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PubMed2002

Predicting patterns of mammography use: a geographic perspective on national needs for intervention research.

OBJECTIVE: To introduce a methodology for planning preventive health service research that takes into account geographic context. DATA SOURCES: National Health Interview Survey (NHIS) self-reports of mammography within the past two years, 1987, and 1993-94. Area Resource File (ARF), 1990. Database of mammography intervention research studies conducted from 1984 to 1994. DESIGN: Bayesian hierarchical modeling describes mammography as a function of county-level socioeconomic data and explicitly estimates the geographic variation unexplained by the county-level data. This model produces county use estimates (both NHIS-sampled and unsampled), which are aggregated for entire states. The locations of intervention research studies are examined in light of the statewide mammography utilization estimates. DATA EXTRACTION: Individual level NHIS data were merged with county-level data from the ARF. PRINCIPAL FINDINGS: State maps reveal the estimated distribution of mammography utilization and intervention research. Eighteen states with low mammography use reported no intervention research activity. County-level occupation and education were important predictors for younger women in 1993-94. In 1987, they were not predictive for any demographic group. CONCLUSIONS: Opportunities exist to improve the planning of future intervention research by considering geographic context. Modeling results suggest that the choice of predictors be tailored to both the population and the time period under study when planning interventions.

Black or African American↗
PubMed1995

The effects of message framing on mammography utilization.

This experiment compared the effectiveness of gain-versus loss-framed messages to persuade women to obtain mammography screening. One hundred and thirty-three women 40 years and older and not adhering to current guidelines for obtaining mammography screening were assigned randomly to view either gain-framed (emphasizing the benefits of obtaining mammography) or loss-framed (emphasizing the risks of not obtaining mammography) persuasive videos that were factually equivalent. Attitudes and beliefs were measured before and immediately following the intervention. Mammography utilization was assessed 6 and 12 months later. Consistent with predictions based on prospect theory, women who viewed the loss-framed message were more likely to have obtained a mammogram within 12 months of the intervention. These findings suggest that loss-framed messages may have an advantage in the promotion of detection behaviors such as mammography.

Adult↗
PubMed1998

Effect of radiotherapy on the interpretation of routine follow-up mammography after conservative breast surgery: a randomized study.

Radiotherapy after conservative surgery causes fat necrosis, fibrosis, skin thickening and other parenchymal distortion of the breast. The interpretation of a mammogram of the irradiated breast may therefore be difficult. We studied the effect of radiotherapy on the interpretation of the routine mammography used in the follow-up of breast cancer patients. A total of 144 low-risk breast cancer patients were randomized to radiotherapy or to no further treatment after conservative surgery. The first routine follow-up mammography was performed 18 months after surgery and every 18 months after that. The number of mammography examinations was estimated per patient and per follow-up year. The number of extra diagnostic tests and the occurrence of positive findings were assessed per mammography session and per follow-up year. Further diagnostic tests prompted by difficulties in interpreting the mammogram were performed to an extent of 0.19 per mammography examination in the radiotherapy group and of 0.15 in the non-radiotherapy group, i.e. 1.3 times more often. Findings that turned out to be negative at confirmation were 2.0 times (P< 0.05) more common in the radiotherapy group. These false-positive findings were more common in the radiotherapy group than in the surgery group and only shortly after treatment. Mammography is more difficult to interpret after radiotherapy than after conservative surgery alone, especially shortly after treatment, and more often involves extra diagnostic tests and findings that will be negative at confirmation.

Breast Neoplasms↗
PubMed2005

Comparison of 1- and 2-year screening intervals for women undergoing screening mammography.

We compared the long-term impact of 1- and 2-year screening mammography intervals using prognostic, screening, and outcome information for women aged 50-74 years obtained from the Screening Mammography Program of British Columbia in two time periods, prior to 1997 (policy of annual mammography) and after 1997 (biennial mammography). Survival was estimated for both periods using a prognostic model and the expected rate of interval and screen-detected cancers. The likelihood of a screen-detected cancer with annual screening was 2.32 per thousand screens and with biennial screening was 3.32 per thousand screens. The prognostic profile of screen-detected cancers was better than that of interval cancers. Among both screen-detected and interval cancers, the prognostic profiles with annual and biennial screening were similar. The estimated breast cancer-specific survival rates for women undergoing annual and biennial screening mammography were 95.2 and 94.6% at 5 years, and 90.4 and 89.2% at 10 years, respectively. Annual compared to biennial mammography was associated with a 1.2% increase in the estimated 10-year breast cancer-specific survival for women aged 50-74 years, diagnosed with invasive breast cancer after screening programme attendance.

Aged↗
PubMed1998

Intervention to increase mammography utilization in a public hospital.

OBJECTIVE: To study the effects of three approaches to increasing utilization of screening mammography in a public hospital setting in Northwest Louisiana. DESIGN: Randomized intervention study. POPULATION: Four hundred forty-five women aged 40 years and over, predominantly low-income and with low literacy skills, who had not had a mammogram in the preceding year. INTERVENTION: All interventions were chosen to motivate women to get a mammogram. Group 1 received a personal recommendation from one of the investigators. Group 2 received the recommendation plus an easy-to-read National Cancer Institute (NCI) brochure. Group 3 received the recommendation, the brochure, and a 12-minute interactive educational and motivational program, including a soap-opera-style video, developed in collaboration with women from the target population. MEASUREMENTS AND MAIN RESULTS: Mammography utilization was determined at 6 months and 2 years after intervention. A significant increase (p = .05) in mammography utilization was observed after the intervention designed in collaboration with patients (29%) as compared with recommendation alone (21%) or recommendation with brochure (18%) at 6 months. However, at 2 years the difference favoring the custom-made intervention was no longer significant. CONCLUSIONS: At 6 months there was at least a 30% increase in the mammography utilization rate in the group receiving the intervention designed in collaboration with patients as compared with those receiving the recommendation alone or recommendation with brochure. Giving patients an easy-to-read NCI brochure and a personal recommendation was no more effective than giving them a recommendation alone, suggesting that simply providing women in a public hospital with a low-literacy-level, culturally appropriate brochure is not sufficient to increase screening mammography rates. In a multivariate analysis, the only significant predictor of mammography use at 6 months was the custom-made intervention.

Adult↗
PubMed1999

A motivational message, external barriers, and mammography utilization.

Based on a theory of behavior, the interaction of a motivational message and external barriers on mammography utilization was tested. Participants (N = 101) had not had mammograms annually, and were identified from an urban clinic serving a disproportionally high percentage of indigent clients. Fifty-five percent were Caucasian; 45% were African-American. In an experimental design, half of the sample received a telephone discussion about rationale, feelings, and beliefs regarding mammograms, and half did not receive this contact. Four months later, nurses assessed women's recent mammography utilization and external barriers (e.g., affordability and accessibility). A logistic regression revealed an interaction between the intervention and barriers on postintervention mammography utilization (odds ratio: 2.12; p < 0.05). As proposed, the intervention was associated with a 64% rate of mammography utilization among women without barriers, but only a 26% rate among women with barriers. Not only should clinicians offer motivational messages about mammography, but also administrators should address external barriers to maximize mammography among socioeconomically disadvantaged groups.

Aged↗
PubMed2003

Comparison of mammography use by older black and white women.

OBJECTIVES: To identify differences in the prevalence of ever having had a mammogram and having had a recent mammogram between older black and white women and to compare factors associated with mammography use in older black and white women. DESIGN: Data analysis and comparative study using nationally representative multistage sampling survey. SETTING: Data were obtained from the 1998 National Health Interview Survey. PARTICIPANTS: Four hundred forty-nine black and 3,328 white older women were examined. MEASUREMENTS: The outcome variables included never having had a mammogram (yes/no) and not having had a mammogram in the past 3 years (yes/no). RESULTS: The results of chi-square tests showed that older blacks were less likely to have ever had a mammogram than older whites, but there was no difference in having had a recent mammogram between older blacks and whites. After adjusting for other related factors, race was not related to mammography use in older blacks and whites. Health insurance was related to mammography use in older whites but not in older blacks. Family income was associated with never having had a mammogram in older whites but not in older blacks. Older blacks with less than 12 years of education were less likely to have had a mammogram (recently or ever) than older whites with less than 12 years of education. CONCLUSIONS: Even though race, per se, was not associated with mammography use in older black and white women, many barriers to mammography use between older black and white women were different or did not have similar effects. To promote mammography use in older black and white women, barriers need to be specifically targeted for each group to enhance the effectiveness of breast cancer screening programs.

Black or African American↗
PubMed1999

Is mammography of value in women with disseminated cancer of unknown origin?

Mammography is often requested to try to identify occult primary breast carcinoma in women with metastatic cancer of unknown primary site. This study aimed to investigate whether mammography is of use in these patients in identifying the breast as the origin of the metastatic disease. Thirty-one women with a working diagnosis of metastatic cancer underwent mammography in an attempt to determine the primary site. None of these women had a palpable breast mass. The site of presentation, pathological type of tumour, site of origin, and benefit of mammography and mammography-provoked biopsy were clarified for each patient. The patients were also followed up to determine survival. The commonest sites of presentation were lung (45%), lymph nodes (19%) and abdomen (16%). The primary sites of these cancers were identified with confidence in 27 patients (87%). The commonest known primary tumour sites were lung (45%), breast (16%) and ovary (16%). Abnormal mammograms were detected in four patients (13%), but three of these did not have breast cancer. In one, the site of origin remained indeterminate, as either breast or lung. Five (16%) had a confident diagnosis of breast carcinoma; all of these women had normal mammograms. We conclude that mammography in women presenting with metastatic disease from an unknown primary site is unhelpful and is not recommended. Furthermore, we could not demonstrate its value in women presenting with axillary lymphadenopathy.

Adult↗
PubMed1999

Pre-operative MR-mammography in breast cancer patients.

AIMS: Pre-operatively, to exclude multiple invasive tumours not discovered by mammography and sonography in patients referred for breast conservation surgery. METHODS: A supplementary MR-mammography was offered to all patients with mammographic and/or sonographic ascertained tumours less than 2 cm in diameter. RESULTS: Forty patients were offered this additional examination. In accordance with the MR diagnosis, 51% of the planned surgical procedures were changed. Nine patients had more than one invasive tumour, and in four patients the tumour was >2cm in diameter. One patient had no tumour at all, and in four patients the MR-mammography suggested benign fibroadenomas, which resulted in small excisions. One patient with a suspect MR-mammography presented sclerosing adenosis at surgery. Three patients had to be excluded due to MR problems. Ten patients preferred mastectomy, although the MR-mammography had shown only a single invasive tumour. CONCLUSION: MR-mammography is recommended as a pre-surgical diagnostic procedure in patients allocated to breast conservation surgery.

Adult↗
PubMed1999

[Computer-assisted visualization of digital mammography images].

PURPOSE: In a clinical study, the feasibility of using a mammography workstation for the display and interpretation of digital mammography images was evaluated and the results were compared with the corresponding laser film hard copies. MATERIALS AND METHODS: Digital phosphorous plate radiographs of the entire breast were obtained in 30 patients using a direct magnification mammography system. The images were displayed for interpretation on the computer monitor of a dedicated mammography workstation and also presented as laser film hard copies on a film view box for comparison. The images were evaluated with respect to the image handling, the image quality and the visualization of relevant structures by 3 readers. RESULTS: Handling and contrast of the monitor displayed images were found to be superior compared with the film hard copies. Image noise was found in some cases but did not compromise the interpretation of the monitor images. The visualization of relevant structures was equal with both modalities. Altogether, image interpretation with the mammography workstation was considered to be easy, quick and confident. CONCLUSIONS: Computer-assisted visualization and interpretation of digital mammography images using a dedicated workstation can be performed with sufficiently high diagnostic accuracy.

Aged↗
PubMed1999

[Image quality and radiation exposure in digital mammography with storage phosphor screens in a magnification technic].

PURPOSE: Comparison of image quality between digital phosphor storage plate mammography in magnification technique and a conventional film screen system regarding the special aspect of radiation exposure. MATERIALS AND METHODS: Radiograms of a RMI-mammography phantom were acquired using a conventional film screen system and two digital storage plate systems. Additionally, the radiograms of one digital system were post-processed emphasizing contrast and included in the comparison. RESULTS: The detectability of details in storage plate mammographies with magnification technique is almost equal to that of film screen mammographies. Thereby, lower radiation exposures were necessary using the digital systems. CONCLUSIONS: Based on these results, storage plate mammography in magnification technique is used in clinical routine at our institution. The correct parameters in image postprocessing are of elementary importance for detail detectability. Future studies must show, whether the lower radiation exposure in digital radiograms of the breast, revealing much higher background noise, will allow the same detail detectability as film screen mammographies.

Female↗
PubMed2000

[The radial scar in contrast media-enhanced MR mammography].

INTRODUCTION: In patients with the mammographic findings of a radial scar, contrast enhanced (CE) MR mammography was evaluated in a retrospective study. MATERIAL AND METHODS: In 24 women with radial opacities and black star configurations, CE MR mammography was performed. Examinations were done on a 1.5 T system using bilateral superficial coil (2D technique, T1-weighted FLASH-sequence, TR 336 ms, TE 5 ms, FA 90 degrees). Findings in mammography and MR mammography were compared with the histological results. RESULTS: 15 radial scars (including 4 with additional ADH) and 9 carcinomas (6 in coexistence with a radial scar) presenting with a diameter of 3 mm to 13 mm were evaluated. There was no evidence of malignancy in MRI in 12 of 15 radial scars. In MR mammography 6 of the carcinomas fulfilled the criteria for malignant tumors. There were 3 borderline cases (scored 3 points) corresponding histologically to 1 radial scar, and to 2 carcinomas. Within the results found in MRI there were 2 false positives and 1 false negative. CONCLUSION: CE MR mammography is superior to other imaging modalities in the differentiation between radial scars and carcinomas. However, lesions suggestive of radial scars have to be removed surgically.

Adult↗
PubMed2001

[Improved diagnosis through digital mammography with the assistance of computer algorithms].

OBJECTIVE: The aim of this survey was to determine improved diagnostics through digital mammography with assistance of computer algorithms and new investigation techniques. MATERIAL AND METHODS: In general, the presented procedures are practicable with all digital mammography procedures. In our clinic the largest clinical experience exists with the only FDA certified full field mammography device Senograph 2000D (GE Medical Systems). RESULTS: First results from initial studies are shown, which are to evaluate the new procedures. The so-called post processing with visualization of microcalcifications, computer-assisted diagnosis, tomosynthesis, energy subtraction, contrast media in mammography and teleradiology are considered in particular. CONCLUSION: Digital mammography represents a promising procedure, opening new possibilities for improved diagnostic in mammography.

Algorithms↗
PubMed2004

[Phantom study for the detection of simulated lesions in five different digital and one conventional mammography system].

PURPOSE: Experimental phantom study for the detection of simulated lesions with five different digital and one conventional screen-film mammography system. MATERIALS AND METHODS: Three radiographs were obtained at various configurations of the phantom with one conventional screen-film system (Mammomat 3000 N) (Siemens), five digital systems (high resolution computed radiography system [Fuji/Siemens], one a-Si detector [GE Medical Systems], two a-Se detectors [Siemens; Hologic / Lorad] and one CCD detector [Fischer Imaging]), applying the same exposure parameters. The Wisconsin Mammographic Random Phantom, Model 152 A, was used. Five investigators with different experience in mammography (3 months to more than 4 years) evaluated the 18 randomly selected radiographs. RESULTS: No significant differences were found in the detection rate of simulated breast lesions for conventional screen-film mammography (84.9 %), high resolution computed radiography (86.7 %) and digital mammography with an a-Si detector (89.8 %). Highly significantly better results (p < 0.001) were found with the two a-Se systems (97.3 %) and the CCD system (100 %). CONCLUSION: Conventional screen-film mammography can be replaced by high resolution computed radiography and digital mammography with a-Si-, a-Se- and CCD-detectors. This has to be confirmed in further clinical studies.

Computer Simulation↗
PubMed1998

[Digital mammography: experiences in its clinical application].

TARGET: In 1989 in the Cantonal Hospital of Lucerne conventional film-screen mammography was replaced by digital mammography. With the support of a retrospective study, it was checked whether or not digital mammography represents an equally valid diagnostic procedure in daily routine. METHODS: 1204 patients were examined using digital mammography. A reevaluation of these patients was carried out using clinical and radiological routine controls. Additionally a radiological and histological examination was performed in 127 cases in which excisional biopsies had been done, paying particular attention to detail perception. RESULTS: The sensitivity of digital mammography achieved a total of 85%, whereas the accuracy was 81%. With additional use of ultrasound and galactography the sensitivity attained 91%. By reevaluation the sensitivity amounted to 87%, the accuracy remaining at 81%. The positive predictive value was especially high with 76% and 77%. CONCLUSION: Digital mammography offers satisfactory diagnostic performance.

Biopsy↗
PubMed1997

[Mammography and mammary ultrasonography: which examination sequence is preferable?].

PURPOSE: To compare primary mammography diagnosis (ultrasound report available) with primary ultrasound diagnosis (mammography report available). METHODS: 89 preoperative patients with suspicious lesions were included. Mammography and ultrasound of all patients were evaluated by two independent experienced readers under clinical conditions. The reports of the complementary modality were available to both observers. Lesion evaluation was done on a per breast basis, in cases of multiple lesions in respect of the lesion with the greatest risk of malignancy. RESULTS: 39 benign and 59 malignant lesions were found. Primary mammography and primary ultrasound yielded 3 and 8 false positives and 10 and 13 false negatives. Concerning the palpable lesions (n = 59), primary mammography and primary ultrasound had no and 4 false positives and 7 and 8 false negatives, respectively, for the non palpable lesions, the figures were 3 and 4 false positive and 3 and 5 false negatives. CONCLUSIONS: Mammography remains the method of first choice in early detection of breast cancer, whereas breast ultrasound should be performed after and in knowledge of the mammogram, in consideration of the known indications (equivocal palpable lesion and mammographic opacity, dense breast).

Adolescent↗
PubMed1997

Diagnostic accuracy of mammography and contrast-enhanced MR imaging in 238 histologically verified breast lesions.

PURPOSE: To determine the sensitivity and specificity of X-ray mammography and of MR imaging in 238 consecutively operated breasts, and to correlate the findings to histopathological diagnosis. MATERIAL AND METHODS: Over 15 months, 220 patients scheduled for breast surgery were examined consecutively, before surgery, by means of both mammography and MR imaging. Of the 220 patients, 18 underwent bilateral breast surgery. The entire breast was examined by means of T1-weighted transversal images using a 3D fast low-angle shot (FLASH) sequence. One pre- and 2 post-contrast scans were performed. Each breast was examined by means of mammography and 3 views were applied as routine. All palpable and mammographically suspect lesions were examined on additional images as microfocus magnification or spot compression. The two methods were evaluated independently of each other. RESULTS: In total, 145 malignant and 93 benign lesions were found at histopathological examination. The sensitivity of mammography was 89% and MR imaging 92%. The specificity was 72% in both methods. When the results of the 2 methods were combined, a sensitivity of 99% and a specificity of 55% was achieved. CONCLUSION: Mammography and MR imaging seemed to complement each other to produce a high sensitivity. Unfortunately it is impossible at present to supplement mammography with MR imaging in each patient as a routine owing to the current technical and financial limitations.

Breast↗
PubMedDate not supplied

The impact of age and race on mammography practices.

Mortality from breast cancer has recently begun to decline, primarily because of increased use of mammography screening. Although initial mammography utilization rates for women over 50 in the general population are high, compliance with regular, repeat mammograms is quite low. Both initial and repeat mammography utilization rates are much lower for older women and minority women. The study purpose was to identify age and racial differences in mammography beliefs of women for whom cost had been eliminated. Effects of age and race on perceived benefits and barriers to mammography were examined. Differences in reasons for not getting a mammogram were explored. Data were collected via self-report surveys from 817 noncompliant women at baseline and 1 to 2 months after an intervention to increase mammography compliance. An interaction effect on total barriers with race and age was demonstrated. Controlling for education and income, younger Caucasians and older African Americans had the highest total barriers scores. Racial and age differences on individual barrier and benefit items also were found. Results can be used to develop interventions targeted to address different barrier patterns for women of different age and racial groups.

Black or African American↗