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PubMedDate not supplied

Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD).

BACKGROUND: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys. METHODS: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998. RESULTS: Receipt of mammography is stable at 70% to 80% among women aged 50 to 64 years, then declines to around 40% among those aged 85 to 90 years. For Pap tests there is a decline from 75% among women aged 50 to 54 years to 25% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt. CONCLUSIONS: Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.

Age Factors↗
PubMed1998

Mammography and Pap test screening among low-income foreign-born Hispanic women in USA.

Little is known about the factors influencing screening among low-income Hispanic women particularly among recent immigrants. A sample of 148 low-income, low-literate, foreign-born Hispanic women residing in the Washington DC metropolitan area participated in the study. The mean age of the sample was 46.2 (SD=11.5), 84% reported annual household incomes ($15,000. All women were Spanish speakers and had low acculturation levels. Ninety six percent had reported having a Pap smear, but 24% were not in compliance with recommended screening (Pap test within the last 3 years). Among women 40 and older, 62% had received a mammogram, but only 33% were compliant with age appropriate recommended mammography screening guidelines. Women in this study had more misconceptions about cancer than Hispanics in other studies. Multivariate logistic models for correlates of Pap test and mammography screening behavior indicate that factors such as fear of the screening test, embarrassment, and lack of knowledge influenced screening behavior. In conclusion, women in this study had lower rates of mammography screening than non-Hispanic women and lower rates of compliance with recommended Mammography and Pap test screening guidelines.

Adult↗
PubMedDate not supplied

[Discomfort and pain during mammography].

INTRODUCTION: Mammography is the most important method for early detection of breast cancer, however, patients frequently complain of discomfort and pain. OBJECTIVE: Evaluate how often discomfort and pain are felt during mammography and identify factors that may be associated to these complaints. METHODS: A prospective study including 2,164 patients recruited from public (996) and private (1,168) health services was carried out. After the imaging procedure, patients quantified pain using a linear analogical scale. Discomfort was qualitatively evaluated by multivariate analysis. RESULTS: Discomfort was reported by 90% of the patients, and of these 12% rated the sensation as intense or intolerable. Only 2% of the women in the study group did not feel any pain during the procedure. Factors associated to pain were: age, use of birth control methods (BCM), previous mastalgia and patients from the private health sector. Discomfort was independently associated to the service where the procedure was performed (OR = 2.50 IC 1.64-5.17) and to previous mastalgia (OR = 3.15 IC 1.96-7.12). When asked about a repeat mammography, 98% of the patients said they would comply. CONCLUSION: Young women (< 50 years), BCM users, mastalgia patients and women who were using the services of a private clinic felt more intense pain and discomfort during mammography.

Adult↗
PubMedDate not supplied

Questionnaire development to predict mammography intention among women in southeastern Louisiana.

This article summarizes the development and psychometric analysis of the Thoughts About Mammography (TAM) questionnaire to predict mammography intention using the Theory of Planned Behavior (TPB). Key themes, obtained from elicitation interviews (N = 45), were categorized, ranked and extracted for item construction. Initial pilot testing supported test-retest reliability (alpha = .85 to .97), internal consistency (alpha = .67 to .91), and content validity (0.86-1.00). After pilot testing, the TAM was administered to 302 rural women in southeastern (SE) Louisiana. The instrument was internally consistent (alpha = 0.77 to 0.92), construct valid (alpha = .18 to .64), and predicted 24% of the variance of mammography intention. The TAM adequately demonstrated reliability and validity to measure mammography intention in rural southeastern Louisiana women.

Adult↗
PubMed1992

Changes in mammography use: economic, need, and service factors.

OBJECTIVES: The purpose of this study was to document changes in mammography use between 1987 and 1990 and assess the relationship of use to selected economic, need, and health system factors. METHODS: Independent random-digit-dialed telephone surveys of women between 52 and 75 years of age were conducted. RESULTS: Between 1987 and 1990, the proportion of women who had had a mammogram in the past year increased from 31% to 51%. Though income was significantly related to overall patterns of use, it was not associated with recent mammogram use in 1990. Women with a family history of breast cancer reported greater use at both times, as did women who reported having a regular physician (particularly a gynecologist or internist). When all other variables were controlled for, women were over nine times more likely to have had multiple and recent mammograms in 1990 than in 1987. CONCLUSIONS: Mammography use dramatically increased between 1987 and 1990. There were strong relationships between the type of regular physician and mammography screening and between economic and personal history and repeated and recent mammography use.

Aged↗
PubMed1994

Physicians' recommendations for mammography: do tailored messages make a difference?

OBJECTIVES: Message tailoring, based on individual needs and circumstances, is commonly used to enhance face-to-face patient counseling. Only recently has individual tailoring become feasible for printed messages. This study sought to determine whether printed tailored recommendations addressing women's specific screening and risk status and perceptions about breast cancer and mammography are more effective than standardized printed recommendations. METHODS: Computer-assisted telephone interviews were conducted with 435 women, aged 40 to 65 years, who had visited family practice groups within the previous 2 years. Subjects were randomly allocated to receive individually tailored or standardized mammography recommendation letters mailed from physicians to patients' homes. Follow-up interviews were conducted 8 months later. RESULTS: Tailored letter recipients were more likely to remember and to have read more of their letters than standardized version recipients. After controlling for baseline status, tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $26,000 and for Black women. CONCLUSIONS: Tailored messages are a more effective medium for physicians' mammography recommendations; tailoring may be especially important for women of low socioeconomic status.

Adult↗
PubMed1997

Race and mammography use in two North Carolina counties.

OBJECTIVES: This study investigated racial differences in mammography use and their association with physicians' recommendations and other factors. METHODS: The study used 1988 survey data for 948 women 50 years of age and older from the New Hanover Breast Cancer Screening Program. Racial differences in terms of physician recommendation, personal characteristics, health characteristics, and attitudes toward breast cancer and mammography were examined. Factors at least minimally associated with race and use were included in multivariate logistic regression analyses to examine the effect of race while controlling for other factors. RESULTS: In comparison with White women. Black women were half as likely to report ever having had a mammogram (27% vs 52%) and having a mammogram in the past year (17% vs 36%). Black women also significantly less often reported physician recommendation (25% vs 52%). Although Black and White women differed significantly in other characteristics, multivariate logistic regression analyses indicated that physician recommendation accounted for 60% to 75% of the initial racial differences in mammography use. CONCLUSIONS: Understanding physicians' recommendations for breast cancer screening is a critical first step to increasing mammography use in disadvantaged populations.

Aged↗
PubMed1999

Changes in Canadian women's mammography rates since the implementation of mass screening programs.

OBJECTIVES: This study reports on Canadian mammography rates between 1990, when mass screening programs were launched, and 1994/95. METHODS: Mammography rates from 2 national surveys were compared according to the presence of a provincial screening program. RESULTS: Mammography rates among women aged 50 to 69 years (the targeted group) increased significantly, by 16%; increases were twice as high in provinces with screening programs. Among women in their 40s (nontargeted group), the changes were insignificant and independent of screening program status. CONCLUSIONS: Screening programs appear to have influenced the mammography rates of targeted women aged 50 to 69 years.

Adult↗
PubMed2001

The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: who gets the message about breast cancer screening?

OBJECTIVES: This study investigated the association between physician recommendation for mammography and race/ethnicity, socioeconomic status, and other characteristics in a rural population. METHODS: In 1993 through 1994, we surveyed 1933 Black women and White women 52 years and older in 10 rural counties. RESULTS: Fifty-three percent of the women reported a physician recommendation in the past year. White women reported recommendations significantly more often than did Black women (55% vs 45%; odds ratio = 1.49). Controlling for educational attainment and income eliminated the apparent racial/ethnic difference. After control for 5 personal, 4 health, and 3 access characteristics, recommendation for mammography was found to be more frequent among women who had access to the health care system (i.e., had a regular physician and health insurance). Recommendation was less frequent among women who were vulnerable (i.e., were older, had lower educational attainment, had lower annual family income). CONCLUSIONS: Socioeconomic status, age, and other characteristics--but not race/ethnicity--were related to reports of a physician recommendation, a precursor strongly associated with mammography use. Efforts to increase physician recommendation should include complementary efforts to help women address socioeconomic and other barriers to mammography use.

Black or African American↗
PubMed2001

Subgroup-specific effects of questionnaire wording on population-based estimates of mammography prevalence.

OBJECTIVES: This study investigated whether an apparent downturn in prevalence rates of mammography use reported in the 1992 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire resulted from a change in questionnaire wording. METHODS: In a pretest-posttest design (1990-1991 vs 1992), piecewise linear regression analyses were based on monthly prevalence estimates of mammography use among female BRFSS respondents 40 years or older. RESULTS: Self-reported mammography use was lower by 3.5 percentage points (95% confidence interval [CI] = 1.5, 5.5) overall--and lower by 13.6 percentage points (95% CI = 2.6, 24.6) among Black women with less than a high school education--when predicted from 1992 data than when predicted from 1990-1991 data. CONCLUSIONS: A change in questionnaire wording in the BRFSS caused demographic-specific effects in population-based estimates of mammography use.

Adult↗
PubMed2001

Colorectal cancer screening participation: comparisons with mammography and prostate-specific antigen screening.

OBJECTIVES: The relation of personal characteristics, health and lifestyle behaviors, and cancer screening practices to current colorectal cancer (CRC) screening was assessed and compared with those factors' relation to current mammography screening in women and prostate-specific antigen (PSA) screening in men. METHODS: A cross-sectional random-digit-dialed telephone survey of 954 Massachusetts residents aged 50 and older was conducted. RESULTS: The overall prevalence of current CRC screening was 55.3%. Logistic regression results indicated that family history of CRC (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.02, 3.86), receiving a regular medical checkup (OR = 3.07; 95% CI = 2.00, 4.71), current screening by mammography in women and PSA in men (OR = 4.40; 95% CI = 2.94, 6.58), and vitamin supplement use (OR = 1.87; 95% CI = 1.27, 2.77) were significant predictors of CRC screening. CONCLUSIONS: Health and lifestyle behaviors were related to increased current CRC, mammography, and PSA screening. Personal factors independently related to CRC screening were not consistent with those related to mammography and PSA screening. This lack of consistency may reflect different stages of adoption of each type of screening by clinicians and the public.

Aged↗
PubMed2006

Prospective assessment of computer-aided detection in interpretation of screening mammography.

OBJECTIVE: The purpose of this study was to prospectively assess the usefulness of computer-aided detection (CAD) in the interpretation of screening mammography and to provide the true sensitivity and specificity of this technique in a clinical setting. SUBJECTS AND METHODS: Over a 26-month period, 5,016 screening mammograms were interpreted without, and subsequently with, the assistance of the iCAD MammoReader detection system. Data collected for actionable findings included dominant feature (calcification, mass, asymmetry, architectural distortion), detection method (radiologist only, CAD only, or both radiologist and CAD), BI-RADS assessment code, associated histopathology for those undergoing biopsy, and tumor stage for malignant lesions. The study population was cross-checked against an independent reference standard to identify false-negative cases. RESULTS: Of the 5,016 cases, the recall rate increased from 12% to 14% with the addition of CAD. Of the 107 (2%) patients who underwent biopsy, 101 (94%) were prompted by the radiologist and six (6%) were prompted by CAD. Of the 124 biopsies performed on actionable findings in the 107 patients, findings in 79 (64%) were benign and in 45 (36%) were in situ or invasive carcinoma. Three study participants who were not recalled by the radiologist with the assistance of CAD developed cancer within 1 year of the screening mammogram and were considered to be false-negative cases. The radiologist detected 43 (90%) of the 48 total malignancies and 45 (94%) of the 48 malignancies with the assistance of CAD. CAD missed eight cancers that were detected by the radiologist, which presented as architectural distortions (n = 3), irregular masses (n = 4), and a circumscribed mass (n = 1). CAD detected two in situ cancers as a faint cluster of calcifications that had not been perceived by the radiologist and one mass that was dismissed by the radiologist, accounting for at least a 4.7% increase in cancer detection rate. Sensitivity of screening mammography with the use of CAD (94%) represented an absolute and relative 4% increase over the sensitivity of the radiologist alone (90%). Specificity of screening mammography with and without the use of CAD was 99%. CONCLUSION: Routine use of CAD while interpreting screening mammograms significantly increases recall rates, has no significant effect on positive predictive value for biopsy, and can increase cancer detection rate by at least 4.7% and sensitivity by at least 4%. This study provides "true" values for sensitivity and specificity for use of CAD in interpretation of screening mammography as measured prospectively in the context of a working clinical setting.

Adult↗
PubMed1986

Comparison of mammography and transillumination light scanning in the detection of breast lesions.

A prospective study was done involving 822 women who had both film screen mammography and a breast transillumination light scan examination. The study population was not randomized; a modified phase-2 study was done. Mammography was superior for detecting malignancy: of the 67 pathologically proved breast cancers, 64 (95.5%) were detected by mammography and 45 (67.2%) were detected by transillumination. Biopsy revealed that 74 patients had benign lesions. In this group of patients, the false-positive rate was 12.2% for light scanning and 79.7% for mammography; however, 117 other patients had false-positive light scans.

Breast Neoplasms↗
PubMed1991

The American College of Radiology Mammography Accreditation Program.

This article discusses the background, goals, criteria, current results, impact, and future directions of the American College of Radiology's (ACR's) Mammography Accreditation Program. To date, approximately one half of the mammographic units in the United States have voluntarily applied for accreditation through the ACR program, with approximately one quarter of the units in the United States now accredited. Application rates have increased steadily since the start of the program in August 1987. The equipment performance criteria and professional criteria defined and employed in the ACR Mammography Accreditation Program have been adopted as standards for the performance of screening mammography by the ACR and have served as a basis for quality assurance standards in state and federal legislation on mammography.

Accreditation↗
PubMed1992

Risk factors for breast cancer in women undergoing mammography.

To determine risk factors for carcinoma of the breast, we compared women with cancer on screening and diagnostic mammography with those in whom cancer was not detected. For 39 months, medical histories were collected by mammography technologists on 3492 women having routine screenings or diagnostic mammograms at our institution. Potential risk factors of women with biopsy-proved breast cancer were compared with those in women who had normal findings on mammograms or negative biopsy results (control subjects). Of the 3492 women, 49 had biopsy-proved breast cancer. There were 3361 patients in the control group, including those women with normal findings on mammograms (3294) and those with negative biopsy results (67). Eighty-two women had incomplete questionnaires or were lost to follow up. Nearly all of the patients with breast cancer were postmenopausal compared with 68% of the control subjects. The mean length of lactation for breast cancer patients was significantly less than for control subjects: 5.6 vs 7.5 weeks (p = .015). This was true also for the postmenopausal patients: 8.1 vs 6.1 weeks (p = .041). Postmenopausal breast cancer patients had menstruated significantly more years (p = .016) than the postmenopausal control subjects: 34 vs 31 years, although the mean age at menarche was not different. When corrected for age, there was no significant difference in the total duration of menstruation in the postmenopausal cancer patients compared with the postmenopausal control subjects. Postmenopausal breast cancer patients had a significantly greater (p = .021) average body weight than postmenopausal control subjects: 71.7 vs 66.7 kg, although body weight was the same when all patients were considered. Similar results were found when Quetelet's index for obesity (weight in kg/height in cm2) (p = .004) was calculated for postmenopausal patients: 28 for cancer patients and 26 for control subjects. There was no significant difference in height between the cancer patients and control subjects when all patients or just the postmenopausal patients were considered. History of oral contraceptive use was significantly less common among postmenopausal breast cancer patients than among postmenopausal control subjects: 9% vs 20%. Patients with breast cancer had lower parity than the control subjects. In our series of patients, women in whom breast cancer was detected on mammography lactated less, showed no significant difference in years of menstruation when corrected for age, had a greater average body weight, used oral contraceptives less often, and had fewer children than women in whom no cancer was detected on mammography.

Body Height↗
PubMed1996

Status of residency training in mammography.

OBJECTIVE: The purpose of this study was to survey the status of residency training in mammography, including mammography quality assurance, and to compare the results with previous surveys from 1990 and 1992. MATERIALS AND METHODS: A telephone interview was conducted with 213 chief residents and 11 other senior residents representing all 224 accredited residency programs in diagnostic radiology. RESULTS: Compared with 1990, more programs had exclusive mammography rotations (74% versus 40%). The number of fellowships in breast imaging increased from 17 to 76. More training programs differentiated screening from diagnostic examinations (50% versus 35%). Compared with 1992, the percentage of residents who knew recommended frequencies of quality control procedures increased by 30% and the percentage who knew the maximum allowable radiation dose increased by 50%. Residents lacked fundamental knowledge about conducting medical audits, such as calculating the positive predictive value for biopsies. CONCLUSION: More time is being devoted to breast imaging in diagnostic radiology residency training, and residents show greater knowledge about mammography quality assurance.

Accreditation↗
PubMed1996

Mammography outcomes analysis: potential panacea or Pandora's box?

As a consequence of the demand for and perceived value of mammography outcomes analysis, collection of community-based mammography data by the NHMN and others has begun and is supported by the radiologists involved. Radiologists are increasing their use of standardized coding of report data necessary for clear communication and data collection but remain justifiably concerned about the confidentiality of these data. If stronger protection of these data is forthcoming, more radiologists will be encouraged to perform practice audits. The pooling of community-based data as exemplified by NHMN will create statistics that measure the actual practice of mammography and estimate its impact on breast cancer. For individual radiologists, the audit process will improve their mammography skills through direct feedback of results and provide important information about their patterns of interpretation. Although this approach will create community standards, comparisons with such standards may be more applicable among various communities than among individual radiologists because of the statistical variation created by the relatively small numbers of cancers found by individual radiologists, the differences in populations served by these radiologists, and the variability in reproducing the audit by individuals or groups. Pooled community data, however, will still be useful to community radiologists as general standards toward which to strive. We believe that medical audits offer important potential public health benefits for breast cancer control. Insofar as confidentiality issues cannot be effectively addressed by individual radiologists, institutions in a position to be advocates should immediately explore how legal underpinnings can be put in place to protect the audit process from disclosure. With such protection, the audit process may fulfill its potential for the radiologist's pivotal role in breast cancer control; without it, the process may prove to be a Pandora's box for the community radiologist.

Data Collection↗
PubMed1999

Ability of mammography to reveal nonpalpable breast cancer in women with palpable breast masses.

OBJECTIVE: Our goal was to determine the frequency with which mammography reveals nonpalpable malignancies in women with benign palpable masses and to compare these nonpalpable malignancies with the palpable malignancies and nonpalpable malignancies detected in asymptomatic women. SUBJECTS AND METHODS: This study of nominally asymptomatic women involved 85,399 consecutive mammographic examinations, of which 3459 (4.1%) examinations were performed on women who had palpable masses identified before or at the time of mammography. A medical outcomes audit identified mammographic examinations after which breast cancer was diagnosed and determined selected surrogate measures for mortality reduction for the mammographically detected malignancies. RESULTS: Of the 3459 examinations in women with palpable masses, 64 cases of cancer were revealed by mammography. Of these, 54 cases involved palpable malignancies (15.6/1000 examinations) and 10 involved nonpalpable malignancies (2.6/1000 examinations). Of the 81,940 examinations in asymptomatic women, 346 cases of nonpalpable cancer were detected (4.2/1000 examinations). Of the 10 cases of nonpalpable cancer detected in women with benign palpable masses, median tumor size was 13.8 mm, 10% had axillary node metastasis, and 10% were stage 2 or higher. The corresponding surrogate measures for cases of nonpalpable cancer detected in asymptomatic women were median tumor size, 13.6 mm; node metastasis, 7%; stage 2 or higher, 14%. The surrogate measures for the 54 palpable malignancies were median tumor size, 23.7 mm; node metastasis, 31%; stage 2 or higher, 63%. CONCLUSION: The surrogate measures for the nonpalpable malignancies in women with benign palpable lesions resemble those in asymptomatic women and are much more favorable than those of palpable malignancies. Therefore, in women with a palpable breast mass, it is important to use mammography to screen the remainder of both breasts for nonpalpable cancer.

Adult↗