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PubMedDate not supplied

Is mammography useful in screening for local recurrences in patients with TRAM flap breast reconstruction after mastectomy for multifocal DCIS?

BACKGROUND: Skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction is being used more often for the treatment of breast cancer. Mammography is not used routinely to evaluate TRAM flaps in women who have undergone mastectomy. We have identified the potential value of its use in selected patients. METHODS AND RESULTS: We report on four women who manifested local recurrences in TRAM flaps after initial treatment for ductal carcinoma in situ (DCIS) or DCIS with microinvasion undergoing skin-sparing mastectomy and immediate reconstruction. All four patients presented with extensive, high-grade, multifocal DCIS that precluded breast conservation. Three of four mastectomy specimens demonstrated tumor close to the surgical margin. Three of the four recurrences were detected by physical examination; the remaining local recurrence was documented by screening mammography. The recurrences had features suggestive of malignancy on mammography. CONCLUSION: We conclude that all patients undergoing mastectomy and TRAM reconstruction for extensive, multifocal DCIS should undergo regular routine mammography of the reconstructed breast. Our experience with this subgroup of patients raises concern about the value of skin-sparing mastectomy with immediate reconstruction for therapy. Adjuvant radiation therapy should be recommended for those patients with negative but close surgical margins.

Adult↗
PubMed1996

A test of two interventions to improve compliance with scheduled mammography appointments.

Failure to attend scheduled appointments for mammography results in missed opportunities for breast cancer screening. We tested interventions to decrease mammography appointment failure among women attending the medicine clinic at a public teaching hospital. Consecutive women with mammography orders from October 1992 to November 1993 (970 women undergoing 1,072 mammograms) were assigned to one of three comparison groups: usual care, mailed reminder, and mailed reminder plus nurse counseling. The appointment failure rates were 25.5% in the usual care group, 20.3% in the mailed reminder group, and 19.7% in the special intervention group (p = .13). We conclude that mailed reminders modestly improve mammography appointment keeping by about 5%, and that nurse counseling has little additional effect.

Appointments and Schedules↗
PubMed1995

Who gets repeat screening mammography: the role of the physician.

To determine rates of, and explore physician factors associated with, repeat mammography, administrative data for 791 women aged 50 years and older were examined. Three-fourths of the women (73%) received repeat mammography (i.e., a second mammogram was obtained within six to 18 months of the first). Provider factors associated with higher repeat mammography rates were: being a woman, practicing in the women's health group rather than the general internal medicine service, and being a fellow or an attending physician (p-values < 0.01). Patients of women attendings/fellows had higher repeat mammography rates than did those of men attendings/fellows, men residents, and women residents. Characteristics (gender, level of training) of providers strongly influence their patients' screening behavior.

Boston↗
PubMed2000

Barriers to mammography and Pap smear screening among women who recently had neither, one or both types of screening.

There is legitimate concern about whether cancer screening programs and other types of prevention and early detection programs are designed to reach those most in need of services. Previous research on barriers to screening has generally addressed screening for specific cancers. The purpose of this study was to evaluate and compare the types and strengths of barriers to both mammography and Pap smear screening experienced by three groups of women. Five hundred and twenty-two women, aged 52-69, who were members of a large health maintenance organization (HMO), completed a survey about cancer screening and associated barriers. Women with no mammogram in the preceding 2 years and with no Pap smear in 3 years were classified into a "safety net" program. We classified women as falling into both (Pap smear and mammography), one (Pap smear or mammography), or neither safety nets. Results consistently revealed that women needing both tests had more numerous and more intense barriers than other women to both types of screening. Factor analyses and descriptive analyses both showed that the types of barriers experienced were very similar for mammography and Pap smear screening. The discussion addresses intervention implications and the additional research needed on women who need both mammogram and Pap smear screening and who have much higher cancer risk than other women.

Aged↗
PubMed1995

Dual-energy subtraction mammography.

Dual-energy subtraction mammography was performed for breast examinations. To obtain a dual-energy subtraction image with a digital radiography unit, high- and low-energy images were obtained at an appropriate time interval under different x-ray exposure conditions. In about 50% of the patients with breast cancer included in this study, we obtained better diagnostic accuracy with dual-energy subtraction images than with conventional mammography. In some cases of breast cancer, it is possible to diagnose intraductal spread of this lesion on the subtracted images. Furthermore, abnormal lesions commonly observed on mammography in cases of fibrocystic disease tended to be erased on subtracted images. Thus, dual-energy subtraction mammography provided useful information for diagnosing breast diseases. However, there were several cases in which the subtracted images lacked sufficient image quality, and several technical problems with subtraction are thought to remain.

Breast Neoplasms↗
PubMed1999

Process mapping in screening mammography.

Successful screening mammography programs aim to screen large numbers of women efficiently and inexpensively. Development of an effective screening mammography program requires skilled personnel, solid infrastructure, and a robust computer system. A group of physicians, technologists, computer support personnel, and administrators carefully analyzed a growing screening mammography program as a series of steps, starting with the request for the examination and ending with the receipt of a hard-copy consultation. The analysis involved a detailed examination of every step and every possible outcome in the screening process. The information gained through process mapping may be used for identification of systemic and personnel problems, allocation of resources, modification of workplace architecture, and design of computer networks. Process mapping is helpful for those involved in designing and improving screening mammography programs. Viewing a process (i.e., obtaining a screening mammogram) as a series of steps may allow for the identification of inefficient components that may limit growth.

Adult↗
PubMed1999

[Preoperative MR mammography in breast carcinoma. Effect on operative treatment from the surgical viewpoint].

INTRODUCTION: In a prospective study the diagnostic validity of magnetic resonance mammography (MRM) as well as its impact on the choice of the operative procedure in the treatment of breast cancer was examined. In 125 patients who were suspected of having breast cancer by clinical examination, ultrasound, and X-ray mammography, additional bilateral MRM was performed. Of special interest was the diagnostic potential of MRM with regard to multifocal, multicentric and contralateral lesions. METHODS: After a complete resection all lesions diagnosed by the various conventional methods were examined patho-histologically. In 112 patients, complete data were available to calculate the sensitivity and the specificity of each method as well as to correlate its results with the pathohistological findings. RESULTS: In 91 cases, a breast carcinoma was diagnosed by conventional methods, with a sensitivity/specificity of 73%/67% for clinical examination, of 58%/86% for ultrasound, and of 89%/20% for X-ray mammography. In this preselected series of patients with a prevalence of 81.25% the diagnosis established by the various methods was confirmed by MRM with sensitivity of 96.7% and specificity of 19%. Forty-six additional suspicious lesions were found only by MRM, of which 28 were malignant (25 multifocal or multicentric and 3 contralateral carcinomas), and 18 benign. The rate of false-positive MRM results was 18%. Due to the MRM findings, the therapeutic procedure was changed from breast preservation to mastectomy in 14.3%. CONCLUSION: Not only for the differential diagnosis of discrepant findings between X-ray mammography and ultrasound, but especially for the diagnosis of multifocal or multicentric lesions, MRM seems to be the method of choice. Consequently, MRM plays an important role in planning the operative procedure in breast cancer patients, especially in the context of breast preservation. To ensure optimal use of this new diagnostic tool high technical standards, proper expertise on the part of the examining radiologist, and effective cooperation among the involved disciplines (radiology, pathology, surgery) must be guaranteed.

Adult↗
PubMed2005

[Clinical results of digital mammography].

Digital mammography is the technology of the future in breast diagnosis. This article provides an overview of all digital mammography units admitted by the Food and Drug Administration (FDA), results of clinical studies, soft copy reading, CAD (computer aided detection), and presents an overview on possible further developments. It is obvious that clinical results are equivalent to conventional screen film mammography and digital mammography.

Breast Neoplasms↗
PubMed2004

Dedicated screening mammography for diagnosis of small breast cancer.

Breast cancer is the most common malignancy in women, and early diagnosis is a cornerstone of successful treatment. Mammography is the sole acceptable method for breast cancer screening, but its efficacy is still disputable. The aim of this study was to determine whether the influence of dedicated mammographic team skills could improve the diagnostic accuracy of screening mammography and detection of small breast cancers. From June 1992 to September 1996 a total of 17,393 screening mammograms and 335 mammographically guided needle-localization breast biopsies were performed. From August 1994, a dedicated mammographer commenced work in our hospital. Screening mammography and biopsy results were compared for the nondedicated period (NDP) and the dedicated period (DP). The biopsy rate decreased from 2.9% to 1.3% (p < 0.0001), and the positive biopsy rate increased from 26.3% to 48.2% (p < 0.0001) during the respective periods. The cancer detection rate not changed significantly (p = 0.27) through the whole study period, but the subgroup of small carcinomas (T0, T1a, T1b) increased significantly (p < 0.04), from 25 cases in the NDP to 40 cases in the DP. We concluded that dedicated mammography team skills can significantly improve the detection of small breast cancers and permit more effective diagnosis of breast cancer by reducing the number of breast biopsies ultimately found to be benign.

Adult↗
PubMed2002

Comparison of lesion size estimated by dynamic MR imaging, mammography and histopathology in breast neoplasms.

To evaluate the accordance of size measurements of malignant breast lesions 65 women with 76 malignant lesions were preoperatively examined with triple diagnosis (mammography was performed in three views with additional views if necessary) and dynamic MR imaging using a subtraction technique with a 3D T1-weighted sequence. Maximum lesion size at histopathology was used as gold standard and compared with maximum lesion size at MRI and mammography. All measurements were made independently for each method. Histopathology verified 48 invasive, 5 in situ, and 23 mixed lesions. No significant difference was found for the pure invasive lesions ( p=0.366). In the mixed lesions a slightly better result for MRI was indicated ( p=0.116), although there was a great spread. Only five pure in situ lesions were assessed, too few to draw any statistical conclusions ( p>0.5). An overall difference indicated a slight superiority of MRI ( p=0.097). The MR imaging and mammography are both good at measuring the size of detected invasive breast malignancies. The total sizes of mixed lesions are frequently underestimated by both MRI and mammography, although the invasive parts were equally well described and measured with both methods.

Breast↗
PubMed2003

Patient dose in full-field digital mammography: an Italian survey.

The aim of this study was to compare performance and patient dose of full-field digital mammography units for clinical use. Measurements of linearity and automatic exposure control stability were performed on four units installed in as many Italian sites. The tube output was also obtained by the same ionization chamber, permitting to evaluate ratios mGy/mAs for each available spectrum. The entrance air-kerma was calculated over a sample of 800 cranio-caudal mammograms and the average glandular dose obtained, assuming two mean glandular compositions of 50 and 30%, respectively. Digital systems showed very good linearity and comparable responses. The stability of the automatic exposure control was better than 5% for all systems. Regarding doses, the two mammography units that work mainly in contrast mode deliver, respectively, 17 and 28% more dose compared with those working in standard mode. For the latter mode, the mean average glandular dose was in the range 1.25-1.37 mGy and 1.37-1.49 mGy for the 50 and 30% glandular composition, respectively. Results of this study were compared with those of other surveys, showing that full-field digital mammography allows a significant clinical dose reduction compared with screen/film mammography.

Breast↗
PubMed2004

Enhancing area surrounding breast carcinoma on MR mammography: comparison with pathological examination.

The enhancing area surrounding breast carcinoma on MR mammography is correlated with findings from pathological examination. We studied 194 patients with breast cancer who underwent preoperative MR mammography. Of all malignant lesions presenting with an enhancing surrounding area on MR mammography, morphologic features including long spicules, a ductal pattern, diffuse enhancement or nodules were evaluated and compared with histopathological examination. A double breast coil was used; we performed a 3D FLASH sequence with contiguous coronal slices of 2 mm, before and after injection of 0.2 mmol/kg GD-DTPA, and subtraction images were obtained. In total, 297 malignant lesions were detected at MR mammography and 101 of them had one or more types of enhancing surrounding area. In 49 of the 53 cancers with long spicules and in 49 of the 55 cancers with surrounding ductal pattern of enhancement, pathological examination showed in situ and/or invasive carcinoma. Multiple nodules adjacent to the carcinoma were seen in 20 patients and corresponded with six cases of invasive and ten cases of ductal in situ carcinoma. A diffuse enhancing area next to a mass was seen in ten patients and consisted of carcinoma in all cases: seven in situ and three invasive carcinomas. Enhancing areas including long spicules, a ductal pattern, noduli, or diffuse enhancement surrounding a carcinoma corresponded with in situ or invasive extension of the carcinoma in 92.5, 89, 80 and 100% of cases, respectively.

Adult↗
PubMed2000

Diagnosis of papillomas of the breast: value of magnetic resonance mammography in comparison with galactography.

The aim of this study was evaluation of MRI alone and in combination with mammography and galactography in the diagnosis of intraductal papillomas. From 1994 to 1998, a total of 48 women presenting with pathologic mammary secretion underwent galactography and magnetic resonance mammography (MRM). Thirty-five patients aged 16-71 years (average age 46 years) subsequently underwent surgery or diagnostic puncture and the histologic findings were compared with the results of the radiologic examination. Histology revealed papillomas in 16 cases. In 6 of these patients, there was associated malignant degeneration. Malignancy without associated papilloma was observed in 3 cases. Galactography displayed a sensitivity of 94% and a specificity of 79% with five false-positive findings and one false-negative finding in the recognition of intraductal papillomas. Malignant processes were detected by mammography/galactography in only one instance. Magnetic resonance mammography visualized pathologic contrast medium uptake in 8 of 9 cases of malignant disease (sensitivity 89%). One patient with in situ ductal carcinoma escaped detection with MRM. Papillomas showed no or below-the-threshold-lying contrast uptakes with no specific sign suggestive of papilloma. Galactography in combination with mammography remains the primary diagnostic procedure in cases of pathologic mammary secretion or suspected papilloma. The addition of MRI permits exclusion of malignant disease with a high degree of certainty; thus, expectant management in individual cases with negative findings appears justified.

Breast↗
PubMed1998

Magnification survey and spot view mammography with a new microfocus X-ray unit: detail resolution and radiation exposure.

The aim of our study was to evaluate a mammography unit capable of magnification of up to fourfold at an equivalent or lower dose than with current systems. A prototype mammography tube with an electron-beam-focusing technology resulting in a focal spot size of 40-120 micro m was combined with a highly intensifying screen-film system. To evaluate contrast-detail resolution, phantom radiographs were performed with the prototype magnification mammography system using a magnification factor of 1.7 for survey views and a magnification factor of 4.0 for spot views. They were compared with unmagnified survey views and magnification spot views (magnification factor 1.9) of a state-of-the-art mammography system. The radiation exposure was measured and mean glandular doses were calculated. The contrast-detail resolution with both prototype (m = 1.7) and conventional (m = 1.1) survey views was equivalent while the entrance dose and the mean glandular dose were approximately 50 % lower with the prototype. For spot views, the contrast-detail resolution was substantially higher for the prototype than for conventional magnification while the dose was equivalent. Dose reduction and improved detail resolution are possible with this new technology.

Acrylic Resins↗
PubMed2005

Breast cancer screening barriers and mammography completion in older minority women.

UNLABELLED: OBJECTIVES The study tested a behavioral and structural barriers model of breast cancer screening, while seeking to determine age effects of behavioral barriers, in order to identify the factors that inhibit screening among older, minority women. METHODS: 405 older African-American women eligible for a federally funded cancer screening program were enrolled in the study. Participants were administered an intake questionnaire and followed for 3 months to determine mammography use. RESULTS: Three months after enrollment in the program, 79% had not received breast cancer screening. The oldest cohort had significantly lower rates of mammography (just 16% of screened women were > or = 60, p<0.05). Behavioral barriers (knowledge/information deficits, cancer risk perception, cancer fears) inhibited mammography in the oldest group; their breast cancer information deficits included less knowledge of breast cancer risk, treatment, and survivability (all p<0.001). CONCLUSIONS: Older women, with greater breast cancer risk than younger cohorts, should be targeted as a high need population for cancer screening. Even when financial and insurance barriers are removed mammography rates are 1/3 those of women <50. Since failure to be screened is related to knowledge and information barriers, health care providers have the potential to educate their older patients and subsequently increase the likelihood they will have regular cancer screening.

Black or African American↗
PubMed2006

Factors affecting sensitivity and specificity of screening mammography and MRI in women with an inherited risk for breast cancer.

BACKGROUND: The MRISC study is a screening study, in which women with an increased risk of hereditary breast cancer are screened by a yearly mammography and MRI, and half-yearly clinical breast examination. The sensitivity found in this study was 40% for mammography and 71% for MRI and the specificity was 95 and 90%, respectively. In the current subsequent study we investigated whether these results are influenced by age, a BRCA1/2 mutation, menopausal status and breast density. PATIENTS AND METHODS: From November 1999 to October 2003, 1909 eligible women were screened and 50 breast cancers were detected. For the current analysis, data of 4134 screening rounds and 45 detected breast cancers were used. For both imaging modalities, screening parameters, receiver operating characteristic (ROC) curves and uni- and multivariate odds ratios (ORs) were calculated. All analyses were separately performed for age at entry (< 40, 40-49, > or =50), mutation status, menopausal status and breast density. RESULTS: Sensitivity of MRI was decreased in women with high breast density (adjusted OR 0.08). False-positive rates of both mammography (OR(adj) 1.67) and MRI (OR(adj) 1.21) were increased by high breast density, that of MRI by pre-menopausal status (OR(adj) 1.70), young age (OR(adj) 1.58 for women 40-49 years versus women > or =50 years) and decreased in BRCA1/2 mutation carriers (OR(adj) 0.74). In all investigated subgroups the discriminating capacity (measured by the area under the ROC-curve) was higher for MRI than for mammography, with the largest differences for BRCA1/2 mutation carriers (0.237), for women between 40 and 49 years (0.227) and for women with a low breast density (0.237). CONCLUSIONS: This report supports the earlier recommendation that MRI should be a standard screening method for breast cancer in BRCA1/2 mutation carriers.

Adult↗
PubMed2006

Minority report - false negative breast assessment in women recalled for suspicious screening mammography: imaging and pathological features, and associated delay in diagnosis.

AIM: We studied imaging, pathology and diagnostic aspects of false negative assessment (FNA) in women recalled for suspicious screening mammography. METHOD: Subjects were women aged 50-69 years undergoing biennial screening mammography within the Florence District screening programme from January 1992-December 2001 (339,953 consecutive screens). We identified all cancers occurring in women recalled to assessment and ascertained, and reviewed, all cases considered as negative on assessment and subsequently diagnosed with breast cancer. We compared imaging features, tumour histology and stage, and diagnostic testing on assessment for all women with cancer, and presentation and length of delay in women falsely negative on assessment. RESULTS: Eleven thousand six hundred and twenty four women were recalled to diagnostic assessment (recall rate = 3.4%) predominantly for suspicious mammography (9,216 positive screens). Breast cancer was missed in 57 cases: a FNA rate of 0.50% (0.37-0.62%) and comprising 4.1% (3.0-5.1%) of cancers occurring in women recalled after a positive screen. Two types of abnormalities were significantly more frequent in FNA cases than cancers detected at assessment: mass with regular borders (21.1 vs. 5.6%, p = 10(-5)), and asymmetrical density (22.8 vs. 5.4%, p = 10(-5)). On review 56% of FNAs were benign or probably benign BI-RADS categories. FNA occurred in 1.4% of early recalls and in 0.4% of initial assessment (p=0.0001). Significantly fewer tests were performed when assessing missed cancers than detected cancers with the most significant difference noted for FNAC (29.8 vs. 96.0%, p=10(-6)); mammography as the only evaluation on assessment was more frequent in missed cancers (31.5% vs 0.2%, p = 10(-6)). The 57 missed cases were subsequently diagnosed at early recall (2 cases), next biennial screen (11 cases), or as interval breast cancers (44 cases) with a mean delay in diagnosis of 628 days. Tumour histology, size and nodal status did not significantly differ between cancers missed and cancers diagnosed on assessment. CONCLUSION: False negatives on assessment represent a minority group in whom screening has failed. They might be reduced by adopting a more intensive diagnostic approach to assessment. Although there was no evidence of a worse prognosis in cancers missed at assessment, the delay in diagnosis is substantial and may impact long-term outcomes.

Aged↗
PubMed1992

Breast cancer survival among women under age 50: is mammography detrimental?

Great uncertainty exists about the benefit of detecting breast cancer by mammography in women under 50 years of age. We have reviewed the survival of patients aged 49 years or less whose cancers were detected by mammography alone. 117 women under the age of 50 years were diagnosed with breast cancer between 1978 and 1991 based only on an abnormal mammogram. Ductal carcinoma in-situ (DCIS) was found in 47 (40%) of these women, whilst 70 (60%) had infiltrating ductal or infiltrating lobular carcinomas. During the same interval, 928 women in this age group presented with palpable breast cancer. DCIS was diagnosed in 82 (9%) of these women, whilst 846 (91%) had infiltrating carcinoma. Among the infiltrating cancers detected by mammography alone, 50% were stage I, whilst only 30% of the women with palpable cancers were stage I. Five-year survival for all mammographically detected cancer patients was 95%, whereas for women with palpable cancers the survival was 74% (p < 0.00005). If DCIS is not included, the corresponding survivals are 91% for mammographically detected infiltrating cancers and 72% for palpable infiltrating cancers. Only 1 woman who died among those with palpable cancer had had a mammogram before diagnosis. Our data contradict the suggestion that women under 50 are put at a survival disadvantage by undergoing mammography. We believe that investigators who have reported negative results in this age group must examine other causes for their results.

Actuarial Analysis↗