Mammography: a radiologist's view.
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Biomedical subjects
P Strax
Publications and source records attributed to P Strax.
Effects of news events on response to a breast cancer screening program.
An opportunity to examine the effects of significant, widely reported events on participation in a breast cancer screening program was presented when countrywide public attention was called to breast cancer by reports of the breast surgery of the wives of President and Vice President of United States. These events occurred in September and October 1974 while a breast cancer screening program was underway in the health Insurance Plan of Greater New York. The research design of this program permitted measurements to be made of the participation of the plan's members in the screening before, during, and after these famous mastectomies and of the participants' characteristics during different periods of the research program. In late 1974, when there was great mass media emphasis on breast cancer, participation rates in the breast cancer screening program increased significantly. In the study periods immediately following, however, participation rates declined to previous levels. The increase in Participation rates in late 1974 was fairly uniform among all demographic groups, whether classified by age, education, income, race, or religion. In addition to increases in the participation rate associated with the events of late 1974, there was also an increased tendency among women who were screened to respond readily to mailed invitations to appear for screenings. This increase insensitivity to efforts to win their participation was more pronounced among those groups that this study and other studies have shown are more likely to participate in preventive health programs and to respond more readily to request to participate.
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Breast imaging: past, present and future.
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Physical methods in breast cancer diagnosis.
Physical methods in differential diagnosis of breast cancer are important for early detection of the disease in order to prevent delay in treatment and unnecessary surgical procedures. This is particularly true of mammography, which is unique in being able to detect nonpalpable cancer. The importance of this fact lies in the results of the Health Insurance Plan of Greater New York study in which early detection has led to substantial long-term reduction in mortality. The commotion over risk of mammography has resulted in the exaggeration of a minute risk and the minimization of a great potential benefit. Other physical methods, such as thermography, ultrasonography and diaphanography, may be useful in making a diagnosis more definite and, occasionally, in reducing the number of so-called "interval" cancers discovered subsequent to screening or physical examination.
Adult↗
Reliability of measurements of total, protein-bound, and unbound estradiol in serum.
Estradiol (E2) circulates in the blood in three states: unbound (U-E2), bound to sex-hormone binding globulin (SHBG-E2), and bound to albumin. There is evidence to support the concept that only U-E2 and albumin-bound E2, are bioavailable (i.e., rapidly extracted by tissues). A case-control study nested within a large cohort of women, in which we are examining the effect of estrogens on breast cancer risk, offered the opportunity to assess the reliability of measurements of E2, the percentage of SHBG-E2, and the percentage of U-E2 based on multiple annual serum specimens. Long-term (1-2 year) reliability, as estimated by the intraclass correlation coefficient, was assessed in a subgroup of 71 premenopausal and 77 postmenopausal controls for whom two or three serum specimens were assayed. In postmenopausal women the intraclass correlation coefficient for a single measurement of total E2 was only 0.51. As for the percentage of SHBG-E2, intraclass correlation coefficients were 0.83 and 0.94, and for U-E2, 0.72 and 0.77 in the premenopausal and postmenopausal groups, respectively. These data suggest that, whereas single determinations of total E2 are insufficient to reliably estimate a woman's true mean level, a single measurement of the percentage of SHBG-E2 or U-E2 is adequate to assess bioavailability of E2 in an epidemiological study, irrespective of day of the menstrual cycle.
Adult↗