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Biomedical subjects

D B Kopans

Publications and source records attributed to D B Kopans.

At least 19 recordsLinked to original sources
PubMed1992

Breast cancer survival among women under age 50: is mammography detrimental?

Great uncertainty exists about the benefit of detecting breast cancer by mammography in women under 50 years of age. We have reviewed the survival of patients aged 49 years or less whose cancers were detected by mammography alone. 117 women under the age of 50 years were diagnosed with breast cancer between 1978 and 1991 based only on an abnormal mammogram. Ductal carcinoma in-situ (DCIS) was found in 47 (40%) of these women, whilst 70 (60%) had infiltrating ductal or infiltrating lobular carcinomas. During the same interval, 928 women in this age group presented with palpable breast cancer. DCIS was diagnosed in 82 (9%) of these women, whilst 846 (91%) had infiltrating carcinoma. Among the infiltrating cancers detected by mammography alone, 50% were stage I, whilst only 30% of the women with palpable cancers were stage I. Five-year survival for all mammographically detected cancer patients was 95%, whereas for women with palpable cancers the survival was 74% (p < 0.00005). If DCIS is not included, the corresponding survivals are 91% for mammographically detected infiltrating cancers and 72% for palpable infiltrating cancers. Only 1 woman who died among those with palpable cancer had had a mammogram before diagnosis. Our data contradict the suggestion that women under 50 are put at a survival disadvantage by undergoing mammography. We believe that investigators who have reported negative results in this age group must examine other causes for their results.

Actuarial Analysis↗
PubMed1992

Calcified suture material in the breast after radiation therapy.

Of 335 women who underwent lumpectomy and radiation therapy for breast cancer, 42 subsequently developed calcifications. Particles typical of calcified suture material were identified in 21 of the 42 women (50%). No obvious calcified suture material was found in approximately 1,140 women of 38,000 (3%) who had undergone mammography after they had previously undergone breast biopsy for a benign lesion and thus had not undergone radiation therapy. Calcified suture material rarely develops in the nonirradiated breast, but it is common after radiation therapy and should not be confused with recurrent breast cancer. These calcifications are likely the result of delayed resorption of catgut sutures, which provide a matrix on which calcium can precipitate in a suitable local environment.

Breast Neoplasms↗
PubMed1992

Screening mammography in women over age 65.

Routine screening by mammography and physical examination can detect breast cancers earlier at all ages. In women over age 65 the sensitivity of mammography is increased, and the positive predictive value for mammography is higher than in younger women. There are no direct data that can be used to determine at what age screening is no longer of value. This question must be evaluated on an individual basis and should take into account the quality of life and competing causes of death. The medical benefit from screening for a given individual should be considered separately from society's cost/benefit goal to reduce health care expenditures, because the two are likely to produce contradictory recommendations.

Aged↗
PubMed1992

Standardized mammography reporting.

The use of mammographic screening to detect breast cancer at a preclinical stage is increasing rapidly in the United States. High-quality imaging and accurate interpretation are critical elements for successful mortality reduction. The communication of the interpretation is being scrutinized in an effort to eliminate ambiguity and confusion. This can be accomplished by an organized approach to interpretation and a structured analysis of significant findings. These can be grouped into five major categories ranging from a negative examination to findings suggesting a very high probability of malignancy. A concisely organized reporting system is to be proposed by committees of the ACR that will provide clinically relevant information. The system will suggest the use of an approved vocabulary and urge that significant findings be described concisely in a standardized format. All studies should be categorized using the five clinically useful assessment groups. This combined with the maintenance of a data base for determining results will improve the accuracy of the screening effort, permit the monitoring of the screening results, and provide feedback for improving the program.

Breast Neoplasms↗
PubMed1990

Medullary carcinoma of the breast. Overdiagnosis of a prognostically favorable neoplasm.

We reviewed 30 cases of breast cancer originally diagnosed as medullary carcinoma during a 10-year period. Of the 30, only 9 proved to be "typical medullary carcinoma" with the associated favorable prognosis. Seven of the remaining 21 cancers were reclassified as "atypical medullary carcinoma," and the remaining 14 were nonmedullary cancers. Overdiagnosis of medullary carcinoma could lead to inappropriately conservative therapy, since medullary carcinoma is a prognostically favorable neoplasm. Those involved with diagnosis and treatment of patients with breast cancer should be aware of this potential problem.

Adult↗
PubMed1990

Mixed form, diffusely scattered calcifications in breast cancer with apocrine features.

Diffusely scattered calcifications visible with mammography are almost always benign. Certain patterns, however, should arouse concern. For example, extensive comedocarcinoma is associated with large areas of mammographically visible calcium deposition. The authors identified 10 women in whom calcifications were visible throughout large volumes of breast tissue at mammography. The calcifications did not resemble those typical of extensive comedocarcinoma, yet they were associated with extensive breast cancer. Their mammographic pattern was characterized by a strikingly wild, chaotic appearance with profuse deposition of calcium. As in many cancers, the particles were heterogeneous, but unlike in most carcinomas, many deposits had a typically benign morphology. Histologic examination showed that even these typically benign calcifications were associated with malignant cells. The authors believe that the apocrine features displayed by many of the cancer cells in these 10 patients may explain the unusual profusion of calcium deposits.

Adult↗
PubMed1990

Canadian National Breast Screening Study: assessment of technical quality by external review.

Mammograms from the Canadian National Breast Screening Study (NBSS) were reviewed by three external experts to provide an objective evaluation of their technical quality, to establish a model for auditing mammograms in a screening program, and to assess whether NBSS mammograms improved over time. The sample reviewed included 10 randomly chosen mammograms from each of 15 screening centers for each calendar year of their operation between 1980 and 1987. All 830 mammograms were reviewed on two consecutive days in randomized sequence by each reader, and rated 0-3 for each of four criteria including positioning and image quality, with a total possible score of 0-12. Although the mammograms were not in temporal sequence when reviewed, the scores assigned by each reader were significantly higher for mammograms dating from later years. Subjects' ages at entry (40-49 vs 50-59 years) did not affect the score. The largest increase in scores was associated with a 1985 protocol change in which mediolateral oblique positioning replaced straight mediolateral positioning. This study reinforces the importance of monitoring technical quality in screening programs and establishes that the NBSS benefited from technical improvements during its operation. A retrospective review of NBSS mammography by three external reviewers confirmed that technical quality improved from 1980 to 1987. This improvement was associated with improved technology (film, processing, and units) and with the quality assurance programs operating during the NBSS, which identified problems and offered remedies.

Adult↗
PubMed1989

Histologic and mammographic specificity of risk factors for benign breast disease.

This study evaluates the effects of potential risk factors for benign breast disease (BBD) with special attention to the histologic and mammographic specificity of the effects. Cases were 172 women with BBD that underwent biopsy; controls were 134 women free of breast signs or symptoms. All cases and controls had undergone mammography. For all types of BBD combined, parity, use of oral contraceptives, and use of exogenous estrogen after menopause were strongly protective, whereas obesity and early menarche were weakly protective. Family history of breast cancer was virtually unrelated to BBD. The protective effect of parity was stronger for BBD with intralobular or extralobular fibrosis, and with mammographic homogeneous density or large nodular densities, than it was for BBD without these characteristics. Similar relations with the histologic and mammographic features were observed for obesity. These findings suggest that some risk factors for BBD have effects that are related to specific features of its morphology.

Breast Diseases↗
PubMed1989

Asymmetric breast tissue.

A prospective study was undertaken to evaluate the significance of asymmetric breast tissue (asymmetric volume of breast tissue, asymmetrically dense breast tissue with preserved architecture, or asymmetrically prominent ducts) on mammograms. Of 8,408 mammograms obtained in 1985, 221 (3%) demonstrated asymmetric breast tissue. Follow-up was 36-42 months after the initial mammographic study. During this time none of the patients underwent biopsy on the basis of mammographic findings, although 20 underwent excisional biopsy because of clinical findings. Breast cancer was diagnosed in two patients and breast lymphoma in one patient. Biopsy specimens from the remaining 17 patients were benign. At mammography, all three malignant lesions had a palpable abnormality associated with the asymmetric tissue. Breast cancer was not found in any of the remaining 201 patients. Therefore, an asymmetric volume of breast tissue, asymmetrically dense breast tissue, or asymmetrically prominent ducts that do not form a mass, do not contain microcalcifications, or do not produce architectural distortion should be viewed with concern only when associated with a palpable asymmetry and are otherwise normal variations.

Adult↗
PubMed1989

Communication problems after mammographic screening.

The authors prospectively assessed the effectiveness of requests for immediate additional evaluation or biopsy made on the basis of the interpretation of abnormal findings on screening mammograms. In 1,125 screening mammograms obtained in asymptomatic women referred by physicians, the findings in 63 (6%) were interpreted as requiring additional imaging or biopsy. Written reports were sent, and in all cases the office of the referring physician was notified directly by phone. Physicians were periodically contacted if no follow-up had been performed to resolve the questioned abnormality. In the first 2.5 months, no action had been taken in 40 of 63 (63%) of the recommendations. After additional calls, this diminished to 10 of 63 (16%) at 3.5 months, but at 4.5 months four of 63 (6%) patients had not undergone the recommended additional studies. These results suggest the need for development of systems to ensure prompt action in patients with abnormal findings at mammographic screening.

Communication↗
PubMed1989

Nonpalpable lesions in the augmented breast: preoperative localization.

Special compression views of the breast were used to detect suspect lesions in eight women who had undergone augmentation mammoplasty. Hook-wire localization with the use of these views proved safe and accurate for preoperative localization in these women, one of whom had a very small cancer.

Breast↗