Elena Schiani MD, Presenter: Nothing to Disclose

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

Elena Venturini, Abstract Co-Author: Nothing to Disclose

Giulia Cristel 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

It is well-known that mammography in 40-49ers women has low sensitivity and negative predictive value due to high breast density. The aim of our study is to evaluate the effectiveness of a breast cancer screening program tailored on individual risk profile and breast tissue density, implementing mammography with further assessment (US/MRI).

From September 2010 to March 2011 we invited 1,589 women. Low-dose photon-counting digital mammography was performed in 2 views (CC/MLO). All images were reviewed blindly by 2 expert radiologists. Indications for US were: high breast density (BIRADS 3/4), HRT, familiarity (lifetime risk 10-25%), breast prosthesis, symptoms or abnormal mammographic findings. MRI was performed in case of genetic risk/high familiarity (lifetime risk >25%), previous mediastinal irradiation or breast surgery for cancer or diagnosis of ADH or LCIS.

1,010 women were enrolled out of 1,589 women invited and we have already screened 792 of them (participation rate 63,6%). The recall rate for US was 62,2% (493/792): 84% (413) due to high breast density and 11% (54) because of abnormal mammographic findings. The recall rate for MRI was <0,001% (2/792). The cancer detection rate was 1,01 % (8 cases). Seven cancer were diagnosed with mammography; 1 was detectable only at US. 6 cancers were IDC, 1 tubular carcinoma and 1 DCIS. Mean tumour size was 1,5 cm; 75% (6/8) were node negative while micrometastasis were found in the sentinel node in 2 cases. Seven women underwent breast conservative surgery and 1 mastectomy. According to the Nottingham Prognostic Index, the 10-year survival rate resulted excellent (98%) for 6 patients and good (90%) for 2 of them.

Our preliminary results demonstrated a breast cancer detection rate in women 40-49ers higher than the incidence reported by the Italian Cancer Registry (0,15-0,2%). Despite the high breast density in 40-49ers women, digital mammography alone detected 7 out of 8 case of cancer. In order to validate US and MRI as additional screening tools it is required to evaluate them on a larger population.

Since low-dose digital mammography succeeded in detecting breast cancer despite of the high breast density, it could offer diagnostic benefits even in 40-49ers women.

Schiani, E, Panizza, P, Venturini, E, Cristel, G, Rodighiero, M, Del Maschio, A, Tailored Breast Cancer Screening in 40-49ers: Unexpected Preliminary Results from an Italian Single Centre Pilot Study.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11011636.html