Elena Venturini MD, Presenter: Nothing to Disclose

Elena Schiani MD, Abstract Co-Author: Nothing to Disclose

Simona Tacchini MD, Abstract Co-Author: Nothing to Disclose

Pietro Panizza MD, Abstract Co-Author: Nothing to Disclose

Mariagrazia Rodighiero MD, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

To assess the feasibility of a screening program on 40-49er women, not usually included in screening programs due to the low sensitivity and negative predictive value of mammography. Anyway, the incidence of breast cancer is increasing in this age group. We planned an innovative screening program tailored on individual risk profile and breast tissue density, implementing mammography with further assessment (US/MRI).

From 9/2010 to 9/2011 we invited 3,017 women living in the town of Segrate (Milan, Italy). We classified the participating population in 3 risk groups according to the lifetime risk of developing breast cancer assessed by the Gail test and breast tissue density with mammographic BIRADS score. All patients underwent low-dose photon-counting digital mammography (Sectra) performed in 2 views (CC/MLO), blinded reviewed by 2 dedicated radiologists. The US and MRI were performed according to the BIRADS density score and the risk group of each patient.

1,666 women were enrolled (participation rate: 55%). The average glandular dose was 1.47 mGy with an average breast thickness of 50 mm. The recall rate for US was 55.4% (923/1666). The recall rate for MRI was 0.55% (9/1666). The cancer detection rate (CDR) was 8.4‰ (14). 12 cancers were diagnosed by mammography, most frequently in high density breasts (83%, 10/12). Two cancers were detectable only at US (US-Incremental CDR 0.24%, 2/836). US-false positives was 1.08% (9/836). All patients were submitted to surgery. Most of the tumors detected were at early stage and were treated with conservative surgery.

We found an higher than expected CDR for the age sample evaluated (0.14-0.21% according to the Italian Cancer Register). Consequently, extending the screening program in 40-49er women could have a real clinical impact. Most cancers were diagnosed by mammography, despite high breast density. Digital mammography with new photon-counting technique could potentially improve the cancer detection even in dense breasts. US allowed to diagnose 2 additional cases of cancer with a limited numbers of false positives. Anyway, considering the small size of the population, the complementary role of US remains to be assessed.

Due to the high mammographic detection rate we assessed, screening programs could offer benefits even in 40-49 years old women. Still, the complementary role of US needs to be further evaluated.

Venturini, E, Schiani, E, Tacchini, S, Panizza, P, Rodighiero, M, Del Maschio, A, Tailored Breast Cancer Screening Program in 40-49ers: Final Results from an Italian Single Centre Pilot Study .  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12032964.html