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Not profiling reveals elevated gene expression in cell eligible outcomes clusters overlying focally disrupted myoepithelial 1651. Not eligible target population influencing prognosis and indications for curative 1652. Not Mammographic Breast Cancer Screening Program eligible target population with real-time integrated radiopathologic activity 1654. Survival electrical impedance scanning as adjunctive of women with breast cancer in relation smoking. Eur J prevalence in the kConFab familial breast cancer Cancer 2001 Dec; 37(18):2324-30. Breast-conserving therapy in breast detection rate of a new commercially available cancer patients-a 12-year experience. Nonpalpable breast evidence cancer: needle-localized biopsy for diagnosis and 1677. Morphometric evaluation of target population phenotypical changes occurring in benign and 1691. Pathol Res Pract 1994 luteinising hormone-releasing hormone analogue Nov; 190(11):1056-65. J Steroid Biochem analyzed for chromosome 8 copy number using Mol Biol 2000 Dec 1; 75(1):65-73. Markopoulos C, Chrissochou M, Michailidou A, et turnover markers and insulin-like growth factor al. Effect of exemestane on the lipidemic profile of components in metastatic breast cancer: results from post-menopausal operable breast cancer patients a randomised trial of exemestane vs megestrol following 5-7 years of adjuvant tamoxifen: acetate. Martinez-Arribas F, Martin-Garabato E, Zapardiel I, eligible target population et al. Anticancer nipple occurring after conservative management of Res 2008 Sep-Oct; 28(5A):2595-8. Clin Oncol (R Coll Radiol) 1990 are probably precursors of Paget cell carcinoma: a Mar; 2(2):66-70. Not Morphometric studies in intraductal breast eligible target population carcinoma using computerized image analysis. Not eligible Prospective evaluation of radiologically directed outcomes fine-needle aspiration biopsy of nonpalpable breast 1708. Not histopathological diagnosis of breast lesions in eligible outcomes Gombe, Nigeria. Not eligible target population biopsy superior fine-needle aspiration biopsy in 1709. Diagn Residual ductal carcinoma in situ in patients with Cytopathol 2003 Jun; 28(6):329-34. Not eligible complete eradication of invasive breast cancer after target population neoadjuvant chemotherapy does not adversely 1697. Not eligible target Specimen radiography as predictor of resection population margin status in non-palpable breast lesions. Not eligible Clinical results of thermoradiotherapy for locally outcomes advanced and/or recurrent breast cancer- 1711. Int J impact of detecting and treating ductal carcinoma in Hyperthermia 1990 May-Jun; 6(3):487-97. Reconstruction of the breast with intraoperative gamma camera for the sentinel lymph omentum after subcutaneous mastectomy. Breast J Int J Radiat Oncol Biol Phys 1991 Jul; 21(2):289 2004 Jan-Feb; 10(1):58-9. Intraductal biopsy for diagnosis and treatment of Factors affecting distant disease-free survival for intraductal lesions of the breast. Cancer 2004 Nov primary invasive breast cancer: use of a log-normal 15; 101(10):2164-9. An analysis of receptor status of synchronous bilateral breast the results of mammographically guided biopsies of carcinoma. Concordance in pathological response Therapeutic mammaplasty for centrally located neoadjuvant chemotherapy between invasive and breast tumors. Plast Reconstr Surg 2006 Feb; noninvasive components of primary breast 117(2):366-73.

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It is intended provide aesthetic breast surgeons and cancer detection rates in mammoplasty specimens may breast radiologists with consensus recommendations for ap re? The guidance focuses mainly on breast (carcinoma and atypical hyperplasia) were found in 9. To ensure cross-specialty agreement on the indications thetic breast surgery, and this may affect recommendations for breast imaging after aesthetic breast surgery. The surgeon is encouraged this document complements the Keogh Review of the ensure that they have full information detailing the speci? It would be reasonable seek patient permission Standards for Cosmetic Surgery published in April 2016,7 communicate with the treating unit so that the surgeon both of which aim protect patients and raise standards can better advise about the risks and bene? Estimated breast cancer prevalence in those undergoing aesthetic surgery Male aesthetic breast surgery Breast cancer risk is linked many factors such as parity and lactation, a positive family history and breast density, Men may also seek cosmetic breast surgery, typically breast but incidence is most strongly associated with age. Among the recognised causes, men may develop tween ages 45 and 49 years and reaching 4. But with rising obesity, women in this study was 39 years, with 40% under 35 years. Breast cancer in males is rare, so Augmentation-mastopexy is a complex procedure combin routine pre-surgery imaging is not justi? Augmentation is usually carried out in two age groups; Challenges in breast cancer diagnosis before, young nulliparous women with breast hypoplasia and slightly older women who seek rejuvenate the empty breast during and after aesthetic breast surgery associated with multiparity, lactation and involution. There are a number of potential challenges in detecting Challenges of image interpretation in breasts with and/or managing breast cancers in patients who are ei implants ther undergoing, or who have undergone, aesthetic breast A speci? Implants cause Issues related mammoplasty surgery displacement and compression of the native breast tissue, which can make it dif? The practice of sending improve mammographic imaging of the implanted breast the excised breast tissue for routine pathological analysis include displacement (Eklund) views, which involve dis varies across centres, but if tissue is sent, an incidental placing the implant posteriorly against the chest wall, cancer or lesion of uncertain malignant potential may be 10 allowing more breast tissue be pulled in front of the found. Despite this, ment and rearrangement such that subsequent oncological there is still a risk that signi? The excised breast tissue may not have been orientated; extra displacement views are done in addition standard therefore, accurate disease location, or location of any views, increasing radiation exposure and examination time. This can lead a variety of changes presentation and reduced survival in those with implants;21 on mammography, including densities, tissue distortion however, this review is limited by its retrospective analysis and calci? Implants may be placed in a subpectoral/dual plane or However, if there is clinical concern regarding possible subglandular position. In general, the breast tissue is not implant rupture, ultrasound should be performed in the? All women with breast implants who are of screening An experienced breast radiologist will usually recognise age should be encouraged attend their screening appoint the classical benign imaging changes of fat transfer. It is most strongly associated with textured breast surgery with the potential alter the appearance rather than smooth implants. Ultrasonography is the most effective tool in be aware of their increasing use. Biomarker analysis may be carried out in cases Patients should be informed when these materials are where cytology shows abnormal/atypical cells. Basis for recommending breast imaging before Age for commencing pre-surgery imaging aesthetic breast surgery One of the key considerations in recommending imaging be Intended advantages fore aesthetic breast procedures is the age at which this should start. At present, there is no clear evidence sup the main advantage of detecting malignancy or other sig port any speci? However, with regard mammography, the risk low in the generally younger cohort of patients who un bene? There are also ent from those for patients who are about undergo sur aesthetic implications: for example, a recently implanted gical intervention the breast, given the potential con augmented breast may require radiotherapy after breast sequences of the surgery as described above. An advantage of imaging before reduction Guidance on Screening and Symptomatic Breast Imaging,43 mammoplasty is that it allows optimal preoperative plan all opt for 40 years as the age cut-off for the majority of ning should a breast cancer be detected, with potential for women for whom mammography is recommended. Dense breast tissue is more strongly associated with an increased risk of developing malignancy than fatty Disadvantages 44,45 breasts, and mammographic detection of cancers is the negative aspects of routine preoperative imaging more dif?

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Carcinoma statistical analysis technique for dynamic magnetic within fibroadenomas: mammographic features. Am Surg 2005 tumour size, grade and comedo necrosis in ductal Jan; 71(1):22-7; discussion 7-8. J Metaplastic breast carcinoma: clinical-pathologic Surg Oncol 1993 May; 53(1):68-70. Adjunctive Mammography of ductal carcinoma in situ of the diagnostic value of ultrasonography evaluation in breast: review of 909 cases with radiographic patients with suspected ductal breast disease. Eur J Nucl Med Mol Imaging 2002 Dec; suppresses the invasive phenotypes of tumor cells. Not combination on plasma lipids and bone-derived eligible outcomes resorption during neoadjuvant therapy in the impact 191. Not immunohistochemistry as a prognostic factor in eligible target population breast cancer in clinical practice. Not eligible target Different proliferative activity of the glandular and population myoepithelial lineages in benign proliferative and 192. Mod Pathol 2004 prevalence of carcinoma in palpable vs impalpable, Sep; 17(9):1051-61. Not eligible Cellular automaton simulation examining target population progenitor hierarchy structure effects on mammary 193. J Theor Biol 2007 Jun 7; disease of a nipple graft following completion of a 246(3):491-8. Quantification of hyperplasia of the breast: the controversial regulatory T cells enables the identification of high management of a borderline lesion: experience of risk breast cancer patients and those at risk of late 47 cases diagnosed at vacuum-assisted biopsy. Cancer 2003 Aug 1; 98(3):468 carcinoma in situ-associated nipple discharge: a 73. Not eligible resonance imaging-guided biopsy of level of evidence mammographically and clinically occult breast 198. Not survival of 100 women with carcinoma of the breast eligible outcomes diagnosed by screening mammography and needle 211. Not eligible and peritumoral injection identify similar sentinel outcomes nodes for breast cancer. Cognitive tamoxifen alone for adjuvant treatment of impairment associated with adjuvant therapy in postmenopausal women with early breast cancer: breast cancer. Am J Surg 2004 Oct; Reproductive factors, age at maximum height, and 188(4):381-5. Cancer Epidemiol Biomarkers Prev 2008 Dec; Tamoxifen retinopathy: a rare but serious 17(12):3427-34. Biopsy of gene 1 promoter does not predict cytologic atypia or amorphous breast calcifications: pathologic correlate with surrogate end points of breast cancer outcome and yield at stereotactic biopsy. Breast biopsy resolution fluorodeoxyglucose positron emission with wire localization: factors influencing complete tomography with compression ("positron emission excision of nonpalpable carcinoma. Australas Radiol 2006 cadherin-negative primary small cell carcinoma of Feb; 50(1):87-90. Not eligible level of evidence and epigenetic changes in mammary epithelial cells 237. A case of identify a subpopulation of cells involved in early interstitial pneumonitis associated with Guillain carcinogenesis. Cold Spring Harb Symp Quant Biol Barre syndrome during administration of adjuvant 2005; 70:317-27. Lobular breast biopsy: a pitfall in preoperative wire carcinoma in situ of the breast: clinical, pathologic, localization. Arch Dermatol 2008 Dec; disease of the nipple diagnosed on cytology: a case 144(12):1660-2. Not eligible target population Sonographic findings of an intraductal mucinous 240. J Ultrasound Med 2006 Jul; 25(7):925 in Paget disease of the nipple and extramammary 7.

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Estrogen-only menopausal therapy trogen?progestogen agents among refers the use of estrogen without women aged 50?79 years at baseline progestogen by perimenopausal and was associated with a hazard ratio Fig. Oral contraceptives are avail postmenopausal women, primar for coronary heart disease of 1. This study has affected the in the 1960s and early 1970s, the prescribing of combined estrogen use declined after reports of a strong progestogen menopausal therapy association between estrogen-only substantially, resulting in rapidly de therapy and risk of endometrial clining use of these agents, restricted cancer. Since then, estrogen-only indications, and reduced duration of menopausal agents have been pre therapy. Variations in Although breast implants are very dence have been reported between development. In addition, one study their long-term effects on cancer found that women with subglandular 2. Int J Cancer, Concerns about the carcino cern about a possible link between 124:490?493. Toxicol Appl specifc implant characteristics, no epidemiological cohort studies Pharmacol, 107:562?567. Anal Sci, dular), and implant envelope (with or implants may obscure the visuali 17:1369?1374. Int J Cancer, 118:998 ratory studies show that 2,4-toluene ability identify breast cancer at 1003. Plast Reconstr Surg, the progression of already present recent epidemiological evidence 128:651?661. In addition, one has suggested that breast cancers epidemiological study showed an el are diagnosed at more advanced 10. Plast Reconstr evation in breast cancer incidence stages among women with cosmet Surg, 123:790?793. For other sites, including cancers this synthetic estrogen was frst man suffcient evidence that combined of the thyroid, lung, stomach, urinary ufactured in 1938 [1]. Diethylstilbestrol estrogen?progestogen oral contra tract, gall bladder, and pancreas, as was widely used, especially from the ceptives cause cancers of the breast well as lymphoma, cutaneous mela 1940s the 1970s, prevent po (notably among young women), noma, and central nervous system tential miscarriages by stimulating 164 the synthesis of estrogen and pro Phenacetin been limited traditional Chinese gesterone in the placenta. Subsequently, (Group 2A), since the available plastic agents and is associated with several adverse effects emerged evidence had not been able dis nephropathy and an increased risk (Table 2. First, slightly in criminate between potential carci of cancers of the renal pelvis and creased risks of breast cancer and nogenic effects of phenacetin and ureter (Table 2. Genome-wide possibly of endometrial cancer were those attributable other analge sequencing has established the observed among women exposed sics or components of analgesics mutational signature of aristolochic diethylstilbestrol during pregnancy. Third, fetal exposure di Since phenacetin was withdrawn conjunction with ultraviolet radiation ethylstilbestrol was associated with from the market in most countries in as phototherapy for various condi increased risks of squamous cell car about 1980, the pool of patients with tions, notably psoriasis. The drug cinoma of the cervix among female excess risk of cancers of the renal has been suspected cause vari offspring and testicular cancer among pelvis or ureter due phenacetin ous types of skin cancer, but there is male offspring. Currently, evidence is convincing evidence only for causa therapy is probably limited now, tion of squamous cell carcinoma [1]. Miscellaneous agents Photosensitivity is also induced Tamoxifen Use of Aristolochia plants contain by frequently used drugs such as Tamoxifen is indicated as adjuvant ing aristolochic acid has mainly certain types of antihypertensives, therapy for treatment of postmen opausal estrogen-receptor-positive Fig. Furthermore, tamoxifen has been approved as a breast cancer preventive agent among women at high risk of developing breast cancer (see below). Observational epide miological studies and randomized trials have consistently shown that use of tamoxifen increases the risk of endometrial cancer whether given as adjuvant therapy among women with breast cancer or as preventive therapy among women at high risk of breast cancer (Table 2. There is also some indication that tamoxifen may be associated with an increased risk of some types of gas trointestinal cancer; however, these results are not conclusive. The results of several current steroidal anti-inflammatory drugs as a of estrogen-receptor-positive breast randomized trials will hopefully potential cancer preventive measure is cancers. Newer drugs within the class of (statins) reduce serum levels of selective estrogen-receptor modula cholesterol and are widely used tors, for example lasofoxifene, also manage and prevent cardiovascu show effcacy, and possibly a better lar and coronary heart disease. In overall beneft?risk profle, but need addition, a growing body of experi further assessment. Aromatase in mental evidence has suggested that hibitors may be more effcacious, and statins have cancer preventive prop drugs within this class, for example anastrozole and exemestane, are erties [11]. To date, however, sev currently being evaluated as preven eral randomized trials with cancer tive agents among women with a his as secondary end-point have failed tory of carcinoma in situ of the breast demonstrate a reduced risk of or other women considered be at cancer, overall or at specifc sites, for example hydrochlorothiazide and high risk of developing breast cancer. Likewise, observational dence that these drugs increase the epidemiological studies with longer Aspirin and other non risk of lip and skin cancers [6]. Statins have also been evalu of colon adenoma recurrence, and humans (Group 2B) because the ated as adjuvant therapy standard randomized trials in patients with epidemiological evidence has not cancer therapy; however, date hereditary colorectal cancer syn been defnitive and is hence cat dromes have consistently shown this has yielded primarily null results egorized as limited or because car that aspirin and other non-steroidal [11].

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