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Early Detection & Treatment of Breast Cancer

Early Detection & Treatment of Breast Cancer

One in eight women will be diagnosed with breast cancer in their lifetime, and two-thirds of women diagnosed with breast cancer are aged 50 and older. Known risk factors include radiation exposure and never being pregnant or having a first child after age 35. Other risk factors include menopause after age 55, postmenopausal hormone therapy, obesity, and having dense breast tissue. Hereditary factors can also be a cause. BRCA1 and BRCA2 gene mutations account for about 20% to 25% of hereditary breast cancers and about 5% to 10% of all breast cancers. A woman whose mother, sister, or daughter had breast cancer—especially if the cancer was bilateral, pre-menopausal, or occurred in more than one first-degree relative—is two or three times more likely to develop breast cancer. Genetic counseling should be considered for women with this history. Reviewing Recent Data on Breast Cancer Diagnosis-Related Failure A recent review of claims data from The Doctors Company revealed that 92% of breast cancer cases involved a diagnosis-related failure, and about 30% of these cases included misinterpreting a diagnostic test, such as a mammogram or breast biopsy. Research suggests that screening mammograms miss 10% to 20% of breast cancers. A study in the New England Journal of Medicine compared traditional mammograms to digital mammograms and found that the digital screenings were superior for women younger than 50, those with dense breast tissue, and women who were premenopausal or in their first year of menopause. Getting on the Same Page: Beginning Screening Mammography There may be some confusion about when screening mammography should begin because recommendations vary. The American Cancer Society recommends that women...

Imaging Use & Atraumatic Headache in the ED

Atraumatic headache is one of the most common complaints in EDs, but only a small subset of patients who present to the ED with this complaint are found to have life-threatening intracranial pathology (ICP) upon imaging. Additionally, imaging guidelines for these patients remain unclear. As a result, emergency physicians face a serious diagnostic dilemma when managing atraumatic headache, says John W. Gilbert, MD. “Imaging infrequently reveals significant findings, but results from these tests nevertheless have the potential to detect life-threatening pathology.” [polldaddy poll=6862787] Several studies have demonstrated that overall use of diagnostic imaging in the ED is increasing. The causes are thought to be multifactorial, ranging from medicolegal concerns and patient demand to the availability of diagnostic scanners that operate at ever-faster rates. This has the potential to lead to imaging overutilization with little benefit and may potentially harm patients. In clinical studies, increased use of imaging has been associated with higher costs, longer patient wait times, greater exposure to ionizing radiation, and decreased ED flow and efficiency. “In the absence of clear evidence-based guidelines and given the potential consequences of misdiagnosis, many physicians understandably struggle when deciding whether to pursue further workup,” explains Dr. Gilbert. “In some cases, they may err on the side of increased testing. It’s important for physicians to be aware of recent trends in imaging utilization, particularly when there’s a sharp increase without obvious corresponding evidence of benefit. This information can help guide efforts toward better defining imaging criteria so that diagnostics are used appropriately.” Imaging & Diagnostics in Atraumatic Headache In the July 2012 Emergency Medicine Journal, Dr. Gilbert and colleagues had a...

Conference Highlights: RSNA 2010

RSNA 2010, the annual meeting of the Radiological Society of North America, was held from November 29 to December 3 in Chicago. The features below highlight just some of the studies that emerged from the meeting. » Assessing Breast Cancer Screenings With MRI » Delaying or Preventing Osteoarthritis in At-Risk Patients » Can Walking Slow Cognitive Decline? Assessing Breast Cancer Screenings With MRI The Particulars: Guidelines currently recommend annual screening with breast MRI in women with a known gene mutation or a strong family history that indicates a lifetime risk of breast cancer greater than 20%. However, there is insufficient evidence to recommend for or against MRI screening in women who have already had breast cancer. Data Breakdown: A retrospective review of initial screening breast MRI examinations of 1,026 women was conducted in a 5-year study. Of these 1,026 women, 327 had a genetic or family history of breast cancer, and 646 had a personal history of treated breast cancer. MRI testing identified 25 of 27 cancers in the group, amounting to a sensitivity rate of 92.6%. The cancer yield in women with a personal history of breast cancer (3.1%) was double that of women with a genetic or family history (1.5%). Take Home Pearl: Women with a personal history of breast cancer should consider annual screening with MRI in addition to mammography. Additional studies are necessary to establish guidelines for screening these women. Delaying or Preventing Osteoarthritis in At-Risk Patients [back to top] The Particulars: Osteoarthritis is one of the most common forms of arthritis and affects an estimated 27 million Americans over the age of 25. Known risk factors for cartilage degeneration...
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