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Mammographic density and interval cancers in mammographic screening : Moving towards more personalized screening

Larsen, Marthe ; Lynge, Elsebeth ; Lee, Christoph I. ; Lång, Kristina LU and Hofvind, Solveig (2023) In Breast 69. p.306-311
Abstract

Purpose: The European Society on Breast Imaging has recommended supplemental magnetic resonance imaging (MRI) every two to four years for women with mammographically dense breasts. This may not be feasible in many screening programs. Also, the European Commission Initiative on Breast Cancer suggests not implementing screening with MRI. By analyzing interval cancers and time from screening to diagnosis by density, we present alternative screening strategies for women with dense breasts. Methods: Our BreastScreen Norway cohort included 508 536 screening examinations, including 3125 screen-detected and 945 interval breast cancers. Time from screening to interval cancer was stratified by density measured by an automated software and... (More)

Purpose: The European Society on Breast Imaging has recommended supplemental magnetic resonance imaging (MRI) every two to four years for women with mammographically dense breasts. This may not be feasible in many screening programs. Also, the European Commission Initiative on Breast Cancer suggests not implementing screening with MRI. By analyzing interval cancers and time from screening to diagnosis by density, we present alternative screening strategies for women with dense breasts. Methods: Our BreastScreen Norway cohort included 508 536 screening examinations, including 3125 screen-detected and 945 interval breast cancers. Time from screening to interval cancer was stratified by density measured by an automated software and classified into Volpara Density Grades (VDGs) 1–4. Examinations with volumetric density ≤3.4% were categorized as VDG1, 3.5%–7.4% as VDG2, 7.5%–15.4% as VDG3, and ≥15.5% as VDG4. Interval cancer rates were also determined by continuous density measures. Results: Median time from screening to interval cancer was 496 (IQR: 391–587) days for VDG1, 500 (IQR: 350–616) for VDG2, 482 (IQR: 309–595) for VDG3 and 427 (IQR: 266–577) for VDG4. A total of 35.9% of the interval cancers among VDG4 were detected within the first year of the biennial screening interval. For VDG2, 26.3% were detected within the first year. The highest annual interval cancer rate (2.7 per 1000 examinations) was observed for VDG4 in the second year of the biennial interval. Conclusions: Annual screening of women with extremely dense breasts may reduce the interval cancer rate and increase program-wide sensitivity, especially in settings where supplemental MRI screening is not feasible.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Breast cancer, Interval cancer, Mammographic density, Mammographic screening, MRI, Personalized screening
in
Breast
volume
69
pages
306 - 311
publisher
Churchill Livingstone
external identifiers
  • scopus:85151443038
  • pmid:36966656
ISSN
0960-9776
DOI
10.1016/j.breast.2023.03.010
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2023
id
98e1d4bf-bd53-4fdb-b539-df0f2d1bbb65
date added to LUP
2023-04-12 16:19:01
date last changed
2024-04-19 20:42:29
@article{98e1d4bf-bd53-4fdb-b539-df0f2d1bbb65,
  abstract     = {{<p>Purpose: The European Society on Breast Imaging has recommended supplemental magnetic resonance imaging (MRI) every two to four years for women with mammographically dense breasts. This may not be feasible in many screening programs. Also, the European Commission Initiative on Breast Cancer suggests not implementing screening with MRI. By analyzing interval cancers and time from screening to diagnosis by density, we present alternative screening strategies for women with dense breasts. Methods: Our BreastScreen Norway cohort included 508 536 screening examinations, including 3125 screen-detected and 945 interval breast cancers. Time from screening to interval cancer was stratified by density measured by an automated software and classified into Volpara Density Grades (VDGs) 1–4. Examinations with volumetric density ≤3.4% were categorized as VDG1, 3.5%–7.4% as VDG2, 7.5%–15.4% as VDG3, and ≥15.5% as VDG4. Interval cancer rates were also determined by continuous density measures. Results: Median time from screening to interval cancer was 496 (IQR: 391–587) days for VDG1, 500 (IQR: 350–616) for VDG2, 482 (IQR: 309–595) for VDG3 and 427 (IQR: 266–577) for VDG4. A total of 35.9% of the interval cancers among VDG4 were detected within the first year of the biennial screening interval. For VDG2, 26.3% were detected within the first year. The highest annual interval cancer rate (2.7 per 1000 examinations) was observed for VDG4 in the second year of the biennial interval. Conclusions: Annual screening of women with extremely dense breasts may reduce the interval cancer rate and increase program-wide sensitivity, especially in settings where supplemental MRI screening is not feasible.</p>}},
  author       = {{Larsen, Marthe and Lynge, Elsebeth and Lee, Christoph I. and Lång, Kristina and Hofvind, Solveig}},
  issn         = {{0960-9776}},
  keywords     = {{Breast cancer; Interval cancer; Mammographic density; Mammographic screening; MRI; Personalized screening}},
  language     = {{eng}},
  pages        = {{306--311}},
  publisher    = {{Churchill Livingstone}},
  series       = {{Breast}},
  title        = {{Mammographic density and interval cancers in mammographic screening : Moving towards more personalized screening}},
  url          = {{http://dx.doi.org/10.1016/j.breast.2023.03.010}},
  doi          = {{10.1016/j.breast.2023.03.010}},
  volume       = {{69}},
  year         = {{2023}},
}