Opportunities in cancer imaging: risk-adapted breast imaging in screening.
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Authors
Gilbert, FJ
Hickman, SE
Baxter, GC
Allajbeu, I
James, J
Caraco, C
Vinnicombe, S
Publication Date
2021-10Journal Title
Clin Radiol
ISSN
0009-9260
Publisher
Elsevier BV
Volume
76
Issue
10
Pages
763-773
Type
Article
This Version
AM
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Gilbert, F., Hickman, S., Baxter, G., Allajbeu, I., James, J., Caraco, C., & Vinnicombe, S. (2021). Opportunities in cancer imaging: risk-adapted breast imaging in screening.. Clin Radiol, 76 (10), 763-773. https://doi.org/10.1016/j.crad.2021.02.013
Abstract
In the UK, women between 50-70 years are invited for 3-yearly mammography screening irrespective of their likelihood of developing breast cancer. The only risk adaption is for women with >30% lifetime risk who are offered annual magnetic resonance imaging (MRI) and mammography, and annual mammography for some moderate-risk women. Using questionnaires, breast density, and polygenic risk scores, it is possible to stratify the population into the lowest 20% risk, who will develop <4% of cancers and the top 4%, who will develop 18% of cancers. Mammography is a good screening test but has low sensitivity of 60% in the 9% of women with the highest category of breast density (BIRADS D) who have a 2.5- to fourfold breast cancer risk. There is evidence that adding ultrasound to the screening mammogram can increase the cancer detection rate and reduce advanced stage interval and next round cancers. Similarly, alternative tests such as contrast-enhanced mammography (CESM) or abbreviated MRI (ABB-MRI) are much more effective in detecting cancer in women with dense breasts. Scintimammography has been shown to be a viable alternative for dense breasts or for follow-up in those with a personal history of breast cancer and scarring as result of treatment. For supplemental screening to be worthwhile in these women, new technologies need to reduce the number of stage II cancers and be cost effective when tested in large scale trials. This article reviews the evidence for supplemental imaging and examines whether a risk-stratified approach is feasible.
Keywords
Breast, Breast Neoplasms, Diagnostic Imaging, Early Detection of Cancer, Female, Humans, Risk
Sponsorship
Cancer Research Uk (None)
Cancer Research UK (A26884)
National Institute for Health Research (IS-BRC-1215-20014)
Identifiers
External DOI: https://doi.org/10.1016/j.crad.2021.02.013
This record's URL: https://www.repository.cam.ac.uk/handle/1810/335492
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
Licence URL: https://creativecommons.org/licenses/by-nc-nd/4.0/
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