PB.21: Relationship between volumetric breast density and socioeconomic status

Abstract

West of Scotland Breast Screening Centre, Glasgow, UK; 2 Scottish Breast Screening Programme, UK Breast Cancer Research 2013, 15(Suppl 1):O3 Introduction: Women with B5a (non-invasive) preoperative core biopsies upgraded to invasive disease at surgery have a high chance of needing further surgery. The average B5a upgrade rate across UK breast screening programmes is around 20%. Through this Scottish review, we aim to identify factors affecting upgrade rates and ways to improve our performance. Methods: This was a retrospective analysis of 1,252 cases of B5a biopsies from the Scottish Breast Screening Programme between 2004 and 2012. Final surgical pathology was correlated with radiological and biopsy factors. Results: B5a upgrade rates for the units ranged from 19.2 to 29.2%, with average of 23.6%. Mean sizes of invasive tumours were small (3 to 11 mm). Upgrade rate was significantly higher for cases where the main mammographic abnormality was mass, distortion or asymmetry, compared with microcalcification alone (33.2% vs. 21.7%) (P = 0.0004). The upgrade rate was significantly lower with use of large-volume vacuum-assisted biopsy (VAB) devices than 14-gauge core needles (19.9% vs. 26%) (P = 0.013). The upgrade rate was lower in stereotactic than ultrasound-guided biopsies (21.2% vs. 36.1%) (P < 0.001). Heterogeneity of data from different units limited evaluation of other potential factors. Conclusion: There is variation in practice across Scottish units, including first-line biopsy technique and/or device and protocols for repeat biopsy. Upgrade rates are lower for cases with microcalcification as the sole mammographic feature, and with use of VAB devices. Nevertheless, it is of interest that a few centres maintain low upgrade rates despite not routinely using VAB as the first-line technique for biopsy of microcalcification.O5 4.5: Diagnosing breast cancer in a high-risk cohort Introduction: MRI is a common method for detecting breast cancer in women at high risk [1,2] These women may instead be diagnosed mammographically or present symptomatically. The aim of this study was to investigate how breast cancer is diagnosed in high-risk women and determine whether there are specific characteristics related to the type of presentation. Methods: A total of 125 high-risk patients with 134 breast cancers (69 BRCA, 65 family history) were managed at the Royal Marsden Hospital from 1994 to 2013. Following ethical approval, data were collected retrospectively for each presentation of breast cancer: method of presentation/diagnosis (MRI, mammography, symptomatic), age at diagnosis, cancer type, grade, size, presence of DCIS, lymphovascular invasion (LVI), nodal status and tumour subtype. Chi-squared and ANOVA analyses determined any association between the parameters, P < 0.05 was significant. Results: Ten breast cancers were MRI detected, 43 mammography detected and 81 symptomatic (mean age 41, 51, and 45 years (P = 0.008); mean size 17, 29, and 34 mm (P = 0.076) respectively).The majority of cancers were high-grade (68%)...

Geographic variation in volumetric breast density between screening regions in the Netherlands

“…To get more insight into the geographic differences, we further studied SES and urbanisation. A (weak) positive association between SES and breast density has been observed before [ 7 , 9 , 11 ]. Despite the differences in setting (e.g., country) and definitions (both SES and density), these results appear to be consistent with our observations.…”

“…As part of the DENSE trial, the volumetric breast density distribution could be determined using unprocessed mammogram data collected from screening units throughout the country [ 6 ]. Although this is, to our knowledge, the first study to address the geographic variation in volumetric breast density within a national screening programme, a few studies have reported on the association of geographic (e.g., urbanisation level) and demographic (e.g., socio-economic status [SES]) characteristics with breast density [ 7 – 11 ]. These factors may help clarify differences between screening areas, but the previous results have been somewhat inconsistent.…”

“…These factors may help clarify differences between screening areas, but the previous results have been somewhat inconsistent. A positive association of breast density with SES [ 7 , 9 , 11 ] and urbanisation [ 8 , 10 ] has been suggested, although disagreement exists on the strength of the associations.…”