Mammography

From Anvita Health Wiki

Contents 1 Indications 2 Procedure 3 Notes 4 More General Terms 5 Additional Terms 6 References

Indications

• screening & diagnosis of breast disease

• screening for breast cancer

Procedure

• imaging studies of the breasts by means of X-rays, ultrasound, & nuclear magnetic resonance

Notes

• benefits of screening mammography often exaggerated [13]
• mortality reduction from breast cancer due to screening is 2.4 per 100,000 or ~1/3 (2.4/7.2) of the 7.2 per 100,000 deaths from breast cancer [10]
  

• Recommendations:

• US Preventive Services Task Force ( USPSTF) [2]

• screening mammography with or without clinical breast examination every 1-2 years for women age 40 & older

• American College of Obstetricians and Gynecologists

• screening mammography annually for women age 40 & older [12]

• no upper age limit [8]
• uncertain benefit for women > 80 years of age [9]
  

• Mammographic breast density: [3]

• risk factor for breast cancer
• genetically determined
• 4 categories of mammographic density [7]

• almost entirely fat (< 25%)
• scattered fibroglandular densities (25-50%)
• heterogenously dense (51-75%)
• extremely dense (>75%)
  

• Sensitivity: 87%, Specificity 97% [4]
• Sensitivity: 36%*, positive predictive value: 89% [5]
• False positives:

• annual screening 10 year window: 61% of women
• biennial screening 10 year window: 42% of women [14]
  

• In this same study (BRCA+ women), sensitivity of MRI = 77% [5]
  
• 3 parameters adversely affecting mammographic screening all affect breast density: [4]

• menopausal hormone therapy

• short-term hormone therapy suspension before mammography not helpful [9]

• prior breast surgery
• body mass index < 25
  

• Digital mammography vs film mammography:

• digital mammography may be better than conventional film mammography when breast tissue is dense [6,15]
• some cancers may be detected by film only or by digital imaging only.
  

• 3D mammography imaging FDA-approved Feb 2011
  
• American College of Radiology Breast Imaging Reporting & Data System (BI-RADS) Assessment Categories:

• 0: incomplete assessment; need additional imaging evaluation, prior mammograms for comparison, or both
• 1: negative; normal mammographic study
• 2: benign findings
• 3: probably benign findings; initial short-interval follow-up suggested
• 4: suspicious abnormality; biopsy should be considered
• 5: highly suggestive of malignancy; appropriate action should be taken
• 6: known- biopsy-proven malignancy; appropriate action should be taken

More General Terms

• radiography (diagnostic imaging, roentgenography)

Additional Terms

• breast cancer
• screening for breast cancer

References

1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
2. Journal Watch 22(8):64, 2002
3. Journal Watch 22(21):159, 2002 Boyd NF et al Heritability of mammographic density, a risk factor for breast cancer. N Engl J Med 347:886, 2002 PMID: [1]
4. Journal Watch 24(21):161, 2004 Banks E, Reeves G, Beral V, Bull D, Crossley B, Simmonds M, Hilton E, Bailey S, Barrett N, Briers P, English R, Jackson A, Kutt E, Lavelle J, Rockall L, Wallis MG, Wilson M, Patnick J. Influence of personal characteristics of individual women on sensitivity and specificity of mammography in the Million Women Study: cohort study. BMJ. 2004 Aug 28;329(7464):477. <PubMed> PMID: [2] <Internet> [3]
5. Journal Watch 24(21):164, 2004 Warner E, Plewes DB, Hill KA, Causer PA, Zubovits JT, Jong RA, Cutrara MR, DeBoer G, Yaffe MJ, Messner SJ, Meschino WS, Piron CA, Narod SA. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 2004 Sep 15;292(11):1317-25. PMID: [4]
6. Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, Conant EF, Fajardo LL, Bassett L, D'Orsi C, Jong R, Rebner M; Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med. 2005 Oct 27;353(17):1773-83. Epub 2005 Sep 16. PMID: [5]
   - Dershaw DD. Film or digital mammographic screening? N Engl J Med. 2005 Oct 27;353(17):1846-7. No abstract available. PMID: [6]
7. Chen J et al, Projecting absolute invasive breast cancer risk in white women with a model that includes mammographic density. J Natl Cancer Inst 2006, 98:1215 PMID: [7]
   - Barlow WE et al, Prospective breast cancer risk prediction model for women undergoing screening mammography J Natl Cancer Inst 2006, 98:1204 PMID: [8]
   - Bondy ML & Newman LA Assessing breast cancer risk: Evolution of the Gail Model. J Natl Cancer Inst 2006, 98:1172 PMID: [9]
8. Badgwell BD, Giordano SH, Duan ZZ, Fang S, Bedrosian I, Kuerer HM, Singletary SE, Hunt KK, Hortobagyi GN, Babiera G. Mammography before diagnosis among women age 80 years and older with breast cancer. J Clin Oncol. 2008 May 20;26(15):2482-8. Epub 2008 Apr 21. PMID: [10]
   - Women 80 and older benefit from mammography, but few are screened [press release]. Alexandria, VA: ASCO American Society of Clinical Oncology; Apr 21 , 2008. [11]
   - Rabin RC. Screening for cancer in elderly fuels fight. New York Times . Jul 8 , 2008. [12]
   - Berry DA et al Flawed inferences about screening mammography's benefit based on observational data. J Clin Oncol 2009 Feb 1; 27:639 PMID: [13]
   - Schonberg MA and McCarthy EP Mammography screening among women age 80 years and older: Consider the risks. J Clin Oncol 2009 Feb 1; 27:640. PMID: [14]
9. Buist DSM et al Short-Term Hormone Therapy Suspension and Mammography Recall Annals of Internal Medicine (June 2, 2009) 150(11):752-765 PMID: [15]
10. Kalager M et al. Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med 2010 Sep 23; 363:1203. PMID: [16]
    - Welch HG. Screening mammography - A long run for a short slide? N Engl J Med 2010 Sep 23; 363:1276. PMID: [17]
11. FDA News Release Feb 11, 2011 FDA approves first 3-D mammography imaging system [18]
12. American College of Obstetricians and Gynecologists Practice Bulletin No. 122: Breast Cancer Screening Ostetrics & Gynecology 2011 122:372 <PubMed> PMID: [19] <Internet> [20]
13. Welch HG and Frankel BA Likelihood That a Woman With Screen-Detected Breast Cancer Has Had Her "Life Saved" by That Screening Arch Intern Med. Published online October 24, 2011 <PubMed> PMID: [21] <Internet> [22]
    - Wilt TJ and Partin MR Comment on "Likelihood That a Woman With Screen-Detected Breast Cancer Has Had Her "Life Saved" by That Screening" Arch Intern Med. Published online October 24, 2011 <PubMed> PMID: [23] <Internet> [24]
14. Hubbard RA et al. Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: A cohort study. Ann Intern Med 2011 Oct 18; 155:481 PMID: [25]
15. Kerlikowske K et al. Comparative effectiveness of digital versus film-screen mammography in community practice in the United States: A cohort study. Ann Intern Med 2011 Oct 18; 155:493. PMID: [26]
16. National Guideline Clearinghouse
    - Appropriate imaging work-up of breast microcalcifications. American College of Radiology ngc-guideline: [27]
    - ACR Appropriateness Criteria for nonpalpable mammographic findings (excluding calcifications). American College of Radiology ngc-guideline: [28]

mammography