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PubMed2006

Dose comparison between screen/film and full-field digital mammography.

The study purpose was the comparison between doses delivered by a full-field digital mammography system and a screen/film mammography unit, both using the same type of X-ray tube. Exposure parameters and breast thickness were collected for 300 screen/film (GE Senographe DMR) and 296 digital mammograms (GE Senographe 2000D). The entrance surface air kerma (ESAK) was calculated from anode/filter combination, kV(p) and mAs values and breast thickness, by simulating spectra through a program based on a catalogue of experimental X-ray spectra. The average glandular dose (AGD) was also computed. Results showed an overall reduction of average glandular dose by 27% of digital over screen/film mammography. The dose saving was about 15% for thin and thick breasts, while it was between 30% and 40% for intermediate thicknesses. Full-field digital mammography dose reduction is allowed by wider dynamic range and higher efficiency of digital detector, which can be exposed at higher energy spectra than screen/film mammography, and by the separation between acquisition and displaying processes.

Breast Diseases↗
PubMed1998

Detection of breast cancer with conventional mammography and contrast-enhanced MR imaging.

The aim of this study was to compare the diagnostic performance of conventional mammography and dynamic contrast-enhanced fast 3D gradient-echo (GRE) MRI regarding the detection and characterization of breast lesions relative to histopathologic analysis and to assess the results of a combined evaluation of both methods. fifty consecutive patients with 63 histopathologically verified breast lesions underwent dynamic contrast-enhanced GRE MRI in addition to routine conventional mammography. All lesions were classified by both methods on a five-point scale as benign or malignant, and the results were correlated to histopathology. Conventional mammography and dynamic MRI yielded a sensitivity and specificity of 82 and 64 %, and 92 and 76 %, respectively. The difference between the results was statistically not significant (p > 0.05) with areas under the receiver-operating-characteristics curves of 0.807 for mammography and 0.906 for MR imaging. Combination of the results of both methods slightly increased the sensitivity for detection of breast cancer to 95 % but decreased specificity to 52 %. In this selected patient subset, including only patients referred for excisional biopsy, contrast-enhanced dynamic MRI proved more sensitive and specific than conventional mammography regarding the detection of malignancy. While a combination of both methods yields a slightly improved sensitivity, specificity is vastly reduced.

Adult↗
PubMed2005

Is there reliable experimental evidence for different dicentric yields in human lymphocytes produced by mammography X-rays free-in-air and within a phantom?

We examined the production of dicentrics in human lymphocytes irradiated with 29 kV X-rays to a depth of 13.5 mm in a PMMA phantom. For these irradiation conditions, which are appropriate for the diagnostic application of mammography X-rays, a coefficient alpha of (5.88+/-0.66) x 10(-2) Gy(-1) of the linear quadratic dose-response relationship was determined. This value does not differ significantly from the coefficient alpha of (6.55+/-0.97) x 10(-2) Gy(-1) obtained earlier for a free-in-air set-up using blood of the same donor. The results are interpreted in terms of both the energy distributions of the photon fluence of mammography X-rays free-in-air and those in the PMMA phantom. Based on earlier results of experiments with monochromatic X-rays in the energy range 1.83-40 keV (completed here by an additional measurement at 25 keV), a fit function alpha(E) to the measured alpha coefficients as a function of the energy E of monochromatic X-rays was used to calculate weighted mean values alpha for both the mammography X-ray spectra free-in-air and in the phantom. As a result, weighted mean values of (4.9+/-1.0) x 10(-2) Gy(-1) and (4.5+/-1.0) x 10(-2) Gy(-1) were obtained, respectively. Although the measured alpha coefficients for mammography X-rays appear to be systematically higher than those calculated as weighted mean values alpha, it can be concluded that the modification of the mammography X-ray spectrum to a depth of 13.5 mm in a PMMA phantom compared with the free-in-air spectrum has no significant influence on the dicentric yields in human lymphocytes.

Air↗
PubMed2006

Effect of model of care delivery on mammography use among elderly breast cancer survivors.

BACKGROUND: Despite gaps in the quality of follow-up care for breast cancer survivors, the most effective model for such care remains unclear. We evaluated receipt of mammography among survivors followed by generalist physicians, specialists, or both (referred to as 'shared care'). METHODS: We used Surveillance, Epidemiology, and End Results tumor registry data and Medicare claims to study 3828 older women, diagnosed with breast cancer in 1995. RESULTS: During the first 3 years after treatment, about two-thirds of patients underwent shared care. Use of mammography in such patients was 84.0, 81.0 and 78.6% in follow-up years 1-3 respectively. For patients not using shared care, use of mammography was 76.3, 70.5, 66.0% in years 1-3 respectively. In a multivariate logistic regression model, women receiving shared care had substantially greater mammography use than others, with an odds ratio of 2.13 (95% CI: 1.74, 2.58) in the first follow-up year and similar odds ratios in subsequent follow-up years. CONCLUSIONS: Most older breast cancer survivors undergo shared care. These patients receive better quality of care as measured by follow-up mammography.

Aged↗
PubMed2005

Are risk factors for breast cancer associated with follow-up procedures in diverse women with abnormal mammography?

OBJECTIVE: We evaluated the association of risk factors for breast cancer with reported follow-up procedures after abnormal mammography among diverse women. METHODS: Women ages 40--80 years were recruited from four clinical sites after receiving a screening mammography result that was classified as abnormal but probably benign, suspicious or highly suspicious, or indeterminate using standard criteria. A telephone-administered survey asked about breast cancer risk factors (family history, estrogen use, physical inactivity, age of menarche, age at birth of first child, parity, alcohol use), and self-reported use of diagnostic tests (follow-up mammogram, breast ultrasound, or biopsy). RESULTS: Nine hundred and seventy women completed the interview, mean age was 56, 42% were White, 19% Latina, 25% African American, and 15% Asian. White women were more likely to have a positive family history (20%), use estrogen (32%), be nulliparous (17%) and drink alcohol (62%). Latinas were more likely to be physically inactive (93%), African Americans to have early onset of menarche (53%) and Asians first child after age 30 (21%). White women were more likely to have suspicious mammograms (40%) and to undergo biopsy (45%). In multivariate models, Latinas were more likely to report breast ultrasound, physical inactive women reported fewer follow-up mammograms, and care outside the academic health center was associated with fewer biopsies. Indeterminate and suspicious mammography interpretations were significantly associated with more biopsy procedures (OR=8.4; 95% CI=3.8-18.5 and OR=59; 95% CI=35-100, respectively). CONCLUSIONS: Demographic profile and breast cancer risk factors have little effect on self-reported use of diagnostic procedures following an abnormal mammography examination. Level of mammography abnormality determines diagnostic evaluation but variance by site of care was observed.

Adult↗
PubMed2005

Geographic association between mammography use and mortality reduction in the US.

BACKGROUND: Breast cancer mortality rates in women have been declining at the same time as breast cancer incidence rates, mammography rates and use of effective adjuvant therapy have been increasing. The objective of this study was to examine population data on breast cancer screening and breast cancer mortality to see if there is any geographic association between mammographic screening and breast cancer mortality reduction in the US, after adjusting for therapy use. METHODS: Regression analysis of the estimated annual percent reduction of breast cancer mortality was performed on mammography use from the Behavioral Risk Factors Surveillance System (BRFSS) at state level. A secondary regression analysis on the SEER-11 region, at an aggregated Health Services Area (HSA) level, was carried out to adjust for use of adjuvant therapy. The annual percent change in the incidence of early stage cancer, calculated from SEER cancer data was used as a surrogate for mammography use. Adjuvant therapy use was estimated from SEER data and adjusted using the Patterns of Care data. All the analyses showed a small but significant negative correlation between mammography usage and mortality reduction (correlation of -0.285, p-value 0.045) in breast cancer (state level) and change in "early" stage breast cancer and mortality reduction (at HSA level) unadjusted (correlation of -0.307, p-value 0.065) and adjusted (partial correlation of -0.337, p-value 0.044) for adjuvant therapy use. DISCUSSION: The results of the two analyses appear to show a moderate effect of mammography usage on decreasing breast cancer mortality in the US, which seems to support the conclusions of randomized mammographic screening trials. While randomized controlled trials are certainly the gold standard in appraising the efficacy of new screening or treatment modalities, such trials are conducted under standardized conditions and do not always reflect the effect of these interventions at population level. This paper attempts to examine population level effects through ecologic analyses. Results, however, need to be interpreted cautiously owing to the limitations and biases inherent in such analyses.

Adult↗
PubMed2006

Population-based mammography screening and breast cancer incidence in New South Wales, Australia.

OBJECTIVE: To analyse breast cancer incidence trends in New South Wales (NSW), Australia, in relation to population-based mammography screening targeting women aged 50 to 69 years. METHODS: Trends in age-specific incidence of invasive breast cancers in NSW women aged > or = 40 years were examined in relation to mammography screening rates and screening cancer detection rates. RESULTS: Incidence of invasive breast cancer in NSW women increased in all age-groups over 1972 to 2002. The incidence trend for women aged 50 to 69 years showed that the steepest rise was associated with increased participation in population-based mammography screening, which was implemented from 1988 and achieved state-wide coverage in 1995. The elevated incidence of invasive cancer significantly exceeded pre-screening levels, and persisted after rates of initial screens declined. This elevated incidence was sustained by the contribution of cancers diagnosed through subsequent screening, and resulted from increased cancer detection rates in subsequent screens. CONCLUSIONS: The recent increase in invasive breast cancer incidence in NSW is associated with mammography screening, and occurred mostly in the target age-group women. Persistence of higher incidence after 1994 was not explicable by inflation of cancer incidence due to detection of prevalent screen cases, but was associated with a trend of increased cancer detection rates in subsequent screening rounds, probably consequent to quality improvements in mammography screening diagnosis.

Aged↗
PubMed2006

Spatial equity in facilities providing low- or no-fee screening mammography in Chicago neighborhoods.

Recent research suggests living in an economically disadvantaged neighborhood is associated with decreased likelihood of undergoing mammography and increased risk of late-stage breast cancer diagnosis. Long distances and travel times to facilities offering low- or no-fee mammography may be important barriers to adherence to mammography screening recommendations for women living in economically disadvantaged urban neighborhoods, in which African-Americans are disproportionately represented. The purpose of this study was to examine whether the spatial distribution of facilities providing low- or no-fee screening mammography in Chicago, Illinois, is equitable on the basis of neighborhood socioeconomic and racial characteristics. We found that distance and travel times via automobile and public transportation to facilities generally decrease as neighborhood poverty increases. However, we also found that the strength of the association between neighborhood poverty level and two of the spatial accessibility measures-distance and public transportation travel time-is less strong in African-American neighborhoods. Among neighborhoods with the greatest need for facilities (i.e., neighborhoods with the highest proportions of residents in poverty), African-American neighborhoods have longer travel distances and public transportation travel times than neighborhoods with proportionately fewer African-American residents. Thus, it appears that the spatial accessibility of low- and no-fee mammography services is inequitable in Chicago. In view of persistent social disparities in health such as breast cancer outcomes, these findings suggest it is important for researchers to examine the spatial distribution of health resources by both the socioeconomic and racial characteristics of urban neighborhoods.

Black or African American↗
PubMed1976

Developments in mammography.

Mammography is presented for the primarily nonradiologic audience. A brief historical review calls attention to some of the milestones in mammography and how it has changed. Xerororadiography is discussed, as it is one of the newer developments and is rapidly gaining broad acceptance in the United States. Clinical applications are included, with a discussion of the various entities which the radiologist can identify on the mammogram. Although the mammographic examination can be extremely accurate in the hands of interested examiners, some carcinomas will not be identified; of these, some can be discovered by routine physical examination. If mammography is made to stand alone, without a physical examination, some women with breast cancer will not be identified and will not receive prompt, adequate treatment. Mammography is an adjunct and a complement to the physical examination. Breast cancer screening appears to be effective in finding small, nonpalpable tumors, many very early in their growth. Definite evidence is now available that early diagnosis of breast cancer leads to prolonged survival. There is promise of further developments in the field of mammography.

Adenofibroma↗
PubMed1983

Mammography after needle aspiration of palpable breast masses.

Hematoma resulting from attempted aspiration of a palpable breast mass can cause incorrect mammographic interpretation by rendering irregular and indistinct the otherwise smooth and sharply defined margins characteristic of a benign lesion. In this study of recently aspirated breast masses, we found 17 benign lesions that demonstrated poorly defined, irregular margins on mammograms that suggested malignancy. All these false-positive interpretations occurred when aspiration preceded mammography by less than 2 weeks (17 of 47, 36 percent); no such diagnostic error occurred in the 31 cases when mammography was delayed for 2 weeks or more after aspiration. An appreciation of the frequency and natural history of postaspiration hematoma formation should either encourage physicians to request mammography before carrying out invasive procedures, or alternatively, to defer mammography until 2 weeks after aspiration, since mammography then should more clearly portray the benign characteristics of truly benign masses, thereby possibly obviating biopsy.

Biopsy, Needle↗
PubMed1995

Mammography and breast implants.

Mammography in the presence of breast implants is complicated by the opacity of the implants, the displacement of breast tissue by the implant, and the presence of secondary changes such as calcification within a fibrous capsule. A special technique of mammography, known as the displacement technique, has been developed by Eklund in the USA, where it is widely used. The displacement technique of X-ray mammography has been shown to provide superior results to the standard compression method. We conducted a telephone survey of 23 mammography units in order to assess mammographic practice in the United Kingdom for the patient with breast implants. We found a wide variation in practice. There was a general lack of awareness of the displacement technique and of its advantages. Only 4 mammography units in our sample (17.4%) used the displacement technique.

Breast Implants↗
PubMed1988

Exploration of factors affecting mammography behaviors.

Of an estimated pool of 1,700 potential participants, only 382 (22%) eligible women participated in a low-cost breast cancer screening program offered to university and medical center employees. Because most women were still available and data were needed to understand why the opportunity to participate was refused by so many, a survey was done to determine factors related to mammography behavior. Three distinct groups of women were identified according to health beliefs, mammography behaviors, and modifying factors. Women who participated in the mammogram program were predominantly well-educated working women who were aware of mammography and its relationship to the breast cancer trajectory; they were affected by cost and convenience issues. One group of women did not participate in the program offered because they had had a recent mammogram; these women were at high risk for breast cancer and perceived mammography to be beneficial. The women who did not participate for other reasons were in nonprofessional jobs, had lower levels of education, and tended not to participate in the health care system as readily as women in the other groups; they perceived themselves less susceptible to breast cancer, valued mammography less, and knew less about breast cancer.

Adult↗
PubMedDate not supplied

Evaluation of equipment performance, patient dose, imaging quality, and diagnostic coincidence in five Mexico City mammography services.

BACKGROUND: Regulations concerning the use of x-rays in medical diagnoses were published in Mexico in 1997. In this work, we evaluate technical aspects of mammography services in the Mexico City area and radiation dose and coincidence between the radiological interpretation by the institution radiologist and by a panel of experts. METHODS: Following methodology proposed by the American College of Radiology and the European Community among others, we have evaluated the performance of six mammography systems in Mexico City public and private services. The studied services carry out approximately one half of the mammography studies in the capital's metropolitan area. RESULTS: The systems comply with 53-82% of a total of 31 applied quality control tests and measurements, which include the mammography unit, x-ray generation, collimation, automatic exposure control, compression devices, grid and image receptor, film processing, darkroom, viewboxes, dose, film rejection, and image quality. The elements that most frequently fail are film processing, darkroom, and light boxes; average ACR phantom score is 11.2 (9.5, 12.0); mean average glandular dose measured with the phantom is 1.00 (0.71-1.15) mGy, and measured in patients is 1.75 (0.3, 4.9) mGy; coincidence between radiologic reports (BI-RADS) by the institution radiologist and a panel of experts is obtained in 35% of studied cases. CONCLUSIONS: Statistical analysis of results indicated that the level of equipment performance is correlated with image quality, image quality estimated by the panel of radiologists is correlated with phantom score, and coincidence in clinical mammography reports is not correlated with equipment performance and appears to depend on the radiologist's experience.

Breast Neoplasms↗
PubMed2005

Is mammography overused in male patients?

There is no agreed protocol for the use of mammography in evaluating the male breast. As a result, the tendency is to use the mammography more often than required. In order to define the role of mammography in men, we carried out a retrospective analysis of all male patients referred to the breast clinic with a history of breast lump between January 2001 and December 2003. The impact of mammography in the evaluation of male breast cancer cases was studied. A total of 220 male patients were referred to the breast clinic during this period. Of these, 134 men had a mammographic examination, with majority (96%) being performed prior to their consultation with the breast clinician as per the clinic protocol. Nine patients under the age of 35 years also had a mammographic evaluation. There were 4 cases of breast cancer diagnosed during this period. Breast cancer was suspected in all patients on clinical examination and was confirmed by biopsy. Breast cancer in men can be suspected on clinical examination in the majority of cases. Mammography appears unnecessary in most men and should not be used as a routine imaging procedure. One should consider imaging only those with clinically suspicious breast lumps to avoid unnecessary imaging particularly in young male patients.

Adolescent↗
PubMed2006

Breast conservation surgery without pre-operative mammography--a definite feasibility.

Mammography is mandatory before breast conservation. Its limited availability in developing countries has discouraged surgeons in rural areas from practicing breast conservation. We analyzed the database of breast surgeries at our institute to investigate whether breast conservation could be safely performed if clinically feasible without the use of mammography. If mammography had not been performed in the 735 patients undergoing surgery, breast conservation could have been erroneously performed in 38 (5.17%) patients; 13 had impalpable mammographic multicentricity and 25 had extensive microcalcifications. A detailed analysis showed that this error in decision would have been detected and rectified in each of the above patients before commencement of radiotherapy. We conclude that although mammography cannot be totally excluded from the treatment algorithm for palpable breast cancer, conservative surgery can be offered in clinically suitable cases even if pre-operative mammography is not available due to limited resources in the developing world.

Breast Neoplasms↗
PubMed2006

Comparison of three interventions to increase mammography screening in low income African American women.

BACKGROUND: Low-income African American women are more likely to die of breast cancer than their Caucasian counterparts, and at least part of the difference in mortality results from differential screening adherence. The purpose of this study was to identify more efficacious methods of promoting routine mammography screening in underserved populations. METHODS: A prospective randomized intervention study of 344 low income African American women compared the impact of three interventions on mammography adherence and stage of readiness: (1) pamphlet only; (2) culturally appropriate video; and (3) interactive computer-assisted instruction program. RESULTS: The interactive computer intervention program produced the greatest level of adherence to mammography (40.0%) compared to the video group (24.6%) and the pamphlet group (32.1%). When subjects in the pamphlet and video groups were combined to form a non-interactive group, this group had a significantly lower adherence than the group who received the interactive computer intervention (27.0% versus 40.0%). There was also significantly more forward movement in mammography stage of readiness among participants in the computer group (52.0%) compared to those in the pamphlet group (46.4%) or the video group (31.3%). When combining the non-interactive technology (pamphlet and video) there was also more forward movement in mammography stage of readiness for those in the interactive intervention group (52.0% moved 1 or 2 stages) compared to those in the non-interactive group (36.2%). CONCLUSIONS: These data indicate that tailored approaches are more effective than targeted messages either in print or video format. Another finding of this study is that interactive interventions are more effective than non-interactive interventions in increasing adherence and moving African American women forward in their mammogram stage of readiness.

Adult↗
PubMed2004

The current status of digital mammography.

Digital imaging has shown rapid advances in recent years. Various different digital mammography systems are now available for clinical use. Digital mammography does have clear advantages over traditional screen film mammography, but this is yet to convincingly translate into improved cancer detection rates. This review aims to describe the different technologies, introduce concepts related to image quality and review the current evidence for the use of digital mammography systems in clinical practice. Advanced applications of digital mammography such as computer-aided detection (CAD) are also discussed.

Adult↗
PubMed2004

Screening mammography was used more, and more frequently, by longer than shorter term Medicaid enrollees.

OBJECTIVE: Recent studies have shown that timing and length of enrollment (LOE) in Medicaid in relation to cancer diagnosis are associated with stage of breast cancer among Medicaid beneficiaries. Whether LOE in Medicaid is also associated with the use of screening mammography (USM) is unclear, however. The objective was to determine whether USM among Medicaid beneficiaries is associated with LOE in Medicaid. STUDY DESIGN AND SETTING: The study used Ohio Medicaid enrollment and claims files, and a cohort approach to estimate USM during the 8-year study period. USM was assessed through (a) the proportion of women receiving screening mammography, and (b) the frequency of screening mammography exams. This study used women 40-64 years of age enrolled in Ohio Medicaid during 1992-1999 (n=140,592). RESULTS: The proportion of women receiving screening mammography increased significantly with each additional year of LOE [adjusted odds ratio (AOR): 1.59, 95% confidence interval (95% CI): 1.57-1.60], and was higher among women presenting comorbid conditions (AOR: 3.05; 95% CI: 2.90-3.20). The mean number of annual mammography exams increased from 0.08 among women with LOE < or = 12 months, to 0.26 among women with LOE > or = 7 years. CONCLUSION: Both LOE and comorbid conditions are independently, significantly, and positively associated with USM, although their interactive effect relative to USM needs to be studied further. These findings have important implications in the methods employed to study use of cancer screening and other preventive services by Medicaid beneficiaries, as well as in Medicaid policy analysis and program management.

Adult↗