Carla Henrica van Gils

The Dense Tissue and Early Breast Neoplasm Screening-2 (DENSE-2) trial addresses whether supplemental contrast-enhanced mammography and abbreviated MRI can lead to fewer interval cancers in women with extremely dense breasts compared with mammography.

Background: Monitoring skeletal muscle mass (SMM) during radiotherapy (RT) is important, as SMM loss is associated with poorer clinical outcomes. Cone-beam CT (CBCT), acquired before each RT fraction, offers the potential to track the lumbar skeletal muscle index (LSMI) over time. However, CBCT has lower image quality than conventional CT. This study assessed the agreement between CT and CBCT and evaluated the reliability of LSMI measurements in patients with head and neck squamous cell carcinoma. Methods: Patients who underwent both CT and CBCT on the same day during RT were included. The cross-sectional muscle area at C3 was measured, converted to L3, and used to calculate the LSMI. Two researchers analyzed all scans, with one repeating the measurements. Agreement and reliability were quantified using intraclass correlation coefficients (ICCs) and visualized with Bland–Altman plots. Results: LSMI measurements showed excellent agreement between CBCT and CT (ICC: 0.97–0.99; 95% CI: 0.95–0.99). The intrarater (ICC: 0.99; 95% CI 0.98–0.99) and interrater reliability (ICC: 0.97; 95% CI: 0.66–0.99) were high. Bland–Altman plots, however, revealed wide limits of agreement. Conclusion: CBCT provides reliable LSMI measurements and agrees well with CT, but the observed variability suggests cautious interpretation. When both modalities are available, CT remains the preferred standard for SMM assessment.

This study aimed to assess whether, in the context of communicating risk-based breast cancer screening results, visualizations of risk information consisting of an icon array depicting quantified breast cancer risk and simplified drawings for "qualitative" risk information (e.g. risk factors, screening frequency) offer added value compared to a textual format presenting numerical information. An online experiment was conducted with a 3 (information format: text with numbers - text with risk visualizations - interactive) ×4 (breast cancer risk category: slightly decreased, average, slightly increased, increased) between-subjects design. We recruited n = 1,047 women aged 40-74 years from the general Dutch population, including 413 (39.4%) with lower education and 269 (25.7%) with a family history of breast cancer. Participants viewed hypothetical screening results. Primary outcomes were verbatim and gist comprehension of numerical probability information and verbatim comprehension of qualitative risk information. Secondary outcomes (e.g. affective reactions, perceived likelihood) and health literacy, numeracy, and graph literacy were also assessed. Results showed no significant differences in comprehension between "text with risk visualizations" and "text with numbers" formats. Verbatim comprehension of numerical probability and qualitative risk information was worse in the "interactive" format compared to "text with numbers" format. Those assigned to a non-average risk category exhibited lower verbatim and gist comprehension. Overall, the visualizations tested in this study did not enhance comprehension of risk-based breast cancer screening results compared to a text format with numerical information. Understanding risk-based screening results may be challenging regardless of format, particularly for people assigned to a non-average risk category.

Supplemental Table 1 includes the descriptive statistics of the 2356 BRCA1 or BRCA2 carriers in the IBCCS consortium who had any available mammograms prior to selection and inclusion in the current study

Supplementary Table 3 includes the descriptive statistics of the women with a pathogenic germline variant in BRCA2 with or without risk-reducing salpingo-oophorectomy who were included in the study analysis (N=290)

Supplemental Figure 1 shows a cross-tabulation of pseudo BI-RADS classification of breast density before and after a risk-reducing salpingo-oophorectomy (RRSO) in women with pathogenic germline variant in BRCA1 or BRCA2

Supplemental Figure 2 shows a cross-tabulation of pseudo BI-RADS classification of breast density at first and second mammograms in women with a pathogenic germline variant in BRCA1 or BRCA2 who did not undergo risk-reducing salpingo-oophorectomy in the interval between mammograms.

Supplemental Table 7 includes analysis of changes in mammographic density in women with pathogenic germline variant in BRCA1 who underwent a risk-reducing salpingo-oophorectomy (RRSO) compared to women with a pathogenic germline variant in BRCA1 who did not undergo RRSO in the interval between mammograms

Supplemental Table 8 includes analysis of changes in mammographic density in women with pathogenic germline variant in BRCA2 who underwent a risk-reducing salpingo-oophorectomy (RRSO) compared to women with a pathogenic germline variant in BRCA2 who did not undergo RRSO in the interim between mammograms

Supplemental Table 5 includes changes in total breast area among women with a pathogenic germline variant in BRCA1 or BRCA2 who did or did not undergo risk-reducing salpingo-oophorectomy in the interval between mammograms