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PubMedDate not supplied

Breast cancer and mammography: an American Cancer Society profile of Philadelphia and Montgomery Counties.

The American Cancer Society, Philadelphia Division, has completed a comprehensive profile of breast cancer and mammography in Philadelphia and Montgomery Counties. The profile consists of three segments: (1) data on incidence of breast cancer and trends in stage at diagnosis; (2) estimates of breast cancer screening practices based on surveys of the population; and (3) results from a survey of mammography providers assessing the region's capacity for and access to mammography. The profile demonstrated that the Philadelphia Division is already close to achieving the national American Cancer Society's goals for breast cancer detection for the year 2000 for the percent of women screened and percent of cancers diagnosed in early stages. New and more ambitious goals for the Division must be set. Although capacity for mammography is high, outreach programs by mammography providers represent only 1% to 2% of all mammograms performed. The profile has been the cornerstone of new programmatic initiatives for the Division.

Adult↗
PubMed1996

[Do an operation and radiotherapy in the breast-preserving therapy of breast carcinoma modify the meaningfulness of subsequent mammographies?].

PURPOSE: Today, whenever possible, mamma carcinoma is operated on by preserving as much breast as possible, and is followed by postoperative radiotherapy of the thoracic wall. This form of treatment can lead to alterations of the skin and parenchyma, visible in mammogram, which may make evaluation of these mammographies difficult with regard to recidive. This paper presented describes nature and frequency of changes of treated breast caused by therapy. PATIENTS AND METHODS: Three hundred and eighty mammographies of 50 female patients were evaluated on alterations of skin and parenchyma caused by combined therapy. Inclusive criteria were among others 2 mammographies in the 1st year after therapy, no advanced or parallel chemotherapy and a follow-up time of at least 5 years. RESULTS: Thirty-two patients (64%) showed no fibrotic changes of breast, 5 patients (10%) initially developed denseness of parenchyma which then, however, reverted back to a completely normal state. Only 13 patients (26%) had irreversible fibrotic alterations of parenchyma, only 3 (6%) of which showed extensive fibrosis which definitely might make recidive diagnostic difficult. CONCLUSION: Major changes of parenchyma caused by preparatory treatment which can be registered by mammography are relatively rare. For this reason, mammography maintains its unchanged high position within post-tumorous treatment, especially as it even today is the only diagnostic method to evidence microcalcifications suspect of being malignant.

Breast↗
PubMed1996

Assessing mammography rates for Medicaid recipients age 50 to 65 years using claims data from a southeastern state.

A retrospective Medicaid claims data analysis for physician-submitted mammography procedure codes was performed for all continuously eligible female Louisiana Medicaid recipients in 1994. The study measured mammography screening and diagnostic radiology procedures, using CPT coding logic. The study population consisted of 19,688 female Medicaid recipients, age 50 to 65, comprising 55% of the total female Medicaid recipients within Louisiana. In this cohort, 18.3% received a mammogram, with approximately 50% being diagnostic mammography procedures. No significant racial difference in utilization of mammography was found for this population. This claims data analysis suggests that Louisiana's Medicaid population appears to be underserved with respect to mammography screening. The authors conclude that community, physician, and public health resources would be well served to place more emphasis on educational and other outreach programs. Louisiana has to increase its rates for Medicaid recipients by 50% to meet the goal of screening 60% of eligible women every 2 years as set forth in Healthy people 2000, by the United States Public Health Service.

Aged↗
PubMed1977

The accuracy of mammography: an analysis of 655 histologically verified cases.

The accuracy of the mammography was studied on 655 breasts which were investigated and biopsied or treated surgically shortly afterward. The mammography reports were classified according to the confidence level of the statements. In 279 cases the mammography was interpreted as positive for malignancy. A total of 224 malignant tumors were found. In 30 cases the malignant lesion was missed on the mammograms. The diagnoses made with a high degree of certainty were correct in 90% of the cases. The sensitivity of the mammography was 86.6% at a specificity of 80.7% for malignant tumors. The value of mammography for the diagnosis of chronic mastopathy could not be determined objectively. The sensitivity for solitary benign tumors or cysts was 80%.

Adult↗
PubMed1997

Access and barriers to mammography in New England community health centers.

BACKGROUND: Historically, screening measures for poor patients have been underemployed. As a result, diagnosis of breast cancer is more likely made at later stages in underserved and minority populations. Regular care in community health centers (CHCs) can mitigate this screening inequity. The purpose of this study was to determine the barriers to and frequency of breast cancer screening in New England CHC women, and to compare our findings with the Healthy People 2000 goal of screening 60% of women aged 50 years and older with mammography every 2 years. METHODS: A consecutive series survey of 3176 women aged 40 years and older was performed between April 1 and August 31, 1995, at 32 CHCs in six states. RESULTS: Completed questionnaires were returned on 2943 patients, including 200 African-American, 2222 white, 370 Hispanic, and 56 Asian women; 932 (32%) were aged 40 to 49 years, and 2011 (68%) were aged 50 and older. Within the preceding 2 years, 2072 (70%) had had a breast examination by a provider. Eighty-seven percent reported that mammography was recommended. More women aged 50 years and older (55%) had had mammography during the last 2 years than women in the 40- to 49-year-old group (45%) (P < .004). The most common reason for not having a mammogram was that the patient thought "the test was not important"; expense and lack of insurance was second. Hispanics had the lowest rates of mammography. CONCLUSIONS: Progress is being made toward Healthy People 2000 goals in New England CHC women. Despite low income status, 55% of women aged > or = 50 years had had mammograms within the past 2 years. Once cost is removed as the greatest barrier, improving patient acceptance promises the largest increase in the use of mammography screening.

Adult↗
PubMedDate not supplied

The effect of Medicare reimbursement for screening mammography on utilization and payment. National Cancer Institute Breast Cancer Screening Consortium.

OBJECTIVE: In January 1991, Medicare extended its mammography benefit to reimburse for breast cancer screening mammograms. In 1991 and again in 1993, the National Cancer Institute Breast Cancer Screening Consortium (BCSC) conducted a survey to test the hypothesis that this benefit would increase mammography use among women over the age of 65. METHODS: The authors analyzed data on non-Hispanic white women ages 65 to 74 living in 11 geographic areas targeted by the BCSC for an earlier study--six that had received cancer screening educational interventions and five control subsites--to measure the impact of the newly adopted Medicare benefit on the use of mammography and use of Medicare to reimburse mammography costs. RESULTS: The data show little overall increase between 1991 and 1993 in reported mammography use among respondents to the survey. However, in six intervention and five control subsites there was an increase in the percentage of women who reported using public payment sources to at least partially reimburse the cost of mammograms. In three intervention subsites, the increase from 1991 to 1993 in the percentage of women using public sources of payment was greater than in the corresponding control subsites. CONCLUSIONS: These findings suggest that public health interventions are more likely to succeed when educational promotion accompanies a financial benefit.

Aged↗
PubMed1976

Radiation exposure of the breast in film- and xero-mammography.

In addition to other advantages, xeoradiography, compared with film-mammography, seems to result in a lower radiation dosage to the breast. In order to get some valid information concerning this point, depth dose measurements, were carried out in a plexiglas phantom for the different radiographic factors used in film- and xero-mammography. It could be shown that the exposure of the skin and the mean exposure of the breast are generally lower in xero-mammography than in film-mammography, and that this difference increased with increasing thickness of the breast. Therefore it can be concluded that xero-mammography should be preferred on account of its lower radiation exposure, whenever it is possible from the diagnostic point of view.

Breast Neoplasms↗
PubMed1996

Mammography screening under 50: a limited perspective on a multifaceted issue.

Navarro and Kaplan's article on the cost-effectiveness of mammography screening for women under 50 offers a limited perspective on a complex and rapidly evolving issue. They suggest that eliminating mammography benefits for younger women will result in the delivery of other important women's health services, but they provide no data on the cost-effectiveness of these programs compared to mammography. Four other areas of omission significantly limit this article's scope and potential impact. Navarro and Kaplan do not discuss: 1) increasing breast cancer incidence in women under 50, particularly in African-American women; 2) the importance of breast cancer risk in relation to mammography screening; 3) the relevance of meta-analyses of randomized clinical trials done by other investigators; and 4) the heterogeneity of mammography screening recommendations in clinical practice.

Adult↗
PubMed1998

The effects of insurance coverage and ethnicity on mammography utilization in a postmenopausal population.

Despite the effectiveness of mammography as a method to detect breast cancer in women ages 50 and older, many women do not obtain screening mammograms. This study used the self-reported mammography history and demographic information obtained during the screening of 2453 post-menopausal women ages 50 to 79 at the San Diego Women's Health Initiative (WHI) center. We used this data to examine individual and social factors that predict mammography use. The WHI center comprised two clinics, one of which focused on Hispanic recruitment and thus provided the opportunity to examine the roles of ethnicity, income, education, marital status, age, and access to medical services on mammography use. Bivariate analysis indicated that the following factors were all strongly associated with women having had a mammogram in the previous two years: having health insurance, a regular medical provider, an annual household income greater than $20,000, and a high-school diploma, as well as being 65 years or older or white (P < 0.001). Multiple logistic regression analysis demonstrated that, when adjusting for all of these factors, having a medical provider (P < 0.001) was significant. Having insurance (P = 0.04) was suggestive, but did not meet the multiple-comparisons significance cutoff of P = 0.006. After adjusting for the above factors, it was found that ethnicity was not significant. The results suggest that improved access to a regular provider could increase the use of screening mammography in underserved populations.

Aged↗
PubMed1998

[Mammography and radiation risk].

Breast cancer is the most frequent malignant neoplasia among women in Germany. The use of mammography as the most relevant diagnostic procedure has increased rapidly over the last decade. Radiation risks associated with mammography may be estimated from the results of numerous epidemiological studies providing risk coefficients for breast cancer in relation to age at exposure. Various calculations can be performed using the risk coefficients. For instance, a single mammography examination (bilateral, two views of each breast) of a women aged 45 may enhance the risk of developing breast cancer during her lifetime numerically from about 12% to 12.0036%. This increase in risk is lower by a factor of 3,300 as compared to the risk of developing breast cancer in the absence of radiation exposure. At the age of 40 or more, the benefit of mammography exceeds the radiation risk by a factor of about 100. At higher ages this factor increases further. Finally, the dualism of individual risk and collective risk is considered. It is shown that the individual risk of a patient, even after multiple mammography examinations, is vanishingly small. Nevertheless, the basic principle of minimising radiation exposure must be followed to keep the collective risk in the total population as low as reasonably achievable.

Adult↗
PubMed1997

[MR mammography. Preoperative marking of non-palpable breast lesions with the Magnetom open at 0.2 T].

PURPOSE: To answer the following questions: whether reliable detection of lesions is possible in low-field-MRI-system (Magnetom Open 0.2 T) equipped with currently available hard- and software components in comparison to high field system (Magnetom Impact 1.0 T). Furthermore, whether localization of lesions suspect in MR-mammography can be realized in MR system of low field (Magnetom Open 0.2 T). PATIENTS AND METHODS: In 11 patients, suspect lesions were diagnosed in diagnostic MR-mammography acquired with high field system (Magnetom Impact 1.0 T) and were compared to low field MR-mammographies of 0.2 T (Magnetom Open 0.2 T). In six of the 11 patients a suspect lesion was localized using wire marking. RESULTS: All lesions considered suspect in diagnostic MR-mammography (Magnetom Impact 1.0 T) were also clearly identified in the 0.2 T system (Magnetom Open). In six cases wire marking was performed without any complications and with an accuracy of < or = 0.5 cm distance to the lesion. CONCLUSION: Although studies in the 0.2 T system clearly showed inferior SNR (34.6 vs. 83.1) and CNR (14.6 vs. 43.5) compared to studies with the high field system, all lesions considered suspect in diagnostic MR-mammography were reliably identified also in 0.2 T studies. Due to its open construction permitting permanent access to the breast and due to sufficient image quality, the Magnetom Open is suitable for interventions on the breast.

Biopsy↗
PubMed1997

Prognostic value of contrast-enhanced MR mammography in patients with breast cancer.

The objective of this study was to evaluate the prognostic value of contrast-enhanced MR mammography in patients with breast cancer. A total of 190 patients with breast cancer (37 noninvasive carcinomas, 153 invasive carcinomas) underwent dynamic contrast-enhanced MR mammography preoperatively. Using 1.5-T unit, T1-weighted sequences (2D FLASH) were obtained repeatedly one time before and five times after IV administration of 0.1 mmol gadopentetate-dimeglumine per kilogram body weight. The findings on MR imaging were correlated with histopathologically defined prognostic factors (histological type, tumor size, tumor grading, metastasis in lymph nodes). In addition, immunohistochemically defined prognostic factors (c-erbB-1, c-erbB-2, p53, Ki-67) were correlated with the signal increase on MR mammogram in 40 patients. There was no significant correlation between the findings on MR mammography and the histopathological type of carcinoma, the grading, and the lymphonodular status. Noninvasive carcinomas showed a higher rate of moderate (38 %) or low (27 %) enhancement on MR imaging than invasive carcinomas (6 and 3 %). The results on MR mammography and the results of immunohistochemical stainings did not correlate significantly. Noninvasive carcinomas showed significantly lower enhancement than invasive carcinomas. However, the signal behavior of contrast-enhanced MR mammography is not related to established histopathological prognostic parameters as subtyping, grading, nodal status, and the expression of certain oncogenes/tumor suppressor genes.

Biomarkers, Tumor↗
PubMed2026

Neighborhood Deprivation and Screening Mammography Utilization: A Retrospective Cross-Sectional Study.

RATIONALE AND OBJECTIVES: Access to screening mammography reduces breast cancer mortality disparities. The Area Deprivation Index (ADI) is a validated measure of neighborhood socioeconomic disadvantage linked to adverse health outcomes. There is limited data evaluating mammography utilization among patients residing in areas of higher deprivation. This study evaluated the association between ADI and screening mammography utilization within an accountable care organization (ACO) affiliated with a multicenter academic medical center in the Upper Midwest. METHODS: This retrospective cross-sectional study included women aged 40-85 years attributed to the ACO in 2022, based on Wisconsin Collaborative for Healthcare Quality criteria. The primary outcome was receipt of screening mammography within two years. The primary exposure was ADI, analyzed by decile (ordinal) and as low (deciles 1-5) versus high (deciles 6-10) deprivation. The logistic regression models evaluated associations between ADI and screening, unadjusted and adjusted for age, race, ethnicity, and preferred language. RESULTS: Among 7463 participants with geographic data, 74.4% completed screening. Screening rates were 75.7% in low-deprivation areas versus 66.2% in high-deprivation areas. Increasing ADI decile was associated with reduced screening in unadjusted (OR 0.891, 95% CI 0.87-0.91, p<0.001) and adjusted analyses (OR 0.897, 95% CI 0.88-0.92, p<0.001). Black participants (OR 0.444, p<0.001) and individuals preferring non-English languages (OR 0.333, p<0.001) had lower screening odds after adjustment. CONCLUSION: Higher neighborhood deprivation is independently associated with lower screening mammography utilization. Targeted, equity-focused interventions addressing neighborhood, racial, and language-related barriers are needed to reduce screening disparities.

Area deprivation Index↗
PubMed2001

99mTc-MIBI scintimammography as a complement of the mammography in patients with suspected breast cancer. A multicentre experience.

The aim of this work has been to evaluate the clinical usefulness of 99mTc-MIBI scintimammography, used as a complement to mammography, in the study of patients with suspected breast cancer. We performed prone breast scintigraphy in 253 patients (268 lesions) with suspected breast cancer. The size and degree of the suspected breast cancer was evaluated by mammography. Diagnosis was established by biopsy. Malignancy was diagnosed in 155 lesions and benign diseases in 113. The results of the scintimammography were a sensitivity of 91%, a specificity of 71%, PPV=81% and NPV=85%. In lesions smaller than 1 cm, sensitivity and specificity were 57% and 100%; in lesions with a diameter of between 1 and 2 cm, these figures were 90% and 72% respectively, and in lesions of more than 2 cm the sensitivity was 99% and the specificity 50%. On mammography, 155 lesions were considered as having a high suspicion of malignancy, whilst 72 were indeterminate and 41 had a low probability. In lesions with a low or indeterminate suspicion of malignancy on mammography, the sensitivity and NPV of the scintimammography were 97% and 98%. Scintimammography is a useful technique in the study of lesions where breast cancer is suspected. Scintimammography results are closely related to tumour size and the degree of mammographic suspicion. Scintimammography can be useful where mammography identifies lesions with a low or indeterminate suspicion of malignancy.

Journal Article↗
PubMed2000

Mammography pain in women treated conservatively for breast cancer.

In this study, pain during mammography in women treated conservatively for breast cancer was examined. It studied pain intensity and its relation to a variety of demographic, medical, and pain coping variables as well as to objective measures of breast compression. Ninety-nine women, treated with lumpectomy (with or without radiation) and undergoing follow-up screening mammography, were asked about strategies they use to cope with everyday pain and then were asked to report pain experienced during the mammogram. Treated and untreated breasts were rated separately and compared with a sample of 125 control women with no history of breast cancer. Women reported significantly greater pain in the treated breast (41% greater than the untreated breast and 32% greater than the control group). There was no consistent relationship between mammography pain and pain coping. Average intensity of pain at last mammogram was the best predictor of pain in both breasts. Women treated conservatively for breast cancer experience significantly greater pain during mammography of their treated breast. Radiologists and technologists can identify women at risk for a painful mammogram by asking about the pain at last mammogram. By applying pain-reducing interventions, they might be able to make the mammography experience more tolerable for these women.

Journal Article↗
PubMed1998

Digital breast imaging: tomosynthesis and digital subtraction mammography.

Advances in the computer technology and the introduction of new digital imaging detectors offer the potential for digital image acquisition and several new mammography techniques, such as tomosynthesis and digital subtraction mammography. Tomosynthesis is a method of obtaining tomographic images of a breast. In tomosynthesis, any number of tomographic planes may be reconstructed from a set of images obtained as the X-ray source is moved in an arc above the breast. By shifting and adding the information obtained at different source positions, any plane of the breast can be brought into a sharp focus, while structures outside this selected plane are blurred. This may lead to improved lesion detection, especially in dense breast tissue. Thus, tomosynthesis may play a role in improving breast cancer screening and lesion characterization. Digital subtraction mammography is a method of breast angiography. It is performed by obtaining a digital radiographic image before, and one or more digital radiographic images after the injection of a contrast agent such as iodine. The pre- and post-contrast images are subtracted, resulting in an image of the vascular structures in the breast. Because breast cancer lesions have increased vascularity, digital subtraction mammography may play an important role in improving lesion detection, characterizing lesions, monitoring response to therapy, and determining lesion extent.Thus, both of these new digital techniques have the potential to address the major limitation of conventional mammography, namely the difficulty in detecting cancer in radiographically dense breasts.

Journal Article↗
PubMed2004

Contrast-enhanced power Doppler sonography in breast lesions: effect on differential diagnosis after mammography and gray scale sonography.

OBJECTIVE: To evaluate the efficacy of contrast-enhanced power Doppler sonography in the differential diagnosis of breast lesions after a mammography-gray scale sonography combination. METHODS: Sixty-eight patients with 69 breast masses underwent power Doppler sonography before and after intravenous injection of a contrast agent. The lesions were diagnosed as "highly suggestive of malignancy" (category 5; n = 32), "suspicious" (category 4; n = 21), and "probably benign" (category 3; n = 16) by mammography and gray scale sonography, modeled on the American College of Radiology Breast Imaging Reporting and Data System classification. Power Doppler findings did not affect patient treatment. The authors subjectively evaluated the estimated area of vascularity, degree of enhancement following contrast agent administration, morphologic features, and distribution of vessels within the lesions. RESULTS: The final diagnoses were malignant in 28 lesions and benign in 41. Significant enhancement after contrast agent injection was detected in both the malignant and benign groups. Only 2 criteria, estimated area of vascularity and degree of enhancement following contrast agent administration, proved to be significant diagnostic determinants for contrast-enhanced power Doppler sonography (P < .001; interobserver agreements, 74.4 and 77.8, respectively). Contrast-enhanced power Doppler sonography provided a higher specificity, positive predictive value, and negative predictive value than power Doppler sonography but a lower sensitivity and negative predictive value than mammography-gray scale sonography. Only in the category 4 lesions could the combination of mammography-gray scale sonography and contrast-enhanced power Doppler sonography accomplish a higher specificity (71%) and positive predictive value (70%) than mammography-gray scale sonography (39% and 53%, respectively). CONCLUSIONS: Power Doppler and contrast-enhanced power Doppler sonography cannot be recommended as confirmatory tests in Breast Imaging Reporting and Data System category 3 and category 5 lesions. Although contrast-enhanced power Doppler sonography may help reduce unnecessary biopsies in Breast Imaging Reporting and Data System category 4 lesions, recommendation of its use has many drawbacks, such as imperfectly established criteria, lack of absolute certainty, and high cost.

Adult↗
PubMedDate not supplied

Digital Mammography: An Update.

Mammography remains important for early detection and diagnosis of malignant breast diseases. In recent years, digital imaging technology has been able to address the challenges inherent in film-screen mammography and improve many aspects of care. Promising techniques include needle biopsies guided by digital mammography, computer-assisted diagnosis, tomosynthesis, contrast-enhanced mammography and scintimammography. Although it is unlikely that digital mammography will revolutionize how breast cancer is treated, it continues to enhance and help provide timely and accurate detection and diagnosis.

Journal Article↗