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

Assessment of the Accuracy of the Gail Model in Women With Atypical Hyperplasia

Assessment of the Accuracy of the Gail Model in Women With Atypical Hyperplasia
V. Shane Pankratz, Lynn C. Hartmann, Amy C. Degnim, Robert A. Vierkant, Karthik Ghosh, Celine M. Vachon, Marlene H. Frost, Shaun D. Maloney, Carol Reynolds, and Judy C. Boughey
J Clin Oncol 26:5374-5379, 2008

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The Gail model significantly underestimates the risk of breast cancer in women with atypia. Its ability to discriminate women with atypia into those who did and did not develop breast cancer is limited. Health care professionals should be cautious when using the Gail model to counsel individual patients with atypia