4. NEED/SCREENING
• 1million new cases /yr ,cancer is a major
health problem
• 18% BC
• 1in 8 US, I in 30 in India
• Advanced Breast Cancer 10-20% US, 3060% in developing countries.
5. Goal
• Goal of any screening test is to use a test
of sufficient sensitivity to detect a large
proportion of a particular disease in
population.
6. HOW
• BSE,BPE,MAMMOGRAPHY can detect
benign ,precancers like
DCIS,LCIS,PAGET’S DISEASE and early
invasive cancers.
• Further evaluation of any suspicious
lesion- Diagnostic Mammography
,Sonography, Elastography, MRI, PET.
7. RECOMMENDATIONS
• ACS/ACR – Annual screening from 40
• USPSTF2009, 50-74 YRS EVRY 2 YRS:
-Overdiagnosis and unnecessary
treatment(10/1life saved)
- Anxiety
- Slight increase in radiation induced BC
- Below 35 yrs not recommended, Sonography
/MRI.
- Cost of screening
8. ROUTINE SCREENING STILL
A MATTEROF DEBATE
• COCHRANE COLLABORATIVE
DATABASES 2011(US/ NORDIC)
Universal screening does more harm than
good and is not reasonable.
Screening detects 3-13% BC
DR in some countries with organized
screening by 2/3rd.
Benefit to risk ratio-48.5/1 (safe)
10. WHAT IS MAMMOGRAPHY
• LOW ENERGY XRAY 30 Kv examines the
breast & typically finds:
• Lump-( well defined/irregular)
-solid/cystic
• Macro calcifications –Ageing
• Micrcalcifications - spiculated
-clustered
-linear branching
13. A Brief History
- 1913 Albert Salomon, German surgeon
- 1950’s - Jacob Gershon-Cohen began to
advocate widespread use of X-rays for
screening
- December 2005 – RSNA brings digital
mammography to US
16. Standard views:
45* M
edio lateral Oblique (M O view)/L
L
undgren’s view
Craniocaudal view (CC view)
RCC
Right
Craniocaudal
LCC
Left
Craniocaudal
RMLO
Right
Mediolateral
Oblique
LMLO
Left
Mediolateral Oblique
17.
18.
19. PROCEDURE
• Breast compressed between two parallel
plates ,reduces the thickness and increases
sensitivity
• 2 views –CC,MLO
• TALCUM POWDERS/DEODORANTS
DISCOURAGED
• 1 WK AFTER MENSES
• < 30 MINS
23. LAT
Left Axillary Tail
LCV
Left Cleavage
LLMO
Left Lateromedial
Oblique
LML
Let Mediolateral
LFB
Left From Below
LRL
Left Roll Lateral
LLM
Left Lateromedial
LRM
Left Roll Medial
39. Digital Mammographic Imaging
Screening Trial
(DMIST)
• Retrospective study of 49,500 asymptomatic women
• Assessed accuracy of digital vs film mammograms
RESULTS:
• Digital mammography significantly more accurate in preand perimenopausal women under 50 with dense
breasts
• Nonsignificant trend toward improved accuracy with film
mammograms in women over 65 with fatty breasts
40.
41.
42.
43. cost issues
• Digital mammography is expensive!
• Using digital technology in all women
would cost >$300,000 per QALY gained
• Targeted use of digital mammography on
basis of age/breast density costs
~$50,000 per QALY gained
44. Computer-Aided Detection
•
•
•
•
Software program that highlights areas of concern on digital
mammograms
Uses image processing algorithms and decision threshold
parameters to detect features in an image likely to be of clinical
significance
Very sensitive – detects 90% of all cancers
However, has a high rate of false positives (2-4 per study)
{"49":"CELEBRITY INAGURATING LOW COST MOBILE MAMMOGRAPHY VAN TO MAKE SCREENING AVAILABLE AT DOOR STEP FOR POOR AND LESS AWARE.\n","38":"Conventional film mammography uses low energy X-rays that pass through the breast and are absorbed by the film which is then developed.\nWith digital, X-rays are recorded on a digital detector instead of film, and then projected on monitor.\nMammography is the last imaging modality to use digital technology; mammography requires high resolution and contrast to produce quality images and thus development of technology to produce digital mammography is very complex, expensive, and time consuming \nImproving the SNR allows for decreased background noise and “cleaner” image, allowing potential for better cancer detection and less background interference \nInstantaneous images allow radiologists to assess quality of the image, and can reposition, magnify certain areas of interest, etc while the patient is still in office.\n","27":"NORMAL DENSE\n","44":"Hope the CAD will aid in detection of breast cancers at an earlier stage.\nHowever, this also results in a higher rate of recall and false positives...\nResearchers at UCDavis reviewed screening mammograms of 222,000 women and found that with the use of CAD, 32% more women were recalled for additional tests, and 20% more women had an additional biopsy. Many of the cancers identified by CAD were localized, in situ cancers that still have an uncertain mortality risk.\nFurthermore, everytime CAD is used, the patient incurs additional costs for their mammogram - $15 per person according to Dr. Conwell.\n","39":"Study conducted in 2003 and published in 2005\nDMIST: retrospective study of 49,500 asymptomatic women that compared the accuracy of digital versus film mammography in population subgroups defined by combinations of age, menopausal status, and breast density by using either biopsy results or follow-up information as the reference standard \ndigital mamm was significantly better than film in detecting breast cancer in pre- and perimenopausal women with dense breasts younger than 50\nin other subgroups, there was no significant difference in diagnostic accuracy between digital and film mammography\nin women over 65 with fatty breasts, there was nonsignificant trend toward improved diagnostic accuracy with film over digital\n","28":"CALCIFICATIONS\n","45":"CAD IMAGES\n","29":"FIBROCYSTIC\n","46":"CAD IMAGE much better separation of microcalcification from background breast tissue.\n","13":"Salomon – first person to use X-ray to study breat tissue. Used X-ray to study breast tissue that had been removed from the body; found that he was able to differentiate between cancerous and benign lesions on X-ray. Did not use this in his own practice.\nEven with Gerson-Cohen’s published results, mammography did not begin to gain widespread popularity until later in 1960s\nIn 12/05, RSNA held first digital mammography training and self-assessment workshop in the US\n","30":"ILL DEFINED LUMP IN A DENSE BREAST\n","47":"MBI/MRI\n","48":"MOLECULAR IMAGING/\n","26":"NORMAL FATTY\n","15":"Modern X ray mammography machine\n","43":"Using info from the DMIST study and publicly available data, researchers evaluated the cost-effectiveness of digital mammography screening for breast cancer\nusing digital technology in all women would cost more than $300 000 per quality-adjusted life-year (QALY) gained. \nTargeting digital mammography on the basis of age or age and breast density costs $26 500 to $84 500 more per QALY gained than film mammography. \nDensity-targeted use of digital mammography in women age 65 years or older costs $97,000 to $257,000 more per QALY gained than film.\nOf interest, Medicare reimburses $50 more per exam for digital mammography\n"}
