Breast symptoms, such as a lump or localized pain, are common and often cause considerable concern. Although these symptoms are usually caused by a benign condition, it is important to rule out breast cancer quickly and reliably. In the Netherlands, women with these symptoms are often examined with both a mammogram (an X-ray of the breast) and a targeted ultrasound of the area where the symptoms occur. This thesis is based on research initiated by breast radiologists at the Radboud university medical center (Radboudumc). Part of the research was conducted in collaboration with St. Antonius Hospital and Noordwest Hospital Group in Alkmaar. The findings show that, in most cases, a targeted ultrasound is sufficient to reliably rule out breast cancer responsible for the breast symptoms. An additional mammogram provides little extra information for women under the age of 40. Performing a mammogram only when the ultrasound raises suspicion or when there is a greater chance of detecting breast cancer that has not yet caused symptoms maintains the quality of care. For women aged 40 years and older, mammography remains important because it can also detect breast cancer before symptoms develop. Avoiding unnecessary mammograms reduces exposure to radiation, limits additional examinations, and is estimated to save approximately €2.4 million in healthcare costs each year. These findings show that the diagnostic evaluation of breast symptoms can become simpler, more patient-friendly, and more cost-effective without compromising safety.
Linda Appelman (1983) completed her fellowship in breast radiology at Radboud university medical center (Radboudumc) in 2019, after which she joined the Department of Radiology and Nuclear Medicine at Radboudumc as a staff radiologist. During her fellowship, she started her PhD research under the supervision of Prof. Ritse Mann, focusing on the diagnostic evaluation of women with focal breast complaints. As part of this work, she initiated the multicenter prospective Breast Ultrasound Study (BUST), conducted at Radboudumc, St. Antonius Hospital, and Noordwest Hospital Group Alkmaar. Since 2023, she has been working as a breast radiologist at the Alexander Monro Hospital in Bilthoven. In addition, she serves as a board member of the Breast Section of the Dutch Society of Radiology (NVvR), a steering committee member of the Breast Cancer Cluster of the Federation of Medical Specialists, and a member of the Locoregional Tumor Working Group of the BOOG Study Center.