| Section I The application value of breast imaging reporting and data system in Chinese breast cancer screeningObjective:To study the use of breast imaging reporting and data system (BI-RADS), and evaluate its value in Chinese breast cancer screening.Methods:A total number of 3483 women participated in screening mammography (MAM) of breast cancer screening in Hexi district in Tianjin from August to December 2009 which was organized by Ministry of Public Health. For all mammograms, BI-RADS assessment categories and recommendations were compared with histological findings. Then calculate the precision, sensitivity, specificity, positive predictive value (PPV) and negaitive predictive value (NPV).Results:Among 3483 MAM cases,267 were almost entirely fat breast,1245 scattered fibroglandular,1890 heterogeneously dense and 81 extremely dense. BI-RADS assessment categories were as follow:category 1 (1011,29.0%), category 2 (1741,50.0%), category 3 (383,11.0%), category 0 (273,7.8%), category 4 (59, 1.7%), and category 5 (16,0.5%), respectively. Totally 71 women with 77 lesions were confirmed by histological examinations. There are 29 malignant and 48 benign lesions. The diagnostic precision, sensitivity, specificity of BI-RADS were 63.6% (49/77),93.1%(27/29) and 45.8%(22/48). The general PPV of BI-RADS was 50.9%(27/53).The PPV of categories 0,4,5 were25.0%(1/4),36.4%(12/33) and 87.5%(14/16). The NPV of categories 2 and 3 were 90.9%(10/11),100.0% (12/12)Conclusion:BI-RADS is of much value in predicting the breast malignancy. It is applicable in Chinese breast cancer screening. Section II Mammographic performance and mammographic density associated factors in Chinese breast cancer screening womenObjective:Mammographic density, a strong risk factor for breast cancer, has been studied a lot in many western countries. The purpose of our study is to describe the measures of mammographic performance in Chinese screening people, to investigate the potential mechanism for mammographic density's effect on breast cancer risk and ethnic differences in mammographic density.Methods:We collected epidemiology and mammographic data from 22 960 screening women who came from 3 cities in China from 2008 to 2009. Mammographic density was based on BI-RADS assessment. The relationship between mammographic density and other breast cancer risk factors were analyzed. The consistency of mammography was also tested.Results:Observed the 19130 participants'mammogram,2720(14.2%) of them are "almost entirely fat",8132(42.5%) are "scattered fibroglandular",6869(35.9%) are "heterogeneously dense" and 1409(7.4%) are "extremely dense" group based on B1-RADS categories. Other breast cancer risk factor, such as age(negatively), body mass index(negatively), age at menarche(negatively), menopause status(negatively), numbers of deliveries(negatively), breast feeding(negatively), abortion(positively), oral contraceptives use(negatively), smoking(positively) and benign breast diseases(positively) was significantly associated with mammographic density category.Conclusion:This screening project provides the native Chinese women's mammographic density data for the first time. Our study shows most the same associations between mammographic density and other risk factors with reported researches. We need more accurate methods to make sure the mammographic density distribution in native Chinese women and investigate the mechanisms linking breast density to breast cancer risk in further studies. Section?Screening Accuracy of Clinical Breast Examination, Mammography, and Breast ultrasonography in a Chinese Pilot StudyObjective:The study aims to evaluate the screening accuracy of MAM, breast ultrasonography (BUS) and clinical breast examination (CBE) as screening methods for the detection of breast cancer in a cross-sectional study in China.Methods:Asymptomatic women aged 45 to 65 were enrolled from four cities in China, and underwent our screening sessions (CBE, MAM, BUS independently and concurrently). Women with suspicious to malignant appearances detected by anyone of these modalities above subsequently underwent biopsy. Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative with one year follow-up. Sensitivity, specificity, positive and negative predictive values were calculated to validate the accuracy of the screening tests.Results:Between July 1,2008, and December 30,2009,22960 women were enrolled and received screening tests. A total of 67 breast cancers, including 59 invasive cancers and 8 ductal carcinomas in situ (DCIS), were detected. Sensitivity, specificity, positive and negative predictive values of CBE were 47.8%,99.5%,23.7%, and 99.8%, respectively; those of BUS,67.2%,98.9%,16.0%, and 99.9%, respectively; and those of MAM,86.2%,93.9%,4.0%, and 100.0%, respectively. Sensitivity of combined CBE and BUS in parallel is 71.6% and combined CBE and MAM in parallel is 92.5%. Sensitivity of combined CBE and BUS in serial is 43.3% and combined CBE and MAM in serial is 40.0%.Conclusion:This largest screening trial drawn from a community-based population indicates that mammography is a more accurate screening tool as a single test for breast cancer among Chinese women. For combinations by testing of two or more modalities in parallel and in serial, the combination of CBE and MAM in parallel was more feasible. The use of combined CBE and BUS may be considered where MAM is not feasible. Further research is needed to investigate the benefit of each screening modality.Conclusion:1?BI-RADS is of much value in predicting the breast malignancy. It is applicable in Chinese breast cancer screening.2?This screening project provides the native Chinese women's mammographic density data for the first time. Our study shows most the same associations between mammographic density and other risk factors with reported researches. We need more accurate methods to make sure the mammographic density distribution in native Chinese women and investigate the mechanisms linking breast density to breast cancer risk in further studies.3?This largest screening trial drawn from a community-based population indicates that mammography is a more accurate screening tool as a single test for breast cancer among Chinese women. For combinations by testing of two or more modalities in parallel and in serial, the combination of CBE and MAM in parallel was more feasible. The use of combined CBE and BUS may be considered where MAM is not feasible. Further research is needed to investigate the benefit of each screening modality. |
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