Breast Cancer Screening

The enormous expansion seen over the last decade in the mammo graphic detection of breast cancer lesions, especially the use of screen ing procedures for the early detection of clinically unsuspected tumors, has made it necessary to summarize the experience made by various centers in the world. The 2nd International Copenhagen Symposium on Detection of Breast Cancer afforded an opportunity of gathering scientists from all over the world to discuss the various problems of early breast cancer detection with special reference to screening procedures. This book forms a synthesis of the information presented by leading scientists from many of the world's mammo graphic centers, particularly those in Sweden and the USA. Hence, the reader will have the opportunity to study the outstanding work carried out by various institutes and centers of breast cancer screening. It is our sincere hope that a study of this volume will encourage other scientists to join in the work on screening procedures. S. Brunner B. Langfeldt P. E. Andersen Contents S. A. Feig: 1 Hypothetical Breast Cancer Risk from Mammography S. A. Feig: Benefits and Risks of Mammography 11 R. L. Egan and M. B. McSweeney: Multicentric Breast Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . 28 M. B. McSweeney and R. L. Egan: Breast Cancer in the Younger Patient: A Preliminary Report 36 M. B. McSweeney and R. L. Egan: Bilateral Breast Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . ' 41 N. Bjurstam: The Radiographic Appearance of Normal and Metastatic Axillary Lymph Nodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 M. Moskowitz, S. A. Feig, C. Cole-Beuglet, S. H.

Breast cancer is the leading site of new cancer cases in women. Breast cancer detection is currently primarily based on physical examination by health care professionals, chance findings by women, breast self-examination and mammography used for diagnosis or for routine screening. Early enough detection through mass screening with mammography has been introduced in many countries in the hope that early intervention would lead to reduced mortality and less aggressive treatment. The aim of this publication is to provide an independent, authoritative review of the evidence of the efficacy and effectiveness of breast cancer screening. This will be of value to governments, public health officials and others concerned with policy recommendations for cancer control.

The outlook for women with breast cancer has improved in recent years. Due to the combination of improved treatments and the benefits of mammography screening, breast cancer mortality has decreased steadily since 1989. Yet breast cancer remains a major problem, second only to lung cancer as a leading cause of death from cancer for women. To date, no means to prevent breast cancer has been discovered and experience has shown that treatments are most effective when a cancer is detected early, before it has spread to other tissues. These two facts suggest that the most effective way to continue reducing the death toll from breast cancer is improved early detection and diagnosis. Building on the 2001 report Mammography and Beyond, this new book not only examines ways to improve implementation and use of new and current breast cancer detection technologies but also evaluates the need to develop tools that identify women who would benefit most from early detection screening. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis encourages more research that integrates the development, validation, and analysis of the types of technologies in clinical practice that promote improved risk identification techniques. In this way, methods and technologies that improve detection and diagnosis can be more effectively developed and implemented.

X-ray mammography screening is the current mainstay for early breast cancer detection. It has been proven to detect breast cancer at an earlier stage and to reduce the number of women dying from the disease. However, it has a number of limitations. These current limitations in early breast cancer detection technology are driving a surge of new technological developments, from modifications of x-ray mammography such as computer programs that can indicate suspicious areas, to newer methods of detection such as magnetic resonance imaging (MRI) or biochemical tests on breast fluids. To explore the merits and drawbacks of these new breast cancer detection techniques, the Institute of Medicine of the National Academy of Sciences convened a committee of experts. During its year of operation, the committee examined the peer-reviewed literature, consulted with other experts in the field, and held two public workshops. In addition to identifying promising new technologies for early detection, the committee explored potential barriers that might prevent the development of new detection methods and their common usage. Such barriers could include lack of funding from agencies that support research and lack of investment in the commercial sector; complicated, inconsistent, or unpredictable federal regulations; inadequate insurance reimbursement; and limited access to or unacceptability of breast cancer detection technology for women and their doctors. Based on the findings of their study, the committee prepared a report entitled Mammography and Beyond: Developing Technology for Early Detection of Breast Cancer, which was published in the spring of 2001. This is a non-technical summary of that report.

An explosive book that exposes the truth about breast cancer screening. For decades, women have been told that mammograms save lives. Yet many scientists say that this is in fact not true. Conspiracy of Hope reveals how breast cancer screening was introduced in the US before there was any good evidence it made any difference, and an unfounded belief in early detection caught on quickly in Canada and other developed countries. Today the evidence is starkly clear. Screening does more harm than good. Still women, and their doctors, continue to buy into a myth perpetuated by greed, fear, and wishful thinking. Conspiracy of Hope illustrates how a vortex of interests came together to make breast screening standard medical practice and why it's so hard to persuade them they are wrong. The radiologists, the imaging machinery manufacturers, and the pink ribbon charities are all part of that story. It is a tale of back-stabbing and intrigue, of exploiting fear and hope, while distorting and misrepresenting the evidence. Or simply ignoring it.

The use of tomosynthesis in breast imaging is growing rapidly due to its superior ability to identify and characterize normal findings, benign lesions, and breast cancer, as well as its optimal performance with dense breast tissue. Providing unparalleled coverage of this breakthrough breast imaging modality, Breast Tomosynthesis explains how this new modality can lead to enhanced interpretation and better patient outcomes. This new reference is an indispensable guide for today's practitioner looking to keep abreast of the latest developments with correlative findings, practical interpretation tips, physics, and information on how tomosynthesis differs from conventional 2D FFDM mammography. Over 900 high-quality images offer visual guidance to effectively reading and interpreting this key imaging modality. Includes over 900 high-quality tomosynthesis and mammography images representing the spectrum of breast imaging. Features the latest Breast Imaging Reporting and Data System (or BI-RADS) standards updated in February 2014. Highlights practical tips to interpreting this new modality and how it differs from 2D mammography. Details how integration of tomosynthesis drastically changes lesion work-up and overall workflow in the department. "Tomo Tips" boxes offer tips and pitfalls for expert clinical guidance.

Breast Cancer Screening: Making Sense of Complex and Evolving Evidence covers broad aspects of breast cancer screening specifically focusing on current evidence, emerging evidence, and issues that will be critical for future breast screening practice such as tailored screening and shared decision-making in breast screening. The scope of the book is relevant to a global audience. This book provides balanced perspectives on this increasingly controversial topic, using scientific evidence to explain the evolution of knowledge relating to breast cancer screening. Breast Cancer Screening covers the key points related to this debate including the context of increasingly complex and conflicting evidence, divergent opinions on the benefits and harms of breast screening, and variability in screening practice and outcomes across settings around the world. Explains complex and evolving evidence on breast screening with a balanced approach Provides balanced information and up-to-date evidence in an increasingly complex area Addresses emerging topical issues such as screening trials of digital breast tomosynthesis, tailored breast screening, and shared decision-making in breast screening Assists academics and researchers in identifying areas needing further research