Surface Temperature Distribution of a Breast With and Without Tumour

Breast cancer is a common and dreadful disease in women. Regular screening helps in its early detection. At present the most common methods of screening are by self examination and mammography. The surface temperature distribution of the breast can also provide some information on the presence of tumour. This distribution has a relation to the size and location of tumour and can be seen using thermography, where the infrared radiation emitted from the surface of the breast is recorded and a thermal pattern obtained. Thermography is a non-invasive and an inexpensive tool which could be used for early detection. In order to simulate the surface temperature distribution, a two-dimensional model of female breast with and without a carcinoma is considered. The breast is modelled with varying layer thickness close to the actual shape and numerically solved using finite element analysis. Temperature profiles are obtained for a normal breast and for a malignant one by varying the tumour size, location and the blood flow rates. The results show that the surface temperature for a malignant breast is higher than that of a normal one. In addition the size and location of the tumour do have an effect on the surface temperature distribution. It can also be seen that tumour of different sizes placed at the same location would yield the same maximum temperature depending on the blood perfusion rate.     

Surface Temperature Distribution of a Breast With and Without Tumour

Abstract

Breast cancer is a common and dreadful disease in women. Regular screening helps in its early detection. At present the most common methods of screening are by self examination and mammography. The surface temperature distribution of the breast can also provide some information on the presence of tumour. This distribution has a relation to the size and location of tumour and can be seen using thermography, where the infrared radiation emitted from the surface of the breast is recorded and a thermal pattern obtained. Thermography is a non-invasive and an inexpensive tool which could be used for early detection. In order to simulate the surface temperature distribution, a two-dimensional model of female breast with and without a carcinoma is considered. The breast is modelled with varying layer thickness close to the actual shape and numerically solved using finite element analysis. Temperature profiles are obtained for a normal breast and for a malignant one by varying the tumour size, location and the blood flow rates. The results show that the surface temperature for a malignant breast is higher than that of a normal one. In addition the size and location of the tumour do have an effect on the surface temperature distribution. It can also be seen that tumour of different sizes placed at the same location would yield the same maximum temperature depending on the blood perfusion rate.     

Effective beam directions using radiobiologically optimized IMRT of node positive breast cancer

The purpose of this study was to investigate the optimal coplanar beam directions when treating an early breast cancer with locoregional lymphatic spread with a few radiobiologically optimized intensity modulated beams. Also to determine the increase in the probability of complication-free cure with the number of beam portals and the smallest number required to perform a close to optimal treatment for this tumour site.Four test patients with stage II left-sided breast cancer were studied with heart, lung and contralateral breast as principal organs at risk. The clinical target volume consisted of the breast tissue remaining after surgery, the axillary, the internal mammary as well as the supraclavicular lymph nodes. Through an exhaustive search of all possible beam directions the most effective coplanar beams with one to four intensity modulated photon beam portals were investigated. Comparisons with uniform beam treatment techniques and up to 12 intensity modulated beams were also made. The different plans were optimized using the probability of complication-free tumour cure, P₊, as biological objective function.When using two intensity modulated beam directions three major sets of suitable directions were identified denoted by A, P and T. A corresponds to an anterior oblique pair of beams around 25° and 325°, P is a perpendicular lateral pair at around 50° and 130° whereas T is a more conventional tangential pair at around 155° and 300°. Interestingly, these configurations identify simply three major effective beam directions namely at 30°±20°, 145°±20° and 310°±15°. For the three intensity modulated beam technique a combination of these three effective beam directions generally covered the global maximum of the probability of complication-free tumour control.The improvement in complication-free cure probability with two optimally selected intensity modulated beams is around 10% when compared to a uniform beam technique with three to four beam portals. This increase is mainly due to a reduction by almost 1% in the probability of injury to the heart and an increase of 6% in the probability of local tumour control. When three or four biologically optimized beam portals are used a further increase in the probability of complication-free cure of about 6% can often be obtained. This improvement is caused by a small decrease in the probability of injury to the heart, left lung and other surrounding normal tissue, as well as a slight further increase in the probability of tumour control. The increase in the treatment outcome is minimal when more than four intensity modulated beams are employed. A small increase in dose homogeneity in the target volume and a slight decrease in the normal tissue volume receiving high dose may be seen, but without appreciably improving the complication-free cure probability.For a stage II breast cancer, three and in more complex cases four optimally oriented beams are sufficient to reach close to the maximum probability of complication-free tumour control when biologically optimized intensity modulated dose delivery is used. Angle of incidence optimization may then be advantageous starting from the given most effective three beam directions.     

A mathematical algorithm that computes breast cancer sizes and doubling times detected by screening

This paper presents a mathematical algorithm that computes the sizes and growth rates of breast cancer detected in a hypothetical population that is screened for the disease. The algorithm works by simulating the outcomes of the hypothetical population twice, first without screening and then with screening. The simulation without screening relies on an underlying model of the natural history of the disease. The simulation with screening uses this natural history model to track the growth of breast tumors backwards in the time starting from the time they would have been detected without screening. The method of tracking tumor growth backward in time is different from methods that track tumor growth forward in time by starting from an estimated time of tumor onset. The screening algorithm combines the natural history model, the method tracking of tumor growth backward in time, the age group, the interval between screening exams, and the detection threshold of the screening exam to compute the joint distribution of tumor size and growth rate among screen-detected and interval patients. The algorithm also computes the sensitivity and leadtime distribution. It allows for arbitrary age groups, detection thresholds and screening intervals and may contribute to the design of future screening trials.     

A mathematical model of the impact of infused targeted cytotoxic agents on brain tumours: implications for detection,design and delivery

Abstract. Motivated by the recent development of highly specific agents for brain tumours, we develop a mathematical model of the spatio-temporal dynamics of a brain tumour that receives an infusion of a highly specific cytotoxic agent (e.g. IL-4-PE, a cytotoxin comprised of IL-4 and a mutated form of Pseudomonas exotoxin). We derive an approximate but accurate mathematical formula for the tumour cure probability in terms of the tumour characteristics (size at time of detection, proliferation rate, diffusion coefficient), drug design (killing rate, loss rate and convection constants for tumour and tissue), and drug delivery (infusion rate, infusion duration). Our results suggest that high specificity is necessary but not sufficient to cure malignant gliomas; a nondispersed spatial profile of pretreatment tumour cells and/or good drug penetration are also required. The most important levers to improve tumour cure appear to be earlier detection, higher infusion rate, lower drug clearance rate and better convection into tumour, but not tissue. In contrast, the tumour cure probability is less sensitive to a longer infusion duration and enhancements in drug potency and drug specificity.     

Nonparametric estimation of asymptomatic duration from a randomized prospective cancer screening trial

We propose a nonparametric estimation of preclinical duration distribution in cancer based on data from a randomized early detection trial. In cancer screening studies, the preclinical duration of a disease is of great interest for better understanding the natural history of the disease, and for developing optimal screening strategies. To estimate the sojourn time distribution nonparametrically, we first estimate the distribution of the age at onset of preclinical disease nonparametrically using data from the screening arm in a randomized screening trial, and the distribution for the age at onset of clinical disease from the control arm of the randomized screening trial. Finally, by using deconvolution the two estimated distributions lead to a nonparametric estimate of the distribution for the gap time between the onset of preclinical disease and the onset of clinical disease. We illustrate the methodology using data from a randomized breast cancer screening trial.     

On estimating the growth function of tumors

The growth rate of a cancerous tumor as a function of its age is a subject of intellectual and practical importance, as it influences both the effectiveness of proposed screening programs and the strategy of treatment. Obtaining direct evidence on the growth rate is quite difficult, owing to the ethical necessity to intervene when cancer is confirmed. The reasonable assumption that there is a common growth function of age and that probability of detection of a tumor in a short time period is proportional to its size allow the growth function to be inferred from data on sizes at detection. These results can be generalized to allow for individual variation in the rate of traversal of the common growth function. An estimator for the growth function from data on size at detection is obtained. Simulations indicate that it performs reasonably. Application of this estimator to data on a large series of cases of breast cancer at U.T. M. D. Anderson Hospital indicates that the growth function in the range of sizes seen at detection, can be adequately described by exponential growth, with rather large individual-to-individual variations in growth rate.     

Testing the Independence of Two Diagnostic Tests

Consider two diagnostic procedures having binary outcomes. If one of the tests results in a positive finding, a more definitive diagnostic procedure will be administered to establish the presence or absence of a disease. The use of both tests will improve the overall screening sensitivity when the two tests are independent, compared with employing two tests that are positively correlated. We estimate the correlation coefficient of the two tests and derive statistical methods for testing the independence of the two diagnostic procedures conditional on disease status. The statistical tests are used to investigate the independence of mammography and clinical breast exams aimed at establishing the benefit of early detection of breast cancer. The data used in the analysis are obtained from periodic screening examinations of three randomized clinical trials of breast cancer screening. Analysis of each of these trials confirms the independence of the clinical breast and mammography examinations. Based on these three large clinical trials, we conclude that a clinical breast exam considerably increases the overall sensitivity relative to screening with mammography alone and should be routinely included in early breast cancer detection programs.     

Breast cancer stage at diagnosis and survival among patients with prior breast implants

Longstanding concern exists regarding the potential for women with breast implants to experience delayed detection of breast cancer. Furthermore, survival among cosmetic breast implant patients who subsequently develop breast cancer is a concern. Since 1976, this institution has monitored cancer incidence in a cohort of 3182 women who underwent cosmetic breast augmentation between 1959 and 1981. The distributions of stage at diagnosis and survival of the 37 women who subsequently developed in situ or invasive breast cancer were compared with the observed population distributions. The distribution of stage at diagnosis for cosmetic breast implant patients who subsequently developed breast cancer was virtually identical to that of all breast cancer patients in Los Angeles County who were of the same age and race, and were diagnosed during the same time period. Furthermore, the 5-year survival rate of the 37 patients did not differ from that which would be expected based on rates established by the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. These results suggest that cosmetic breast implant patients are not at increased risk of delayed detection of breast cancer, nor do they suffer a poorer prognosis when breast cancer does occur. Although the number of breast cancer patients in this study is small, the results are highly consistent with the existing epidemiologic evidence related to breast cancer detection and survival among breast implant patients. Although breast implant patients should continue appropriate breast cancer screening behavior, there seems to be no cause for alarm.     

Japanese cancer screening programs during the COVID-19 pandemic: Changes in participation between 2017-2020

BackgroundThe impact of the coronavirus disease 2019 (COVID-19) pandemic on cancer screening participation is a global concern. A national database of screening performance is available in Japan for population-based cancer screening, estimated to cover approximately half of all cancer screenings.MethodsUtilizing the fiscal year (FY) 2017–2020 national database, the number of participants in screenings for gastric cancer (upper gastrointestinal [UGI] series or endoscopy), colorectal cancer (fecal occult blood test), lung cancer (chest X-ray), breast cancer (mammography), and cervical cancer (Pap smear) were identified. The percent change in the number of participants was calculated.ResultsCompared with the pre-pandemic period (FY 2017–2019), in percentage terms FY 2020 recorded the largest decline in gastric cancer UGI series (2.82 million to 1.91 million, percent change was −32.2 %), followed by screening for breast cancer (3.10 million to 2.57 million, percent change was −17.2 %), lung cancer (7.92 million to 6.59 million, percent change was −16.7 %), colorectal cancer (8.42 million to 7.30 million, percent change was −13.4 %), cervical cancer (4.26 million to 3.77 million, percent change was −11.6 %), and gastric cancer via endoscopy (1.02 million to 0.93 million, percent change was −9.0 %).ConclusionThe number of participants in population-based screenings in Japan decreased by approximately 10–30 % during the pandemic. The impact of these declines on cancer detection or mortality should be carefully monitored.     

On the Probability of Random Genetic Mutations for Various Types of Tumor Growth

In this work, we consider the problem of estimating the probability for a specific random genetic mutation to be present in a tumor of a given size. Previous mathematical models have been based on stochastic methods where the tumor was assumed to be homogeneous and, on average, growing exponentially. In contrast, we are able to obtain analytical results for cases where the exponential growth of cancer has been replaced by other, arguably more realistic types of growth of a heterogeneous tumor cell population. Our main result is that the probability that a given random mutation will be present by the time a tumor reaches a certain size, is independent of the type of curve assumed for the average growth of the tumor, at least for a general class of growth curves. The same is true for the related estimate of the expected number of mutants present in a tumor of a given size, if mutants are indeed present.     

Breast self-examination: importance of technique in early diagnosis.

Shortly after diagnosis of breast cancer 416 patients were interviewed about their use of screening procedures and the method of tumour detection. Although 72% reported that they performed breast self-examination (BSE), only 12% actually inspected and palpated their breasts monthly. BSE was not significantly associated with tumour size or involvement of the lymph nodes; however, thorough inspection was associated with smaller tumours, and careful palpation with the absence of palpable nodes. Of those who no longer or never had examined their breasts 40% reported having annual breast examinations by their physician and had significantly smaller tumours than did the others. Most of the women (86%) reported having detected their own tumours, and BSE did not significantly increase the likelihood of self-detection. The frequency of use of screening procedures was similar in a sample of women without breast cancer.     

A proportional hazards cure model for the analysis of time to event with frequently unidentifiable causes

We propose a semiparametric method for the analysis of masked-cause failure data that are also subject to a cure. We present estimators for the failure time distribution, the cure rate, and the covariate effect on each of these, assuming a proportional hazards cure model for the time to event of interest and we use the expectation-maximization algorithm to conduct the likelihood maximization. The method is applied to data from a breast cancer clinical trial.     

Tumour size can have an impact on the outcomes of epidemiological studies on second cancers after radiotherapy

Obtaining a correct dose–response relationship for radiation-induced cancer after radiotherapy presents a major challenge for epidemiological studies. The purpose of this paper is to gain a better understanding of the associated uncertainties. To accomplish this goal, some aspects of an epidemiological study on breast cancer following radiotherapy of Hodgkin’s disease were simulated with Monte Carlo methods. It is demonstrated that although the doses to the breast volume are calculated by one treatment plan, the locations and sizes of the induced secondary breast tumours can be simulated and, based on these simulated locations and sizes, the absorbed doses at the site of tumour incidence can also be simulated. For the simulations of point dose at tumour site, linear and non-linear mechanistic models which predict risk of cancer induction as a function of dose were applied randomly to the treatment plan. These simulations provided for each second tumour and each simulated tumour size the predicted dose. The predicted-dose–response-characteristic from the analysis of the simulated epidemiological study was analysed. If a linear dose–response relationship for cancer induction was applied to calculate the theoretical doses at the simulated tumour sites, all Monte-Carlo realizations of the epidemiological study yielded strong evidence for a resulting linear risk to predicted-dose–response. However, if a non-linear dose–response of cancer induction was applied to calculate the theoretical doses, the Monte Carlo simulated epidemiological study resulted in a non-linear risk to predicted-dose–response relationship only if the tumour size was small (<?1.5 cm). If the diagnosed breast tumours exceeded an average diameter of 1.5 cm, an applied non-linear theoretical-dose–response relationship for second cancer falsely resulted in strong evidence for a linear predicted-dose relationship from the epidemiological study realizations. For a typical distribution of breast cancer sizes, the model selection probability for a resulting predicted-dose linear model was 61% although a non-linear theoretical-dose–response relationship for cancer induction had been applied. The results of this study, therefore, provide evidence that the shapes of epidemiologically obtained dose–response relationships for cancer induction can be biased by the finite size of the diagnosed second tumour, even though the epidemiological study was done correctly.     

A projection of benefits due to fecal occult blood test for colorectal cancer

Objectives: A prospective study to estimate benefits due to fecal occult blood tests for colorectal cancer are carried out for both males and females, under different screening frequencies. Methods: We apply the statistical method developed by Wu et al. (2007) [1] using the Minnesota colorectal cancer study group data, to make Bayesian inference for the lead time, the time of diagnosis advanced by screening for both male and female participants in a periodic screening program. The lead time is distributed as a mixture of a point mass at zero and a piecewise continuous distribution. The two parts of the mixture correspond to two aspects of the screening: the probability of no benefit, or the percentage of interval cases; and the probability distribution of the early diagnosis time. We present estimates of these two measures for males and females by simulation studies using the Minnesota study group data. We also provide the mean, mode, variance, and density curve of the program's lead time by gender. This may provide policy makers important information on the effectiveness of the FOBT screening in colorectal cancer early detection. Results: The mean lead time increases as the screening time interval decreases for both males and females. The standard error of the lead time also increases as the screening time interval decreases for both genders. Females seem get more benefit than males, in that females usually have a longer lead time than males if both take the test at the same time interval and the lead time mode for females is greater than that of males in the same screening time interval. Conclusion: According to the predictive estimation of the lead time distribution, to guarantee a 90% chance of early detection, it seems necessary for the males to take the fecal occult blood test every 9 months, while the females can take it annually.     

The Diagnosis of Breast Pre-Cancer By the Chronobra- II. The Breast Pre-Cancer Test

Contemporary screening programmes for early breast cancer based on X-rays (mammography) are very expensive and have two serious limitations in their potential to control the disease. First, soft-tissue radiology imaging is poor at resolving a tumour in the youngest third of cancer patients because of breast density; second, by the time size of a tumour enables a diagnosis to be made, there are already hundreds of thousands of malignant cells; depending on the particular biology of the tumour they may have disseminated.

For effective control of the disease there must be some understanding of breast cancer biology so that appropriate pre-cancer therapeutic strategies can be implemented. There is persuasive evidence from the growth kinetics of excised tumours; the prognosis of the breast cancer process; the protection afforded by an early first pregnancy; the age-related sensitivity to diagnostic X-rays; and, the age-correlated presence of oestrogen receptors in tumours, that the genesis of cancer is usually in the pre-menopause (the second or third decade). Breast cancer prevention programmes have to take this early genesis into their reckoning. Also, to see any progenitor or pre-cancerous lesions the histopathologist must look in the cancer mastectomy specimens of the younger patient. When this is done, such mastectomies reveal multiple benign focal hyperplasias and cysts very much more numerous than in age-matched consecutive autopsy breasts. These abnormalities may represent a failure of acinisation and an abnormal maturation pathway with a large number of uncommitted epithelial cells vulnerable to mutation since they are not fully differentiated.     

MLE and Bayesian inference of age-dependent sensitivity and transition probability in periodic screening

This article extends previous probability models for periodic breast cancer screening examinations. The specific aim is to provide statistical inference for age dependence of sensitivity and the transition probability from the disease free to the preclinical state. The setting is a periodic screening program in which a cohort of initially asymptomatic women undergo a sequence of breast cancer screening exams. We use age as a covariate in the estimation of screening sensitivity and the transition probability simultaneously, both from a frequentist point of view and within a Bayesian framework. We apply our method to the Health Insurance Plan of Greater New York study of female breast cancer and give age-dependent sensitivity and transition probability density estimates. The inferential methodology we develop is also applicable when analyzing studies of modalities for early detection of other types of progressive chronic diseases.     

Management of Breast Cancer in Old Age

In a retrospective survey of 301 women aged over 70 with breast cancer the factors affectingfive-year survival are evaluated. The local disease is more advanced when the patient presents with it in old age than in younger women, possibly associated with a lesser degree of awareness or a long history of the primary tumour. It is not associated with a different average rate of tumour growth in old age, as measured by scar recurrences after surgery. Radical surgery may be followed by a high five-year survival rate in patients carefully selected on medical grounds, but in this unselected series the five-year survival rate was practically the same whether the local disease was limited or extensive at presentation and whatever the treatment given. The probability of five-year survival in a woman over 70 with breast cancer will depend mainly on her general health.     

Inhibition of Growth of Methylcholanthrene-induced Mammary Carcinoma in Rats by Anti-Adenohypophysis Serum

FURTH¹ proposed that a specific inhibition of acidophilic cells in the adenohypophysis might be used, as an alternative to hypophysectomy, to block the growth of some types of mammary tumours and even as a prophylactic measure in patients when there is a high probability that breast cancer will develop. We have suggested a new approach to the therapy of growth hormone-dependent tumours using heterologous anti-adeno-hypophysis (anti-AH) serum². The experiment described here is based on the finding that the methylcholanthrene (MQ-induced mammary carcinoma and other types of tumour induced in rats by carcinogens are, like some types of human breast cancer, dependent on or sensitive to growth hormone^3–10. Our results suggest the possibility of delaying the onset and inhibiting the growth of MC-induced breast cancer in female rats by treatment with anti-AH serum.     

Transabdominal ultrasound screening for early ovarian cancer.

OBJECTIVE--To assess the value of ultrasonography in a screening procedure for early ovarian cancer. DESIGN--Prospective study of at least 5000 self referred women without symptoms of ovarian cancer. Each woman was scheduled to undergo three annual screenings (consisting of one or more scans) to detect grossly abnormal ovaries or non-regressing masses. SETTING--The ovarian screening clinic at King''s College Hospital, London. SUBJECTS--5479 Self referred women without symptoms (aged 18-78, mean age 52). INTERVENTIONS--Women with a positive result on screening were referred for laparoscopy or laparotomy, or both. MAIN OUTCOME MEASURES--Findings at surgery and from histology of abnormal ovaries. RESULTS--A total of 14,594 screenings (15,977 scans) were performed. A positive result was obtained at 338 screens (2.3%) comprising 326 subjects (5.9%). Five patients with primary ovarian cancer (four stage Ia, one stage Ib; two at first screening three at second) were identified (prevalence 0.09%). An additional four patients had metastatic ovarian cancer (three at first screening, one at second). The apparent detection rate was 100%. It was not possible to differentiate between the ultrasonic appearance of early malignant and benign tumours. The rate of false positive results for primary ovarian cancer was 3.5% at the first screening, 1.8% at the second, and 1.2% at the third. Overall the rate of false positive results was 2.3%; the specificity was 97.7% and the predictive value of a positive result on screening was 1.5%. The odds that a positive result on screening indicated the presence of an ovarian tumour, any ovarian cancer, or primary ovarian cancer were about one to two, one to 37, and one to 67 respectively. CONCLUSION--Ultrasonography can be used to screen women without symptoms for persistent ovarian masses that will include early ovarian cancer.