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PubMed1996

Maximizing the referral of older women for screening mammography.

The primary care physician is in a crucial position to facilitate mammography referral of women older than 50 years. Physician underestimation of the importance of the physician role or overestimation of patient resistance can result in lost opportunities for referral. Research is summarized on the impact of physician encouragement on use of mammography and on sources of reluctance to get mammography as reported by patients. Common patients' concerns are discussed. Mammography referral can usually be accomplished successfully by raising the issue and briefly addressing patients' concerns in regard to breast cancer and screening mammography.

Breast Neoplasms↗
PubMedDate not supplied

Predictors of screening mammography: implications for office practice.

BACKGROUND: The completion of annual screening mammography and other preventive health services among women aged 50 years and older remains an important quality of care indicator. METHODS: A biracial sample of 843 rural women (aged > or =50 years) from a population-based sample reported demographic and preventive health services utilization in the last year including the completion of screening mammography. Bivariate analysis and logistic regression were used to investigate the extent to which completion of other screening examinations, including Papanicolaou (Pap) smears and clinical breast examination, is associated with successful completion of mammography relative to demographic and health service variables. RESULTS: The completion of mammography was associated with age, race, education, health insurance, and the presence of a regular primary care physician, but the strongest predictors were the completion of a clinical breast examination and/or a Pap smear. CONCLUSIONS: Women who receive a clinical breast examination and/or a Pap smear appear far more likely to receive screening mammography, suggesting a synergy in screening services. The relative efficacy of interventions to increase the completion of clinical breast examinations as well as other age-appropriate preventive services during routine office visits or during a single preventive services office visit should be further explored in primary care settings. Residency programs should provide training on the successful incorporation of such services into office practice patterns in an effort to continually improve quality of care.

Aged↗
PubMed2006

Targeting screening mammography according to life expectancy among women undergoing dialysis.

BACKGROUND: Screening guidelines recommend that mammography be targeted to women likely to live longer than 5 years. Because women undergoing dialysis have a reduced but variable life expectancy, their appropriate use of screening is controversial. Therefore, we conducted this study to describe national mammography rates among women undergoing dialysis with differing prognostic factors and to determine whether screening is targeted to healthier women who live longer. METHODS: Using the US Renal Data System, we identified 17,090 women aged 50 years or older who started dialysis in 1997. We tracked women for 5 years to ascertain their use of screening mammography or death. RESULTS: The 5-year survival rate was 25%. The biennial screening mammography rate was 25%, ranging from 12% for women aged 80 years or older to 69% for women who were ever on the transplant list. Women who were screened in the past year had a lower death rate than those who were not (hazards ratio, 0.55; 95% confidence interval, 0.51-0.59). Yet, 2198 women (13%) who died within 5 years underwent screening, and 2004 women (12%) who lived more than 5 years while receiving dialysis did not undergo screening. CONCLUSIONS: Screening mammography rates are appropriately low among women undergoing dialysis because the 5-year survival rate is low. Screening is being targeted to women who are healthier and live longer. However, targeting could be improved by increasing screening in the few women undergoing dialysis with substantial life expectancies while decreasing screening in most women undergoing dialysis who live less than 5 years.

Aged↗
PubMed1990

Lightscanning versus mammography for the detection of breast cancer in screening and clinical practice. A Swedish multicenter study.

State of the art lightscanning of the breast was tested against mammography in 2568 women in a Swedish multicenter study. The study was in two parts. One was in women with symptoms from the breasts (the clinical study) comprising 3178 examined breasts with 198 cancers; the other in asymptomatic women (the screening study) comprising 1909 examined breasts with 126 cancers. In women with symptoms from the breasts, lightscanning did not contribute to clinical examination and mammography. In the screening situation, it was poor to pick up small cancers. Mammography alone falsely diagnosed cancer in 6.9% of the patients whereas lightscan falsely diagnosed cancer in 19.1%. Lightscan was not better than mammography in young women. The study shows that lightscanning in its current form is inferior to standard mammography.

Adult↗
PubMed1995

The impact of mammography in 1096 consecutive patients with breast cancer, 1979-1993: equal value for patients younger and older than age 50 years.

BACKGROUND: Although the benefit of screening mammography in healthy women younger than age 50 remains controversial, few studies have addressed the impact of mammography over time and by patient age, on means of diagnosis and stage of disease among women with breast cancer. METHODS: One thousand ninety-six consecutive patients with operable breast cancer (both invasive and noninvasive intraductal) treated in this practice between 1979 and 1993 were stratified by primary means of diagnosis (patient, physician, or mammography), age < 50 years, 50 years and older), and time period (1979-83, 1984-88, and 1989-93). Tumor size, lymph node status, and tumor type were compared among these groups. RESULTS: (1) Mammography was the primary means of diagnosis in 28.8% of younger and 42.4% of older patients treated most recently (1989-1993), significantly more often than in the past (P < 0.0005). (2) For cancers diagnosed primarily by either patients or physicians, there was not significant change over time (for either younger or older patients) in clinical presentation, tumor size, lymph node status, or histology. (3) For cancers diagnosed primarily by mammogram, i) 95% of patient self-exams and 56% of physician exams were negative, ii) tumor size was significantly smaller (P < 0.00005), iii) lymph nodes more often were negative (P = 0.0002), and d) histology was more likely to be either in-situ or microinvasive (P < 0.00005). These findings were equally true for younger and older patients. CONCLUSION: Increased use of mammography, rather than improvement in patient or physician breast examination, explains the progressively earlier stage of breast cancers found in recent years, a benefit equally apparent in patients younger and older than age 50.

Age Factors↗
PubMed2002

Interventions for relieving the pain and discomfort of screening mammography.

BACKGROUND: Pain of mammography is recognised as a significant deterrent to breast screening and therefore may effect the success or failure of any screening programme. OBJECTIVES: To review research of interventions related to any aspect of breast screening to reduce or relieve the pain and discomfort of screening mammography. SEARCH STRATEGY: The Cochrane Breast Cancer Group conducted a search of their specialised register in the Cochrane Library. In addition a wide variety of databases and websites were searched using keywords 'mammography' and 'pain', along with handsearching selected journals. Information was requested from a wide range of interested people and organisations. SELECTION CRITERIA: Randomised controlled trials and non-randomised trials with a comparison group were considered. Studies had to include assessment of both pain and quality of mammograms. DATA COLLECTION AND ANALYSIS: Identified studies were independently reviewed by two reviewers to determine if they met the inclusion criteria. Additional information was sought from investigators as necessary. Each study was reviewed for quality, including concealment of the allocation sequence, generation of the allocation sequence, comparability between groups at the baseline, inclusion of all randomised participants in the analysis and blinding after allocation. MAIN RESULTS: Three RCTs were identified for inclusion. A well designed study found that patient controlled breast compression gave a significant reduction in discomfort. However, the quality of mammograms was only maintained if the technologist controlled the first compression. Another study involved the technologist reducing compression force for one view. This study was poorly designed and showed no significant differences. The result was the same in a well designed study of the use of acetoaminophen as a premedication. The differences in interventions, and the inconsistency in measures and validation of pain scales and assessment of quality of mammograms, mean that the results of the studies cannot be combined. REVIEWER'S CONCLUSIONS: The only intervention suggesting significant reduction in the pain and discomfort was of patient controlled compression. Further research is required to determine if these findings can be replicated. Reducing technologist applied compression force did not result in significant reduction in pain suggesting that more than actual compression force is involved in pain and discomfort. However, the poor design of this study could have influenced the results. Premedication with acetoaminophen has no effect on the pain of mammography. More research into interventions to reduce the pain of mammography is needed if this is to continue as the preferred screening method in the detection of breast cancer.

Acetaminophen↗
PubMed2003

Mammography screening among Chinese-American women.

BACKGROUND: Breast carcinoma is the most common major malignancy among several Asian-American populations. This study surveyed mammography screening knowledge and practices among Chinese-American women. METHODS: In 1999, the authors conducted a cross-sectional, community-based survey in Seattle, Washington. Bilingual and bicultural interviewers administered surveys in Mandarin, Cantonese, or English at participants' homes. RESULTS: The survey cooperation rate (responses among reachable and eligible households) was 72% with 350 eligible women (age >or= 40 years with no prior history of breast carcinoma or double mastectomy). Seventy-four percent of women reported prior mammography screening, and 61% of women reported screening in the last 2 years. In multivariate analysis, a strong association was found between mammography screening and recommendations by physicians and nurses (prior screening: odds ratio [OR], 16.0; 95% confidence interval [95% CI], 7.8-35.0; recent screening: OR, 7.0; 95% CI, 3.8-13.6). This finding applied to both recent immigrants (< 15 years in the U.S.) and earlier immigrants (>or= 15 years in the U.S.). Thirty-two percent of women reported that the best way to detect breast carcinoma was a modality other than mammogram. CONCLUSIONS: The authors recommend a multifaceted approach to increase mammography screening by Chinese-American women: recommendations from the provider plus targeted education to address the effectiveness of screening mammography compared with breast self examination and clinical breast examination.

Aged↗
PubMed2007

Differences in health and cultural beliefs by stage of mammography screening adoption in African American women.

Behavioral studies show that women's stage of readiness to adopt mammography screening affects their screening rates and that beliefs about breast cancer and screening affect stages of screening. The purposes of this study were to determine, first, the relationship between particular health and cultural beliefs and stage of mammography screening adoption in urban African American women, and second, whether demographic and experiential characteristics differed by stage. Data were analyzed from 344 low-income African American women nonadherent to mammography screening who participated in a 21-month trial to increase screening. At baseline, these women were randomized into 1 of 3 groups: tailored interactive computer instruction, targeted video, or usual care. Participants were categorized by stage of mammography screening adoption at 6 months as precontemplators (not planning to have a mammogram), contemplators (planning to have a mammogram), or actors (had received a mammogram). Although demographic and experiential variables did not differentiate stages of screening adoption at 6 months postintervention, some health and cultural beliefs were significantly different among groups. Actors were more preventive-health-oriented than precontemplators and had fewer barriers to screening than did contemplators. Precontemplators had more barriers, less self-efficacy, and greater discomfort with the mammography screening environment than did contemplators or actors. These results will be useful, not to change cultural beliefs, but to guide the design of health education messages appropriate to an individual's culture and health belief system. Cancer 2007. (c) 2006 American Cancer Society.

Black or African American↗
PubMedDate not supplied

What every surgical oncologist should know about digital mammography.

This article reviews the available information on digital mammography for surgeons who care for patients with breast cancer. The limitations of the current film-based technology and why digital mammography promises to improve breast cancer detection and breast lesion diagnosis are described. The basics of digital imaging technology are reviewed, including a description of image contrast and spatial resolution and its variance from currently available clinical digital mammography systems. The results of clinical trials completed to date are reported. An upcoming large screening trial for digital mammography, sponsored by the National Cancer Institute, is described. Future technological developments, including improvements in softcopy display, image processing, computer-aided detection and diagnosis (CADD), tomosynthesis, and digital subtraction mammography (DSM), are briefly discussed.

Breast Neoplasms↗
PubMedDate not supplied

Enhancing mammography referral in primary care.

BACKGROUND: This 1-year randomized trial tested the efficacy of behavioral techniques for increasing mammography referrals by primary care physicians in small, community practices. METHODS: Sixty-one practices were randomly assigned to one of three conditions: (1) education-only control, (2) education plus cue enhancement using mammography chart stickers, and (3) education plus cue enhancement plus feedback and token rewards. Quarterly chart audits of a defined sample (N = 11,716) of women patients 50 years of age or older were conducted to document mammography referrals, completions, and compliance. RESULTS: Referral and completion rates increased from baseline to first quarter and gradually declined thereafter. Overall, these rates were higher in the cuing conditions than in the control condition. In contrast, compliance rates in both experimental conditions increased over the year while remaining static in the control condition, demonstrating a strong and continuing effect for cue enhancement. Compliance increases were greatest for physicians who were older, nonwhite, with a second speciality, in solo practice, not members of the AMA, not residency trained, and not board certified. CONCLUSIONS: Chart stickers can significantly increase mammography utilization in small, community practices. These practices are an efficient route to reaching large numbers of older women in need of mammography screening.

Family Practice↗
PubMed1999

Cigarette smoking, alcohol consumption, and screening mammography among women ages 50 and older.

BACKGROUND: The associations among cigarette smoking and alcohol consumption with recent screening mammograms were evaluated among women ages 50 years and older. METHODS: The sample included 946 white and African-American women ages 50 years and older from the 1995 Maryland Behavioral Risk Factor Survey. Bivariate and logistic regression analyses were performed to evaluate the associations between current cigarette smoking and alcohol consumption in the past month (none, 1-7 drinks, >7 drinks) with obtaining a screening mammogram in the past 2 years (recent mammogram), controlling for sociodemographic and health variables. RESULTS: Seventy-eight percent of respondents had recent mammograms, 15% smoked cigarettes, 18% reported 1-7 drinks, and 12% reported >7 drinks in the past month. Smokers had lower mammography rates than nonsmokers (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.30-0.75). Women who drank alcoholic beverages had higher mammography rates than nondrinkers (OR = 1.37, 95% CI = 1.03-1.83). Smokers had the lowest mammography rates, regardless of their consumption of alcohol. An interaction was observed among white but not African-American women: nonsmokers who consumed moderate amounts of alcohol (1-7 drinks) had the highest mammography rates in this subgroup. CONCLUSIONS: To reduce breast cancer mortality, it is important to increase screening mammography among all women over age 50 and especially among smokers and the oldest women.

Black or African American↗
PubMed1996

Effects of partial volume and phase shift between fat and water in gradient-echo magnetic resonance-mammography.

The signal modulations caused by partial volume effect and phase shift between fat and water signal in gradient-echo magnetic resonance mammography (GRE MR-mammography) have been calculated. Based on this, the theoretical sensitivity and specificity of GRE MR-mammography has been investigated considering different evaluation methods for the gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA)-based signal enhancement. The results show that both in- and out-of-phase sequences suffer from partial volume effects in voxels that contain both fat and water. This can decrease sensitivity to Gd-DTPA uptake in small, fat-embedded lesions or in pathology that contains fat interspersed histologically. Additionally, out-of-phase sequences can suffer from phase cancellation effects that can further decrease their sensitivity to Gd-DTPA uptake. In the worst case signal can actually decrease during Gd-DTPA influx. Determination of enhancement relative to the baseline value can decrease the specificity of GRE MR-mammography in the out-of-phase condition and decrease the sensitivity in the in-phase condition. These effects are less pronounced when enhancement is calculated relative to fat. These effects need to be understood since Gd-DTPA uptake is the prime indicator of malignancy in MR-mammography.

Breast↗
PubMed1996

Timeliness of follow-up after abnormal screening mammography.

Little information has been published concerning the timeliness of follow-up after abnormal mammography. This article presents data on follow-up after abnormal mammography, including differences in follow-up by age, race, mammographic interpretation, and type of tracking system. From unpublished data, the rate of timely follow-up 8 to 12 weeks after index abnormal mammography ranges from 69% to 99%. Women aged 65 and older, those of lower socioeconomic status, and those who are instructed to have repeat evaluations in four to six months have the highest proportion of untimely follow-up. With use of computer-based tracking systems, timely follow-up ranges from 89% to 99%. Computer-based tracking systems should be encouraged to promote timely follow-up of abnormal mammography. Further research is needed to better delineate those at risk for untimely follow-up after abnormal mammography, causes of untimely follow-up, the impact of untimely follow-up on breast cancer stage and mortality, and interventions that maximize timely follow-up.

Age Factors↗
PubMed2002

[Physical and technical aspects of digital mammography].

The establishment of digital mammography systems constitutes a slow process, the reason for this being the general need of particular image quality in mammography. This article provides an overview of the physical basis of digital mammography with high image quality and dose as low as reasonably achievable. The trade-off of high contrast resolution and effective quantum efficiency of the imaging system on the one hand, and the demand of high spatial resolution or very small pixel size on the other hand is discussed. The actual status of the available digital detector technology for mammography is described. The digital systems presently available are superior to conventional screen-film mammographic systems with respect to contrast resolution. An outlook on possible further developments in the field of digital mammography is presented.

Equipment Design↗
PubMed2004

[Radiological diagnosis of mammary carcinomas. I: pathology and x-ray mammography].

Breast cancer is the most common malignant tumor in women: almost 10 % will suffer from breast cancer during their life and almost half of these will die of it. The spectrum of radiologic methods for diagnosing breast cancer is wide, including X-ray mammography, ultrasound, magnetic resonance mammography, and minimally invasive biopsies. After long-lasting controversies, breast cancer screening using X-ray mammography has now been introduced in Germany, following the projects in the Netherlands and Sweden. However, assessing mammographic films under screening conditions requires skills distinctly different from those needed under clinical conditions. This first part of two covers the histopathological basics and X-ray mammography; the second will deal with ultrasound of the breast and magnetic resonance mammography.

Breast Neoplasms↗
PubMed2005

[Introduction of a mammography screening program in Germany. Consideration of benefits and risks].

For women between 50 and 70 years of age, X-ray mammography presently represents the most effective method for early breast cancer detection. It is commonly accepted that quality assured mammography examinations conducted at regular intervals can reduce mortality from breast cancer. In the year 2002, the German Bundestag agreed to the implementation of a mammography screening program for Germany based on the European guidelines. The effectiveness of a mammography screening program is controversially discussed and two of the most commonly cited hazards are the occurrence of false-positive results and the so-called overdiagnosis. Another issue of criticism is the radiation risk due to the mammography examinations. However, in women aged 50-70 years the radiation risk has no substantial importance. In contrast to the present situation in Germany in which opportunistic screening is widespread, standardized quality assured screening will guarantee that false-positive rates are kept as low as possible and that further assessment diagnostics are effective and minimally invasive.

Adult↗
PubMed2002

Screen film vs full-field digital mammography: image quality, detectability and characterization of lesions.

The objective of this study was to compare screen-film mammography (SFM) to full-field digital mammography (FFDM) regarding image quality as well as detectability and characterization of lesions using equivalent images of the same patient acquired with both systems. Two mammography units were used, one with a screen-film system (Senographe DMR) and the other with a digital detector (Senographe 2000D, both GEMS). Screen-film and digital mammograms were performed on 55 patients with cytologically or histologically proven tumors on the same day. Together with these, 75 digital mammograms of patients without tumor and the corresponding previous screen-film mammograms not older than 1.5 years were reviewed by three observers in a random order. Contrast, exposure, and the presence of artifacts were evaluated. Different details, such as the skin, the retromamillary region, and the parenchymal structures, were judged according to a three-point ranking scale. Finally, the detectability of microcalcifications and lesions were compared and correlated to histology. Image contrast was judged to be good in 76%, satisfactory in 20%, and unsatisfactory in 4% of screen-film mammograms. Digital mammograms were judged to be good in 99% and unsatisfactory in 1% of cases. Improper exposure of screen-film system occurred in 18% (10% overexposed and 8% underexposed). Digital mammograms were improperly exposed in 4% of all cases but were of acceptable quality after post-processing. Artifacts, most of them of no significance, were found in 78% of screen-film and in none of the digital mammograms. Different anatomical regions, such as the skin, the retromamillary region, and dense parenchymal areas, were better visualized in digital than in screen-film mammography. All malignant tumors were seen by the three radiologists; however, digital mammograms allowed a better characterization of these lesions to the Breast Imaging Reporting and Data System (BI-RADS;) [corrected] categories (FFDM better than SFM in 23 of 165 vs 9 of 165 judged cases in SFM). In conclusion, digital mammography offers a consistent, high image quality in combination with a better contrast and without artifacts. Lesion detection in digital images was equal to that in screen-film images; however, categorization of the lesions to the BI-RADS classification was slightly better.

Adult↗
PubMed2002

Influence of the radiographer on the pain felt during mammography.

Mammography is the only useful examination in screening for breast cancer. Mortality from breast cancer can be reduced if women go regularly for a screening mammography. Moreover, it is still the key examination in diagnosis of breast diseases and in the follow-up of patients treated for breast cancer. Pain with mammography can deter women from going for regular screening or follow-up; therefore, it is important to reduce pain experience or discomfort from mammography. In this study we evaluate the impact of the "radiographer" on the pain risk during mammography by analysing questionnaires filled in by women and radiographers. Study results reveal that the opinion of the radiographer, the information and communication during the examination and the number of years of experience are important factors in pain and discomfort experience. The attitude of the radiographer plays an important role in the pain experience.

Age Factors↗