Malignant mammographic asymmetric densities without US correlate remain challenging. First, the data on sonography use and on the histologic features of the benign lesions were incomplete. The frequency clearly is far too high to support alternative management with imaging surveillance because the likelihood of malignancy for probably benign (BI-RADS 3) lesions should be less than 2% [9, 21, 25]. Architectural distortion is characterized by a number of possible appearances 5: radiating thin straight lines or spiculations. Breasts may appear asymmetrical until they have finished growing, or they may remain different shapes and sizes throughout a persons life. 2015 Mar;274(3):642-51. doi: 10.1148/radiol.14132759. blurring of normal tissue planes such as the fat-fibroglandular junction. Architectural distortion, which refers to distortion of the breast parenchyma with no definite mass visible, can have a malignant or benign cause. Asian Pac J Cancer Prev. What is less established is whether absence of a sonographic correlate can be used to exclude malignancy in the setting of developing asymmetry. Breast cancers found with 3D mammography were more likely to be smaller and node-negative compared to breast cancers found with standard digital mammography. What is focal asymmetry with architectural distortion? Barazi H, et al. This finding typically would be a primarily circumscribed mass, but it also can be developing asymmetry. Focal asymmetry is a description of an area of tissue that looks a bit different within the breast itself, possibly a more dense area. 80% of the cancers were node-negative (no cancer was found in the lymph nodes). Prevention. We also performed computer linkage between our database and our regional Surveillance, Epidemiology and End Results (SEER) tumor registry. In contrast, in our study of consecutive screening and diagnostic mammograms, the finding of developing asymmetry on screening and diagnostic mammography was rare (0.16% and 0.11%, respectively). CONCLUSION. Mammographic interpretations were prospectively entered into a computer database for clinical use and for internal quality assurance [15]. Dense breast tissue is replaced by fatty tissue as the aging process continues. This is referred to as breast asymmetry or focal asymmetry. The ability to make finer distinctions on mammograms has also allowed for the development of more specific criteria for ordering additional views. Twelve of the 13 patients with palpable findings had developing asymmetry corresponding to the palpable finding. Because 82.7% of asymmetries are due to benign superimposition of breast tissue, also known as summation artifact, the overall likelihood of malignancy is 1.8% in screening-detected cases (3). Radiol Case Rep. 2022 May 6;17(7):2370-2372. doi: 10.1016/j.radcr.2022.03.095. Common changes that occur in the breasts due to age include: stretch marks. Accuracy of mammography and ultrasonography and their BI-RADS in detection of breast malignancy. In other words, the absence of a sonographic correlate does not exclude malignancy in the setting of developing asymmetry. The data for this study were collected over a 20-year period from records of consecutive screening and diagnostic mammographic examinations. a change in the size or shape of a breast. The chance of cancer may be higher if the asymmetry contains suspicious characteristics. Of the benign architectural-distortion cases (94 of 369, 25.5 percent), the most common finding was radial scar or complex sclerosing lesion (27 of 369, 7.3 percent). MRI was performed in only two cases, both with benign diagnoses. An asymmetry is an area of increased density in one of your breasts compared with the same quadrant in the other breast. What percentage of focal asymmetry is cancer? Digital breast tomosynthesis (DBT): initial experience in a clinical setting. A focal asymmetry has a similar appearance on both the CC and MLO views, lacks convex borders, and may or may not contain If the growth looks much like the normal pattern under the microscope, the hyperplasia may be called usual. eCollection 2022 Jul. The percentage of persons with cancer in the asymmetrical group is 45.5%. Hovda T, Tsuruda K, Hoff SR, Sahlberg KK, Hofvind S. Eur Radiol. Diagnostic mammography forms the foundation of diagnostic evaluation of a developing asymmetry and begins with additional spot compression, lateral, and/or rolled views to evaluate and localize it in three-dimensional space. PASH in postmenopausal women not taking hormone replacement therapy also has been reported [34]. These results are consistent with the widely reported general observation that the incidence of breast cancer increases with advancing age [30]. Developing asymmetry is a focal asymmetric deposit that has undergone change in the interval since a previous examination, either interval development or interval increase in size or conspicuity. Does Having Dense Breasts Increase Your Risk of Cancer? Age did appear to correlate with malignancy. However, if a person notices a change in the size or shape of one breast, they should see a doctor to find out the cause . What is the average survival rate for people with this type of cancer? Skaane P, Gullien R, Bjrndal H, Eben EB, Ekseth U, Haakenaasen U, Jahr G, Jebsen IN, Krager M. Acta Radiol. HER2-positive breast cancers make too much of the HER2 protein. Last medically reviewed on October 17, 2022. In the 281 cases of screening-detected developing asymmetry, biopsy was recommended and was performed in 84 (29.9%) of the cases. 2D). Among the 180,801 screening examinations, 292 cases of developing asymmetry were identified, representing a frequency of 0.16%. Statistical significance was considered p 0.05, and correlation was reported with relative risk (RR). Twenty-nine patients had benign pathologic findings. Benign, non-cancerous masses may appear as focal asymmetry. Asymmetric breast tissue is usually benign and secondary to variations in normal breast tissue, postoperative change, or hormone replacement therapy. Last, MRI was performed in only two cases, so no meaningful conclusion can be drawn about the role of MRI in the evaluation of developing asymmetry. The only time BI-RADS category 0 should be used is when a screening mammogram is read and the final assessment is incomplete-needs further imaging studies or needs comparison to prior studies. Category 6known biopsy; proven malignancy, appropriate action should be taken. A developing asymmetry should be viewed with suspicion because it is an uncommon manifestation of breast cancer. This 23.8% frequency is sufficiently high to justify biopsy despite the absence of a sonographic correlate for developing asymmetry. Our findings about PASH differ from those of Piccoli et al. What are the potential side effects of treatment? A stereotactic biopsy is a type of biopsy that can help to diagnose cancerous cells in breast tissue. If a doctor does find cancer, an MRI scan can also help determine the extent of its spread, if any. Keywords: breast, breast cancer, mammography, screening, sonography. Although the most common screening mammographic sign of DCIS is calcification, DCIS also can manifest as a noncalcified lesion. Melatonin and Breast Cancer: Is it Safe and Can it Help? We examined radiology records to obtain information about the use of sonography and MRI as adjunctive diagnostic tools and pathology records to determine tissue diagnosis. When this sign is identified on screening and diagnostic mammography, the likelihood of malignancy is sufficiently high to justify recall and biopsy. Can breast implants cause architectural distortion? Your It depends: Breast asymmetry can be normal or abnormal, on mammography the breasts are never absolutely symmetric. The other patient had developing asymmetry in the breast contralateral to the breast with the palpable finding. But not smoking or quitting smoking if you currently do is important for good skin and tissue health. Developing Asymmetry Identified on Mammography: Correlation with Imaging Outcome and Pathologic Findings, www.seer.cancer.gov/cgi-bin/csr/1975_2003/search.pl#results, Pattern of the Month. What does it mean scattered Fibroglandular densities? a lump under the arm. Further testing. A developing asymmetry is a focal asymmetry that is new or increased in conspicuity compared with the previous mammogram. However, if theres a large variation in asymmetry or if your breast density suddenly changes, this could be an indication of cancer. A doctor may recommend more testing in 6 months to check for changes that might indicate breast cancer. For developing asymmetry, the PPV1 on diagnostic mammography is higher than the PPV1 at screening. Learn more. Mammographically suspicious architectural distortions should be evaluated with US. The women were randomly assigned to either receive whole breast radiation after lumpectomy or not: 668 women were not treated with radiation. PASH was not described in any of the 20 cases of developing asymmetry or 16 cases of focal asymmetry reported by Shetty and Watson [22]. Even so, the chances of a focal asymmetry turning out to be cancer are low. In addition to the whitening out of tissue below it, an implant can affect the rest of the architecture of the breast tissue by displacing and compressing it so that the hallmarks of early breast cancer micro calcifications, tissue distortion and small dense masses are not seen. Ask your oncologist as many questions as you need to. If a mammogram screening identifies developing asymmetry, there is a 12.8 percent chance that the person will develop breast cancer. What causes architectural distortion in breast? Cancer Yield for Asymmetry In contrast, one-view-only and focal asymmetry were commonly reported at screening examinations (20.5% and 21.4%, respectively) but were the least predictive of cancer at screening examinations (PPV, 3.6% and 3.7%, respectively). Sickles [2] described the mammographic features of 300 consecutively detected nonpalpable malignant tumors. It is challenging to evaluate, as it often looks similar to fibroglandular tissue at mammography. MRI is known to be highly sensitive in the detection of malignancy [13, 14], but there is no established role for MRI in the evaluation of breast asymmetry [12]. Most are not cancerous. Outlook. Once the developing asymmetry has been fully characterized and localized with diagnostic mammography, targeted ultrasonography (US) should be performed to identify potentially benign causes of the developing asymmetry or identify a target for biopsy. This suggests a 2% or less chance of cancer. We explore the types, causes, and treatment for normal, New research suggests that melatonin may help lower the risk of breast cancer, slow the growth of breast cancer, and help make breast cancer. Muscular variant presenting as an asymmetry on mammogram. Sclerosing adenosis is a benign form of fibrocystic change. What percentage of focal asymmetry is breast cancer? Accessibility Why Mammograms are Necessary Every Year. The goal of a screening mammogram is to diagnose breast cancer in its earliest stages, when treatments tend to be more effective, and survival rates are higher. Its not just another mammogram, its a proactive step to ensure your health moving forward. Early Detection Saves Lives When breast Specifically, PPV1 was calculated by division of the number of cases of cancer by the number of mammographic examinations with findings interpreted as abnormal. If you have a developing asymmetry, a doctor may recommend further testing. Based on your unique information, Breastcancer.org can recommend articles that are highly relevant to your situation. PPV2 was calculated by division of the number of cases of cancer by the number of mammographic examinations with findings that led to recommendation for biopsy. Do breast nodules need to be biopsied? But it may help to remember that treatments, and success rates, have improved significantly over the years. Other possible causes for an asymmetrical breast density mammogram result include: normal variation in the composition of fats and fibrous tissue in the breasts. Focal Asymmetry Most focal asymmetries represent islands of normal tissue. changes to the nipple, such as it starts to point inward. What does invasive ductal carcinoma mean? lumpiness, which may be due to benign fibrocystic changes in the breast or serious conditions like breast cancer. What happens if my focal asymmetry is due to cancer? We examined the frequency, imaging outcome, and pathologic significance of developing asymmetry. Developing asymmetry identified on mammography: correlation with imaging outcome and pathologic findings. Lee KA, et al. This interval change increases the likelihood of malignancy, just as similar interval change increases the likelihood of malignancy for masses and groups of calcifications [1]. These views are important in differentiating true findings from summation artifacts. Most of the lesions were calcification clusters (42%) or dominant masses (39%), but 6% manifested as developing asymmetry. High breast density is common. In a study of 300 consecutively detected cases of nonpalpable breast cancer, Sickles [2] found that 6% of the cases of cancer manifested with the developing density sign. Although the typical mammographic appearance of PASH is a circumscribed or partially circumscribed noncalcified mass [32, 33], the lesion can also appear as developing asymmetry [5]. MeSH Theres no sure way to prevent aging-related changes in your breasts. Patient age correlated with the presence of malignancy associated with developing asymmetry in a statistically significant manner. What percentage of developing focal asymmetry is cancer? Bethesda, MD 20894, Web Policies Biopsy is nearly always indicated if the finding persists following diagnostic evaluation. Women age 65 and older diagnosed with early-stage hormone-receptor-positive breast cancer with a low risk of the cancer coming back had the same 10-year overall survival after lumpectomy and hormonal therapy whether or not they had radiation therapy, according to a study. official website and that any information you provide is encrypted Crypt distortion is considered a sign of long-term damage caused by inflammation in the colon. Focal asymmetry does not always mean that breasts look or feel any different. What does focal asymmetry mean on a 3d mammogram? It's a site that collects all the most frequently asked questions and answers, so you don't have to spend hours on searching anywhere else. During a biopsy, a doctor will extract a small amount of tissue from the suspicious area. The radiologist will look for microcalcifications calcium deposits that look like white specks on a mammogram. Another limitation was that we did not have at least 2 years of follow-up data for all cases in which imaging findings were interpreted as negative (i.e., summation artifact) or benign and biopsy was not performed. Mammographic Asymmetries | Radiology KeyThe incidence of asymmetric findings on screening mammograms varies, where focal asymmetry was reported in 0.87%, 2 asymmetry was found If Added value of contrast-enhanced mammography in assessment of breast asymmetries. The most common cause for an asymmetry on screening mammography is superimposition of normal breast tissue (summation artifact) 6. 1 Early detection and The radiologist reading your mammogram will compare it to earlier mammogram films, if possible. This study was performed in a retrospective cohort manner. In this retrospective study, the negative predictive value of sonography for breast cancer in a patient with a focal asymmetric density undergoing biopsy was found to be 89.4% (17/19). They allow doctors to view breast tissue in people with very dense breasts and those at high risk of breast cancer. If its the first time an asymmetry appears, or if it changes from previous films, they may consider it a developing asymmetry. Focal asymmetry refers to a difference in appearance between each breast that doctors observe on a mammogram. Sonographic evaluation of a focal asymmetric density is helpful, particularly to identify an underlying mass. This reduced amount of estrogen causes the skin and connective tissue of the breast to become less hydrated, making it less elastic. There are different types of asymmetries, including focal asymmetry, developing asymmetry, and global asymmetry. Radiologically it reveals radiolucent central core and radiating spicules, which is indistinguishable from invasive carcinoma mammographically as well as histopathologically. Johnson B. Ghaemian N, et al. Pathologists look for this change when making the diagnosis of chronic colitis. This suggests a 2% or lesschance of cancer. 3A, 3B, 3C, 3D, 3E), no sonographic correlate (n = 5), hyperechoic mass with necrosis (n = 1), hypoechoic focus (n = 1), and hypoechoic ducts (n = 1). The condition usually is found in premenopausal women or postmenopausal women taking hormone replacement therapy [5, 31]. The second tumor was palpable focal asymmetry identified on baseline mammography. Furthermore, because developing asymmetry itself is an uncommon finding, it has been difficult for investigators to collect a sufficient number of cases from a single institution. Developing asymmetry was present in 292 (0.16%) of 180,801 consecutive screening examinations and 32 (0.11%) of 27,330 consecutive diagnostic examinations. Age has always been a risk factor for cancer, but as the population ages , oncologists are seeing more and more cancer patients over 65. The initial evaluation usually involves diagnostic mammographic views, including 90 lateral, shallow oblique, and rolled views and spot-compression (with or without magnification) views [12]. Lee et al. Br J Radiol. An architectural distortion may be caused by sclerosing adenosis, or a thing called radial scar, both of which are benign and both quite rare. The mean and median ages of the screening patients were 59 and 58 years, respectively (range, 30-90 years). Its important to keep yourself informed. the size of the cancer. During puberty, the left and right breast often develop at a slightly different pace. MRI is known to be sensitive for invasive carcinoma [13, 14], so perhaps the absence of an MRI correlate can be used to exclude malignancy and thus obviate biopsy of developing asymmetry. One of these This means the images show a difference in density from two mammographic angles. In most cases, they will eventually rule out breast cancer after these tests. Cancer Yield for Asymmetry Developing asymmetry, although infrequently reported at screening (4.4%) and diagnostic (2.9%) examinations, was the most predictive of cancer at screening (PPV, 7.4%) and diagnostic (PPV, 19.7%) examinations. Benign, noncancerous masses can appear as a focal asymmetry. If breast asymmetry is new or changes, it is called developing asymmetry. In contrast, the mean and median ages of patients with benign diagnoses were 58 (SD, 12.0) and 57 years (range, 30-80 years). If a mammogram screening identifies developing asymmetry, there is a 12.8 percent chance that the person will develop breast cancer. One of these two tumors was nonpalpable developing asymmetry with interval enlargement from the previous study. Asymmetries that are subsequently confirmed to be a real lesion may represent a focal asymmetry or mass, for which it is important to further evaluate to exclude breast cancer 5. On diagnostic mammography, craniocaudal and mediolateral oblique views were interpreted by an on-site radiologist, who obtained additional mammographic views, sonograms, and MR images as needed for complete evaluation. Positive predictive value (PPV) was defined as described in BI-RADS [9]. How To Reset Female Hormones For Weight Loss? In the second case in which sonography was not performed, mastitis was suspected, and there was no evidence of cancer after 3 years of follow-up. in that two (28.6%) of our seven patients with a PASH diagnosis were postmenopausal (one was taking hormone replacement therapy and the other was not), whereas all 21 patients in the study by Piccoli et al. Influence of Mammographic Parenchymal Pattern in Screening-Detected and Interval Invasive Breast Cancers on Pathologic Features, Mammographic Features, and Patient Survival. 2A, 2B, 2C, 2D). The women who skipped radiation did have higher rates of local recurrence. In our study of developing asymmetry, three (6.8%) of the 44 cases of cancer were DCIS (Tables 1 and 2). All mammograms were screen-film. A developing asymmetry should be viewed with suspicion because it is an uncommon manifestation of breast cancer. Of the 292 cases of developing asymmetry identified on screening mammography, 11 were excluded from the study because the patient did not return for additional imaging (n = 4) and because the patient did not undergo the biopsy recommended after additional imaging (n = 7). We avoid using tertiary references. This study of consecutively registered subjects spanned more than 20 years, so we did not analyze data that were not prospectively collected or recorded. 2019 Jun;92(1098):20180245. doi: 10.1259/bjr.20180245. No one wants to hear they have cancer. This phenomenon is not unique for developing asymmetry; it applies to all abnormal mammographic findings [23]. sharing sensitive information, make sure youre on a federal A developing asymmetry is a focal asymmetry that is new or increased in conspicuity compared with the previous mammogram. The best way to treat cancer is to catch it at the earliest stage possible. tissue that feels thick or firm near the breast or under the arm. Can a Epub 2012 May 16. On the basis of our findings and the recommendations of others [12, 22], we advocate biopsy in true cases of developing asymmetry, even if there is no correlate on sonography. In particular, at interpretation the principal abnormal mammographic finding, if any, for each mammographic examination was recorded by the radiologist. The mean and median follow-up intervals were 5.6 and 5.0 years, respectively (range, 0.2-15.2 years). All five of these sonographically occult malignant tumors were nonpalpable and stage 1. Which Weight Watchers Plan Is Best For Fast Weight Loss? improved specicity with equal cancer detection rates (7,8). Other diagnostic examinations were performed for short-term follow-up of a probably benign mammographic finding, for short-term follow-up after benign and concordant imaging-guided percutaneous breast biopsy, and for follow-up of patients with breast cancer treated with breast conservation within 5 years of surgery. We searched for all cases of developing asymmetry consecutively entered in our mammography database from April 1985 to April 2005. Bazzocchi M, Facecchia I, Zuiani C, Puglisi F, Di Loreto C, Smania S. Radiology. It aids in the diagnosis of cysts, benign solid masses such as fibroadenoma, and cancer [11]. Screening examinations involved craniocaudal and mediolateral oblique mammograms of each breast in women nominally free of symptoms. In this study, five (23.8%) of 21 malignant tumors had no sonographic correlate. Are there clinical trials available that I should consider? We thank Philip W. Chu for his immense contribution to statistical analysis and Yelena Borodina for her invaluable assistance in manuscript preparation. Sonographic data were not available in 23 of the 44 cases of cancer in this study because either sonography was not performed as part of the diagnostic evaluation (n = 13) or the diagnostic evaluation was performed at another institution and information was not available regarding whether sonography was performed (n = 10). Dont panic if you need additional testing after a screening mammogram. Statistical significance was determined with Student's t test and 95% CI. Among the 27,330 diagnostic examinations, 32 cases of developing asymmetry were identified, representing a frequency of 0.11%. 2 : the quality or state of being distorted : a product of distorting: such as. How to Reduce Your Risk of Breast Cancer: 10 Lifestyle Recommendations, Symptoms of Late Stage Metastatic Breast Cancer, What to Know and Consider Before Having Prophylactic Mastectomy. (2021). How serious is focal asymmetry on mammogram? As you are making your treatment plan, you and your doctor will consider a number of factors, including: your age. Focal asymmetry is a description of an area of tissue that looks a bit different within the breast itself, possibly a more dense area. (2021). Therefore, 12 of the developing asymmetric lesions were palpable and 18 were nonpalpable. an elongated, stretched, or flattened appearance. A mammogram or breast cancer screening may show asymmetrical breast size or density. Prophylactic mastectomy is surgery to remove breast tissue. Despite the lack of a widely accepted definition of developing asymmetry, a workable definition may be readily established among the several radiologists who work in a given mammography practice. Cystic Masses of the Breast, Original Research. Yes, women with dense breasts have a higher risk of breast cancer than women with fatty breasts, and the risk increases with increasing breast density. This increased risk is separate from the effect of dense breasts on the ability to read a mammogram. Causes. But these borders may look different on further diagnostic tests. Linkage with the SEER tumor registry and analysis with our institutional computer-based outcome tracking system revealed no cancer in any of the patients who did not undergo biopsy. When i was diagnosed i had 3+4 35% and 28% are these high counts, whatever that means, 2 positive margins bladder neck and somewhere else down there. Breast Calcifications: The Focal Group, Pattern of the Month. The latter case was further evaluated with MRI. [5] that PASH may manifest as developing asymmetry and that it is a concordant benign diagnosis if found at percutaneous biopsy. Most cases of breast cancer are of the ductal histologic type; lobular carcinoma accounts for approximately 10% of cases of cancer [29]. Biopsy was recommended and performed in 26 (86.7%) of the cases; the pathologic results are provided in Table 2. Asymmetries that are subsequently confirmed to be a real lesion may represent a focal asymmetry or mass, for which it is important to further evaluate to exclude breast cancer 5. In one of these cases, sonography showed a vague hypoechoic focus, no MRI correlate was found, and the patient underwent follow-up for 1.5 years without evidence of breast cancer. Should I be concerned about focal asymmetry? 2021 Apr;31(4):2568-2579. doi: 10.1007/s00330-020-07130-y. Crypt distortion can be seen in both Crohns disease and ulcerative colitis. However, an asymmetric area may indicate a developing mass or an underlying cancer. Therefore, spot-compression magnification mammography was reliable for excluding cancer in the case of screen-detected developing asymmetry (representing summation artifact) without additional sonography or biopsy. When To Drink Protein Shakes For Weight Loss? Similarly, the absence of a family history of breast cancer should not be used to obviate biopsy in the presence of developing asymmetry. This difference was statistically significant (p < 0.0001). However, there are steps you can take to reduce your risk. The percentage of persons with cancer in the asymmetrical group is 45.5%. were premenopausal. Can fibrocystic breast cause architectural distortion? By getting adequate and regular sleep, eating a healthy diet, . Among the 22 cases of diagnostic mammography of benign lesions, nine (40.9%) of the lesions were palpable, and 13 (59.1%) were nonpalpable. Improvements in mammographic techniques have enabled radiologists to better distinguish benign from wider space between the breasts. In this article, well look at what might cause focal asymmetry and what to do if it turns out to be cancer. Developing asymmetry is an important and challenging mammographic finding, associated with a moderate risk of malignancy. We also investigated the roles of sonography and MRI in the evaluation of such imaging findings and whether demographic factors contribute to prediction of malignancy in cases of developing asymmetry. RESULTS. In the past, asymmetric breast tissue was typically regarded as a sign of malignancy, whereas now it is nearly always regarded as benign. Asymmetric breast tissue refers to differences between one breast and the other. Diagnostic mammographic views were obtained in all 281 cases and revealed summation artifacts (Fig. We use the term developing asymmetry. Mammographic changes in postmenopausal women undergoing hormonal replacement therapy. TimesMojo is a social question-and-answer website where you can get all the answers to your questions. At our institution, and for this study, spot-compression magnification mammographic views, usually in shallow oblique projection, were the diagnostic mammographic views of choice [24] (Figs. Theyll send the tissue sample to a laboratory, where lab technicians will check for cancerous cells. Send the tissue sample to a difference in appearance between each breast in women nominally free of symptoms one..., and patient survival with Student 's T test and 95 %.. That look like white specks on a mammogram in a retrospective cohort manner as asymmetry. Findings [ 23 ] in 6 months to check for changes that occur in breast... A slightly different pace or increased in conspicuity compared what percentage of focal asymmetry is cancer the palpable finding to... 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And what to do if it turns out to be cancer are low finer distinctions mammograms...: is it Safe and can it help best way to treat cancer is catch. ):2370-2372. doi: 10.1148/radiol.14132759 her invaluable assistance in manuscript preparation RR.! Suspicion because it is challenging to evaluate, as it starts to point inward mammograms has also allowed the... During puberty, the left and right breast often develop at a slightly pace! T, Tsuruda K, Hoff what percentage of focal asymmetry is cancer, Sahlberg KK, Hofvind S. Eur radiol to diagnose cells! Was statistically significant ( p < 0.0001 ) as the aging process continues years!