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PubMed2006

Cost-effectiveness of screening with contrast enhanced magnetic resonance imaging vs X-ray mammography of women at a high familial risk of breast cancer.

Contrast enhanced magnetic resonance imaging (CE MRI) is the most sensitive tool for screening women who are at high familial risk of breast cancer. Our aim in this study was to assess the cost-effectiveness of X-ray mammography (XRM), CE MRI or both strategies combined. In total, 649 women were enrolled in the MARIBS study and screened with both CE MRI and mammography resulting in 1881 screens and 1-7 individual annual screening events. Women aged 35-49 years at high risk of breast cancer, either because they have a strong family history of breast cancer or are tested carriers of a BRCA1, BRCA2 or TP53 mutation or are at a 50% risk of having inherited such a mutation, were recruited from 22 centres and offered annual MRI and XRM for between 2 and 7 years. Information on the number and type of further investigations was collected and specifically calculated unit costs were used to calculate the incremental cost per cancer detected. The numbers of cancer detected was 13 for mammography, 27 for CE MRI and 33 for mammography and CE MRI combined. In the subgroup of BRCA1 (BRCA2) mutation carriers or of women having a first degree relative with a mutation in BRCA1 (BRCA2) corresponding numbers were 3 (6), 12 (7) and 12 (11), respectively. For all women, the incremental cost per cancer detected with CE MRI and mammography combined was pound28 284 compared to mammography. When only BRCA1 or the BRCA2 groups were considered, this cost would be reduced to pound11 731 (CE MRI vs mammography) and pound15 302 (CE MRI and mammography vs mammography). Results were most sensitive to the unit cost estimate for a CE MRI screening test. Contrast-enhanced MRI might be a cost-effective screening modality for women at high risk, particularly for the BRCA1 and BRCA2 subgroups. Further work is needed to assess the impact of screening on mortality and health-related quality of life.

Adult↗
PubMed2000

[Initial clinical experiences with digital full-field mammography].

OBJECTIVE: Digital full-field mammography has been used at the Department of Radiology of Charité Medical Center in Berlin since June 1999. This study compares the new digital technique with conventional mammography including a survey of its value in breast imaging and an outline of future prospects. MATERIAL AND METHODS: More than 1,000 of a total of over 5,000 mammographies performed between June 1999 and April 2000 have been obtained using the digital full-field mammography system Senographe 2000D (GE Medical Systems). The digital mammograms were compared with previous conventional films and conventional mammographies performed during the same period (Philips UC Diagnost, Senographe DMRplus). RESULTS: Digital mammographies were equal to conventional ones in all cases and seemed to be superior in detecting microcalcifications in dense glandular tissue. Adequate assessment was possible despite the lower spatial resolution compared to conventional mammography. Additional magnified images were obtained with both techniques for differentiating microcalcifications. CONCLUSIONS: Digital full-field mammography appears to be at least equal to the conventional technique and even superior in some respects. In our experience, the lower spatial resolution of digital mammography has no major disadvantages. The digital system provides new options for electronic storage of mammograms, telemammography, and computer-aided diagnosis.

Breast Neoplasms↗
PubMed2003

[Dose reduction through gridless technique in digital full-field mammography].

PURPOSE: To determine the role of the scatter grid in digital full-field mammography with respect to image quality and dose and to compare the experimental results with initial clinical experience. MATERIALS AND METHODS: A phantom consisting of 205 fields that enclose gold dots of different thickness and size (CD-Mam phantom, Medical Department, Nijmegen, Netherlands) was used for digital full-field mammography with the conventional grid module and a special gridless module. Four different breast thicknesses were simulated using Plexiglas as scatter material. First, the phantom was exposed at the parameter and dose settings automatically selected in each experimental setup (with and without grid). Subsequently, the phantom was exposed at the different simulated breast thicknesses using the gridless module in combination with the parameters automatically selected for the grid module. This was followed by a series of phantom mammograms obtained with the experimental setup reversed. The 16 mammograms were evaluated by 3 readers and the results compared considering breast thickness, radiation dose, and quality. The gridless module was used for preoperative labeling in 16 patients for comparison of mammograms obtained with and without a grid. RESULTS: For the same entrance dose used in routine mammography, digital mammography without grid is superior to digital mammography with grid when performed on simulated thin breasts (Plexiglas less than 3 cm), with no difference found when performed on simulated large breasts. The advantages of gridless mammography are more pronounced at a markedly reduced entrance dose (identical parenchymal dose without and with grid using the dose automatically selected for the gridless module). This tendency is confirmed by the initial clinical comparison. CONCLUSION: Gridless digital full-field mammography has the potential to reduce the dose further, in addition to already known mechanisms of dose reduction. However, the gridless system must be adjusted (markedly higher "switch-off dose" at the detector) to achieve an overall dose reduction since gridless mammography is inferior to grid mammography for identical doses at the detector plane.

Artifacts↗
PubMed2005

[Diagnostic mammography and sonography: concordance of the breast imaging reporting assessments and final clinical outcome].

PURPOSE: The purpose of the study was to assess the final clinical outcome of BI-RADS Categories for diagnostic mammography and sonography. MATERIAL AND METHODS: We analysed 632 mammography and sonography examinations from women with diagnostic indications (age: 23 - 100, mean 58) performed during 2001 and 2003. All patients received mammography and sonography examinations at different outside facilities and all patients received an additional sonography examination at the university radiology department and if necessary supplemental mammographic views. Final clinical outcome (Histology: 554; follow-up: 78) was ascertained in each case and concordance of BI-RADS-categories for mammography and sonography and final diagnosis were analysed. RESULTS: Final diagnosis yielded 230 benign lesions (36 %) and 402 cancers (64 %). Concordance of BI-RADS Assessment and final outcome was documented in 542 cases (86 %). There were 11 correct category 1 and 2 assessments (2 %). 142 lesions were classified with BI-RADS 3 (22 %) with 5 false negative ratings. There were 264 category 4 lesions (42 %) with a PPV for a malignant lesion of 71 % (187/264) and finally 215 BI-RADS 5 lesions with a PPV of 98 % (210/215). Overall sensitivity of mammography was 92 % with specificity of 75 % and for sonography 86 % and 76 %. Mammography had a significantly higher detection rate for malignant lesions than sonography. The highest correlation between BI-RADS category and final outcome was documented for the diagnostic combination of mammography and sonography with a kappa-value of 0.817 (p < 0.001), followed by mammography (kappa: 0.684) and sonography (kappa: 0.631). The overall correlation was 0.681 (p < 0.001). CONCLUSION: BI-RADS assessments of diagnostic mammography and sonography yields in a high cancer detection rate with a justifiable part of false positive ratings.

Adult↗
PubMed1994

[Controversial attitude to mammography screening in asymptomatic women between 40 and 50 years of age].

The results of screening studies conducted in the United States and in Europe in females between the ages of 40 and 50 are analysed. It is shown, that the results of this study on mortality reduction are less favourable, the poorer the technique of mammography (foregoing of general two-view mammography) and the longer the time interval between two mammography screenings. Arguments are presented, that are brought forward when declining to perform general mammography screening in this age group. The author's own results, obtained in the Hamburg mammography screening study, which included from 1971 to 1986 also premenopausal women, show, that the survival rates of patients below 50 years of age with mammographically detected carcinomas of the breast do not differ from those in patients older than 50 years, according to a relevant age group classification. The advances in the technique of mammography in recent years are analysed on the basis of the author's own patient material. It is evident, that the positive predictive value has been doubled, especially in the age group between 40 and 50. An analysis of the distribution of diagnosed noninvasive carcinomas compared with the invasive carcinomas reveals, that particularly this age group has the highest percentage of identification of prognostically favourable carcinoma stages. Further analyses show, why the randomised European mammography studies could not yield a significant mortality rate improvement. A prerequisite for the inclusion of mammography screening in the legally prescribed early detection of carcinoma examinations, however, are the quality controls, whose realisation, in our health system, will have to be confirmed by the German mammography study.

Adult↗
PubMed2002

Mutagenicity of low-filtered 30 kVp X-rays, mammography X-rays and conventional X-rays in cultured mammalian cells.

PURPOSE: To measure the mutagenic effectiveness of low-filtered 30 kVp X-rays, mammography X-rays and conventional (200 kVp) X-rays in mammalian cells. MATERIALS AND METHODS: Two different cell lines and mutation assays were used. Exponentially growing SV40-transformed human fibroblasts were exposed to graded doses of mammography (29 kVp, tungsten anode, 50 microm Rh filter) or conventional X-rays and the frequency of 6-thioguanine-resistent HPRT-deficient mutants was determined. Exponentially growing hamster A(L) cells, which contain a single human chromosome 11 conferring the expression of the human surface protein CD59, were subjected to magnetic cell separation (MACS) in order to remove spontaneous mutants before irradiation with low-filtered 30 kVp (tungsten anode, 0.5 mm Al filter) or conventional X-rays. Fractions of radiation-induced CD59- mutants were quantified by flow-cytometry after immunofluorescence labelling of CD59 proteins. RESULTS: Mammography X-rays were more effective than conventional X-rays at inducing killing of human fibroblasts, whereas 30 kVp X-rays and conventional X-rays were about equally effective at killing Al. cells. Mutant frequencies were linearly related to dose in both mutation assays. An RBE = 2.7 was calculated for the yield of HPRT mutants in human fibroblasts exposed to mammography relative to conventional X-rays and an RBE = 2.4 was obtained for the CD59 mutant frequency in A(L) cells irradiated with low-filtered 30 kVp relative to conventional X-rays. CONCLUSIONS: Both low-filtered 30 kVp and mammography X-rays are mutagenic in mammalian cells in vitro. It is unknown if and how the enhanced mutagenicity of mammography X-rays measured in human cells in vitro translates into breast cancer risk for predisposed women with an enhanced inherited risk for breast cancer. Although the ICRP guidelines attribute the same relative biological effectiveness to all radiations of low LET, including X- and gamma-radiations of all energies for radiobiological protection purposes including the assessment of risks in general terms, they also state that 'for the estimation of the likely consequences of an exposure of a known population, it will sometimes be better to use absorbed dose and specific data relating to the relative biological effectiveness of the radiations concerned and the probability coefficients relating to the exposed population' (ICRP 1991: 32). This latter statement may apply for the population of familial predisposed women. We hope that the presented data on the enhanced mutagenicity of mammography X-rays may stimulate a re-evaluation of the risk assessment of mammography for familial predisposed women. In the meantime, one should be cautious and avoid early and frequent mammography exposure of predisposed women. Alternative examination methods should be applied for these women with an inherited increased risk for breast cancer.

Animals↗
PubMed2000

Patterns of mammography use among Hispanic, American Indian, and non-Hispanic White women in New Mexico, 1994-1997.

For screening efforts to maximally reduce mortality in the general population, a large proportion of women need to utilize mammography routinely. To investigate utilization of mammography in a community setting, the authors used population-based data collected by the New Mexico Mammography Project for residents of the Albuquerque, New Mexico, metropolitan area for the period 1994-1997. The authors computed screening rates and the proportion of women who routinely use mammography. The utilization of mammography was low. Only 50% of the women aged 50-74 years were screened each year. Less than one third of women aged 40-49 years or 75 years and older were screened annually. The percentage of women who routinely used mammography on an annual or biennial basis was low in all age groups, especially among Hispanics and American Indians. Women aged 50-74 years had the highest percentage of routine annual mammography use, ranging from 30% in non-Hispanic Whites to 20% in Hispanics. Current utilization of mammography in community-based screening efforts is unlikely to achieve a potential 30% reduction in breast cancer mortality. Interventions are needed to increase the routine use of mammography.

Adult↗
PubMed1993

Mammography adherence and psychological distress among women at risk for breast cancer.

BACKGROUND: Previous studies estimate that first-degree relatives of women with breast cancer have a twofold to 10-fold increased risk of developing breast cancer. Recently, attention has focused on the mammography screening practices of women who are at high risk for breast cancer. PURPOSE: Our purpose was to characterize mammography screening practices in a sample of first-degree relatives of breast cancer patients and to identify variables that may serve as barriers to or facilitators of adherence to mammography. METHODS: Cross-sectional (rather than prospective) data were collected by telephone interviews with 140 women aged 35-79 years who had a family history of breast cancer in at least one first-degree relative (mother, sister, or daughter). Data were recorded on mammography screening patterns, depression, stress impact, and breast cancer worries. RESULTS: Women whose mammography history adhered to age-specific recommendations varied by age: 76% of first-degree relatives aged 35-39 years, 86% aged 40-49 years, and 63% aged 50 years or more. In bivariate analyses, level of education (P = .001), employment (P = .046), and time since diagnosis of the index patient (P = .044) were significantly and positively associated with mammography adherence. Variables associated negatively with adherence included age (P = .019), intrusive thoughts about breast cancer (P = .042), and breast cancer worries that interfered with daily functioning (P = .004). Multivariate analysis by logistic regression indicated that only breast cancer worries (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.09-5.9) and education (OR = 4.8; CI = 1.6-14.3) were significant independent predictors of mammography adherence. CONCLUSIONS: This study suggests that most women at high risk for breast cancer adhere to the recommended mammography screening guidelines of the National Cancer Institute. However, rates of adherence among high-risk women aged 50 years and older are suboptimal; only 63% of these women received annual screening mammograms, and 13% had never been screened. Breast cancer worries may pose a barrier to mammography adherence among high-risk women, particularly those with less formal education. IMPLICATIONS: Prospective longitudinal studies are needed to validate the present findings and to evaluate the impact of psychoeducational interventions for women with affected first-degree relatives.

Adult↗
PubMed2001

Magnetic resonance imaging and mammography in women with a hereditary risk of breast cancer.

BACKGROUND: Although breast cancer screening is recommended to start at a younger age for women with a hereditary risk of breast cancer, the sensitivity of mammography for these women is reduced. We compared magnetic resonance imaging (MRI) with mammography to determine which is more sensitive and whether MRI could play a role in the early detection of breast cancer for these women. METHODS: We constructed a retrospective cohort of all breast MRI and mammography surveillance reports made in our department from November 1994 to February 2001. All of the 179 women in the cohort had received biannual palpation in addition to annual imaging by MRI, mammography, or both. The 258 MRI images and the 262 mammograms were classified with the use of the BI-RADS (i.e., Breast Imaging Reporting and Data System) scoring system, which has five categories to indicate the level of suspicion of a lesion. Receiver operator characteristic curves were generated for MRI and mammography, and the area under each curve (AUC) was assessed for the entire cohort of 179 women and for a subset of 75 women who had received both an MRI and a mammographic examination within a 4-month period. All statistical tests were two-sided. RESULTS: In the cohort of 179 women, we detected 13 breast cancers. Seven cancers were not revealed by mammography, but all were detected by MRI. For the entire cohort, the AUC for mammography was 0.74 (95% confidence interval [CI] = 0.68 to 0.79), and the AUC for MRI was 0.99 (95% CI = 0.98 to 1.0). For the subset of women who had both examinations, the AUC for mammography was 0.70 (95% CI = 0.60 to 0.80), and the AUC for MRI was 0.98 (95% CI = 0.95 to 1.0). CONCLUSION: MRI was more accurate than mammography in annual breast cancer surveillance of women with a hereditary risk of breast cancer. Larger prospective studies to examine the role of MRI in screening programs are justified.

Adult↗
PubMed2002

Performance of diagnostic mammography for women with signs or symptoms of breast cancer.

BACKGROUND: The performance of diagnostic mammography for women with signs or symptoms of breast cancer has not been well studied. We evaluated whether age, breast density, self-reported breast lump, and previous mammography influence the performance of diagnostic mammography. METHODS: From January 1996 through March 1998, prospective diagnostic mammography data from women aged 25-89 years with no previous breast cancer were linked to cancer outcomes data in six mammography registries participating in the Breast Cancer Surveillance Consortium. We used the final mammographic assessment at the end of the imaging work-up to determine abnormal mammographic examination rate, positive predictive value (PPV), sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. We used age, breast density, prior mammogram, and self-reported breast lump jointly as predictors of performance. All statistical tests were two-sided. RESULTS: Of 41 427 diagnostic mammograms, 6279 (15.2%) were judged abnormal. The overall PPV was 21.8%, sensitivity was 85.8%, and specificity was 87.7%. Multivariate analysis showed that sensitivity and specificity generally declined as breast density increased (P =.007 and P<.001, respectively), that previous mammography decreased sensitivity (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.36 to 0.74; P<.001) but increased specificity (OR = 1.43, 95% CI = 1.31 to 1.57; P<.001), and that a self-reported breast lump increased sensitivity (OR = 1.64, 95% CI = 1.13 to 2.38; P =.013) but decreased specificity (OR = 0.54, 95% CI = 0.49 to 0.59; P<.001). ROC analysis showed that higher breast density and previous mammography were negatively related to accuracy (P<.001 for both). CONCLUSIONS: Diagnostic mammography in women with signs or symptoms of breast cancer shows higher sensitivity and lower specificity than screening mammography does. Higher breast density and previous mammographic examination appear to impair performance.

Adult↗
PubMed2005

Digital mammography using iodine-based contrast media: initial clinical experience with dynamic contrast medium enhancement.

PURPOSE: We sought to evaluate the potential of dynamic contrast enhancement after the intravenous administration of an iodine-based contrast medium in full-field digital mammography. MATERIAL AND METHODS: A protocol for image acquisition was established for contrast-enhanced mammography and the mammography unit (Senographe 2000D, GE Healthcare, Buc, France) changed as required. The effect of the protocol parameters on imaging was investigated. Subsequently, 21 patients with 25 suspicious lesions of the breast (10 benign, 1 borderline, and 14 malignant) underwent mammography with administration of an iodine-based contrast medium (Ultravist 370, Schering AG, Berlin, Germany), after approval of ethical committee as well as permission of German federal office for Radiation protection, and informed consent from each patient was obtained. Three sequential digital mammographic images of the respective breast were acquired after administration of the contrast medium at a dose of 1 mL/kg body weight and a flow of 4 mL/s. The postcontrast images were acquired 60, 120, and 180 seconds after administration. Subsequently, the precontrast image was logarithmically subtracted from the postcontrast images. Enhancement of the lesions was measured in absolute terms as well as relative to the enhancement of the glandular tissue. The subtracted images were evaluated for lesion depiction and dynamic contrast enhancement. Lesion-enhancement kinetics were compared with the histologic findings. RESULTS: All malignant lesions were identified on the contrast-enhanced images of digital mammography. Three of the tumors (2 malignant, 1 benign) were detected only by contrast-enhanced mammography and not by standard mammography. Dynamic enhancement curves of benign and malignant tumors in contrast-enhanced mammography look similar to the curves known from gadolinium-enhanced magnetic resonance imaging. Nevertheless differentiation between malignant and benign tumors based on the enhancement patterns cannot be directly taken over from magnetic resonance imaging, as suggested by our initial results. The results are somewhat better when tumor enhancement relative to surrounding glandular tissue is used instead of absolute enhancement. CONCLUSION: The results of this preliminary study suggest that contrast-enhanced digital mammography is a potentially useful tool for the detection and the differentiation of benign and malignant breast lesions.

Animals↗
PubMed2002

Health insurance and mammography: would a Medicare buy-in take us to universal screening?

OBJECTIVE: To determine whether health insurance expansions via a Medicare buy-in might plausibly increase mammography screening rates among women aged 50-64. DATA SOURCES: Two waves of the Health and Retirement Study (HRS) (1994, 1996). STUDY DESIGN: A longitudinal study with most explanatory variables measured at the second wave of HRS (1994); receipt of mammography, number of physician visits, and breast self exam (BSE) were measured at the third wave (1996). DATA EXTRACTION: Our sample included women aged 50-62 in 1994 who answered the second and third HRS interview (n = 4,583). PRINCIPAL FINDINGS: From 1994 to 1996, 72.7 percent of women received a mammogram. Being insured increased mammography in both unadjusted and adjusted analyses. A simulation of universal insurance coverage in this age group increased mammography rates only to 75-79 percent from the observed 72.7 percent. When we accounted for potential endogeneity of physician visits and BSE to mammography, physician visits remained a strong predictor of mammography but BSE did not. CONCLUSION: Even in the presence of universal coverage and very optimistic scenarios regarding the effect of insurance on mammography for newly insured women, mammography rates would only increase a small amount and gaps in screening would remain. Thus, a Medicare buy-in could be expected to have a small impact on mammography screening rates.

Breast Self-Examination↗
PubMed2005

The relation between projected breast cancer risk, perceived cancer risk, and mammography use. Results from the National Health Interview Survey.

BACKGROUND: Although the use of mammography on at regular intervals can save lives, not all women obtain the repeat mammography recommended in guidelines. OBJECTIVE: To assess the associations between routine mammography use, perceived cancer risk, and actual projected cancer risk. METHODS: We include women who were 45 to 75 years of age and who had responded to the 2000 National Health Interview Survey. Women who reported that they believed their risk of getting cancer in the future was "medium" or "high" were considered jointly as "medium/high-risk perception.""Routine mammography use" was defined as having > or =3 mammograms in the previous 6 years. We used logistic regression to determine the independent relation between cancer risk perception, projected breast cancer risk, and routine mammography use. RESULTS: Of the 6,002 women who met our inclusion criteria, 63.1% reported routine mammography use. About 76% of women in the highest quartile of projected breast cancer risk reported routine mammography use, compared with only 68%, 64%, and 51% in the third, second, and first quartiles, respectively (P<.001 chi-square test for trend). After adjusting for indicators of access to care, sociodemographic and behavioral factors, and perceived cancer risk, women in the highest quartiles of projected cancer risk were significantly more likely to report routine mammogram use than women in the lowest quartile (odds ratio [OR] of women in third and fourth quartiles were 1.57 [1.24 to 1.99], and 2.23 [1.73 to 2.87] vs the lowest quartile, respectively). Women with a higher perceived cancer risk were significantly more likely to undergo routine mammography (adjusted OR: 1.29 [1.12 to 1.48] P=.001). Cancer risk perceptions tended to be higher among women who were younger age, obese, smokers, depressed, or reported one of the following breast cancer risk factors: family breast cancer history, prior abnormal mammogram, and early age at menarche. CONCLUSION: Actual and perceived risk were independent predictors of routine mammography use, suggesting that efforts to incorporate risk profiles into clinical decision making may need to involve more than just relaying information about projected risks to patients, but also to explore how risk perceptions can be affected by this information.

Aged↗
PubMed1995

UKCCCR multicentre randomised controlled trial of one and two view mammography in breast cancer screening.

OBJECTIVE: To compare one view (oblique) and two view (oblique and craniocaudal) mammography in breast cancer screening. DESIGN: Randomised controlled trial. SETTING: Nine breast screening centres in England. SUBJECTS: 40,163 women aged 50-64 attending their first breast screening examination. INTERVENTIONS: Women were randomised to have one view mammography, two view mammography, or two view mammography in which one view was read by one reader and both views were read by another. MAIN OUTCOME MEASURES: Prevalence of cancer detected, recall rates, cost per cancer detected, and marginal cost per extra cancer detected. RESULTS: Two view mammography detected 24% more women with breast cancer (95% confidence interval 16% to 31%) than one view mammography. Prevalence of detected cancer was 6.84 with two view mammography and 5.52 per 1000 women with one view. The proportion of women recalled for assessment was 15% lower (95% confidence interval 6% to 23%) with two view (6.97%) than with one view (8.16%) mammography. The cost of two view screening was higher (26.46 pounds compared with 22.00 pounds per examination) but the average cost per cancer detected was similar (5330 pounds compared with 5310 pounds) and the marginal cost per extra cancer detected with two views was similar to the average cost (5400 pounds). CONCLUSION: Two view mammography is medically more effective than one view; it detects more cancers and reduces recall rates; it is also similarly cost effective financially.

Breast Neoplasms↗
PubMed2005

Screening mammography: costs and use of screening-related services.

PURPOSE: To determine the costs and screening-related services in women undergoing screening mammography. MATERIALS AND METHODS: Study procedures were approved by the institutional committee for the protection of human subjects, and participants gave prior written consent. Data from a statewide mammography registry were used to identify imaging examinations, clinical consultations, interventional procedures, and pathology reports associated with screening mammography. The analysis included 99 064 women in the New Hampshire Mammography Network who underwent screening mammography between November 1, 1996, and March 31, 2000. Use of screening-related services in each case was tracked over an 18-month period, and procedure-specific national Medicare reimbursement rates from 2002 were applied for estimation of costs. Descriptive statistics (means, medians, standard deviations, 95% confidence intervals, frequencies, and percentages of resources and of costs) were calculated. RESULTS: The majority of subjects (85 809, or 87%) underwent screening mammography only. Of the 13 255 (13%) who underwent diagnostic imaging, additional mammographic views were obtained in most at the time of screening, within days or weeks of screening, or at short-interval follow-up. The total cost was $12 287 739. Approximately 80% ($9 777 670) of the total cost was related to imaging, and 68% ($8 410 313), specifically to screening mammography. Twenty percent ($2 510 069) of the total cost was associated with consultation and interventional procedures in only 2942 (3%) of the women, primarily those who underwent biopsy. Procedures resulted in benign findings in 2247 (76%) of the 2942. Mean total direct medical costs per capita were low ($99) in women who underwent screening mammography only, moderate ($286) in women who also underwent diagnostic imaging, and substantially greater in women who underwent biopsy ($993). CONCLUSION: While the largest component cost of screening mammography is that incurred in obtaining screening views alone, the highest costs per capita are associated with interventional procedures.

Adult↗
PubMed1996

Effect of a legislative mandate on mammography use and coding practices in Maryland.

PURPOSE: To analyze the effect of the 1991 Maryland legislative mandate of screening mammography benefits. MATERIALS AND METHODS: Claims submitted between January 1991 and December 1993 for outpatient mammograms obtained in women covered under Blue Cross Blue Shield of Maryland insurance indemnity contracts were analyzed for the distribution of services and charges. RESULTS: For 184,723 women, 285,241 claims were submitted by 851 Maryland providers. Claims for "mammography bilateral," which were considered "diagnostic," represented 67%; 24% were submitted for "screening mammography bilateral," and 9% were submitted for "mammography unilateral." Mammography claims increased only 25% during the 3 years, despite an estimated fivefold increase in the number of women with the screening mammography benefit. Mammography coding shifted from bilateral to screening. CONCLUSION: The number of mammograms obtained increased only modestly after the mandate, but claims coded for mammography bilateral declined dramatically. Removal of financial barriers appears to be insufficient to increase appropriate use of screening mammography.

Adult↗
PubMed2001

Providing professional mammography services: financial analysis.

PURPOSE: To perform a financial analysis of mammography services to determine whether the key underlying economic drivers of this service are aligned with the public's expectations. MATERIALS AND METHODS: The financial status of mammography services at seven university-based programs was assessed by using an extensive financial survey encompassing revenue, direct and indirect costs, and volume data for 1997 and 1998. At one of the institutions, an activity-based costing analysis was performed by procedure type: screening mammography, diagnostic mammography, breast ultrasonography, interventional procedures, and review of outside mammograms. RESULTS: All seven institutions incurred losses in the professional component of mammography services. The underlying financial problem was a negative contribution margin (total mammography revenues minus direct expenses). The driver of the financial loss was the volume of diagnostic mammograms, which generated a loss per procedure. Diagnostic mammogram volume drove the mammography full-time equivalent count (P =.039) and was highly and negatively correlated with contribution margin (P <.001). CONCLUSION: The reimbursement rate for mammography procedures, especially diagnostic mammography, needs to be increased to reflect the current reality of the resources necessary to maintain the accessibility and accuracy of this evolving mix of clinical services.

Costs and Cost Analysis↗
PubMed2006

Accuracy of the combination of mammography and sonography in predicting tumor response in breast cancer patients after neoadjuvant chemotherapy.

BACKGROUND: Residual tumor size after neoadjuvant chemotherapy is an important consideration in surgical planning. We examined the accuracy of the combination of mammography and sonography in predicting pathologic residual tumor size. METHODS: Tumor size was evaluated by physical examination, mammography, and sonography at diagnosis and before surgery in 162 breast cancer patients who received neoadjuvant chemotherapy. Agreement between the predicted and the pathologic responses and the predicted and the pathologic tumor sizes was calculated. The effect of invasive lobular carcinoma, high nuclear grade, hormone receptor positivity, and the presence of an extensive intraductal component on the accuracy of mammography and sonography in predicting pathologic residual tumor size was analyzed. RESULTS: Forty-two patients (25.9%) had a pathologic complete response (pCR). Overall agreement between predicted and pathologic responses was 53% for physical examination, 67% for mammography plus sonography, and 63% for physical examination plus mammography and sonography. The sensitivity of mammography and sonography in predicting pCR was 78.6%, and the specificity was 92.5%; the accuracy was 88.9%. Residual tumor size determined by mammography and sonography correlated with pathologic residual tumor size (r = .662); pathologic tumor size was within .5 cm of predicted in 69.1% of patients. Multivariate analysis showed that pathologic residual tumor size was underestimated for lobular carcinoma and overestimated for poorly differentiated tumors. CONCLUSIONS: The combination of mammography and sonography has a high accuracy in predicting pCR after neoadjuvant chemotherapy. Agreement of residual tumor size in mammography and sonography with pathologic residual tumor size was moderate.

Adult↗