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PubMed1980

Mammography of symptomatic breasts. A report on 1119 consecutive patients.

Two-picture mammography was performed as a routine diagnostic measure in the evaluation of 1119 consecutive patients (97.9% of which were women), who attended the hospital with breast symptoms 67.8% also had fine needle aspiration biopsy. The sensitivity of mammography in diagnosing the 97 carcinomas was 91.8%, the specificity was 95.6%. The false negative findings on mammography constituted 8.2% of the 97 carcinomas, aspiration biopsy was falsely negative in 25.7% of 70 carcinomas. Mammography was found to be valuable in distinguishing malignant from benign lesions with a high degree of accuracy, in localizing both palpable and occult lesions prior to aspiration or open biopsy, as well as in demonstrating the entire symptomatic breast and also the other breast for diagnosis. Of all the women 23.6% were under 30 years of age, but in this group only one carcinoma was found. It is suggested that mammography should not be performed in women with breast symptoms under 30, unless ther is suspicion of malignancy. Mammography of both breast should, on the other hand, be performed in all those over 30 years.

Adolescent↗
PubMed1995

Repeat mammography use among women ages 50-75.

It has been demonstrated clearly that the use of regular screening mammography reduces mortality among women ages 50 years and over. The primary objective of this study was to investigate factors associated with repeat mammography participation. A random sample of women ages 50-75 years residing in four Washington State counties was surveyed by telephone during mid-1989. The Health Belief Model was used as a conceptual framework for the analysis. Three groups of women with different mammography experiences in the previous 5 years were compared: (a) nonusers; (b) onetime users; and (c) repeat users. The survey response rate was 72%, and the study sample included 1357 women. One time users were more likely to have health insurance coverage, to visit a gynecologist or other primary care physician regularly, and to believe mammography is more effective than breast self-examination; they were less likely to think that at least 1 in 10 women are diagnosed with breast cancer or that mammography is inconvenient to obtain than were nonusers. Factors associated with repeat versus onetime use included routinely visiting a gynecologist, thinking the lifetime risk of breast cancer is at least 10%, and perceiving a high personal susceptibility to disease. Women who perceive themselves as being vulnerable to breast cancer are more likely to report repeat mammograms. Visiting a gynecologist regularly is associated with repeat as well as initial mammography use. These factors could be considered as the focus of promotional efforts moves from encouraging women to obtain their first mammogram to encouraging repeat use.

Aged↗
PubMed1995

Efficacy of screening mammography. A meta-analysis.

OBJECTIVE: To determine the efficacy of screening mammography by age, number of mammographic views per screen, screening interval, and duration of follow-up. DESIGN: Literature review and meta-analysis. DATA IDENTIFICATION AND ANALYSIS: Literature search of English-language studies reported from January 1966 to October 31, 1993, using MEDLINE, manual literature review, and consultation with experts. A total of 13 studies were selected, and their results were combined using meta-analytic techniques based on the assumption of fixed effects. MAIN RESULTS: The overall summary relative risk (RR) estimate for breast cancer mortality for women aged 50 to 74 years undergoing screening mammography compared with those who did not was 0.74 (95% confidence interval [CI], 0.66 to 0.83). The magnitude of the benefit in this age group was similar regardless of number of mammographic views per screen, screening interval, or duration of follow-up. In contrast, none of the summary RR estimates for women aged 40 to 49 years was significantly less than 1.0, irrespective of screening intervention or duration of follow-up. The overall summary RR estimate in women aged 40 to 49 years was 0.93 (95% CI, 0.76 to 1.13); the summary RR estimate for those studies that used two-view mammography was 0.87 (95% CI, 0.68 to 1.12) compared with 1.02 (95% CI, 0.73 to 1.44) for those studies that used one-view mammography, and for those studies with 7 to 9 years of follow-up, the summary RR estimate was 1.02 (95% CI, 0.82 to 1.27) compared with 0.83 (95% CI, 0.65 to 1.06) for those studies with 10 to 12 years of follow-up. CONCLUSION: Screening mammography significantly reduces breast cancer mortality in women aged 50 to 74 years after 7 to 9 years of follow-up, regardless of screening interval or number of mammographic views per screen. There is no reduction in breast cancer mortality in women aged 40 to 49 years after 7 to 9 years of follow-up. Screening mammography may be effective in reducing breast cancer mortality in women aged 40 to 49 years after 10 to 12 years of follow-up, but the same benefit could probably be achieved by beginning screening at menopause or 50 years of age.

Adult↗
PubMedDate not supplied

Specialty differences and the ordering of screening mammography by primary care physicians.

BACKGROUND: Careful attention to factors that affect women and their physicians is necessary to achieve the national goal that, by the year 2000, 60 percent of women should have had a screening mammogram in the previous 2 years. This report evaluates factors that differentiate primary care physicians who regularly order mammograms from those who do not. The study was conducted as part of a large demonstration project in Washington State and includes a survey of women served by the physicians. METHODS: We conducted a survey of primary care physicians and women in four counties to assess factors that influenced self-reported ordering of screening mammography. RESULTS: Among the 73 percent of family physicians, general practitioners, internists, and obstetrician-gynecologists who returned the questionnaire, there were more obstetrician-gynecologists (76 percent) who reported ordering screening mammograms in 90 percent or more of women aged 50 to 75 years, but they cared for only 15 percent of women in the sample. Women's survey results confirmed the physicians' reported differences and also revealed demographic characteristics that distinguished populations associated with particular primary care specialists. These specialists differed in their perceptions of their colleague's mammography practices, the adequacy of insurance coverage, and how often they had spent an unreasonable time explaining mammography results. In a multivariate model of factors expected to influence behavior, performance of clinical breast examination rather than specialty was the salient factor associated with ordering screening mammography. CONCLUSIONS: These results suggest that the context of practice, rather than specialty type or beliefs about mammography, has the major influence upon behavior. To achieve national screening mammography goals in the Northwest, we must influence the context of family physicians' preventive care practices because they care for 47 percent of women aged 50 years or older.

Aged↗
PubMedDate not supplied

Mammography update.

The collected data show that the typical registered mammographer is female, 39 years old, passed the ARRT mammography exam on her first attempt, was trained on the job, had less than five years of experience in mammography at the time she took the examination, performs more than 20 mammographic exams per week, has participated in a mammography-specific seminar within the past year, and works at an ACR-accredited mammography facility. This information is designed to draw a picture of the typical mammographer, not to establish any type of standard qualifications for personnel who perform mammography. If you have specific questions about mammography registrants that were not answered by this article, please write to the ARRT.

Accreditation↗
PubMed1993

Proactive screening mammography counseling within the Cancer Information Service: results from a randomized trial.

In 1987, the Division of Cancer Prevention and Control, National Cancer Institute (NCI), funded a randomized trial of a proactive counseling protocol to promote screening mammography among age-eligible female callers to the Cancer Information Service (CIS). This protocol included interactive counseling by CIS counselors to help callers overcome barriers to screening mammography; this counseling was an extension of usual service and was combined with a 2-week follow-up mailout to reinforce the brief (6-minute) proactive telephone-counseling protocol. The screening-mammography counseling intervention was tested in two regional CIS offices using a randomized two-group design. Callers were randomly assigned to the intervention or control group based on the week of their call to the CIS (n = 1831 eligible female callers). Self-reported adherence to NCI screening-mammography guidelines was assessed from telephone interviews conducted at 12 months' follow-up (87% response rate). Among all CIS callers enrolled in this study, self-reported adherence to screening-mammography guidelines at 12 months' follow-up was 63.5%. The most frequently cited barriers to screening mammography reported by CIS callers were inconvenience/being too busy (52%), cost (36%), lack of physician referral (34%), no symptoms (34%), and fear of radiation (29%). A significant intervention effect on adherence behavior was found but only in one of the two test sites and only among CIS callers reporting total family income of $30,000 or more (odds ratio = 1.38, P = .04). The vast majority (90%) of CIS callers (both intervention and control subjects) endorsed the concept of proactive counseling by the CIS. The implications of these findings for the CIS and future research are discussed.

Adult↗
PubMed1976

The addition of mammography to breast carcinoma screening in a general gynecology practice. One year's experience.

Obstetrician-gynecologists must be in the vanguard of the effort to reduce the death rate from breast carcinoma for it is they who regularly examine a large number of American women. Routine mammography was incorporated into a general gynecologic practice and was recommended for all women over 30. Of 750 women clinically examined, 524 had mammography, and there were 8 carcinomas detected in this group. Six of these were detected by mammography, 5 by mammography alone. Four of these 5 were in situ lesions. In 2 cases the clinical examination was suspicious and the mammography negative. Only 2 of the 8 patients with cancer fell into the commonly cited "high-risk" groups. Based on this experience, suggestions are made for incorporation of mammography into the routine gynecologic examination.

Adult↗
PubMed1995

Who uses screening mammography regularly?

We evaluated factors associated with the regular use of screening mammography among women presenting for screening. Six thousand two hundred forty-four women ages 55 and older who participated in the 1991-1992 Texas Breast Screening Project were classified as regular or irregular users of mammography according to self-reported mammographic history since 1986. Logistic regression was applied to determine odds ratios of specified factors. Fourteen % were regular users of mammographic screening. Being older, black or Hispanic, receiving regular care from a family doctor, believing in a lower prospect of cure of breast cancer, and lacking health insurance coverage were associated with less regular use of screening mammography. Higher educational level, family history of breast cancer, prior breast biopsy, annual income > or = +35,000, receiving regular care from a gynecologist, believing that life would be difficult with breast cancer, and believing in a greater personal risk for breast cancer were associated with a greater likelihood of regular use (P < 0.01). Among multiple factors associated with regular use of screening mammography, sociodemographic variables associated with regular mammography use are similar to those influencing initial use of screening mammography. Women who are difficult to persuade to obtain mammographic screening may be equally difficult to persuade to adhere to regular use.

Age Distribution↗
PubMedDate not supplied

Increased use of mammography among Hispanic women: baseline results from the NCI Cooperative Group on Cancer Prevention in Hispanic Communities.

BACKGROUND: The Healthy People 2000 report set the objective of increasing the percentage of women 40 or older who had ever received a mammogram and clinical breast examination to 80% by the year 2000. The report used a baseline of 36% for all American women and 20% for Hispanic women. The purpose of this study was to compare baseline estimates with data obtained in five Hispanic communities. METHODS: Common survey measures were administered in five studies participating in a National Cancer Institute Cooperative agreement. The surveys evaluated history of mammography in five Hispanic communities in the southwestern Unites States. RESULTS: Across the five communities, the rates of mammography use were significantly higher than the national baseline. Among women 40-49 years of age, 55% had completed mammography (95% confidence interval [CI] = 52%, 57%). Among women 50 years of age or older, 64% had received a mammogram (95% CI = 62%, 66%). Older women (above age 50) were significantly more likely to have completed the test than younger women (younger than age 50), and mammography was obtained less often among women who were uninsured and those who had lower levels of acculturation. CONCLUSIONS: We conclude that the rate of mammography use among Hispanic women has increased significantly over the last few years and that we are on track to reach the goal of 80% mammography compliance for Hispanic women 40 years and older by the year 2000.

Acculturation↗
PubMedDate not supplied

Evaluation of three methods for improving mammography rates in a managed care plan.

INTRODUCTION: Mammography has been shown to reduce breast cancer mortality among women 50 and older. Although mammography rates are increasing nationally, this effective screening tool remains underused. This study was conducted among 395 women who were members of a network model health maintenance organization (HMO) in Philadelphia in order to determine which of three methods was most effective in increasing mammography rates: (1) a birthday card reminder only (the standard method); (2) a personalized letter from the medical director and materials promoting mammography; and (3) a multicomponent phone call incorporating a reminder, counseling, and scheduling of appointments. An additional goal was to determine whether the interventions were more or less effective depending on a woman's readiness to get a mammogram, as measured by stage of change. METHODS: Eligible women were randomized into one of three treatment groups described earlier. Mammography rates were calculated on the basis of a claims review and follow-up phone interviews after a period of six months. RESULTS: Women who received the telephone intervention were most likely to obtain a mammogram (28%); followed by the group that received the birthday card only (15%), and those who received the mailed intervention (9%). CONCLUSIONS: These results indicate that a multicomponent phone intervention is significantly effective in promoting mammography in managed health care plan members. An analysis by women's stage of change found a difference in the effectiveness of the three interventions among contemplators only.

Aged↗
PubMed1997

Compliance with mammography screening in Israeli women: the impact of a pre-scheduled appointment and of the letter-style.

The objectives of this study were to determine the impact of different personal invitations on screening mammography attendance and to clarify the influence of personal characteristics and health-related attitudes and behaviors on compliance. One thousand and five hundred women, aged 50-74 years, were randomly selected in the city of Haifa. Four letters of invitation were used. Actual mammography performance was validated by a national computerized database. All other data was collected via a telephone interview following the mammography. The overall compliance rate amounted to 45%. The major predictors of compliance were having had a clinical breast examination within the previous year (p = 0.0008), having a health professional recommend routine mammography (p = 0.01) and perceiving mammography as efficient in early detection of breast cancer (p = 0.02). Aggressiveness of message details, or a family physician's or higher authority's signature on the letter had no impact on compliance. A letter of invitation for a routine mammogram at a specific time resulted in an overall rate of compliance 3-fold higher than the baseline. Based on the results of this study. Kupat Holim Clalit decided to implement use of personal invitations for screening mammography to israeli women on a regular basis.

Aged↗
PubMed1997

A virtual repository approach to clinical and utilization studies: application in mammography as alternative to a national database.

A national mammography database was proposed, based on a centralized architecture for collecting, monitoring, and auditing mammography data. We have developed an alternative architecture relying on Internet-based distributed queries to heterogeneous databases. This architecture creates a "virtual repository", or a federated database which is constructed dynamically, for each query and makes use of data available in legacy systems. It allows the construction of custom-tailored databases at individual sites that can serve the dual purposes of providing data (a) to researchers through a common mammography repository and (b) to clinicians and administrators at participating institutions. We implemented this architecture in a prototype system at the Brigham and Women's Hospital to show its feasibility. Common queries are translated dynamically into database-specific queries, and the results are aggregated for immediate display or download by the user. Data reside in two different databases and consist of structured mammography reports, coded per BIRADS Standardized Mammography Lexicon, as well as pathology results. We prospectively collected data on 213 patients, and showed that our system can perform distributed queries effectively. We also implemented graphical exploratory analysis tools to allow visualization of results. Our findings indicate that the architecture is not only feasible, but also flexible and scaleable, constituting a good alternative to a national mammography database.

Computer Communication Networks↗
PubMedDate not supplied

Beliefs and mammography screening.

INTRODUCTION: Breast cancer is a leading form of preventable cancer among women in the United States. Despite improvements in mammography and other early detection techniques, special populations, including older and minority women, continue to experience high incidence and mortality rates. Knowledge, attitudes, and beliefs are ubiquitous constructs in preventive medicine, health behavior, and behavioral epidemiology. These constructs often are used to explain variation in health screening behavior. While all three have been examined in relation to mammography screening, concentration on the single category of beliefs and the relation between specific beliefs and mammography screening practices has remained largely uninvestigated. METHODS: Using logistic regression modeling, we examined the relationship between four individual beliefs and mammography screening in a cross-sectional study of 407 women. RESULTS: After we controlled for confounding factors in a multivariable analysis, belief in the efficacy of early detection in improving breast cancer outcome (odds ratio [OR] = 2.98; 95% confidence intervals [CI] = 1.62, 5.47) and perceived risk (OR = 0.49; 95% CI = 0.26, 0.94) were significantly associated with screening practice. Belief that mammography is dangerous (OR = 0.46; 95% CI = 0.18, 1.18) or painful (OR = 1.25; 95% CI = 0.75, 2.08) was not significantly associated with screening practice. CONCLUSIONS: Information on the relationship between beliefs and screening practices may be used both to understand screening behaviors and to develop targeted strategies to improve mammography compliance.

Adult↗
PubMed1998

Factors associated with women's adherence to mammography screening guidelines.

OBJECTIVE: To examine individual and environmental factors associated with adherence to mammography screening guidelines. DATA SOURCES: A unique data set that combines a national probability sample (1992 National Health Interview Survey); a national probability sample of mammography facility characteristics (1992 National Survey of Mammography Facilities); county-level data on 1990 HMO market share; and county-level data on the supply of primary care providers (1991 Area Resource File). STUDY DESIGN: The design was cross-sectional. DATA EXTRACTION/ANALYSIS: Data sets were linked to create an individual-level sample of women ages 50-74 (weighted n = 2,026). We used multipart, sequential logistic regression models to examine the predictors of having ever had mammography, having had recent mammography, and adherence to guidelines. We categorized women as adherent if they reported a lifetime number of exams appropriate for their age (based on screening every two years) and they reported having had an exam in the past two years. PRINCIPAL FINDINGS: Only 27 percent of women had the age-appropriate number of screening exams (range 16 percent-37 percent), while 59 percent of women had been screened within two years. Women were significantly more likely to adhere to screening guidelines if they reported participating with their doctor in the decision to be screened; were younger; had smaller families, higher education and income, and a recent Pap smear; reported breast problems; and lived in an area with a higher percentage of mammography facilities with reminder systems, no shortage of primary care providers, higher HMO market share, and higher screening charges. CONCLUSIONS: A small percentage of women adhere to screening guidelines, suggesting that adherence needs to become a focus of clinical, programmatic, and policy efforts.

Aged↗
PubMed1998

[Is mammography useful in the detection of breast cancer in women 35 years of age or younger?].

Breast cancer in women 35 years old or younger is unusual. It accounts for 1-3.6% of all breast cancers but is the leading cause of cancer mortality in women 15-35 years old. The diagnostic delay, with T2 or more advanced cancer at clinical presentation, is due to the patient's age and the opinion of low mammographic reliability for cancer diagnosis in this age group. To assess the usefulness of mammography in breast cancer patients aged 35 years or younger, we reviewed the clinical, mammographic and histologic data of 65 cancers collected in 7 breast diagnosis and counseling centers in Lombardy. Fifty-three patients (81.5%) were referred for a palpable breast mass, which was a T2 or more advanced cancer in 23 cases. Mammography showed malignant patterns (spiculated opacities, clusters of microcalcifications, casting, branching and ductal type calcifications) in 31 patients (47.7%). Mammography was not definitive but correctly suggested further examinations in 30 women and it had only 4 false negatives. Ultrasonography performed in 43 patients was negative in 3 (7%), pathologic and pathognomonic for cancer in 27 (62.8%) and pathologic but not indicative of malignancy in 13 (20.2%). The cytologic or histologic diagnosis of breast cancer was made under US guidance in 24 cases. In women aged 35 years or younger mammography was effective in identifying breast cancers; US and fine-needle aspiration biopsy (FNAB) complete mammography. We believe that mammography can be a valuable screening tool in young women at high risk for breast cancer because of family history.

Adult↗
PubMed1995

A Comparison of Mass Screening for Breast Cancer Using Mammography and Physical Examination Alone in Japan.

To compare the sensivity of breast cancer screening methods by conventional physical examination and film mammography, a trial of mass screening for breast cancer using mammography was principally carried out in asymptomatic women over 50 years of age in Tokushima Prefecture. In this trial craniocaudal and mediolateral oblique imagings of the breast using two-view film mammography and physical examination, using inspection and palpation of the breasts were performed independently. Breast cancer was detected in 8 of a total of 950 examinees by mammography alone, and no cases of breast cancer were detected by physical examination. The detection rate of breast cancer was 0.84%, that is 7 times higher than that(0.12%) obtained by conventional mass screening using physical examination alone. The detection rate of increased especially in the sixth and seventh decades of life. The stage of the detected breast cancer was stage 0 (Tis) in 5 cases and stage T, with a tumor size of 1.0 cm or less, in 3 cases. All 8 cases were in the early stage, and they underwent breast conservation therapy. Based on these results, it is recommended to employ mammography in breast cancer screening for asymptomatic women aged over 50 years. We consider mammography alone may be sufficient for mass screening for breast cancer in these subjects.

Journal Article↗
PubMed2000

Digital and Computer-Aided Mammography.

Digital mammography uses an electronic system to record an image of the breast that can be stored on a computer instead of on hardcopy films. There are a number of digital mammography technologies under evaluation. The potential advantages of digital mammography include improvements in image contrast, manipulation of the image after it is performed (avoiding repeats for technical problems), elimination of lost films, reduction in film library maintenance costs, and the ability to transmit the images over long distances (telemammography). Challenges and potential problems for digital mammography include a need to prove equivalence in detection and diagnosis with conventional mammography, the high cost of digital mammography equipment, and lagging workstation technology. Computer-aided detection and diagnosis (CAD) uses analysis by a computer program to assist the interpreting physician in identifying abnormal findings on mammograms and in making a benign versus malignant diagnosis of calcifications and masses. Several studies suggest that this technology can reduce the incidence of missed cancers and improve the positive predictive value for biopsies. CAD can be performed after digitization of hardcopy films but is best suited to digitally acquired soft copy images.

Journal Article↗
PubMed2001

Differential diagnosis of solid breast lesions: contribution of Doppler studies to mammography and gray scale imaging.

OBJECTIVE: To assess the role of Doppler sonography when used in conjunction with mammography and gray scale sonography in differentiating solid breast lesions and to find out whether lesion size is a limiting factor for Doppler evaluation. METHODS: One hundred twelve lesions (70 malignant and 42 benign) detected with mammography and sonography were prospectively examined with color, power, and pulsed Doppler sonography. Vascularity was analyzed morphologically (vessel location, form, and color tone) and semiquantitatively (by spectral indices) to determine the valuable diagnostic flow characteristics. The lesions were classified by 2 observers as benign or malignant on the basis of each diagnostic technique (namely, a combination of mammography and gray scale sonography, presence or absence of blood flow, morphologic flow analysis, and spectral flow analysis). The results were compared with the histologic diagnosis in 105 lesions and with the clinical and radiologic diagnosis after at least 2 years of follow-up in 7 lesions. RESULTS: The sensitivity and specificity of the mammography-gray scale sonography combination were 98.6% and 76.2%, respectively. Neither morphologic nor spectral Doppler analysis proved to be successful on its own, however, information obtained from investigated morphologic and spectral flow features increased the specificity of mammography and gray scale sonography for lesions 10 mm and smaller (from 88.9% to 100%) and those larger than 10 mm (from 70% to 96.6%). CONCLUSIONS: Our data show that Doppler sonography is a beneficial adjunct to mammography and gray scale sonography for solid breast lesions 10 mm and smaller and those larger than 10 mm.

Age Factors↗