Screening mammography improves breast cancer outcomes by enabling early detection and treatment. However, false positive callbacks for additional imaging from screening exams cause unnecessary procedures, patient anxiety, and financial burden. This work demonstrates an AI algorithm that reduces false positives by identifying mammograms not suspicious for breast cancer. We trained the algorithm to determine the absence of cancer using 123,248 2D digital mammograms (6,161 cancers) and performed a retrospective study on 14,831 screening exams (1,026 cancers) from 15 US and 3 UK sites. Retrospective evaluation of the algorithm on the largest of the US sites (11,592 mammograms, 101 cancers) a) left the cancer detection rate unaffected (p=0.02, non-inferiority margin 0.25 cancers per 1000 exams), b) reduced callbacks for diagnostic exams by 31.1% compared to standard clinical readings, c) reduced benign needle biopsies by 7.4%, and d) reduced screening exams requiring radiologist interpretation by 41.6% in the simulated clinical workflow. This work lays the foundation for semi-autonomous breast cancer screening systems that could benefit patients and healthcare systems by reducing false positives, unnecessary procedures, patient anxiety, and expenses.

This chapter conducts a preliminary overview of the current state of knowledge about life imprisonment in Asia, as developed in this book, and compares it with what is known about life imprisonment internationally. The chapter explains the important role that debates about the future of the death penalty have played in understanding policies towards life imprisonment in Asia in particular. It shows how the complexity of life imprisonment has been reflected in the way it is defined in Asian countries. These definitions are largely a product of the colonial history of the countries concerned. The chapter also summarises what is now known about the process of imposing and enforcing life imprisonment across Asia, and the extent to which this knowledge is supported by statistics, as well as by evidence of how life-sentenced prisoners are treated in practice. Finally, the chapter considers the use that is made of international human rights standards in critiquing the life imprisonment regimes in many Asian countries. It concludes that, while there is a lively policy debate about life imprisonment in Asia, knowledge of what is happening on the ground is sometimes wanting. This book is a significant first step in addressing that knowledge gap.

OBJECTIVE:The objective of this study was to assess trends in screening breast MRI utilization among privately insured women in the U.S. from 2007 to 2017. METHODS:The utilization of screening breast MRI among women aged 25-64 years from January 1, 2007, to December 31, 2017, was obtained using the MarketScan Commercial Database. We used Current Procedural Terminology codes to exclude breast MRI exams performed in women with a new breast cancer diagnosis and in women imaged to assess response to neoadjuvant therapy in the preceding 90 days. During the 11-year study, 351 763 study-eligible women underwent 488 852 MRI scans. RESULTS:An overall 55.0% increase in screening breast MRI utilization was observed over the study period, with a steadily increasing trend. The greatest annual increase in percent utilization was from 2007 to 2008 at 16.6%. The highest utilization rate was in 2017, in which 0.4% of women aged 25-64 years underwent screening breast MRI. Of the women who underwent screening MRI with sufficient follow-up, 76.5% underwent only one examination during the study period. CONCLUSION:Utilization of screening breast MRI has increased steadily in the past decade to a peak of 0.4% of adult women. However, an estimated 9% of U.S. women are eligible for high-risk breast MRI screening; thus, utilization falls short of optimal compliance. Further studies to evaluate the barriers to screening compliance may help optimize utilization.

Background: Identifying pathways that can be targeted to reduce breast density and breast cancer incidence is an unmet need, especially in premenopausal women. Receptor activator of nuclear factor-κB ligand (RANKL) signaling mediates the major proliferative response of mammary epithelium to progesterone and is positively associated with breast density but there are no clinical trial data on the impact of RANKL inhibition on breast tissue markers in women with dense breasts. We, therefore, determined the impact of RANKL inhibition on breast tissue gene expression in high-risk premenopausal women with dense breasts. Study design: Pilot phase I clinical trial of 9 healthy high-risk pre-menopausal women (≥35 years of age) with dense breasts performed at Washington University School of Medicine, St. Louis, MO from July 2018-December 2018. Fifty-five percent of participants had a positive family history of breast cancer in a first degree relative. Intervention: Participants were given a single dose of subcutaneous RANKL antibody, denosumab (60mg), at baseline (Day 1). On the same day, prior to the denosumab injection, participants had an ultrasound guided core needle biopsy and a blood draw. All study participants returned for repeat core needle biopsy and blood draw after 60 days (Day 60). Outcome Measures: Changes in breast tissue gene expression between Day 1 and Day 60 with a focus on immune/inflammatory and hormone markers. Gene expression was profiled using NanoString nCounter platform. We performed pathway enrichment analysis and used Cell Maker Enrichment library from EnrichR to identify differentially expressed genes. Genes with a p-value<0.05 on differential expression analysis were considered statistically significant for utilization in pathway enrichment analysis. Libraries utilized for pathway enrichment using the EnrichR platform included the ChEA transcription factor library, GO Biological Process library, and Cellular Components library. Results: Macrophage markers, including CCR5, CD86, CD300A, and CD84 and targets downstream of IRF8: (p-value =4.73e-7), neutrophil degranulation/neutrophil activation in the immune response (p-value=6.0e-21), and the secretory granule membrane pathways (p-value=2.4e-14) were downregulated in breast tissues on Day 60. Pathways involved in progesterone metabolism (p-value=0.0003), estrogen response (p-value=0.0014) and fatty acid metabolism, (p-value=0.0001) were significantly upregulated on Day 60. Specifically, genes involved in steroid hormone metabolism such as DHRS2 (p-value=3.13e-05), and AKR1B15: p-value=4.12e-05) were upregulated on Day 60. Conclusions: A single 60 mg dose of subcutaneous denosumab injection was associated with alterations in pathways involved in hormone, immune and inflammatory signaling in the breast tissues of healthy premenopausal women with dense breasts. Citation Format: Michael Waters, Kay Jayachandran, Debbie Bennet, Jin Zhang, Katherine Weilbaecher, Ian S. Hagemann, Graham A. Colditz, Catherine M. Appleton, Adetunji T. Toriola. Pilot phase I clinical trial of RANKL inhibition and breast tissue gene expression in high-risk premenopausal women with dense breasts [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2206.

The purpose of the study was to assess the utility of tumor biomarkers, ultrasound (US) and US-guided diffuse optical tomography (DOT) in early prediction of breast cancer response to neoadjuvant therapy (NAT). This prospective HIPAA compliant study was approved by the institutional review board. Forty one patients were imaged with US and US-guided DOT prior to NAT, at completion of the first three treatment cycles, and prior to definitive surgery from February 2017 to January 2020. Miller-Payne grading was used to assess pathologic response. Receiver operating characteristic curves (ROCs) were derived from logistic regression using independent variables, including: tumor biomarkers, US maximum diameter, percentage reduction of the diameter (%US), pretreatment maximum total hemoglobin concentration (HbT) and percentage reduction in HbT (%HbT) at different treatment time points. Resulting ROCs were compared using area under the curve (AUC). Statistical significance was tested using two-sided two-sample student t-test with P < 0.05 considered statistically significant. Logistic regression was used for ROC analysis. Thirty-eight patients (mean age = 47, range 24–71 years) successfully completed the study, including 15 HER2 + of which 11 were ER + ; 12 ER + or PR + /HER2−, and 11 triple negative. The combination of HER2 and ER biomarkers, %HbT at the end of cycle 1 (EOC1) and %US (EOC1) provided the best early prediction, AUC = 0.941 (95% CI 0.869–1.0). Similarly an AUC of 0.910 (95% CI 0.810–1.0) with %US (EOC1) and %HbT (EOC1) can be achieved independent of HER2 and ER status. The most accurate prediction, AUC = 0.974 (95% CI 0.933–1.0), was achieved with %US at EOC1 and %HbT (EOC3) independent of biomarker status. The combined use of tumor HER2 and ER status, US, and US-guided DOT may provide accurate prediction of NAT response as early as the completion of the first treatment cycle. Clinical Trial Registration number: NCT02891681. https://clinicaltrials.gov/ct2/show/NCT02891681 ,Registration time: September 7, 2016

BACKGROUND:Because of the mixed reports from smaller studies, we examined associations of race with mammographic breast density and evaluated racial differences in the determinants of breast density.METHODS:Participants included 37 839 women (23 166 non-Hispanic white and 14 673 African American) receiving screening mammograms at the Joanne Knight Breast Health Center at Washington University School of Medicine from June 2010 to December 2015. Mammographic breast density was assessed using the Breast Imaging Reporting and Data System (5th edition). To determine the association of race and participant characteristics with mammographic breast density, we used multivariable polytomous logistic regression models (reference group: almost entirely fatty).RESULTS:African American women had increased odds of extremely dense (adjusted odds ratio = 1.31, 95% confidence interval = 1.13 to 1.52) and reduced odds of heterogeneously dense breasts (adjusted odds ratio = 0.91, 95% confidence interval = 0.84 to 0.99) compared with non-Hispanic white women. Altogether, race, parity and age at first birth, current age, current body mass index (BMI), BMI at age 18 years, menarche, family history of breast cancer, oral contraceptive use, alcohol use, and menopausal status explained 33% of the variation in mammographic breast density. Among African American and non-Hispanic white women, these factors explained nearly 28.6% and 33.6% of the variation in mammographic density, respectively. Current BMI provided the greatest explanation of breast density (26.2% overall, 22.2% in African American, and 26.2% in non-Hispanic white women).CONCLUSIONS:The determinants of mammographic breast density were generally similar between African American women and non-Hispanic white women. After adjustments for confounders, African Americans had higher likelihood of extremely dense breasts but lower likelihood of heterogeneously dense breasts. The greatest explanation of breast density was provided by BMI, regardless of race.

PURPOSE:Our purpose was to describe the risk of radiation-induced brachial plexopathy (RIBP) in patients with breast cancer who received comprehensive adjuvant radiation therapy (RT).METHODS AND MATERIALS:Records for 498 patients who received comprehensive adjuvant RT (treatment of any residual breast tissue, the underlying chest wall, and regional nodes) between 2004 and 2012 were retrospectively reviewed. All patients were treated with conventional 3 to 5 field technique (CRT) until 2008, after which intensity modulated RT (IMRT) was introduced. RIBP events were determined by reviewing follow-up documentation from oncologic care providers. Patients with RIBP were matched (1:2) with a control group of patients who received CRT and a group of patients who received IMRT. Dosimetric analyses were performed in these patients to determine whether there were differences in ipsilateral brachial plexus dose distribution between RIBP and control groups.RESULTS:Median study follow-up was 88 months for the overall cohort and 92 months for the IMRT cohort. RIBP occurred in 4 CRT patients (1.6%) and 1 IMRT patient (0.4%) (P = .20). All patients with RIBP in the CRT cohort received a posterior axillary boost. Maximum dose to the brachial plexus in RIBP, CRT control, and IMRT control patients had median values of 56.0 Gy (range, 49.7-65.1), 54.8 Gy (47.4-60.5), and 54.8 Gy (54.2-57.3), respectively.CONCLUSIONS:RIBP remains a rare complication of comprehensive adjuvant breast radiation and no clear dosimetric predictors for RIBP were identified in this study. The IMRT technique does not appear to adversely affect the development of this late toxicity.

We explored the impact of the relative volume of a tumor versus the entire breast on outcomes in patients undergoing breast conservation therapy (BCT) versus mastectomy and reconstruction (M + R). We hypothesized that there would be a threshold tumor:breast ratio (TBR) below which patient-reported outcomes (PRO) would favor BCT and above which would favor M + R. We conducted a prospective cohort study of patients with ductal carcinoma in situ (DCIS) or invasive breast cancers undergoing BCT or M + R. A prerequisite for inclusion, analysis of tumor and breast volumes was conducted from three-dimensional magnetic resonance imaging reconstructions to calculate the TBR. Three-dimensional photography was utilized to calculate pre- and postoperative volumes and assess symmetry. Oncologic, surgical, and patient-reported outcome data were obtained from relevant BREAST-Q modules administered pre- and postoperatively. The BCT cohort had significantly smaller tumor volumes (p = 0.001) and lower TBRs (p = 0.001) than patients undergoing M + R overall. The M + R group, however, comprised a broader range of TBRs, characterized at lower values by patients opting for contralateral prophylactic mastectomy. Postoperative satisfaction with breasts, psychosocial, and sexual well-being scores were significantly higher in the BCT cohort, while physical well-being significantly favored the M + R cohort 480.2 ± 286.3 and 453.1 ± 392.7 days later, respectively. Relative to BCT, M + R was used to manage a broad range of TBRs. The relative importance of oncologic and surgical risk reduction, symmetry, and number of procedures can vary considerably and may limit the utility of TBR as a guide for deciding between BCT and M + R. Clinical Trial StatementThis study was registered with clinicaltrials.gov as “A Prospective Trial to Assess Tumor:Breast Ratio and Patient Satisfaction Following Lumpectomy Versus Mastectomy With Reconstruction”, Identifier: NCT02216136.

While the ‘zoom function’ of prison ethnography is widely acknowledged for the unprecedented access it gives to people's lives (Bandyopadhyay, Jefferson and Ugelvik 2013, p.28), relatively little attention has been paid by researchers to young people's experience of imprisonment, and even less given to children who are serving long-term and life sentences. Rachel Rose Tynan addresses both of these gaps in her ethnographic study of the lives of 17 children, aged between 15 and 17 years, all of whom are serving long or indefinite terms of imprisonment in England. Although a small group of prisoners, assault rates and incidents of self-harm among children living in custody are worryingly high (Prison Reform Trust 2019), and yet little attempt has been made to understand their individual stories, backgrounds, and circumstances. In Young Men's Experiences of Long-Term Imprisonment, Tynan argues for a revised approach to prison ethnography and calls for a phenomenological understanding of youth crime and punishment, shifting attention away from a focus on the prison itself to the real-life stories of the young people who are living there. In her attempt to achieve just that, this book casts a much-needed light on how young people experience long-term imprisonment, their lives before their incarceration, how they adapt to, and manage, being imprisoned, and the impact and consequences of living life in prison at a young age. Sentencing young people to lengthy prison terms is rare across Europe, and children are exempt from serving indeterminate or life sentences in most countries around the world (Van Zyl Smit and Appleton 2019). Yet, as Tynan reports, England and Wales has the highest rate of child incarceration in Western Europe and is ‘one of only three states that continues to sentence young people indefinitely’, sentenced not to live in child specialist or therapeutic environments, but to live in institutions that ‘state inspectors repeatedly report as unsanitary and unsafe’ (p.2). Importantly, Tynan interrogates the use and purpose of youth imprisonment, and questions the assumption that it has become normal in England and Wales to imprison children for lengthy, and even indeterminate terms. Her book situates the current approach to young people serving long-term prison sentences within the wider social context of criminal and social justice, including the idealisation of certain childhoods, the treatment of marginalised groups, processes of racialisation and identity, and the sociology of the body. Drawing on Bourdieu's (1986, 1990) concepts of habitus and capital, and Fanon's (1952, 1967) theorising of colonisation, Tynan analyses the relationships between biography, trauma, and habitus to expose the ways in which class, racial, and legal status are imposed, experienced, and resisted by young people who are living their lives in prison. Tynan's interest in researching young people's experiences of long-term imprisonment was triggered in 2007 by a news report of an 18-year-old sentenced to spend 30 years for two murders, committed when he was 16 years old. How does a young person motivate themselves through a sentence measured in more years than they have been alive – ‘was it survivable, psychologically or physically and, if so how?’ (p.41). In Chapter 3, entitled ‘Real Talk’, Tynan documents the methodological journey she took to address this question with unusual detail and clarity, not only justifying her conceptual and methodological approach but also acknowledging the (often) blurred social and emotional space between the researcher and the researched. Any doctoral student or researcher about to embark on prison ethnography would benefit from Tynan's open and reflective account of role uncertainty, recruiting, and interviewing participants, and ethical safety. Of significance, she reflects on the physical and emotional aspects of carrying out prison research that can often be underplayed or overlooked in published works by empirical researchers (see also Nielsen 2010). In Chapters 4 and 5, Tynan draws on the biographies of her young participants to assess how they adapt to living life in confinement, as well as the strategies they use to manage, ameliorate, and resist the pains of imprisonment. Tynan describes how young prisoners draw on resources and resilience gained from past difficulties outside to manage their time and cope with imprisonment. Having navigated through difficult and often traumatic events (including the murder or suicide of a parent; sexual, physical and emotional abuse; abandonment or neglect), her young participants learned at an early age how to manage emotional, and often physical, pain. In particular, Tynan highlights a set of qualities – authenticity, humility, presentation of self, displacement, and expectation management – that young people rely on to adjust to, and cope with, the day-to-day turmoil of prison life. However, in adjusting and adapting to prison life, young prisoners were also ‘prone to being viewed as more dangerous than vulnerable’ (p.88), leaving their futures less certain and the chances of being released less likely. Chapter 6 explores the (dominant) role and cycle of violence in the lives of the participants. It is made clear that all participants in the study were convicted of serious violence, and most had witnessed serious acts of violence against themselves or others close to them. Violence in prison was described by participants as unwanted but unavoidable, a means to protect individual and collective identities, and sometimes the only means of communication within an environment where it is not easy to be heard. Chapter 7 considers the ways in which young prisoners manage social relations with loved ones and how they develop new relationships inside prison. For some, relationships outside prison were essential to survive: ‘If you don't have the support of your family you can't make it in a place like jail’ (p.139). Others deliberately withdrew from external connections, sometimes due to the practical difficulties of being based far away from home but also as a means to avoid the pains of separation and loss: ‘I could call them but I don't want to cos they're doing certain things I would have always done … and that I'm gonna miss’ (p.144). Tynan's final chapter brings together the main themes raised in the book and ends with a significant discussion of the complexities and nuances of youth crime and punishment. She reflects on how young people ‘draw on their biographies to manage imprisonment and to imagine and shape their futures’ (p.160), and that these narratives need to be understood within the context of economic, racial, and social injustice. Tynan highlights the litany of problems faced by young long-term prisoners, and calls for an approach to understanding youth imprisonment that moves beyond the ‘(purely) sociological imagination’ (p.168) to encompass a ‘broader discussion about what it means to be a young prisoner – and what it means to be a citizen in a society that condemns young people to long-term imprisonment with no stated purpose’ (p.170). Arguably, more could have been done by the author to assess the generalisability of the study, as well as the room and potential to call for legislative, policy, and penal reform of long-term and life imprisonment. Tynan's study, however, prompts reflection on topics not often found in the spotlight and covers issues that essentially make sense but are rarely considered or addressed. It contributes to a relatively small, but growing, collection of empirical work on the experience of adapting to long-term and life imprisonment in England and Wales (Crewe, Hulley and Wright 2020). The harm caused to, and by, the study participants is a prominent theme throughout this book. In exposing the humanity of her research participants, it becomes hard for the reader to imagine the necessity or value in imposing long-term imprisonment on young people. As noted on the book's cover, Tynan's work can be considered particularly suitable for students and researchers interested in the sociology of prisons, punishment, and ethnographic research methodology, but I would add to this prison staff and others who are seeking to improve the well-being and treatment of children who are living life in prison. In sum, this is a thought-provoking book.

Mammographic breast density is a strong risk factor for breast cancer. We comprehensively investigated the associations of body mass index (BMI) change from ages 10,18, and 30 to age at mammogram with mammographic breast density in postmenopausal women. We used multivariable linear regression models, adjusted for confounders, to investigate the associations of BMI change with volumetric percent density, dense volume, and nondense volume, assessed using Volpara in 367 women. At the time of mammogram, the mean age was 57.9 years. Compared with women who had a BMI gain of 0.1-5 kg/m(2) from age 10, women who had a BMI gain of 5.1-10 kg/m(2) had a 24.4% decrease [95% confidence interval (CI), 6.0%-39.2%] in volumetric percent density; women who had a BMI gain of 10.1-15 kg/m(2) had a 46.1% decrease (95% CI, 33.0%-56.7%) in volumetric percent density; and women who had a BMI gain of >15 kg/m(2) had a 56.5% decrease (95% CI, 46.0%-65.0%) in volumetric percent density. Similar, but slightly attenuated associations were observed for BMI gain from ages 18 and 30 to age at mammogram and volumetric percent density. BMI gain over the life course was positively associated with nondense volume, but not dense volume. We observed strong associations between BMI change over the life course and mammographic breast density. The inverse associations between early-life adiposity change and volumetric percent density suggest that childhood adiposity may confer long-term protection against postmenopausal breast cancer via its effect of mammographic breast density.

Purpose: The purpose of this study is to evaluate factors contributing to medical malpractice claims relating to breast cancer and the field of breast imaging. Method and materials: A retrospective analysis of jury verdict and settlement reports in US state and federal courts on the Westlaw legal database was performed. The database was searched for 'malpractice' and 'breast cancer' related terms from 2005 to 2015. 253 cases were evaluated for factors including case outcome, award amounts, type of physician defendants, plaintiff age, stage at diagnosis, length of delay in diagnosis, and symptomatology, among other factors. Data were summarized using descriptive statistics. Logistic regression was used to evaluate associations between factors and plaintiff award. Results: Median plaintiff age was 46 (IQR 39, 56). In cases that resulted in plaintiff payment, the award amount was $978,858 +/- 2,308,598. Delay in diagnosis was cited as a reason for claimed negligence in 82% of cases. Mean length of delay was 17 +/- 13 months. Named defendants were radiologists (43%), surgeons (27%), obstetrician/gynecologists (26%), and internal medicine/family practice (15%). Age, defendant type, and cancer stage were not significant predictors of case outcome. Failure to refer to a surgeon was twofold (OR [95% CI]: 2.44 [1.085, 5.489]) more likely to be resolved with payment compared to those cases without that factor. Cases with a delay in diagnosis of a >= 12 months were twofold (OR [95% CI]: 2.129 [1.086, 4.175)) more likely to be resolved with payment compared to a delay < 12 months. Patients who failed to follow up as recommended were twofold (OR [95% CI]: 2.31 [1.05, 5.10]) less likely to have their case be resolved with payment. Conclusion: Plaintiffs involved in breast cancer imaging related medical malpractice cases tend to be younger than the median age of diagnosis of breast cancer for US women (62 per NCI Surveillance, Epidemiology and End Results data). Breast cancer imaging suits involve physicians from multiple specialties, radiology being the most common. Delay in diagnosis >= 12 months, lack of surgeon referral, and lack of recommended follow up are related to plaintiff payments and may be areas of professional practice to target as radiology professionals. Clinical relevance/application: Medical malpractice relating to breast cancer and breast imaging remains very prevalent and costly for all involved. Radiologists are being named in these lawsuits more frequently than in the past.

BACKGROUND: Progesterone is a proliferative hormone in the breast. Combined estrogen plus progestin use in postmenopausal women increases mammographic density; a very strong risk for breast cancer. Circulating progesterone and genetic variations in progesterone receptor (PGR)-related genes are positively associated with mammographic density in postmenopausal women, but there are limited data in premenopausal women, with conflicting results. Notably, besides hormone therapy, genetic variation in PGR genes are known to modulate circulating progesterone levels. We, therefore, investigated the associations of genetic variations in PGR-related genes (PGR and Progesterone Receptor Membrane Component 1 (PGRMC1) with mammographic density in premenopausal women and determine, for the first time, whether these associations are mediated via circulating progesterone.METHODS: We genotyped 179 PGR-related single nucleotide polymorphisms (SNPs) (155 for PGR and 24 for PGRMC1 - 17 of which were synonymous variants and were filtered) in 364 cancer-free premenopausal women who had screening mammography at the Joanne Knight Breast Health Center at Washington University School of Medicine, St. Louis in 2016. We used Volpara to determine volumetric percent density, and dense volume. Variants were coded in dominant mode of inheritance. For causal mediation analysis, multivaraite linear regression models were applied to both the mediator (circulating PGR in logarithm scale) with variants and volumetric percent density, and dense volume with variant, PGR in logarithm scale and their interaction, both adjusting for age, body mass index, family history of breast cancer, and parity. The causal mediation effect, direct effect and total effect, by gentoype and averaged across genotypes were estimated with 95% confidence intervals and p values. Significance was claimed with p-value≤0.05.RESULTS: The mean age of the study participants was 47.5 years. Most participants (42.1%) had volumetric percent density between 3.5-7.5%, equivalent to BI-RADS® category b. Rs2020875 (PGR11) had a positive average direct effect (estimate=0.22, 95% CI, 0.016~0.44, p-value=0.024) and rs645213 (PGR11) had a borderline inverse direct effect (-0.25, -0.48~0.0004, p-value=0.052) on volumetric percent density. Further, rs11224565 (PGR11): 0.19, 0.04~0.34, p-value=0.028 had positive average direct effects on dense volume. None of the mediation effects were statistically signficiant.CONCLUSIONS: SNPs in PGR-related genes are associated with mammographic density in premenopausal women. Circulating progesterone levels did not mediate the associations between variants in PGR-related genes and mammographic density. Larger studies are needed to confirm our findings.Citation Format: Favour A. Akinjiyan, Yunan Han, Jingqin R. Luo, Aldi Kraja, Catherine M. Appleton, Graham A. Colditz, Adetunji T. Toriola. Genetic variations in progesterone receptor (PGR)-related genes and mammographic density in premenopausal women: Are the associations mediated by circulating progesterone [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1585.

In my graphic memoir The Wounds of Separation I combined personal memory and historical fact incorporating conceptual insights to tell a story about the way traumas are remembered. The story describes the forced migration of a child and how, in order to survive the devastation of WWII a young girl is separated from her parents and home causing lasting impacts on her life. The narrative content was enriched by a research process that involved understandings gained from trauma theories. In this paper I explore how these theoretical understandings shaped the creation of my graphic memoir and how representational theories helped direct the narrative choices to communicate the experience of trauma. I show how the conceptual underpinnings have been realised in my multimodal narrative identifying the text/image options that make the graphic memoir an appropriate representational choice. In my analysis of pages I describe the intended meanings I aim to communicate and explain the creative expression of those ideas.

OBJECTIVES:To determine the number and characteristics of cancers detected and the optimal imaging evaluation in women presenting with focal breast pain (FBP).MATERIALS AND METHODS:We performed a retrospective review of 4720 women who underwent imaging for FBP from 2001 to 2013. Women 18 and over with one or two foci of breast pain and no concurrent breast symptoms were included. 944 patients met criteria. We recorded the imaging work-up, presence and type of finding at the site of pain, BI-RADS® assessment, and pathological outcomes. Subsequent imaging and clinical follow up was recorded.RESULTS:Imaging evaluation consisted of sonogram alone in 286 women, mammogram alone in 231 women, and both in 427 women. 113 women had an imaging finding at the site of pain; 103 were designated benign or probably benign. 12 biopsies of corresponding findings were performed: 9 benign, 1 invasive lobular carcinoma, 1 invasive ductal carcinoma, 1 ductal carcinoma in situ. All three malignancies were seen mammographically; 2 had an ultrasound correlate. At initial evaluation, 4 incidental breast cancers were diagnosed remote from the site of FBP. All were seen on mammogram and 2 of 4 had an ultrasound correlate. On follow up evaluation, 9 cancers were diagnosed at the site of pain and 13 incidental cancers were diagnosed.CONCLUSION:FBP is rarely associated with malignancy. Targeted ultrasound may be deferred in women 40 and older with FBP, no other clinical findings, and a negative mammogram.

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We have developed a single-breath-hold photoacoustic computed tomography (SBH-PACT) system to detect tumors and reveal detailed angiographic information about human breasts. SBH-PACT provides high spatial and temporal resolutions with a deep in vivo penetration depth of over 4 cm. A volumetric breast image can be acquired by scanning the breast within a single breath hold (similar to 15 sec). We imaged a healthy female volunteer and seven breast cancer patients. SBH-PACT clearly identified all tumors by revealing higher blood vessel densities and lower compliance associated with the tumors.