The use of an expert system of composite risk factors in breast cancer screening.

Mass Screening seems to be the only promising way to discover breast cancer patients at an early and more curable stage and a positive method improving the cost-effectiveness and compliance of mass screening is the use of prognostic factors, to identify the high-risk group, who alone then would be screened. In a 200 women sample, who had undergone screening for breast cancer with clinical examination and bilateral mammography, we calculated the Composite Risk Factors of six Characteristics (C6RF), which are family history for breast cancer, pregnancy history, menstrual history, history of cystic breast disease, history of regular breast clinical or self-examination and presence or not of breast lump, using an expert system in IBM-compatible personal computer. In these cases the average C6RF was 0.18 (SD +/- 0.19) in low-risk group and 2.61 (SD +/- 4.76) in high-risk group and all cases with C6RF values higher than 0.56 were put in the high-risk group. Under these conditions, the sensitivity of the C6RF method, in discovering breast cancer, was 90% and the specificity 81.5% and the C6RF method was proved to be clinically valuable in identifying the high-risk group and controlling breast cancer.

Breast compliance: a new method for evaluation of cosmetic outcome after conservative treatment of early breast cancer.

As a measure of cosmetic outcome, the compliance of normal and irradiated breasts has been quantified using a new method of Breast Compliance Evaluation (BCE). A total of 151 women were studied, of whom 100 were normal controls and 51 had previous breast irradiation as part of breast-conserving treatment. Compliance was taken as the difference between the anterior breast surface length from infra-mammary fold to the nipple when the patient was in erect and supine positions. Irradiated cases were rated as having satisfactory outcome (good or excellent cosmetic result) or unsatisfactory (fair or poor cosmetic result). Mean compliance of normal cases was 1.8 cm. In the irradiated women with satisfactory cosmetic results, mean compliance was 1.45 compared with only 0.77 cm in those with unsatisfactory outcome. The difference between the compliance of both breasts was 0.1 cm for the controls, 0.3 cm in the satisfactory group and 2 cm in the unsatisfactory group. A difference in compliance greater than 1 cm was usually associated with an unsatisfactory cosmetic outcome. Factors determining cosmetic outcome included volume of excised lump and breast size. The cosmetic result was not affected by tumour site, clinical or pathological tumour size, or the total number of axillary nodes excised. This simple, painless, and easily reproducible measurement may be a useful objective indicator of cosmetic result after conservative treatment of early breast cancer.