Frecuencia de la mamografía, ecografía, examen clínico y autoexamen de mama en población general / Frequency of mammography, ultrasound, clinical breast exam and self-exam in the general population

Introducción. El cáncer de mama es el cáncer que más afecta a las mujeres. Se estima que 1 en 8 mujeres desarrollarán cáncer de mama eventualmente. Una de las herramientas contra el cáncer de mama es crear estrategias de detección temprana de la enfermedad, y la mamografía ha demostrado ser de mucha utilidad. El objetivo del estudio fue determinar la frecuencia de la mamografía, ecografía, examen clínico y autoexamen mamario, y evaluar su uso como pruebas de tamización para cáncer de mama en una cohorte de pacientes atendidas en la Clínica del Prado en Medellín, Colombia. Metodología. Estudio descriptivo, transversal, efectuado a través de encuesta en 318 usuarias atendidas entre junio y diciembre de 2018. Se estimó la frecuencia de los diferentes métodos de tamización y se evaluaron las características sociodemográficas, antecedentes personales y antecedentes familiares. Adicionalmente, se buscó si había asociación significativa entre la práctica de la mamografía como prueba de tamización y las variables de estudio. Resultados. La media de la edad fue de 44,2 años. El método de tamización más usado fue el autoexamen (70,1%), en su mayoría mensual (76,7%), seguido por la mamografía (56%), en su mayoría ocasional (46%). El examen clínico de mama (ECM) se utilizó en el 45,9% de las pacientes, con una frecuencia anual en el 50% de ellas. Por último, la ecografía de mama se practicó en el 43,1% de las encuestadas, con una frecuencia en su mayoría ocasional (39,4%). Se realizó un análisis independiente para mujeres entre los 50 y 69 años, y aunque el 93,8% se habían realizado la mamografía, solo el 9,3% lo hizo bienal, como lo recomienda el Ministerio de Salud y Protección Social. No se hallaron diferencias estadísticamente significativas entre las variables de estudio y la realización de la mamografía como método de tamización. Conclusión. En la población estudiada, el autoexamen de mama es realizado por la mayoría de las mujeres con una frecuencia mensual. La frecuencia de la mamografía, el ECM y la ecografía de mama fue muy similar, y se esperaba encontrar un mayor porcentaje de mamografías realizadas como prueba de tamización. Se requiere fortalecer esta estrategia efectiva para la detección temprana de cáncer de mama, teniendo en consideración la situación particular de cada paciente, la efectividad y beneficio de la técnica, así como los costos asociados

Breast cancer is the most frequent cancer that affects women. It is estimated that 1 in 8 women will eventually develop breast cancer. One of the tools against breast cancer is to create early detection strategies, and mammography has proven to be very useful. The aim of this study was to determine the frequency of mammography, ultrasound, clinical breast exam and self-exam, and to evaluate their use as screening tests for breast cancer in a cohort of patients that attended at the Clinica del Prado in Medellin, Colombia. Methodology. Descriptive, cross-sectional study, carried out through a survey in 318 women between June and December 2018. The frequency of the different screening methods was estimated and the sociodemographic characteristics, personal history and family history were evaluated. Additionally, a possible association between the practice of mammography as a screening test and the different variables was analyzed. Results. Mean age was 44.2 years. The most used screening method was the self-exam (70.1%), mostly monthly (76.7%), followed by mammography (56%), mostly occasional (46%). The clinical breast exam was used in 45.9% of the patients, with an annual frequency in 50% of them. Lastly, breast ultrasound was performed in 43.1% of those surveyed, mostly occasional (39.4%). An independent analysis was carried out for women between 50 and 69 years old, and although 93.8% had mammograms, only 9.3% had them every 2 years, as recommended by the Ministry of Health and Social Protection guidelines. No statistically significant differences were found between the study variables and the use of mammography as a screening method. Conclusion. In the studied population, breast self-exam is performed by most women on a monthly basis. The frequency of mammography, clinical breast exam and ultrasound was very similar. A higher percentage of mammograms performed as a screening test was expected. It is necessary to strengthen this effective strategy for the early detection of breast cancer, taking into consideration the particular situation of each patient, the effectiveness and advantages of the technique, and the associated costs

Positive predictive value of nonpalpable breast lesions according to bi-rads® classification / Valor preditivo positivo das lesões mamárias não palpáveis utilizando a classificação BI-RADS®

Introduction: Breast cancer is the neoplasm that most affects women in Brazil and the world, and its incidence has increased steadily over the last decade. Due to screening mammography programs, according to age group, the mortality rate of breast cancer has decreased by 31%. With the increase in the number of screening examinations, there has also been increase in the number of suspicious lesions diagnosed and, consequently, increase in the indication and performance of breast biopsies. With the help of the categorizations that the American College of Radiology published, according to the Breast Imaging Reporting and Data System (BI-RADS®), it was possible to standardize the reports and descriptions of breast lesions, both in mammography and ultrasound, facilitating decision-making in regard to suspicious lesions. Objective: To evaluate the positive predictive value (PPV) of nonpalpable breast lesions biopsied in the Radiodiagnostic Service of Hospital Naval Marcílio Dias. Method: A retrospective and analytical study of 88 patients submitted to stereotaxic guided mammary biopsies from December 2015 to December 2016 with suspected diagnosis of malignant lesions, classified by mammographic BI-RADS in categories 4 and 5 and later correlation with the histopathological reports. Results: PPV was high for category 5 lesions, and for category 4 lesions PPV was low and progressively increased with the subcategories. Conclusion: BI­RADS categorization is an effective predictor for the risk of malignancy in suspicious mammographic lesions.

Introdução: O câncer de mama é a neoplasia que mais acomete mulheres no Brasil e no mundo e sua incidência vem aumentando progressivamente ao longo dessa última década. Devido aos programas de rastreamento mamográfico, de acordo com a faixa etária, a taxa de mortalidade por câncer de mama diminuiu em 31%. Com o aumento do número de exames de rastreamento houve aumento, também, da quantidade de lesões suspeitas diagnosticadas e, consequentemente, um aumento na indicação e realização de biópsias mamárias. Com o auxílio das categorizações que o American College of Radiology publicou, segundo o Breast Imaging Reporting and Data System (BI-RADS®), foi possível padronizar os laudos e as descrições das lesões mamárias, tanto na mamografia quanto na ultrassonografia, facilitando a tomada de decisão perante a lesões de aspecto suspeito. Objetivo: Avaliar o valor preditivo positivo (VPP) das lesões mamárias não palpáveis nas quais foi realizada biópsia no Serviço de Radiodiagnóstico do Hospital Naval Marcílio Dias. Método: Estudo retrospectivo e analítico de 88 pacientes submetidas a biópsias mamárias guiadas por estereotaxia no período de dezembro de 2015 a dezembro de 2016 com diagnóstico suspeito de lesões malignas, classificadas no BI-RADS® mamográfico em categorias 4 e 5, com posterior correlação com os laudos histopatológicos. Resultados: Foi encontrado alto valor preditivo positivo na categoria cinco e, nas lesões classificadas como categoria quatro, o VPP foi menor, aumentando progressivamente com as subcategorias. Conclusão: A categorização BI-RADS® é um preditor eficaz para o risco de malignidade nas lesões suspeitas na mamografia.

Distribuição geográfica e acesso ao mamógrafo no estado da Bahia / Distribución geográfica y acceso a la mamografía en el estado de Bahía / Geographic distribution and access to mammography in the state of Bahia

Objetivos: Analisar a distribuição geográfica e o acesso ao mamógrafo por meio da estimativa de cobertura mamográfica no Estado da Bahia (BA), Brasil, no período de 2010 a 2012. Métodos: Estudo de desenho ecológico, transversal e descritivo, utilizando dados secundários provenientes da base de dados do Departamento de Informática do SUS ? DATASUS. A análise estatística foi realizada por meio do programa SPSS. Utilizou-se o coeficiente de correlação de Spearman para avaliar a associação entre o coeficiente de distribuição geográfica dos mamógrafos e os indicadores de morbimortalidade e média do indicador socioeconômico PIB per capita. Para o cálculo da cobertura mamográfica, foi utilizada a recomendação do Instituto Nacional do Câncer (INCA). Resultados: observou-se, neste estudo, uma distribuição irregular do equipamento entre as macrorregiões de saúde do estado, com concentração em regiões com melhores condições socioeconômicas e baixa cobertura e tendência à iniquidade no acesso da população-alvo a essa tecnologia pelo Sistema Único de Saúde. Não foi possível concluir que a alocação de mamógrafos do SUS na Bahia tenha levado em consideração o critério epidemiológico. Conclusão: distribuição geográfica e cobertura são elementos importantes para a avaliação do acesso e suas questões de equidade/iniquidade, principalmente aqueles que envolvem tecnologias de alto e médio custo, como o mamógrafo.

Objetivos: Analizar la distribución geográfica y el acceso a la mamografía a través de la cobertura de mamografía estimar el estado de Bahía, Brasil, en el período 2010 a 2012. Métodos: Estudio de diseño ecológico, transversal, descriptivo, utilizado datos secundarios de la base de datos el Departamento de Informática de SUS ? DATASUS. Análisis estadístico se realizó mediante el programa SPSS. Se utilizó el coeficiente de correlación de Spearman para evaluar la asociación entre el coeficiente de distribución geográfica de la mamografía y la morbilidad y los indicadores de mortalidad y medio del PIB indicador socio-económico per cápita. Para calcular la cobertura de mamografía se utilizó la recomendación del Instituto Nacional del Cáncer (INCA). Resultados: Se observó en este estudio una distribución irregular de este equipo entre las macro-regiones de salud del estado, con la concentración en zonas con mejores condiciones socioeconómicas, baja cobertura y la tendencia a la anarquía en el acceso de la población objetivo de esta tecnología, el Sistema Único de Salud . No se pudo completar la asignación de SUS mamografía en Bahía ha tenido en cuenta los criterios epidemiológicos. Conclusión: La distribución geográfica y la cobertura son elementos importantes para la evaluación del acceso y las cuestiones de equidad / inequidad, particularmente los relacionados con tecnologías de alta y media de coste, como la mamografía.

Objectives: To analyze the geographical distribution and access to mammography through estimate mammography coverage in the state of Bahia, Brazil, from 2010 to 2012. Methods: Ecological, cross-sectional and descriptive study, making use of secondary data from the database of the Department of Informatics of SUS ? DATASUS. A statistical analysis was performed using the SPSS program. We used the Spearman?s correlation coefficient to evaluate the association between the geographical distribution coefficient of the mammography devices and the morbidity and mortality indicators, as well as the average socio-economic indicator ? GDP per capita. To calculate the mammography coverage area, we used the recommendation of the National Cancer Institute (INCA). Results: We observed in this study an irregular distribution of the abovementionedequipment among the state?s health macro-regions, with concentration in areas with better socioeconomic conditions, low coverage and tendency to iniquity concerned to the access of the target population to this technology via the Brazilian Unified Health System. It was not possible to conclude that the allocation of mammography devices in Bahia has taken into account the epidemiological criteria. Conclusion: Geographic distribution and coverage are important elements for the evaluation of access by the population and issues regarding equity/inequity, particularly those involving high and average cost technologies, such as the mammographydevice.

Utilización correcta de las técnicas de detección de cáncer de mama en mujeres mexicanas / Correct utilization of breast cancer detection techniques in Mexican women

Objetivo. Identificar las características asociadas con la prevalencia de utilización correcta de la autoexploración manual (AE), el examen clínico (EC) y la mamografía (MA) para la detección de cáncer mamario (CaMa). Material y métodos. Se entrevistó a 1 030 mujeres mexicanas, sanas, de entre 20 y 88 años sobre su historia reproductiva y sociodemográfica. Con base en la forma y frecuencia de realización de estas técnicas de detección, se construyó un índice de utilización correcta. Resultados. La prevalencia de utilización correcta de la AE fue de 11% y del EC de 5.4%. El 7.6% de las mujeres entre 40 y 49 años y 31.6% de las mujeres con 50 años o más se realizaron una MA de acuerdo con la norma vigente al momento del estudio. El aseguramiento por parte del Instituto Mexicano del Seguro Social, del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado o del Seguro Popular fue el principal determinante de la utilización de la MA. Conclusiones. Se evidencia la necesidad de incrementar la correcta utilización de la AE, el EC y la MA.

Objective. Identify the characteristics associated with correct utilization of self examination (SE), clinical exam (CE) and mammography (MA) for breast cancer (BC) early detection. Materials and methods. Interviews were undertaken with 1 030 Mexican women (n=1 030), 20 to 88 years of age, regarding their reproductive and sociodemographic characteristics. An index of correct utilization was constructed based on the form and frequency practice of those techniques. Results. The prevalence of correct utilization of SE was 11% and 5.4% for CE. Further, 7.6% of women 40-49 years of age with 2 or more BC risk factors had MA during the two years prior to the interview, and for 31.6% among women ≥50 years of age the MA was annually. The main determinant of MA utilization was having financial protection from either IMSS, ISSSTE or Seguro Popular. Conclusions. It is necessary to improve the correct utilization of BC detection techniques in Mexico.

Mammographic breast density and other risk factors in Malaysian women with breast cancer

Aim: This study was performed to: (i) determine the association of breast cancer with dense breasts, and (ii) determine the breast cancer association with early onset of menarche, nulliparity, late age at first childbirth, not breast-feeding, and family history of breast cancer. Methods: This was a retrospective hospital-based case-control study. The 231 cases were women diagnosed with breast cancer on histology during the study period from July 1998 to April 2005. The 231 controls were age-matched and randomly selected women who did not have breast cancer but had mammography performed during the same time interval. Tabar classification was used to classify the mammographic parenchymal pattern of the 462 samples. The same radiologist analysed the parenchymal pattern based on the craniocaudal and mediolateral oblique views. Statistical analysis was done using the SPSS package. Results: Majority of women with breast cancer (55%) had dense breasts (29% Type IB, 19% Type IC, 4% Type IV, 3% Type V). Majority of controls (58%) had dense breasts (22% Type IB, 26% Type IC, 6% Type IV, 4% Type V). The majority of women with breast cancer had menarche at 12 years or older (93%), were parous (89%), had the first childbirth before 35 years old (91%), had breast-fed (67%), and did not have family history of breast cancer (84%). For controls, the majority had menarche at 12 years or older (88%) were parous (87%), had the first childbirth before 35 years old (98%), had breast-fed (66%), and did not have family history of breast cancer (85%). All factors explored, including breast density, were not significantly associated with breast cancer. The odds ratio for breast cancer among those with dense breast compared to those with non-dense breast is 0.8 (95% CI=0.6, 1.2). Conclusion: This study found no association between breast cancer and dense breasts (p=0.398). There was also no association between breast cancer with early onset of menarche (p=0.174), nulliparity (p=0.448), older age at first childbirth (p=0.065), not breast-feeding (p=0.716) and family history of breast cancer (p=0.665).

Study for Mammographic Patterns of Korean Breast Cancer / 한국유방암학회지

BACKGROUND: In Korea, the incidence of breast cancer is relatively lower than in western country, but it is in increasing slope. However the mammographic patterns of Korean breast cancer patients are not well known. METHODS: The authors collected the clinical and radiologic data from new breast cancer patients between January 1992 and December 1997, and analysed the mammographic pattern. RESULTS: Of the 418 patients, the age-specific incidences were 153 (37.0%) for 40 to 49 years of age, 99 (23.9%) for 30 to 39 years, 81 (19.6%) for 50 to 59 years, 55 (13.3%) for 60 to 69 years, 14 (3.3%) for over 70 years, and 12 (2.9%) for 20 to 29 years. According to the TNM staging system, there were 2 (0.6%) with stage 0, 102 (24.9%) with stage I, 147 (35.9%) with stage IIA, 72 (17.6%) with stage IIB, 85 (20.8%) with stage IIIA, 1 (0.2%) with stage IV. The non-palpable lesions were 7.5% on physical examination. According to Wolfe's classification, there were 78 (19.0%) for N1, 78 (19.0%) for P1, 133 (32.4%) for P2, and 122 (29.7%) for DY pattern. On mammography, lumps were found in 312 cases (75.8%). Among mammographic lumps, 51.9% was not clearly defined margin. The mammographic calcifications were found in 48.3% of all patients. In the distribution of calcification, 20.6% was diffuse type and 79.4% was localized type. The size of calcifications was variable in 92.9% and the shape of calcifications was amorphous pattern in 85.6%. We could not suspect cancer in 14.7% of patients on mammography, and 10.1% of patients on ultrasound examination. CONCLUSION: We believe that these baseline mammographic data of Korean breast cancer patients may contribute to the accurate diagnosis of breast cancer, but more data will be needed.