Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd...
Transcript of Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd...
![Page 1: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/1.jpg)
Screening Breast Imaging
Michelle Townsend-Watts, M.D.
MedStar Medical Group Radiology
Chief of Diagnostic Radiology
Section Chief Breast Imaging
MedStar Union Memorial Hospital
MedStar Good Samaritan Hospital
![Page 2: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/2.jpg)
Objectives◼ To discuss screening mammography
◼ Normal risk
◼ High risk populations
◼ To discuss supplemental screening strategies◼ Ultrasound
◼ Breast MRI
◼ Molecular breast imaging
![Page 3: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/3.jpg)
Breast cancer◼ Most common cancer diagnosed in women
◼ 2nd cause of cancer death amongst women
◼ Lifetime risk 12%
◼ 1 in 8 women
◼ 2019
◼ 331,000 cases of invasive breast cancer
◼ 268,000 invasive
◼ 441, 760 women expected to succumb to the disease
![Page 4: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/4.jpg)
Goals of screening mammography
◼ Early detection of node negative cancer
◼ Decrease mortality from breast cancer◼ Since regular screening
began in the U.S. in the 1980’s there has been a reduction in breast cancer mortality of 42 %
◼ 384, 000 – 614, 000 lives saved
![Page 5: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/5.jpg)
USPSTF 2009
![Page 6: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/6.jpg)
Medicare Utilization 2005-2010
Journal of the American College of Radiology 2013
10, 21-24DOI: (10.1016/j.jacr.2012.07.008
![Page 7: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/7.jpg)
USPSTF 2015 Recommendations
◼ Screening 40-49 should be
determined on a personal
basis
◼ C rating
◼ Recommend biennial
screening beginning at age 50
– 74
◼ B rating
◼ Recommendation for
screening after 74
◼ I rating
◼ B Rating◼ The USPSTF recommends this
service. There is high certainty that the
net benefit is moderate or there is
moderate certainty that the net benefit
is moderate to substantial
◼ C Rating◼ The USPSTF recommends selectively
offering this service to individual
patients based on professional
judgment and patient preference.
There is at least a moderate certainty
that the net benefit is small
◼ I Rating◼ The USPSTF concludes that the
current evidence is insufficient to
assess the balance of benefits and
harms of the service
![Page 8: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/8.jpg)
ACS and USPSTF
◼ The support data agree that mammography
significantly reduces breast cancer death
◼ ACS
◼ Opportunity to begin annual screening 40-44
◼ Recommend annual / biennial screening
◼ USPSTF
◼ Biennial screening 50 - 74
![Page 9: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/9.jpg)
Year of Life Lost due to Death from Breast Cancer by Age at Diagnosis
0% 0%
2%
5%
9%
12%
15% 15%
13%
10%
7%
5%
4%
2%2%
0%
2%
4%
6%
8%
10%
12%
14%
16%
15
-19
20
-24
25
-29
30
-34
35
-39
40
-44
45
-49
50
-54
55
-59
60
-64
65
-69
70
-74
75
-89
80
-84
85
+
% o
f to
tal Y
LL
du
e t
o B
C
Age at diagnosis
![Page 10: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/10.jpg)
Benefits of three Recommended StrategiesMean 2009 CISNET
ScreeningStrategy
Examinations
per 1,000
women
Percentage
Mortality
Reduction
BC Deaths
Averted per
1000 women
LYGs per 1000
women
screened
NNS per Death
Averted NNS per LYG
Annual
40-84 36,550 39.6 11.9 189 84 5.3
Annual 45-54
Biennial 55-79 19,846 30.8 9.25 149 108 6.7
Biennial 50-74y 11,066 23.2 6.95 110 144 9.1
Adapted from Arleo et al –
Comparison of recommendations
for screening mammography using
CISNET models. Cancer 2017
![Page 11: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/11.jpg)
Screening Benefits2019 & 2016 CISNET Model
Regimen Percent Mortality
reduction
Approximate number
of mammograms
ACR/SBI 40 % 36, 550
ACS
Annual 45 – 54
Biennial 55 -79
31 % 19, 846
USPSTF
Biennial 50 –74
23 % 11, 066
Arleo et al. Cancer 2017
![Page 12: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/12.jpg)
Performance of Screening Mammography (BCSC)
Age Exams CDR Sensitivity PPV
50-59 186,944 3.7/1000 – 77.3% 22.2%
60-69 116,362 4.0 /1000 – 80.1% 29.3%
70-79 75,692 6.2/1000 – 80.4% 37.6%
80-89 23,409 7.9/1000 – 83.4% 40.7%
90-101 1,041 14.1/1000 –
93.8%
55.6%
Sinclair et al
Accuracy of screening
mammography in older
women. Am J Roentgenology
2011
![Page 13: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/13.jpg)
Screening Mammography Recommendations
◼ American College of Radiology / American Cancer
Society
◼ Annual screening mammography beginning at age 40
◼ American College of Obstetricians and
Gynecologists
◼ Screening every 1-2 years 40 – 49 years of age
◼ Annually after age 50
◼ Recommended CBE for all women
![Page 14: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/14.jpg)
Screening Mammography Recommendations
◼ Screening Interval – Recommended time
between periodic screens
◼ NCI – Every 1 -2 years
◼ Canada – Every two years 50 - 69
◼ UK – Every three years 47-73
◼ USPSTF –
◼ 40 – 49 discuss with physician
◼ Every two years 50-74
![Page 15: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/15.jpg)
Screening Stats
◼ 1 in 6 breast cancers diagnosed in 40 -49 year old age
group
◼ 1/3 of lives lost from breast cancer are women in their
40’s.
◼ 70 % of the women dying from breast cancer in their
40’s belong the 20% of patient’s not being screened.
![Page 16: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/16.jpg)
◼ Screened women
◼ 60 % lower mortality at 10 years follow up
◼ 47 % lower mortality at 20 years follow up
▪ Tabar et al. Cancer 2018 November
![Page 17: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/17.jpg)
Benefits of early diagnosis
◼ Node negative cancer
◼ Decreases morbidity◼ Less extensive surgery
◼ Improved treatment options
◼ Overall decrease in healthcare costs
![Page 18: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/18.jpg)
Harms of screening
◼ False positive mammogram
◼ Patient anxiety
◼ Over diagnosis◼ Treating lesion that would not have become
clinically apparent
◼ Three components
![Page 19: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/19.jpg)
Harms of screening
![Page 20: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/20.jpg)
Harms of screening
◼ Patient anxiety◼ Most patient’s do not report lasting harm if they
are recalled for a diagnostic examination.
◼ Most patient’s agree that the benefit of being tested far outweighs testing anxiety
◼ Paternalistic perspective
![Page 21: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/21.jpg)
Harms of screening
◼ Overdiagnosis 1 – 10%◼ The cancer would not have a caused a problem in
the patient’s lifetime.
◼ DCIS
◼ Heterogenous
◼ Non obligate precursors to IDC
◼ Breast cancer does not spontaneously involute
◼ Should not outweigh the thousands of lives saved yearly
![Page 22: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/22.jpg)
Health Care Disparity
◼ African American women and Caucasian women are diagnosed at similar rates with breast cancer
◼ Recent ACS data confirms that non Hispanic black women have death rates 39 % higher that non Hispanic white women◼ Access to mammography
◼ Health care delivery patterns
◼ Delays in diagnosis
◼ Delays in treatment initiation
◼ Tumor biology
![Page 23: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/23.jpg)
Health Care Disparity
◼ One study found that ◼ Before USPSTF guidelines 56 % of PCP
recommended annual screening beginning at age 40
◼ After USPSTF guidelines only 20% PCP gave the recommendations
![Page 24: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/24.jpg)
Screening Mammography
◼ All women are advised to undergo breast cancer risk assessment at the age of 30 to determine the type of screening program from which they would derive the greatest benefit◼ Average risk
◼ High risk > 20 % Lifetime risk
![Page 25: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/25.jpg)
Screening Mammography
◼ Average Risk◼ Shall begin at the age of 40 – no later than 45
◼ Shall continue as long as the woman is in good health ,chooses to be screened, intends to seek and tolerate treatment and or the life expectancy is equal to or greater than 10 years
![Page 26: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/26.jpg)
Screening Mammography
◼ Transgender men◼ Shall begin at the age 40 without mastectomy and
average risk for breast cancer
◼ Transgender women◼ On at least 5 years of hormonal therapy shall
begin routine mammography at the age of 50
![Page 27: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/27.jpg)
High Risk Populations
◼ Genetic predisposition – 5 – 10 % of all breast cancers
◼ BRCA 1 – 50 – 80 %
◼ BRCA 2 – 45 %
◼ Strong family history – absent known genetic mutation
◼ First degree relatives ; age of diagnosis
![Page 28: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/28.jpg)
High Risk Populations
◼ Chest or mantle radiation young age
◼ Personal history of breast cancer◼ Recurrence or second breast cancer
◼ 50 year old or younger - > 20 % lifetime risk of a new breast cancer
◼ Previous biopsy
◼ Dense breast tissue
![Page 29: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/29.jpg)
Screening Modalities
◼ Mammography 2D with or without DBT
◼ Ultrasound
◼ Breast MRI
![Page 30: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/30.jpg)
Screening Mammography
◼ Sensitivity in high risk women
◼ 25 – 59 %
![Page 31: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/31.jpg)
◼ Dense Breast Tissue – Relative risk 1.25
![Page 32: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/32.jpg)
![Page 33: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/33.jpg)
Digital Breast Tomosynthesis(DBT)
◼ Overlapping tissue is a reason for the false
positive rate for screening mammography
◼ Deals with the problem of structural overlap,
thereby enhancing lesion detection
![Page 34: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/34.jpg)
Digital Breast Tomosynthesis
Benefits
◼ Increases CDR
◼ Decreases the recall rate
◼ 15-40%
◼ Increases PPV
◼ Decreases the use of
additional views
Limitations
◼ 2x interpretation time
◼ Large storage
requirements
◼ Evolving reimbursement
![Page 35: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/35.jpg)
Mammography
![Page 36: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/36.jpg)
![Page 37: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/37.jpg)
![Page 38: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/38.jpg)
Screening breast ultrasound
◼ Greater than 10 year life expectancy
◼ High risk women unable to undergo MR
screening
◼ Pregnant
◼ Lack of access to MR
◼ Severe claustrophobia
◼ Dense breasts - > 50% of population
◼ Mammography should also be performed
![Page 39: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/39.jpg)
ACRIN 6666
◼ Results◼ Single screening ultrasound in addition to
mammography – an additional yield of 1.1 – 7.2 cancers / 1000 high risk women
◼ Dense breast tissue only factor
◼ 3.2/1000 women
◼ Will also substantially increase the risk of false positives
◼ Personal or family history of breast cancer increased specificity
![Page 40: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/40.jpg)
◼ Women whose only risk is dense breast
tissue
◼ 3.2/ 1000 – incremental cancer detection rate
![Page 41: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/41.jpg)
Maryland Density Notification Legislation
◼ October 1, 2013
◼ Requires mammography centers notify
patients of their breast density
![Page 42: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/42.jpg)
![Page 43: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/43.jpg)
Breast MRI
◼ Examination requires intravenous contrast –abnormal vascularity of the tumor
◼ Approximately 30 – 45 minutes
◼ Optimally obtained during follicular phase of menstrual cycle –days 7- 10
![Page 44: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/44.jpg)
Breast MRI
◼ More sensitive than either MRI or US in high risk populations◼ Sensitivity
◼ MRI 90 %
◼ Mammography 37%
◼ Ultrasound 35 %
![Page 45: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/45.jpg)
![Page 46: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/46.jpg)
Supplemental MRI eligibility
◼ American Cancer Society◼ Models that incorporate first and second degree
family history
◼ Claus
◼ Tyrer-Cuzick▪ PenRad – Mammography Reporting System
◼ BRCAPRO
![Page 47: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/47.jpg)
Supplemental Screening MRI
◼ Screening MRI
◼ Genetic predisposition
◼ Chest wall radiation prior to age 30
◼ Life time risk > 20 %
◼ Clarification of MRI use
◼ Personal history of breast cancer
◼ Biopsy proven atypia and LCIS
◼ Intermediate risk 15 – 20 %
◼ Dense breast tissue
![Page 48: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/48.jpg)
Screening Protocol
◼ Genetic based/Strong Family History◼ Screening mammography – beginning age 30
◼ Screening breast MRI – 25 – 30
![Page 49: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/49.jpg)
Screening Protocol
◼ Chest Wall Radiation – younger than 30◼ Screening mammography with or without DBT
annual at the age of 25 or 8 years after the cessation of chest wall therapy – whichever is later.
◼ Screening MRI – begin between the ages of 25 –30.
◼ Incremental detection rate 4%
![Page 50: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/50.jpg)
Screening Protocol
◼ Women with personal history of breast
cancer and dense tissue
◼ Combination of factors > 20 % lifetime risk
◼ Screening mammography at time of diagnosis
◼ Supplemental breast MRI
![Page 51: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/51.jpg)
Screening protocol
◼ Women diagnosed with breast cancer age 50 or younger◼ Supplemental breast MRI
◼ Early stage biologically aggressive tumors
◼ Decrease interval cancers
![Page 52: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/52.jpg)
BSGI
◼ Injection of a radiopharmaceutical
◼ Technetium – 99m Sestamibi
◼ Sensitivity > 95 %
◼ Specificity 80 %
◼ Decrease in small cancers
◼ DCIS
![Page 53: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/53.jpg)
BSGI
◼ Multicenter trial 201 women both MRI and
BSGI
◼ Equal sensitivity to MRI
◼ Not hampered by breast density
◼ Reduces the rate of false positivity by 50%
◼ Incremental detection rate - breast density
primary factor
◼ 7.7 – 8.8 / 1000 women
![Page 54: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/54.jpg)
BSGI
◼ Less images than MRI
◼ All patients
◼ Overall decrease cost
![Page 55: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/55.jpg)
BSGI
◼ Increased radiation dose – biodistributionwill result in whole body exposure
![Page 56: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/56.jpg)
![Page 57: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/57.jpg)
![Page 58: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/58.jpg)
BSGI/Molecular Breast Imaging
◼ The future …◼ Screening dense breasts
◼ Assessing response to neoadjuvantchemotherapy
![Page 59: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/59.jpg)
Summary
◼ Annual screening mammography beginning at age 40 saves the most lives
◼ Screening with PCP’s beginning at the age of 30 will identify more patient’s who will benefit from additional screening.
◼ Supplemental Breast MRI is the most sensitive adjunct screening modality
◼ Breast US should be considered more by our referring physician population
![Page 60: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/60.jpg)
References
◼ 29th Annual Symposium of American Society of Breast Disease April 14-16,
2005
◼ ACR Practice Guidelines for the performance of contrast enhanced MRI
breast Revised 2008
◼ Medgadget.com
◼ The Requisites Breast Imaging Ikeda, Debra
◼ AJR “Molecular Breast Imaging: Use of a Dual-Head Dedicated Gamma
Camera to Detect Small Breast Tumors” Hruska, Carrie; Phillips, Stephen;
Whaley, Dana; Rhodes, Deborah; O’Connor, Michael
![Page 61: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/61.jpg)
References
◼ Radiologic Clinics of North America “Breast Imaging”; Sickles,
Edward. September 2007 Volume 45, Number 5
◼ Society of Breast Imaging
◼ Stat Dx
◼ “Breast Specific Gamma Imaging Compared to Breast MRI in
Patients Requiring Diagnostic Imaging after Screening
Mammography” Thomas Jefferson University, Philadelphia, PA;
Methodist Hospital, Philadelphia, PA; Bertrand Solis Breast Center,
Greensboro NC; Eisenhower Medical Center, Rancho Mirage , Ca
◼ The American Journal of Surgery “ Real-world application of
breast-specific gamma imaging, initial experience at a community
breast center and its potential impact on clinical care”
![Page 62: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/62.jpg)
References
◼ The American Journal of Surgery “ Real-world application of
breast-specific gamma imaging, initial experience at a community
breast center and its potential impact on clinical care” Zhou,
Minhao MD; Johnson, Nathalie MD; Blanchard, Deb MD; Bryn,
Sally RN; Nelson, Joanne MD
◼ The Annals of Internal Medicine “Screening for Breast Cancer: U.S.
Preventive Services Task Force Recommendation Statement
11/17/2009.
◼ JAMA “Combined Screening with Ultrasound and Mammography
vs. Mammography Alone in Women at Elevated Risk of Breast
Cancer” Berg, Wendy MD PhD; Blume, Jeffrey MD; Cormack, Jean
Ph.D; Mendelson, Ellen, MD; Lehrer, Daniel. May 14 2008
![Page 63: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/63.jpg)
References
◼ Sinclair N, Littenberg B, Geller B, Muss H. Accuracy of screening
mammography in older women. AJR Am J Roentgenol 2011; 197
(5): 1268-1273
◼ Monticciolo D, Newel M, Hendric, E, Helvie Mark, Moy,L, Breast
Cancer Screening for Average –Risk Women: Recommendations
from the ACR Commission on Breast Imaging JACR September
2017 Volume 14: 1137-1143
◼ Sharpe R, Levin D, Parker L, Rao, V The Effect of the Controversial
US Preventive Services Task Force Recommendations of the Use
of Screening Mammography JACR January 2013 Volume 10: 21-24
![Page 64: Screening Breast Imaging - MedStar HealthBreast cancer Most common cancer diagnosed in women 2nd cause of cancer death amongst women Lifetime risk 12% 1 in 8 women 2019 331,000 cases](https://reader036.fdocuments.in/reader036/viewer/2022062920/5f0250a37e708231d403a8f4/html5/thumbnails/64.jpg)
◼ https://www.acr.org/Clinical-
Resources/Breast-Imaging-
Resources/Mammography-CME-Toolkit