Mamografija u screeningu karcinoma dojke
Autori: Mersiha Mehmedović1*, Semra Šeper1
1Klinički centar univerziteta u Sarajevu
ABSTRAKT
From the early 70s of the last century until today, huge progress has been made in the technological development of imaging methods for breast cancer screening, which includes imaging methods, methods of image analysis and optimization of image quality. The introduction of artificial intelligence has made it possible for devices to offer valuable information that helps with greater precision in diagnostic disciplines and the detection of changes that deserve the attention of medical staff.
Objectives and methodology
In the framework of the work, and in accordance with the analysis of available research, we present the advantages and disadvantages of available imaging modalities in breast cancer screening and prove that digital tomosynthesis provides the best results in breast cancer screening.
By analyzing the available data and consulting the professional literature available on the PubMed service, we try to answer the following question:
Is breast cancer screening with digital breast tomosynthesis (DTD) associated with improved cancer detection rates in all age groups and all breast density groups compared with digital mammography?
Retrospective research was conducted by analyzing research published on PubMed in the last 10 years, with open access to information about the design and method of conducting the research and a description of the key aspects of the research conducted.
Globally, in 2020, 2.3 million women were diagnosed with breast cancer, with 685,000 deaths per year. By the end of 2020, there were 7.8 million living women diagnosed with breast cancer in the last 5 years, making it the most common cancer in the world.
According to the report Health status of the population, which was published by the Institute for Public Health of the Federation of Bosnia and Herzegovina in 2018, malignant neoplasms of the breast (C50) are among the leading causes of death from malignant neoplasms in women. Although the Ministry's report emphasized a slight downward trend, other studies show that the age limit of women who develop this disease is decreasing. This emphasizes the importance of timely and early detection of the appearance of malignant neoplasms, at a time when the disease is best treated.
Breast cancer is most often diagnosed in women aged 55 to 64, and the risk increases with age. Early diagnosis increases the patient's chances of achieving a cure and also reduces the morbidity of treatment. Breast cancer therapies continue to improve and have contributed to a reduction in mortality, but early diagnosis through mammographic screening has had a greater overall impact on mortality reduction.
Breast cancer arises in epithelial cells of the ducts (85%) or lobules (15%) in the tissue of the mammary gland. Initially, a cancerous growth is confined to a duct or lobule ("in situ") where it generally causes no symptoms and has minimal potential for spread (metastasis). Over time, these in situ (stage 0) cancers can progress to invade the surrounding breast tissue (invasive breast cancer) and then spread to nearby lymph nodes (regional metastases) or to other organs in the body (distant metastases). If a woman dies from breast cancer, it is because of widespread metastases.
Conclusion
Globally, but also at the level of Bosnia and Herzegovina, breast cancer represents an important public health problem. According to the report of the Institute of Public Health of the Federation of Bosnia and Herzegovina from 2018, malignant neoplasms of the breast (C50) are among the leading causes of death from malignant neoplasms in women in the Federation of Bosnia and Herzegovina. Multiple studies have shown improved screening results with digital breast tomosynthesis, including lower recall rates and higher cancer detection rates, ranging from 1.6 cancers/1000 scans to 2.4 cancers/1000 scans. The use of DTD reduced the number of recalls for false positive findings on screening (15%-37%), which contributed to the improvement of specificity in the diagnostic evaluation. Numerous retrospective studies have shown that DTB increased cancer detection by 15-30%, and the radiation dose was higher by up to 20%. Based on the above-mentioned conclusions, we can conclude that we have proven that breast cancer screening by digital breast tomosynthesis is associated with improved cancer detection rates in all age groups and all groups of breast density compared to digital mammography.
