Explaining variance in the cumulus mammographic measures that predict breast cancer risk: a twins and sisters study.

Background: Mammographic density, the area of the mammographic image that appears white or bright, predicts breast cancer risk. We estimated the proportions of variance explained by questionnaire-measured breast cancer risk factors and by unmeasured residual familial factors.

Methods: For 544 MZ and 339 DZ twin pairs and 1,558 non-twin sisters from 1,564 families, mammographic density was measured using the computer-assisted method Cumulus.

Examining the sensitivity of ultrasound-guided large core biopsy for invasive breast carcinoma in a population screening programme.

Introduction: To evaluate the sensitivity of ultrasound-guided core-needle biopsy (UCB) in invasive breast carcinoma and to establish causes of false-negative biopsy in a population screening programme.

Method: We identified 571 consecutive women diagnosed with surgically proven invasive breast cancer. Histology from 14-gauge UCB was compared with surgical histology to identify true-positive and false-negative ultrasound core biopsies.

Cancer on a mammogram is not memorable: readers remember their recalls and not cancers.

Aim: To determine if presence of cancer on a mammogram makes that mammogram more memorable.

Materials And Methods: A total of 100 mammograms (25 cancers) were grouped into 5 sets of 20 cases. Set pairs were presented in five reads to eight radiologist readers.

Inference about causation from examination of familial confounding: application to longitudinal twin data on mammographic density measures that predict breast cancer risk.

Background: Mammographic density is a strong risk factor for breast cancer. It is unknown whether there are different causes of variation in mammographic density at different ages.

Methods: Mammograms and questionnaires were obtained on average 8 years apart from 327 Australian female twin pairs (204 monozygous and 123 dizygous).

Are genetic and environmental components of variance in mammographic density measures that predict breast cancer risk independent of within-twin pair differences in body mass index?

To understand the role of mammographic density on breast cancer risk, it is important to take into account body mass index (BMI). As with age, BMI is negatively confounded with mammographic density, and a previous US twin study found that the covariance structure of mammographic density depended on the extent to which pairs differ in BMI. Using a computerised thresholding technique, we measured mammographic dense area for 571 monozygous (MZ) and 380 dizygous (DZ) twin pairs aged 40-70 years from Australia and North America.

Image-guided sampling reveals increased stroma and lower glandular complexity in mammographically dense breast tissue.

Mammographic density (MD) adjusted for age and body mass index (BMI) is a strong heritable breast cancer risk factor; however, its biological basis remains elusive. Previous studies assessed MD-associated histology using random sampling approaches, despite evidence that high and low MD areas exist within a breast and are negatively correlated with respect to one another. We have used an image-guided approach to sample high and low MD tissues from within individual breasts to examine the relationship between histology and degree of MD.

Variation in mammographic appearance between projections of small breast cancers compared with radial scars.

Aims: The study aims to assess variation in appearance between mammographic projections (conspicuity variation) for invasive breast cancers (IBCs) compared with radial scars (RS). Conspicuity variation has been previously described as characteristic of RS. The lesions were also compared with respect to breast density and the proportion of cases detected by one of two readers and required a third (consensus) read.

Malignancy detection in digital mammograms: important reader characteristics and required case numbers.

Rationale And Objectives: To determine the relationship between heightened levels of reader performance and reader practice in terms of number of cases read and previous experience.

Materials And Methods: A test set of mammograms was developed comprising 50 cases. These cases consisted of 15 abnormals (biopsy proven) and 35 normals (confirmed at subsequent rescreen).

Common genetic variants associated with breast cancer and mammographic density measures that predict disease.

Mammographic density for age and body mass index (BMI) is a heritable risk factor for breast cancer. We aimed to determine if recently identified common variants associated with small gradients in breast cancer risk are associated with mammographic density. We genotyped 497 monozygotic and 330 dizygotic twin pairs and 634 of their sisters from 903 families for 12 independent variants.

Predictors of mammographic density: insights gained from a novel regression analysis of a twin study.

Understanding which factors influence mammographically dense and nondense areas is important because percent mammographic density adjusted for age is a strong, continuously distributed risk factor for breast cancer, especially when adjusted for weight or body mass index. Using computer-assisted methods, we measured mammographically dense areas for 571 monozygotic and 380 dizygotic Australian and North American twin pairs ages 40 to 70 years. We used a novel regression modeling approach in which each twin's measure of dense and nondense area was regressed against one or both of the twin's and co-twin's covariates.

Using mammographic density to improve breast cancer screening outcomes.

It is possible that the performance of mammographic screening would be improved if it is targeted at women at higher risk of breast cancer or who are more likely to have their cancer missed at screening, through more intensive screening or alternative screening modalities. We conducted a case-control study within a population-based Australian mammographic screening program (1,706 invasive breast cancers and 5,637 randomly selected controls). We used logistic regression to examine the effects of breast density, age, and hormone therapy use, all known to influence both breast cancer risk and the sensitivity of mammographic screening, on the risk of small (15 mm) screen-detected and interval breast cancers.

Imaging surveillance of the breast in a patient diagnosed with scleroderma after breast-conserving surgery and radiotherapy.

Collagen vascular disease (CVD), particularly scleroderma, is a contraindication to radiation therapy because of increased risk of fibrosis. We report a patient with early stage breast cancer diagnosed with scleroderma after breast-conserving surgery and radiation. She developed marked breast fibrosis, rendering mammographic, sonographic, and clinical surveillance ineffective.

Use of breast cancer screening and treatment services by Australian women aged 25-44 years following Kylie Minogue's breast cancer diagnosis.

Objective: To examine the effects of the publicity surrounding Kylie Minogue's diagnosis with breast cancer on doctor-referred breast imaging, image-guided biopsy, and cancer excisions among a low-risk population of women in Australia. Method We examine changes in unilateral and bilateral breast imaging, image-guided breast biopsies, and surgical excisions of breast cancer before and after the announcement of Kylie Minogue's diagnosis with breast cancer in May 2005. The study included procedures provided through the Australian public health system to women aged 25-44 years from October 2004 and June 2006.

Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy?

In a screening population of women, the mammographic characteristics for 68 cases of atypical ductal hyperplasia (ADH) diagnosed by needle core biopsy (NCB) were reviewed to seek mammographic findings which differentiate between ductal carcinoma in situ (DCIS) and ADH. A blinded analysis by two radiologists was performed for 48 cases with microcalcification. The mammographic findings were correlated with the surgical histological results of benign non-atypical, ADH and carcinoma (DCIS or invasive) to identify features which were associated with a higher or lower odds ratio (OR) for malignancy.

Painful diabetic mastopathy as a reason for mastectomy.

A 34 year old woman with longstanding insulin-dependent diabetes mellitus experienced disabling bilateral breast pain and tenderness associated with the benign breast lesions of diabetic mastopathy. Diabetic mastopathy is typically associated with nontender lesions, however we present a case where disabling pain and tenderness lead to bilateral mastectomy, as requested by the patient. This relieved the patient of her symptoms.

Mammographic densities during the menopausal transition: a longitudinal study of Australian-born women.

Objective: The objective of this study was to investigate hormonal and other factors associated with mammographic density during the menopausal transition and in postmenopause.

Design: Mammograms were obtained from 252 participants in the Melbourne Women's Midlife Health Project-a longitudinal population-based study that included annual interviews, blood collection, and physical measurements; 869 original films of the right craniocaudal view were digitized. Total area of the breast and the area of dense tissue were measured, and the percentage of mammographically dense tissue (PMD) was calculated.

Margins and outcome of screen-detected breast cancer with extensive in situ component.

Background: In situ disease surrounding invasive tumours is an important consideration in the management of patients with early breast cancer. This study of screen-detected breast cancers assessed the influence of in situ disease including an extensive in situ component (defined as ductal carcinoma in situ involving more than 25% of the area within the invasive tumour) on surgical management, local recurrence and survival of a group of patients.

Methods: A total of 595 cases of invasive breast cancer detected at St Vincent's BreastScreen were retrospectively reviewed to determine presence and extent of in situ disease, the surgical procedure and adequacy of excision.

The heritability of mammographically dense and nondense breast tissue.

Background: Percent mammographic density (PMD) is a risk factor for breast cancer. Our previous twin study showed that the heritability of PMD was 63%. This study determined the heritabilities of the components of PMD, the areas of dense and nondense tissue in the mammogram.

Can sonography be used to help differentiate between radial scars and breast cancers?

The aim of this study was to determine whether sonography can help differentiate radial scars (RS) from breast cancers. Series of 75 consecutive mammographic screen-detected RS and carcinomas were reviewed: shape, orientation, echotexture, halo, acoustic attenuation and architectural distortion were compared for sonographic RS and cancers. RS were 43% sonopositive (25/58 examined) vs.

Hormone replacement therapy, percent mammographic density, and sensitivity of mammography.

Objective: We examine to what extent the lower mammographic sensitivity found in hormone replacement therapy (HRT) users can be explained by any association of HRT use with higher mammographic density and more difficult to detect cancers.

Methods: We used logistic regression to estimate the odds of a false-negative screen (a breast cancer diagnosed in the 24 months after a negative screening examination) for HRT users and to estimate, and adjust for, mammographic density (measured on a continuous scale, blinded, using a reliable, computer-assisted method), tumor characteristics (size, grade, and morphology), and potential confounders (age, symptom status, family history, and prior screening) among women ages > or =55 years who attended BreastScreen Victoria for first round screening mammography in 1994 and 1995 (1,086 breast cancers) and for subsequent round screening (471 breast cancers) in 1995 and 1996.

Results: After adjusting for confounders, HRT users were more likely to have a false-negative screen [first round: odds ratio (OR), 1.

False-positive breast screening due to fat necrosis following mammography.

Traumatic fat necrosis can result in a spectrum of imaging appearances that range from characteristically benign to those indistinguishable from malignancy. In such cases, biopsy might be required for diagnosis. The present case demonstrates a suspicious mammographic mass lesion appearing following a haematoma caused by a previous screening mammogram.