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Mammography how safe & effective screening tool
- 4. NEED/SCREENING • 1million new cases /yr ,cancer is a major health problem • 18% BC • 1in 8 US, I in 30 in India • Advanced Breast Cancer 10-20% US, 3060% in developing countries.
- 5. Goal • Goal of any screening test is to use a test of sufficient sensitivity to detect a large proportion of a particular disease in population.
- 6. HOW • BSE,BPE,MAMMOGRAPHY can detect benign ,precancers like DCIS,LCIS,PAGET’S DISEASE and early invasive cancers. • Further evaluation of any suspicious lesion- Diagnostic Mammography ,Sonography, Elastography, MRI, PET.
- 7. RECOMMENDATIONS • ACS/ACR – Annual screening from 40 • USPSTF2009, 50-74 YRS EVRY 2 YRS: -Overdiagnosis and unnecessary treatment(10/1life saved) - Anxiety - Slight increase in radiation induced BC - Below 35 yrs not recommended, Sonography /MRI. - Cost of screening
- 8. ROUTINE SCREENING STILL A MATTEROF DEBATE • COCHRANE COLLABORATIVE DATABASES 2011(US/ NORDIC) Universal screening does more harm than good and is not reasonable. Screening detects 3-13% BC DR in some countries with organized screening by 2/3rd. Benefit to risk ratio-48.5/1 (safe)
- 10. WHAT IS MAMMOGRAPHY • LOW ENERGY XRAY 30 Kv examines the breast & typically finds: • Lump-( well defined/irregular) -solid/cystic • Macro calcifications –Ageing • Micrcalcifications - spiculated -clustered -linear branching
- 11. SENSIVITY/SPECIFICITY • SENSSITIVITY-79%,LESS IN YOUNG(Effective) • SPECIFICITY: FALSE NEGATIVE 10-30% FALSE POSITIVE -7%(UNNECESSARY FOLLOW UP SCREENING )
- 12. Reporting of mammography findings: • BIRADS SCORE(BREAST IMAGING REPORTING AND DATA SYSTEM)/ACR • 0-6=INCOMPLETE-BIOPSY PROVED
- 13. A Brief History - 1913 Albert Salomon, German surgeon - 1950’s - Jacob Gershon-Cohen began to advocate widespread use of X-rays for screening - December 2005 – RSNA brings digital mammography to US
- 14. Mammography Tube cone Breast Stand Past & Present Similar equipments were & are still being used, these can be called as old fashioned equipments
- 16. Standard views: 45* M edio lateral Oblique (M O view)/L L undgren’s view Craniocaudal view (CC view) RCC Right Craniocaudal LCC Left Craniocaudal RMLO Right Mediolateral Oblique LMLO Left Mediolateral Oblique
- 19. PROCEDURE • Breast compressed between two parallel plates ,reduces the thickness and increases sensitivity • 2 views –CC,MLO • TALCUM POWDERS/DEODORANTS DISCOURAGED • 1 WK AFTER MENSES • < 30 MINS
- 20. WORK UP • SCREENING • DIAGNOSTICMAMMOGRAPHY • STEROTACTIC OR US GUIDED CORE BIOPSY
- 23. LAT Left Axillary Tail LCV Left Cleavage LLMO Left Lateromedial Oblique LML Let Mediolateral LFB Left From Below LRL Left Roll Lateral LLM Left Lateromedial LRM Left Roll Medial
- 25. CONVE IONAL CC VIE NT W E L K UND CC VIE W
- 33. Mammography In digital mammography screen-film system has been replaced by Detectors to give the digital images
- 35. Mammography CCD camera Work station Present & future Equipments look like this
- 38. ADVANTAGES • Improved signal-to-noise ratio • Ability to magnify, change contrast, or alter the brightness. • Near instantaneous image acquisition
- 39. Digital Mammographic Imaging Screening Trial (DMIST) • Retrospective study of 49,500 asymptomatic women • Assessed accuracy of digital vs film mammograms RESULTS: • Digital mammography significantly more accurate in preand perimenopausal women under 50 with dense breasts • Nonsignificant trend toward improved accuracy with film mammograms in women over 65 with fatty breasts
- 43. cost issues • Digital mammography is expensive! • Using digital technology in all women would cost >$300,000 per QALY gained • Targeted use of digital mammography on basis of age/breast density costs ~$50,000 per QALY gained
- 44. Computer-Aided Detection • • • • Software program that highlights areas of concern on digital mammograms Uses image processing algorithms and decision threshold parameters to detect features in an image likely to be of clinical significance Very sensitive – detects 90% of all cancers However, has a high rate of false positives (2-4 per study)
Editor's Notes
- {"49":"CELEBRITY INAGURATING LOW COST MOBILE MAMMOGRAPHY VAN TO MAKE SCREENING AVAILABLE AT DOOR STEP FOR POOR AND LESS AWARE.\n","38":"Conventional film mammography uses low energy X-rays that pass through the breast and are absorbed by the film which is then developed.\nWith digital, X-rays are recorded on a digital detector instead of film, and then projected on monitor.\nMammography is the last imaging modality to use digital technology; mammography requires high resolution and contrast to produce quality images and thus development of technology to produce digital mammography is very complex, expensive, and time consuming \nImproving the SNR allows for decreased background noise and “cleaner” image, allowing potential for better cancer detection and less background interference \nInstantaneous images allow radiologists to assess quality of the image, and can reposition, magnify certain areas of interest, etc while the patient is still in office.\n","27":"NORMAL DENSE\n","44":"Hope the CAD will aid in detection of breast cancers at an earlier stage.\nHowever, this also results in a higher rate of recall and false positives...\nResearchers at UCDavis reviewed screening mammograms of 222,000 women and found that with the use of CAD, 32% more women were recalled for additional tests, and 20% more women had an additional biopsy. Many of the cancers identified by CAD were localized, in situ cancers that still have an uncertain mortality risk.\nFurthermore, everytime CAD is used, the patient incurs additional costs for their mammogram - $15 per person according to Dr. Conwell.\n","39":"Study conducted in 2003 and published in 2005\nDMIST: retrospective study of 49,500 asymptomatic women that compared the accuracy of digital versus film mammography in population subgroups defined by combinations of age, menopausal status, and breast density by using either biopsy results or follow-up information as the reference standard \ndigital mamm was significantly better than film in detecting breast cancer in pre- and perimenopausal women with dense breasts younger than 50\nin other subgroups, there was no significant difference in diagnostic accuracy between digital and film mammography\nin women over 65 with fatty breasts, there was nonsignificant trend toward improved diagnostic accuracy with film over digital\n","28":"CALCIFICATIONS\n","45":"CAD IMAGES\n","29":"FIBROCYSTIC\n","46":"CAD IMAGE much better separation of microcalcification from background breast tissue.\n","13":"Salomon – first person to use X-ray to study breat tissue. Used X-ray to study breast tissue that had been removed from the body; found that he was able to differentiate between cancerous and benign lesions on X-ray. Did not use this in his own practice.\nEven with Gerson-Cohen’s published results, mammography did not begin to gain widespread popularity until later in 1960s\nIn 12/05, RSNA held first digital mammography training and self-assessment workshop in the US\n","30":"ILL DEFINED LUMP IN A DENSE BREAST\n","47":"MBI/MRI\n","48":"MOLECULAR IMAGING/\n","26":"NORMAL FATTY\n","15":"Modern X ray mammography machine\n","43":"Using info from the DMIST study and publicly available data, researchers evaluated the cost-effectiveness of digital mammography screening for breast cancer\nusing digital technology in all women would cost more than $300 000 per quality-adjusted life-year (QALY) gained. \nTargeting digital mammography on the basis of age or age and breast density costs $26 500 to $84 500 more per QALY gained than film mammography. \nDensity-targeted use of digital mammography in women age 65 years or older costs $97,000 to $257,000 more per QALY gained than film.\nOf interest, Medicare reimburses $50 more per exam for digital mammography\n"}