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PubMed2003

Extension of ductal carcinoma in situ: histopathological association with MR imaging and mammography.

The purpose of this study is to evaluate the capability of breast MRI (magnetic resonance imaging) and mammography in determining tumor extent and the detectability of ductal carcinoma in situ (DCIS) in association with histopathological features. Thirty women with breast cancer underwent 3D dynamic MRI. Twelve women had pure DCIS and 18 women had DCIS with microinvasion. We analyzed the results of preoperative MRI and mammography with histopathologic results, retrospectively. The mean lesion size was 55.1 mm from the histopathologic results. Twenty-six lesions were detected through the MRI (a sensitivity of 86.7%). MRI depicted eight lesions without mammographically detected microcalcification. In seven cases, MRI showed tumor extent accurately compared with mammography, and the combined diagnosis improved the accuracy of evaluating tumor extent. MRI can complement mammography in guiding surgical treatment of DCIS by providing better assessment of the extent of the lesion.

Adult↗
PubMed1992

Construction of the Hyman-Baker Mammography Questionnaire, a measure of health belief model variables.

Despite its considerable promise as a screening tool, mammography has thus far not been as widely used as seems warranted. One conceptualization of patient-related factors or motivation useful in previous research on use of services is the Health Belief Model, which postulates that health behavior can be predicted by people's perceptions of the seriousness of the disease, their susceptibility to the disease, and their perceptions of the benefits of and barriers to the health behavior. Yet no psychometrically sound measure of these variables as related to mammography was found in a search of the literature. This study reports the construction and preliminary validation of such an instrument. Factor analysis, moderate or zero correlation of the subscales, and a higher mean score on the Barriers subscale for women referred for mammography as compared to those actually presenting for mammography support the validity of the questionnaire. Although reliability coefficients for Benefits were low, those for Susceptibility and Barriers were adequate. The questionnaire appears to be a promising measure awaiting further validation.

Aged↗
PubMedDate not supplied

Influence of advertisement on women's attitudes toward mammography screening.

This project represents an effort to incorporate a feminist perspective into research on mammography screening. The purpose of this study was to assess women's attitudes toward four advertisements designed to encourage mammography screening. The goal was to create awareness about women's attitudes toward mammography advertisements in order to encourage the development of more effective and responsive motivational materials. The results indicated that each ad communicated different messages about the seriousness of breast cancer and the efficacy of mammography in detecting early breast cancer. Each ad also affected women differently regarding their feelings of control over breast cancer, their perceived loss of sex appeal resulting from a breast cancer diagnosis, and their general fear of breast cancer.

Adult↗
PubMedDate not supplied

A systematic review of mammography educational interventions for low-income women.

OBJECTIVE: We conducted a systematic review to examine the effectiveness of educational interventions in increasing mammography screening among low-income women. DATA SOURCES: Bibliographic databases, including MEDLINE, The Cochrane Central Register of Controlled Trials, The Cochrane Database of Systematic Reviews, and the ISI Web of Science, were searched for relevant articles. STUDY INCLUSION AND EXCLUSION CRITERIA: Randomized, community-based trials targeting low-income women and published between January 1980 and March 2003 were included. DATA EXTRACTION: The search yielded 242 studies; 24 met all inclusion criteria. DATA SYNTHESIS: Three studies used mammography vans, three used low-cost vouchers or provided free mammograms, three used home visits, one used community education alone, one provided referrals, five incorporated multiple intervention strategies, two used phone calls, one used videos and print material, and five used primarily print material. RESULTS: Of nine studies that reduced barriers to care via mammography vans, cost vouchers, or home visits, eight showed statistically significant increases in mammography screening. Seven of the eight studies that used peer educators had significant increases in screening, as did four of the five studies that used multiple (intervention) components. CONCLUSIONS: Interventions that used peer educators, incorporated multiple intervention strategies, or provided easy access via vans, cost vouchers, or home visits were effective in increasing screenings. Mailed letter or telephone reminders were not effective in trials involving low-income women, which is contrary to findings from middle/upper-income studies.

Female↗
PubMedDate not supplied

How important are psychosocial predictors of mammography receipt among older women when immediate access is provided via on-site service?

PURPOSE: The purpose of the study was to examine the relative importance of psychosocial variables (i.e., health beliefs, knowledge, barriers) in predicting mammogram receipt compared with providing access through a mobile mammography unit among older women who participated in a mobile mammography intervention. DESIGN: The data were collected during a randomized trial involving 499 women (60 to 84 years old) recruited from 60 community sites. SETTING: The study was conducted at 60 sites in Los Angeles where seniors gather, including meal sites, senior centers, and recreational clubs. SUBJECTS: Participants were older women (60 to 84 years old) who spoke English or Spanish, had a telephone, had no significant cognitive deficits, and had not received a mammogram during the past 12 months. MEASURES: The baseline survey assessed demographics and psychosocial factors (i.e., health beliefs, knowledge, barriers). A follow-up telephone survey at 3 months assessed mammography receipt. RESULTS: Results support the importance of behavioral intentions in predicting mammogram receipt, even among women able to access a mammogram through the mobile unit. However, other recognized psychosocial factors failed to predict screening receipt among women randomized to the mobile mammography intervention. Results suggest that the importance of psychosocial predictors might be diminished when a major access barrier has been removed, and they highlight the importance of convenience. CONCLUSION: Future interventions should focus on not only removing obvious concrete and psychosocial barriers but also on enhancing convenience.

Aged↗
PubMed1988

Comparison of mammary serum antigen assay with mammography in patients with breast cancer.

Mammary serum antigen levels and two-view xeromammography were evaluated in a study of 97 patients who presented at a specialist breast clinic in a major teaching hospital, in order to determine their single and combined value in the detection of breast cancer. Raised mammary serum antigen levels (greater than 300 inhibition units) were found in 76% of patients with stage-1 (including carcinoma-in-situ) and stage-II breast cancer compared with 54% of patients whose mammograms were suggestive of cancer (probability of carcinoma, greater than 50%). Four patients with carcinoma-in-situ had elevated mammary serum antigen levels, but their mammograms did not suggest the presence of cancer (probability of carcinoma, less than 50%). The over-all sensitivity, specificity and predictive value of a positive test-result in detecting breast cancer were 76%, 82% and 72%, respectively, for the mammary serum antigen test, and 54%, 88% and 74%, respectively, for mammography. When the mammary serum antigen test and mammography were used together, a combined evaluation enhanced the sensitivity in the detection of breast cancer (89%) but with a concomitant reduction in specificity (72%). The mammary serum antigen test was superior to mammography in the detection of breast cancer in this study and may prove to be a useful adjunct to conventional methods of clinical assessment and to mammography for the detection of breast cancer.

Adult↗
PubMed1992

Comparative study of mammography and mammary serum antigen estimation for breast cancer screening.

OBJECTIVE: To compare mammary serum antigen (MSA) levels with mammography as a screening test for breast cancer. To determine the value of MSA testing to decrease the need for women to undergo mammography. DESIGN: A blind prospective comparison of MSA levels and mammography to detect breast cancer. SETTING: Royal Women's Hospital Breast Cancer Screening Clinic. Women were mainly self-referred. RESULTS: MSA levels had a wide range in normal women and women with mammography-detected breast cancer. Mean MSA levels in women with breast cancer reflected tumour volume, but a wide range was again seen. At 60% specificity, the sensitivity of an elevated MSA level for breast cancer was 63% for invasive cancer and zero for in-situ disease. MSA levels were modestly but significantly elevated in smokers over non-smokers. CONCLUSION: The MSA level is an insufficiently sensitive or specific marker to have a role in screening for breast cancer.

Antigens, Neoplasm↗
PubMed2004

[Full-field digital mammography with amorphous silicon-based flat- panel detector: physical imaging characteristics and signal detection].

The physical characteristics of a clinical amorphous silicon-based flat-panel imager for full-field digital mammography were investigated. Pre-sampled modulation transfer functions (MTF) were measured by using a slit method. Noise power spectra were determined for different input exposures by fast Fourier transform. The MTFs of full-field digital mammography systems showed significantly higher values than those of the computed radiography (CR) system. The full-field digital mammography system showed a lower noise level than that of the CR system under the same exposure conditions. Contrast detail analysis has been performed to compare the detectability of the full-field digital mammography system with that of the screen-film (Min-R 2000/Min-R 2000) system. The average contrast-detail curves of digital and film images were obtained from the results of observation. Image quality figures (IQF) were also calculated from the individual observer performance tests. The results indicated that the digital contrast-detail curves and IQF, on average, are superior to those of the screen-film system.

Fourier Analysis↗
PubMed1997

Cost-effectiveness of extending screening mammography guidelines to include women 40 to 49 years of age.

BACKGROUND: Screening mammography is recommended for women 50 to 69 years of age because of its proven efficacy and reasonable cost-effectiveness. Extending screening recommendations to include women 40 to 49 years of age remains controversial. OBJECTIVE: To compare the cost-effectiveness of screening mammography in women of different age groups. DESIGN: Cost-effectiveness analysis done using Markov and Monte Carlo models. PATIENTS: General population of women 40 years of age and older. INTERVENTIONS: Biennial screening from 50 to 69 years of age was compared with no screening. Screening done every 18 months from ages 40 to 49 years, followed by biennial screening from ages 50 to 69 years, was compared with biennial screening from ages 50 to 69 years. MEASUREMENTS: Life-expectancy, costs, and incremental cost-effectiveness. RESULTS: Screening women from 50 to 69 years of age improved life expectancy by 12 days at a cost of $704 per woman, resulting in a cost-effectiveness ratio of $21,400 per year of life saved. Extending screening to include women 40 to 49 years of age improved life expectancy by 2.5 days at a cost of $676 per woman. The incremental cost-effectiveness of screening women 40 to 49 years of age was $105,000 per year of life saved. On the basis of a multiway sensitivity analysis, there is a 75% chance that screening mammography in women 50 to 69 years of age costs less than $50,000 per year of life saved, compared with a 7% chance in women 40 to 49 years of age. CONCLUSION: The cost-effectiveness of screening mammography in women 40 to 49 years of age is almost five times that in older women. When breast cancer screening policies are being set, the incremental cost-effectiveness of extending mammographic screening to younger women should be considered.

Adult↗
PubMed1997

The role of numeracy in understanding the benefit of screening mammography.

BACKGROUND: Quantitative information about risks and benefits may be meaningful only to patients who have some facility with basic probability and numerical concepts, a construct called numeracy. OBJECTIVE: To assess the relation between numeracy and the ability to make use of typical risk reduction expressions about the benefit of screening mammography. DESIGN: Randomized, cross-sectional survey. SETTING: A simple random sample of 500 female veterans drawn from a New England registry. INTERVENTION: One of four questionnaires, which differed only in how the same information on average risk reduction with mammography was presented. MEASUREMENTS: Numeracy was scored as the total number of correct responses to three simple tasks. Participants estimated their risk for death from breast cancer with and without mammography. Accuracy was judged as each woman's ability to adjust her perceived risk in accordance with the risk reduction data presented. RESULTS: 61% of eligible women completed the questionnaire. The median age of these women was 68 years (range, 27 to 88 years), and 96% were high school graduates. Both accuracy in applying risk reduction information and numeracy were poor (one third of respondents thought that 1000 flips of a fair coin would result in < 300 heads). Accuracy was strongly related to numeracy: The accuracy rate was 5.8% (95% CI, 0.8% to 10.7%) for a numeracy score of 0, 8.9% (CI, 2.5% to 15.3%) for a score of 1, 23.7% (CI, 13.9% to 33.5%) for a score of 2, and 40% (CI, 25.1% to 54.9%) for a score of 3. CONCLUSIONS: Regardless of how information was presented, numeracy was strongly related to accurately gauging the benefit of mammography. More effective formats are needed to communicate quantitative information about risks and benefits.

Adult↗
PubMed2003

Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography.

BACKGROUND: The relationships among breast density, age, and use of hormone replacement therapy (HRT) in breast cancer detection have not been fully evaluated. OBJECTIVE: To determine how breast density, age, and use of HRT individually and in combination affect the accuracy of screening mammography. DESIGN: Prospective cohort study. SETTING: 7 population-based mammography registries in North Carolina; New Mexico; New Hampshire; Vermont; Colorado; Seattle, Washington; and San Francisco, California. PARTICIPANTS: 329 495 women 40 to 89 years of age who had 463 372 screening mammograms from 1996 to 1998; 2223 women received a diagnosis of breast cancer. MEASUREMENTS: Breast density, age, HRT use, rate of breast cancer occurrence, and sensitivity and specificity of screening mammography. RESULTS: Adjusted sensitivity ranged from 62.9% in women with extremely dense breasts to 87.0% in women with almost entirely fatty breasts; adjusted sensitivity increased with age from 68.6% in women 40 to 44 years of age to 83.3% in women 80 to 89 years of age. Adjusted specificity increased from 89.1% in women with extremely dense breasts to 96.9% in women with almost entirely fatty breasts. In women who did not use HRT, adjusted specificity increased from 91.4% in women 40 to 44 years of age to 94.4% in women 80 to 89 years of age. In women who used HRT, adjusted specificity was about 91.7% for all ages. CONCLUSIONS: Mammographic breast density and age are important predictors of the accuracy of screening mammography. Although HRT use is not an independent predictor of accuracy, it probably affects accuracy by increasing breast density.

Adipose Tissue↗
PubMed1999

Mammography and 99mTc-MIBI scintimammography in suspected breast cancer.

UNLABELLED: The aim of this work has been to evaluate whether a diagnostic protocol based on the joint use of mammography and 99mTc-methoxyisobutyl isonitrile (MIBI) scintimammography is capable of reducing the number of biopsies required in patients with suspected breast cancer. METHODS: We performed prone scintimammography in 90 patients with suspected breast cancer, involving 97 lesions. In all patients, the diagnosis was established by way of biopsy. On mammography, we evaluated the degree of suspicion of malignancy and the size of the lesion (smaller or larger than 1 cm in diameter). RESULTS: The results of only 41 of the biopsies indicated malignancy. On mammography, 20 lesions (of which 1 was breast cancer) were considered to be of low suspicion of malignancy, 31 (of which 4 were breast cancer) as indeterminate and 46 (of which 36 were breast cancer) as high. Fourteen lesions (2 low probability, 2 indeterminate and 10 high) were smaller than 1 cm, whereas 83 (18 low probability, 29 indeterminate and 36 high) were larger. The sensitivity, specificity, positive predictive value and negative predictive value of scintimammography were 85%, 79%, 74% and 88%, respectively. Scintimammography was positive in all cases of breast cancer that initially had a low or indeterminate suspicion of malignancy according to mammography, as well as in 30 cases of breast cancer that initially were highly suspicious. Six false-negative scintimammography studies were obtained in lesions with a high suspicion of malignancy. CONCLUSION: We propose a diagnostic protocol with a biopsy performed on lesions that have a high suspicion of malignancy as well as those with low or indeterminate suspicion that are smaller than 1 cm or with positive scintimammography results. This would have reduced the total number of biopsies performed by 34%. More importantly, there would have been a 65% reduction in number of biopsies performed in the low and indeterminate mammographic suspicion groups. All 41 cases of breast cancer would have been detected.

Adult↗
PubMed1998

[Combination of mammography with automated ultrasound (Sono-X) in routine diagnosis?].

A new technique for breast imaging is presented. This technique combines radiographic mammography directly with automated ultrasound. The combined examination, which is performed without decompression of the breast, yields the conventional mammography films as well as a complete set of B-mode scans and ultrasound projections. These can be geometrically matched with each other in a definitive manner. A prototype of the device was first used in a pilot study of 50 patients followed by a study of an additional 450 patients with a total of 492 breast lesions, of which 269 were confirmed by histology or cytology. The results show that X-ray and ultrasound are complementary in the detection of cancer. The use of an experimental mode of image interpretation for combined mammography and automated ultrasound reduced the number of mammographically suspicious findings that ultimately turned out to be benign. These results were also confirmed in two blind studies including a total of 160 histologically or cytologically confirmed lesions and 40 cases without lesions. With further technical advancement of the technique aimed at rapid and easy application and confirmation of the results obtained so far, the combination of mammography and automated ultrasound might be introduced into a routine clinical setting.

Breast↗
PubMed1994

FDA's mammography facility quality assurance program.

To summarize, the key features of the MQSA program are: To operate lawfully after October 1, 1994, a mammography facility must be certified by FDA as providing quality mammography services. For a facility to be certified, it must be accredited by a federally-approved private nonprofit or state accreditation body. To be accredited, the facility must undergo periodic review of its clinical images and meet federally-developed quality standards for personnel qualifications, quality assurance programs, and recordkeeping and reporting. To maintain its certification, the facility must pass an annual inspection conducted by federal or state personnel. If congress grants FDA authority, the agency will establish interim standards initially but will eventually replace them with more comprehensive final standards. After October 1, 1994, mammography facilities unable to comply with the quality standards in effect at a given time will not be permitted to continue in operation. FDA believes that once the comprehensive standards and inspection program are in place, the goal of assuring all women access to quality mammography will soon be reached.

Ambulatory Care Facilities↗
PubMed1996

Eighteen years of mammography experience in an HMO: 1975-1992.

OBJECTIVE: To describe the mammographic experience for the years 1975 to 1992 at Kaiser Permanente, Northwest Region (KPNW). SETTING: Large, group practices HMO. DESIGN: Clinical databases. PARTICIPANTS: KPNW women in various subgroups. MAIN OUTCOME MEASURES: Mammogram rates. RESULTS: The rate of mammography at KPNW was fairly low (2% to 5%) until 1983, when it began to rise rapidly, almost exclusively as a result of a great increase in screening examinations of otherwise normal women. By 1992 the annual rate of mammography had increased to 40.2% for all women over age 40, and 52.4% for women aged 50 to 69. Women aged 40 to 49 and those over 70 had rates 10% to 15% lower than women aged 50 to 69. Summary figures for all KPNW women hide the striking effect of duration of membership in this HMO. Women aged 50 to 69 who had been members for at least 2 years had mammography rates (at least one examination in that 2-year period) of 75% to 76%. Longer membership resulted in gradually higher rates. The annual mammogram rate for women with 4 years of membership was 58%. CONCLUSIONS: Though there may be significant personal barriers to regular mammography, the effect may be less important in the HMO setting. An efficient, organized system can effect high rates of mammographic screening. The longer a woman remains a member of such an organization the greater her likelihood of receiving regular screening mammograms.

Adult↗
PubMed1998

Quality mammography standards--FDA. Proposed rule.

The Food and Drug Administration (FDA) is proposing to amend its regulations governing mammography that published in a document entitled "Quality Mammography Standards." The purpose of these amendments is to eliminate a conflict between the mammography regulations, which must be followed by all facilities performing mammography, and FDA's Electronic Product Radiation Control (EPRC) performance standards, which establish radiation safety performance requirements for x-ray units, including mammographic systems.

Female↗
PubMed1998

[History of mammography].

The History of mammography began in 1913, when a Berliner surgeon, A. Salomon realized a roentgeno-histological study on 3,000 mastectomies. This work is the basis of mammography. Until 1938, few articles were published but were of little help to mammography. From 1947 to 1970, the second period brought the results of roentgenologic and clinical correlation. R. Leborgne was the first accountable for the wide development of this method. Since 1951, many American and European radiologists brought their contribution. Ch. Gros is the best known. He gave this technique an acknowledgment throughout the world for the diagnosis of breast diseases. Since 1970, the third period emphasizes the value of mammography as a technique for detection of breast cancer. Some "Screening working groups" are being set up. The problem is mainly economical.

Adult↗
PubMed1999

[Proficiency test in clinical mammography. Results of a consecutive series of 130 volunteer Italian radiologists].

PURPOSE: We evaluated the results obtained by 130 Italian radiologists undergoing a proficiency test of clinical mammography. MATERIAL AND METHODS: Radiologists were invited to report a series of 100 mammograms (two views), including 32 cancers and 78 non-cancers, with limited information regarding age, subjective symptoms, and findings at palpation. Sensitivity and specificity were then calculated. The test was validated by a panel of experts, and standards for test sufficiency were established on that basis (sensitivity > 80%, specificity > 85%). The tested radiologists differed by mammographic practice (average = 5.7 years, range 0.5-18), total number of mammograms read (average = 8,784, range 300-50,000) and per year (average = 1,535 range 300-5,000). RESULTS: Sensitivity (standard > 80%, average 81.1%, range 39-100%) and specificity (standard > 85%, average 84.0%, range 38-98%) standards were reached by 79 (60.8%) and 81 (62.3%) radiologists, respectively. Overall, only 37 (28.5%) radiologists passed the test (reached both standards). Mammographic practice (years of experience) (chi 2 for trend 5.26, p = 0.02), total mammograms read (chi 2 5.86, p = 0.05), and mammograms read per year (chi 2 8.07, p = 0.01) significantly correlated with a sufficient test. DISCUSSION: The evaluated sample is rather large but not necessarily representative of Italian radiologists. Had the sample been selected, there is no way to know if the results would have been biased towards a better or worse figure with respect to the national average. A significant correlation was found with reading experience (the best results were obtained by operators with > 10,000 films read and with > 2,000 films read/year), as which is important because most Italian radiologists reporting mammography usually read a limited number of cases. CONCLUSIONS: These results on such a wide sample of radiologists, possibly representative of the national average, are disappointing, and suggest that the average quality of mammography reporting in Italy may not be up to standards. Thus, we suggest that quality control program for clinical mammography not only test the equipment but include training and accreditation of radiologists.

Clinical Competence↗