Treatment of breast tumours
CWD Cheung and AE Johnson from Mount Vernon Hospital reviewed measurement and management in carcinoma of the breast looking at the value of the data in January 1991 (Cheung and Johnson BJR 1991; 64(757): 29-36) and tumour regression in February 1991 (Cheung and Johnson BJR 1991; 64(758): 121-132). They developed insights into biological changes accompanying the treatment of human tumours.
The standardised and traditional multifield irradiation technique for breast tumours was described by JJW Lagendijk and P Hoffman (Lagendijk and Hoffman BJR 1992; 65(769): 56-62) in January 1992.
Image source: Lagendijk and Hoffman BJR 1992; 65(769): 56-62
Patient dose in mammography was reviewed by J Law from Edinburgh in April 1991 (Law BJR 1991; 64(760): 360-365). There is a conflict between image quality and patient dose and whilst at one time mammography had been considered a high dose procedure by 1991 this was no longer the case. This paper looked at patient dose in the breast screening programme in Scotland. In August 1993 J Law (Law BJR 1993; 66(788): 691-698) described differences in doses received in different breast screening programmes.
JAAM van Dijck and others from the Netherlands (van Dijck, Verbeek, Hendricks and Holland BJR 1992; 65(779): 971-976) looked at one versus two view mammography in baseline screening for breast cancer and concluded that if a programme using one view had already achieved a high sensitivity and specificity then the use of an additional craniocaudal view was only marginal. The value of the second view in screening mammography was considered by RML Warren in January 1996 (Warren, Duffy and Bashir BJR 1996; 69(818): 105-108).
Image source: Warren, Duffy and Bashir BJR 1996; 69(818): 105-108
A Bull and others (Bull, Mountney and Sanderson BJR 1991; 64(762): 516-519) found a significant shift in the stage distribution in breast cancer at presentation from 1975 to 1985. They discussed the difficulties in demonstrating a reduction in mortality and the publicity associated with the screening programme.
The National Health Service Breast Screening Programme defines objectives with objective and achievable standards. Interval cancers are a problem and these were looked at by AE Johnson and J Shekhdar in August 1995 (Johnson and Shekhdar BJR 1995; 68(812): 862-869). The conclusion of the paper was that there is an irreducible minimum of interval cancers and that the anticipated achievable standards may have been over optimistic.
As well as the effects of radiation there are also psychological effects of screening mammography and these were assessed by AR Bull and MJ Campbell (Bull and Campbell BJR 1991; 64(762): 510-515). The majority of women commented favourably on the programme but there was a raised awareness or fear of potential cancer among the screened population.
Breast imaging has a significant role in symptomatic breast disease and IR Brand and others from Bradford reviewed the subject in May 1993 (Brand, Sapherson and Brown BJR 1993; 66(785): 394-397) concentrating on women under the age of 35. The relative role of ultrasound and mammography were compared.
As the 1990s progressed several paper were published on the use of MRI in the breast including a paper by AD Murray and others on dynamic magnetic resonance mammography of both breasts following the treatment of breast cancer (Murray, Redpath, Needham, Gilbert, Brookes, and Eremin BJR 1996; 69(823): 594-600). The technique was useful in diagnosing multifocal and second primary tumours.
Image source: Murray, Redpath, Needham, Gilbert, Brookes, and Eremin BJR 1996; 69(823): 594-600