Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes Marie L. De Bruin, Judith Sparidans, Mars B.

Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes
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
Journal of Clinical Oncology, Vol 27, No 26 (September 10), 2009: pp. 4239-4246

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Reduction of radiation volume appears to decrease the risk for Breast Cancer after Hodgkin's Lymphoma.

In addition, shorter duration of intact ovarian function after irradiation is associated with a significant reduction of the risk for Breast Cancer

Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes

Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes
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, Flora E. van Leeuwen
Journal of Clinical Oncology, Vol 27, No 26 (September 10), 2009: pp. 4239-4246

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Reduction of radiation volume appears to decrease the risk for BC after HL. In addition, shorter duration of intact ovarian function after irradiation is associated with a significant reduction of the risk for BC

Early detection of second breast cancers improves prognosis in breast cancer survivors

Early detection of second breast cancers improves prognosis in breast cancer survivors
N. Houssami, S. Ciatto, F. Martinelli, R. Bonardi, and S. W. Duffy
Ann Oncol 2009 20: 1505-1510

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Detection of second breast cancers in the asymptomatic phase leads to detection of early-stage cancer and improves relative survival by between 27% and 47%

Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?

Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?
C. Simmons, N. Miller, W. Geddie, D. Gianfelice, M. Oldfield, G. Dranitsaris, and M. J. Clemons

Ann Oncol 2009 20: 1499-1504

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This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumor and metastases, which led to altered management in 20% of cases. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence

Follow-up may not be beneficial after treatment of grade 1 breast cancer

Follow-up may not be beneficial after treatment of grade 1 breast cancer

M. Kontos, D. Allen, D. T. Trafalis, G. Jones, H. Garmo, L. Holmberg, H. Hamed
British Journal of Surgery 2009; 96: 999 – 1004

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Identification of women treated for breast cancer who have a low risk of locoregional recurrence or contralateral breast cancer, and who can be discharged safely from follow-up, would lower costs without compromising prognosis. This study investigated the risk of locoregional recurrence and contralateral breast cancer in women treated for grade 1 breast cancer

Some 1143 women who had surgery for breast cancer were followed, and the rate of locoregional recurrence or contralateral breast cancer was determined. The risk was compared to the tumour grade

At a mean follow-up of 9·1 years, 10-year estimates of the cumulative risk of locoregional recurrence or contralateral breast cancer for grade 1, 2 and 3 breast cancer were 0·03 (95 per cent confidence interval (c.i.) 0·01 to 0·08), 0·12 (0·09 to 0·15) and 0·16 (0·13 to 0·20) respectively. Grade 1 tumours had a risk of locoregional recurrence or contralateral breast cancer of 285 (95 per cent c.i. 93 to 670) per 100 000 person-years

Women treated for grade 1 breast cancer could be discharged from follow-up after completion of the primary treatment, without compromising their quality of care

The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography?

The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography?
Ayano Akita, Akihiro Tanimoto, Hiromitsu Jinno, Kaori Kameyama, Sachio Kuribayashi
Eur Radiol (2009) 19: 2089–2096

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The purpose of this study was to evaluate the clinical value of bilateral breast magnetic resonance (MR) imaging (MRI) in patients showing suspicious microcalcifications on mammography and negative ultrasound findings. Fifty patients underwent MRI before stereotactic vacuum-assisted breast biopsy (SVAB). MR findings were classified into five types for interpretation, and types 4 and 5 were considered malignant. SVAB revealed 13 carcinomas and 37 benign lesions. Malignant lesions were more frequently found in cases of positive MRI diagnoses than in negative MRI diagnoses (P  < 0.001). Mammography had a sensitivity of 100%, a specificity of 24% and an accuracy of 44%, whereas mammography plus MRI had a sensitivity of 85%, a specificity of 100% and an accuracy of 96%. In the evaluation of mammographically detected microcalcifications, bilateral breast MRI is of good diagnostic value and may alter the indications for SVAB

Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T

Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T
Nicky H. G. M. Peters, Carla Meeuwis, Chris J. G. Bakker, Willem P. Th. M. Mali, Arancha M. Fernandez-Gallardo, Richard Hillegersberg, Marguerite E. I. Schipper, Maurice A. A. J. Bosch
Eur Radiol (2009) 19: 1639–1644

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The feasibility of large-core-needle magnetic resonance imaging (MRI)-guided breast biopsy at 3 T was assessed. Thirty-one suspicious breast lesions shown only by MRI were detected in 30 patients. Biopsy procedures were performed in a closed-bore 3-T clinical MR system on a dedicated phased-array breast coil with a commercially available add-on stereotactic biopsy device. Tissue sampling was technically successful in 29/31 (94%) lesions. Median lesion size (n  = 29) was 9 mm. Histopathological analysis showed 19 benign lesions (66%) and one inconclusive biopsy result (3%). At follow-up of these lesions, 15 lesions showed no malignancy, no information was available in three patients and two lesions turned out to be malignant (one lesion at surgical excision 1 month after biopsy and one lesion at a second biopsy because of a more malignant enhancement curve at 12-months follow-up MRI). Nine biopsy results showed a malignant lesion (31%) which were all surgically removed. No complications occurred.

MRI-guided biopsy at 3 T is a safe and effective method for breast biopsy in lesions that are occult on mammography and ultrasound. Follow-up MRI at 6 months after the biopsy should be performed in case of a benign biopsy result

Technical aspects of breast MRI—do they affect outcomes?

Technical aspects of breast MRI—do they affect outcomes?
Ruth Warren, Stefano Ciatto, Petra Macaskill, Richard Black, Nehmat Houssami
Eur Radiol (2009) 19: 1629–1638

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In a systematic review of breast MRI for assessing ipsilateral breast cancer to detect additional lesions, technical details were extracted from publications to assess their effect on diagnostic performance. Where technical parameters were complete, we examined their effect on summary ROC models, and the TP:FP ratio and PPV, using random-effects logistic regression. A total of 2,801 breasts in 19 publications underwent statistical analysis for year of study, slice thickness, and repetitions after contrast-medium injection. None were associated with TP/FP ratio. Summary ROC analysis provided weak evidence (P  = 0.09) of an association between diagnostic performance and time period, however no trend over time. Tesla strength was reported in 2,801 cases. Other key information was omitted including whether both breasts were examined for 1683 (60%), position of the patient in 1,375 (49%), and imaging planes used in 688 (25%). Contrast agent and dose were reported for 2,646 (95%) breasts. Reporting technique was inconsistently reported. Single radiology reports were found in 1,637 (58%) cases, double in 347 (12.4%), and in 960 (34%) knowledge of mammography or ultrasound findings was not stated. Slice thickness, number of sequences after contrast medium, and year of study did not show significant performance differences. Other technical information was deficient. There is an urgent need to improve the quality of reporting of breast MRI studies

Real-time US elastography in the differentiation of suspicious microcalcifications on mammography

Real-time US elastography in the differentiation of suspicious microcalcifications on mammography
Nariya Cho, Woo Kyung Moon, Jeong-Seon Park
Eur Radiol (2009) 19: 1621–1628

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When a cutoff point between elasticity scores of 1 and 2 was used, US elastography showed 97% (34/35) sensitivity, 62% (26/42) specificity, 68% (34/50) PPV, and 96% (26/27) NPV with an Az value of 0.852 (0.753–0.923, 95% confidence interval) in the differentiation of benign and malignant microcalcifications. Our results suggest that US elastography has the potential to differentiate benign and malignant lesions associated with microcalcifications detected at screening mammography

Diffusion-weighted imaging (DWI) in MR mammography (MRM): clinical comparison of echo planar imaging (EPI) and half-Fourier single-shot turbo spin ech

Diffusion-weighted imaging (DWI) in MR mammography (MRM): clinical comparison of echo planar imaging (EPI) and half-Fourier single-shot turbo spin echo (HASTE) diffusion techniques
P. A. T. Baltzer, D. M. Renz, K.-H. Herrmann, M. Dietzel, I. Krumbein, M. Gajda, O. Camara, J. R. Reichenbach, W. A. Kaiser
Eur Radiol (2009) 19: 1612–1620

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The sensitivity and specificity of routine diagnostics (97.4% and 85.7%) were superior to EPI-DWI (87.2% and 82.9%) and HASTE-DWI (76.9% and 88.6%). Selecting only nonmass lesions, DWI did not prove to be of diagnostic value. Lesion demarcation by DWI was significantly lower compared with that by CE-T1w, with EPI-DWI showing the better performance (p  < 0.001). No significant differences were found for size measurements between CE-T1w and DWI. Although clearly inferior compared with CE-T1w imaging, both DWI techniques are applicable for lesion assessment and size measurements

Weighing the Benefits and Burdens of Mammography Screening Among Women Age 80 Years or Older

Weighing the Benefits and Burdens of Mammography Screening Among Women Age 80 Years or Older
Mara A. Schonberg, Rebecca A. Silliman, and Edward R. Marcantonio
J Clin Oncol 27:1774-1780, 2009

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The majority of women ≥ 80 years are screened with mammography yet few benefit.
Meanwhile, 12.5% experience a burden from screening.

The data from this study can be used to inform elderly women's decision making and potentially lead to more rational use of screening.

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience
B Cutuli, C Lemanski, A Fourquet, B de Lafontan, S Giard, A Meunier, R Pioud-Martigny, F Campana, H Marsiglia, S Lancrenon, E Mery, F Penault-Llorca, E Fondrinier & C Tunon de Lara
Br J Cancer 2009 100: 1048-1054

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Ductal carcinoma in situ was diagnosed by mammography in 87.6% of patients. Mastectomy, conservative surgery alone (CS) and CS with radiotherapy (CS+RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Thus, 89% of patients treated by CS received adjuvant RT. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients (80% tamoxifen).

Median tumour size was 14.5 mm (6, 11 and 35 mm for CS, CS+RT and mastectomy, respectively, P<0.0001). Nuclear grade was high in 21% of patients, intermediate in 38.5% and low in 40.5%. Excision was considered complete in 92% (CS) and 88.3% (CS+RT) of patients. Oestrogen receptors were positive in 69.8% of assessed cases (31%). Treatment modalities varied widely according to region: mastectomy rate, 20–37%; adjuvant RT, 84–96%; hormone treatment, 6–34%.

This survey on current DCIS management in France has highlighted correlations between pathological features (tumour size, margin and grade) and treatment options, with several similar variations to those observed in recent UK and US studies.

Evaluation of extension of breast screening to women aged 65–70 in England using screening performance measures

Evaluation of extension of breast screening to women aged 65–70 in England using screening performance measures
R L Bennett, R G Blanks & S M Moss
Br J Cancer 2009 100: 1043-1047

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Average uptake was 72.8% for women aged 65–70 and 76.7% for women aged 50–64. For women screened within the last 5 years, uptake was 88.7% for older women and 89.1% for younger women. For women previously screened within 5 years the invasive cancer detection rate was 17% higher in the 65–70 age group than in the 60–64 age group.

The rates of recall to assessment and PPV were 3.5 and 27.6% in women aged 65–70 and 3.4 and 24.6% in women aged 50–64 respectively.

These results suggest that, as in the earlier demonstration studies, uptake rates remain high in older women, and many more older women attend following an invitation than had previously self-referred.

The cancer detection rate is higher in this older age group, whereas rates of recall are generally similar to those in younger women; consequently the PPV is also higher in older women.

Effect of Margin Status on Local Recurrence After Breast Conservation and Radiation Therapy for Ductal Carcinoma In Situ

Effect of Margin Status on Local Recurrence After Breast Conservation and Radiation Therapy for Ductal Carcinoma In Situ
Clive Dunne, John P. Burke, Monica Morrow, and Malcolm R. Kell
J Clin Oncol 27:1615-1620, 2009

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Surgical margins negative for DCIS should be obtained after BCS for DCIS. A margin threshold of 2 mm seems to be as good as a larger margin when BCS for DCIS is combined with RT

There is a difference between Europe and North America regards the amount of normal tissue that should be removed for clear margins in DCIS. In Europe, 10mm is the favoured margin, whereas 1mm may be regarded as clear in North America.

This study shows that a smaller margin combined with radiation therapy is as effective as taking a larger margin

Breast Cancer in the Elderly

Led by Professor Bob Leonard from the Royal Marsden Hospital, a number of excellent articles on breast oncology issues in the elderly

How Age affects the biology of breast cancer
Breast Cancer in Older Women: Trials and Tribulations
The Role of Surgery in the Treatment of Older Women with Breast Cancer
Breast Radiotherapy: Considerations in Older Patients
Quality of Life and Patient-reported Outcomes in the Older Breast Cancer Patient