Ruth English

Comparison of various characteristics of women who do and do not attend for breast cancer screening

BackgroundInformation regarding the characteristics and health of women who do and do not attend for breast cancer screening is limited and representative data are difficult to obtain.MethodsInformation on age, deprivation and prescriptions for various medications was obtained for all women at two UK general practices who were invited to breast cancer screening through the National Health Service Breast Screening Programme. The characteristics of women who attended and did not attend screening were compared.ResultsOf the 1064 women invited to screening from the two practices, 882 (83%) attended screening. Screening attenders were of a similar age to non-attenders but came from significantly less deprived areas (30% of attenders versus 50% of non-attenders came from the most deprived areas, P < 0.0001) and were more likely to have a current prescription for hormone replacement therapy (32% versus 19%, P < 0.0001). No significant differences in recent prescriptions of medication for hypertension, heart disease, hypercholesterolaemia, diabetes mellitus, asthma, thyroid disease or depression/anxiety were observed between attenders and non-attenders.ConclusionWomen who attend the National Health Service Breast Screening Programme come from less deprived areas and are more likely to have a current prescription for hormone replacement therapy than non-attenders, but do not differ in terms of age or recent prescriptions for various other medications.

Influence of personal characteristics of individual women on sensitivity and specificity of mammography in the Million Women Study: cohort study

Abstract Objectives To examine how lifestyle, hormonal, and other factors influence the sensitivity and specificity of mammography. Methods Women recruited into the Million Women Study completed a questionnaire about various personal factors before routine mammographic screening. A sample of 122 355 women aged 50-64 years were followed for outcome of screening and incident breast cancer in the next 12 months. Sensitivity and specificity were calculated by using standard definitions, with adjustment for potential confounding factors. Results Breast cancer was diagnosed in 726 (0.6%) women, 629 in screen positive and 97 in screen negative women; 3885 (3.2%) were screen positive but had no subsequent diagnosis of breast cancer. Overall sensitivity was 86.6% and specificity was 96.8%. Three factors had an adverse effect on both measures: use of hormone replacement therapy (sensitivity: 83.0% (95% confidence interval 77.4% to 87.6%), 84.7% (73.9% to 91.6%), and 92.1% (87.6% to 95.0%); specificity: 96.8% (96.6% to 97.0%), 97.8% (97.5% to 98.0%), and 98.1% (98.0% to 98.2%), respectively, for current, past, and never use); previous breast surgery v no previous breast surgery (sensitivity: 83.5% (75.7% to 89.1%) v 89.4% (86.5% to 91.8%); specificity: 96.2% (95.8% to 96.5%) v 97.4% (97.3% to 97.5%), respectively); and body mass index < 25 v ≥ 25 (sensitivity: 85.7% (81.2% to 89.3%) v 91.0% (87.5% to 93.6%); specificity: 97.2% (97.0% to 97.3%) v 97.4% (97.3% to 97.6%), respectively). Neither sensitivity nor specificity varied significantly according to age, family history of breast cancer, parity, past oral contraceptive use, tubal ligation, physical activity, smoking, or alcohol consumption. Conclusions The efficiency, and possibly the effectiveness, of mammographic screening is lower in users of hormone replacement therapy, in women with previous breast surgery, and in thin women compared with other women.

Fusion of contrast-enhanced breast MR and mammographic imaging data

Increasing use is being made of Gd-DTPA contrast-enhanced MRI (CE-MRI) for breast cancer assessment since it provides three-dimensional (3D) functional information via pharmacokinetic interaction between contrast agent and tumour vascularity, and because it is applicable to women of all ages as well as patients with post-operative scarring. CE-MRI is complementary to conventional X-ray mammography, since it is a relatively low-resolution functional counterpart of a comparatively high-resolution 2D structural representation. However, despite the additional information provided by MRI, mammography is still an extremely important diagnostic imaging modality, particularly for several common conditions such as ductal carcinoma in situ (DCIS) where it has been shown that there is a strong correlation between microcalcification clusters and malignancy. Pathological indicators such as calcifications and fine spiculations are not visible in CE-MRI and therefore there is clinical and diagnostic value in fusing the high-resolution structural information available from mammography with the functional data acquired from MRI. This article is a clinical overview of the results of a technique to transform the coordinates of regions of interest (ROIs) from the 2D mammograms to the spatial reference frame of the contrast-enhanced MRI volume. An evaluation of the fusion framework is demonstrated with a series of clinical cases and a total of 14 patient examples.

A biologically inspired algorithm for microcalcification cluster detection

The early detection of breast cancer greatly improves prognosis. One of the earliest signs of cancer is the formation of clusters of microcalcifications. We introduce a novel method for microcalcification detection based on a biologically inspired adaptive model of contrast detection. This model is used in conjunction with image filtering based on anisotropic diffusion and curvilinear structure removal using local energy and phase congruency. An important practical issue in automatic detection methods is the selection of parameters: we show that the parameter values for our algorithm can be estimated automatically from the image. This way, the method is made robust and essentially free of parameter tuning. We report results on mammograms from two databases and show that the detection performance can be improved by first including a normalisation scheme.

Impact of use of hormone replacement therapy on false positive recall in the NHS breast screening programme: results from the million women study

About half of the women attending the NHS breast screening programme have used hormone replacement therapy.1 Although previous studies have reported that use of hormone replacement therapy increases the risk of being recalled after mammography for further assessment, with no subsequent diagnosis of breast cancer (“false positive recall”), the effect of different patterns of use is unclear.2 Relative risk of false positive recall in postmenopausal women in relation to time since last use of hormone replacement therapy. (Relative risk compared with never users (1057/44 427 recalled) stratified by screening centre, age, previous screening, body mass index, previous breast operation, and time since menopause in: current users of hormone replacement therapy (relative risk 1.64, 95% confidence interval 1.50 to 1.80; 1157/28 634 recalled); past users ceasing use <1 year ago (1.42, 1.08 to 1.86; 63/1758 recalled), 1-4 years ago (1.23, 1.04 to 1.46; 176/5910 recalled), and ≥5 years ago (1.07, 0.85 to 1.34; 92/3800 recalled)). Results are plotted according to the median number of years since last use of hormone replacement therapy in each of these categories From June 1996 to March 1998, 87 967 postmenopausal women aged 50-64 invited to routine …

DETERMINING CORRESPONDENCE BETWEEN VIEWS

Two-view breast screening using cranio-caudal (CC) and medio-lateral oblique (MLO) mammograms has been shown to detect more cancers and lead to less women being recalled to assessment [11], [12] than one-view screening. However, matching signs between two views of the same breast can be a difficult task due to the changing geometry and, crucially, the effects of breast compression. If it were only the geometry that were changing the matching problem would reduce to being one of wide-angle stereo [1]. In this paper we develop a model-based method for finding a curve in the medio-lateral oblique mammogram which corresponds to the potential positions of a point marked in the cranio-caudal mammogram. A more mathematical version of this paper is in [7]. Related work on this problem [10], [9] does not explicitly consider compression. However, work on analysis of stomach x-rays [6] has shown the possibilities of modelling 3D deformations using a model-based approach.

Ultrasound estimation of breast tissue biomechanical properties using a similarity-based non-linear optimization approach

The in vivo estimation of tissue elasticity parameters is important for realistic tissue deformation modelling and diagnosis tasks such as cancer mass detection and characterization. Elastography (strain imaging) provides non-quantitative information about tissue stiffness and is becoming well established clinically. Acoustic radiation force imaging, supersonic shear wave imaging and (Youngs) modulus imaging are all evolving as quantitative methods. This paper concerns the latter. The established approach to Youngs modulus reconstruction involves solving the so-called inverse elasticity problem of recovering elastic parameters by comparing the displacement field from the measurements and the theoretical tissue deformation modelling. In this paper, a new modulus imaging pathway is proposed in which the inverse problem of elasticity reconstruction has been converted into a global optimization problem involving an image similarity measure. This approach is applied to ultrasound images and the tissue elasticity distribution is recovered by adaptively adding new regions based on the local mismatch of the images using a multiscaled split-and-merge approach. For this experimental evaluation of the performance of the proposed method, first synthetic images are used with different Gaussian noise levels. The reconstructed elasticity shows good agreement with the ground-truth. A comparison of the proposed method with a conventional displacement-based method is made using a gelatine phantom. The results using both methods agree remarkably well with the theoretical prediction. A further in vivo study on 19 breast cancer masses was performed. The present method estimated an elasticity contrast of 6.41 ± 0.98 between cancerous tissue and normal tissue, which is consistent with values reported elsewhere in the literature.

MRI-Mammography 2D/3D Data Fusion for Breast Pathology Assessment

Increasing use is being made of contrast-enhanced Magnetic Resonance Imaging (Gd-DTPA) for breast cancer assessment since it provides 3D functional information via pharmacokinetic interaction between contrast agent and tumour vascularity, and because it is applicable to women of all ages. Contrast-enhanced MRI (CE-MRI) is complimentary to conventional X-ray mammography since it is a relatively low-resolution functional counterpart of a comparatively high-resolution 2D structural representation. However, despite the additional information provided by MRI, mammography is still an extremely important diagnostic imaging modality, particularly for several common conditions such as ductal carcinoma in-situ (DCIS) where it has been shown that there is a strong correlation between microcalcification clusters and malignancy [1]. Pathological indicators such as calcifications and fine spiculations are not visible in CE-MRI and therefore there is clinical and diagnostic value to fusing the high-resolution structural information available from mammography with the functional data acquired from MRI imaging. This paper presents a novel data fusion technique whereby medio-lateral (ML) and cranio-caudal (CC) mammograms (2D data) are registered to 3D contrast-enhanced MRI volumes. We utilise a combination of pharmacokinetic modelling, projection geometry, wavelet-based landmark detection and thin-plate spline non-rigid registration to transform the coordinates of regions of interest (ROIs) from the 2D mammograms to the spatial reference frame of the contrast-enhanced MRI volume.

Women doctors' use of hormone replacement therapy. High prevalence of use is not confined to doctors.

# High prevalence of use is not confined to doctors {#article-title-2} EDITOR,—A J Isaacs and colleagues report high rates of use of hormone replacement therapy among a sample of women doctors.1 They note the relative paucity of information regarding the prevalence of use and remark that this high rate among female doctors may “presage more widespread use in the general population.” We carried out a survey of use of hormone replacement …

SLIP IMAGING: REDUCING AMBIGUITY IN BREAST LESION ASSESSMENT

Ultrasound elasticity imaging (elastography) is gaining popularity as an adjunct to B-mode ultrasound for breast cancer diagnosis. Cancerous masses are usually stiffer than normal tissue, hence, using elasticity imaging should lead to better differentiation between benign and malignant masses than using B-mode alone. Clinicians assess the mobility of masses on palpation; cancers usually being less mobile. We introduce a method to estimate mobility, called slip imaging and combine it with conventional B-mode and elasticity data. In the reported evaluation on 70 women recalled to a breast assessment clinic, images were scored by three breast radiologists independently. Diagnostic accuracy increased from 75.7% with B-mode alone, to 78.1% when including elasticity imaging, to 80.0% when further including slip imaging. Specificity increased (74.6%:75.4%:82.5% respectively), with an apparent trade-off in sensitivity (77.1%:81.3%:77.1%). We conclude that Slip imaging is potentially a useful adjunct to B-mode and elasticity imaging and should undergo further research and development.