Summary of quality control protocols followed by the included studies. Four different quality control protocols that have different approaches to exposure measurements 10— 50 patients BCT 50—60 mm Table 4 were followed. The EP was updated to include digital mam- Patients number mography 21 , a supplement fourth edition of the Minimum 10 patient Minimum 10 patient European guidelines has been published 69 , and BCT 40—60 mm BCT 50—60 mm according to the European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services website, a further update is on the way The 75th percentile is more common and is used when there is a large range Different reference values available for different BCT.
Nonetheless, when establishing DRLs, any recom- mendations of lowering dose should be balanced with a measure of image quality as poor image quality degrades image interpretation accuracy 72 — 75 A diverse range of standard BCTs has been reported depending on the protocol followed. In general, a thicker BCT requires higher ex- useful and accurate international comparison can be posure and is expected to receive higher dose in a made.
The standard EP phantom also has an 1. World Health Organisation. Although establishing DRLs normally requires the 2. Tabar, L. Swedish two-county trial: impact of mam- use of standard BCT, any study that aims to establish mographic screening on breast cancer mortality during 3 DRLs for mammography could also include a range decades. BreastScreen Australia monitoring report measure of dose variations across the population. Cancer series CAN International Commission of Radiation Protection.
ICRP Publication ICRP 26 2 , 1— 47 Although breast thickness is not the only factor to 5. Other factors that effect MGD are not con- ionising radiation in relation to medical exposures. The lack of consistency and a worldwide standard 7. Nassivera, E. Quality control programme methodology to establish DRLs complicates compari- in mammography: second level quality controls.
International compari- Br. Heggie, J. Survey of doses in screening mammography. Faulkner, K. Assessment of Norway 1. Hauge et al. Comparative study of dose values and image quality in mammography to contribute to lower dose values and hence lower in the area of Madrid. DRLs within the Irish study Both studies found A survey of doses to patients in a large that MGDs varied depending on the model of mam- public hospital resulting from common plain film radio- mography units; Hauge et al.
Ciraj-Bjelac, O. Mammography radiation dose: initial percentile 1. Jensen, J. Breast exposure: nationwide trends; a mammographic quality assurance program— DRLs for mammography have been established results to date. Fitzgerald, M. The most common method used was Mammographic practice and dosimetry in Britain. Breslow, L. Final of 45 —55 and 55— 65 mm. DRLs for these ranges reports of the National Cancer Institute ad hoc Working varied with the 75th percentiles ranging from 1.
Cancer Inst. However, an internationally accepted protocol Boag, J. Karlsson, M. Moher, D. Absorbed dose in mammary radiography. Preferred reporting items for systematic reviews and Radiol. International Commission of Radiation Protection and — Protection of the patient in nuclear medi- Avramova-Cholakova, S. A survey of cine and Statement from the Como Meeting of the state of mammography practice in Bulgaria. ICRP 17 Rothenberg, L.
Baldelli, P. Guidance on the establishment and use of diag- Results of Comprehensive Dose Survey for Mammography. Bor, D. Performance measure- Perry, N. Holland, R. European , — Guidelines for Quality Assurance in Breast Cancer Borg, M. Mammography equip- Screening and Diagnosis, 4th edn. Chevalier, M.
European Guidelines for Cepeda, T. Patient dose in digital mam- Quality Assurance in Mammography Screening. Office mography. Hauge, I. New diagnostic reference level for full-field digital mam- Zoetelief, J. Office for Official Publications of the European Michielsen, K. Results of a International Atomic Energy Agency.
Dosimetry in European dose survey for mammography. International Atomic Energy Agency Moran, P. Kereiakes, J. The thirteen studies that satisfied the eligibility criteria reported 16 estimates of overdiagnosis. The overtreatment that accompanies overdetection is what causes the harm. Most overdetection is driven by the diagnosis of ductal carcinoma in situ dcis.
The literature contains much debate about the value of screen detection of dcis and subsequent treatment of the disease.
Before the widespread use of screening mammography in the United States, 6 cases of dcis were detected annually per , women; after the introduction of screening, 37 cases of dcis were detected per , women On mammography, dcis is most often detected as new microcalcifications Figure 2 , although it can present as a palpable mass.
It can also be both mammographically and clinically occult. Breast magnetic resonance imaging mri has been shown to be more sensitive than mammography for detecting high nuclear grade dcis The main goal of bc a screening is to detect bc a early and thus to lower the incidence of locally advanced bc a. Locally advanced breast cancer in a year-old woman, with calcifications seen at the same site 5 years earlier, likely an evolution from ductal carcinoma in situ DCIS. A Bilateral digital mammograms demonstrate heterogeneously dense breasts American College of Radiology, BI-RADS C , with a large spiculated mass in the central left breast causing left nipple retraction corresponding to the palpable mass.
An ultrasound-guided breast biopsy not shown confirmed invasive ductal carcinoma, with axillary node metastases. B Maximal-intensity projection image from magnetic resonance imaging shows tumour occupying most of the left breast, measuring more than 5 cm. C Photographic enlargement of the left breast mass shows fine pleomorphic calcifications within the mass, characteristic for DCIS. D Photographic enlargement of the left breast from a screening mammogram 2 years earlier shows a smaller cluster of calcifications within the same area, not detected at screening.
E Photographic enlargement of the left breast from a screening mammogram 5 years earlier shows a very small group of fine pleomorphic calcifications, likely DCIS, identified only in retrospect. Does detecting dcis reduce the rate of invasive cancer? Currently, no tools are available to predict which dcis will progress and which will not. In the United Kingdom, Duffy et al. Data were obtained for 5. Interval cancers diagnosed symptomatically within 36 months after the relevant screen were recorded.
The average detection frequency of dcis was 1. A significant negative association was observed for screen-detected dcis and the rate of invasive interval cancers; for every 3 screen-detected cases of dcis , 1 fewer invasive interval cancer occurred in the subsequent 3 years. The study concluded that detection and treatment of dcis was worthwhile for the prevention of future invasive disease.
To mitigate the harm of overdiagnosis, women should be involved in the decision-making for dcis treatment, based on information about the risks of treatment compared with watchful waiting. False negatives are more likely with certain bc as—in particular, lobular carcinomas that tend to grow along the normal breast architecture in a lepidic pattern, making them more difficult to detect.
False negatives are also more likely in patients with dense breast tissue, which masks bc a. One technologic advance in screening mammography was the transition from film screen to digital mammography. The dmist trial showed that, in women with dense breasts, the sensitivity of digital mammography was significantly increased Increasingly, dbt is being used as an adjunct screening tool for the detection of bc a.
Two-dimensional 2D mammography and tomosynthesis can be obtained in a single compression, and synthesized 2D projection images can also be reconstructed from the dbt data The radiation dose received when dbt is combined with conventional 2D mammography is nearly double that of digital mammography alone, but within the established and acceptable safe dose limits 53 — When combined with digital mammography, dbt helps to improve bc a screening and diagnosis.
Several screening studies have shown incremental invasive cancer detection rates of 1. The main advantage of tomosynthesis is its ability to diminish the masking effect of tissue overlap and structure noise usually encountered with 2D mammography. If dbt is used in the screening setting, the marginal definition is equal to that of spot magnification, and so women with masses detected at screening can forego additional mammographic views and attend just for ultrasonography.
Few studies have investigated the long-term sustainability of the improved screening outcomes with dbt. A retrospective analysis looked at outcomes data from 3 years of dbt screening of an entire population at an academic centre. The results showed that dbt screening outcomes were sustainable, with a significant recall reduction, an increase in the cancer cases identified in recalled patients, and a decline in interval cancers In the United States and Canada, , asymptomatic women between the ages of 45 and 74 years will be enrolled.
The study aims to provide a modern basis for implementation of the combination technology for bc a screening. The Canadian Lead-in Study began recruitment in , and the full study opened in Currently, no widely accepted view for the supplemental screening of women with dense breasts has been reached, even though the sensitivity of screening mammography is recognized to be reduced in such women. No rct s have determined any mortality benefit from supplemental screening.
Multiple studies have shown increased detection 3—4 per of small, invasive, node-negative cancers when supplementary screening is performed for women with dense breasts 72 , The j-start prospective rct of ultrasonography has shown favourable preliminary results for detecting early-stage cancers, with fewer interval cancers Currently, 32 U.
Personalized screening could become more of a reality in the future, whereby, depending on risk and density, supplemental screening might be offered. That approach has been proposed in Quebec with the international Perspective Project Recently, studies of contrast-enhanced mammography have shown promise in improving the detection of bc a by relying on its enhanced vascularity 76 , Although still experimental and currently used only in the diagnostic setting, that type of screening could have future applications.
Breast mri has also recently been proposed as a method of screening for average-risk women: a recent study showed a high supplemental cancer detection rate of In the latter study, more biologically active tumours were found with mri. However, given the higher cost, the requirement for intravenous contrast, and the lower specificity, breast mri has not become a part of routine screening. For women who undergo biopsy, only 1 in 3 will be diagnosed with a malignancy.
False negatives with mammography are an important limitation, often being related to bc as hidden by dense breast tissue. Digital breast tomosynthesis has the potential to simultaneously increase cancer detection and lower the rate of false positives.
In addition, supplemental screening with breast ultrasonography, breast mri , and contrast-enhanced mammography shows promise for further increasing the detection of biologically significant bc as in women at higher risk of bc a. In , based on the best available current evidence, screening mammography should be recommended every 1—2 years for women 40—74 years of age at average risk. In future, as assessment of risk and breast tissue density becomes a reality, more personalized screening will likely be added to that screening mammography regimen.
National Center for Biotechnology Information , U. Journal List Curr Oncol v. Curr Oncol. Published online Jun Find articles by J. Find articles by T.
Author information Copyright and License information Disclaimer. Correspondence to: Jean M. E-mail: ac. Copyright Multimed Inc. This article has been cited by other articles in PMC. Abstract Although screening mammography has delivered many benefits since its introduction in Canada in , questions about perceived harms warrant an up-to-date review. Keywords: Breast cancer, screening mammography, digital breast tomosynthesis, overdiagnosis. Benefits: Number Needed to Invite Compared With Number Needed to Screen Absolute benefit can be measured as the number needed to invite to screening nni or the number needed to screen nns to prevent 1 death Independent Review 5 50—70 e 3 20 50— NA 0.
Open in a separate window. National Health Service is in the process of extending breast cancer screening to include mammography in women 47—73 years of age. Guidelines for Screening to Maximize Benefit Most national screening guidelines suggest that there is value in mammography screening for women in their 40s 10 , 15 , 17 , Breast Cancer Screening in Young Women An often-touted reason not to screen women 40—49 years of age is that most bc as occur in women more than 50 years of age.
TABLE II Summary of quality indicators for women 50—69 years of age in organized breast cancer screening programs across Canada, — screen years a.
Cancer incidence and mortality worldwide: sources, methods and major patterns in globocan Int J Cancer. Estimates of global cancer prevalence for 27 sites in the adult population in Estimates of the worldwide mortality from 25 cancers in Canadian Cancer Statistics Effectiveness of screening with annual magnetic resonance imaging and mammography: results of the initial screen from the Ontario high risk breast screening program. J Clin Oncol.
N Engl J Med. J Med Screen. Pan-Canadian study of mammography screening and mortality from breast cancer. Search life-sciences literature Over 39 million articles, preprints and more Search Advanced search.
Abstract Similar Articles. Bagni B Search articles by 'Bagni B'. Bagni B ,. Pedrazzini L Search articles by 'Pedrazzini L'. Pedrazzini L. Affiliations All authors 1. Share this article Share with email Share with twitter Share with linkedin Share with facebook. The manual collects data published by many authors and suggests a method to estimate the dose released to the glandular tissue considered at risk for breast cancer in the most commonly used conditions for mammography.
Besides translation manual, the program holds an algorithm developed by the authors, which allows the dose to the glandular tissue to be evaluated, given the following data: projection: craniocaudal or mediolateral; compression level: firm or moderate; breast size: small, medium or large; breast composition: percentage of glandular tissue content by weight ; X-ray beam quality: HVL mm Al.
The algorithm is obtained from a bidimensional fit of the original data and is based on the terms contained in the manual. The program flow is guided by menus that make the procedure suitable for inexperienced operators too, both for consulting and printing and for computing program.
Similar Articles To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Spectral dependence of glandular tissue dose in screen-film mammography. Average glandular dose conversion coefficients for segmented breast voxel models. Average glandular dose in routine mammography screening using a Sectra MicroDose Mammography unit. Investigation of breast dose in five screening mammography centres in Greece. Joining Europe PMC.
0コメント