Tomosynthesis reduces breast cancer screening recall rate

Main Category: Medical Devices / Diagnostics
Also Included In: Breast Cancer
Article Date: 01 Aug 2013 - 1:00 PDT Current ratings for:
Tomosynthesis reduces breast cancer screening recall rate

Digital tomosynthesis is an effective tool for reducing the recall rate in breast cancer screening, according to a new study published online in the journal Radiology.

Digital mammography is the gold standard for breast cancer screening, but may yield suspicious findings that turn out not to be cancer. These false-positive findings are associated with a higher recall rate, or the rate at which women are called back for additional imaging or biopsy.

Digital breast tomosynthesis has shown promise at reducing recall rates, particularly in younger women and in those with dense breast tissue. Tomosynthesis is similar to mammography in that it relies on ionizing radiation to generate images of the breast. However, unlike conventional mammography, tomosynthesis allows for three-dimensional (3-D) reconstruction of the breast tissue, which can then be viewed as sequential slices through the breast.

"Tomosynthesis increases the conspicuity of cancers by removing superimposed and overlapping tissue from the view," said Brian M. Haas, M.D., from Yale University School of Medicine in New Haven, Conn.

In the study, Dr. Haas worked with Liane E. Philpotts, M.D., also of Yale University, and other colleagues to compare screening recall rates and cancer detection rates in two groups of women: those who received conventional digital mammography alone and those who had tomosynthesis in addition to mammography.

Of the 13,158 patients who underwent screening mammography, 6,100 received tomosynthesis. The cancer detection rate was 5.7 per 1,000 in patients receiving tomosynthesis, compared with 5.2 per 1,000 in patients receiving mammography alone. The addition of tomosynthesis resulted in a 30 percent reduction in the overall recall rate, from 12.0 percent for mammography alone to 8.4 percent in the tomosynthesis group.

"All age groups and breast densities had reduced risk for recall in the tomosynthesis group," Dr. Haas said. "Women with dense breasts and those younger than age 50 particularly benefited from tomosynthesis."

Lower recall rates help reduce patient anxiety and also reduce costs from additional diagnostic examinations, Dr. Haas said.

Tomosynthesis has one significant drawback: a radiation dose approximately double that of digital mammography alone. However, Dr. Haas noted that new technology approved by the U.S. Food and Drug Administration could reduce the dose.

"The technology involves taking the tomosynthesis data and collapsing it into planar imaging that resembles 2-D mammography," he said. "It has the potential to eliminate the need for acquisition of the conventional 2-D images in addition to the tomosynthesis images."

The research group is currently in the process of comparing the cancers found on tomosynthesis with those found on mammography. They are also tracking the study group for interval cancers - those that develop in the interval between screenings - to make sure that the reduced recall rate associated with tomosynthesis is not resulting in missed cancers.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our medical devices / diagnostics section for the latest news on this subject.

"Comparison of Tomosynthesis Plus Digital Mammography and Digital Mammography Alone for Breast Cancer Screening." Collaborating with Drs. Haas and Philpotts were Vivek Kalra, M.D., Jaime Geisel, M.D., Madhavi Raghu, M.D., and Melissa Durand, M.D.

Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc.

RSNA is an association of more than 51,000 radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill. (RSNA.org)

For patient-friendly information on breast imaging, visit http://radiologyinfo.org.

Radiological Society of North America

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Hospital screening tool for suicide risk among self-harmers should be ditched, UK

Main Category: Mental Health
Also Included In: Psychology / Psychiatry;  Medical Devices / Diagnostics
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Hospital screening tool for suicide risk among self-harmers should be ditched, UK

A screening tool used in general hospitals to detect suicide risk among patients who have self harmed should be ditched, concludes a study published online in Emergency Medicine Journal.

The technique (SADPERSONS Scale) fails to pick up most of those who require admission to a psychiatric unit, community psychiatric aftercare, or to determine those at risk of self harming again, say the researchers.

The SADPERSONS Scale was developed in the USA in 1983 as a means of assessing suicide risk among patients who had self harmed. It is based on 10 major risk factors, but has changed little since it was first devised, say the researchers.

National guidance in England stipulates that all patients who go to hospital after an episode of self harm should be given a full psychosocial assessment. But current pressures in hospitals to meet waiting time targets, combined with a reduction in the availability of mental health services, mean that emergency care staff are increasingly minded to use rating scales to find out which patients can be discharged without a full psychosocial assessment, say the researchers.

They therefore assessed SADPERSONS scores that had been recorded for 126 patients consecutively admitted to one emergency medicine department in a major general hospital in Oxford during the summer of 2011, to see how accurate it was at predicting how these patients were subsequently managed and treated.

This included admission to a psychiatric unit, a proxy for psychosocial assessment; the provision of community psychiatric aftercare; and bouts of repeated self harm in the following six months.

Self harm was defined as any act of poisoning or injury, irrespective of its purpose. Most of the patients (102; 81%) had taken an overdose; around one in 10 (11%) had cut themselves; and the remaining 10 patients (8%) had inflicted other forms of injury on themselves.

Admission to a psychiatric unit was required in five cases (4%) and community psychiatric aftercare in just over half (55%; 70). One in four patients (24.6%) self harmed again at least once.

The SADPERSONS Scale only picked up 2% of those requiring admission to a psychiatric unit, around 6% of those needing community psychiatric aftercare, and just over 6.5% of those likely to self harm again.

The authors point out that for the purposes of suicide prevention, any technique designed to spot potential suicide risk must have a low rate of false negative results - in other words, it must be accurate and not miss most of those at risk of killing themselves.

While the small numbers of patients in this study don't allow any conclusions to be drawn about the Scale's usefulness in predicting suicide risk, the scores did not pick up very accurately those most at risk of further self harm, which is particularly associated with suicide risk, say the study authors.

Twenty three out of 31 of the episodes of self harm occurred within the first three months of the first visit to emergency care. But only two of these patients had high scores on the SADPERSONS Scale; the rest had low to moderate scores, suggesting they were not at high risk.

"The results clearly show that the SADPERSONS Scale has a very limited role, if any, to play in the assessment of patients presenting to the emergency department following an episode of self harm," write the authors.

"Indeed, arguably, our results show that reliance on the scale for determining who should receive a psychosocial assessment or otherwise using it for prediction is not only misleading, it could be dangerous," they add.

The use of rating scales has become increasingly widespread in response to the need to standardise practice for ever increasing numbers of patients. But these tools often overlook individual dynamics, they say.

"A greater focus on clinical judgement is needed, accompanied by the necessary education, training and supervision, if we are to more accurately fully identify and intervene with those who are at greatest risk following self harm," they conclude.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Should cancer screening be stopped as dementia progresses?

Main Category: Alzheimer's / Dementia
Also Included In: Cancer / Oncology;  Preventive Medicine
Article Date: 24 Jul 2013 - 0:00 PDT Current ratings for:
Should cancer screening be stopped as dementia progresses?

Research from the Regenstrief Institute and the Indiana University Center for Aging Research has found that many family caregivers of older adults with dementia are willing to consider stopping cancer screening of the elderly individual; they are also relieved when the older adult's physician brings it up.

"This openness of dementia caregivers to considering cancer screening cessation for older adults provides potential to reduce both patient burden and health care costs as well as family caregiver distress, while improving the overall quality of care for patients with dementia," said Regenstrief Institute investigator Alexia Torke, M.D., an IU Center for Aging Research scientist and an associate professor of medicine at the IU School of Medicine, who led the study. She points to other research showing that patients with serious illness such as dementia often receive cancer screening tests such as colonoscopy and mammography that may be burdensome to the patient but unlikely to be beneficial.

The researchers conducted focus groups with caregivers - from urban and suburban settings in one Midwest metropolitan area and of differing socio-economic status - attending support meetings for family members of dementia patients. The investigators found that caregivers' concerns about cancer screening for older adults with dementia targeted four areas:

Quality versus quantity of life. Burdens placed on the patient and caregiver by the screening. How to end screening. Variability of physician expertise on the risks and benefits of screening for this population.

"As dementia progresses, caregivers must take over the process of medical decision-making," Dr. Torke said. "Prior to our study, little had been known about how decisions to continue or stop screening are actually made by caregivers of family members with dementia, or if caregivers' perspectives on cancer screening were as positive as previous studies have found in other populations, including older adults."

For example, the perspective of the caregivers, who mostly favored forgoing cancer screening for older adults with dementia, differs from the perspective of older adults without cognitive impairment. A previous study conducted by the authors of this study found that adults who were not cognitively impaired viewed cancer screening as an automatic, recommended or obligatory action.

The researchers report in this new study that caregivers of people with dementia are not only willing to consider stopping cancer screening, many are relieved when physicians bring it up. Caregivers are most open to discussions of screening cessation when these discussions focus on quality of life and burdens and benefits for the person with dementia.

One caregiver said, "I was concerned about her quality of life and making sure that she was very, very comfortable, and I think that means more than putting people through a lot of unnecessary, uncomfortable ... procedures. ... It's not going to make the person better. It might make them linger on, but are you really living?"

The caregiver of another older adult said specifically of colon cancer screening, "At the point where my mother is right now, there's no way in the world I could get her to drink all that stuff and not eat. I'm thinking who's going to monitor all 24 hours a day? I can't do it. I can't do it. It's utterly impossible. So I can't send her through that and I can't go through it."

The caregivers, men and women ranging in age from 49 to 85, were primarily spouses or children of older adults with dementia.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alzheimer's / dementia section for the latest news on this subject.

The study "Caregiver perspectives on cancer screening for persons with dementia: Why put them through it?" appears July 19 online in advance of publication in the Journal of the American Geriatrics Society.

In addition to Dr. Torke, who is also a faculty member of the Fairbanks Center for Medical Ethics of IU Health, co-authors of the study are Peter H. Schwartz, M.D., Ph.D., of the IU School of Medicine and IU Center for Bioethics; Laura R. Holtz, B.S., and Kianna Montz, M.A., of the Regenstrief Institute and the IU Center for Aging Research; and Greg A. Sachs, M.D., of the Regenstrief Institute, IU School of Medicine and IU Center for Aging Research.

The study was funded by a grant (P30AG024967) from the National Institute on Aging. The content of the study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Indiana University

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