Stereotactic Core Biopsy Following Screening Mammography: A Danish Retrospective National Cohort Study

Background: Since introducing stereotactic core biopsy (SCB) on breast lesions in Denmark, no national follow-up of the procedure has been executed. Purpose: To evaluate performance of SCB in Danish mammography screening. 3 areas were selected for evaluation: diagnostic value of SCB, performance of the Danish 7-tier mamma-radiological classifications system, DKBI-RADS, and diagnostic delay for SCB-diagnosis. Materials & Methods: Danish retrospective national cohort study including 2195 screening patients undergoing SCB. Study period: 01.01.2010 to 30.09.2012. Patients were identified from The Danish National Patient Register. Pathology-data were obtained from the Danish Pathology Database. Radiological-data according to DKBI-RADS were recorded. Diagnostic delay from clinical mammography until diagnosis was registered. Results: 173 SCBs indicated cancer;all operated with 3 cases finalized as benign. 1296 cases were determined benign with diagnostic surgery in 81 cases of which 31 were concluded pre-malignant/malignant. Correlation between DKBI-RADS and pathology diagnosis: 329 of 485 DKBI-RADS3, 227 of 450 DKBI-RADS4 were benign. 4 of 16 DKBI-RADS5 were benign. The diagnostic value of pre-malignant/malignant SCB related to results from surgery showed 94.4% sensitivity and a positive predictive value of 93.9%. Median diagnostic-time of single-biopsy was 13 days. Conclusion: The performance of SCB in Denmark is comparable to international studies regarding the diagnostic value of malignant SCB. The study indicates that DKBI-RADS classifications are not used consistently regarding micro-calcifications selected in screening-mammographies. Diagnostic delay is acceptable, subject to EUSOMA specifications, regarding single-biopsy.

Timely Mammography Use among a Sample of Black American Women: A Community-Based Study

Breast cancer deaths are more common among Black American women than White women. In 2012, the Centers for Disease Control and Prevention reported that Black American women had a higher incidence rate (130.0) compared to White women (128.9). But it is the double burden of incidence and low survival that is particularly alarming (American Cancer Society, 2011). While research is underway to better understand the role that genes play, such as those that are associated with the aggressive triple negative breast cancer which is more commonly diagnosed in Black American women, there is more to learn about the utilization of the screening mammography. At the time this study was conducted the age controversy to receive a baseline screening was just beginning. The American Medical Association, the American College of Radiology, and the American Cancer Society all supported baseline screenings at age 40 but, currently the United States Preventive Services Task Force guidelines recommend biennial screening for women aged 50 to 74 years who are at average risk for breast cancer. Furthermore, mammograms are not routinely recommended for women age 40 to 49 because they are more likely to have false biopsies. We do not yet know the long-term impact of implementing a longer timeline to screen for breast cancer. Although Black American women, have narrowed the gap, they still lag behind regarding mammography screening and are more likely to be diagnosed with an aggressive form of breast cancer. This paper investigates the predictors of mammography use among a small, low-income, U.S. community-based sample of Black African American women age 42 and older.