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Breast Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Breast density has direct biological relevance. The percent of mammographic density (PMD) is a well-established risk factor for BrCA; the risk increases proportionally with increasing PMD.14 In addition, tumors associated with denser breasts tend to have a poorer prognosis.15 Unfortunately, dense breasts are far more prevalent among younger women, a group that should not be screened with mammography.16
Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Depending on regulatory approval in different world regions, raloxifene is used for the treatment and prevention of osteoporosis in postmenopausal women, for the reduction of risk and treatment of invasive breast cancer, or to reduce breast density. It was first approved by the FDA to prevent and treat osteoporosis (bone thinning) in postmenopausal women based on its estrogenic effect in bone tissue. Unlike some other hormone replacement therapies, raloxifene does not reduce menopausal vasomotor symptoms. Later clinical studies showed that, taken once a day, it works almost as well as tamoxifen in lowering the relative risk of breast cancer by up to approximately 40%. It was shown to reduce breast density in postmenopausal women, a known risk factor for breast cancer. However, in comparative clinical trials it was shown to cause fewer cases of uterine cancer than tamoxifen (due to the negligible estrogenic activity in the uterus), and did not increase the risk of cataracts, a common tamoxifen side effect. Furthermore, although both groups of patients developed more blood clots in the veins and lungs compared to a control group, this side effect was more common with tamoxifen than raloxifene.
The Promise of Artificial Intelligence and Machine Learning
Published in Paul Cerrato, John Halamka, Reinventing Clinical Decision Support, 2020
Yala et al.’s retrospective analysis used risk factor information from patients’ electronic health records (EHRs) and questionnaires to develop 3 approaches to risk assessment: one used traditional risk factors and logistic regression, a second used a CNN to analyze mammogram images, and a third combined the traditional approach with the deep learning method. They found the CNN model more accurate than the TC model, by a large margin. The hybrid approach was even more accurate than the CNN model. The study concluded: “When our hybrid DL model was compared with breast density, we found that patients with non-dense breasts and model-assessed high risk had 3.9 times the cancer incidence of patients with dense breasts and model-assessed low risk.” If these findings can be confirmed with prospective trials, the implications are clinically significant. Nearly 50% of women are told they are at increased risk of breast cancer because they have dense breasts based on traditional risk scoring, and many may develop a false sense of security when told they have non-dense breasts.
Economic evaluation of supplemental breast cancer screening modalities to mammography or digital breast tomosynthesis in women with heterogeneously and extremely dense breasts and average or intermediate breast cancer risk in US healthcare
Published in Journal of Medical Economics, 2023
Michael Blankenburg, Irene Sánchez-Collado, Busayo Oladimeji Soyemi, Örjan Åkerborg, Amrit Caleyachetty, James Harris, Elizabeth Morris, Gillian Newstead, Franziska Lobig
Women with dense breasts face a “four-fold challenge” related to accurate detection of breast cancer. Firstly, greater breast density is associated with elevated cancer risk. Women with dense breasts face a 3–5-fold higher risk of developing breast cancer than those with non-dense breasts4,5. Secondly, breast malignancies are more likely to be missed with routine screening modalities, such as x-ray mammography (XM) and digital breast tomosynthesis (DBT) – due to reduced sensitivity in dense breast tissue6–9. Thirdly, while guidelines recommend supplemental screening for women with dense breasts10, there is a lack of clarity on which supplemental modalities are preferred, and there is restricted access to supplemental modalities. Finally, breast density assessment and reporting in XM is inconsistent across the USA. Currently, 38 states are required to inform women about their breast density, but which patients are informed and the type of information received is not standardized across states11. A national requirement by the FDA has been recently issued where, by 2024, all states will need to send federal density notification statements (“not dense” or “dense”) to patients12. This has the potential to enhance the low understanding of elevated risk among women with dense breasts13.
Breast cancer genetics and risk assessment: an overview for the clinician
Published in Climacteric, 2023
After advancing age, increased breast density is the most important single non-genetic risk factor for breast cancer for an individual woman [3,17,23,24]. Breast density reflects the amount of glandular breast tissue compared to adipose tissue within the breast. Breast density is a largely inherited trait, cannot be determined by physical examination and decreases with age. Mammographic breast density, as measured using the Breast Imaging Reporting and Data System (BI-RADS) classification system, defines four categories of breast density: 1 = almost entirely fat, 2 = scattered fibroglandular, 3 = heterogeneously dense, 4 = extremely dense. Both heterogeneously dense and extremely dense breasts are considered high density categories and increase breast cancer risk. Approximately 48% of women of screening age have heterogeneously dense or extremely dense breasts [25–27].
Coffee Intake Interacted with the Bcl-2 rs1944420, rs7236090, and rs2849382 Haplotype to Influence Breast Cancer Risk in Middle-Aged Women
Published in Nutrition and Cancer, 2022
Meiling Liu, Sang Shin Song, Sunmin Park
Many factors are known to affect breast cancer risks, such as childbearing patterns, height, and BMI, age at menarche and menopause, and extensive/high breast density. Both endogenous estrogen and progesterone in premenopausal women and estrogen and progestin in postmenopausal women on hormone-replacement therapy stimulate the proliferation of epithelial and stromal cells in high-density breast tissues (41). Thus, hormone-replacement therapy promotes tumorigenesis and increases breast cancer risk (41). Furthermore, age at menarche and postmenopause is significantly related to the risk of breast cancer (11), which is consistent with our results. The breast cancer incidence of postmenopausal women is significantly higher than that of premenopausal women. Contrary to the results of this study, a meta-analysis of 118,964 breast cancer cases in 117 epidemiological studies showed early menarche increases and that early menopause decreases the risk of breast cancer in European women (42). However, it was reported that menopause is associated with a higher risk of breast cancer in Asian women, but that early menopause does not prevent the risk (12), which is consistent with our observations.