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PubMed1988

Demographic, clinical, and financial factors relating to the completion rate of screening mammography.

A retrospective analysis of the UCLA Family Health Center Research Data Base was performed to determine the relationship between completion rates of screening mammography and various patient demographic, clinical, and financial factors. Data from a 16-month period, from July 1984 through October 1985, were analyzed. Eight hundred twenty-seven women over 50 years of age were seen in the UCLA Family Health Center at least once during the study period. One hundred thirty-six (16.4%) of these women had screening mammography performed. Health insurance coverage was an important determinant of mammography completion. Patients covered by a health maintenance organization were 2.5 (P less than .05) times more likely to receive screening mammography. Uninsured patients were only 0.5 times as likely to have this procedure performed. The completion rate for screening mammography increased significantly with increasing number of visits during the study period (P less than .001). The age groups analyzed were significantly associated with completion rate. Marital status had a significant relationship to completion rate, but this was due to a lower completion rate in the group of patients whose marital status could not be determined. The employment status could not be evaluated due to the high rate of missing data. Race, smoking status, alcohol consumption, and the sex and training level of the primary provider were not found to be significantly associated with screening mammogram completion rates.

Aged↗
PubMed1986

The value of diaphanography as an adjunct to mammography in breast diagnostics.

Histologically classified carcinoma and benign breast disorder was present in 100 respectively 163 cases of symptomatic women. The results of diaphanography were correlated with those obtained by clinical examination, mammography and histology. A false negative diagnosis was made in 17 cases (15.5%) using diaphanography and in 13 cases (11.8%) using mammography. A false positive diagnosis was made in 15 cases (9.2%) with diaphanography and in 33 cases (20.2%) with mammography. The use of both mammography and diaphanography reduced the number of false negatives from 11.8 per cent to 5.5 per cent. In conclusion, diaphanography has been demonstrated to be a useful adjunct to mammography.

Adult↗
PubMed1987

Mammography screening: successes and problems in implementing widespread use in the United States.

Deterrents to the use of screening mammography include perceived risks of radiation, perceived "unnecessary" biopsies and overdiagnosis, and high cost. In addition, physicians and patients have attitudinal barriers that do not reflect objective realities. Professional and public education efforts are needed to enable women and their physicians to develop a more sophisticated understanding of the usefulness of screening mammography and the role played by the radiologist. As part of their efforts to increase the implementation of screening mammography, the American College of Radiology has developed a Mammography Accreditation Program for radiological facilities and has produced a free Mammography Resource Kit for radiologists, while the American Cancer Society has undertaken the support of local and national campaigns to establish screening programs at reduced cost. Both organizations continue to strive in partnership to increase the acceptance of screening throughout the United States.

Allied Health Personnel↗
PubMed1995

Barriers to screening: the theory of reasoned action applied to mammography use in a military beneficiary population.

BACKGROUND: Mammography practices of women eligible for military health care are not known. METHODS: A questionnaire was mailed to a stratified sample of 500 military beneficiary women. The hypothesis was that this group would not differ from the general population in regular mammography use (31%) and that the theory of reasoned action (TRA) is significantly associated with intent to obtain a mammogram. RESULTS: Only 12.8% of these women had regular mammography according to current recommendations. High participation is associated with breast cancer risk factors, income, education, perceived risk of breast cancer, and a doctor's recommendation. The expanded model of the TRA regression is significantly associated with intent. CONCLUSIONS: Regular use of mammography among military beneficiaries is lower than rates in the non-military population. Providers need to stress regular use and address scheduling problems and patient beliefs about mammography. The TRA is a useful model for screening behavior.

Adult↗
PubMed1995

Digital mammography, computer-aided diagnosis, and telemammography.

Film-screen x-ray mammography is an effective tool for the detection and diagnosis of breast cancer. Several limitations of current mammographic technology have been identified, and there is now good evidence that improved image quality and possibly reduced radiation dose could be achieved if mammograms are acquired directly in digital form. In this article, the rationale for digital mammography is presented and various approaches to the design of a digital mammography system are described. Current challenges in developing a practical, clinically acceptable digital mammography system are discussed and applications of digital mammography to computer-aided diagnosis, telemammography, and quantitative imaging are suggested.

Artifacts↗
PubMed1995

Why question screening mammography for women in their forties?

Groups that do not recommend mammography for all women in their forties do so with reason. Even after seven randomized controlled trials and participation by over 170,000 women it is not clear whether screening women in this age group for breast cancer saves lives. It is clear that in contrast to older women, in women in their forties there is no effect for several years after screening begins, and an uncertain marginal effect after a decade. If an effect is present it may be owing to the fact that women move into an age group when mammography is effective. The uncertainty about mammography in younger women is strong enough that investigators from the seven trials are working to conduct overview analyses of the data from all the trials to assess better at what age breast cancer screening saves lives. There also is enough uncertainty that a trial with almost 200,000 women has begun in the United Kingdom and another one is being considered for Europe. If the answer about mammography for women in their forties is clear, why would such large new trials be started? Meanwhile, evidence exists that breast cancer screening costs a great deal, not just in dollars but in human terms. There also is increasing concern about the possibility of overdiagnosis. The financial costs primarily are owing to charges for screening mammograms. The human costs primarily are owing to false-positive readings and, if present, overdiagnosis. Ultimately, the decision to screen women in their forties for breast cancer involves a weighting of benefits (in mortality reduction) and costs (in dollars, anxiety over false-positive results, biopsy and surgery for noncancerous lesions, and overdiagnosis). Most emphasis in the debate about breast cancer screening has been on the evidence about effectiveness. But the costs are substantial. Groups that do not recommend routine screening mammography for all women in their forties require a greater standard of evidence for effectiveness of screening than those that do. Why is this so? First, there are financial considerations. When a health care intervention is recommended for every person in our society, costs mount fast. At any time, but particularly in an era of cost constraints, it is not only reasonable but incumbent on all involved in health care to look carefully at how much benefit there is for the expenditure and how strong is the scientific evidence. Second, many persons who consider prevention activities argue that there is an ethical reason.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

Perceptions of the mammography experience.

The 1993 projections for breast cancer indicate a morbidity of 183,000 women with a mortality rate of 18%. Mammography is one of three approaches available for the early detection of breast cancer. However, underutilization has been reported and attributed to pain associated with the procedure, the expense to the consumer, and lack of referral by physicians. Other reasons for the low utilization rates include fears on the part of the woman of a positive diagnosis, radiation, and a possible mastectomy. This study provides an analysis of the responses of a convenience sample of 272 women, aged 30-90 years, to two open-ended questions about the mammography experience. The words and phrases women used to describe the mammography experience and the sensations experienced in their breasts during mammography were subjected to content analysis. The results of this study suggest that the word descriptors women use to describe their experience during mammography are highly individualistic and may not be totally captured by numeric or descriptive rating scales of pain intensity.

Adult↗
PubMed1994

Use of screening mammography by general internists.

While physician endorsement has been shown to be highly important in motivating women to obtain screening mammograms, there is evidence that doctors do not refer women for the procedure as often as they should. The objective of this study was to help understand why physicians do not routinely utilize screening mammography. Randomly selected Washington State general internists were surveyed by mail, concerning mammography, during 1989. An expanded theory of reasoned action was used as a broad conceptual framework for considering factors potentially associated with use. The survey response rate was 66%, yielding a study sample of 85. Only 38% of the respondents reported they always ordered mammograms for women aged 50 years and over during preventive office visits. Nearly half (43%) had no reminder system for the test. Correlates of use included beliefs concerning the screening behavior of other doctors, the location of mammography facilities in relation to physician offices, and age. Physician-related barriers, such as doubts about effectiveness, were found to affect use more than patient-related barriers, such as cost. The recommendations of professional organizations were shown to have been important in influencing physician use of screening mammography. This study indicates a proportion of general internists are not routinely ordering mammograms for their age-eligible female patients. The findings identify barriers to use of mammography that need to be overcome if national efforts to promote use of the procedure by primary care physicians are to succeed. Implications for intervention are reviewed.

Aged↗
PubMedDate not supplied

Physicians' awareness of mammography charges.

Although physicians commonly report cost as a barrier to screening mammography, their awareness of mammography charges is unknown. Using a statewide sample, we assessed accuracy of primary care physicians' estimates of mammography charges among 506 eligible physicians who returned questionnaires. Differences between estimated charges and actual charges at their mammography referral facilities were small (mean = $2.74, median = 0) and unrelated to physicians' specialty, age, gender, or practice type. We conclude that physicians are cognizant of mammography charges. Overestimates in charges may not explain low mammographic screening rates.

Awareness↗
PubMed1994

Attitudes, practices, and role of nurses in the use of mammography.

This research examined the mammography behavior of 145 nurses as well as their patient teaching practices about mammography. A subsample of 100 were identified as compliant or noncompliant with mammogram screening guidelines. Nurses who complied and those who did not comply were not significantly different on variables of age, licensure, education level, or clinical practice setting. Nor was a positive family history associated with compliance. In patient teaching about mammography, only 25% of nurses reported teaching. The vast majority of nurses, 75%, rarely or only occasionally did the patient teaching. Reasons cited for not teaching included not thinking about it and feeling unqualified to do this teaching. However, all nurses thought it was important for educating nurses about the need to teach women about mammography screening. The health belief model was applied as a framework for further research exploring nurses educating women about mammography.

Adult↗
PubMed1994

[Utilization of mammography--who will come and why?].

Mammography has been used to detect early stages of breast cancer in women over the age of 40 years. Nationally organized mammography screening has not been initiated in Norway, but women have the possibility of undergoing mammography at many hospitals and private institutions. This article describes the use of mammography at Røntgensenteret, a private institute, from January to July 1992. Women in the age group 40 to 50 years were the most frequent users. The most important reason for the women undergoing mammography was a recommendation from their physician. Living near to the examination unit was also an important factor.

Adult↗
PubMed1993

Mammography: role of the occupational health nurse.

1. According to ACS and NCl guidelines, women should begin screening mammography with a baseline film between 35 and 39 years of age. She should then maintain routine mammography screening per the guidelines. 2. Twenty-five percent of women diagnosed with breast cancer have known risk factors. 3. Further investigation of the effectiveness of worksite mammography and mobile mammography vans is needed. 4. Occupational health nurses are in an optimal position to increase the level of current mammography usage.

Adult↗
PubMed1993

Office systems for promoting screening mammography. A survey of primary care practices.

BACKGROUND: Office tracking, scheduling, and reminder systems have been shown to improve utilization of screening mammography, but little is known about the use of these systems by primary care physicians. METHODS: We surveyed 132 primary care and obstetrics and gynecology practices affiliated with an independent practice association model health maintenance organization in central Massachusetts to determine their use of reminder, scheduling, and follow-up systems, and education and counseling services aimed at increasing screening mammography rates. RESULTS: The use of chart flags to remind physicians of a patient's need for mammography screening was reported by 30% of practices. Thirty-one percent reported the use of flow sheets, and 27% reported the use of mail or telephone patient reminders. At least one of these three systems was used by 57% of the practices, whereas 43% reported having none of these three systems. Variations in the use of these office systems were related to specialty type, physician number, and clinical staffing. The majority of practices (77%) reported using written educational materials, and 42% offered prevention counseling with nonphysician staff. Very few offices (8%) reported using mail or telephone reminders for previously scheduled appointments. CONCLUSIONS: Despite the proven effectiveness of reminder systems for screening mammography, many practices do not have a system in place. Promotion of reminder systems in primary care practices could have a substantial impact on mammography utilization.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Women's responses to the mammography experience.

BACKGROUND: Accounts of mammography-related anxiety, embarrassment, and pain have been barriers to women contemplating a mammogram. Because it is not known how many women have had bad mammography experiences, we designed a study to learn what women actually experience when they have a mammogram. METHODS: Two hundred fifty-five women were interviewed immediately after having a mammogram at three different breast-imaging centers in the Philadelphia area. RESULTS: Significant racial differences were noted in this study with reports of mammography-related anxiety and pain. Nonwhite women and women who had less than a high-school education reported significantly more anxiety about having a mammogram. Sixty percent of all women interviewed were anxious about having a mammogram; 20 percent of them reported being extremely anxious. White women reported pain more often than African-American women. Only 12 percent of the women reported that their physicians had explained the mammography procedure, but 61 percent of those women reported no anxiety versus 37 percent of women whose physicians did not explain the procedure. More than one-third (34 percent) of women having a first mammogram stated that their mammogram experience affected their future plans for having another. CONCLUSION: Extra physician or nurse time spent in explaining mammography to women could result in lower anxiety, higher levels of future intentions to get mammograms, and better experiences for the women themselves.

Anxiety↗
PubMed1993

Nonparticipation in mammography screening: apathy, anxiety or cost?

AIMS: A survey was undertaken to find out why only 46% of eligible women had taken the opportunity to join the South Canterbury mammography screening programme in the first 22 months of operation. METHODS: One hundred and sixty seven randomly chosen women, aged between 40 and 65 years, who had not had a mammogram, were questioned about their knowledge of, and attitudes to, mammography screening. RESULTS: The answers showed that apathy, lack of concern and lack of perceived need were reasons quoted for nonattendance by almost half of respondents. Other important barriers to mammography screening were: (1) fear of a positive screen result (admitted by 39%); (2) lack of encouragement by some general practitioners (quoted by 19%); and (3) lack of knowledge about screening mammography (one third did not know that mammography was a screening and not just a diagnostic procedure). The current cost is a major deterrent for many unscreened women with only 28% saying they would be willing to pay more than $55.00, but only 10% unwilling to pay at all and only 5% quoting cost as their reason for nonattendance. CONCLUSION: Strategies to improve attendance are suggested.

Adult↗
PubMedDate not supplied

Mammography in the 1990s: a plea for objective doctors and informed patients.

Mammography screening is increasingly promoted as a means to avoid death from breast cancer. Although some randomized trials have shown a mortality benefit in the older screened groups, not all the results have been statistically significant; benefit has not been shown in younger age groups. Mammography detects smaller lesions than physical examination, but the only randomized trial comparing the mortality benefits of mammography and physical examination shows no benefit for mammography. The systemic nature of breast cancer raises questions about the theoretical mortality benefit of screening. Patients undergoing mammography may experience unexpected anxiety about the results. Candidates for screening should be routinely informed of these issues.

Adult↗
PubMed1996

As mammography use increases, are some providers omitting clinical breast examination?

OBJECTIVE: To explore use of clinical breast examination (CBE) among women receiving mammography. METHODS: A retrospective cohort analysis of 100 women aged 50 years or older with at least one bilateral mammogram. Chart review documented demographic information, severity of illness, and performance of CBE (from 1 year prior to 18 months after the mammogram). RESULTS: The mean age of the 100 women was 63 years. They were predominantly unmarried (60%), nonwhite (58%), and not currently employed (57%). Three quarters (76%) had mammography and CBE (comprehensive screening), while the remaining 24% had mammography only. Sociodemographic factors did not differ for women with and without comprehensive screening (P>.1). However, patients of female providers were more likely to receive comprehensive screening than patients of male providers. Specifically, 95% of women seen by female attending physicians or fellows had comprehensive screening vs 67% for male attending physicians or fellows and 61% for residents (P=.008). CONCLUSIONS: Mammography may be replacing CBE especially among patients of male providers. Interventions targeted to these providers could help improve the use of CBE and mammography.

Aged↗
PubMed1996

The relative diagnostic impact of screening mammography and physical examination.

OBJECTIVE: To determine the relative diagnostic impact of screening mammography and physical examination. METHODS: Data from the first 3.5 years of operation of the Ontario Breast Screening Program's regional facility in London were analyzed. A total of 14,646 women underwent screening, which involved both mammography and physical examination. The authors examined the relative contribution of the two types of examination according to detection rate, as well as size, stage and histologic type of the identified breast cancers. RESULTS: In total, 135 cancers were detected. Mammography revealed 131 (97.0%) of all cancers, whereas physical examination revealed only 66 (48.9%). Furthermore, the lesions detected by mammography were generally smaller and found at an earlier stage. CONCLUSION: Although most other screening programs involve mammography only, physical examination did make a contribution to the detection rate at the authors' facility. However, in an era of declining resources and cost containment, critical analysis of the value added by physical examination is necessary.

Aged↗