Background: Primary Non-Hodgkin's Lymphoma (PHNL) of the breast is a rare entity, while secondary involvement of the breast with diffuse disease of Non-Hodgkin's lymphoma (NHL) is more common. However, PNHL is the most frequent haematopoietic tumour of the breast. Diagnostic criteria for PNHL of the breast are presence of technically adequate pathologic specimens, close association of mammary tissue and lymphomatous infiltrate, no prior diagnosis of an extarammamary lymphoma, and no evidence of concurrent widespread disease, except for ipsilateral axillary lymph nodes if concomitant with the primary lesion.
The effectiveness of breast screening in women aged 50-64 has been well established by randomised trials, and recent analyses have shown that screening in women aged 65-69 is probably as effective in terms of reducing mortality from breast cancer as screening in women aged 50-64 (Chen et al, 1995).The report of the Forrest committee (Forrest, 1986) in 1986, which led to the implementation of the NHS Breast Screening Programme in the United Kingdom, recommended that women aged 50-64 be invited for screening every 3 years, with women aged 65 and over being able to self-refer. The main reason for this distinction was concern over possible lower acceptance rates among older women, together with possible reduced costeffectiveness due to decreased life expectancy in older women.Population screening in a number of countries includes women up to age 69 or 70 (Shapiro et al, 1998). Some demonstration studies of inviting older women also showed that their uptake was only slightly lower than that for 50-64 year olds from the same locality, implying that reasonable uptakes could be achieved across the NHS as a whole (Hobbs et al, 1990;Hendry and Entwhistle, 1996;Horton-Taylor et al, 1996). The number of selfreferrals in women aged 65 and over had increased to 65 032 by 1998/9, 44 811 of these being aged 65-69.Demonstration studies at 3 sites were established by the Department of Health to determine the implications of extending the NHS Breast Screening Programme to women aged 65-69 by including this age-group in the routine invitation system. Findings from one of the sites after one year have previously been reported (Rubin et al, 1998). This paper presents the results of the evaluation of the full 3 years of all 3 sites. Decisions on the extension of the programme have been made on the basis of the results of these studies. METHODSThe demonstration studies were scheduled to run for 3 years at each of 3 sites, with appointments for women aged 65-69 intermingled with those of women aged 50-64 and self-referrals of older women. As for women aged 50-64, those aged 65-69 were sent by post an invitation to attend at a specific date/time for mammographic screening. Those with an abnormality detected on the mammogram were sent an appointment for further assessment, which could include clinical examination, further mammographic views and ultrasound.East Sussex, Brighton and Hove began screening for the study in May 1996, Nottingham in February 1997 and Leeds and Wakefield in April 1997. This timing means that women aged 65-67 had mostly been invited 3 years previously in the most recent screening round, but those aged 68-69 had mostly missed a round and would have been last invited 6 years previously.The principal screening process and outcome measures were already routinely recorded at each demonstration site as part of the NHSBSP; these measures were analysed by age and time since last screen. Comparisons with equivalent data for the whole of England for the age-group 50-64 have been made to determine the representativeness of t...
)Purpose To validate the predictive power for determining breast cancer risk of an automated breast density measurement system with full-fi eld digital mammography (FFDM). Materials and methods Two hundred cancers and 200 controls were imaged with FFDM. Density was measured separately on MLO and CC images using an integral automated volumetric breast density measurement system (Hologic, Quantra). For each cancer, the contralateral mammogram was used. Each cancer was matched to a control case by date of birth, age at examination and laterality of mammogram used for density determination. Breast density (percentage of fi broglandular tissue) was analyzed by Quantra. Data were analyzed by conditional logistic regression to determine the eff ect on breast cancer risk. Results The percentage of breast density ranged from 6% to 63%. Density declined signifi cantly with age (P <0.001). Overall, there was no signifi cant association of density with risk of breast cancer (P = 0.4). There was a suggestive increase in risk with dense volume higher than 35% (OR = 1.80, 95% CI = 0.96 to 3.39, P = 0.07). There was signifi cant heterogeneity by age in the eff ect of density on risk (P = 0.04). In women aged <50, density was signifi cantly associated with increased risk (P = 0.02), with odds ratios of 6.06, 3.98 and 10.59 for density volumes of 15 to 24%, 25 to 34% and ≥35% respectively, relative to those with <15%. In women aged ≥50 years there was no association of density with risk (P = 0.5). Conclusions Quantra automated volumetric breast density measurement is strongly associated with breast cancer risk in women aged under 50, but not in women aged ≥50 years or over. O2Ultrasound elastography as an adjuvant to conventional ultrasound in the preoperative assessment of axillary lymph nodes in suspected breast cancer: a pilot study K Taylor Introduction NICE guidelines recommend conventional ultrasound (CU) of the axilla as preliminary staging in patients with breast cancer. However, up to one-third of nodes showing normal morphology are metastatic on surgical histology [1]. Ultrasound elastography (UE) uses received radiofrequency data to produce an elastogram depicting tissue stiff ness. UE has been researched in the breast but there are no published data regarding UE of the axilla. Methods Fifty women attending the breast unit as symptomatic GP referrals with breast lesions sonographically suspicious of breast cancer underwent UE of the axilla simultaneously with routine CU examination. Elastograms were visually scored, strain measurements calculated and nodal perimeter and area measurements recorded. UE was compared with CU with histology as the reference standard. Results Twenty-nine nodes were histologically normal, 21 were metastatic. Normal nodes were indistinguishable from surrounding tissue on UE. Using cut-off points for biopsy selected for the study, sensitivity was 90% for UE visual scoring, 100% for strain scoring and 76% for CU. Specifi cities were 86%, 48% and 78% respectively. ROC analysis yielded AUC values ...
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