Breast cancer screening in women at increased risk according to different family histories: an update of the Modena Study Group experience

BACKGROUND: Breast cancer (BC) detection in women with a genetic susceptibility or strong family history is considered mandatory compared with BC screening in the general population. However, screening modalities depend on the level of risk. Here we present an update of our screening programs based on risk classification. METHODS: We defined different risk categories and surveillance strategies to identify early BC in 1325 healthy women recruited by the Modena Study Group for familial breast and ovarian cancer. Four BC risk categories included BRCA1/2 carriers, increased, intermediate, and slightly increased risk. Women who developed BC from January 1, 1994, through December 31, 2005 (N = 44) were compared with the number of expected cases matched for age and period. BRCA1/2 carriers were identified by mutational analysis. Other risk groups were defined by different levels of family history for breast or ovarian cancer (OC). The standardized incidence ratio (SIR) was used to evaluate the observed and expected ratio among groups. All statistical tests were two-sided. RESULTS: After a median follow-up of 55 months, there was a statistically significant difference between observed and expected incidence [SIR = 4.9; 95% confidence interval (CI) = 1.6 to 7.6; p < 0.001]. The incidence observed among BRCA carriers (SIR = 20.3; 95% CI = 3.1 to 83.9; P < 0.001), women at increased (SIR = 4.5; 95% CI = 1.5 to 8.3; P < 0.001) or intermediate risk (SIR = 7.0, 95% CI = 2.0 to 17.1; P = 0.0018) was higher than expected, while the difference between observed and expected among women at slightly increased risk was not statistically significant (SIR = 2.4, 95% CI = 0.9 to 8.3; P = .74). CONCLUSION: The rate of cancers detected in women at high risk according to BRCA status or strong family history, as defined according to our operational criteria, was significantly higher than expected in an age-matched general population. However, we failed to identify a greater incidence of BC in the slightly increased risk group. These results support the effectiveness of the proposed program to identify and monitor individuals at high risk, whereas prospective trials are needed for women belonging to families with sporadic BC or OC

Bivariate statistical approach to spillway design flood

The problem of selecting the appropriate design flood is a constant concern to dam engineering and, in general, in the hydrological practice. Overtopping represents more than 40% of dam failures in the world. The determination of the design flood is based in some cases on the T-year quantile of flood peak, and in other cases considering also the T-year quantile of flood volume. However, flood peak and flood volume have a positive (strong or weak) dependence. To model properly this aspect a bivariate probability distribution is considered using the concept of 2-Copulas, and a bivariate extreme value distribution with generalized extreme value marginals is proposed. The peak–volume pair can then be transformed into the correspondent flood hydrograph, representing the river basin response, through a simple linear model. The hydrological safety of dams is considered checking adequacy of dam spillway. The reservoir behavior is tested using a long synthetic series of flood hydrographs. An application to an existing dam is given

Laparoscopic cholangiography in the early diagnosis of jaundice due to bilio-pancreatic cancer

Les auteurs jugent que la cholangiographie laparoscopique est une investigation radiologique préopératoire de grande utilité dans le diagnostic différentiel des ictères cholestatiques. Sur 85 patients atteints d'un ictère cholestatique la cholangiographie laparoscopique a permis d'en préciser la nature chez 75, dont 29 par cancer bilio-pancréatique

Bivariate statistical approach to check adequacy of dam spillway

The problem of selecting the appropriate design flood is a constant concern to dam engineering and, in general, in the hydrological practice. Overtopping represents more than 40% of dam failures in the world. The determination of the design flood is based in some cases on theT-year quantile of flood peak, and in other cases considering also the T-year quantile of flood volume. However, flood peak and flood volume have a positive (strong or weak) dependence. To model properly this aspect a bivariate probability distribution is considered using the concept of 2-Copulas, and a bivariate extreme value distribution with generalized extreme value marginals is proposed. The peak-volume pair can then be transformed into the correspondent flood hydrograph, representing the river basin response, through a simple linear model. The hydrological safety of dams is considered checking adequacy of dam spillway. The reservoir behavior is tested using a long synthetic series of flood hydrographs. An application to an existing dam is given

Contrast-enhanced ultrasound in the characterisation of breast masses: utility of quantitative analysis in comparison with MRI.

OBJECTIVE: To evaluate the reliability of contrast-enhanced ultrasound quantitative analysis (CE-US) in characterizing breast lesions, in comparison with MRI. MATERIALS: Thirty-nine patients with breast lesions BI-RADS 3-5 at US or mammography underwent CE-US and MRI. All lesions underwent histological and quantitative enhancement evaluation with both imaging methods. B-mode US, colour/power Doppler US and CE-US were used; an amplitude and phase modulation technique (CPS) read the signals produced by microbubbles and dedicated software produced the following parameters on time/intensity (T/I) curves: peak %, time to peak (TTP), mean transit time (MTT), regional blood volume (RBV) and regional blood flow (RBF). Student's t test was used to calculate the diagnostic accuracy of CE-US parameters compared with histological results. MRI (1.5 T) was performed before and after bolus gadolinium enhancement. Time/intensity curves were generated for all nodules and Fischer's multimodal score was used to classify them. RESULTS: Pathology showed 43 nodules (11 benign; 32 malignant). Peak and RBF were the most significant parameters in differential diagnosis, with p values of 0.02 and 0.004, respectively. Positive predictive value (PPV) of CE-US evaluation was 91%, negative predictive value (NPV) was 73% with a high concordance index (k = 0.59) with MRI. CONCLUSIONS: CE-US quantitative analysis offers an objective and reproducible assessment of lesion vascularisation, with good correlation with the results of MRI