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PubMed1991

A program to improve mammography skills of practicing radiologic technologists.

Periodic screening mammography and clinical breast examination have significantly reduced the breast cancer mortality rate in the United States for women 50 years of age and older. The Breast Cancer Screening Project of the University of Massachusetts, Worcester, developed a pilot mammography continuing-education program for radiologic technologists that included a didactic and a clinical on-site, hands-on training workshop with preinstruction, postinstruction, and six-month follow-up evaluations to improve their mammography skills. Because of a small sample size, a high dropout rate, and limitations in study design, posttest gains cannot be attributed to the program. Most significant is the finding of wide variability in radiologic technologists' mammography skills, which may compromise mammogram quality and the value of such screening.

Breast Neoplasms↗
PubMed1975

Validity of clinical examination and mammography as screening tests for breast cancer.

This study is aiming to determine the validity and observer variability of clinical examination and mammography as screening tests for breast cancer. Women over the age of forty are given two independent clinical examinations of the breasts, and mammograms are taken and read independently by two radiologists. This paper presents the results of screening the first 1215 women to be enrolled in the study. At their first screening attendance, 231 women (19%) were referred for surgical opinion, 119 (9-8%) underwent biopsy, and cancer was diagnosed in 17 (1-4%). 2 further cancers were diagnosed in the ensuing six months among women who had been negative on initial screening, representing a false-negative rate of 2 out of 19 (11%). Clinical examination resulted in 189 referrals (15-6%), 90 biopsies (7-4%), and detected 11 cancers; corresponding figures for mammography were 76 referrals (6-3%), 55 biopsies ((4-5%), and 14 cancers. Observer variability was greater for clinical examination than for mammography. These early results suggest that as a screening test mammography compares favourably with clinical examination, but both tests are necessary if many false negatives are to be avoided.

Adult↗
PubMedDate not supplied

Do women who screen positive for mental disorders in primary care have lower mammography rates?

Disparities in mammography rates have been documented for underserved populations, yet no data are available for women with mental illness in primary care settings. We analyzed data on mammography rates for 526 women age 40-70 who were new patients and completed the Primary Care Evaluation of Mental Disorders (PRIME-MD). There were no significant differences in mammography rates among women who screened negative and positive for any mental illness (56% and 53%, respectively). Screening for mental disorders in primary care does not appear to identify women at risk for nonreceipt of mammography.

Adult↗
PubMedDate not supplied

[The practice of preventive mammography in Catalonia [Spain]: a step forward].

OBJECTIVE: To determine and compare the practice of periodic preventive mammography in women aged 50-69 years in the eight health regions of Catalonia in 1994 and 2002. METHODS: Data from the 1994 and 2002 Catalan Health Survey Interview were used. A cross-sectional survey of a representative sample of the non-institutionalized population of Catalonia was performed. All women aged 20 years old or older who directly answered the questionnaire (5,986 and 3,265 women in 1994 and 2002, respectively) were included. The influence of age, social class, type of health insurance and health region was evaluated using multivariate logistic regression analysis. RESULTS: In 1994, women aged 40-49 years reported a higher proportion of mammographic screening (42.8% of women in this age group) than the other groups, while in 2002 the highest proportion (76.3%) was observed in women aged 50-59 years. Rates of screening mammography in women aged 50-69 years were 26.9% in 1994 and 69.1% in 2002, increasing in all health regions and reducing differences among regions. In 1994 and 2002 women in the most advantaged social classes (I, II and III) reported higher proportions of mammographic screening than those in social class V, although this gap was smaller in 2002. CONCLUSIONS: The practice of preventive periodic mammography has significantly increased in women in the target group (women aged 50-69 years). Preventive mammography was lower in non-targeted age groups except in the group of women aged 40-49 years old, in which it was significantly increased. No significant differences in the practice of mammographic screening were observed among health regions in 2002.

Adolescent↗
PubMed2002

Ultrasound as a complement to mammography and breast examination to characterize breast masses.

This study was designed to determine if complementary ultrasound (US) imaging and Doppler could decrease the number of biopsies for benign masses. A total of 761 breast masses were sequentially scored on a level of suspicion (LOS) of 1-5, where 1 represented low, and 5 was a high suspicion of malignancy, for mammography, US, and color flow with pulse Doppler (DUS). After biopsy, the results were analyzed using 2 x 2 contingency tables and ROC analysis, for mammography alone and in combination with US and DUS. The addition of US increased the specificity from 51.4% to 66.4% at a prevalence of 31.3% malignancy. ROC analysis showed that the addition of US significantly improved the performance over mammography alone in women < 55 years old (p = 0.049); > 55 years old (p = 0.029); masses < 1 cm (p = 0.016) and masses > 1 cm (p = 0.016). These results show that the addition of US to mammography alone could substantially reduce the number of breast biopsies for benign disease.

Biopsy↗
PubMed2003

Health beliefs, salience of breast cancer family history, and involvement with breast cancer issues: adherence to annual mammography screening recommendations.

Involvement in breast cancer (BC) issues, and the degree to which family history of BC influences perceived risk (salience of family history), have been proposed as additions to the Health Belief Model as applied to mammography adherence. Barriers and benefits of mammography, perceived susceptibility, severity, cues to action, salience of family history, and issue involvement with respect to BC were examined in adherent (n=97) and non-adherent (n=213) women. Adherent women with positive family histories reported greater benefits of mammography, greater response to cues to action, and higher salience of family history than women with negative family histories. Non-adherent women with positive family histories reported fewer benefits of mammography and greater issue involvement, and perceived BC as less severe than those with negative family histories. Benefits (OR=1.51), susceptibility (OR=1.41), issue involvement (OR=1.59), severity (OR=0.66), and cues to action (OR=0.75) were significantly associated with adherence. Results have implications for evidence-based interventions.

Adult↗
PubMed1999

Full-field digital mammography designed as a complete system.

Although mammography is currently considered by many to be the best tool for the early detection of breast cancer, conventional film-screen imaging is still far from perfect. A fundamental limitation of film-screen mammography is the fact that the detection, display and storage devices are one and the same, making it impossible to separately optimize each device. In addition to a potentially equivalent or better image quality compared to the film-screen technology, full-field digital mammography (FFDM) will provide the radiologist with numerous advantages: digital image management, digital data transfer and new medical applications. Nevertheless, to fulfil the potential of digital mammography, an FFDM unit must not only provide an outstanding technology for X-ray detection, but should be designed as a complete system. Each component of the FFDM system should be designed to provide or to increase the current image quality, the current ease of use and the current throughput: the X-ray tube, the gantry, the image receptor packaging, the detector, the acquisition electronics, the softcopy review workstation, the user interface, as well as the network capabilities.

Breast Diseases↗
PubMed1998

The effectiveness of mailed patient reminders on mammography screening: a meta-analysis.

BACKGROUND: Researchers have tried to increase mammography screening rates by using patient-oriented reminders. This paper compares the effectiveness of mailed patient reminders at increasing mammography screening. METHODS: Sixteen published articles met the inclusion criteria and were included in the meta-analysis. To assess the association between reminders and mammography screening, the Mantel-Haenszel odds ratio (OR) was calculated. RESULTS: Among U.S. studies in which controls did not receive any type of reminder, women who received reminders were approximately 50% more likely to get a mammogram (OR 1.48; chi(2)MH(1) = 38.27, P < .001). In addition, tailored letters were found to be more effective than generic reminders (OR 1.87; chi(2)MH(1) = 4.70, P < .05). Combining cost and effectiveness data allowed for estimates of cost per woman screened, which ranged from $0.96 to $5.88. CONCLUSIONS: Patient reminders are effective at increasing mammography screening. More research is needed to assess (1) the cost-effectiveness of patient reminders and (2) their effectiveness across race, education, income, and type of insurance.

Breast Neoplasms↗
PubMed2002

Current status of screening mammography.

The results of RCTs conducted around the world indicate that screening mammography can substantially reduce death rates from breast cancer among women aged 40 years and over. Compelling evidence suggests that annual screening should be more effective than screening offered every 1 to 2 years. Annual screening beginning at age 40 years is now recommended by the American Cancer Society, the American Medical Association, and the American College of Radiology* Based on Swedish studies, it is likely that screening mammography can reduce breast cancer deaths by at least 50%. Screening mammography is highly cost-effective and can be performed at acceptable levels of radiation risk and rates of false-positive biopsies. By recommending screening mammography to their patients, the primary care physician can have a pivotal role in reducing the death rate from a major disease of women, similar to the effectiveness of screening for carcinoma of the cervix.

Adult↗
PubMed1998

Mammography use by elderly women: a methodological comparison of two national data sources.

PURPOSE: Estimates of mammography utilization vary considerably, depending on the data source. Among women aged 65 years and older, recent estimates of annual mammography derived from the 1992 National Health Interview Survey (NHIS) were 50% higher than estimates from Medicare claims. We investigated possible reasons for the different estimates. METHODS: We identified differences in the populations covered by the two data sources and made appropriate adjustments. Differences due to age were addressed by age restriction and age adjustment. Women in health maintenance organizations were eliminated from the NHIS sample so it more closely resembled the Medicare database, and estimates of mammography utilization by noninstitutionalized women were derived for Medicare to increase comparability with NHIS. By using the Medicare Current Beneficiary Survey to obtain individual-level comparisons between self-report and claims, we explored potential biases in self-reported data and missing claims. RESULTS: Differences between the sample populations accounted for more than one-fourth of the rate difference. About half of the difference could be attributed to erroneous self-reports, biases in self-reported dates (forward and reverse telescoping) and missing Medicare claims. CONCLUSIONS: Most of the discrepancy between the two data sources can be plausibly explained. However, caution must be used in using either data source alone, or both together, to represent the "true" mammography rate.

Aged↗
PubMed2000

Localization of concealed norplant implants and implant fragments by a modified mammography technique.

A modified mammography technique for localization of concealed Norplant implants and Norplant fragments was applied to four patients, ages 18, 35, 22, and 25. A dedicated mammography unit and mammography film screen system affording high resolution and high contrast was applied under the same conditions to each patient. 26 kilovoltage peak (KVp) was used, ranging from 60 to 150 milliamperes. Using both the automatic exposure control and manual techniques, specific milliampere range depended on the specific case. The technique proved successful, as concealed Norplant capsules were exquisitely visualized by films obtained with a Siemens Mammomat 3000. Applying the same modified technique, precise location of the Norplant implants was determined using a fenestrated compression plate with an alphanumeric grid in a manner similar to hookwire localization of breast lesions under mammographic guidance. The capsules were then safely retrieved. We conclude that this modified technique may provide practitioners with valuable assistance in the exact localization of the Norplant capsule(s) or fragments, thereby facilitating their removal. Application of a modified mammography technique reveals precise localization of concealed Norplant capsules facilitating their removal.

Adolescent↗
PubMedDate not supplied

[Psychological adjustment of short interval follow-up mammography: about 50 cases].

The objective was to investigate women's perceptions and the perceived stress experience when undergoing surveillance mammography for benign lesions (ACR3, BI-RADS). A semi-prospective study was carried out on women with diagnosed "probably benign" breast abnormalities. It was a multicentric study from 1st March to 10th June 2002. The survey was performed at the first follow-up mammography and included questions about perceptions and perceived stress related to the follow-up experience. The response is analysed with chi-square test. Fifty women (35-75 years) answered the questionnaire. All women were satisfied with reception. The mammographies were painful (23 cases). Subsequent time seemed to be too long (seven cases) and they were anxious in 19 cases. Quality of life was spoiled (disturbed) (20 cases). Professional and social perturbations were not frequent (four cases). Speaking to a relative is frequent (39 cases), but patients were not satisfied with it (33 cases). Medical information was estimated (47 cases) but was not satisfactory (36 cases). The median of the stress scale is 4-5. There are two pickaxes, one at 2 (11 cases), the second at 5 (8 cases). "Low-stressed" women could have an avoidance coping. "High-stressed" women could use a helplessness- hopelessness coping strategy. Women reported a good and informative medical support and adequate comprehension of the short follow-up mammography. They were reassured by the medical care, but the evaluation of the stress level shows it to be high, probably due to the uncertainty of diagnosis.

Adaptation, Psychological↗
PubMed1999

Breast cancer screening by mammography in Norway. Is it cost-effective?

BACKGROUND: Mammography screening is a promising method for improving prognosis in breast cancer. PATIENTS AND METHODS: In this economic analysis, data from the Norwegian Mammography Project (NMP), the National Health Administration (NMA) and the Norwegian Medical Association (NMA) were employed in a model for cost-effectiveness analysis. According to the annual report of the NMP for 1996, 60,147 women aged 50-69 years had been invited to a two-yearly mammographic screening programme 46,329 (77%) had been screened and 337 (0.7%) breast cancers had been revealed. The use of breast conserving surgery (BCS) was in this study estimated raised by 17% due to screening, the breast cancer mortality decreased by 30% and the number of life years saved per prevented breast cancer death was calculated 15 years. RESULTS: The cost per woman screened was calculated 75.4 Pounds, the cost per cancer detected 10.365 Pounds and the cost per life year (LY) saved 8.561 Pounds. A raised frequency of BCS, diagnosis and adjuvant chemotherapy brought two years forward, follow-up costs and costs/savings due to prevented breast cancer deaths were all included in the analysis. A sensitivity analysis documented mammography screening cost-effective in Norway when four to nine years are gained per prevented breast cancer death. CONCLUSION: Mammography screening in Norway looks cost-effective. Time has come to encourage national screening programmes.

Aged↗
PubMed2004

The influence of clinical information on the accuracy of diagnostic mammography.

OBJECTIVE: This study examined the influence of knowledge of clinical information on the accuracy of mammography in women referred for investigation of breast symptoms. METHODS: Subjects were sampled from all women consecutively attending a symptomatic breast clinic and aged 25-55 years. This included all 240 women shown to have breast cancer and 240 age-matched women shown not to have cancer. Mammography films were prospectively reported by two radiologists independently of each other in a blinded manner and without knowledge of any clinical information. The films were then re-read with information about the type and site of symptoms (and without knowledge of the level of suspicion of cancer on clinical examination). The accuracy of reading with and without information on symptoms was compared using sensitivity and specificity and receiver operating characteristic (ROC) curves. The effect of age on changes in test accuracy was examined. RESULTS: Reporting the mammogram with knowledge of clinical information (compared to without any information) significantly improved sensitivity (75.8 vs. 71.3%, P = 0.003) for one radiologist, with a non-significant reduction in specificity (85.4 vs. 87.1%, P = 0.22). For the other radiologist, it resulted in non-significant improvement in both sensitivity (75.4 vs. 73.8%, P = 0.13) and specificity (89.2 vs. 87.9%, P = 0.25). Age did not have a statistically significant effect on changes in test accuracy in our data. ROC curves for both radiologists showed that reporting mammography with knowledge of clinical information resulted in small (about 2%) but significant improvement in overall test accuracy. CONCLUSION: Our findings support the provision of clinical information relating to patients' presentation to radiologists reporting diagnostic mammography.

Adult↗
PubMed1992

Assessing elements of women's decisions about mammography.

We investigated motivational and cognitive processes of behavior change with respect to mammography screening. One hundred forty-two women (ages 40 and older) recruited from three worksites answered a 41-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors: a six-item component representing positive perceptions of mammography (Pros) and a six-item component representing avoidance of mammography (Cons). Analysis of variance showed that Pros, Cons, and a derived Decisional Balance measure (Pros minus Cons) were associated with stage of mammography adoption. Results are consistent with applications of the model to smoking cessation. The model is also discussed as it relates to other theories of behavior change and as a general strategy for analyzing perceptual data pertinent to health-related actions and intentions for behavioral change.

Adult↗
PubMed1997

Confirmatory analysis of opinions regarding the pros and cons of mammography.

This investigation extends prior research to apply decision-making constructs from the transtheoretical model (TTM) of behavior change to mammography screening. Study subjects were 8,914 women ages 50-80, recruited from 40 primarily rural communities in Washington State. Structural equation modeling showed that favorable and unfavorable opinions about mammography (i.e., pros and cons) fit the observed data. Analysis of variance supported the associations between readiness to obtain screening (i.e., stage of adoption) and opinions about mammography (i.e., decisional balance) previously found in research using smaller samples from another geographic region. This report extends these earlier studies by using structural equation modeling, opinion scales based both on principal component analyses and on a priori definitions, a developmental sample and a confirmatory sample, and by sampling from a different geographic region. It is recommended that future research examine whether opinions regarding the cons of mammography are more individually specific than the pros.

Aged↗
PubMedDate not supplied

Effects of screening mammography on the comparative survival rates of African American, white, and Hispanic beneficiaries of a comprehensive health care system.

This study reviewed mammographic screening related to breast carcinoma diagnosis and treatment between 1987 and 1997 at Brooke Army Medical Center, San Antonio, TX. Epidemiologic data from the Department of Defense Automated Central Tumor Registry were merged with data from patients' medical records and responses of the patients or their families to a mailed survey. The cases of 907 women grouped by race-white, African American, and Hispanic-were analyzed. Breast carcinoma diagnosed by mammographic screening showed a reversed ratio of early to late stage of cancer occurring for all three groups. That ratio was 1.45 for African Americans, 2.67 for Hispanics, and 3.08 for whites. For those women diagnosed with screening mammography, no statistically significant difference in 5-year survival was found between the races: 86% for whites, 83% for Hispanics, and 80% for African Americans. Mammographic screening as a diagnostic tool appears to equalize survival among whites, Hispanics, and African Americans, in spite of differences in age, stage of diagnosis, and military rank used as a proxy for socioeconomic status. When not controlling for mammographic diagnosis, Kaplan-Meier analysis revealed significant differences in survival patterns between whites, Hispanics, and African Americans. Five-year survival rates were 71% for whites, 74% for Hispanics, and 53% for African Americans. Screening mammography reduced 5-year mortality by almost 59% in African Americans, 52% in whites, and 36% in Hispanics. Whites were diagnosed with breast carcinoma, on average, at 57 years of age-11 years later than African Americans (average age 46 years) and 7 years later than Hispanic women (average age 50 years). As a diagnostic tool, screening mammography was used to discover breast cancer in 36% of white women, 33% of Hispanics, and 22% of African Americans. Further research is recommended to examine the use of mammography among various racial/ethnic groups.

Adult↗
PubMed2002

Average glandular dose with amorphous silicon full-field digital mammography - Clinical results.

PURPOSE: Determination of average glandular dose with a full-field digital mammography system using a flat-panel X-ray detector based on amorphous silicon technology for a large group of patients. MATERIAL AND METHODS: The patient group includes women who were examined in a 4-month period with the digital mammographic system Senographe 2000D. The number of women was 591 and the number of exposures was 1116; only cranio-caudal projections were considered. Various quantities, including entrance surface air kerma, tube loading, and compressed breast thickness, were determined during actual mammography. Average glandular dose was determined using conversion factors g for standard breast composition. RESULTS: The mean average glandular dose was 1.51 mGy (0.66 - 4.05 mGy) for a single view. The mean compressed breast thickness was 55.7 mm. The mean age of patients was 55 years (34 - 81 years). CONCLUSION: The results demonstrate that full-field digital mammography with a flat-panel detector based on amorphous silicon needs about 25 % less dose in comparison with conventional screen-film mammography.

Adult↗