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Opportunities in cancer imaging: risk-adapted breast imaging in screening. | LitMetric

Opportunities in cancer imaging: risk-adapted breast imaging in screening.

Clin Radiol

Thirlestaine Breast Centre, Cheltenham, UK; Ninewells Hospital and Medical School, University of Dundee, UK.

Published: October 2021

AI Article Synopsis

  • In the UK, women aged 50-70 are routinely invited for mammograms every three years, with some tailored screening for those at higher risk of breast cancer.
  • Stratifying women based on risk factors like breast density and genetic scores allows for identifying those at both low and high risk, aiding in more personalized screening approaches.
  • Studies suggest that adding alternative imaging methods like ultrasound or contrast-enhanced mammography can improve cancer detection in women with dense breast tissue, highlighting the need for cost-effective supplemental screening options.

Article Abstract

In the UK, women between 50-70 years are invited for 3-yearly mammography screening irrespective of their likelihood of developing breast cancer. The only risk adaption is for women with >30% lifetime risk who are offered annual magnetic resonance imaging (MRI) and mammography, and annual mammography for some moderate-risk women. Using questionnaires, breast density, and polygenic risk scores, it is possible to stratify the population into the lowest 20% risk, who will develop <4% of cancers and the top 4%, who will develop 18% of cancers. Mammography is a good screening test but has low sensitivity of 60% in the 9% of women with the highest category of breast density (BIRADS D) who have a 2.5- to fourfold breast cancer risk. There is evidence that adding ultrasound to the screening mammogram can increase the cancer detection rate and reduce advanced stage interval and next round cancers. Similarly, alternative tests such as contrast-enhanced mammography (CESM) or abbreviated MRI (ABB-MRI) are much more effective in detecting cancer in women with dense breasts. Scintimammography has been shown to be a viable alternative for dense breasts or for follow-up in those with a personal history of breast cancer and scarring as result of treatment. For supplemental screening to be worthwhile in these women, new technologies need to reduce the number of stage II cancers and be cost effective when tested in large scale trials. This article reviews the evidence for supplemental imaging and examines whether a risk-stratified approach is feasible.

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Source
http://dx.doi.org/10.1016/j.crad.2021.02.013DOI Listing

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