y la carencia de estadísticas, estos tratamientos se basan en lo que conocemos de la raza caucásica. Ahora bien, cuando uno les pregunta acerca del cáncer de mama a las mujeres mapuches, la mayoría niega conocer esta patología, o dice que es una enfermedad de la mujer blanca. Pero, ¿es esto realmente así? Objetivos Identificar las causas a las que la mujer mapuche atribuye el cáncer de mama y qué métodos de prevención utiliza. Identificar factores de riesgo para el cáncer de mama en la población mapuche. Describir métodos de diagnóstico y tratamiento de cáncer de mama en la población mapuche. Describir las características epidemiológicas y tumorales y compararlas con la población no mapuche. Material y método Se analizaron en forma retrospectiva las historias clínicas de las pacientes que fueron internadas en el Hospital de Área El Bolsón (haeb) por patología oncológica en los últimos 4 años y las historias clínicas de las pacientes atendidas en consultorios externos por los Servicios de Oncología, Patología Mamaria y Ginecología. Se recurrió también a los registros de la Asociación Lucha Contra el Cáncer Comarca Andina Paralelo 42 (alceccap 42°). Se tomaron datos de las pacientes atendidas en Bariloche de las bases del sitam. Se confeccionó una encuesta de 25 preguntas que se llevó a cabo con un cuestionario estructurado el cual se realizó con la modalidad de entrevista personal. Resultados El diagnóstico de cáncer de mama en El Bolsón se realiza en estadios avanzados, en especial en la población mapuche, en la cual el 50% debuta en los Estadios IIIA en adelante. La edad promedio de diagnóstico de cáncer de mama en la población mapuche es de 59 años, 5 años más tarde que en la población no indígena de la misma localidad. Solo el 32% de las encuestadas había realizado una mamografía a los 40 años. Los tipos histológicos encontrados fueron: 60% ductal invasivo, 16% lobular, 8% medular, 8% indiferenciado, 4% cdis y 4% mucinoso. Las mujeres refieren desconocimiento de la necesidad de realizar los controles, falta de interés y dificultad en el acceso al sistema de salud. Gran parte de estas mujeres atribuyen el cáncer de mama a los traumatismos mamarios y reconoce como factor protector a la lactancia materna. Conclusiones Las mujeres mapuches identifican a los traumatismos mamarios y a la falta de lactancia como principales factores de riesgo para el cáncer de mama


Introduction In the departments of Bariloche and Cushamen there is a significant concentration of the Mapuche race and some continue with their customs: at any health problem, they consult with the Medicine Man (Mapuche medical figure) who, with different herbs and methods, treats the health problems of their community. However, many have integrated with the community and are treated in our hospitals, but, due to the lack of knowledge of this race and the lack of statistics, they are treated based on the knowledge we have on the Caucasian race. But, when one asks to Mapuche women about breast cancer, most deny knowing this pathology or say it is a disease of the white woman. Objectives To identify the causes at which Mapuche women attribute breast cancer and what methods of prevention they use. Identify risk factors for breast cancer in the Mapuche population. Describe methods of diagnosis and treatment of breast cancer in the Mapuche population. Describe the epidemiological and tumoral characteristics and to compare with Caucasian race. Materials and method To obtain the different data, the clinical histories of the patients who were admitted to the El Bolsón Area Hospital (haeb) for oncological pathology in the last 4 years were retrospectively analyzed. The clinical histories of the patients attended by the Service of Oncology, Mammary Pathology, Gynecology, and the alceccap 42 records were also used. Data was also taken from the sitam bases of patients treated in Bariloche. A survey was made of 25 questions that according to the result some were broken down. The survey was carried out with a structured questionnaire with the personal interview modality. Results The diagnosis of breast cancer in El Bolsón is made in advanced stages especially in the Mapuche population where 50% debuted in Stages IIIA and later. The average age of diagnosis of breast cancer in the Mapuche population is 59 years, 5 years later than in the non-indigenous population. Only 32% of the respondents had a mammogram at age 40. The histological types found were: 60% ductal invasive, 16% lobular, 8% medullar, 8% indifferent, 4% cdis and 4% mucinous. The women report ignorance of the need to perform the controls, lack of interest to perform them and difficulty in accessing the health system. Many of these women attribute breast cancer to breast traumas and recognize breastfeeding as a protective factor. Conclusions The Mapuche women recognize breast traumas and the lack of breastfeeding as principal risk factor for breast cancer. Inside the risk factors in this population, we found the alcohol ingest and body mass index as predominating. The diagnosis is made in advanced stages when the illness generates symptoms, and this brings women to the consultation; rarely they come for a physical exam or mammographic control. They are, and they should continue being treated as we treat any women with breast cancer as long as we do not dispose more information


Subject(s)
Breast Neoplasms , Mammography , Indigenous Peoples
8.
Rev. colomb. obstet. ginecol ; 70(1): 58-67, Jan-Mar. 2019. graf
Article in Spanish | LILACS (Americas) | ID: biblio-1042829

ABSTRACT

RESUMEN Objetivo: presentar un caso de enfermedad de Paget (EP) de la mama, sin carcinoma ductal asociado, y realizar una revisión de literatura respecto a su diagnóstico y tratamiento. Materiales y métodos: mujer de 59 años, con lesión pruriginosa, eritematosa y ulcerada crónica, en pezón izquierdo, de 2 años de evolución, quien recibió inicialmente manejo dermatológico con corticoides tópicos sin mejoría clínica, que acude finalmente a una institución de atención primaria en Tunja (Colombia) para su diagnóstico, el cual se realizó por biopsia mediante inmunohistoquímica y posterior manejo por cuadrantectomía central con patología posquirúrgica negativa para malignidad, sin recurrencia al año de seguimiento. Se realizó una búsqueda en las bases de datos Medline vía PubMed, SciELO, ProQuest, ScienceDirect y Google Académico con los términos "Paget´s Disease", "Breast Neoplasms", "Mammography" "Ultrasonography Mammary", "Biopsy" y "Mastectomy", rastreando artículos de revisión bibliográfica, editoriales, reportes y series de casos clínicos en inglés y español, sin límite de tiempo. Resultados: se incluyeron 11 publicaciones correspondientes a 5 reportes de caso, 3 series de casos, 1 revisión de la literatura a partir de un caso clínico, y 2 cartas al editor que describieron casos relacionados con enfermedad de Paget del pezón sin carcinoma asociado. El diagnóstico se fundamentó en la sospecha clínica de la enfermedad con la posterior realización de biopsia de la lesión; la inmunohistoquímica fue útil en el diagnóstico diferencial. El tratamiento varió desde mastectomía hasta resección de complejo areola-pezón. La radioterapia también ha sido utilizada. Conclusiones: el diagnóstico de la enfermedad de Paget sin carcinoma ductal asociado se fundamenta en una sospecha clínica temprana y en el estudio histopatológico del complejo areola-pezón. No hay consenso sobre el manejo quirúrgico de esta lesión. Se requieren estudios de seguimiento de este subgrupo de pacientes tratado con radioterapia o cirugía conservadora.


ABSTRACT Objective: To present one case of Paget's disease (PD) of the breast without associated ductal carcinoma, and to conduct a review of the literature on its diagnosis and treatment. Materials and methods: A 59-year-old woman with a two-year history of a chronic erythematous, ulcerated, itchy lesion in the left nipple, initially treated dermatologically with topical steroids with no improvement, finally visits a primary healthcare institution in the city of Tunja, Colombia for diagnosis. A biopsy and histochemical testing were performed to make the diagnosis and the lesion was then treated with central quadrantectomy. The post-operative pathology testing was negative for malignancy, without recurrence at one-year follow-up. A search was conducted in the PubMed, SciELO, ProQuest, ScienceDirect and Google Scholar databases using the terms "Paget´s Disease," "Breast Neoplasms," "Mammography," "Ultrasonography," Mammary," "Biopsy," and "Mastectomy," tracking bibliographic review articles, editorials, reports and clinical case series in English and Spanish, without time limitation. Results: Overall, 11 publications were included consisting of 5 case reports, 3 case series, 1 review of the literature based on a clinical case, and 2 letters to the editor describing cases related to Paget's disease of the nipple with no associated carcinoma. The diagnosis was based on the clinical suspicion of the disease and a biopsy of the lesion. Histochemistry was useful for the differential diagnosis: treatment options ranged from mastectomy to nipple-areolar complex resection. Radiotherapy has also been used. Conclusions: The diagnosis of Paget's disease with no associated ductal carcinoma is based on early clinical suspicion and histopathology of the nipple-areolar complex. There is no consensus regarding surgical management of this lesion. Follow-up studies of this subgroup of patients treated with radiotherapy or conservative surgery are required.


Subject(s)
Female , Paget's Disease, Mammary , Biopsy , Mammography , Ultrasonography, Mammary , Mastectomy
9.
Rev. colomb. radiol ; 30(1): 5088-5093, 2019. ilus, graf
Article in Spanish | LILACS (Americas), COLNAL | ID: biblio-1008249

ABSTRACT

La mamografía, como método de tamizaje, ha demostrado disminuir la mortalidad al detectar de manera temprana el cáncer de mama; sin embargo, en mamas muy densas se dificulta la detección, por lo que se han venido generando nuevos métodos de tamizaje y diagnóstico. La mamografía con contraste espectral (CESM) es uno de estos métodos que, con la utilización de medio de contraste, facilita la detección de lesiones sospechosas. Será tema de revisión de este artículo su técnica e historia, repasando su comparación con la mamografía convencional y con una serie de casos se expondrán sus indicaciones, ventajas y desventajas.


Mammography as a screening method has been shown to reduce mortality by early detection of breast cancer; however, in very dense breasts it is difficult to detect, so new methods of screening and diagnosis have been devised. Contrast enhanced spectral contrast mammography (CESM) is one of these methods that, with the use of contrast medium, facilitates the detection of suspicious lesions. We will briefly discuss the CESM technique and history, review its comparison with conventional mammography, and with a series of cases we will discuss its indications, advantages and disadvantages.


Subject(s)
Humans , Mammography , Breast Neoplasms , Contrast Media
10.
Rev. med. (Säo Paulo) ; 98(3): 187-193, maio-jun. 2019. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-1009601

ABSTRACT

Introdução: O câncer de mama é a principal causa de morte por câncer na população feminina e a segunda neoplasia mais frequente no mundo. A detecção precoce da doença, principalmente por meio da mamografia, é fundamental para reduzir o número de óbitos e melhorar o prognóstico. Objetivo: analisar o conhecimento de mulheres entre 35 e 69 anos cadastradas em Estratégias de Saúde da Família (ESF) de Alfenas ­ MG acerca do rastreamento do câncer de mama. Métodos: Estudo quantitativo, descritivo e transversal no qual foram aplicados questionários em uma população amostral, selecionada a partir do total de mulheres cadastradas em cinco ESF de Alfenas ­ MG, sendo entrevistadas 224 mulheres a partir de questionário estruturado. Os dados foram analisados utilizando-se a estatística multivariada por meio da técnica de componentes principais. Todos os critérios éticos foram respeitados. Resultados: As ações preventivas de rastreamento influenciaram na redução da mortalidade e melhor prognóstico da doença. A terapia de reposição hormonal está correlacionada com as alterações encontradas nas mamas. A idade da primeira menstruação mostrou-se correlacionada às mulheres que já estão na menopausa, características essas consideradas de risco para o desenvolvimento da neoplasia de mama. A regularidade com que as mulheres realizam a mamografia depende de seu conhecimento acerca deste exame, considerando-se a realização e prática do autoexame importante. Verificou-se que o uso de anticoncepcional está diretamente relacionado com a idade e o estado civil, além de alterações encontradas no exame clínico das mamas. Estar na menopausa esteve diretamente relacionado à realização de mamografia. Fatores de risco para câncer de mama como tabagismo, dieta rica em gordura e etilismo, além de estarem altamente correlacionados, apresentaram uma relação inversa com a realização da mamografia. Conclusões: o conhecimento acerca dos exames preventivos e da sua importância está relacionado com a regularidade com que as mulheres os realizam.


Introduction: Breast cancer is the leading cause of cancer death in the female population, and the second most frequent neoplasm in the world. The early detection of neoplasms, mainly through mammography, is fundamental to reduce the number of deaths and improve the prognosis. Objective: analyze the knowledge of women between 35 and 69 years of age enrolled in Family Health Strategies (ESFs) of Alfenas - MG, about the screening of breast cancer. Methods: A quantitative, descriptive and cross - sectional study in which questionnaires were applied in a sample population, selected from the total number of women enrolled in five ESFs in Alfenas - MG, and 224 women were interviewed from a structured questionnaire. Data were analyzed using multivariate statistics using the principal components technique. All ethical criteria have been respected. Results: The preventive actions of screening influenced the reduction of mortality and better prognosis of the disease. Hormone replacement therapy is correlated with changes found in breasts. The age of the first menstrual period was shown to be correlated to the women who are already in menopause, characteristics considered to be at risk for the development of breast cancer. The regularity with which women perform mammography depends on their knowledge about this examination, considering the performance and practice of the important self-examination. It was verified that the use of contraceptives is directly related to age and marital status, as well as alterations found in the clinical examination of the breasts. Being in menopause was directly related to mammography. Risk factors for breast cancer, such as smoking, high fat diet and alcoholism, besides being highly correlated, presented an inverse relationship with mammography. Conclusions: knowledge about preventive exams and their importance is related to the regularity with which women perform them.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Women , Breast Neoplasms/diagnosis , Breast Neoplasms/prevention & control , Mammography , Mass Screening , Early Detection of Cancer , Knowledge
11.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-772116

ABSTRACT

OBJECTIVE@#To develop a deep features-based model to classify benign and malignant breast lesions on full- filed digital mammography.@*METHODS@#The data of full-filed digital mammography in both craniocaudal view and mediolateral oblique view from 106 patients with breast neoplasms were analyzed. Twenty-three handcrafted features (HCF) were extracted from the images of the breast tumors and a suitable feature set of HCF was selected using -test. The deep features (DF) were extracted from the 3 pre-trained deep learning models, namely AlexNet, VGG16 and GoogLeNet. With abundant breast tumor information from the craniocaudal view and mediolateral oblique view, we combined the two extracted features (DF and HCF) as the two-view features. A multi-classifier model was finally constructed based on the combined HCF and DF sets. The classification ability of different deep learning networks was evaluated.@*RESULTS@#Quantitative evaluation results showed that the proposed HCF+DF model outperformed HCF model, and AlexNet produced the best performances among the 3 deep learning models.@*CONCLUSIONS@#The proposed model that combines DF and HCF sets of breast tumors can effectively distinguish benign and malignant breast lesions on full-filed digital mammography.


Subject(s)
Breast Neoplasms , Classification , Diagnostic Imaging , Deep Learning , Diagnosis, Computer-Assisted , Methods , Female , Humans , Mammography , Methods
12.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-772099

ABSTRACT

OBJECTIVE@#To develop a digital breast tomosynthesis (DBT) imaging system with optimizes imaging chain.@*METHODS@#Based on 3D tomography and DBT imaging scanning, we analyzed the methods for projection data correction, geometric correction, projection enhancement, filter modulation, and image reconstruction, and established a hardware testing platform. In the experiment, the standard ACR phantom and high-resolution phantom were used to evaluate the system stability and noise level. The patient projection data of commercial equipment was used to test the effect of the imaging algorithm.@*RESULTS@#In the high-resolution phantom study, the line pairs were clear without confusing artifacts in the images reconstructed with the geometric correction parameters. In ACR phantom study, the calcified foci, cysts, and fibrous structures were more clearly defined in the reconstructed images after filtering and modulation. The patient data study showed a high contrast between tissues, and the lesions were more clearly displayed in the reconstructed image.@*CONCLUSIONS@#This DBT imaging system can be used for mammary tomography with an image quality comparable to that of commercial DBT systems to facilitate imaging diagnosis of breast diseases.


Subject(s)
Algorithms , Artifacts , Breast , Diagnostic Imaging , Female , Humans , Mammography , Methods , Phantoms, Imaging , Radiographic Image Enhancement , Methods
13.
Journal of Breast Cancer ; : 579-586, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-783963

ABSTRACT

PURPOSE: Currently, the standard screening tool for breast cancer is screening mammography. There have been many efforts to develop a blood-based diagnostic assay for breast cancer diagnosis; however, none have been approved for clinical use at this time. The purpose of this study was to determine the accuracy of a novel blood-based proteomic test for aiding breast cancer diagnosis in a relatively large cohort of cancer patients.METHODS: A blood-based test using multiple reaction monitoring (MRM) measured by mass spectrometry to quantify 3 peptides (apolipoprotein C-1, carbonic anhydrase 1, and neural cell adhesion molecule L1-like protein) present in human plasma was investigated. A total of 1,129 blood samples from 575 breast cancer patients, 454 healthy controls, and 100 patients with other malignancies were used to verify and optimize the assay.RESULTS: The diagnostic sensitivity, specificity, and accuracy of the MRM-based proteomic assay were 71.6%, 85.3%, and 77%, respectively; the area under the receiver operating characteristic curve was 0.8323. The proteomic assay did not demonstrate diagnostic accuracy in patients with other types of malignancies including thyroid, pancreatic, lung, and colon cancers. The diagnostic performance of the proteomic assay was not associated with the timing of blood sampling before or after anesthesia.CONCLUSION: The data demonstrated that an MRM-based proteomic assay that measures plasma levels of three specific peptides can be a useful tool for breast cancer screening and its accuracy is cancer-type specific.


Subject(s)
Anesthesia , Biomarkers , Blood Proteins , Breast Neoplasms , Breast , Carbonic Anhydrases , Cohort Studies , Colonic Neoplasms , Diagnosis , Humans , Lung , Mammography , Mass Screening , Mass Spectrometry , Neural Cell Adhesion Molecules , Peptides , Plasma , Proteomics , ROC Curve , Sensitivity and Specificity , Thyroid Gland
14.
Journal of Breast Cancer ; : 635-640, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-783958

ABSTRACT

The purpose of this study aimed to determine whether intraoperative specimen mammography is an effective margin assessment method in Asian women. Thus, 182 patients who underwent breast-conserving surgery (BCS) were evaluated. After wide excision, intraoperative specimen mammography was used to assess margin adequacy. The control group comprised 84 patients who underwent BCS and were evaluated for margin of frozen section during surgery. 61.6% patients had dense breasts and 85.7% of dense breasts could margin assess by intraoperative specimen mammography. There were no significant differences in the incidence of extremely close margins (p = 0.421) and second operation (p = 0.252) between both groups. Significant correlations were found between radiological and histological margins (R² = 0.222, p < 0.05). The frozen section analysis group had longer operative time than the specimen mammography group. The study results show that intraoperative specimen mammography of breast lesions in BCS is useful in identifying margin clearance.


Subject(s)
Asian Continental Ancestry Group , Breast , Breast Neoplasms , Female , Frozen Sections , Humans , Incidence , Mammography , Mastectomy, Segmental , Methods , Operative Time
15.
Journal of Breast Disease ; (2): 16-22, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-764288

ABSTRACT

PURPOSE: Ultrasonography plays a supplementary role in detecting breast microcalcifications as localizing these microcalcifications without mammographic aid is not always successful. This study aimed to evaluate the clinical implications of intraoperative sonography (IOUSG) in localized excisions after mammographically guided wire insertion. METHODS: Between May 2011 and December 2017, 90 localized excisional biopsies were included. All excisions were preceded by mammographically guided wire insertion. We divided them into two groups according to the use of IOUSG and compared the surgical outcomes between the two groups. RESULTS: Of the 90 localized excisions analyzed, IOUSG was performed in 40 (the USG group) localized excisions and not in the remaining 50 (the no USG group) localized excisions. The median cluster size of the target microcalcifications and the median specimen volume were smaller in the USG group than that in the no USG group (1.4 cm vs. 2.0 cm, p=0.02; 10.9 cm3 vs. 30.3 cm3, p<0.001, respectively). Additional excisions due to the incomplete coverage of the target microcalcifications on the specimen mammography were more frequent in the no USG group than in the USG group (30% vs. 15%, respectively, p<0.001). In the multivariate analyses, performing an IOUSG was the only significant risk factor, reducing the need for additional excision after adjusting the other risk factors (adjusted hazard ratio, 0.203; 95% confidence interval, 0.078–0.529). Performing an IOUSG significantly reduced the specimen volume excised after adjusting the cluster size of the microcalcifications. CONCLUSION: IOUSG could be helpful in improving the accuracy of surgical excision for breast microcalcifications localized with mammographically guided wire insertion.


Subject(s)
Biopsy , Breast , Calcinosis , Mammography , Multivariate Analysis , Risk Factors , Surgery, Computer-Assisted , Ultrasonography
16.
Journal of Breast Cancer ; : 311-325, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-764260

ABSTRACT

PURPOSE: Digital mammography (DM) has replaced screen-film mammography (SFM). However, findings of comparisons between the performance indicators of DM and SFM for breast-cancer screening have been inconsistent. Moreover, the summarized results from studies comparing the performance of screening mammography according to device type vary over time. Therefore, this study aimed to compare the performance of DM and SFM using recently published data. METHODS: The MEDLINE, Embase, and Cochrane Library databases were searched for paired studies, cohorts, and randomized controlled trials published through 2018 that compared the performance of DM and SFM. All studies comparing the diagnostic accuracy of DM and SFM in asymptomatic, average-risk women aged 40 years and older were included. Two reviewers independently assessed the study quality and extracted the data. RESULTS: Thirteen studies were included in the meta-analysis. The pooled sensitivity (DM, 0.76 [95% confidence interval {CI}, 0.70–0.81]; SFM, 0.76 [95% CI, 0.70–0.81]), specificity (DM, 0.96 [95% CI, 0.94–0.97]; SFM, 0.97 [95% CI, 0.94–0.98]), and area under the receiver-operating characteristic curve (DM, 0.94 [95% CI, 0.92–0.96]; SFM, 0.92 [95% CI, 0.89–0.94]) were similar for both DM and SFM. The pooled screening performance indicators reinforced superior accuracy of full-field DM, which is a more advanced type of mammography, than SFM. The advantage of DM appeared greater among women aged 50 years or older. There was high heterogeneity among studies in the pooled sensitivity, specificity, and overall diagnostic accuracy estimates. Stratifying by study design (prospective or retrospective) and removing studies with a 2-year or greater follow-up period resulted in homogeneous overall diagnostic accuracy estimates. CONCLUSION: The breast-cancer screening performance of DM is similar to that of SFM. The diagnostic performance of DM depends on the study design, and, in terms of performance, full-field DM is superior to SFM, unlike computed radiography systems.


Subject(s)
Breast Neoplasms , Cohort Studies , Early Detection of Cancer , Female , Follow-Up Studies , Humans , Mammography , Mass Screening , Population Characteristics , Radiography , Sensitivity and Specificity
17.
Article in English | WPRIM (Western Pacific) | ID: wprim-719597

ABSTRACT

OBJECTIVE: To compare digital breast tomosynthesis (DBT) and conventional full-field digital mammography (FFDM) in the detectability of breast cancers in patients with dense breast tissue, and to determine the influencing factors in the detection of breast cancers using the two techniques. MATERIALS AND METHODS: Three blinded radiologists independently graded cancer detectability of 300 breast cancers (288 women with dense breasts) on DBT and conventional FFDM images, retrospectively. Hormone status, histologic grade, T stage, and breast cancer subtype were recorded to identify factors affecting cancer detectability. The Wilcoxon signed-rank test was used to compare cancer detectability by DBT and conventional FFDM. Fisher's exact tests were used to determine differences in cancer characteristics between detectability groups. Kruskal-Wallis tests were used to determine whether the detectability score differed according to cancer characteristics. RESULTS: Forty breast cancers (13.3%) were detectable only with DBT; 191 (63.7%) breast cancers were detected with both FFDM and DBT, and 69 (23%) were not detected with either. Cancer detectability scores were significantly higher for DBT than for conventional FFDM (median score, 6; range, 0–6; p < 0.001). The DBT-only cancer group had more invasive lobular-type breast cancers (22.5%) than the other two groups (i.e., cancer detected on both types of image [both-detected group], 5.2%; cancer not detected on either type of image [both-non-detected group], 7.3%), and less detectability of ductal carcinoma in situ (5% vs. 16.8% [both-detected group] vs. 27.5% [both-non-detected group]). Low-grade cancers were more often detected in the DBT-only group than in the both-detected group (22.5% vs. 10%, p = 0.026). Human epidermal growth factor receptor-2 (HER-2)-negative cancers were more often detected in the DBT-only group than in the both-detected group (92.3% vs. 70.5%, p = 0.004). Cancers surrounded by mostly glandular tissue were detected less often in the DBT only group than in the both-non-detected group (10% vs. 31.9%, p = 0.016). DBT cancer detectability scores were significantly associated with cancer type (p = 0.012), histologic grade (p = 0.013), T and N stage (p = 0.001, p = 0.024), proportion of glandular tissue surrounding lesions (p = 0.013), and lesion type (p < 0.001). CONCLUSION: Invasive lobular, low-grade, or HER-2-negative cancer is more detectable with DBT than with conventional FFDM in patients with dense breasts, but cancers surrounded by mostly glandular tissue might be missed with both techniques.


Subject(s)
Breast Neoplasms , Breast , Carcinoma, Intraductal, Noninfiltrating , Epidermal Growth Factor , Female , Humans , Mammography , Retrospective Studies
18.
Cad. Saúde Pública (Online) ; 35(6): e00099817, 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1011692

ABSTRACT

Abstract: Our objectives with this study were to describe the spatial distribution of mammographic screening coverage across small geographical areas (micro-regions) in Brazil, and to analyze whether the observed differences were associated with spatial inequities in socioeconomic conditions, provision of health care, and healthcare services utilization. We performed an area-based ecological study on mammographic screening coverage in the period of 2010-2011 regarding socioeconomic and healthcare variables. The units of analysis were the 438 health micro-regions in Brazil. Spatial regression models were used to study these relationships. There was marked variability in mammographic coverage across micro-regions (median = 21.6%; interquartile range: 8.1%-37.9%). Multivariable analyses identified high household income inequality, low number of radiologists/100,000 inhabitants, low number of mammography machines/10,000 inhabitants, and low number of mammograms performed by each machine as independent correlates of poor mammographic coverage at the micro-region level. There was evidence of strong spatial dependence of these associations, with changes in one micro-region affecting neighboring micro-regions, and also of geographical heterogeneities. There were substantial inequities in access to mammographic screening across micro-regions in Brazil, in 2010-2011, with coverage being higher in those with smaller wealth inequities and better access to health care.


Resumo: O estudo teve como objetivos descrever a distribuição espacial do rastreamento por mamografia entre áreas geográficas pequenas (microrregiões) no Brasil, além de investigar se as diferenças observadas estavam associadas a inequidades espaciais nas condições socioeconômicas, na prestação de assistência à saúde e no uso de serviços de saúde. Este foi um estudo ecológico de base territorial, comparando a cobertura do rastreamento por mamografia em 2010-2011 com fatores socioeconômicos e de cuidados de saúde. O estudo usou 438 microrregiões sanitárias brasileiras como as unidades analíticas. Foram utilizados modelos de regressão espacial para estudar as associações. Houve uma importante variabilidade na cobertura por mamografia entre microrregiões (mediana = 21,6%; variação interquartil: 8,1%-37,9%). A análise multivariada identificou: forte desigualdade na renda familiar, número baixo de radiologistas/100 mil habitantes, número baixo de aparelhos de mamografia/10 mil habitantes e número baixo de mamografias realizadas com cada aparelho enquanto correlatos independentes da baixa cobertura mamográfica no nível microrregional. Houve evidência de forte dependência espacial nessas associações, em que as mudanças em uma microrregião afetavam as microrregiões vizinhas, além de heterogeneidade geográfica. O estudo revelou importantes inequidades no acesso ao exame de mamografia entre microrregiões brasileiras em 2010-2011, com cobertura mais alta nas microrregiões com menor desigualdade de renda e melhor acesso geral aos cuidados de saúde.


Resumen: Los objetivos de este estudio fueron describir la distribución espacial de la cobertura del cribado mamográfico, a través de pequeñas áreas geográficas (microrregiones) en Brasil, y examinar si las diferencias observadas estuvieron asociadas con inequidades espaciales, en términos de condiciones socioeconómicas, sistema de atención de salud, y utilización de servicios de salud. Se trata de un estudio ecológico, basado en áreas incluidas en la cobertura de cribado mamográfico durante 2010-2011 y relacionadas con variables socioeconómicas y de salud. Las unidades de análisis fueron 438 microrregiones de salud en Brasil. Se utilizaron modelos de regresión espacial para estudiar estas relaciones existentes. Hubo una variabilidad marcada en relación con la cobertura mamográfica a través de las microrregiones (media = 21.6%; rango intercuartílico: 8,1%-37,9%). Los análisis multivariables identificaron una alta inequidad en los ingresos por hogar, bajo número de radiólogos/100,000 habitantes, bajo número de máquinas de mamografía/10.000 habitantes, y un bajo número de mamografías realizadas por cada máquina, lo que está independiente correlacionado con la baja cobertura de mamografías en el nivel de microrregión. Hubo evidencias de una dependencia espacial fuerte de estas asociaciones, con cambios en una microrregión afectando a microrregiones vecinas, y también de heterogeneidades geográficas. Hubo inequidades sustanciales en el acceso al cribado mamográfico a través de las microrregiones en Brasil, en 2010-2011, con una cobertura superior en aquellas con pequeñas inequidades respecto a la riqueza y mejor acceso a los servicios de salud.


Subject(s)
Humans , Female , Middle Aged , Aged , Breast Neoplasms/diagnostic imaging , Mammography/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Socioeconomic Factors , Brazil , Mammography/economics , Residence Characteristics , Healthcare Disparities/economics , Healthcare Disparities/statistics & numerical data , Early Detection of Cancer , Spatial Analysis , Health Services Accessibility/economics , Health Services Needs and Demand/statistics & numerical data
19.
Appl. cancer res ; 39: 1-8, 2019. tab
Article in English | LILACS (Americas), Inca | ID: biblio-999247

ABSTRACT

Background: The population-based mammography screening program (MSP) is aimed to reduce breast cancer mortality, to detect breast cancer at an early stage, and to allow for less invasive treatment. However, it also has some potential harms, such as overdiagnosis and overtreatment. Therefore, it is necessary that women receive sufficient and balanced information to enable informed decision-making. We examined knowledge about benefits and harms of the MSP in Germany among first-time invitees of different socio-demographic backgrounds. Methods: This observational study assessed knowledge about benefits and harms of the MSP among women who were invited to the MSP for the first time by six multiple choice items, using a postal survey. We investigated (i) single items of knowledge, (ii) the distribution of sufficient knowledge stratified by education, migration status and invitation, and (iii) possible determinants of sufficient knowledge by analyzing Odds Ratios (ORs) using bivariate and multivariate logistic regression. Results: In total, 5397 women included in the analyses. 46.1% of the study population had sufficient knowledge about benefits and harms of the MSP. However, women with low educational level and migration background had higher proportions of insufficient knowledge and used most frequently the option "don't know". Women had the most difficulties answering the numeric question and the question about the target group correctly. Results from the logistic regression showed that the odds of having sufficient knowledge were higher among well-educated women (OR 3.84, 95%CI 3.24­4.55), among women who already received the MSP invitation (OR 1.38, 95%CI 1.20­1.59) and lowest among Turkish women (OR 0.14, 95%CI 0.07­0.25). Conclusions: Women with low education and migration background need adapted information regarding benefits and harms of the MSP and are important target groups for further developing the information material about mammography screening to reduce disparities in knowledge and enable informed decision-making (AU)


Subject(s)
Humans , Female , Transients and Migrants , Mammography , Mass Screening , Knowledge , Patient Harm , Observational Study
20.
Rev. bras. cancerol ; 65(3)19/09/2019.
Article in Portuguese | LILACS (Americas) | ID: biblio-1047846

ABSTRACT

Introdução: Os danos cardiovasculares do rastreamento mamográfico não têm sido objeto de estudo ou preocupações, inclusive na área de cardio-oncologia. O resultado é uma importante lacuna na literatura a despeito de evidências da grande magnitude do sobrediagnóstico e do sobretratamento no rastreamento e sua ligação com aumento da mortalidade cardiovascular. Objetivo: Apresentar e discutir as principais evidências a respeito das causas de aumento de mortalidade cardiovascular associadas ao rastreamento. Método: Foram realizadas buscas sistemáticas na literatura, por meio de quatro estratégias de busca em duas bases de dados (MEDLINE e LILACS), para identificar as causas de aumento de mortalidade cardiovascular potencialmente associadas ao sobrediagnóstico e ao sobretratamento. Para cada uma das estratégias de busca, os resultados tiveram seu nível de evidência atribuídos de acordo com a classificação do Oxford Centre for Evidence-Based Medicine. Resultados: Dois grandes grupos de causas de aumento da mortalidade cardiovascular foram identificados: o primeiro ligado diretamente ao diagnóstico de câncer de mama; e o segundo ao tratamento do câncer de mama, incluindo cirurgia e radioterapia adjuvante. O aumento de mortalidade cardiovascular incluiu diversos subgrupos de causas, tais como infarto agudo do miocárdio, tromboembolismo pulmonar, insuficiência cardíaca, arritmias, doença orovalvar e acidente vascular encefálico. Conclusão: Existem evidências consistentes sobre mortalidade cardiovascular associada ao diagnóstico e ao tratamento do câncer de mama em situações clinicamente compatíveis com o rastreamento. É provável também que essa seja uma das causas mais importantes da mortalidade relacionada ao rastreamento, em especial aquelas associadas ao sobretratamento com radioterapia adjuvante.


Introduction: Cardiovascular harms of mammographic screening have not been the subject of study or concern, including in the cardio-oncology area of. The result is an important gap in literature despite the evidence of great magnitude of overdiagnosis and overtreatment in screening and its association with increased cardiovascular mortality. Objective: Present and discuss the main evidence regarding the causes of increased cardiovascular mortality associated with screening. Method: Systematic searches were performed in the literature through four search strategies in two databases (MEDLINE and LILACS), to identify the causes of increased cardiovascular mortality potentially associated with overdiagnosis and overtreatment. For each one of the search strategies, it was used the classification of the Oxford Centre for Evidence-Based Medicine to assign the level of evidence of the results. Results: Two major groups of causes of increased cardiovascular mortality were identified: the first linked directly to the diagnosis of breast cancer; and the second to the treatment of breast cancer, including surgery and adjuvant radiotherapy. The increase of cardiovascular mortality included several subgroups of causes such as acute myocardial infarction, pulmonary thromboembolism, heart failure, arrhythmias, heart valve disease and stroke. Conclusion: There are consistent evidence about cardiovascular mortality associated with breast cancer diagnosis and treatment in conditions clinically compatible with screening. It is also likely to be one of the most important causes of mortality related to screening, especially those associated with overtreatment with adjuvant radiotherapy.


Introducción: El daño cardiovascular causado por el cribado mamográfico no ha sido objeto de estudio ni de preocupación, incluso en el área de la cardio-oncología. El resultado es una brecha importante en la literatura a pesar de la evidencia de la gran magnitud del sobrediagnóstico y el sobretratamiento en cribado. y su asociación con el aumento de la mortalidad cardiovascular. Objetivo: Presentar y discutir los principales pruebas en las causas del aumento de la mortalidad cardiovascular asociados con la tamización. Método: Se realizaron búsquedas sistemáticas en la literatura a través de cuatro estrategias de búsqueda en dos bases de datos (MEDLINE y LILACS), para identificar las causas del aumento de la mortalidad cardiovascular potencialmente asociadas con el sobrediagnóstico y el sobretratamiento. Para cada una de las estrategias de búsqueda, a los resultados se les asignó su nivel de evidencia de acuerdo con la clasificación del Oxford Centre for Evidence-Based Medicine. Resultados: Se identificaron dos grupos principales de causas de aumento de la mortalidad cardiovascular: el primero relacionado directamente con el diagnóstico de cáncer de mama; y el segundo para el tratamiento del cáncer de mama, incluida la cirugía y la radioterapia adyuvante. El aumento de la mortalidad cardiovascular incluyó varios subgrupos de causas como infarto agudo de miocardio, tromboembolismo pulmonar, insuficiencia cardíaca, arritmias, enfermedad orovalvar y accidente cerebrovascular. Conclusión: Existe evidencia consistente de mortalidad cardiovascular asociada con el diagnóstico y tratamiento del cáncer de mama en condiciones clínicamente compatibles con la tamización. También es probable que sea una de las causas más importantes de mortalidad relacionada con la tamización, especialmente aquellas asociadas con el sobretratamiento con radioterapia adyuvante.


Subject(s)
Humans , Female , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Cardiovascular Diseases/mortality , Medical Overuse , Mammography , Mass Screening , Radiotherapy, Adjuvant
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