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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_230"
                     title="Radiation Benefit of Digital Mammogram Not Clear (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/HematologyOncology/BreastCancer/tb/18087?impressionId=1265818107309"
                     
      &lt;p&gt;Digital mammography exposes women to a lower radiation dose than standard film mammography, but digital imaging is likely to require more than four normal views in about 20% of women screened, according to a subset analysis of data from a study of almost 50,000 women.&lt;/p&gt;
&lt;p&gt;The mean glandular dose per view was 2.37 mGy for film mammography versus 1.86 mGy for full-field digital mammography, a difference of 22%, R. Edward Hendrick, PhD, of the University of Colorado-Denver, and colleagues reported in the February issue of the &lt;em&gt;American Journal of Roentgenology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;But only 12% of women screened with traditional mammography required more than four normal views compared with 21% of the women imaged with digital systems.&lt;/p&gt;
&lt;p&gt;When the need for additional views was factored in, they wrote, the difference in radiation exposure between the two modalities dropped to 17%, 4.14 mGy for digital versus 4.98 mGy for standard mammography.&lt;/p&gt;
&lt;p&gt;Furthermore, these differences were not standard  --  there was a wide variation across manufacturers. For example, the average mean glandular dose per view was 3.77 for Fischer digital versus 5.03 for Hologic Selenia, which was also the only manufacturer in which the digital dose was higher than the standard film dose.&lt;/p&gt;
&lt;p&gt;Doses were compared on a manufacturer basis  --  film mammography versus digital: &lt;ul&gt; &lt;li&gt;5.36 mGy for Fischer standard film versus 3.77 mGy for Fischer digital&lt;/li&gt; &lt;li&gt;4.02 mGy for Fugifilm standard film versus 4.45 mGy for Fugifilm digital&lt;/li&gt; &lt;li&gt;5.03 mGy for GE standard film versus 4.02 mGy for GE digital&lt;/li&gt; &lt;li&gt;5.01 mGy for Hologic CCD standard film versus 4.60 for Hologic CCD digital&lt;/li&gt; &lt;li&gt;4.24 mGy for Hologic Selenia versus 5.03 for Hologic Selenia digital &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The analysis of parameters and radiation dose was culled from data collected by the American College of Radiology Imaging Network Digital Mammographic Imaging Screening (DMIST) trials, which enrolled 49,528 women from October 2001 through October 2003.&lt;/p&gt;
&lt;p&gt;The primary goal of DMIST was to compare the accuracy of the two technologies. The results, reported in 2005, found that digital mammography was superior for younger women and for women with dense breasts, but when results from all 50,000 women were considered there was no significant difference.&lt;/p&gt;
&lt;p&gt;This latest study was based on technical data compiled on 5,102 women of which 4,366 cases yielded &quot;clean&quot; data that were included in the analysis.&lt;/p&gt;
&lt;p&gt;The researchers did find a significant difference in the pressure each modality exerted on the breast. &quot;Mean compression force was 10.7 dN for screen-film mammography and 10.1 dN for full-field digital mammography (5.5% difference, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001),&quot; they wrote.&lt;/p&gt;
&lt;p&gt;There was also a 1.7% statistically significant difference in mean compressed breast thickness  --  5.3 cm for screen-film mammography versus 5.4 cm for digital.&lt;/p&gt;
&lt;p&gt;But the difference in breast compression, while statistically significant, was &quot;likely clinically insignificant,&quot; Hendrick and colleagues concluded.&lt;/p&gt;
&lt;p&gt;The authors noted that the study was limited by the advances in imaging technology  --  since the study was conducted, film manufacturers have introduced &quot;new screen-film combinations, such as double-sided screens and double-emulsion films that were not available during DMIST.&quot;&lt;/p&gt;
&lt;p&gt;For that reason, &quot;breast dose along with image quality and other parameters should be carefully compared between existing screen-film mammography and any new [digital] system being considered for integration into a breast imaging practice.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The DMIST trial was supported by the National Cancer Institute and by the Lynn Safe Breast Cancer Research Foundation.&lt;/p&gt;&lt;p&gt;Hendrick disclosed that he is a consultant to GE Healthcare on digital breast tomosynthesis and other breast imaging projects not related to DMIST.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3586"
                     title="ASTRO: Breast Brachytherapy Use Outpaces Evidence (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASTRO/tb/16858?impressionId=1265818107309"
                     
      &lt;p&gt;CHICAGO  --  Use of brachytherapy to treat breast cancer continues to increase despite unresolved questions about long-term outcomes, according to data presented here.&lt;/p&gt;
&lt;p&gt;From 2001 through 2006, breast brachytherapy accounted for 5% of all radiation therapy administered to a cohort of more than 6,000 postmenopausal breast cancer patients. However, in the years after 2004  --  when Medicare began reimbursing for the modality  --  use of the modality more than doubled, to 10% in the first half of 2006.&lt;/p&gt;
&lt;p&gt;The findings strongly suggest that nonclinical factors will determine breast brachytherapy&apos;s role in coming years.&lt;/p&gt;
&lt;p&gt;&quot;Despite ongoing debate over long-term outcomes, breast brachytherapy has been rapidly incorporated into treatment of breast cancer,&quot; Thomas A. Buchholz, MD, of the University of Texas M. D. Anderson Cancer Center in Houston, said here at the American Society for Radiation Oncology meeting.&lt;/p&gt;
&lt;p&gt;&quot;The availability of clinical evidence is less likely to be a major force in determining the diffusion of this new technology. Instead, nonclinical factors  --  such as public policy and socioeconomic factors  --  are likely to play an important role.&quot;&lt;/p&gt;
&lt;p&gt;The efficacy of whole-breast irradiation after conservative surgery has been demonstrated in Phase III clinical trials involving 60,000 to 100,000 patient-years of follow-up, said Buchholz. In contrast, Phase III data of partial breast irradiation with brachytherapy has yet to mature and comprises about 1,500 patient-years of follow-up.&lt;/p&gt;
&lt;p&gt;The lack of supporting data for breast brachytherapy has created controversy regarding use of the radiation modality, he added.&lt;/p&gt;
&lt;p&gt;Access to a nationwide database of Medicare beneficiaries with private supplemental insurance provided an opportunity to examine the use of breast brachytherapy and the factors associated with its use.&lt;/p&gt;
&lt;p&gt;Buchholz and his colleagues identified 6,882 women ages 65 and older with newly diagnosed breast cancer from 2001 through 2006. The database provided access to information about inpatient, outpatient, and prescription claims.&lt;/p&gt;
&lt;p&gt;All of the patients had breast-conserving surgery followed by radiation therapy  --  external-beam radiation, brachytherapy, or a combination of the two modalities.&lt;/p&gt;
&lt;p&gt;Patients had a mean age of 75, 8% had axillary involvement, and 4% had metastatic disease. Buchholz said that 78% of the cohort had axillary dissection, 10% had chemotherapy, and 65% received endocrine therapy.&lt;/p&gt;
&lt;p&gt;Overall, external-beam radiation therapy accounted for 95% of all radiotherapy administered to the patients. Fewer than 1% received both external-beam radiation and brachytherapy, and the remaining patients had brachytherapy as the sole form of radiotherapy.&lt;/p&gt;
&lt;p&gt;Trend analysis showed that use of brachytherapy remained stable at about 1% of cases from 2001 to the first half of 2002, when the FDA approved the therapy. Use of brachytherapy increased to about 3% of cases in the second half of 2002 and remained at that level until the first half of 2004, when Medicare started covering brachytherapy.&lt;/p&gt;
&lt;p&gt;Brachytherapy continued to account for about 4% of all radiation therapy used to treat breast cancer through 2004, then increased to more than 6% of cases in the first half of 2005, 8% in the second half of 2005, and 10% during the first six months of 2006.&lt;/p&gt;
&lt;p&gt;Analysis of clinical factors associated with use of brachytherapy revealed three significant predictors: &lt;ul&gt; &lt;li&gt;Node-negative disease (OR 2.19, 95% CI 1.17 to 4.11)&lt;/li&gt; &lt;li&gt;Axillary surgery (OR 1.72, 95% CI 1.28 to 2.44)&lt;/li&gt; &lt;li&gt;No chemotherapy (OR 1.68, 95% CI 1.01 to 2.80)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Examination of nonclinical factors such as geography, type of healthcare system, income, and availability of radiation oncologists and surgeons all influenced the use of brachytherapy.&lt;/p&gt;
&lt;p&gt;Using the northeast region of the U.S. as reference, Buchholz and colleagues found increased use of breast brachytherapy in western states (OR 2.83), in the South (2.36), and in the Midwest (OR 1.62).&lt;/p&gt;
&lt;p&gt;Treatment by non-HMO providers also was associated with increased use of brachytherapy (OR 1.81).&lt;/p&gt;
&lt;p&gt;A higher median income made use of brachytherapy more likely (OR 1.58), as did a low density of radiation oncologists in an area (1.78) and a high density of surgeons (OR 2.36).&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3221"
                     title="ASCO Breast: DCIS Recurs More Often in Younger Women"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASCOBreast/tb/16387?impressionId=1265818107309"
                     
      SAN FRANCISCO  --  Young women with ductal carcinoma in situ (DCIS) may get poorer outcomes with breast conserving surgery than older patients do, though survival is unaffected, researchers found.&lt;br&gt;
&lt;br&gt;Local recurrence rates after lumpectomy and radiation therapy were 64% to 83% higher for those diagnosed before age 45 than among older women, Iwa Kong, MD, of the Sunnybrook Odette Cancer Center in Toronto, and colleagues reported here at the ASCO Breast Cancer Symposium.&lt;br&gt;
&lt;br&gt;But Kong warned against taking the population-based study findings as support for universal mastectomy for younger women.&lt;br&gt;
&lt;br&gt;&quot;This is really preliminary data, so this in no way suggests that young women cannot be treated safely with breast conserving surgery,&quot; she cautioned.&lt;/p&gt;
&lt;p&gt;Even though recurrence rates rose with age, the absolute rates were still acceptably low for all groups, said discussant Lawrence J. Solin, MD, of Albert Einstein Medical Center in Philadelphia.&lt;/p&gt;
&lt;p&gt;Overall survival rates were uniformly high at 97% to 99% at five years (&lt;em&gt;P&lt;/em&gt;=NS).&lt;/p&gt;
&lt;p&gt;Instead of serving to deny younger women less aggressive surgery, the results emphasize the importance of good clinical follow-up and that omission of radiation is not suitable for any subgroup of younger women, Solin said.&lt;/p&gt;
&lt;p&gt;The researchers analyzed an administrative database of all women under age 50 diagnosed with DCIS from 1994 through 2003 in Ontario. Among the 1,659 women in this category, 624 received lumpectomy and radiation therapy as validated by chart review.&lt;/p&gt;
&lt;p&gt;Few had high grade pathology (7%) or surgical margins that weren&apos;t positive (13%).&lt;/p&gt;
&lt;p&gt;Across age ranges in the cohort, similar radiation doses (most commonly 5,000 cGy) and use of boost radiation therapy to the surgical cavity (about 30%) were seen.&lt;/p&gt;
&lt;p&gt;But local recurrence rates did differ by age during the average 7.8 years of follow-up.&lt;/p&gt;
&lt;p&gt;Any local recurrence  --  DCIS or invasive  --  was seen in 20% of those under age 40, in 19% of those 40 to 44, and in 12% of those 45 to 50.&lt;/p&gt;
&lt;p&gt;After adjustment for boost radiation dose, nuclear grade, and year of diagnosis, the risk remained elevated for the younger age groups with a hazard ratio of 1.83 for those under age 40 (&lt;em&gt;P&lt;/em&gt;=0.05) and 1.64 for those age 40 to 44 (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;Local recurrence-free survival rates were highest for the oldest of the age groups (86% when diagnosed at age 45 to 50) but declined significantly with younger age (79% at 40 to 44, and 77% under 40, &lt;em&gt;P&lt;/em&gt;=0.04).&lt;/p&gt;
&lt;p&gt;However, the differences were not significant for invasive cancer recurrences alone.&lt;/p&gt;
&lt;p&gt;Possible explanations for the differences in recurrence rates might be that younger women with DCIS are more likely to have BRCA mutations or biologically aggressive disease or that surgeons do a less thorough lumpectomy to improve cosmesis in younger women, Kong speculated.&lt;/p&gt;
&lt;p&gt;But she acknowledged that the study was limited by lack of data on tamoxifen use and volume of tissue excised.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Canadian Cancer Society Research Institute.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Solin reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3239"
                     title="ASCO Breast: Partial Irradiation Methods Equal In Practice"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASCOBreast/tb/16410?impressionId=1265818107309"
                     
      &lt;p&gt;SAN FRANCISCO  --  All three variations of accelerated partial breast irradiation appear to have promising and similar outcomes in early stage breast cancer, according to results from a center that pioneered the treatment in the United States.&lt;/p&gt;
&lt;p&gt;Brachytherapy, 3-D conformal external beam radiation, and MammoSite yielded overall survival rates of 89%, 87%, and 92%, respectively, at five years, Peter Y. Chen, of William Beaumont Hospital in Royal Oak, Mich., and colleagues reported here at the ASCO Breast Cancer Symposium.&lt;/p&gt;
&lt;p&gt;Local control at five years with the partial irradiation strategies was in the same 1% to 2% range seen with conventional whole breast radiotherapy, commented Eleanor Harris, MD, of the Moffitt Cancer Center in Tampa, Fla. co-chair of the session at which the findings were discussed.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s reassuring that when you do apply these very strict selection criteria, that the outcomes do look promising,&quot; she said.&lt;/p&gt;
&lt;p&gt;However, Harris cautioned that while patients are increasingly demanding these more convenient radiation approaches, all professional societies with guidelines on use have recommended warning patients that accelerated partial breast irradiation is not standard of care.&lt;/p&gt;
&lt;p&gt;Part of the concern is a relatively short follow-up, added Stephen Edge, MD, of the Roswell Park Cancer Institute in Buffalo, New York, who with co-chaired the session with Harris.&lt;/p&gt;
&lt;p&gt;&quot;We&apos;re in a dilemma right now,&quot; he said. &quot;People are applying these technologies, but there is not long term evidence. The trials are not mature.&quot;&lt;/p&gt;
&lt;p&gt;So Chen&apos;s group examined their institution&apos;s experience, which is among the longest in the nation. They looked at outcomes from the 373 patients treated with one of the three forms of accelerated partial breast irradiation from 1993 through 2006: &lt;ul&gt; &lt;li&gt;199 got template-based interstititial needle-catheter brachytherapy (120 with a low 50 Gy dose over 96 hours and 79 as 32 Gy in eight fractions or 34 Gy in 10 fractions). &lt;/li&gt; &lt;li&gt;94 got 3-D conformal radiation therapy using three to five non-coplanar beams for 34 Gy in 10 fractions for the first six patients and 10 fractions of 3.85 Gy each thereafter. &lt;/li&gt; &lt;li&gt;80 with MammoSite at a dose of 3.4 Gy twice a day to 34 Gy prescribed at 1.0 cm from the applicator surface.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Eligibility criteria included age over 40, diagnosis of invasive ductal carcinoma of at least 3 cm, lobular carcinoma or ductal carcinoma in situ, partial mastectomy with negative margins, and no negative nodes, skin involvement, or Paget&apos;s disease.&lt;/p&gt;
&lt;p&gt;At five years, actuarial outcome rates with brachytherapy, 3-D conformal radiation, and MammoSite, respectively, were: &lt;ul&gt; &lt;li&gt;For overall survival, 87%, 92% and 91%, (&lt;em&gt;P&lt;/em&gt;=0.335).&lt;/li&gt; &lt;li&gt;For breast cancer-specific survival, 97%, 99%, and 98%, (&lt;em&gt;P&lt;/em&gt;=0.896).&lt;/li&gt; &lt;li&gt;For local recurrence, 1.6%, 1.1%, and 2.6% (&lt;em&gt;P&lt;/em&gt;=0.676).&lt;/li&gt; &lt;li&gt;For distant metastasis, 3.2%, 6.6%, and 1.3% (&lt;em&gt;P&lt;/em&gt;=0.512).&lt;/li&gt; &lt;li&gt;For disease-free survival, 96%, 92%, and 96% (&lt;em&gt;P&lt;/em&gt;=0.856).&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;These rates were comparable to previously published results for all three, Chen noted.&lt;/p&gt;
&lt;p&gt;Cosmesis was good to excellent in nearly all patients as well: 99% with brachytherapy, 89% with 3-D conformal therapy, and 94% with MammoSite.&lt;/p&gt;
&lt;p&gt;Although the brachytherapy patients averaged nearly 10 years of follow-up, the other accelerated partial breast irradiation methods need continued follow-up to determine long-term efficacy and equivalence, Chen cautioned.&lt;/p&gt;
&lt;p&gt;He noted that class I evidence is maturing in five phase III trials, with one in high-risk patients.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported conflicts of interest with Hologic for MammoSite.&lt;/p&gt;&lt;p&gt;Harris reported serving in an advisory or consultancy role with Calypso. Edge reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_634"
                     title="ASTRO: Hair Loss May Be Stopped by Intensity-Modulated Palliative Brain Radiation"
                     score="-0.005"
                     href="