Publications by authors named "Nataliia Moshina"

16 Publications

  • Page 1 of 1

Quality of life among women with symptomatic, screen-detected, and interval breast cancer, and for women without breast cancer: a retrospective cross-sectional study from Norway.

Qual Life Res 2021 Oct 26. Epub 2021 Oct 26.

Cancer Registry of Norway, Majorstuen, P.O. 5313, 0304, Oslo, Norway.

Purpose: Breast cancers detected at screening need less aggressive treatment compared to breast cancers detected due to symptoms. The evidence on the quality of life associated with screen-detected versus symptomatic breast cancer is sparse. This study aimed to compare quality of life among Norwegian women with symptomatic, screen-detected and interval breast cancer, and women without breast cancer and investigate quality adjusted life years (QALYs) for women with breast cancer from the third to 14th year since diagnosis.

Methods: This retrospective cross-sectional study was focused on women aged 50 and older. A self-reported questionnaire including EQ-5D-5L was sent to 11,500 women. Multivariable median regression was used to analyze the association between quality of life score (visual analogue scale 0-100) and detection mode. Health utility values representing women's health status were extracted from EQ-5D-5L. QALYs were estimated by summing up the health utility values for women stratified by detection mode for each year between the third and the 14th year since breast cancer diagnosis, assuming that all women would survive.

Results: Adjusted regression analyses showed that women with screen-detected (n = 1206), interval cancer (n = 1005) and those without breast cancer (n = 1255) reported a higher median quality of life score using women with symptomatic cancer (n = 1021) as reference; 3.7 (95%CI 2.2-5.2), 2.3 (95%CI 0.7-3.8) and 4.8 (95%CI 3.3-6.4), respectively. Women with symptomatic, screen-detected and interval cancer would experience 9.5, 9.6 and 9.5 QALYs, respectively, between the third and the 14th year since diagnosis.

Conclusion: Women with screen-detected or interval breast cancer reported better quality of life compared to women with symptomatic cancer. The findings add benefits of organized mammographic screening.
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http://dx.doi.org/10.1007/s11136-021-03017-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547129PMC
October 2021

Comparability and validity of cancer registry data in the northwest of Russia.

Acta Oncol 2021 Oct 23;60(10):1264-1271. Epub 2021 Aug 23.

Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.

Background: Despite the elaborate history of statistical reporting in the USSR, Russia established modern population-based cancer registries (PBCR) only in the 1990s. The quality of PBCRs data has not been thoroughly analyzed. This study aims at assessing the comparability and validity of cancer statistics in regions of the Northwestern Federal District (NWFD) of Russia.

Material And Methods: Data from ten Russian regional PBCRs covering ∼13 million (∼5 million in St. Petersburg) were processed in line with IARC/IACR and ENCR recommendations. We extracted and analyzed all registered cases but focused on cases diagnosed between 2008 and 2017. For comparability and validity assessment, we applied established qualitative and quantitative methods.

Results: Data collection in NWFD is in line with international standards. Distributions of diagnosis dates revealed higher variation in several regions, but overall, distributions are relatively uniform. The proportion of multiple primaries between 2008 and 2017 ranged from 6.7% in Vologda Oblast to 12.4% in Saint-Petersburg. We observed substantial regional heterogeneity for most indicators of validity. In 2013-2017, proportions of morphologically verified cases ranged between 61.7 and 89%. Death certificates only (DCO) cases proportion was in the range of 1-14% for all regions, except for Saint-Petersburg (up to 23%). The proportion of cases with a primary site unknown was between 1 and 3%. Certain cancer types (e.g., pancreas, liver, hematological malignancies, and CNS tumors) and cancers in older age groups showed lower validity.

Conclusion: While the overall level of comparability and validity of PBCRs data of four out of ten regions of NWFD of Russia meets the international standards, differences between the regions are substantial. The local instructions for cancer registration need to be updated and implemented. The data validity assessment also reflects pitfalls in the quality of diagnosis of certain cancer types and patient groups.
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http://dx.doi.org/10.1080/0284186X.2021.1967443DOI Listing
October 2021

History and current status of cancer registration in Russia.

Cancer Epidemiol 2021 08 2;73:101963. Epub 2021 Jun 2.

Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.

Background: Russia, then part of the Union of Soviet Socialist Republics (the USSR), introduced compulsory cancer registration in 1953, but a clear overall contemporary description of the cancer surveillance system in Russia is not available.

Methods: We summarized historical landmarks and the development of the standards of classification and coding of neoplasms in Russia and described current population-based cancer registries' (PBCR) procedures and practices.

Results: Cancer registration is organized according to the administrative division of the Russian Federation. More than 600,000 cases are registered annually. All medical facilities, without exception, are required to notify the PBCR about newly diagnosed cases, and each regional PBCR is responsible for registering all cancers diagnosed in citizens residing in the region. The data collection can be described as passive and exhaustive. Hematological malignancies, brain, and CNS tumors are often not referred to cancer hospitals in some regions, explaining the problems in registering these cancers.

Conclusion: Russia's cancer registration system is population-based, and practices seem to be generally internationally comparable. However, coding practices and national guidelines are still outdated and not up to the most recent international recommendations. Further analyses are needed to assess the comparability, validity, completeness, and timeliness of Russia's PBCRs data.
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http://dx.doi.org/10.1016/j.canep.2021.101963DOI Listing
August 2021

Factors associated with attendance and attendance patterns in a population-based mammographic screening program.

J Med Screen 2021 06 17;28(2):169-176. Epub 2020 Jun 17.

Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.

Objective: To explore the factors associated with attendance and attendance pattern in BreastScreen Norway.

Methods: We evaluated the number of invitations (n = 1,253,995) and attendances, 2015-2019, stratified by age, invitation method, screening unit and time of appointment. Attendance pattern was analysed for women invited 10 times (n = 47,979), 1996-2019. The association of education level, body mass index, physical activity and smoking status with attendance was analysed for a sub-sample of women (n = 37,930). Descriptive statistics were used to analyse attendance, and negative binomial regression was used to analyse the association between the total number of attendances and education level and lifestyle factors.

Results: The attendance rate was 76.0%, 2015-2019. The rate was 78.0% for women aged >64 and 73.9% for those <55 . We found a rate of 82.0% for women who received a digital invitation, while it was 73.7% for those invited by post. The rate was 78.1% for invitations in the late afternoon, 3-6 p.m., while later appointments reached a rate of 73.7%. Half of the women invited 10 times attended all times. The predicted total number of attendances was 9 out of 10 for the factors investigated.

Conclusion: The highest attendance rates were shown for women aged >64, those who received digital invitations and those having appointments in late afternoon. The differences in predicted number of attendances between the investigated factors were minor. Overall, BreastScreen Norway has a high attendance rate. However, efforts aimed at increasing the attendance in specific groups should be considered.
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http://dx.doi.org/10.1177/0969141320932945DOI Listing
June 2021

Interval and Subsequent Round Breast Cancer in a Randomized Controlled Trial Comparing Digital Breast Tomosynthesis and Digital Mammography Screening.

Radiology 2021 07 11;300(1):66-76. Epub 2021 May 11.

From the Cancer Registry of Norway, PO 5313, Maiorstuen, 0304 Oslo, Norway (S.H., N.M., Å.S.H., A.S.D.); Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Services, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (N.H.); Department of Radiology (H.S.A., I.S.H.), Department of Pathology (L.A.A.), and Mohn Medical Imaging and Visualization Centre (I.S.H.), Haukeland University Hospital, Bergen, Norway; and Department of Clinical Medicine (H.S.A., I.S.H.), Section for Pathology (L.A.A.), and Centre for Cancer Biomarkers CCBIO (L.A.A.), University of Bergen, Bergen, Norway.

Background Prevalent digital breast tomosynthesis (DBT) has shown higher cancer detection rates and lower recall rates compared with those of digital mammography (DM). However, data are limited on rates and histopathologic tumor characteristics of interval and subsequent round screen-detected cancers for DBT. Purpose To follow women randomized to screening with DBT or DM and to investigate rates and tumor characteristics of interval and subsequent round screen-detected cancers. Materials and Methods To-Be is a randomized controlled trial comparing the outcome of DBT and DM in organized breast cancer screening. The trial included 28 749 women, with 22 306 women returning for subsequent DBT screening 2 years later (11 201 and 11 105 originally screened with DBT and DM, respectively). Differences in rates, means, and distribution of histopathologic tumor characteristics between women prevalently screened with DBT versus DM were evaluated with Z tests, tests, and χ tests. Relative risk (RR) with 95% CIs was calculated for the cancer rates. Results Interval cancer rates were 1.4 per 1000 screens (20 of 14 380; 95% CI: 0.9, 2.1) for DBT versus 2.0 per 1000 screens (29 of 14 369; 95% CI: 1.4, 2.9; = .20) for DM. The rates of subsequent round screen-detected cancer were 8.1 per 1000 (95% CI: 6.6, 10.0) for women originally screened with DBT and 9.1 per 1000 (95% CI: 7.4, 11.0; = .43) for women screened with DM. The distribution of tumor characteristics did not differ between groups for either interval or subsequent screen-detected cancer. The RR of interval cancer was 0.69 (95% CI: 0.39, 1.22; = .20) for DBT versus DM, whereas RR of subsequent screen-detected cancer for women prevalently screened with DBT versus DM was 0.89 (95% CI: 0.67, 1.19; = .43). Conclusion Rates of interval or subsequent round screen-detected cancers and their tumor characteristics did not differ between women originally screened with digital breast tomosynthesis (DBT) versus digital mammography. The analysis suggests that the benefits of prevalent DBT screening did not come at the expense of worse downstream screening performance measures in a population-based screening program. © RSNA, 2021 See also the editorial by Taourel in this issue.
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http://dx.doi.org/10.1148/radiol.2021203936DOI Listing
July 2021

Digital breast tomosynthesis in a population based mammographic screening program: Breast compression and early performance measures.

Eur J Radiol 2021 Jun 19;139:109665. Epub 2021 Mar 19.

Cancer Registry of Norway, Oslo, Norway; Faculty of Health Sciences Oslo Metropolitan University, Oslo, Norway. Electronic address:

Purpose: We aimed to determine if compression force or pressure could be associated with early performance measures for women screened with digital breast tomosynthesis (DBT) in BreastScreen Norway. Early performance measures included rates of consensus, recall, and screen-detected breast cancer.

Method: Data on compression force and pressure, compressed breast thickness and breast characteristics were extracted from an automated software for density assessment of DBT screening examinations for 25,286 women. For descriptive analyses, force (Newton, N) and pressure (kilopascal, kPa) were categorized into quartiles. Analyses were stratified by mammographic view, craniocaudal (CC) and mediolateral oblique (MLO). Logistic regression with restricted cubic splines was used to investigate the association between force and pressure as continuous exposures and early performance measures adjusted for age, compressed breast thickness and fibroglandular volume.

Results: Mean age of the screened women was 60.7 (SD = 5.2) years. Mean compression force was 90.8 (SD = 14.2) N for CC and 106.3 (SD = 20.6) N for MLO, and pressure was 11.3 (SD = 3.6) kPa for CC and 8.7 (SD = 2.0) kPa for MLO. The highest rates of screen-detected cancer were observed for low force (1.04 % for <82.5 N for CC and 1.07 % for <92.0 N for MLO) and low pressure (1.07 % for <7.2 kPa for MLO). No association was found between force or pressure as continuous exposures and early performance measures in adjusted regression analyses.

Conclusions: We found the highest rates of screen-detected cancer for low force and pressure, but no significant association between continuous values of force or pressure and early performance measures in DBT. The findings might indicate that the levels of force and pressure in DBT are of lower significance for screening performance than reported in standard digital mammography.
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http://dx.doi.org/10.1016/j.ejrad.2021.109665DOI Listing
June 2021

Comparing Screening Outcomes for Digital Breast Tomosynthesis and Digital Mammography by Automated Breast Density in a Randomized Controlled Trial: Results from the To-Be Trial.

Radiology 2020 12 15;297(3):522-531. Epub 2020 Sep 15.

From the Cancer Registry of Norway, PO Box 5313, Majorstuen, 0304 Oslo, Norway (N.M., A.S.D., S.H.); Department of Radiology, Haukeland University Hospital, Bergen, Norway (H.S.A., I.S.H.); Department of Clinical Medicine, University of Bergen, Bergen, Norway (H.S.A., I.S.H.); Department of Radiology, Seattle Cancer Care Alliance, University of Washington, Seattle, Wash (C.I.L.); Department of Translational Medicine, Diagnostic Radiology, Lund University Cancer Center, Malmö, Sweden (S.Z.); and Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway (S.H.).

Background Digital breast tomosynthesis (DBT) is considered superior to digital mammography (DM) for women with dense breasts. Purpose To identify differences in screening outcomes, including rates of recall, false-positive (FP) findings, biopsy, cancer detection rate, positive predictive value of recalls and biopsies, and histopathologic tumor characteristics by density using DBT combined with two-dimensional synthetic mammography (SM) (hereafter, DBT+SM) versus DM. Materials and Methods This randomized controlled trial comparing DBT+SM and DM was performed in Bergen as part of BreastScreen Norway, 2016-2017. Automated software measured density (Volpara Density Grade [VDG], 1-4). The outcomes were compared for DBT+SM versus DM by VDG in descriptive analyses. A stratified log-binomial regression model was used to estimate relative risk of outcomes in subgroups by screening technique. Results Data included 28 749 women, 14 380 of whom were screened with DBT+SM and 14 369 of whom were screened with DM (both groups: median age, 59 years; interquartile range [IQR], 54-64 years). The recall rate was lower for women screened with DBT+SM versus those screened with DM for VDG 1 (2.1% [81 of 3929] vs 3.3% [106 of 3212]; = .001) and VDG 2 (3.2% [200 of 6216] vs 4.3% [267 of 6280]; = .002). For DBT+SM, adjusted relative risk of recall (VDG 2: 1.8; < .001; VDG 3: 2.4; < .001; VDG 4: 1.8; = .02) and screen-detected breast cancer (VDG 2: 2.4; = .004; VDG 3: 2.8; = .01; VDG 4: 2.8; = .05) increased with VDG, whereas no differences were observed for DM (relative risk of recall for VDG 2: 1.3; = .06; VDG 3: 1.1; = .41; VDG 4: 1.1; = .71; and relative risk of screen-detected breast cancer for VDG 2: 1.7; = .13; VDG 3: 2.1; = .06; VDG 4: 2.2; = .15). Conclusion Screening with digital breast tomosynthesis combined with synthetic two-dimensional mammograms (DBT+SM) versus digital mammography (DM) yielded lower recall rates for women with Volpara Density Grade (VDG) 1 and VDG 2. Adjusted relative risk of recall and screen-detected breast cancer increased with denser breasts for DBT+SM but not for DM. © RSNA, 2020 See also the editorial by Sechopoulos and Athanasiou in this issue.
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http://dx.doi.org/10.1148/radiol.2020201150DOI Listing
December 2020

Breast compression and experienced pain during mammography by use of three different compression paddles.

Eur J Radiol 2019 Jun 14;115:59-65. Epub 2019 Apr 14.

Cancer Registry of Norway, P.O. 5313 Majorstuen, 0304, Oslo, Norway; Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway. Electronic address:

Objectives: We aimed to compare pain experienced during screening mammography, using three different compression paddles: a fixed paddle standardizing pressure (study paddle), a flexible, and a fixed paddle.

Material And Methods: Using a numeric rating scale (NRS), ranged 0-10, we collected information on pain experienced during mammography from a questionnaire completed by 4,675 women screened in Stavanger, May-November 2017, as a part of BreastScreen Norway. The questionnaire also provided information on factors possibly associated with pain. Data on compression force, pressure and breast characteristics were extracted from the DICOM-header, and a breast density software. T-tests were used to compare mean values of the parameters between the types of compression paddles. Linear regression was used to determine the association of a score of ≥7 versus <7 on NRS for experienced pain by compression paddle, adjusting for pressure, breast characteristics and associated factors.

Results: The mean of experienced pain did not differ for the study and flexible paddle (2.5 on NRS), and was lower for the study paddle compared to the fixed paddle (2.4 versus 2.6 on NRS, p < 0.05). Pain in shoulder(s) and/or neck prior to mammography was associated with 33% (RR 1.33, 95%CI 1.07-1.65) higher risk of a score of ≥7 versus <7 for experienced pain.

Conclusion: The majority of women reported low scores of experienced pain during mammography, independent of compression paddle used. Further research on image quality is needed to fully understand which paddles should be preferred in a screening setting.
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http://dx.doi.org/10.1016/j.ejrad.2019.04.006DOI Listing
June 2019

Automated Volumetric Analysis of Mammographic Density in a Screening Setting: Worse Outcomes for Women with Dense Breasts.

Radiology 2018 08 26;288(2):343-352. Epub 2018 Jun 26.

From the Cancer Registry of Norway, Oslo, Norway (N.M., S.S., K.M.T., S.H.); Departments of Radiology (C.I.L.) and Medicine (J.G.E.), University of Washington School of Medicine, Seattle, Wash; Department of Clinical Medicine, Section for Pathology, Centre for Cancer Biomarkers (CCBIO), Bergen, Norway (L.A.A.); Department of Pathology, Haukeland University Hospital, Bergen, Norway (L.A.A.); and Oslo Metropolitan University, Faculty of Health Science, Oslo, Norway (S.H.).

Purpose To describe screening outcomes from BreastScreen Norway stratified by volumetric breast density (VBD). Materials and Methods This retrospective study included data from 107 949 women aged 50-69 years (mean age ± standard deviation, 58.7 years ± 5.6) who underwent 307 015 screening examinations from 2007 to 2015. Automated software classified mammographic density as nondense (VBD <7.5%) or dense (VBD ≥7.5%). Rates and distributions of screening outcomes (recall, biopsy, screen-detected and interval breast cancer, positive predictive values of recall and of needle biopsy, sensitivity, specificity, and histopathologic tumor characteristics) were analyzed and stratified by density. Tests of proportions, including propensity score and t tests, were used. Results In 28% (87 021 of 307 015) of the screening examinations, the breasts were classified as dense. Recall rates for women with nondense versus dense breasts were 2.7% (5882 of 219 994) and 3.6% (3101 of 87 021); biopsy rates were 1.1% (2359 of 219 994) and 1.4% (1209 of 87 021); rates of screen-detected cancer were 5.5 (1210 of 219 994) and 6.7 (581 of 87 021) per 1000 examinations; and rates of interval breast cancer were 1.2 (199 of 165 324) and 2.8 (185 of 66 674) per 1000 examinations, respectively (P < .001 for all). Sensitivity was 82% (884 of 1083) for nondense breasts and 71% (449 of 634) for dense breasts, whereas specificity was 98% (160 973 of 164 440) and 97% (64 250 of 66 225), respectively (P < .001 for both). For screen-detected cancers, mean tumor diameter was 15.1 mm and 16.6 mm (P = .01), and lymph node-positive disease was found in 18% (170 of 936) and 24% (98 of 417) (P = .02) of women with nondense and dense breasts, respectively. Conclusion Screening examinations of women with dense breasts classified by using automated software resulted in higher recall rate, lower sensitivity, larger tumor diameter, and more lymph node-positive disease compared with women with nondense breasts.
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http://dx.doi.org/10.1148/radiol.2018172972DOI Listing
August 2018

The impact of compression force and pressure at prevalent screening on subsequent re-attendance in a national screening program.

Prev Med 2018 03 11;108:129-136. Epub 2018 Jan 11.

Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway; Oslo and Akershus University College of Applied Sciences, P.O. 4, St. Olavs plass, 0130 Oslo, Norway. Electronic address:

Adherence to screening may indirectly help assess whether a prior screening examination deters women from returning for a subsequent examination. We investigated whether compression force and pressure in mammography were associated with re-attendance among prevalently screened women in the organized breast cancer screening program in Norway. Data on compression force (kg) and pressure (kPa) from women's first screening examination in the program (prevalent screening) and subsequent re-attendance were available for 31,225 women aged 50-68, screened during 2007-2013. Crude re-attendance rates and log-binomial regression models estimating the prevalence ratio of re-attendance were used to identify the association between compression force or pressure and re-attendance two-years later. Age and year at prevalent screening, county of residence, screening result (negative or false positive), breast volume, and breast density were included in analyses. Overall, 27,197 (87.1%) women re-attended the program. Re-attendance was highest for women who received a compression force of 10.0-13.9 kg (87.5%) or pressure of 9.0-17.9 kPa (87.8%) and lowest for those who received a compression force of <10.0 kg (85.0%) or pressure of <9.0 kPa (84.7%). The adjusted prevalence of re-attendance was 3% lower for women who received low compression force (<10.0 kg) and 2% lower for women who received low compression pressure (<9.0 kPa) relative to the reference groups (10.0-13.9 kg and 9.0-17.9 kPa, respectively). Future research related to re-attendance should also include information about women's experience of pain, anxiety and stress, as well as image quality.
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http://dx.doi.org/10.1016/j.ypmed.2018.01.008DOI Listing
March 2018

Breast compression parameters and mammographic density in the Norwegian Breast Cancer Screening Programme.

Eur Radiol 2018 Apr 2;28(4):1662-1672. Epub 2017 Nov 2.

Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304, Oslo, Norway.

Objectives: To investigate possible associations between breast compression parameters, including compression force, pressure and compressed breast thickness, and mammographic density assessed by an automated software.

Methods: We obtained data on breast compression parameters, breast volume, absolute and percentage dense volume, and body mass index for 14,698 women screened with two-view (craniocaudal, CC, and mediolateral oblique, MLO) digital mammography, in the Norwegian Breast Cancer Screening Programme, 2014-2015. The Spearman correlation coefficient (ρ) was used to measure correlation between breast compression parameters, breast volume and absolute and percentage dense volume. Linear regression was used to examine associations between breast compression parameters and absolute and percentage dense volume, adjusting for breast volume, age and BMI.

Results: A fair negative correlation was observed between compression pressure and absolute dense volume (ρ = - 0.37 for CC and ρ = - 0.34 for MLO). A moderate negative correlation was identified for compressed breast thickness and percentage dense volume (ρ = - 0.56 for CC and ρ = - 0.62 for MLO). These correlations were corroborated by the corresponding associations obtained in the adjusted regression analyses.

Conclusions: Results from this study indicate that breast compression parameters may influence absolute and percentage dense volume measured by the automated software.

Key Points: • A fair correlation was identified between compression pressure and absolute dense volume • A moderate correlation was identified between compressed breast thickness and percentage dense volume • Breast compression may influence automated density estimates.
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http://dx.doi.org/10.1007/s00330-017-5104-5DOI Listing
April 2018

Comparison of subjective and fully automated methods for measuring mammographic density.

Acta Radiol 2018 Feb 31;59(2):154-160. Epub 2017 May 31.

1 Cancer Registry of Norway, Oslo, Norway.

Background Breast radiologists of the Norwegian Breast Cancer Screening Program subjectively classified mammographic density using a three-point scale between 1996 and 2012 and changed into the fourth edition of the BI-RADS classification since 2013. In 2015, an automated volumetric breast density assessment software was installed at two screening units. Purpose To compare volumetric breast density measurements from the automated method with two subjective methods: the three-point scale and the BI-RADS density classification. Material and Methods Information on subjective and automated density assessment was obtained from screening examinations of 3635 women recalled for further assessment due to positive screening mammography between 2007 and 2015. The score of the three-point scale (I = fatty; II = medium dense; III = dense) was available for 2310 women. The BI-RADS density score was provided for 1325 women. Mean volumetric breast density was estimated for each category of the subjective classifications. The automated software assigned volumetric breast density to four categories. The agreement between BI-RADS and volumetric breast density categories was assessed using weighted kappa (k). Results Mean volumetric breast density was 4.5%, 7.5%, and 13.4% for categories I, II, and III of the three-point scale, respectively, and 4.4%, 7.5%, 9.9%, and 13.9% for the BI-RADS density categories, respectively ( P for trend < 0.001 for both subjective classifications). The agreement between BI-RADS and volumetric breast density categories was k = 0.5 (95% CI = 0.47-0.53; P < 0.001). Conclusion Mean values of volumetric breast density increased with increasing density category of the subjective classifications. The agreement between BI-RADS and volumetric breast density categories was moderate.
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http://dx.doi.org/10.1177/0284185117712540DOI Listing
February 2018

Is breast compression associated with breast cancer detection and other early performance measures in a population-based breast cancer screening program?

Breast Cancer Res Treat 2017 Jun 29;163(3):605-613. Epub 2017 Mar 29.

Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304, Oslo, Norway.

Purpose: We aimed to investigate early performance measures in a population-based breast cancer screening program stratified by compression force and pressure at the time of mammographic screening examination. Early performance measures included recall rate, rates of screen-detected and interval breast cancers, positive predictive value of recall (PPV), sensitivity, specificity, and histopathologic characteristics of screen-detected and interval breast cancers.

Methods: Information on 261,641 mammographic examinations from 93,444 subsequently screened women was used for analyses. The study period was 2007-2015. Compression force and pressure were categorized using tertiles as low, medium, or high. χ test, t tests, and test for trend were used to examine differences between early performance measures across categories of compression force and pressure. We applied generalized estimating equations to identify the odds ratios (OR) of screen-detected or interval breast cancer associated with compression force and pressure, adjusting for fibroglandular and/or breast volume and age.

Results: The recall rate decreased, while PPV and specificity increased with increasing compression force (p for trend <0.05 for all). The recall rate increased, while rate of screen-detected cancer, PPV, sensitivity, and specificity decreased with increasing compression pressure (p for trend <0.05 for all). High compression pressure was associated with higher odds of interval breast cancer compared with low compression pressure (1.89; 95% CI 1.43-2.48).

Conclusions: High compression force and low compression pressure were associated with more favorable early performance measures in the screening program.
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http://dx.doi.org/10.1007/s10549-017-4214-8DOI Listing
June 2017

Compression forces used in the Norwegian Breast Cancer Screening Program.

Br J Radiol 2017 Mar 17;90(1071):20160770. Epub 2017 Feb 17.

1 Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.

Objective: Compression is used in mammography to reduce breast thickness, which is claimed to improve image quality and reduce radiation dose. In the Norwegian Breast Cancer Screening Program (NBCSP), the recommended range of compression force for full-field digital mammography (FFDM) is 11-18 kg (108-177 N). This is the first study to investigate the compression force used in the programme.

Methods: The study included information from 17,951 randomly selected females screened with FFDM at 14 breast centres in the NBCSP, during January-March 2014. We investigated the applied compression force on the left breast in craniocaudal and mediolateral oblique views for breast centres, mammography machines within the breast centres and for the radiographers.

Results: The mean compression force for all mammograms in the study was 116 N and ranged from 91 N to 147 N between the breast centres. The variation in compression force was wider between the breast centres than that between mammography machines (range 137-155 N) and radiographers (95-143 N) within one breast centre. Approximately 59% of the mammograms in the study complied with the recommended range of compression force.

Conclusion: A wide variation in applied compression force was observed between the breast centres in the NBCSP. This variation indicates a need for evidence-based recommendations for compression force aimed at optimizing the image quality and individualizing breast compression. Advances in knowledge: There was a wide variation in applied compression force between the breast centres in the NBCSP. The variation was wider between the breast centres than that between mammography machines and radiographers within one breast centre.
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http://dx.doi.org/10.1259/bjr.20160770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601524PMC
March 2017

Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program.

Eur J Radiol 2016 Jan 25;85(1):248-254. Epub 2015 Nov 25.

Cancer Registry of Norway, Oslo, Norway; Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo, Norway. Electronic address:

Objective: To investigate the probability of breast cancer among women recalled due to abnormal findings on the screening mammograms (PPV-1) and among women who underwent an invasive procedure (PPV-2) by mammographic density (MD), screening mode and age.

Methods: We used information about 28,826 recall examinations from 26,951 subsequently screened women in the Norwegian Breast Cancer Screening Program, 1996-2010. The radiologists who performed the recall examinations subjectively classified MD on the mammograms into three categories: fatty (<30% fibroglandular tissue); medium dense (30-70%) and dense (>70%). Screening mode was defined as screen-film mammography (SFM) and full-field digital mammography (FFDM). We examined trends of PPVs by MD, screening mode and age. We used logistic regression to estimate odds ratio (OR) of screen-detected breast cancer associated with MD among women recalled, adjusting for screening mode and age.

Results: PPV-1 and PPV-2 decreased by increasing MD, regardless of screening mode (p for trend <0.05 for both PPVs). PPV-1 and PPV-2 were statistically significantly higher for FFDM compared with SFM for women with fatty breasts. Among women recalled, the adjusted OR of breast cancer decreased with increasing MD. Compared with women with fatty breasts, the OR was 0.90 (95% CI: 0.84-0.96) for those with medium dense breasts and 0.85 (95% CI: 0.76-0.95) for those with dense breasts.

Conclusion: PPVs decreased by increasing MD. Fewer women needed to be recalled or undergo an invasive procedure to detect one breast cancer among those with fatty versus dense breasts in the screening program in Norway, 1996-2010.
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http://dx.doi.org/10.1016/j.ejrad.2015.11.030DOI Listing
January 2016

Mammographic density and histopathologic characteristics of screen-detected tumors in the Norwegian Breast Cancer Screening Program.

Acta Radiol Open 2015 Sep 17;4(9):2058460115604340. Epub 2015 Sep 17.

Cancer Registry of Norway, Oslo, Norway ; Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo, Norway.

Background: High mammographic density might mask breast tumors, resulting in delayed diagnosis or missed cancers.

Purpose: To investigate the association between mammographic density and histopathologic tumor characteristics (histologic type, size, grade, and lymph node status) among women screened in the Norwegian Breast Cancer Screening Program.

Material And Methods: Information about 1760 screen-detected ductal carcinoma in situ (DCIS) and 7366 invasive breast cancers diagnosed among women aged 50-69 years, 1996-2010, was analyzed. The screening mammograms were classified subjectively according to the amount of fibroglandular tissue into fatty, medium dense, and dense by breast radiologists. Chi-square test was used to compare the distribution of tumor characteristics by mammographic density. Odds ratio (OR) of tumor characteristics by density was estimated by means of logistic regression, adjusting for screening mode (screen-film and full-field digital mammography), and age.

Results: Mean and median tumor size of invasive breast cancers was 13.8 and 12 mm, respectively, for women with fatty breasts, and 16.2 and 14 mm for those with dense breasts. Lymph node positive tumors were identified among 20.6% of women with fatty breasts compared with 27.2% of those with dense breasts (P < 0.001). The proportion of DCIS was significantly lower for women with fatty (15.8%) compared with dense breasts (22.0%). Women with dense breasts had an increased risk of large (OR, 1.44; 95% CI, 1.18-1.73) and lymph node positive tumors (OR, 1.26; 95% CI, 1.05-1.51) compared with women with fatty and medium dense breasts.

Conclusion: High mammographic density was positively associated with tumor size and lymph node positive tumors.
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http://dx.doi.org/10.1177/2058460115604340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580120PMC
September 2015
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