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PubMed1995

Single-view screening mammography: psychological, endocrine and immunological effects of recalling for a complete three-view examination.

To investigate influences of a recall due to inconclusive findings on screening mammography, 45 women were examined with psychological ('mood' and 'coping'), endocrine and immunological tests immediately after complete mammography (first interview), 2-3 days after the initial screening mammography, and 3 weeks after the women had been informed of normal findings (second interview). The mood score in the first interview was significantly lower than in the second. No differences were found in the endocrine and immunological tests. The recall for complete mammography provoked a significant short-term emotional reaction not reflected in changes in the endocrine and immune functions.

Affect↗
PubMed1994

Screening mammography: interpretation of the data.

The literature on screening mammography includes a plethora of conflicting articles. More recently, individuals and various medical organizations have recommended and established their own guidelines for screening mammography. A review of salient breast screening randomized clinical trials in women over and under the age of 50 years is provided and compared with the more recent results of the Canadian National Breast Screening Study. In women under the age of 50 years, screening mammography cannot be supported from the results of these trials. In women over the age of 50 years, screening mammography leads to a significant reduction in breast cancer mortality and should be strongly recommended.

Adult↗
PubMed1994

Mammography screening guidelines for women 40 to 49 and over 65 years old.

Many organizations in the United States recommend mammography screening at 1- to 2-year intervals for those 40 to 49 years old. In most areas of Canada and Europe, screening mammography is not recommended for women 40 to 49 years old. These differences have arisen over interpretation of data from the Health Insurance Plan (HIP) study and the Breast Cancer Detection Demonstration Project (BCDDP). The apparent benefit in the HIP study is probably attributable to poor survival of control subjects with stage 1 cancers. In the BCDDP, although high cancer detection rates by mammography and improved survival of patients with screen-detected cancer were seen, the latter was probably largely due to lead time bias. The screening studies in Canada and Europe show no evidence of effectiveness of mammography screening in women 40 to 49 years old, at least in the first 10 years after screening is initiated. For women over 65 there are few data, but screening to age 74 is probably appropriate.

Adult↗
PubMed2004

Experiences with a workstation prototype for softcopy reading within the Bavarian mammography recertification program: workstations and education.

RATIONALE AND OBJECTIVES: In January 2002, the Bavarian Statutory Health Care Administration ("Kassenärztliche Vereinigung Bayerns", KVB) started a recertification program for quality assurance and quality improvement in mammography reading. MATERIALS AND METHODS: All accredited radiologists and gynecologists are asked to prove their qualification every 1-2 years. The recertification program requires the physicians to read 50 cases randomly selected from a larger collection of high-quality test cases. The portion of malignant and benign cases corresponds to the requirements of the German National Association of Statutory Health Insurance Physicians ("Kassenäztliche Bundesvereinig ung", KBV). In order to perform the recertification in a manageable manner a decentralized approach (test at different locations in parallel) was preferred over a centralized one. Therefore, the X-ray films were digitized and converted to DICOM Digital Mammography format to be read on a softcopy device. To verify the applicability of digitized mammograms for recertification purposes, a comparative study with 32 trained radiologists and gynecologists was performed. RESULTS: A system of two high-resolution/high-contrast monitors (2048 X 2560 pixels, > or = 350 cd/m2) in combination with a 5 mega-pixel dual-head graphics adapter with calibrated output was chosen for the mammography workstation. The software was implemented according to the particular requirements of this program. As a result, the comparative study showed that there was no significant difference in the error rate of the reported findings between conventional film and softcopy reading. CONCLUSION: The first intermediate results of this quality initiative are promising. As of 2003, the test is mandatory for all mammography-reading physicians in Bavaria.

Breast Neoplasms↗
PubMed2004

Factors affecting increasing radiation dose for mammography in North Carolina from 1997 through 2001: an analysis of Food and Drug Administration annual surveys.

RATIONALE AND OBJECTIVES: To determine which factors affected the increase in average glandular dose recorded at the annual US Food and Drug Administration Mammography Quality Standards Act inspections of mammography equipment in North Carolina from 1997 to 2001. MATERIALS AND METHODS: Average glandular dose, HVL, kVp, ambient light, luminance, equipment age, processing speed, and system speed for every mammography unit at all facilities in the state were collected by state inspectors. A mixed-effect model was used to assess the average changes of glandular dose over time and to identify the factors associated with these changes. RESULTS: There was a statistically significant increase in the average glandular dose in North Carolina in 1999, 2000, and 2001 when compared with the baseline year of 1997. Factors that were statistically significantly linked to this effect were changes in kVp, processing speed, and system speed. CONCLUSION: Average glandular dose for mammography has recently increased in North Carolina. This change is likely caused by changes in screen-film products and processing techniques.

Annual Reports as Topic↗
PubMed2006

Correlation of HER-2/neu overexpression with mammography and age distribution in primary breast carcinomas.

RATIONALE AND OBJECTIVES: HER-2/neu is a valuable prognostic and therapeutic marker in primary breast carcinoma. The objective of this study was to determine the mammographic and patient characteristics (age) that correlate with HER-2/neu overexpression in primary breast carcinoma. MATERIALS AND METHODS: HER-2/neu characteristics and preoperative mammograms were available in 498 patients with 543 primary breast carcinomas (526 invasive carcinomas and 17 ductal carcinoma in situ). HER-2/neu status was determined by immunohistochemistry and fluorescence in situ hybridization. For evaluation of patient age distribution, age was divided into 5 groups. For mammography, breast composition and abnormal findings were categorized. Abnormal findings were divided into mass, calcification, architectural distortion, asymmetric density, or none. RESULTS: For age distribution, women under than 50 years had more frequent HER-2/neu overexpression than women aged 60-69 years (P < .05). On mammography, there was no significant correlation between breast composition and HER-2/neu status (P > .05). Calcifications were more significantly frequent in carcinomas with HER-2/neu overexpression (56%) than in those without HER-2/neu overexpression (40%) (P = .001). Of the 242 carcinomas with calcifications on mammography, fine linear morphology was more significantly frequent in carcinomas with HER-2/neu overexpression (20%) when compared with those without HER-2/neu overexpression (10%) (P = .023). Diffuse distribution of calcifications was more common in carcinomas with HER-2/neu overexpression (11%) compared with carcinomas without HER-2/neu overexpression (5%) (P = .051). CONCLUSION: HER-2/neu overexpression in primary breast carcinoma is correlated with patients' age (under age 50) and calcifications at mammography.

Adult↗
PubMed2004

Analysis of the use of specimen mammography in breast conservation therapy.

BACKGROUND: Obtaining tumor-negative margins when performing breast-conserving surgery is the standard of care to prevent local recurrence. We believe two-view specimen mammography is a useful method for intraoperative determination of adequacy of excision. METHODS: A retrospective review was performed on patients who underwent wire-localized partial mastectomy for invasive cancer in our Breast Center from 2000 to 2001. Two-view specimen mammography reports were compared to the pathologic evaluation. RESULTS: Eighty-eight of 93 patients (95%) had complete primary excision. Sixteen patients had additional margins excised at the time of the initial operation based on specimen mammogram. Six patients would have had positive margins had additional excision at the primary surgery not been performed. CONCLUSIONS: Specimen mammography can help reduce reoperation rate by identifying patients who need additional margin excision at the time of initial surgery for breast conservation therapy. Using two-view specimen mammography, our reoperation rate was reduced from 12% to 5%.

Breast Neoplasms↗
PubMed2005

A methodology to evaluate differential costs of full field digital as compared to conventional screen film mammography in a clinical setting.

PURPOSE: The use of full field digital mammography (FFDM) in alternative to conventional screen film mammography (SFM) in the current practice is delayed by the high costs of FFDM. The present study, performed at the Centro per lo Studio e la Prevenzione Oncologica of Florence, using both FFDM and SFM, was aimed at estimating the impact of introducing the new FFDM technique on overall mammography costs. MATERIAL AND METHODS: We estimated the differential costs of both methods, based on real expenditures, as provided by the administrative department, and on radiologists, radiographers and other staff's working time. Two different workload scenarios (5000 and 10,000 tests/year per mammography equipment) were considered. Common costs of both techniques were censored for study purpose. RESULTS: Beside a higher cost due to purchase and hire/leasing costs of equipment, FFDM implies a greater workload for radiologists (reading time almost doubled). SFM implies a greater workload for the administrative staff to run the archive and for loading/unloading films of the roller viewer, whereas no different workload has been observed for radiographers. Overall FFDM costs 24.22-26.46 for examination more than SFM for the 5000 tests scenario and 9.91-12.15 more for the 10,000 tests scenario. DISCUSSION: Although present study estimates cannot easily be generalised to any local setting, the model for cost calculation is easy to be exported to another scenario by applying different local parameters. The advantages made available by FFDM (computerised data recording, tele-transmission, tele-reporting, tele-consulting, automatic display on monitor of previous exams and use of CAD) may justify the higher cost, but a limited reduction in purchase and assistance costs could easily allow a turnover, with FFDM being more convenient than SFM even on the cost side.

Breast Neoplasms↗
PubMed2006

Mammography utilization rates among young white and black women in the USA.

OBJECTIVE: To determine mammography utilization rates for randomly selected white and black women in the USA. STUDY DESIGN: This was an observational study using data from 1988 to 2000. Data were extracted from the Behavioral Risk Factor Surveillance System, an annual self-report telephone survey conducted nationally by the Centers for Disease Control and Prevention. METHODS: The main outcome measure was the mammography utilization rates of women ages 18-40 years responding to 'Have you ever had a mammogram?'. In total, 354097 women were included in this study [310336 (87.6%) white women and 43761 (12.4%) black women]. RESULTS: In women ages 18-33, black women showed consistently higher mammography utilization rates than white women. Utilization rates among women ages 18-23 years were 20.0% and 11.0% for black and white women, respectively. Among women ages 24-29 years, rates were 22.2% and 11.5% for black and white women, respectively. For women ages 30-33 years, rates were 25.7% and 18.1% for black and white women, respectively. Utilization rates were similar in black and white women over 33 years of age. CONCLUSIONS: This study found that young black women were receiving more mammography screening than young white women between 1988-2000. This may be due to the increased risk of fibroid masses in young black women.

Adolescent↗
PubMed2005

Randomized controlled trial of a repeat mammography intervention: effect of adherence definitions on results.

BACKGROUND: As overall mammography rates approach national goals, mammography promotion efforts must increasingly focus on repeat adherence. This randomized controlled trial examined the effect of two interventions on repeat mammography utilization using various adherence definitions. METHODS: 1,558 women aged 40-63 receiving a mammogram through a federally funded screening program were randomized to three groups: mailed reminder (minimum group); mailed thank you card, newsletters, and reminder (maximum group); no mailings (control). The primary outcome (repeat mammogram) was assessed 13, 15, 18, and 24 months after the qualifying mammogram using administrative data. RESULTS: The proportions receiving a repeat mammogram within 13 months were 0.28, 0.30, and 0.32 for control, minimum, and maximum groups, respectively. The corresponding proportions were 0.38, 0.43, and 0.45 at 15 months; 0.43, 0.49, and 0.51 at 18 months; and 0.47, 0.52, and 0.54 at 24 months. There were no significant differences across study groups at 13 months. The differences between control and maximum subjects at 15, 18, and 24 months were statistically significant. The differences between control and minimum subjects were significant only at 18 months. CONCLUSIONS: The two low-cost mailed interventions evaluated modestly increased repeat mammography utilization. However, effects were not visible until at least 15 months after the qualifying mammogram.

Breast Neoplasms↗
PubMed2003

Effect of false-positive mammograms on return for subsequent screening mammography.

There has been concern that false-positive mammograms may deter women from future screening mammograms. We sought to determine whether false-positive mammograms affected follow-up for rescreening. We studied a cohort of 41,844 women in the Vermont Mammography Registry. We measured the proportion of women returning for the next screening mammogram for 30 months following an initial screening mammogram, and compared rates of follow-up screening at 18 and 30 months in women with false-positive and true-negative initial mammograms. We adjusted for potential confounders using multivariable logistic regression models. Of the 2469 women aged 50 years or older with false-positive mammograms, 67.2% (n = 1660) returned at 18 months for rescreening, compared with 63.9% (16,948/26,521) of the women with true-negative mammograms (P = 0.001). Similarly, 86.8% (2143/2469) of the women with false-positive mammograms returned at 30 months for rescreening, compared with 84.7% (22,466/26,521) of the women with true-negative mammograms (P = 0.005). After adjusting for age, use of hormone replacement therapy, prior mammography, prior false-positive mammography, and education, women with false-positive mammograms were more likely to return at 18 months (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.30 to 1.51) and at 30 months (OR = 1.30; 95% CI: 1.18 to 1.44). Despite previous concerns, false-positive screening mammograms did not discourage women from returning for subsequent screening mammography. However, other deleterious effects of false-positive results still warrant improvements in the accuracy of breast cancer screening.

Adult↗
PubMed1999

Clinical value of mammography for symptomatic women 35 years of age and younger.

OBJECTIVE: This retrospective observational study was designed to answer the following question: Is mammography clinically effective in the evaluation of women </=35 years old with breast symptoms or findings. STUDY DESIGN: A retrospective review was undertaken of 1908 consecutive initial mammogram reports of symptomatic women </=35 years old who came to a referral breast clinic. The clinic records were analyzed for the working diagnoses and management plans before and after the input of the initial mammogram reports. RESULTS: Of the 4160 initial mammograms of women who came (1992-1995) to the Breast Diagnostic Center at Women's and Children Hospital, Los Angeles, Calif, 1908 were of women </=35 years old. The mammogram reports were reviewed and tabulated by age group for mammography recommendations. The working diagnoses and management plans in the center's charts were retrospectively evaluated before and after the mammogram reports to ascertain whether the mammogram reports altered clinical management in this patient population and age group. No clinically unsuspected cancers were perceived by mammography performed at the center in women </=35 years old. (All of the 23 invasive cancers were palpable and had prior diagnoses after fine-needle aspiration biopsy.) The initial mammogram reports did not change the working diagnosis or clinical management of these cases in this patient population and clinic setting. Ultrasonography was recommended by the radiologists in 37% of the study cases. CONCLUSIONS: Routine initial mammography was not cost-effective or clinically beneficial in the evaluation of breast symptoms or findings and management of the cases of women </=35 years old who came to our center.

Adenocarcinoma↗
PubMed2001

The diagnostic accuracy of mammography in the evaluation of male breast disease.

BACKGROUND: The role of mammography in the evaluation of male patients presenting with breast disease is controversial. This controversy is a function of the lack of specific data concerning the diagnostic accuracy of mammography when used in this clinical setting. The purpose of this study was to define the diagnostic accuracy of mammography in the evaluation of male breast disease. METHODS: One hundred and four prebiopsy mammograms from 100 patients with tissue diagnoses were read blindly by two independent radiologists, and placed into one of five predetermined categories: definitely malignant, possibly malignant, gynecomastia, benign mass, and normal. Radiologic/pathologic correlation was performed and the sensitivity (Sn), specificity (Sp), positive (Ppv) and negative predictive value (Npv), and accuracy (Ac) for each of the mammographic diagnostic category determined. RESULTS: The pathologic diagnoses were 12 cancers, including 1 patient with bilateral breast cancer, 70 cases of gynecomastia, 16 benign masses, and 6 normals. The accuracy data for the mammographic diagnostic categories are as follows: malignant (combined definitely and possibly malignant), Sn 92%, Sp 90%, Ppv 55%, Npv 99%, Ac 90%; and overall benignity (combined gynecomastia, benign mass, and normal), Sn 90%, Sp 92%, Ppv 99%, Npv 55%, Ac 90%. Six cancers (50%) coexisted with gynecomastia. CONCLUSIONS: Mammography can accurately distinguish between malignant and benign male breast disease. Although not a replacement for clinical examination, its routine use could substantially reduce the need for biopsy in patients whose mammograms and clinical examination suggest benign disease.

Breast Neoplasms, Male↗
PubMed1994

Reasons underlying negative mammography in patients with palpable breast cancer.

It is well recognized that a negative mammogram report does not exclude the presence of breast carcinoma. This study examines the accuracy of mammography in patients with palpable breast cancer. In particular, the study evaluates the reasons underlying negative mammography in breast cancer. All patients with Paget's disease, carcinoma in situ lesions or lesions infiltrating skin were excluded. A total of 291 patients presenting with palpable breast carcinoma underwent mammography prior to biopsy. False negative reports occurred in 16.5% (48). The sensitivity of mammography increased with age, from 70% (14/20) in 31-40-year-olds to 91% (113/124) in women over 60 years. Retrospective review of false negative mammograms showed that 30% of these were deemed normal while 20% were obvious oversights. The remaining 50% showed subtle radiographic abnormalities, consistent with but not diagnostic of malignancy.

Adult↗
PubMed2002

Screening mammography: proven benefit, continued controversy.

Screening mammography, despite its limitations, remains the best means for diagnosing breast cancer in asymptomatic women. Regarding the continuing controversies concerning the age at which screening should start, evidence supports beginning regular screening at age 40 in women at average risk . Similarly, evidence suggests that the screening interval should be yearly, especially in younger women. Rather than an arbitrary age at which screening should stop, the decision on screening elderly women should be made on an individual basis, taking into account level of health and life expectancy. More work needs to be done on determining the optimum screening strategies for high-risk women. As to the interpretation of screening mammography, a certain level of observer variability and of false-negative and false-positive readings are inherent in the process. These should be kept to a minimum through efforts by the interpreting radiologist to improve performance through auditing of individual results and continuing education. The impact of double reading and computer-aided detection in the interpretation of screening mammograms warrants further evaluation in terms of efficacy and cost-effectiveness. Despite these continuing controversies, mortality from breast cancer in the United States has been decreasing steadily for the past 25 years. The magnitude of the decrease has been reported to range from 8% to 25%. Although some of this decrease may be attributable to improvements in the treatment of breast cancer, early detection through screening mammography has undoubtedly played a role in this mortality reduction. The controversies that surround the issue of screening should not detract from the fact that screening mammography has proved to save lives.

Age Factors↗
PubMed2000

Digital mammography, sestamibi breast scintigraphy, and positron emission tomography breast imaging.

Digital mammography allows for the separate optimization of image acquisition and display. Through this technology, and the application of image processing and computer aided diagnosis, breast cancer detection and breast lesion diagnosis might be improved. Besides the obvious data storage, retrieval, and transmission advantages that digital mammography will allow, additional advances such as tomosynthesis, dual energy mammography and digital subtraction mammography are in development. The possible future utility of Sestamibi breast scintigraphy and breast imaging with positron emission tomography is also discussed.

Breast↗
PubMed1997

Storage phosphor digital mammography.

Digital mammography using storage phosphor CR is still in the investigational stage. It is the only digital mammography system that has been tested in preliminary clinical trials with promising early results. Further clinical studies are needed to assess the impact of the limited spatial resolution of storage phosphor technology on its application as a digital screening mammography system. Further studies also are needed to determine the optimum image processing parameters needed in digital mammography.

Breast Neoplasms↗
PubMed2003

Comparison of tailored interventions to increase mammography screening in nonadherent older women.

BACKGROUND: Recent increases in mammography use have led to a decrease in mortality from breast cancer. METHODS: Building on the Health Belief Model, the Transtheoretical Model, and past effectiveness of tailored interventions, we conducted a prospective randomized trial (n = 773) to test the efficacy on mammography adherence of tailored interventions delivered by five different methods, i.e., telephone counseling, in-person counseling, physician letter, and combinations of telephone with letter and in-person with letter. RESULTS: All five interventions increased mammography adherence significantly relative to usual care (odds ratios, 1.93 to 3.55) at 6 months post intervention. The combination of in-person with physician letter was significantly more effective than telephone alone or letter alone. Women thinking about getting a mammogram at baseline were more likely to be adherent by 6 months; even those in usual care achieved 48% adherence compared with 50-70% in the intervention groups. In contrast, women not thinking about getting a mammogram needed the interventions to increase their adherence from 13% to over 30%. CONCLUSIONS: All five interventions were effective at increasing mammography adherence. Women not thinking about getting a mammogram were most likely to benefit from these tailored interventions while other women might need less intensive interventions.

Breast Neoplasms↗