Benefits and harms of mammography screening

Løberg, Magnus; Lousdal, Mette Lise; Bretthauer, Michael; Kalager, Mette

doi:10.1186/s13058-015-0525-z

Cited by 286 publications

(220 citation statements)

References 59 publications

(130 reference statements)

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“…Mammography remains the cornerstone for early breast cancer detection, 3,4 and the transition from screenfilm to digital mammograms (DMs) has enhanced the potential for imaging-based measures. In particular, image-derived indices of breast density 5,6 and parenchymal texture patterns 7 have emerged as promising risk factors for breast cancer in epidemiologic studies, paving the way toward personalized recommendations regarding women's cancer risk evaluation and screening.…”

Section: Introductionmentioning

confidence: 99%

Breast parenchymal patterns in processed versus raw digital mammograms: A large population study toward assessing differences in quantitative measures across image representations

et al. 2016

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Purpose: With raw digital mammograms (DMs), which retain the relationship with x-ray attenuation of the breast tissue, not being routinely available, processed DMs are often the only viable means to acquire imaging measures. The authors investigate differences in quantitative measures of breast density and parenchymal texture, shown to have value in breast cancer risk assessment, between the two DM representations. Methods: The authors report data from 8458 pairs of bilateral raw ("FOR PROCESSING") and processed ("FOR PRESENTATION") DMs acquired from 4278 women undergoing routine screening evaluation, collected with DM units from two different vendors. Breast dense tissue area and percent density (PD), as well as a range of quantitative descriptors of breast parenchymal texture (statistical, co-occurrence, run-length, and structural descriptors), were measured using previously validated, fully automated software. Feature measurements were compared using matched-pairs Wilcoxon signed-ranks test, correlation (r), and linear-mixed-effects (LME) models, where potential interactions with woman-and system-specific factors were also assessed. The authors also compared texture feature correlations with the established risk factors of the Gail lifetime risk score (r G ) and breast PD (r PD ), and evaluated the within woman intraclass feature correlation (ICC), a measure of bilateral breast-tissue symmetry, in raw versus processed images. Results: All density measures and most of the texture features were strongly (r ≥ 0.6) or moderately (0.4 ≤ r < 0.6) correlated between raw and processed images. However, measurements were significantly different between the two imaging formats (Wilcoxon signed-ranks test, p w < 0.05). The association between measurements varied across features and vendors, and was substantially modified by woman-and system-specific image acquisition factors, such as age, BMI, and mAs/kVp, respectively. The strongest correlation, combined with minimal LME-model interactions, was observed for structural texture features. Overall, texture measures from either image representation were weakly associated with Gail lifetime risk (−0.2 ≤ r G ≤ 0.2), weakly to moderately associated with breast PD (−0.6 ≤ r PD ≤ 0.6), and had overall strong bilateral symmetry (ICC ≥ 0.6). Conclusions: Differences in measures from processed versus raw DM depend highly on the feature, the DM vendor, and image acquisition settings, where structural features appear to be more robust across the different DM settings. The reported findings may serve as a reference in the design of future large-scale studies on mammographic features and breast cancer risk assessment involving multiple DM representations. C

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Section: Introductionmentioning

confidence: 99%

Breast parenchymal patterns in processed versus raw digital mammograms: A large population study toward assessing differences in quantitative measures across image representations

et al. 2016

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“…98,99 In the 30-year span from 1974 to 2004, the DCIS incidence has increased from 1.87 to 32.5 cases per 100,000 females. 100 The increased detection of DCIS by screening mammography has led to extensive assessments involving the magnitude of overdiagnosis owing to breast screening; 101 that is, the detection of DCIS cases which would not have become clinically apparent owing to either the non-progression of disease or the manifestation of a different ailment before the consequences of DCIS could become threatening. Although overdiagnosis is often considered the primary harm of screening based on the assumption that overdiagnosis leads to overtreatment, 101 this review takes an alternative position, agreeing with the opinion of Michell,102 in believing that overtreatment should be the primary focus rather than its predecessor overdiagnosis.…”

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confidence: 99%

Is the false-positive rate in mammography in North America too high?

Le¹,

Mothersill²,

Seymour³

et al. 2016

BJR

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The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.

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“…[2][3] Estudos recentes apontam que os incrementos na incidência do câncer de mama podem estar relacionados ao aumento da expectativa de vida, ao processo de urbanização e de industrialização bem como à melhora da tecnologia diagnóstica e a ampliação de programas de rastreamento. [4][5][6] No entanto, tendências de aumento de incidência e morte refletem diferenças nos padrões de fatores de risco, acesso e disponibilidade à detecção precoce e tratamento oportuno. Relatos da associação entre altos índices de mortalidade, diagnóstico tardio e assistência médica incipiente, têm sido amplamente divulgados e parecem ser frequentes nos países em desenvolvimento.…”

Section: Introductionunclassified