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J-Y Seror F Scetbon B Sheuer-Niro C Ghenassia-vidal L Rousseau Cabinet de Radiologie Paris 6

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J-Y Seror F Scetbon B Sheuer-Niro C Ghenassia-vidal L Rousseau Cabinet de Radiologie Paris 6

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    5. Évaluation de la densité mammaire Leborgne précurseur en 1953 (Uruguay)  Wolfe  1976 Boyd 1980 Tabar 1997  Bi Rads ACR 2000 ………

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    16. : Cancer Epidemiol Biomarkers Prev. 2003 Aug;12(8):728-32.   Wolfe's parenchymal pattern and percentage of the breast with mammographic densities: redundant or complementary classifications? Brisson J, Diorio C, Masse B. Population Health Research Unit and Breast Centre, Centre hospitalier affilie universitaire de Quebec, Quebec, Quebec G1S 4L8, Canada. jbrisson@uresp.ulaval.ca Mammographic breast densities are one of the strongest breast cancer risk factors. The two most frequently used classifications of breast densities are Wolfe's parenchymal pattern and the percentage of the breast with densities. In this analysis, associations of these two classifications with breast cancer risk were compared, and the dose response curve of risk with densities was examined. Three case-control studies were combined totaling 1060 cases with newly diagnosed breast cancer and 2352 controls. A single observer had assessed parenchymal pattern and percent density without any information on subjects. Relative risks (RRs) were estimated with logistic regression and spline functions adjusting for age and body weight. The two classifications were strongly correlated (r = 0.81, P = 0.0001). Breast cancer risk increased progressively with percent density reaching a 5-6-fold increase for women with 85% or more of the breast with densities compared with women with no density. In contrast, women with P2 or DY patterns had only a 2-3-fold increase in risk compared with women with N1 pattern. More importantly, among women with P2 or DY, RR varied substantially with percent density, whereas, among women with a given percent density, RR varied little with parenchymal pattern. Comparisons of multivariate models reveal that in the presence of parenchymal pattern, inclusion of percent density in the model improved the prediction of breast cancer risk (chi(2) = 35.5, P = 0.0082) but not the opposite (chi(2) = 1.1, P = 0.7662). These findings show that the percentage of the breast with densities provide more information on breast cancer risk than Wolfe's parenchymal patterns and that, once percent breast density is taken into account, no more information on breast cancer risk is given by assessing parenchymal pattern : Cancer Epidemiol Biomarkers Prev. 2003 Aug;12(8):728-32.   Wolfe's parenchymal pattern and percentage of the breast with mammographic densities: redundant or complementary classifications?

    17. : Cancer Epidemiol Biomarkers Prev. 2003 Aug;12(8):728-32.   Wolfe's parenchymal pattern and percentage of the breast with mammographic densities: redundant or complementary classifications? Brisson J, Diorio C, Masse B. Population Health Research Unit and Breast Centre, Centre hospitalier affilie universitaire de Quebec, Quebec, Quebec G1S 4L8, Canada. jbrisson@uresp.ulaval.ca Mammographic breast densities are one of the strongest breast cancer risk factors. The two most frequently used classifications of breast densities are Wolfe's parenchymal pattern and the percentage of the breast with densities. In this analysis, associations of these two classifications with breast cancer risk were compared, and the dose response curve of risk with densities was examined. Three case-control studies were combined totaling 1060 cases with newly diagnosed breast cancer and 2352 controls. A single observer had assessed parenchymal pattern and percent density without any information on subjects. Relative risks (RRs) were estimated with logistic regression and spline functions adjusting for age and body weight. The two classifications were strongly correlated (r = 0.81, P = 0.0001). Breast cancer risk increased progressively with percent density reaching a 5-6-fold increase for women with 85% or more of the breast with densities compared with women with no density. In contrast, women with P2 or DY patterns had only a 2-3-fold increase in risk compared with women with N1 pattern. More importantly, among women with P2 or DY, RR varied substantially with percent density, whereas, among women with a given percent density, RR varied little with parenchymal pattern. Comparisons of multivariate models reveal that in the presence of parenchymal pattern, inclusion of percent density in the model improved the prediction of breast cancer risk (chi(2) = 35.5, P = 0.0082) but not the opposite (chi(2) = 1.1, P = 0.7662). These findings show that the percentage of the breast with densities provide more information on breast cancer risk than Wolfe's parenchymal patterns and that, once percent breast density is taken into account, no more information on breast cancer risk is given by assessing parenchymal pattern : Cancer Epidemiol Biomarkers Prev. 2003 Aug;12(8):728-32.   Wolfe's parenchymal pattern and percentage of the breast with mammographic densities: redundant or complementary classifications?

    22. Le risque relatif entre les seins de densités extrêmes :45000 femmes étude randomisée multicentrique RR 6.05 (IC 95% : 2.82-12.97) J Natl Cancer Inst. 1995 May 3;87(9):670-5. Related Articles, Links Quantitative classification of mammographic densities and breast cancer risk: results from the Canadian National Breast Screening Study. Boyd NF, Byng JW, Jong RA, Fishell EK, Little LE, Miller AB, Lockwood GA, Tritchler DL, Yaffe MJ. Division of Preventive Oncology, Ontario Cancer Treatment and Research Foundation, Toronto, Canada. BACKGROUND: The radiographic appearance of the female breast varies from woman to woman depending on the relative amounts of fat and connective and epithelial tissues present. Variations in the mammographic density of breast tissue are referred to as the parenchymal pattern of the breast. Fat is radiologically translucent or clear (darker appearance), and both connective and epithelial tissues are radiologically dense (lighter appearance). Previous studies have generally supported an association between parenchymal patterns and breast cancer risk (greater risk with increasing densities), but there has been considerable heterogeneity in risk estimates reported. PURPOSE: Our objective was to determine the level of breast cancer risk associated with varying mammographic densities by quantitatively classifying breast density with conventional radiological methods and novel computer-assisted methods. METHODS: From the medical records of a cohort of 45,000 women assigned to mammography in the Canadian National Breast Cancer Screening Study (NBSS), a multicenter, randomized trial, mammograms from 354 case subjects and 354 control subjects were identified. Case subjects were selected from those women in whom histologically verified invasive breast cancer had developed 12 months or more after entering the trial. Control subjects were selected from those of similar age who, after a similar period of observation, had not developed breast cancer. The mammogram taken at the beginning of the NBSS was the image used for measurements. Mammograms were classified into six categories of density, either by radiologists or by computer-assisted measurements. All radiological classification and computer-assisted measurements were made using one craniocaudal view from the breast contralateral to the cancer site in case subjects and the corresponding breast of control subjects. All P values represent two-sided tests of statistical significance. RESULTS: For all subjects, there was a 43% increase in the relative risk (RR) between the lower and the next higher category of density, as determined by radiologists, and there was a 32% increase as determined by the computer-assisted method. For all subjects, the RR in the most extensive category relative to the least was 6.05 (95% confidence interval [CI] = 2.82-12.97) for radiologists and 4.04 (95% CI = 2.12-7.69) for computer-assisted methods. Statistically significant increases in breast cancer risk associated with increasing mammographic density were found by both radiologists and computer-assisted methods for women in the age category 40-49 years (P = .005 for radiologists and P = .003 for computer-assisted measurements) and the age category 50-59 years (P = .002 for radiologists and P = .001 for computer-assisted measurements). CONCLUSION: These results show that increases in the level of breast tissue density as assessed by mammography are associated with increases in risk for breast cancer. J Natl Cancer Inst. 1995 May 3;87(9):670-5. Related Articles, Links Quantitative classification of mammographic densities and breast cancer risk: results from the Canadian National Breast Screening Study. Boyd NF, Byng JW, Jong RA, Fishell EK, Little LE, Miller AB, Lockwood GA, Tritchler DL, Yaffe MJ. Division of Preventive Oncology, Ontario Cancer Treatment and Research Foundation, Toronto, Canada. BACKGROUND: The radiographic appearance of the female breast varies from woman to woman depending on the relative amounts of fat and connective and epithelial tissues present. Variations in the mammographic density of breast tissue are referred to as the parenchymal pattern of the breast. Fat is radiologically translucent or clear (darker appearance), and both connective and epithelial tissues are radiologically dense (lighter appearance). Previous studies have generally supported an association between parenchymal patterns and breast cancer risk (greater risk with increasing densities), but there has been considerable heterogeneity in risk estimates reported. PURPOSE: Our objective was to determine the level of breast cancer risk associated with varying mammographic densities by quantitatively classifying breast density with conventional radiological methods and novel computer-assisted methods. METHODS: From the medical records of a cohort of 45,000 women assigned to mammography in the Canadian National Breast Cancer Screening Study (NBSS), a multicenter, randomized trial, mammograms from 354 case subjects and 354 control subjects were identified. Case subjects were selected from those women in whom histologically verified invasive breast cancer had developed 12 months or more after entering the trial. Control subjects were selected from those of similar age who, after a similar period of observation, had not developed breast cancer. The mammogram taken at the beginning of the NBSS was the image used for measurements. Mammograms were classified into six categories of density, either by radiologists or by computer-assisted measurements. All radiological classification and computer-assisted measurements were made using one craniocaudal view from the breast contralateral to the cancer site in case subjects and the corresponding breast of control subjects. All P values represent two-sided tests of statistical significance. RESULTS: For all subjects, there was a 43% increase in the relative risk (RR) between the lower and the next higher category of density, as determined by radiologists, and there was a 32% increase as determined by the computer-assisted method. For all subjects, the RR in the most extensive category relative to the least was 6.05 (95% confidence interval [CI] = 2.82-12.97) for radiologists and 4.04 (95% CI = 2.12-7.69) for computer-assisted methods. Statistically significant increases in breast cancer risk associated with increasing mammographic density were found by both radiologists and computer-assisted methods for women in the age category 40-49 years (P = .005 for radiologists and P = .003 for computer-assisted measurements) and the age category 50-59 years (P = .002 for radiologists and P = .001 for computer-assisted measurements). CONCLUSION: These results show that increases in the level of breast tissue density as assessed by mammography are associated with increases in risk for breast cancer. J Natl Cancer Inst. 1995 May 3;87(9):670-5. Related Articles, Links Quantitative classification of mammographic densities and breast cancer risk: results from the Canadian National Breast Screening Study. Boyd NF, Byng JW, Jong RA, Fishell EK, Little LE, Miller AB, Lockwood GA, Tritchler DL, Yaffe MJ. Division of Preventive Oncology, Ontario Cancer Treatment and Research Foundation, Toronto, Canada. BACKGROUND: The radiographic appearance of the female breast varies from woman to woman depending on the relative amounts of fat and connective and epithelial tissues present. Variations in the mammographic density of breast tissue are referred to as the parenchymal pattern of the breast. Fat is radiologically translucent or clear (darker appearance), and both connective and epithelial tissues are radiologically dense (lighter appearance). Previous studies have generally supported an association between parenchymal patterns and breast cancer risk (greater risk with increasing densities), but there has been considerable heterogeneity in risk estimates reported. PURPOSE: Our objective was to determine the level of breast cancer risk associated with varying mammographic densities by quantitatively classifying breast density with conventional radiological methods and novel computer-assisted methods. METHODS: From the medical records of a cohort of 45,000 women assigned to mammography in the Canadian National Breast Cancer Screening Study (NBSS), a multicenter, randomized trial, mammograms from 354 case subjects and 354 control subjects were identified. Case subjects were selected from those women in whom histologically verified invasive breast cancer had developed 12 months or more after entering the trial. Control subjects were selected from those of similar age who, after a similar period of observation, had not developed breast cancer. The mammogram taken at the beginning of the NBSS was the image used for measurements. Mammograms were classified into six categories of density, either by radiologists or by computer-assisted measurements. All radiological classification and computer-assisted measurements were made using one craniocaudal view from the breast contralateral to the cancer site in case subjects and the corresponding breast of control subjects. All P values represent two-sided tests of statistical significance. RESULTS: For all subjects, there was a 43% increase in the relative risk (RR) between the lower and the next higher category of density, as determined by radiologists, and there was a 32% increase as determined by the computer-assisted method. For all subjects, the RR in the most extensive category relative to the least was 6.05 (95% confidence interval [CI] = 2.82-12.97) for radiologists and 4.04 (95% CI = 2.12-7.69) for computer-assisted methods. Statistically significant increases in breast cancer risk associated with increasing mammographic density were found by both radiologists and computer-assisted methods for women in the age category 40-49 years (P = .005 for radiologists and P = .003 for computer-assisted measurements) and the age category 50-59 years (P = .002 for radiologists and P = .001 for computer-assisted measurements). CONCLUSION: These results show that increases in the level of breast tissue density as assessed by mammography are associated with increases in risk for breast cancer. J Natl Cancer Inst. 1995 May 3;87(9):670-5. Related Articles, Links

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    25. Mammographie et statut ménopausique

    26. La sensibilité du mammography moderne est la plus haute parmi des femmes âgées 50 ans et plus vieux qui ont principalement la densité grasse de sein. La sensibilité est la plus basse parmi des femmes plus jeune que 50 ans et particulièrement bas quand le temps entre les criblages est environ 2 ans ou quand les femmes ont des antécédents familiaux de cancer de sein, probablement en raison de la croissance rapide de tumeur.: JAMA. 1996 Jul 3;276(1):33-8. Related Articles, Links Comment in: JAMA. 1996 Jul 3;276(1):73-4. JAMA. 1996 Nov 13;276(18):1470; author reply 1470-1. Effect of age, breast density, and family history on the sensitivity of first screening mammography. Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Department of Epidemiology and Biostatistics, University of California, San Francisco, USA. OBJECTIVE--To determine factors that influence the sensitivity of modern first screening mammography. DESIGN--Cross-sectional. SETTING--Nine counties in northern California. PARTICIPANTS--A total of 28 271 women aged 30 years and older referred for first screening mammography to the Mobile Mammography Screening Program of the University of California, San Francisco, from April 1985 to March 1992, of whom 238 were subsequently diagnosed as having breast cancer. MEASUREMENTS--Breast cancer risk profile, 2 standard mammographic views per breast, breast density, and follow-up of abnormal and normal mammography by contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results tumor registry to determine the occurrence of any invasive cancer or ductal carcinoma in situ. RESULTS--For women aged 50 years and older, the sensitivity of first screening mammography was relatively high and decreased slightly with increasing length of follow-up after mammography: 98.5% for 7 months of follow-up, 93.2% for 13 months, and 85.7% for 25 months. Sensitivity was higher among women aged 50 years and older when breast density was primarily fatty rather than primarily dense (98.4% vs 83.7%; P < .01). For women younger than 50 years, the sensitivity of first screening mammography also decreased with increasing length of follow-up but was significantly lower than for older women: 87.5% for 7 months of follow-up, 83.6% for 13 months, and 71.4% for 25 months. For women younger than 50 years, breast density did not affect the sensitivity of mammography (81.8% for those with primarily fatty breasts vs 85.4% for those with primarily dense breasts) and was lower among those with a family history of breast cancer (68.8%). CONCLUSIONS--The sensitivity of modern mammography is highest among women aged 50 years and older who have primarily fatty breast density. Sensitivity is lowest among women younger than 50 years and particularly low when the time between screenings is about 2 years or when women have a family history of breast cancer, possibly because of rapid tumor growth 40–49 50-59 60-69 >70 Type 1 2,6 0 7 12,9 Type 2 18 46 51,2 51,6 Type 3 59 48,7 39,5 35,5 Type 4 20,5 5,4 2,3 0La sensibilité du mammography moderne est la plus haute parmi des femmes âgées 50 ans et plus vieux qui ont principalement la densité grasse de sein. La sensibilité est la plus basse parmi des femmes plus jeune que 50 ans et particulièrement bas quand le temps entre les criblages est environ 2 ans ou quand les femmes ont des antécédents familiaux de cancer de sein, probablement en raison de la croissance rapide de tumeur.: JAMA. 1996 Jul 3;276(1):33-8. Related Articles, Links

    27. Involution mammaire : début 30-35 ans et jusqu’à 50 ans. Avant 50 ans 60% de seins denses Après 50 ans 63 % des seins clairs Après 70 ans 30% de seins denses sans THS (75 – 79 ans 6% de seins denses)

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    29. Régime alimentaire et Densité mammaire

    30. Répartition des graisses et Densité mammaire

    31. Liens familiaux et Densité mammaire

    32. Liens familiaux et Densité mammaire

    33. Liens familiaux et Densité mammaire

    34. Liens familiaux et Densité mammaire

    35. Facteurs de risques histologiques et densité mammaire J Natl Cancer Inst. 1992 Aug 5;84(15):1170-9. Related Articles, Links Relationship between mammographic and histological risk factors for breast cancer. Boyd NF, Jensen HM, Cooke G, Han HL. Division of Epidemiology and Statistics, Ontario Cancer Institute, Canada. BACKGROUND: Information on breast cancer risk can be obtained both from the histological appearance of the breast epithelium in biopsy specimens and from the pattern of parenchymal densities in the breast revealed by mammography. It is not understood, however, how parenchymal densities influence breast cancer risk or whether these densities are associated with histological risk factors. PURPOSE: We have estimated, in a large cohort of women, the relative risk of detecting carcinoma in situ, atypical hyperplasia, hyperplasia without atypia, or nonproliferative disease in biopsy specimens from women with different extents of mammographic density. We also examined the association between these histological classifications and radiological features present specifically at the biopsy site. METHODS: The source of study material was a population of women aged 40-49 years who were enrolled in the Canadian National Breast Screening Study (NBSS). Mammograms from women who had undergone a biopsy (n = 441) and from a comparison group of women (n = 501) randomly selected from the mammography arm of the NBSS were classified according to the extent of mammographic density. The corresponding histological slides were independently classified by a review pathologist. RESULTS: Compared with women showing no mammographic densities, women with the most extensive densities (i.e., occupying greater than 75% of the breast volume) had a 9.7 times greater risk of developing carcinoma in situ or atypical hyperplasia (95% confidence interval [CI] = 1.75-53.97), a 12.2 times greater risk of developing hyperplasia without atypia (95% CI = 2.97-50.14), and a 3.1 times greater risk of developing non-proliferative disease (95% CI = 1.20-8.11). The gradients in risk were not monotonic across the five classifications of mammographic density. The association could not be explained by the presence of mammographic densities at the biopsy site, but calcification at the biopsy site was strongly associated with high-risk histological changes (relative risk = 24; 95% CI = 5.0-156.0). CONCLUSIONS: These results suggest that the radiological patterns referred to as mammographic dysplasia may influence breast cancer risk by virtue of their association with high-risk histological changes in the breast epithelium. IMPLICATIONS: Identification of the factors responsible for high-risk histological changes may offer new insights into the etiology of breast cancer and potentially lead to the development of methods for its prevention. J Natl Cancer Inst. 1992 Aug 5;84(15):1170-9. Related Articles, Links

    36. Facteurs de risques histologiques et densité mammaire

    37. Facteurs de prolifération biologique et densité mammaire

    39. La sensibilité du mammography moderne est la plus haute parmi des femmes âgées 50 ans et plus vieux qui ont principalement la densité grasse de sein. La sensibilité est la plus basse parmi des femmes plus jeune que 50 ans et particulièrement bas quand le temps entre les criblages est environ 2 ans ou quand les femmes ont des antécédents familiaux de cancer de sein, probablement en raison de la croissance rapide de tumeur.: JAMA. 1996 Jul 3;276(1):33-8. Related Articles, Links Comment in: JAMA. 1996 Jul 3;276(1):73-4. JAMA. 1996 Nov 13;276(18):1470; author reply 1470-1. Effect of age, breast density, and family history on the sensitivity of first screening mammography. Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Department of Epidemiology and Biostatistics, University of California, San Francisco, USA. OBJECTIVE--To determine factors that influence the sensitivity of modern first screening mammography. DESIGN--Cross-sectional. SETTING--Nine counties in northern California. PARTICIPANTS--A total of 28 271 women aged 30 years and older referred for first screening mammography to the Mobile Mammography Screening Program of the University of California, San Francisco, from April 1985 to March 1992, of whom 238 were subsequently diagnosed as having breast cancer. MEASUREMENTS--Breast cancer risk profile, 2 standard mammographic views per breast, breast density, and follow-up of abnormal and normal mammography by contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results tumor registry to determine the occurrence of any invasive cancer or ductal carcinoma in situ. RESULTS--For women aged 50 years and older, the sensitivity of first screening mammography was relatively high and decreased slightly with increasing length of follow-up after mammography: 98.5% for 7 months of follow-up, 93.2% for 13 months, and 85.7% for 25 months. Sensitivity was higher among women aged 50 years and older when breast density was primarily fatty rather than primarily dense (98.4% vs 83.7%; P < .01). For women younger than 50 years, the sensitivity of first screening mammography also decreased with increasing length of follow-up but was significantly lower than for older women: 87.5% for 7 months of follow-up, 83.6% for 13 months, and 71.4% for 25 months. For women younger than 50 years, breast density did not affect the sensitivity of mammography (81.8% for those with primarily fatty breasts vs 85.4% for those with primarily dense breasts) and was lower among those with a family history of breast cancer (68.8%). CONCLUSIONS--The sensitivity of modern mammography is highest among women aged 50 years and older who have primarily fatty breast density. Sensitivity is lowest among women younger than 50 years and particularly low when the time between screenings is about 2 years or when women have a family history of breast cancer, possibly because of rapid tumor growth 40–49 50-59 60-69 >70 Type 1 2,6 0 7 12,9 Type 2 18 46 51,2 51,6 Type 3 59 48,7 39,5 35,5 Type 4 20,5 5,4 2,3 0La sensibilité du mammography moderne est la plus haute parmi des femmes âgées 50 ans et plus vieux qui ont principalement la densité grasse de sein. La sensibilité est la plus basse parmi des femmes plus jeune que 50 ans et particulièrement bas quand le temps entre les criblages est environ 2 ans ou quand les femmes ont des antécédents familiaux de cancer de sein, probablement en raison de la croissance rapide de tumeur.: JAMA. 1996 Jul 3;276(1):33-8. Related Articles, Links

    40. Les faux négatif des cancers de l’intervalle Les cancers de l’intervalle avec signaux à minima Les cancers occultes : non visibles sur la mammographie réalisée au moment du diagnostic, même rétrospectivement. Les cancers de l’intervalle vrai Le cancer d’intervalle

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    43. Faux cancer d’intervalle Insuffisance technique + Erreur d’interprétation

    44. Tabar [i] a rappelé l’intérêt de la surveillance annuelle. Il a évalué à 30% la réduction de la mortalité par le dépistage tous les deux ans dans le groupe d’âge 50-74 ans et 13 % dans le groupe 40-49 ans. La faible impact sur la mortalité du dépistage dans le groupe 40-49 ans est du à la progression rapide de la tumeur ( temps d’expression clinique (T1-T0) d’une tumeur du sein augmente avec l’âge 40 - 49 = 2.4 ans, 50 - 59 = 3.7 ans, 60 - 69 = 4.2 ans, et 70-79 = 4 ans) Il estime qu’un contrôle annuel dans ce groupe 40-49 ans pourrait réduire la mortalité de 19%. L’American Cancer Society dans sa mise à jour 2003 rappelle l’intérêt d’un contrôle mammographique annuel à partie de 40 ans chez les femmes sans facteur de risque en pré ménopause de moins de 55 ans[ii],[iii]. Cette recommandation trouve tout son intérêt dans ce groupe d’âge (40-55 ans) avec des seins plus denses ( facteur de risque indépendant), des tumeurs avec un développement plus rapide et une sensibilité de la mammographie moindre .L’utilisation de l’échographie pour l’exploration de seins denses doit être fréquente (1/3 des cas de mammographie à notre avis(à condition qu’elle soit réalisée avec des appareils avec sonde de haute fréquence,) réalisée au cours de la même séance que la mammographie (le radiologue doit décider de l’intérêt ou non de réaliser une échographie en fonction de la densité mammaire) mais en gardant à l’esprit le risque délétère de cette technique par ses faux positifs. [i] Tabár L, Vitak B, Chen HH, et al. The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up. Radiol Clin North Am 2000;38: 625–651   [ii] Michaelson J, Satija S, Moore R, et al. The pattern of breast cancer screening utilization and its consequences. Cancer 2002;94:37–43.   [iii] American Cancer Society Guidelines for Breast Cancer Screening: Update 2003 CA Cancer J Clin 2003; 53:141-169 ; 2003 American Cancer Society   Tabar [i] a rappelé l’intérêt de la surveillance annuelle. Il a évalué à 30% la réduction de la mortalité par le dépistage tous les deux ans dans le groupe d’âge 50-74 ans et 13 % dans le groupe 40-49 ans. La faible impact sur la mortalité du dépistage dans le groupe 40-49 ans est du à la progression rapide de la tumeur ( temps d’expression clinique (T1-T0) d’une tumeur du sein augmente avec l’âge 40 - 49 = 2.4 ans, 50 - 59 = 3.7 ans, 60 - 69 = 4.2 ans, et 70-79 = 4 ans) Il estime qu’un contrôle annuel dans ce groupe 40-49 ans pourrait réduire la mortalité de 19%. L’American Cancer Society dans sa mise à jour 2003 rappelle l’intérêt d’un contrôle mammographique annuel à partie de 40 ans chez les femmes sans facteur de risque en pré ménopause de moins de 55 ans[ii],[iii]. Cette recommandation trouve tout son intérêt dans ce groupe d’âge (40-55 ans) avec des seins plus denses ( facteur de risque indépendant), des tumeurs avec un développement plus rapide et une sensibilité de la mammographie moindre .L’utilisation de l’échographie pour l’exploration de seins denses doit être fréquente (1/3 des cas de mammographie à notre avis(à condition qu’elle soit réalisée avec des appareils avec sonde de haute fréquence,) réalisée au cours de la même séance que la mammographie (le radiologue doit décider de l’intérêt ou non de réaliser une échographie en fonction de la densité mammaire) mais en gardant à l’esprit le risque délétère de cette technique par ses faux positifs.

    45. La sensibilité du mammography moderne est la plus haute parmi des femmes âgées 50 ans et plus vieux qui ont principalement la densité grasse de sein. La sensibilité est la plus basse parmi des femmes plus jeune que 50 ans et particulièrement bas quand le temps entre les criblages est environ 2 ans ou quand les femmes ont des antécédents familiaux de cancer de sein, probablement en raison de la croissance rapide de tumeur.: JAMA. 1996 Jul 3;276(1):33-8. Related Articles, Links Comment in: JAMA. 1996 Jul 3;276(1):73-4. JAMA. 1996 Nov 13;276(18):1470; author reply 1470-1. Effect of age, breast density, and family history on the sensitivity of first screening mammography. Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Department of Epidemiology and Biostatistics, University of California, San Francisco, USA. OBJECTIVE--To determine factors that influence the sensitivity of modern first screening mammography. DESIGN--Cross-sectional. SETTING--Nine counties in northern California. PARTICIPANTS--A total of 28 271 women aged 30 years and older referred for first screening mammography to the Mobile Mammography Screening Program of the University of California, San Francisco, from April 1985 to March 1992, of whom 238 were subsequently diagnosed as having breast cancer. MEASUREMENTS--Breast cancer risk profile, 2 standard mammographic views per breast, breast density, and follow-up of abnormal and normal mammography by contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results tumor registry to determine the occurrence of any invasive cancer or ductal carcinoma in situ. RESULTS--For women aged 50 years and older, the sensitivity of first screening mammography was relatively high and decreased slightly with increasing length of follow-up after mammography: 98.5% for 7 months of follow-up, 93.2% for 13 months, and 85.7% for 25 months. Sensitivity was higher among women aged 50 years and older when breast density was primarily fatty rather than primarily dense (98.4% vs 83.7%; P < .01). For women younger than 50 years, the sensitivity of first screening mammography also decreased with increasing length of follow-up but was significantly lower than for older women: 87.5% for 7 months of follow-up, 83.6% for 13 months, and 71.4% for 25 months. For women younger than 50 years, breast density did not affect the sensitivity of mammography (81.8% for those with primarily fatty breasts vs 85.4% for those with primarily dense breasts) and was lower among those with a family history of breast cancer (68.8%). CONCLUSIONS--The sensitivity of modern mammography is highest among women aged 50 years and older who have primarily fatty breast density. Sensitivity is lowest among women younger than 50 years and particularly low when the time between screenings is about 2 years or when women have a family history of breast cancer, possibly because of rapid tumor growth 40–49 50-59 60-69 >70 Type 1 2,6 0 7 12,9 Type 2 18 46 51,2 51,6 Type 3 59 48,7 39,5 35,5 Type 4 20,5 5,4 2,3 0La sensibilité du mammography moderne est la plus haute parmi des femmes âgées 50 ans et plus vieux qui ont principalement la densité grasse de sein. La sensibilité est la plus basse parmi des femmes plus jeune que 50 ans et particulièrement bas quand le temps entre les criblages est environ 2 ans ou quand les femmes ont des antécédents familiaux de cancer de sein, probablement en raison de la croissance rapide de tumeur.: JAMA. 1996 Jul 3;276(1):33-8. Related Articles, Links

    46. La sensibilité du mammography moderne est la plus haute parmi des femmes âgées 50 ans et plus vieux qui ont principalement la densité grasse de sein. La sensibilité est la plus basse parmi des femmes plus jeune que 50 ans et particulièrement bas quand le temps entre les criblages est environ 2 ans ou quand les femmes ont des antécédents familiaux de cancer de sein, probablement en raison de la croissance rapide de tumeur.: JAMA. 1996 Jul 3;276(1):33-8. Related Articles, Links Comment in: JAMA. 1996 Jul 3;276(1):73-4. JAMA. 1996 Nov 13;276(18):1470; author reply 1470-1. Effect of age, breast density, and family history on the sensitivity of first screening mammography. Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Department of Epidemiology and Biostatistics, University of California, San Francisco, USA. OBJECTIVE--To determine factors that influence the sensitivity of modern first screening mammography. DESIGN--Cross-sectional. SETTING--Nine counties in northern California. PARTICIPANTS--A total of 28 271 women aged 30 years and older referred for first screening mammography to the Mobile Mammography Screening Program of the University of California, San Francisco, from April 1985 to March 1992, of whom 238 were subsequently diagnosed as having breast cancer. MEASUREMENTS--Breast cancer risk profile, 2 standard mammographic views per breast, breast density, and follow-up of abnormal and normal mammography by contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results tumor registry to determine the occurrence of any invasive cancer or ductal carcinoma in situ. RESULTS--For women aged 50 years and older, the sensitivity of first screening mammography was relatively high and decreased slightly with increasing length of follow-up after mammography: 98.5% for 7 months of follow-up, 93.2% for 13 months, and 85.7% for 25 months. Sensitivity was higher among women aged 50 years and older when breast density was primarily fatty rather than primarily dense (98.4% vs 83.7%; P < .01). For women younger than 50 years, the sensitivity of first screening mammography also decreased with increasing length of follow-up but was significantly lower than for older women: 87.5% for 7 months of follow-up, 83.6% for 13 months, and 71.4% for 25 months. For women younger than 50 years, breast density did not affect the sensitivity of mammography (81.8% for those with primarily fatty breasts vs 85.4% for those with primarily dense breasts) and was lower among those with a family history of breast cancer (68.8%). CONCLUSIONS--The sensitivity of modern mammography is highest among women aged 50 years and older who have primarily fatty breast density. Sensitivity is lowest among women younger than 50 years and particularly low when the time between screenings is about 2 years or when women have a family history of breast cancer, possibly because of rapid tumor growth 40–49 50-59 60-69 >70 Type 1 2,6 0 7 12,9 Type 2 18 46 51,2 51,6 Type 3 59 48,7 39,5 35,5 Type 4 20,5 5,4 2,3 0La sensibilité du mammography moderne est la plus haute parmi des femmes âgées 50 ans et plus vieux qui ont principalement la densité grasse de sein. La sensibilité est la plus basse parmi des femmes plus jeune que 50 ans et particulièrement bas quand le temps entre les criblages est environ 2 ans ou quand les femmes ont des antécédents familiaux de cancer de sein, probablement en raison de la croissance rapide de tumeur.: JAMA. 1996 Jul 3;276(1):33-8. Related Articles, Links

    48. Type 1 Type 2 Type 3 Type 4 Se 88.2% 82.1% 68.9% 62.2% Sp 96.5% 93% 90.8% 89.9% Ann Intern Med. 2003 Feb 4;138(3):168-75. Related Articles, Links Erratum in: Ann Intern Med. 2003 May 6;138(9):771. Comment in: Ann Intern Med. 2003 Feb 4;138(3):I-28.   Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Carney PA, Miglioretti DL, Yankaskas BC, Kerlikowske K, Rosenberg R, Rutter CM, Geller BM, Abraham LA, Taplin SH, Dignan M, Cutter G, Ballard-Barbash R. Department of Community & Family Medicine, Dartmouth Medical School, 1 Medical Center Drive, HB 7925, Lebanon, NH 03756, USA. Patricia.A.Carney@dartmouth.edu. BACKGROUND: The relationships among breast density, age, and use of hormone replacement therapy (HRT) in breast cancer detection have not been fully evaluated. OBJECTIVE: To determine how breast density, age, and use of HRT individually and in combination affect the accuracy of screening mammography. DESIGN: Prospective cohort study. SETTING: 7 population-based mammography registries in North Carolina; New Mexico; New Hampshire; Vermont; Colorado; Seattle, Washington; and San Francisco, California. PARTICIPANTS: 329 495 women 40 to 89 years of age who had 463 372 screening mammograms from 1996 to 1998; 2223 women received a diagnosis of breast cancer. MEASUREMENTS: Breast density, age, HRT use, rate of breast cancer occurrence, and sensitivity and specificity of screening mammography. RESULTS: Adjusted sensitivity ranged from 62.9% in women with extremely dense breasts to 87.0% in women with almost entirely fatty breasts; adjusted sensitivity increased with age from 68.6% in women 40 to 44 years of age to 83.3% in women 80 to 89 years of age. Adjusted specificity increased from 89.1% in women with extremely dense breasts to 96.9% in women with almost entirely fatty breasts. In women who did not use HRT, adjusted specificity increased from 91.4% in women 40 to 44 years of age to 94.4% in women 80 to 89 years of age. In women who used HRT, adjusted specificity was about 91.7% for all ages. CONCLUSIONS: Mammographic breast density and age are important predictors of the accuracy of screening mammography. Although HRT use is not an independent predictor of accuracy, it probably affects accuracy by increasing breast density. PMID: 12558355 [PubMed - indexed for MEDLINE] Type 1 Type 2 Type 3 Type 4 Se 88.2% 82.1% 68.9% 62.2% Sp 96.5% 93% 90.8% 89.9% Ann Intern Med. 2003 Feb 4;138(3):168-75. Related Articles, Links

    49. Type 1 Type 2 Type 3 Type 4 Se 88.2% 82.1% 68.9% 62.2% Sp 96.5% 93% 90.8% 89.9% Ann Intern Med. 2003 Feb 4;138(3):168-75. Related Articles, Links Erratum in: Ann Intern Med. 2003 May 6;138(9):771. Comment in: Ann Intern Med. 2003 Feb 4;138(3):I-28.   Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Carney PA, Miglioretti DL, Yankaskas BC, Kerlikowske K, Rosenberg R, Rutter CM, Geller BM, Abraham LA, Taplin SH, Dignan M, Cutter G, Ballard-Barbash R. Department of Community & Family Medicine, Dartmouth Medical School, 1 Medical Center Drive, HB 7925, Lebanon, NH 03756, USA. Patricia.A.Carney@dartmouth.edu. BACKGROUND: The relationships among breast density, age, and use of hormone replacement therapy (HRT) in breast cancer detection have not been fully evaluated. OBJECTIVE: To determine how breast density, age, and use of HRT individually and in combination affect the accuracy of screening mammography. DESIGN: Prospective cohort study. SETTING: 7 population-based mammography registries in North Carolina; New Mexico; New Hampshire; Vermont; Colorado; Seattle, Washington; and San Francisco, California. PARTICIPANTS: 329 495 women 40 to 89 years of age who had 463 372 screening mammograms from 1996 to 1998; 2223 women received a diagnosis of breast cancer. MEASUREMENTS: Breast density, age, HRT use, rate of breast cancer occurrence, and sensitivity and specificity of screening mammography. RESULTS: Adjusted sensitivity ranged from 62.9% in women with extremely dense breasts to 87.0% in women with almost entirely fatty breasts; adjusted sensitivity increased with age from 68.6% in women 40 to 44 years of age to 83.3% in women 80 to 89 years of age. Adjusted specificity increased from 89.1% in women with extremely dense breasts to 96.9% in women with almost entirely fatty breasts. In women who did not use HRT, adjusted specificity increased from 91.4% in women 40 to 44 years of age to 94.4% in women 80 to 89 years of age. In women who used HRT, adjusted specificity was about 91.7% for all ages. CONCLUSIONS: Mammographic breast density and age are important predictors of the accuracy of screening mammography. Although HRT use is not an independent predictor of accuracy, it probably affects accuracy by increasing breast density. PMID: 12558355 [PubMed - indexed for MEDLINE] Type 1 Type 2 Type 3 Type 4 Se 88.2% 82.1% 68.9% 62.2% Sp 96.5% 93% 90.8% 89.9% Ann Intern Med. 2003 Feb 4;138(3):168-75. Related Articles, Links

    50. Circonstances de découverte : Clinique (autopalpation + examen clinique) : 52 % des cas Échographie : 22 % des cas IRM : 22 % des cas Incidence de profil : 1 cas ? Intérêt de l’examen clinique dans le dépistage

    57. Les séquences non injectées

    58. IRM et densité mammaire

    59. IRM et densité mammaire

    61. Dia 42Dia 42

    63. Salminen TM, Acta Oncol. 2000;39(8):969-72. Acta Oncol. 2000;39(8):969-72. Related Articles, Links Is a dense mammographic parenchymal pattern a contraindication to hormonal replacement therapy? Salminen TM, Saarenmaa IE, Heikkila MM, Hakama M. Tampere School of Public Health, University of Tampere, Finland. cstisa@uta.fi The aim of the study was to find out whether the effect of hormonal replacement therapy (HRT) is modified by the mammographic parenchymal patterns on the risk of breast cancer. Subjects were 4163 Finnish women aged 40-47 years at entry who were invited to breast cancer screening every second year from 1982 to 1990. Mammographic parenchymal patterns (Wolfe's classification) were recorded at each screening round. The information, on use of HRT, was recorded from 1984. The follow-up ended in 1993 and up until that time 68 new breast cancers were diagnosed. A Poisson regression model was used in the analysis of the data. Use of HRT was not related to the risk of breast cancer (RR = 0.7, 95% CI 0.4-1.4), whereas mammographic parenchymal pattern was statistically significantly associated with risk of breast cancer. The age-adjusted relative risk of breast cancer among women with P2 versus N1 pattern was 2.5 (95% CI 1.3-4.8) and with DY versus N1 pattern 4.9 (951% CI 1.6-15.1). Women using HRT and with DY pattern were at substantially increased risk of breast cancer (RR = 11.6, 95% CI 2.5-53.6) compared with women not using HRT and with N1 pattern. There was an increased risk of breast cancer among women with DY mammographic parenchymal pattern who used HRT, which was consistent with a synergistic joint effect Acta Oncol. 2000;39(8):969-72. Related Articles, Links

    64. Densité mammaire et risque de cancer du sein Marqueur de risque indépendant Effet de masque Conclusion

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