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Screening
Thermography in screening for breast
cancer.
by Williams KL., Phillips BH., Jones PA., Beaman SA.,
Fleming PJ.
1990
Royal United Hospital, Bath, Avon, United Kingdom.
The aim of the study was to determine whether thermography could be used
to identify women with breast cancer or women at risk of developing the
disease within five years. DESIGN--Women were screened for breast cancer
and a documentary follow up was conducted five years later through
general practitioner records. SETTING--The project involved Women
resident in the Bath District Health Authority area, who were invited to
attend a breast screening clinic. SUBJECTS--10,238 women aged between 40
and 65 were screened. Of these, 4284 accepted personal letters of
invitation from their general practitioners and 5954 volunteered to take
part in the project in response to publicity; 9819 (96.5%) were traced
after five years. MEASUREMENTS AND MAIN RESULTS--All the women had a
thermographic and clinical examination of their breasts. If either
examination was abnormal they were referred for mammography. Sensitivity
of thermography was found to be 61% and specificity 74%. A documentary
follow up of each woman was cond ucted five years later, when it was
found that 71.6% of the women who developed breast cancer had had a
normal thermogram at the time of examination, as did 73% of those who
did not. CONCLUSIONS--Thermography is not sufficiently sensitive to be
used as a screening test for breast cancer, nor is it useful as an
indicator of risk of developing the disease within five years.
Thermographic detection of breast cancer
by Foster KR.
1998
Dept. of Bioeng., Pennsylvania State Univ., University Park,
PA;
The author outlines the historical attempts made to use infrared
thermography for breast cancer detection. He concludes that the
technique was a great idea that failed. One can produce good thermal
images of the breast, and these images often show features that reflect
disease. But the association between skin temperature and breast cancer
is too weak to be useful, given the need to detect small tumors and the
statistics of breast cancer. However, infrared imaging has experienced
great progress in recent years, which is a result of military research
in night vision. Several groups in the U.S., Canada, and Japan are
experimenting with advanced thermographic systems for detection of
breast cancer. This work, the "new thermography", is still in
preliminary stages and no extensive clinical studies have apparently
been published. The obvious hope is that improved thermal sensitivity
will result in improved sensitivity as a medical test -a plausible but
so far unproven hypothesis. Detection of breast cancer gr aphically
illustrates the very large difference between getting a medical
technology to "work" in a technical or engineering sense, and in meeting
the needs of physicians and their patients. There is also a difference
between observing promising results with individual patients, and in
showing that a technique will benefit the many patients with whom it
will be used. We would do our students a favor by helping them to
understand the difference. And those who fail to learn the lessons of
the past may have to repeat them again
Dynamic infrared imaging for the detection of malignancy.
by Button TM., Li H., Fisher P., Rosenblatt R.. Dulaimy K., Li S., O'Hea B., Salvitti M., Geronimo V.,
Geronimo C., Jambawalikar S., Carvelli P., Weiss R.
2004
Department of Radiology, State University of New York at Stony Brook,
Stony Brook, NY 11794, USA. tbutton@radiol.som.sunysb.edu
The potential for malignancy detection using dynamic infrared imaging
(DIRI) has been investigated in an animal model of human malignancy.
Malignancy was apparent in images formed at the vasomotor and
cardiogenic frequencies of tumour bearing mice. The observation of
malignancy was removed by the administration of an agent that blocks
vasodilation caused by nitric oxide (NO). Image patterns similar to
those that characterize malignancy could be mimicked in normal mice
using an NO producing agent. Apparently DIRI allows for cancer
detection in this model through vasodilation caused by malignancy
generated NO. Dynamic infrared detection of vasomotor and cardiogenic
surface perfusion was validated in human subjects by a comparison with
laser Doppler flowmetry (LDF). Dynamic infrared imaging technology was
then applied to breast cancer detection. It is shown that dynamic
infrared images formed at the vasomotor and cardiogenic frequencies of
the normal and malignant breast have image pattern differences, which
may allow for breast cancer detection.
Risk Evaluation
Application of Second Generation Infrared Imaging with Computerized Image Analysis to Breast Cancer Risk Assessment
by Jonathan F. Head, Ph.D., Charles A. Lipari, Ph.D., Fen Wang, M.D., Ph.D., JamesE. Davidson, B.Ar., Robert L. Elliot, M.D., Ph.D.
1996
Launch PDF
Cancer Risk assesment with a second generation infrared imaging system
by Jonathan F. Head, Ph.D., Charles A. Lipari, Ph.D., Fen Wang, M.D., Ph.D., Robert L. Elliot, M.D., Ph.D
1997
Launch PDF
A reappraisal of the use of infrared thermal image analysis in medicine.
by Jones BF.
1998
School of Computing, University of Glamorgan, Pontypridd, UK. bfjones@glam.ac.uk
Infrared thermal imaging of the skin has been used for several decades
to monitor the temperature distribution of human skin. Abnormalities
such as malignancies, inflammation, and infection cause localized
increases in temperature which show as hot spots or as asymmetrical
patterns in an infrared thermogram. Even though it is nonspecific,
infrared thermology is a powerful detector of problems that affect a
patient's physiology. While the use of infrared imaging is increasing
in many industrial and security applications, it has declined in
medicine probably because of the continued reliance on first generation
cameras. The transfer of military technology for medical use has
prompted this reappraisal of infrared thermology in medicine. Digital
infrared cameras have much improved spatial and thermal resolutions,
and libraries of image processing routines are available to analyze
images captured both statically and dynamically. If thermographs are
captured under controlled conditions, they may be interpreted readily
to diagnose certain conditions and to monitor the reaction of a
patient's physiology to thermal and other stresses. Some of the major
areas where infrared thermography is being used successfully are
neurology, vascular disorders, rheumatic diseases, tissue viability,
oncology (especially breast cancer), dermatological disorders,
neonatal, ophthalmology, and surgery.
Assessment of physiologic and pathologic radiative heat dissipation using dynamic infrared imaging.
by Anbar M.
2002
Department of Physiology and Biophysics, School of Medicine and
Biomedical Sciences, University at Buffalo (SUNY), New York 14214, USA.
amara@adelphia.net
This paper reviews the mechanism and assessment of regulated radiative
heat dissipation, involving the circulatory system and the skin. It
describes the quantitative assessment of skin temperature modulation.
The main regulating process, which can be quantitatively monitored by
fast and sensitive dynamic infrared imaging, involves autonomic nervous
control of cutaneous and subcutaneous perfusion. This control is
significantly affected by a variety of local or systemic pathologic
conditions, including cancer and certain neuropathies. A potential
clinical application that objectively assesses local attenuation of
temperature modulation in the presence of breast cancer is described in
some detail. Systemic aberrations in skin temperature modulation can be
clinically useful also in neurology. It can be used also in psychology
and psychiatry to evaluate transient effects of mental stress on the
autonomic nervous system.
Breast cancer : new technologies for risk assessment and diagnosis.
by Wright T., McGechan A.
2003
Adis International Inc., Yardley, Pennsylvania, USA.
In the US, one in every eight women will develop breast cancer in her
lifetime. Despite the advances made in treating breast cancer, the
causal mechanisms underlying this disease have yet to be fully
elucidated; 85% of breast cancer cases occur sporadically without any
known genetic mutation.Too little is known about the pathogenesis of
breast cancer for primary prevention to be feasible in the near- to
mid-term. Secondary prevention through screening offers an alternative
that has been widely adopted. For decades, breast self-examination has
been touted as a technique for the early identification of breast
cancer. However, it has been recently suggested that this technique is
a waste of time and resources for both doctors and patients.Mammography
finds breast cancer earlier than breast self-examination, and will
reduce the risk of death from breast cancer by approximately 30% in
women over 50 years old. Mammography is limited in that cancer, like
breast tissue, appears white on the x-ray; therefore lesi ons may be
difficult to detect in women with very dense breasts, and a tumor may
not cast a significant shadow until it is quite large. Some cancers are
so aggressive that they can spread quickly, before routine screening
can detect them. Despite these limitations, mammography is still viewed
as the best tool currently available for screening and early
diagnosis.Improved methods to detect and diagnose breast cancer early,
when it is most curable, are required if a significant impact on
morbidity and mortality from breast cancer is to be made. Various new
and innovative technologies are being investigated for improving the
early detection and diagnosis of breast cancer. About 85% of breast
cancers begin in the milk ductal system of the breast. As cancer
develops in the breast, abnormalities occur, including atypical
hyperplasia, ductal carcinoma in situ, and invasive breast carcinoma.
Thus, the early screening of ductal cells can provide a parallel
benefit to the 'Pap' smear, which is used virtually unive rsally to
identify the abnormal cells that can lead to cervical cancer. Two
technologies to monitor for atypical ductal epithelial cells are Cytyc
Corporation's FirstCyte trade mark Ductal Lavage system and Nastech
Pharmaceutical Company's Mammary Aspiration Cytology Test.Matritech,
Inc. is searching for biomarkers linked to breast cancer. Researchers
at Matritech have detected the presence of nuclear matrix protein (NMP)
in the blood of women at the early stage of breast cancer, which is
absent in the blood of healthy women, as well as those with
fibroadenoma, a benign breast disease. NMP66 has been selected as a
marker for further development and clinical trials of a test for use in
the detection and monitoring of women with, or at risk for, breast
cancer have been initiated.Technologies developed by the US Department
of Defense are under investigation as breast cancer screening. Advanced
Image Enhancement, Inc. has licensed naval sonar technology for digital
image enhancement of mammograms. New thermo graphy applications are
also being investigated in two separate projects sponsored by the US
Department of Defense using military thermal surveillance tools adapted
for cancer detection. Both are enhancements of older thermal imaging
technology based on the principle that heat equates to unwanted
activity, in the case of breast cancer, abnormal cell proliferation.
Computerized breast thermography: study of image segmentation and temperature cyclic variations.
by Ng EY., Chen Y., Ung LN.
2001
School of Mechanical and Production Engineering, Nanyang Technological
University, Singapore. mykng@ntu.edu.sg
Breast cancer is a common and dreadful disease in women. The surface
temperature and the vascularization pattern of the breast could
indicate breast diseases. Establishing the surface isotherm pattern of
the breast and the normal range of cyclic variations of temperature
distribution can assist in identifying the abnormal infrared images of
diseased breasts. This paper investigates the cyclic variation of
temperature and vascularization of the normal breast thermograms under
a controlled environment. More than 50 Asian women, were examined and
some of them have been examined continuously for two month. All
together, not less than 800 thermograms were obtained. Before these
thermograms can be analysed objectively via a computer algorithm, they
must be digitized and segmented. The authors present a method to
segment thermograms and extract the useful region from the background.
After the image processing, these thermograms can be analysed and then
the best time to perform an examination can be chosen. All these
results are important for establishing a data bank of normal breast
thermography, to choose the best time for an examination and as a
systematic methodology for evaluating and analysing the abnormal breast
thermography in the future.
From tanks to tumors.
by Paul JL., Lupo JC.
2002
Applied Research Associates, Alexandria, Virginia, USA.
"Tanks to Tumors" succeeded in bringing several different communities
together--medical, military, academic, industrial, and engineering.
They worked together in panels to determine how the United States might
adopt thermal imaging diagnostic technology in an orderly and
demonstrable way for the early detection of breast cancer and other
conditions. The panel recommendations will serve to guide the
transition of military technology developments in ATR, the VDL, and IR
sensors to the civilian medical community. The result will be a new
tool in the war against breast cancer--a major benefit to the military
and civilian population. A CD of the workshop proceedings is available
at no cost through Advanced Concepts Analysis, Falls Church, Virginia;
+1 703 914 9237; e-mail: diakides@erols.com.
Infrared imaging technology and biological applications.
by Kastberger G., Stachl R.
2003
Institute of Zoology, University of Graz, Graz, Austria. gerald.kastberger@uni-graz.at
Temperature is the most frequently measured physical quantity, second
only to time. Infrared (IR) technology has been utilized successfully
in astronomy (for a summary,see Hermans-Killam, 2002b) and in
industrial and research settings (Gruner, 2002; Madding, 1982, 1989;
Wolfe & Zissis, 1993) for decades. However, fairly recent
innovations have reduced costs, increased reliability, and resulted in
noncontact IR sensors offering mobile, smaller units of measurement
(EOI, 2002; Flir, 2000, 2001,2002). The advantages of using IR imaging
are (1) rapidity in the millisecond range, facilitating measurement of
moving targets, (2) noncontact procedures, allowing measurements of
hazardous or physically inaccessible objects, (3) no interference and
no energy lost from the target, (4) no risk of contamination, and (5)
no mechanical effect on the surface of the object. All these factors
have led to IR technology's becoming an area of interest for new kinds
of applications and users. In both manufacturing and quality control,
temperature plays an important role as an indicator of the condition of
a product or a piece of machinery (EOI, 2002; Flir, 2000, 2001, 2002;
Raytek, 2002). In medical and veterinary applications, IR thermometry
is increasingly used in organ diagnostics, in the evaluation of sports
injuries and the progression of therapy, in disease evaluation (e.g,
breast cancer, arthritis, and SARS; Flir, 2003), and in injury and
inflammation examinations in horses, livestock (Tivey & Banhazi,
2002), and zoo animals (Hermans-Killam, 2002a; Thiesbrummel, 2002).
Lastly, physiological expressions of life processes in animals
(Kastberger, Winder, & Steindl, 2001; Stabentheiner, Kovac, &
Hagmuller, 1995; Stabentheiner, Kovac, & Schmaranzer, 2002;
Stabentheiner & Schmarnzer, 1987) and plants
(Bermadinger-Stabentheiner & Stabentheiner, 1995) can be monitored.
The most recent field in which IR technology has been applied is animal
behavior. This article focuses on the practical options for noncontact
IR thermometry--i n particular, in biological applications.
Numerical computation as a tool to aid thermographic interpretation.
by Ng EY., Sudharsan NM.
2001
School of Mechanical and Production Engineering, Nanyang Technological
University, 50 Nanyang Avenue, Singapore 639798.
Thermography is an non-invasive and a painless tool for the detection
of breast cancer. However, performing and interpreting thermograms
requires meticulous training. It was found that women with an abnormal
thermogram are at a higher risk and have a poorer prognosis. One of the
main drawbacks of the thermogram is the high incidence of
false-positive results. The authors believe that the fault lies in
misinterpretation of the thermogram, rather than the thermogram itself.
The paper aims to show that computer simulations could be an adjunct
tool to help the clinician in the interpretation. This would greatly
reduce the false-positive diagnosis.
Relationship between microvessel density and thermographic hot areas in breast cancer.
by Yahara T., Koga T., Yoshida S., Nakagawa S., Deguchi H., Shirouzu K.
2003
Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
PURPOSE: This study was conducted to evaluate the validity of
thermography in breast examination. METHODS: We performed contact
thermography and measured the direct temperature by inserting a
needle-type thermometer into the tissue. The core temperature of the
tumor (dTt) and the temperature of the tissue surrounding the tumor
(dTs) were compared with normal tissue. The microvessel density (MVD)
and the MIB-1 labeling index (MIB-1 LI) of the tumor were examined
immunohistochemically. The subjects were 48 women with primary invasive
ductal carcinoma. The area of the tumor was diagnosed pathologically,
and the hot area was measured using thermography. RESULTS: The dTt was
significantly higher than the dTs. Both the dTt and dTs were
significantly higher when the thermographical hot area was positive, or
when more than four lymph node metastases were found. The dTs was
correlated with MVD. A correlation between MVD and tumor temperature
measured directly was also confirmed. A higher dTs was related to the
di ssociated wide area of the thermogram. CONCLUSION: These findings
suggested a relationship between dTs and the high-risk group of breast
cancer. We also found that abnormalities in temperature were reflected
in thermography and that a higher dTs was related to the dissociated
wide area of the thermogram.
Role of cancer thermography for detection of breast cancer.
by Yokoe T., Ishida T., Ogawa T., Iino Y., Kawai T., Izuo M.
1990
2nd Dept. of Surgery, Gunma Univ. School of Med.
Out of one hundred and sixty-two patients that examined by contact
thermography, forty-five cases involving 55 cancers were assessed for
malignancy. The sensitivity and the specificity of this method of
testing were 81.5% and 83.5%, respectively. False negative cases
included early stage, small sized and papillotubular carcinomas.
Twenty-five per cent of the fibroadenoma and mastopathy cases showed
false positive findings. Further, half of the phyllodes tumor and
mastitis cases also showed false positive findings. Two of six T0, Tis
cases (33.3%) were diagnosed as malignant tumors by thermography.
Contact thermographic examinations will be more widely used in the near
future.
Adjuvant Diagnostics
Efficacy of computerized infrared imaging analysis to evaluate mammographically suspicious lesions.
by Parisky YR., Sardi A., Hamm R., Hughes K., Esserman L., Rust S., Callahan K.
2003
USC/Norris Cancer Center, 1441 Eastlake Ave., Los Angeles, CA 90033, USA.
The purpose of this clinical trial was to determine the efficacy of a
dynamic computerized infrared imaging system for distinguishing between
benign and malignant lesions in patients undergoing biopsy on the basis
of mammographic findings. SUBJECTS AND METHODS: A 4-year clinical trial
was conducted at five institutions using infrared imaging of patients
for whom breast biopsy had been recommended. The data from a blinded
subject set were obtained in 769 subjects with 875 biopsied lesions
resulting in 187 malignant and 688 benign findings. The infrared
technique records a series of sequential images that provides an
assessment of the infrared information in a mammographically identified
area. The suspicious area is localized on the infrared image by the
radiologist using mammograms, and an index of suspicion is determined,
yielding a negative or positive result. RESULTS: In the 875 biopsied
lesions, the index of suspicion resulted in a 97% sensitivity, a 14%
specificity, a 95% negative predictive value , and a 24% positive
predictive value. Lesions that were assessed as false-negative by
infrared analysis were microcalcifications, so an additional analysis
was performed in a subset excluding lesions described only as
microcalcification. In this restricted subset of 448 subjects with 479
lesions and 110 malignancies, the index of suspicion resulted in a 99%
sensitivity, an 18% specificity, a 99% negative predictive value, and a
27% positive predictive value. Analysis of infrared imaging performance
in all 875 biopsied lesions revealed that specificity was statistically
improved in dense breast tissue compared with fatty breast tissue.
CONCLUSION: Infrared imaging offers a safe noninvasive procedure that
would be valuable as an adjunct to mammography in determining whether a
lesion is benign or malignant.
Computer simulation in conjunction with medical thermography as an adjunct tool for early detection of breast cancer.
by Ng EY., Sudharsan NM.
2004
School of Mechanical and Production Engineering, Nanyang Technological
University, 50 Nanyang Avenue, Singapore 639798, Singapore.
mykng@ntu.edu.sg
Mathematical modelling and analysis is now accepted in the engineering
design on par with experimental approaches. Computer simulations enable
one to perform several 'what-if' analyses cost effectively. High speed
computers and low cost of memory has helped in simulating large-scale
models in a relatively shorter time frame. The possibility of extending
numerical modelling in the area of breast cancer detection in
conjunction with medical thermography is considered in this work.
METHODS: Thermography enables one to see the temperature pattern and
look for abnormality. In a thermogram there is no radiation risk as it
only captures the infrared radiation from the skin and is totally
painless. But, a thermogram is only a test of physiology, whereas a
mammogram is a test of anatomy. It is hoped that a thermogram along
with numerical modelling will serve as an adjunct tool. Presently
mammogram is the 'gold-standard' in breast cancer detection. But the
interpretation of a mammogram is largely dependent on the radiologist.
Therefore, a thermogram that looks into the physiological changes in
combination with numerical simulation performing 'what-if' analysis
could act as an adjunct tool to mammography. RESULTS: The proposed
framework suggested that it could reduce the occurrence of
false-negative/positive cases. CONCLUSION: A numerical bioheat model of
a female breast is developed and simulated. The results are compared
with experimental results. The possibility of this method as an early
detection tool is discussed.
Combination of thermographic and ultrasound methods for the diagnosis of female breast cancer.
by Ramlau C., Sledzikowski J.
1993
Oncological Clinic, Medical Academy in Poznan, Poznan Polytechnic's Research Centre.
The experiment leads to the formulation of a non-invasive and highly
efficient method for the detection of the female breast cancer. The
proposed method is a combination of the results of ultrasound and
thermography tests of the breast. The study is expected to produce the
principles of test results analysis offering a 90% success rate in
detecting breast cancer.
Recent trends in U.S. breast cancer incidence, survival, and mortality rates.
by Chu KC., Tarone RE., Kessler LG., Ries LA., Hankey BF., Miller BA., Edwards BK.
1997
Special Population Studies Branch, National Cancer Institute, National
Institutes of Health, Bethesda, MD 20892, USA.
Clinical trials have demonstrated that use of mammographic screening
and advances in therapy can improve prognosis for women with breast
cancer. PURPOSE: We determined the trends in breast cancer mortality
rates, as well as incidence and survival rates by extent of disease at
diagnosis, for white women in the United States and considered whether
these trends are consistent with widespread use of such beneficial
medical interventions. METHODS: We examined mortality data from the
National Center for Health Statistics and incidence and survival data
by extent of disease from the Surveillance, Epidemiology, and End
Results Program of the National Cancer Institute, all stratified by
patient age, using statistical-regression techniques to determine
changes in the slope of trends over time. RESULTS: The age-adjusted
breast cancer mortality rate for U.S. white females dropped 6.8% from
1989 through 1993. A significant decrease in the slope of the mortality
trend of approximately 2% per year was observed in every decade of age
from 40 to 79 years of age. Trends in incidence rates were also similar
among these age groups: localized disease rates increased rapidly from
1982 through 1987 and stabilized or increased more slowly thereafter;
regional disease rates decreased after 1987; and distant disease rates
have remained level over the past 20 years. Three-year relative
survival rates increased steadily and significantly for both localized
and regional disease from 1980 through 1989 in all ages, with no
evidence of an increase in slope in the late 1980s. IMPLICATIONS: The
decrease in the diagnosis of regional disease in the late 1980s in
women over the age of 40 years likely reflects the increased use of
mammography earlier in the 1980s. The increase in survival rates,
particularly for regional disease, likely reflects improvements in
systemic adjuvant therapy. Statistical modeling indicates that the
recent drop in breast cancer mortality is too rapid to be explained
only by the increased use of mammography; likew ise, there has been no
equivalent dramatic increase in survival rates that would implicate
therapy alone. Thus, indications are that both are involved in the
recent rapid decline in breast cancer mortality rates in the United
States.
Role and evaluation of mammography and other imaging methods for breast cancer detection, diagnosis, and staging.
by Feig SA.
1999
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Mammographic screening of women age 40 and older can reduce breast
cancer deaths by at least 30% to 40%. However, not all cancers are
detected by mammography. Although a new supplementary modality for
screening could, in theory, fill in this detection gap, such
utilization must be based on rigorous demonstration of its ability to
consistently and frequently find early cancers missed by mammography,
such as those occurring in dense breasts or rapidly growing interval
cancers that surface clinically between mammographic screens. After an
abnormality is found at mammographic screening, supplementary
mammographic views and/or ultrasound are now used to match the finding
with an ACR BIRADS final diagnostic assessment category to indicate the
relative likelihood of a normal, benign, or malignant diagnosis so that
routine screening, short interval follow-up, or biopsy can then be
advised. Appropriate categorization will maximize early cancer
detection and minimize false-positive biopsies. Application of a new i
maging method to this type of diagnostic evaluation requires
well-designed studies to determine its effectiveness for this purpose.
Skin reactions after breast-conserving therapy and prediction of late complications using physiological functions.
by Sekine H., Kobayashi M., Honda C., Aoki M., Nakagawa M., Kanehira C.
2000
Department of Radiology, Division of Radiotherapy, The Jikei University
School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461,
Japan.
The temperature of the skin remains elevated long after
breast-conserving treatment with irradiation, perhaps because
evaporative cooling is impaired. We investigated physiological changes
of the irradiated skin and reevaluated the radiosensitivity of sweat
glands on a functional basis to determine whether severe complications
can be predicted. METHODS: Breast and axillary skin temperatures were
measured with thermography and sweat production in response to local
thermal stimuli was measured on the basis of changes in electrical skin
resistance with a bridge circuit in 45 women before, during, and after
breast irradiation for breast cancer. RESULTS: Breast and axillary skin
temperatures were significantly increased after irradiation. In
response to cutaneous thermal stimuli, the electric skin resistance of
nonirradiated areas decreased significantly because of sweating, but
that of irradiated areas was unchanged. CONCLUSION: Impairment of
sweating may play an important role in skin damage after irradiati on.
Although glandular tissue is not usually radiosensitive, the results of
our functional assessment suggest that sweat glands are more
radiosensitive than expected.
Statement from the National Cancer Institute on the National Cancer Advisory Board Recommendations on Mammography.
by National Cancer Institute
1997
The National Cancer Institute (NCI) accepts the recommendations of the
National Cancer Advisory Board on screening mammography. As a result,
NCI will recommend that:
Women in their 40s should be screened every one to two years with mammography.
Women aged 50 and older should be screened every one to two years.
Women who are at higher than average risk of breast cancer should seek
expert medical advice about whether they should begin screening before
age 40 and the frequency of screening.
The board also stated that because of mammography's limitations, it is
important that a clinical breast examination by a health care provider
be included as part of regular, routine health care. NCI will include
that statement in its recommendations. Richard Klausner, M.D., NCI
director, expressed his gratitude to the board for coming to closure on
the issue quickly and for helping to bring clarity to this important
issue. He said the board also made important recommendations for future
research on breast cancer screening and education, and that NCI would
address those research recommendations. Klausner said the institute
will immediately begin to develop new educational materials to
communicate the screening recommendations and to help women and health
professionals determine an individual's breast cancer risk. He said
that NCI also will work with the American Cancer Society, other
government agencies, advocacy organizations, cancer centers, and other
groups to educate the public and health professionals about the
benefits, limitations, and risks of screening mammography.
Switch to the angiogenic phenotype during tumorigenesis.
by Folkman J., Hanahan D.
1991
Department of Surgery, Children's Hospital, Boston, Massachusetts.
Tumor growth and metastasis are angiogenesis-dependent. Virtually all
solid tumors are neovascularized by the time they are detected.
However, there is a prevascular phase during early tumor development
where few or no tumor cells are angiogenic and expansion of the tumor
is restricted to a few mm3. When enough tumor cells become angiogenic,
the tumor can expand progressively and shed metastatic cells. This
angiogenic switch has recently been quantitated for human breast
cancer, as well as for prostate cancer. We have studied the problem of
how tumors switch to the angiogenic phenotype by using transgenic mice
in which tumors develop at a predictable time and in discrete
prevascular and vascular stages. When the transgene is the bovine
papilloma virus (BPV) genome, angiogenic fibrosarcomas develop from
non-angiogenic precursors called fibromatoses. The fibrosarcomas
secrete growth factors for capillary endothelial cells. In contrast,
the fibromatoses do not secrete endothelial cell growth factors. When t
he transgene consists of the large "T" antigen of SV40 under the
control of the rat insulin promoter, 70% of pancreatic islets become
hyperplastic and 4-10% of these become angiogenic at 6-7 weeks. Tumors
arise from these neovascularized hyperplastic islets and reach >
1000 x the volume of the preangiogenic islets. The onset of angiogenic
activity coincides with the secretion of acidic fibroblast growth
factor (aFGF) and other growth factors not fully identified at this
writing. These studies help to explain the switch to the angiogenic
phenotype during tumorigenesis and provide models to discover
antiangiogenic therapies directed at the source of angiogenic activity.
Such therapy, when developed, may be co-administered with currently
available angiogenesis inhibitors which are directed at the target of
angiogenic activity, vascular endothelial cells.
The effectiveness of the Gail model in estimating risk for development of breast cancer in women under 40 years of age.
by MacKarem G., Roche CA., Hughes KS.
2001
Breast Cancer Treatment Center and the Department of General Surgery,
Lahey Hitchcock Medical Center, Burlington, Massachusetts, USA.
Epidemiologic studies have provided information on risk factors for
breast cancer. Gail and associates identified five risk factors using
the Breast Cancer Detection Demonstration Project (BCDDP) population
and developed a model to calculate a composite relative risk (RR). This
model is commonly used to counsel women regarding their risk for breast
cancer and was used by the National Surgical Adjuvant Breast Project
(NSABP) for eligibility for the Breast Cancer Prevention Trial. Because
the BCDDP population was composed almost entirely of women 40 years of
age or older, our purpose was to evaluate the effectiveness of the Gail
model in estimating the risk of breast cancer for women under 40 in the
clinical setting. The Gail risk factors were assessed for 124 patients
under the age of 40 treated for either ductal carcinoma in situ (DCIS)
or invasive breast cancer at the Lahey Hitchcock Medical Center between
1983 and 1995. The RR was calculated using the Gail model. For
comparison, two cohorts of women un der the age of 40 were used: 107
randomly selected patients who underwent a breast biopsy because of a
benign condition and 129 nurses from our institution who responded to a
questionnaire that included reproductive and family history information
as used in the Gail model. The RR calculated was the RR that existed at
the time of the surgical consultation for a suspicious breast lesion.
The Tarone-Ware method was used to analyze statistical significance of
differences between distribution. Contingency tables were analyzed
using Miettinen's modification of Fisher's exact test. No differences
were found between the median RR for all groups. Only 2 of the 124
patients with breast cancer had a RR of 5 or more (the RR required to
enter the Breast Cancer Prevention Trial). The distribution of age at
menarche (AGEMEN) was the same for each group. No difference was found
for the distribution of age at first live birth (AGEFLB) between those
with breast cancer and those with a benign biopsy or the control group.
T he number of breast biopsies (NBIOPS) was higher in patients with a
benign breast biopsy. No difference was found in the distribution of
number of first-degree relatives with breast cancer (NUMREL). Overall
the Gail model failed to differentiate those women about to have cancer
diagnosed from two control populations. The Gail model is not useful in
identifying immediate risk of breast cancer in women under 40 and
should not be used for that purpose.
Tumor angiogenesis and metastasis--correlation in invasive breast carcinoma.
by Weidner N., Semple JP., Welch WR., Folkman J.
1991
Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115.
BACKGROUND. Experimental evidence suggests that the growth of a tumor
beyond a certain size requires angiogenesis, which may also permit
metastasis. To investigate how tumor angiogenesis correlates with
metastases in breast carcinoma, we counted microvessels (capillaries
and venules) and graded the density of microvessels within the initial
invasive carcinomas of 49 patients (30 with metastases and 19 without).
METHODS. Using light microscopy, we highlighted the vessels by staining
their endothelial cells immunocytochemically for factor VIII. The
microvessels were carefully counted (per 200x field), and their density
was graded (1 to 4+), in the most active areas of neovascularization,
without knowledge of the outcome in the patient, the presence or
absence of metastases, or any other pertinent variable. RESULTS. Both
microvessel counts and density grades correlated with metastatic
disease. The mean (+/- SD) count and grade in the patients with
metastases were 101 +/- 49.3 and 2.95 +/- 1.00 vessels, resp ectively.
The corresponding values in the patients without metastases were
significantly lower--45 +/- 21.1 and 1.38 +/- 0.82 (P = 0.003 and P
less than or equal to 0.001, respectively). For each 10-microvessel
increase in the count per 200x field, there was a 1.59-fold increase in
the risk of metastasis (95 percent confidence interval, 1.19 to 2.12; P
= 0.003). The microvessel count and density grade also correlated with
distant metastases. For each 10-microvessel increase in the vessel
count per 200x field, there was a 1.17-fold increase in the risk of
distant metastasis (95 percent confidence interval, 1.02 to 1.34; P =
0.029). CONCLUSIONS. The number of microvessels per 200x field in the
areas of most intensive neovascularization in an invasive breast
carcinoma may be an independent predictor of metastatic disease either
in axillary lymph nodes or at distant sites (or both). Assessment of
tumor angiogenesis may therefore prove valuable in selecting patients
with early breast carcinoma for aggressive therapy.
Treatment Monitoring
Use of digital infrared imaging in enhanced breast cancer detection and monitoring of the clinical response to treatment
by Francis Arena M.D, Clement Barone M.D, Thomas DiCicco
2003
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Dynamic
infrared imaging of newly diagnosed malignant lymphoma compared with
with gallium-67 and fluorine-18 fluorodeoxyglucose (fdg) positron
emission tomography.
by Milos J. Janicek, M.D, Ph.D, George Memetri, M.D, Milos R. Janicek, Kitt Shaffer, M.D, Ph.D, Mark A. Fauci, B.S.S., M.B.A.
2003
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Multi-modality
data fusion aids early detection of breast cancer using conventional
technology and advanced digital infrared imaging .
by Francis Arena M.D., Thomas DiCicco, Azad Anand M.D.
2004
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Infrared Imaging as a Useful Adjunct to Mammography
by Oncology News International
1997
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