Mammographic features and screening outcome in a randomized controlled trial comparing digital breast tomosynthesis and digital mammography

Purpose To compare the distribution of mammographic features among women recalled for further assessment after screening with digital breast tomosynthesis (DBT) versus digital mammography (DM), and to assess associations between features and final outcome of the screening, including immunohistochemical subtypes of the tumour. Methods This randomized controlled trial was performed in Bergen, Norway, and included 28,749 women, of which 1015 were recalled due to mammographic findings. Mammographic features were classified according to a modified BI-RADS-scale. The distribution were compared using 95 % confidence intervals (CI). Results Asymmetry was the most common feature of all recalls, 24.3 % (108/444) for DBT and 38.9 % (222/571) for DM. Spiculated mass was most common for breast cancer after screening with DBT (36.8 %, 35/95, 95 %CI: 27.2−47.4) while calcifications (23.0 %, 20/87, 95 %CI: 14.6−33.2) was the most frequent after DM. Among women screened with DBT, 0.13 % (95 %CI: 0.08−0.21) had benign outcome after recall due to indistinct mass while the percentage was 0.28 % (95 %CI: 0.20−0.38) for DM. The distributions were 0.70 % (95 %CI: 0.57−0.85) versus 1.46 % (95 %CI: 1.27−1.67) for asymmetry and 0.24 % (95 %CI: 0.16−0.33) versus 0.54 % (95 %CI: 0.43−0.68) for obscured mass, among women screened with DBT versus DM, respectively. Spiculated mass was the most common feature among women diagnosed with non-luminal A-like cancer after DBT and after DM. Conclusions Spiculated mass was the dominant feature for breast cancer among women screened with DBT while calcifications was the most frequent feature for DM. Further studies exploring the clinical relevance of mammographic features visible particularly on DBT are warranted.publishedVersio

Improved breast cancer screening for women and society: A radiological approach

Breast cancer is the most common cancer in women, and early detection by mammographic screening is demonstrated to reduce mortality from the disease. BreastScreen Norway offers women aged 50-69 biennial mammographic screening. The overall aim of this thesis was to investigate ways to improve early detection of breast cancers in BreastScreen Norway and included analyses of screening techniques and screen-readers’ performance. A prospective study compared screening with a new mammographic technique, digital breast tomosynthesis, with standard digital mammography. A 50% increase in cancer detection at screening was observed in women screened with tomosynthesis, with no reduction in interval cancer. Cancers detected by tomosynthesis were mainly smaller and less aggressive compared with those detected by standard digital mammography. A retrospective, consensus based and fully informed review of mammograms from diagnosis and prior screening from women diagnosed with screen-detected or interval cancer indicated a potential for earlier diagnosis in a proportion of the cases. Analyses of the characteristics of these cancers may contribute to a reduction of cancers missed at screening

Høytrykksprosessering av sjømat. Litteraturgjennomgang

Rapporten gir en oversikt over den relativt nye og skånsomme prosesseringsteknologien høytrykksprosessering (HP); hva som er gjort innen HP av sjømat, hvilken effekt prosessen har på mattrygghet og kvaliteten av produktene. I tillegg til gjennomgang av litteratur om effekten av HP på ulike matprodukter og mikroorganismer, er det inkludert kapitler om metoder som er aktuelle for testing av produkter og matkvalitet i prosjektet. Det er også kort nevnt beskrivelse av mulige kombinasjoner av høytrykk med andre metoder. Høytrykksprosessering er per i dag i mindre grad benyttet på prosesserte sjømatprodukter sammenlignet med landbruksbaserte produkter. Innen sistnevnte kategori finnes en rekke kommersielle produkter av juice, kjøttpålegg og ferdigmat. For sjømat finnes det noen fiskebaserte ferdigmatprodukter hvor HP blir benyttet for å gi økt holdbarhet. Innen sjømat-sektoren har derimot HP vært en suksess for bruk til “shucking”; åpning av skjell og enklere løsne krabbe/hummer-muskel fra skallet. Bruk av HP til f.eks. åpning av østers og inaktivering av patogene virus er en stor industri i USA. Rapporten utgjør en del av arbeidspakke 1 i HPsjømat prosjektet. Det er forsøkt å gi en oversikt over relevant forskning hvor de viktigste hovedlinjene er med, og den vil være med å danne grunnlag for arbeidet som skal utføres i de øvrige arbeidspakkene.Høytrykksprosessering av sjømat. LitteraturgjennomgangpublishedVersio

Effect of high pressure and thermal processing on shelf life and quality of strawberry purée and juice

acceptedVersio

Screening outcome for interpretation by the first and second reader in a population-based mammographic screening program with independent double reading

Background - Double reading of screening mammograms is associated with a higher rate of screen-detected cancer than single reading, but different strategies exist regarding reader pairing and blinding. Knowledge about these aspects is important when considering strategies for future use of artificial intelligence in mammographic screening. Purpose - To investigate screening outcome, histopathological tumor characteristics, and mammographic features stratified by the first and the second reader in a population based screening program for breast cancer. Material and Methods - The study sample consisted of data from 3,499,048 screening examinations from 834,691 women performed during 1996–2018 in BreastScreen Norway. All examinations were interpreted independently by two radiologists, 272 in total. We analyzed interpretation score, recall, and cancer detection, as well as histopathological tumor characteristics and mammographic features of the cancers, stratified by the first and second readers. Results - For Reader 1, the rate of positive interpretations was 4.8%, recall 2.3%, and cancer detection 0.5%. The corresponding percentages for Reader 2 were 4.9%, 2.5%, and 0.5% (P  Conclusion - Despite reaching statistical significance, mainly due to the large study sample, we consider the differences in interpretation scores, recall, and cancer detection between the first and second readers to be clinically negligible. For practical and clinical purposes, double reading in BreastScreen Norway is independent

Rapport/Report 20/2014 English summary

-I Norge er det et mål å øke forbruket av frukt, bær og grønnsaker. Ved økt produksjon av disse, vil man i høysesongen kunne få en høyere produksjon enn det som blir solgt for fersk konsum. Høytrykksprosessering (HP) kan benyttes til å lage høykvalitetsprodukter av disse overskuddsråvarene. Denne typen høykvalitetsprodukter, basert på norske frukt- og bær-produkter, vil kunne ha stort potensiale da norske råvarer oppleves som ferske, sunne og gode. Høytrykksbehandling av mat kan benyttes for å oppnå produkter med forbedret kvalitet, lengre holdbarhet og økt mattrygghet. Maten blir også sunnere og friskere da næringsstoffene blir bedre bevart enn ved varmebehandling. I dette forprosjektet har det vært arbeidet med bringebær og plommer. Forsøk med høytrykksprosessering av bringebærjuice, mos og hele bær ble utført. Resultatene viste at prøver behandlet med HP har en betydelig lenger holdbarhet sammenlignet med kontrollprøver. Juiceprøver lagret i 97 dager viste svært lav bakteriell vekst, og analyse av sukker og syreinnhold viste at trykk hadde liten innvirkning på viktige smakskomponenter.Norwegian fruits and berries have an unused potential. During the peak season, there is a higher production than is being sold for fresh consumption. High pressure processing (HPP) can be used for making high quality products from the excess production. HPP of foods can be used to increase the quality and shelf life of foods. The food will also be healthier and fresher as the nutrients will be better preserved in HPP than by heat treatment. In this project the focus has been on high pressure processing of raspberries and plums. Studies on raspberry juice, purée and whole berries showed a considerably longer shelf life compared to control samples. Analysis of sugar and acid content indicated that HPP had low impact on important flavouring components

Økt utnyttelse av plommer, søtkirsebær og bringebær med høytrykksprosessering

I Norge er det et mål å øke forbruket av frukt, bær og grønnsaker. Ved økt produksjon av disse, vil man i høysesongen kunne få en høyere produksjon enn det som blir solgt for fersk konsum. Høytrykksprosessering (HP) kan benyttes til å lage høykvalitetsprodukter av disse overskuddsråvarene. Denne typen høykvalitetsprodukter, basert på norske frukt- og bær-produkter, vil kunne ha stort potensiale da norske råvarer oppleves som ferske, sunne og gode. Høytrykksbehandling av mat kan benyttes for å oppnå produkter med forbedret kvalitet, lengre holdbarhet og økt mattrygghet. Maten blir også sunnere og friskere da næringsstoffene blir bedre bevart enn ved varmebehandling. I dette forprosjektet har det vært arbeidet med bringebær og plommer. Forsøk med høytrykksprosessering av bringebærjuice, mos og hele bær ble utført. Resultatene viste at prøver behandlet med HP har en betydelig lenger holdbarhet sammenlignet med kontrollprøver. Juiceprøver lagret i 97 dager viste svært lav bakteriell vekst, og analyse av sukker og syreinnhold viste at trykk hadde liten innvirkning på viktige smakskomponenter

Rapport/Report 20/2014 English summary

-I Norge er det et mål å øke forbruket av frukt, bær og grønnsaker. Ved økt produksjon av disse, vil man i høysesongen kunne få en høyere produksjon enn det som blir solgt for fersk konsum. Høytrykksprosessering (HP) kan benyttes til å lage høykvalitetsprodukter av disse overskuddsråvarene. Denne typen høykvalitetsprodukter, basert på norske frukt- og bær-produkter, vil kunne ha stort potensiale da norske råvarer oppleves som ferske, sunne og gode. Høytrykksbehandling av mat kan benyttes for å oppnå produkter med forbedret kvalitet, lengre holdbarhet og økt mattrygghet. Maten blir også sunnere og friskere da næringsstoffene blir bedre bevart enn ved varmebehandling. I dette forprosjektet har det vært arbeidet med bringebær og plommer. Forsøk med høytrykksprosessering av bringebærjuice, mos og hele bær ble utført. Resultatene viste at prøver behandlet med HP har en betydelig lenger holdbarhet sammenlignet med kontrollprøver. Juiceprøver lagret i 97 dager viste svært lav bakteriell vekst, og analyse av sukker og syreinnhold viste at trykk hadde liten innvirkning på viktige smakskomponenter.Norwegian fruits and berries have an unused potential. During the peak season, there is a higher production than is being sold for fresh consumption. High pressure processing (HPP) can be used for making high quality products from the excess production. HPP of foods can be used to increase the quality and shelf life of foods. The food will also be healthier and fresher as the nutrients will be better preserved in HPP than by heat treatment. In this project the focus has been on high pressure processing of raspberries and plums. Studies on raspberry juice, purée and whole berries showed a considerably longer shelf life compared to control samples. Analysis of sugar and acid content indicated that HPP had low impact on important flavouring components

Early performance measures following regular versus irregular screening attendance in the population-based screening program for breast cancer in Norway

Irregular attendance in breast cancer screening has been associated with higher breast cancer mortality compared to regular attendance. Early performance measures of a screening program following regular versus irregular screening attendance have been less studied. We aimed to investigate early performance measures following regular versus irregular screening attendance. Methods We used information from 3,302,396 screening examinations from the Cancer Registry of Norway. Examinations were classified as regular or irregular. Regular was defined as an examination 2 years ± 6 months after the prior examination, and irregular examination >2 years and 6 months after prior examination. Performance measures included recall, biopsy, screen-detected and interval cancer, positive predictive values, and histopathological tumor characteristics. Results Recall rate was 2.4% (72,429/3,070,068) for regular and 3.5% (8217/232,328) for irregular examinations. The biopsy rate was 1.0% (29,197/3,070,068) for regular and 1.7% (3825/232,328) for irregular examinations, while the rate of screen-detected cancers 0.51% (15,664/3,070,068) versus 0.86% (2003/232,328), respectively. The adjusted odds ratio was 1.53 (95% CI: 1.49–1.56) for recall, 1.73 (95% CI: 1.68–1.80) for biopsy, and 1.68 (95% CI: 1.60–1.76) for screen-detected cancer after irregular examinations compared to regular examinations. The proportion of lymph node-positive tumors was 20.1% (2553/12,719) for regular and 25.6% (426/1662) for irregular examinations. Conclusion Irregular attendance was linked to higher rates of recall, needle biopsies, and cancer detection. Cancers detected after irregular examinations had less favorable histopathological tumor characteristics compared to cancers detected after regular examinations. Women should be encouraged to attend screening when invited to avoid delays in diagnosis

Survival among women diagnosed with screen-detected or interval breast cancer classified as true, minimal signs, or missed through an informed radiological review

Objectives: “True” breast cancers, defined as not being visible on prior screening mammograms, are expected to be more aggressive than “missed” cancers, which are visible in retrospect. However, the evidence to support this hypothesis is limited. We compared the risk of death from any cause for women with true, minimal signs, and missed invasive screen-detected (SDC) and interval breast cancers (IC). Methods: This nation-wide study included 1022 SDC and 788 IC diagnosed through BreastScreen Norway during 2005–2016. Cancers were classified as true, minimal signs, or missed by five breast radiologists in a consensus-based informed review of prior screening and diagnostic images. We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of death from any cause associated with true, minimal signs, and missed breast cancers, adjusting for age at diagnosis, histopathologic tumour diameter and grade, and subtype. Separate models were created for SDC and IC. Results: Among SDC, 463 (44%) were classified as true and 242 (23%) as missed; among IC, 325 (39%) were classified as true and 235 (32%) missed. Missed SDC were associated with a similar risk of death as true SDC (HR = 1.20, 95% CI (0.49, 2.46)). Similar results were observed for missed versus true IC (HR = 1.31, 95% CI (0.77, 2.23)). Conclusions: We did not observe a statistical difference in the risk of death for women diagnosed with true or missed SDC or IC; however, the number of cases reviewed and follow-up time limited the precision of our estimates