Elizabeth Wylie

Reducing delay in the diagnosis of pregnancy-associated breast cancer: How imaging can help us

Introduction: The evaluation of breast symptoms during pregnancy or lactation can be challenging but prompt, appropriate assessment of symptoms may lead to earlier cancer detection.

Screening for breast cancer post reduction mammoplasty

AIM To investigate whether remodelling of the breast after breast reduction surgery has an effect on mammographic cancer detection. METHODS AND MATERIALS For women who attended population-based screening between January 1998 to December 2007, data were extracted on their age, history of previous breast reduction, and the result of screening (recall for further assessment, cancer, or no cancer). The number of cancers detected, recalls per 1000 screens and the characteristics of the cancers detected in the two groups was compared. RESULTS In total 244,147 women with 736,219 screening episodes were reviewed. In the 4743 women who had a breast reduction, 51 breast cancers were detected [age standardized rate (ASR) of 4.28 per 1000 screening episodes; 95% CI 3.11-5.46], compared with 4342 breast cancers in 239 404 women screened in the non-reduction group (ASR of 5.99 per 1000 screening episodes; 95% CI 5.81-6.16). There were fewer cancers in the breast reduction group with a relative risk of 0.71. There was no significant difference in the rate of recall between the two groups, with a crude recall rate of 46.1 per 1000 screening episodes post-breast reduction compared with 50.7 per 1000 screening episodes for women without breast reduction. There was no significant difference in the pathological type or location of the cancer between the two groups of women. CONCLUSION Postoperative breast changes following reduction mammoplasty do not significantly hinder analysis of the screening mammogram.

Effect of false-positive screening mammograms on rescreening in Western Australia

Objectives: To quantify the effect of previous false‐positive mammogram results on rescreening rates in a population of women participating in the BreastScreen WA (BSWA) program.

Clinical and imaging features of male breast disease, with pathological correlation: A pictorial essay

The majority of male breast diseases are benign. The most common is gynaecomastia. Although it is rare, the most critical diagnosis is a malignancy. Radiologists are generally less familiar with breast disease in males compared with females. This pictorial review will highlight the ultrasonographic, mammographic and pathological features of a spectrum of benign and malignant male breast diseases. This includes gynaecomastia, fat necrosis, lipoma, epidermoid cyst, subareolar abscess, chronic inflammation, melanoma and ductal carcinoma.

Assessing the effectiveness of a mammography screening service

Background:  Trials have shown that mammography screening reduces mortality and probably decreases morbidity related to breast cancer.

Hormone replacement therapy and mammographic screening outcomes in Western Australia

Objectives: The study objectives were three-fold: to estimate the effect of hormone replacement therapy (HRT) use on the sensitivity of mammographic screening; to examine the odds of having an interval cancer as a function of duration of HRT use and to compare the size, grade, lymph node and hormone receptor status of tumours for HRT users and non-users. Setting: Perth, Western Australia, where a free, population-based mammographic screening service targets women aged 50–69 years. Methods: The cohort consisted of 113,310 women who had 119,296 screening episodes between January 1998 and December 1999. Unconditional logistic regression was used to model the odds of having an interval cancer as a function of the effect of the duration of HRT use (measured in years). Using subsequent screening rounds, χ 2-tests were used to examine whether HRT users differed from HRT non-users in terms of tumour characteristics. Results: Ninety-seven screen-detected and 31 interval cancers were diagnosed among women who were on initial screening rounds, and 393 screen-detected and 153 interval cancers were diagnosed among women on subsequent screens, two years post screening. Two-year sensitivity outcomes were significantly lower for HRT users on initial screening rounds. For women on subsequent screening rounds, the odds of having an interval cancer increased with the duration of HRT use (odds ratio 1.09, 95% confidence interval 1.04–1.14, P<0.04) after controlling for age, family history, tumour grade, size and pathology type. The histopathological characteristics of cancers did not differ for HRT users compared with HRT non-users. Conclusion: The sensitivity of mammographic screening was reduced and the odds of having an interval cancer were increased for HRT users compared with HRT non-users. For women on subsequent screening episodes, the odds of having an interval cancer increased with duration of HRT use.

Rates for mastectomy are lower in women attending a breast-screening programme

Background:  Mammographic screening for breast cancer facilitates earlier recognition of lesions, thus potentially allowing for breast‐conserving surgery. Few studies have compared the final surgical outcomes of women presenting through breast screening programmes with those presenting via other sources. Are breast cancer patients presenting through BreastScreen more likely to undergo breast‐conserving surgery than those presenting from other sources?

Nipple discharge in a screening programme: imaging findings with pathological correlation.

BreastScreen Australia provides free mammographic screening for asymptomatic women over the age of 40, targeting women aged 50–69. Occasionally women will present to screening programmes with a history of nipple discharge, which is uncommonly associated with significant underlying breast disease. Seventy‐six women with a history of nipple discharge were recalled to BreastScreen Western Australia assessment centres from 2004 to 2008, of whom 72 were recalled primarily for their symptoms. Thirty‐six of these patients had pathology investigations, including 18 nipple discharge smears, 17 fine needle aspirations, 11 core biopsies and eight surgical biopsies or therapeutic resections. The biopsies found 11 intraduct papillomas and one invasive ductal carcinoma with ductal carcinoma in situ. Fourteen patients had imaging findings consistent with benign mammary duct ectasia. Our findings confirm that the presentation of nipple discharge in a screening programme is uncommonly associated with significant breast disease, and present representative cases of the radiological findings with pathological correlation of benign and malignant causes including mammary duct ectasia, intraduct papillomas, multiple papillomas, invasive ductal carcinoma and ductal carcinoma in situ.

Is Step Down Assessment of screen‐detected lesions as safe as workup at a Metropolitan Assessment Centre?

Objective: BreastScreen WA offers population mammographic screening via fixed clinics in the metropolitan area and mobile clinics that visit country areas every two years. If an abnormality is suspected following mobile clinic screening, women undergo Step Down Assessment; diagnostic further views are performed at the mobile clinic and if a possibly significant abnormality persists, country women are referred to a Perth Metropolitan Breast Assessment Centre. The purpose of this retrospective cohort study was to determine if Step Down Assessment in country Western Australia offered the same diagnostic effectiveness as screening and assessment in the metropolitan area.

Mammographic appearances following breast prosthesis removal.

A number of reasons exist for women have breast prosthesis removed. Not least of these are fears concerning the safety of silicone prosthesis with carcinogenesis and association with connective tissue disease both being subjects of much discussion and debate in the recent medical literature and lay press. As many of these women approach the age where they are eligible for screening mammography, it is likely that radiologists will encounter an increasing number of patients who have had their implants removed. We present the mammographic abnormalities found in 12 patients who have had prosthesis removed.