Health benefits and harms of mammography screening in older women (75+ years)-a systematic review.

BACKGROUND: There is little evidence on the balance between potential benefits and harms of mammography screening in women 75 years and older. The aim of this systematic review was to synthesise the evidence on the outcomes of mammography screening in women aged 75 years and older. METHODS: A systematic review of mammography screening studies in women aged 75 years and over. RESULTS: Thirty-six studies were included in this review: 27 observational studies and 9 modelling studies. Many of the included studies used no or uninformative comparison groups resulting in a potential bias towards the benefits of screening. Despite this, there was mixed evidence about the benefits and harms of continuing mammography screening beyond the age of 75 years. Some studies showed a beneficial effect on breast cancer mortality, and other studies showed no effect on mortality. Some studies showed some harms (false positive tests and recalls) being comparable to those in younger age-groups, with other studies showing increase in false positive screens and biopsies in older age-group. Although reported in fewer studies, there was consistent evidence of increased overdiagnosis in older age-groups. CONCLUSION: There is limited evidence available to make a recommendation for/against continuing breast screening beyond the age of 75 years. Future studies should use more informative comparisons and should estimate overdiagnosis given potentially substantial harm in this age-group due to competing causes of death. This review was prospectively registered with PROSPERO (CRD42020203131).

An atypically located pleomorphic adenoma: Radiological and pathological correlation.

Pleomorphic adenoma is a common benign salivary gland neoplasm which very rarely occurs in the breast. Its radiologic and pathologic appearance may be mistaken for other benign or malignant lesions such as a fibroadenoma or invasive ductal carcinoma. Due to the risk of local recurrence and, rarely, malignant transformation, wide local excision with clear margins is recommended. As such, a correct diagnosis of this lesion is important to ensure appropriate surgical treatment. We report a case of an atypically located pleomorphic adenoma with radiologic-pathologic correlation in an asymptomatic 63-year-old woman.

Bloody nipple discharge in Carney complex: A case report.

Carney complex (CNC) is an extremely rare, autosomal dominant genetic syndrome consisting of pigmented skin and mucosal changes with multiple endocrine and nonendocrine tumors, including the breast. Breast tumors are typically multiple and benign and are most commonly reported as myxoid fibroadenomas and/or intraductal papillomas. We present a young female patient with known CNC who presented with copious bloody nipple discharge with multiple breast lumps and discuss the breast imaging features regarding this complex and often underrecognized genetic condition.

Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk-stratified population screening.

OBJECTIVES: To estimate rates of screen-detected and interval breast cancers, stratified by risk factor, to inform discussions of risk-stratified population screening. DESIGN: Retrospective population-based cohort study; analysis of routinely collected BreastScreen WA program clinical and administrative data. SETTING, PARTICIPANTS: All BreastScreen WA mammography screening episodes for women aged 40 years or more during 1 July 2007 - 30 June 2017. MAIN OUTCOME MEASURES: Cancer detection rate (CDR) and interval cancer rate (ICR), by risk factor. RESULTS: A total of 323 082 women were screened in 1 026 137 screening episodes (mean age, 58.5 years; SD, 8.6 years). The overall CDR was 68 (95% CI, 67-70) cancers per 10 000 screens, and the overall ICR was 9.7 (95% CI, 9.2-10.1) cancers per 10 000 women-years. Interactions between the effects on CDR of age group and five risk factors were statistically significant: personal history of breast cancer (P = 0.039), family history of breast cancer (P = 0.005), risk-relevant benign conditions (P = 0.012), hormone-replacement therapy (P = 0.002), and self-reported symptoms (P < 0.001). The influence of these risk factors (except personal history) increased with age. For ICR, only the interaction between age and hormone-replacement therapy was significant (P < 0.001), although weak interactions between age and family history of breast cancer or having dense breasts were noted (each P = 0.07). The influence of family history on ICR was significant only for women aged 40-49 years. CONCLUSIONS: Screening CDR and (for some risk factors) ICR were higher for women in some age groups with personal histories of breast cancer or risk-relevant benign breast conditions or first degree family history of breast cancer, women with dense breasts or self-reported breast-related symptoms, and women using hormone-replacement therapy. Our findings could inform the evaluation of risk-based screening.

Arterial contrast extravasation in severe seat belt-related female breast trauma on CT: Conservative management at a level 1 trauma centre.

Seat belt-related female breast trauma (SFBT) is an uncommon cause of haemorrhage following motor vehicle collision. Classification systems have been used to grade the severity of SFBT, ranging from mild class I to severe class IV injuries with evidence of active haemorrhage. In the case of class IV injuries, contrast extravasation represents active haemorrhage, prompting angiographic embolisation or surgery to arrest the bleed. Contrary to the majority of reports published in the literature, our institution has been successful with conservative management of class IV SFBT. None of the patients required specific intervention to control haemorrhage from SFBT.

Effect of false-positive screening mammograms on rescreening in Western Australia.

OBJECTIVES: To quantify the effect of previous false-positive mammogram results on rescreening rates in a population of women participating in the BreastScreen WA (BSWA) program. DESIGN AND PARTICIPANTS: Retrospective cohort study of women aged 50-69 years who received free screening mammograms at BSWA between 1 January 1995 and 31 December 2007. MAIN OUTCOME MEASURES: Percentages of women attending rescreening, and risk ratios for rescreening. RESULTS: A total of 22 396 screening mammograms were falsely reported as positive, and 560 333 mammogram screens were reported as normal (negative). Women with a false-positive index mammogram result were less likely than women with a true-negative index mammogram result to attend rescreening at 27 months (67.6% v 70.7%; risk ratio, 0.96; P < 0.001). A reduced rescreening rate was seen in all subgroups of women except Indigenous women. Rescreening rates were affected by the types of assessment done at the recall visit. CONCLUSION: Mammographic population screening services should keep their false-positive result rates low, to prevent women from being deterred from screening.