{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:19:33Z","timestamp":1787494773380,"version":"build-2736575974"},"reference-count":37,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T00:00:00Z","timestamp":1614643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004710","name":"Fondazione Umberto Veronesi","doi-asserted-by":"publisher","award":["no grant number available"],"award-info":[{"award-number":["no grant number available"]}],"id":[{"id":"10.13039\/501100004710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Breast cancer is a clear example of excellent survival when it is detected and properly treated in the early stage. Currently, screening of this cancer relies on mammography, which may be integrated by new imaging techniques for more exhaustive evaluation. The Personalized, Integrated, Network, Knowledge (P.I.N.K.) study is a longitudinal multicentric study involving several diagnostic centres across Italy, co-ordinated by the Italian National Research Council and co-funded by the Umberto Veronesi Foundation. Aim of the study is to evaluate the increased diagnostic accuracy in detecting cancers obtained with different combinations of imaging technologies, and find the most effective diagnostic pathway matching the characteristics of an individual patient. The study foresees the enrolment of 50,000 women over the age of 40 years presenting for breast examination and providing informed consent to data handling. So far, the 15 participating centres across Italy have recruited a total of 22,848 patients. Based on the analyses of the first 175 histopathological-proven breast cancers, mammographic sensitivity was estimated to be 61.7% (n = 108 cancers), whereas diagnostic accuracy increased by 35.5% (n = 44 cancers) when mammography was integrated with other imaging modalities (ultrasound and\/or digital breast tomosynthesis). Increase was mainly determined by ultrasound alone. Given the ongoing data collection and recruitment, the number of cancers detected is too low to allow any further in-depth analysis to explore links to patient characteristics. Past studies show that the uniform approach of population screening guidelines should be revised in favour of more personalised regimens, where known standards are integrated by imaging techniques most suitable for the individual\u2019s characteristics. With the ultimate goal of identifying early breast cancer detection strategies, our preliminary results suggest that integrated diagnostic approach could lead to a paradigm shift from an age-based regimen toward more specific and effective risk-based personalised screening regimens, in order to reduce mortality from breast cancer.<\/jats:p>","DOI":"10.3390\/ijerph18052456","type":"journal-article","created":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T21:24:01Z","timestamp":1614720241000},"page":"2456","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The P.I.N.K. Study Approach for Supporting Personalized Risk Assessment and Early Diagnosis of Breast Cancer"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5272-341X","authenticated-orcid":false,"given":"Michela","family":"Franchini","sequence":"first","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8130-4967","authenticated-orcid":false,"given":"Stefania","family":"Pieroni","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgardo","family":"Montrucchio","sequence":"additional","affiliation":[{"name":"Senologica SrL, 19124 La Spezia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Nori Cucchiari","sequence":"additional","affiliation":[{"name":"Breast Unit, Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosimo","family":"Di Maggio","sequence":"additional","affiliation":[{"name":"Studimed Cadorna Srl, 35123 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Cassano","sequence":"additional","affiliation":[{"name":"Istituto Europeo di Oncologia IRCCS, 20141 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brunella","family":"Di Nubila","sequence":"additional","affiliation":[{"name":"Istituto Europeo di Oncologia IRCCS, 20141 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian","family":"Giuseppetti","sequence":"additional","affiliation":[{"name":"Department of Radiology, Azienda Ospedaliera Universitaria Ancona, 60030 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Nicolucci","sequence":"additional","affiliation":[{"name":"Studi Michelangelo SrL, 50129 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Scaperrotta","sequence":"additional","affiliation":[{"name":"Istituto Tumori, 20133 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Belli","sequence":"additional","affiliation":[{"name":"F. Policlinico Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Santicchia","sequence":"additional","affiliation":[{"name":"AUSL della Romagna Centro di Prevenzione Oncologica, 47923 Rimini, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7221-0873","authenticated-orcid":false,"given":"Sabrina","family":"Molinaro","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"on behalf of the PINK Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2955","DOI":"10.1002\/cncr.28771","article-title":"Breast cancer screening in an era of personalized regimens: A conceptual model and National Cancer Institute initiative for risk-based and preference-based approaches at a population level","volume":"120","author":"Onega","year":"2014","journal-title":"Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1634\/theoncologist.2010-0123","article-title":"Nonpalpable breast carcinomas: Long-term evaluation of 1258 cases","volume":"15","author":"Veronesi","year":"2010","journal-title":"Oncologist"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1001\/jama.299.18.2151","article-title":"Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer","volume":"299","author":"Berg","year":"2008","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1148\/radiol.11110469","article-title":"Swedish two-county trial: Impact of mammographic screening on breast cancer mortality during 3 decades","volume":"260","author":"Vitak","year":"2011","journal-title":"Radiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1258\/jms.2010.010083","article-title":"Cancer mortality in the 50\u201369 year age group before and after screening","volume":"17","author":"Duffy","year":"2010","journal-title":"J. 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