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PubMed1993

Characteristics of primary care office systems as predictors of mammography utilization.

OBJECTIVE: To evaluate the association between primary care office systems and mammography utilization by women older than 50 years. DESIGN: Cross-sectional. SETTING: An independent-practice association health maintenance organization (HMO) in Massachusetts. PARTICIPANTS: One hundred thirty-two primary care practices, representing 321 physicians and 4378 women with at least 12 months of recent, continuous assignment to a practice participating in the HMO. MEASUREMENTS: Practice characteristics and procedures for mammography referral and follow-up were ascertained by interviews of office managers. For each practice, the proportion of women older than 50 years who received a mammogram during their most recent 12-month period of assignment to the practice was calculated. MAIN RESULTS: Forty-five percent of eligible women received a mammogram during their most recent year of assignment to an HMO practice. In a regression model, use of one particular urban mammography center, group practice, and low percentage of Medicaid patients in the practice were each associated with 9% to 12% higher mammography utilization; use of flowsheets and the scheduling of mammograms by the patients themselves were associated with 7% to 9% higher utilization. Smaller, nonsignificant increases were associated with the use of reminders to patients (5%) and the presence of only internists on staff (5%). The model accounted for 51% of the variation in mammography utilization among practices. CONCLUSIONS: Mammography utilization among women older than 50 years, in a population in which cost was not a barrier, was related to specific office characteristics. Features of the mammography center, the process for scheduling mammograms, the use of flowsheets to prompt physicians, and the use of reminders to patients are important.

Aged↗
PubMed2001

Newspaper reporting of screening mammography.

BACKGROUND: Continuing controversy surrounds screening mammography, particularly for women 40 to 49 years of age. Newspapers are potentially important sources of information on this topic, but it is not known whether they provide well-founded and objective information and recommendations. OBJECTIVE: To examine how screening mammography is reported in newspapers. DESIGN: Cross-sectional descriptive study. SETTING: 6 top-circulation U.S. newspapers, 1990 to 1997. MEASUREMENTS: Number of articles about screening mammography, issues covered by the articles, information sources, content and sources of quotes, recommendations cited in articles, and presentation of risks and benefits. RESULTS: The most common theme of newspaper articles about mammography was screening for women 40 to 49 years of age. Thirty-one percent of the articles presented information without citing a source or justification. Quotes and recommendations in the articles were approximately twice as likely to support as to express reservations about mammography for women aged 40 to 49 years. Recommendations changed little over time and rarely reflected changes in recommendations of national organizations. Of the 102 articles describing the benefits of mammography, 95% expressed them in relative terms and 11% expressed them in absolute terms. CONCLUSIONS: Newspapers tended to overrepresent support for screening mammography for women aged 40 to 49 years. Reports would have been improved by identification of all sources for information cited, less reliance on relatively few sources, and discussion of benefits in absolute as well as relative terms. Medical journalism may benefit from identification of standards similar to those used for reporting medical research.

Adult↗
PubMed2002

Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis.

BACKGROUND: There is little consensus about recommending mammography for women 75 years of age and older. These women have mammography less frequently and are more likely to receive a diagnosis of advanced breast cancer. OBJECTIVE: To examine the relationship between use of screening mammography and size and stage of cancer at diagnosis in older women. DESIGN: Retrospective cohort study. SETTING: Tumor registries in the Surveillance, Epidemiology, and End Results (SEER) program. PATIENTS: 12 038 women who were Medicare beneficiaries, were at least 69 years of age, resided in a SEER area, and received a new diagnosis of breast cancer in 1995 through 1996. MEASUREMENTS: Screening mammograms obtained in the 2 years before breast cancer diagnosis (none, one, or at least two) and stage and size of tumor at diagnosis. RESULTS: Older women (> or =75 years of age) had larger tumors at diagnosis and were less likely to have undergone screening mammography than younger women (69 to 74 years of age). The association between increased mammography use and smaller tumor size and stage was significantly greater in older women than in younger women (P = 0.010 for stage; P = 0.001 for size). The percentage of regular mammography users who received a diagnosis of high-stage disease (28% vs. 26%; P > 0.2) and the mean size of the tumors (15.0 mm vs. 15.1 mm; P > 0.2) did not significantly differ between younger and older women, respectively. These findings remained constant after controlling for factors that might contribute to biases. CONCLUSION: Mammography in older women is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis.

Age Distribution↗
PubMed1999

Clinical experiences with direct magnification mammography with the DIMA Plus M11.

OBJECTIVE: The evaluation of mammographies carried out by conventional technique (standard imaging and focal imaging with 1.9x magnification) should be compared with a direct magnification image (standard imaging with 1.7x magnification, focal imaging with 4x magnification and preparation imaging with 7x magnification) provided by the mammographic device DIMA Plus M11 of the company feinfocus Medizintechnik. MATERIAL AND METHODS: Out of over 1,000 mammographies (DIMA technique) 50 histologically proved cases were selected for evaluation. Within a three months period these cases underwent conventional standard mammography as well as 1.9x magnification and DIMA-mammographies. The second X-ray was carried out when it was necessary for a pre-operative marking. RESULTS: When mammographies of mammaries, which were radiologically transparent and easily compressible, where taken by DIMA-technique, they showed a distinct advantage, especially in unclear micro-calcification cases, in comparison to the mammographies carried out by the conventional standard imaging. CONCLUSIONS: Direct magnification images carried out by DIMA Plus M11 provide a better breast cancer diagnostic. This refers in particular to focal images with 4x magnification and to digital mammography, which is yet being developed.

Breast Neoplasms↗
PubMed1993

Quality standards and certification requirements for mammography facilities--FDA. Interim rule with request for comments.

The Food and Drug Administration (FDA) is issuing regulations to implement the Mammography Quality Standards Act of 1992 (the MQSA), which requires the establishment of a Federal certification and inspection program for mammography facilities; regulations and standards for accrediting bodies for mammography facilities; and standards for mammography equipment, personnel, and practices, including quality assurance. This rule establishes requirements for certification of mammography facilities, including quality standards for mammography. This action is being taken to assure safe, accurate, and reliable mammography on a nationwide basis. The agency requests comments on the contents of this document.

Ambulatory Care Facilities↗
PubMed1994

High-quality mammography: information for referring providers.

This Quick Reference Guide for Clinicians contains highlights from Quality Determinants of Mammography, Clinical Practice Guideline No. 13 of interest to health care providers who refer women for mammography. The Quality Determinants of Mammography Guideline Panel, a private-sector panel of health care professionals and consumers, developed the Guideline after comprehensively analyzing the research literature and current scientific knowledge concerning elements necessary for high-quality mammography. Specific recommendations are made in the following areas: Components of complete breast cancer screening. Responsibilities of women, mammography facilities, and referring providers as to screening and followup care. Communication of results. Limitations of mammography. Certification of mammography facilities.

Adult↗
PubMed2000

Performance of screening mammography in organized programs in Canada in 1996. The Database Management Subcommittee to the National Committee for the Canadian Breast Cancer Screening Initiative.

BACKGROUND: The results of randomized trials show that breast cancer screening by mammography reduces breast cancer mortality by up to 40% in women aged 50-69 years. Because of these results, by 1998, 22 countries, including Canada, had established population-based organized screening programs. This paper presents the results of screening mammography in 1996 for 7 provincially organized breast cancer screening programs in Canada. METHODS: Analyses of interim performance indicators for screening mammography have been calculated from data submitted to the Canadian Breast Cancer Screening database. The data set consisted of data from 7 provincial programs and was limited to mammographic screens for women aged 50-69 years (n = 203,303). Screening outcomes and performance indicators were calculated for abnormalities detected by screening mammography only. RESULTS: The abnormal recall rate was 9.5% for first screens and 4.6% for subsequent screens, and the cancer detection rate per 1000 women screened was 6.9 for first screens and 3.8 for subsequent screens. The positive predictive value (i.e., the proportion of women who tested positive by mammography who were found to have breast cancer on screen-initiated diagnostic work-up) increased from 7.2% at the first screen to 8.2% at subsequent screens. Estimated participation rates within organized programs varied from 10.6% to 54.2%, depending on the province. INTERPRETATION: For 1996, organized breast cancer screening programs met or exceeded many of the interim measures used in international programs. It is possible to translate the benefits of breast cancer screening by mammography, as demonstrated in randomized trials, into population-based community programs. Screening mammography through organized programs should increase to allow more comprehensive monitoring in Canada.

Aged↗
PubMed2001

Implementation of current Louisiana mammography legislation: a time for review.

Breast cancer mortality rates in the state of Louisiana are higher than national averages despite a lower than average incidence rate. Given the importance of early diagnosis in determining breast cancer outcomes, one potential explanation for relatively high mortality rates is an under-utilization of effective techniques for early detection. Comparison of mammography rates in Medicare recipients indicates that Louisiana mammography rates are among the lowest in the nation. To better assess barriers to mammography utilization, all certified mammography sites in Louisiana were contacted by telephone by a surveyor posing as a family member attempting to schedule a mammogram for a 50-year-old woman. Of the 151 sites in Louisiana, successful scheduling of a mammogram by phone was accomplished nine times. The vast majority of sites (94%) did not schedule a mammogram. Furthermore, 75.9% of the sites contacted provided no assistance to the consumer seeking a mammogram. Current Louisiana law requires that mammography be ordered by a licensed health care provider. Though compliance with current law is high, this law may provide a barrier to interested consumers attempting to schedule mammography. A revision of current law and policy may be indicated in an effort to increase mammography utilization rates. Such an effort may potentially help to decrease mortality from the second leading cause of cancer death in women.

Appointments and Schedules↗
PubMedDate not supplied

Competing demands in the office visit: what influences mammography recommendations?

BACKGROUND: The multiple competing demands of the busy office visit have been shown to interfere with delivery of preventive services. In this study we used physician recommendations for screening mammography to examine the relative importance of physician, patient, and visit characteristics in determining on which patient visits this preventive service will be provided. METHODS: Physicians in the Ambulatory Sentinel Practice Network (ASPN) completed a questionnaire describing their knowledge, attitudes, and beliefs about screening mammography. They also described the content of a series of nonacute care visits with women aged 40 to 75 years with regard to making a recommendation when the patient was due for screening mammography. The data were linked, and univariate and multivariate logistic regression methods were used to examine the relative importance of physician, patient, and visit characteristics on making a recommendation for mammography. RESULTS: Ninety-three physicians reported making a recommendation for screening mammography on 53.1% of nonacute visits. When modeling physician, patient, and visit characteristics separately, 70% of the variability in the model is explained by physician characteristics only, 63% by patient characteristics only, and 73% by visit characteristics only. A combined model using all characteristics explained 85% of the variability. CONCLUSIONS: Although characteristics of physicians and patients can predict frequency of recommendations for mammography, the specific characteristics of the visit are equally important. Efforts to improve delivery of preventive services in primary care that emphasize physician education and performance feedback are unlikely to increase rates of mammography recommendation. Effective strategies must consider the multiple competing demands faced by patients and physicians during each office visit and seek ways for assisting them in setting rational priorities for services.

Attitude of Health Personnel↗
PubMed2001

African-American women's perceptions of mammography screening.

While mammography has been shown to decrease breast cancer mortality, many African-American women are not receiving annual screenings. African-American women's reasons for not having mammograms are not well understood. This study therefore surveyed 164 African-American women concerning barriers to mammography screening. Outreach coordinators in two urban and one rural site in Texas asked African-American women to complete a checklist about the barriers to mammography screening. The 23-item Mammography Barriers Checklist, which was developed based upon one of the author's clinical experience and the research literature, included both internal and external barriers to screening. Women in all three geographic areas identified fear of finding cancer and mammography cost as the most important reasons for not having mammograms. These results suggest that outreach strategies that address fears related to mammography screening and help women find low-cost mammography resources may be more effective than those focusing strictly on providing information.

Adult↗
PubMed2002

Screening mammography for Oklahoma Medicare beneficiaries: a national priority for quality improvement.

Breast cancer is one of the most common malignancies diagnosed in women in the United States. It is estimated that more than 2,700 new cases of female breast cancer will be diagnosed in Oklahoma this year. Using the Medicare mammography denominator file and Medicare claims data (October 1999 through September 2001), we assessed the utilization of mammography for this population. The overall biennial mammography rate for Oklahoma Medicare patients was 46.9% (95% CI 46.7-47.1) and was 54.7% (95% CI 54.3-55.2) for Medicare patients aged 50-67 years. There were significant racial disparities in utilization of mammography. In addition, there was substantial county-to-county variation in the utilization of mammography in Oklahoma. When compared to other states and territories, Oklahoma mammography rates for this population were in the lowest quartile nationally, ranking 47th in the nation. Increasing the use of mammography services for Medicare patients is a national priority for healthcare quality improvement.

Breast Neoplasms↗
PubMed2003

Mammography screening in the county of Fyn. November 1993-December 1999.

This report covers the outcome of the first three invitation rounds of the organised mammography screening programme in the county of Fyn. The programme started in November 1993, and the third invitation round ended on 31 December 1999. The screening takes place either at a special clinic located at University Hospital Odense or in a mobile unit. Women living in and around the city of Odense are examined at the clinic (about 55%), while the rest are examined in the mobile unit. Two-view mammography is used at the first screening. Women with dense breast tissue will continue to have two-view mammography (about 60%), whereas the rest will have singleview mammography at the subsequent screens. All screening images are exposed at the mammography-screening clinic and evaluated with double reading in the clinic. The programme targets women aged 50-69, except those undergoing treatment for breast cancer or going for regular check-ups following breast cancer. Based on the updated population register, the IT-Centre of the county of Fyn issues the invitations. Invited are all women aged 50-69 and living in the county of Fyn when their general practitioners' patients are invited. During the first 3 invitation rounds, 136,079 screening tests were made. Of these, 129,375 tests were made in the women aged 50-69 targeted by the programme. In addition, 6682 screening tests were made in women aged 70 and above, and 22 screening tests were made in women below the age of 50. As a consequence of the mammography screening 2657 assessments were made, 1145 women had surgery, 782 women were diagnosed with invasive breast cancer, and 109 women were diagnosed with ductal carcinoma in situ. A participation rate for the first invitation round was calculated immediately after the end of the round based on the number of participants divided by the number of women invited. This percentage was 88%. Invitation data are, however, not stored. It is therefore not possible now to calculate the participation rates in previous invitation rounds based on the same method. We have therefore chosen to calculate the participation rate as the coverage, i.e. the number of participants divided by the average number of women in the county of Fyn during a given invitation round. Calculated in this way, 84% participated in the first round, 84% in the second round, and 82% in the third round. It should be remembered that these figures do not take into account that some women are not invited because they 1) were undergoing current treatment for breast cancer or going for regular check-ups following breast cancer, or 2) did not participate in the previous round (and never actively informed the programme that they wanted an invitation to the next invitation round), relevant only for the second and third invitation round. For the second and third invitation rounds, the programme only invited women who participated in the previous invitation round, asked the clinic for an invitation, or entered the target population since the last invitation round. Therefore the participation rate in the second invitation round among actually invited women will be close to 94%, as 94% of those participating in the first round came for the second round. For the third invitation round, the participation rate among actually invited women will be close to 96%, as 96% of those participating in the first and second rounds came for the third round. One per cent of the participants in the first invitation round were diagnosed with invasive breast cancer or ductal carcinoma in situ. The detection rate was 0.5% in both the second and third invitation rounds. Ductal carcinoma in situ cases constituted 14% of the detected cases in the first and second rounds, and 10% in the third round. The percentage of invasive breast cancer 10 mm of less was 38%, 31%, and 32%, respectively, and 68%, 74%, and 73%, respectively, were node-negative. The screening programme of the county of Fyn fulfilled all the quality assessment parameters specified by the European guidelines on breast cancer screening, except two. The proportionate interval cancer rate was higher than specified in the guidelines, probably mainly due to the fact that the Fyn programme operates without early recalls. The proportion of stage II+ cancers was higher than specified in the guidelines, which seems, however, to be due to inconsistency between some of the performance indicators in the European guidelines. This analysis of the outcome from the first three invitation rounds of the mammography screening programme in the county of Fyn thus showed that it is a programme of high quality with a favourable profile of the prognostic indicators. The screening programme is hopefully well on its way to reducing breast cancer mortality in the county of Fyn.

Aged↗
PubMed1992

The role of mammography to evaluate palpable breast tumours.

Mammography is the best screening tool at present available to detect early breast cancer in asymptomatic women. Its diagnostic ability to clarify the true nature of a palpable tumour in symptomatic breast disease remains controversial. To investigate this, case records of 115 women over 35 years, who presented clinically with a palpable and solid breast tumour over a 5 1/2-year period at Universitas Hospital, Bloemfontein, were retrospectively reviewed. All women were pre-operatively evaluated by clinical examination, mammography and fine-needle aspiration cytology and all patients subsequently underwent open surgical biopsy. Results of this triple diagnostic regimen were correlated to the final histopathological diagnosis. No differences in diagnostic accuracy could be found between mammography and either clinical or cytological diagnosis alone. Combining the clinical finding with that of either mammography or cytology significantly improved the diagnostic ability of both. Malignant disease diagnosed by cytology alone negated the additional diagnostic role of mammography in this context. However, to enable confirmation of a benign tumour, mammography proved to be an essential addition to clinical and cytological evaluation. Mammography correctly detected multicentricity in 7% of malignant tumours, proving it to be essential before breast-conserving surgery could be carried out for malignant tumours.

Adult↗
PubMedDate not supplied

Controversies in mammography.

Concerns about screening mammography include questions of efficacy, high recall rates, false positives, and age at which to institute annual screening. Annual screening mammography can decrease breast cancer mortality by 45% in women over fifty and 23% in women between forty and fifty years of age. Patient recall rates and accuracy of interpretation vary among radiologists. Suggestions for improving accuracy of mammographic interpretation include continuing education with emphasis on quality of interpretation, computer-assisted detection, double reading, increased volume per reader, and performance-related skills testing. Having fewer radiologists reading more mammograms may result in decreased patient access to mammography services. Poor reimbursement for mammography and high prevalence of breast cancer-related litigation are disincentives for radiologists to provide mammography services; these issues must be addressed to ensure patient access to mammography. The public must be educated so that reasonable expectations on the benefits and limitations of mammography will develop.

Breast Neoplasms↗
PubMedDate not supplied

Women's attitudes toward screening mammography.

Although mammography has been proven an effective tool in screening asymptomatic women, it has been underused because of poor physician and patient compliance. At a university mammography clinic in Southern California, we administered questionnaires to 381 asymptomatic women to determine what women perceived to be incentives and deterrents to mammography. A factor analysis grouped the incentives into five factors, in decreasing significance: "doctor's recommendation," "personal experience," "media," "others' recommendation," and "breast symptoms." Similarly, we grouped the deterrents according to five factors, in decreasing significance: "cost," "fear of medical intervention," "unnecessary screening," "time demands," and "transportation difficulties." We compared the relative significance of these incentive and deterrent factors for demographics, aspects of the doctor-patient relationship, and individual characteristics. Younger, married women rated incentives, particularly "personal experience," higher and deterrents lower in general than older, unmarried women who had more concerns about "cost." However, all demographic groups rated "doctor's recommendation" as the highest incentive, and we found few differences among races or socioeconomic status for any factor. Women whose physicians had initiated the discussion of mammography viewed the doctor's recommendation as a greater incentive than women who had to initiate the discussion about mammography. Women under the care of gynecologists saw the doctor's recommendation as a greater incentive than women under any other specialists' care. Gynecologists initiated the discussion of mammography and recommended screening more often than other specialists. Women with the following individual characteristics identified more incentives to mammography: knew someone with breast or other cancer, estimated themselves to be at high risk for breast cancer, or had at least one previous mammogram.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Repeat mammography among women over 50 years of age.

Mammography decreases mortality among women 50 years of age and older. Although recent surveys show that mammography use has increased since 1983, it continues to be underused by women at risk for breast cancer. The frequency of repeat screening at recommended intervals remains an important unanswered question. This record audit study included all visits from 1986 to 1988 for active female patients, 51-64 years of age, in a family medicine practice. The practice has a disproportionately black patient population, many of whom are on public assistance, characteristics associated with lower compliance with cancer screening guidelines. I reviewed medical records for a physician's recommendation for mammography and also for a radiology report documenting receipt of the mammogram. I also abstracted from the medical record the reason for mammography, a history of breast cancer risk factors, and sociodemographic information. In addition, I noted documentation of a clinical breast examination (CBE) and CBE results. Records for 150 patients were included in the analysis. The results indicate that repeat screening mammography is not common: 3% had three mammograms during the study period; 19% had two; 33% had one; and 44% had none. Physician recommendation for first-time mammography and clinical examination occurred with low frequency. As others report, mammography use is strongly associated with physician recommendation for a mammogram.

Age Factors↗
PubMedDate not supplied

CR digital mammography: an affordable entry.

CR full-field digital mammography (FFDM) has been used extensively in other countries, and it was one of the 4 digital mammography technologies employed in the Digital Mammographic Imaging Screening Trial. Affordability and easy integration with pre-existing mammography systems makes CR FFDM an attractive way to secure the advantages of filmless mammography imaging. CR mammography is true digital mammography--it is merely a different way of acquiring the image. The FDA has recently approved the first CR FFDM system for sale in the United States. At Gundersen Lutheran Health System (La Crosse, Wisconsin), CR FFDM is the most practical technology for realizing the potential everyday clinical benefits of filmless mammography imaging.

Device Approval↗
PubMed1991

Patterns of utilization of mammography comparison by physician specialties in 6,000 consecutive mammograms.

Mammography is regarded as the most important screening test for breast cancer. The combination of physical examination of the breast by a physician and mammography can result in reduced breast cancer mortality. Evidence is mounting that mammography alone can produce similar results. Despite these facts, mammography is underutilized in the United States. In an attempt to define the utilization of mammography in the Ochsner Medical Institutions, New Orleans, Louisiana, the records of 6,000 consecutive patients who underwent mammography were reviewed with respect to the specialty of the physician ordering the test. The ratio of the number of mammograms ordered by each service to the number of eligible patients (women over age 50) visiting that service provided insight into the patterns of utilization of mammography in the Ochsner Clinic. This information will allow for efficient utilization of time and resources in planning continuing education programs geared toward mammographic screening.

Adult↗