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New Developments in Breast Screening

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Julie Carroll

on 27 August 2013

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Transcript of New Developments in Breast Screening

New Developments in Breast Screening
by
Julie Carroll

Interim Results of OSLO Trial


85% of breast screening units in the UK have at least one digital mammography set (July, 2011).
Age extension
NHSBSP is being extended to include women aged 47-49 and 71-73. But is extending the age range beneficial?

The phasing-in of the age extension is being randomised. This has allowed a randomised control trial to be undertaken.
Mortality from breast cancer by age 60 for women invited to have an additional early screen (before 50) versus those not invited.

Mortality from breast cancer by age 80 for women invited to have an additional late screen (after age 70) versus those not invited.
The NHS Breast Screening Programme saves approx 1,300 lives in the UK every year.
Reduced recall rates
BENEFITS VERSUS HARMS
Information given to women
on harms and benefits of
screening needs improving

NEW SCREENING LEAFLET
New patient support materials
are being developed
Aims to provide women with
clearer statements so they
can make an informed choice

CITIZEN'S JURY
'Overtreatment' is easier to
umderstand than 'overdiagnosis'
The Marmot Review
Out of Hours
Study

Promoting Early Presentation Intervention (PEP)

NEW AND EMERGING TECHNOLOGIES
For every woman saved 3 women will be diagnosed with a breast tumour that would not otherwise have become apparent in their lifetime.
Benefits outweigh harms and the NHSBSP should continue.
TOMMY trial
In the USA five states have passed legislation which states that radiologists must notify women about the density of their breasts following a screening mammogram - Connecticut, New York, Texas, Virginia and California.

In the UK women are not informed of their breast density



Digital breast tomosynthesis

Automated whole breast ultrasound (AWBU)

Molecular Breast Imaging (MBI)

Multistatic Array processing for Radiowave Image Acquisition (MARIA)

Informed Choice about Cancer Screening
Invitation Letter
Leaflet
Literature Review
Literature Review
Literature Review
Automated Whole Breast Ultrasound
Berg WA, Blume JD, Cormack JB, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008; 299:2151–2163.

Kelly KM, Dean J, Comulada WS, Lee SJ. Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. Eur Radiol. 2010; 20:734–742.
AWBU is a reproducible standardised examination
Scan times are only 5 - 7 minutes in comparison to approximately 19 minutes for hand-held ultrasound screening.
Combined with mammography has higher detection rates (3.6 per 1,000 for mammography alone and 7.2 per 1,000 for both modalities).
Combined with mammography has lower false positive rates.
Molecular Breast Imaging (MBI) or
Breast Specific Gamma Imaging (BSGI)
Rhodes D, Hruska C, Phillips S, et al. Dedicated dual-head gamma imaging for breast cancer screening in women with mammographically dense breasts. Radiology. 2011; 258(1): 106-118.
ADVANTAGES
Multistatic Array processing for Radiowave Image Acquisition (MARIA)
Hope, J. (2011, December 2). The eight-second scan that can detect breast cancer. Daily Mail, p.7.

Klemm, M., Craddock, I., Leendertz, J., Preece, Gibbins, D., Shere, M. et al. (2010). Clinical trials of a UWB imaging radar for breast cancer. Proceedings of the Antennas and Propagation (EUCAP) 4th European Conference. (pp. 1-4). University of Bristol.
Technology has its origins in landmine detection.
Still in its infancy and the prototype needs further refinement.
Clinical trial involving 95 patients was carried out at Frenchay Hospital in Bristol.
Detection rate was about 60% - 80%.
It is a small piece of equipment and could easily be used in GP surgeries and mobile units.
AIM - To compare tomosynthesis with digital mammography in the NHSBSP.

It will collect data from 7,000 women.

Findings are due to be published early in 2015.
A recent study comparing
tomosynthesis plus digital
mammography and digital
mammography alone for breast
cancer screening found that
the addition of tomosyntesis
reduced recll rates.
12% to 8.4%a (Haas et al., 2013)
40% increase in the detection rate
of invasive cancers when both
mammography and tomosynthesis
were utilised compared to
mammography alone.
False positive rates decreased
by 15%.

References
Berg WA, Blume JD, Cormack JB, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008; 299:2151–2163.

Forbes, L., Linsell, L., Atkins, L., Burgess, C., Tucker, l., Omar, L. & Ramirez A. (2011). A promoting early presentation intervention increases breast cancer awareness in older women after 2 years: a randomised controlled trial. Br J Cancer, 105(1): 18–21.

Haas,B., Kalra, V., Geisel, J., Raghu, M., Durand, M. & Philpotts, L. (2013). Comparison of Tomosynthesis Plus Digital Mammography and Digital Mammography Alone for Breast Cancer Screening. Radiology, doi: 10.1148/radiol.13130307.

Hope, J. (2011, December 2). The eight-second scan that can detect breast cancer. Daily Mail, p.7.

Independent UK Panel on Breast Cancer Screening led by Professor Sir Michael Marmot (2012). The benefits and harms of breast cancer screening: an independent review. The Lancet, 380(9855), 1778-1786.

Kelly, K., Dean, J., Comulada, W. & Lee, S. (2010). Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. European Radiology, 20(3), 734-742.









References
References
Kelly, K., Dean, J., Lee, S. & Comulada, W. (2010). Breast cancer detection : radiologists’ performance using mammography with and without automated whole-breast ultrasound. European Radiology, 20(11), 2557-25564.

Klemm, M., Craddock, I., Leendertz, J., Preece, Gibbins, D., Shere, M. et al. (2010). Clinical trials of a UWB imaging radar for breast cancer. Proceedings of the Antennas and Propagation (EUCAP) 4th European Conference. (pp. 1-4). University of Bristol.

National Institute for Health Research (2013). Details of HTA project in progress: TOMMY trial: A comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme. Retrieved August, 16, 2013 from http://www.hta.ac.uk/2296.

Patnick, J. (2011). Evaluating the net effects of extending the age range for breast screening in the NHS Breast Screening Programme in England from 50-70 years to 47-73 years. ClinicalTrials.gov identifier: NCT01081288. Retrieved August, 16, 2013 from http://clinicaltrials.gov/ct2/show/study/NCT01081288.

Skaane, P., Bandos, A., Gullien, R., Eben, E., Ekseth, U., Haakenaasen, U. et al. (2013). Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening programme. Radiology, 10.1148/radiol.12121373.





Tomosynthesis is 3-D mammography.

An x-ray tube moves in an arc around the compressed
breast and multiple images are taken which are then
reconstructed using algorithms similar to those used in CT.

The radiation dose is comparable to that of digital
mammography.

Images can either be viewed sequentially as slices or as
a moving video.

Superimposition of breast tissue is minimised.



Digital Breast Tomosynthesis
Any Questions?


Primary Outcome Measures
Dense Breast Notification
Patient age and classification of breast density

Checka, C., Chun, J., Schnabel, F., Lee, J. & Toth, H. (2012).The relationship of mammographic density and age: implications for breast cancer screening. American Journal of Roentgenology, 198(3), W292-295
MBI is a more sensitive screening tool than mammography (3 out of 12 known cancers detected by mammography, 10 out of 12 detected by MBI).
False positive rates are high, but more favourable than mammography.
DISADVANTAGES
Long acquisition time of 40 minutes.
High radiation dose (6.5 mSv effective dose compared to 0.1mSv - 1.0mSv for a mammogram).
National Institute for Health Research (2013). Details of HTA project in progress: TOMMY trial: A comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme. Retrieved August, 16, 2013 from http://www.hta.ac.uk/2296
DIGITALISATION
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