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PubMed2000

Role of mammography in diagnosis of breast cancer in an inner-city hospital.

Mammography continues to play a strategic role in breast cancer diagnosis. Its place in the urban inner-city population among individuals in lower socioeconomic groups has been shown to differ from contemporary trends. A retrospective review of all women diagnosed with breast cancer over a 5-year period (1993 to 1997) in an inner-city hospital was undertaken. Primary cancers (128) were diagnosed in 123 patients during this period. Only 17 patients (12%) had their disease diagnosed with the help of mammography. All other 111 patients were diagnosed clinically. All 17 patients diagnosed by mammogram evaluation had Stage II carcinoma or earlier in contrast with three-fourths of the clinically detected group of patients. Twelve percent of the black women were diagnosed by mammography, whereas 21% of white patients were diagnosed by the same modality. All these proportions are lower than those cited in the regular literature. Better utilization of mammography needs to be applied in inner-city populations to improve early detection of breast cancer.

Biopsy, Needle↗
PubMed2000

Indications for MR mammography. A Belgian study.

The problem of dynamic MR mammography remains its low specificity. Therefore, the examination is only useful when it is performed as a complementary examination and only for good indications. The aim of the study was to analyse the indications for MR mammography in 12 Belgian hospitals and to evaluate whether MRI was useful for these indications. The two most frequent reasons for which MR mammography was performed in these hospitals were a diagnostic problem after clinical examination, mammography and ultrasound, and differentiation between post-therapeutic changes and recurrent disease, both of which are good indications. MRI examinations in the 12 hospitals were useful in patients receiving the examination for a good indication. However, in the group of the known poor indications we see much false positive MRI results.

Belgium↗
PubMed2000

Results of preliminary clinical trials of the positron emission mammography system PEM-I: a dedicated breast imaging system producing glucose metabolic images using FDG.

UNLABELLED: Early detection of breast cancer is crucial for efficient and effective treatment. We have developed an instrument for positron emission mammography (PEM) called PEM-I that performs high-resolution metabolic imaging of breast cancer. Images of glucose metabolism are obtained after injection of 75 MBq FDG. The PEM detectors are integrated into a conventional mammography system, allowing acquisition of the emission images immediately after the mammogram, without subject repositioning, and accurate coregistration of images from the 2 modalities. In this article, we present the results of the first clinical pilot study with the instrument. METHODS: Sixteen subjects (age range, 34-76 y) were studied. All subjects were nondiabetic, nonpregnant, and without a history of cancer. They had recently been found to have suggestive mammography findings or a palpable breast mass and underwent lumpectomy or mastectomy within 2 wk of the study. Results from the PEM study were compared with those from mammography and pathology. A PEM test was classified positive (indicating the presence of cancer) if significant focal uptake was seen in the image or if the counting rate in the breast with suggestive findings was significantly higher than in the contralateral breast. RESULTS: Of the 16 subjects studied, 14 were evaluable. Ten cancerous tumors and 4 benign tumors were confirmed by pathologic examination after complete removal of the tumor. PEM correctly detected the presence of disease in 8 of 10 subjects. Findings were false-negative in 2 instances and false-positive in none, giving the instrument 80% sensitivity, 100% specificity, and 86% accuracy. CONCLUSION: Our preliminary results suggest that PEM can offer a noninvasive method for the diagnosis of breast cancer. Metabolic images from PEM contain unique information not available from conventional morphologic imaging techniques and aid in expeditiously establishing the diagnosis of cancer. In all subjects, the PEM images were of diagnostic quality, with an imaging time of 2-5 min.

Adult↗
PubMed2000

Costs and cost-effectiveness of a church-based intervention to promote mammography screening.

OBJECTIVES: To evaluate the costs of implementing a church-based, telephone-counseling program for increasing mammography use, and to identify the components of costs and the likely cost-effectiveness in hypothetical communities with varying characteristics. DATA SOURCES/STUDY SETTING: An ethnically and socioeconomically diverse sample of 1,443 women recruited from 45 churches participating in the Los Angeles Mammography Promotion (LAMP) program were followed from 1995 to 1997. STUDY DESIGN: Churches were stratified into blocks and randomized into three intervention arms-telephone counseling, mail counseling, and control. We surveyed participants before and after the intervention to collect data on mammography use and demographic characteristics. DATA COLLECTION/EXTRACTION METHODS: We used call records, activity reports, and interviews to collect data on the time and materials needed to organize and carry out the intervention. We constructed a standard model of costs and cost-effectiveness based on these data and the Year One results of the LAMP program. PRINCIPAL FINDINGS: The cost in materials and overhead to the church site was $10.89 per participant and $188 per additional screening. However, when the estimated cost for church volunteers' time was included, the cost of the intervention increased substantially. CONCLUSIONS: A church-based program to promote the use of mammography would be feasible for many churches with the use of volunteer labor and resources.

Aged↗
PubMed2000

Flow cytometric DNA analysis of specimen mammography-guided fine-needle aspirates of ductal carcinoma in situ.

Flow cytometric studies of screening mammography detected ductal carcinoma in situ (DCIS) are limited by the lack of fresh cell samples. We have performed flow cytometric DNA analyses of specimen mammography-guided fine-needle aspirates of 50 consecutive DCIS lesions detected by screening mammography. The comedo histologic subtype had an aneuploidy rate of 39% (9 of 23); noncomedo subtypes had an aneuploidy rate of 19% (5 of 27), p=ns. Noncomedo subtypes were more likely to have low (less than 2.2%) S-phase percentages, 59% (16 of 27) as compared to comedo, 9% (2 of 23), p<0.05. High and intermediate nuclear grade DCIS lesions had an insignificantly greater rate of aneuploidy, 35% (9 of 26) and 33% (4 of 12) respectively, as compared to low nuclear grade lesions, 8% (1 of 12), p=ns. Low and intermediate nuclear grade DCIS lesions had low S-phase percentage rates of 67% and 50% respectively, as compared to the high nuclear grade lesions low S-phase percentage rate, 15%, p=ns. Aneuploidy and lesser rates of low S-phase percentages were significantly associated with necrosis and apoptosis. Our data suggest that flow cytometric DNA analysis of mammographic lesion-specific, fresh cell samples obtained by fine-needle aspiration under specimen mammographic guidance can assess mammography-detected DCIS lesions when gross fresh tissue procurement is not possible.

Adult↗
PubMed2001

Going the distance: how far will women travel to undergo free mammography?

This study examined the effect of travel distance on mammography facility choice, with mammography cost held constant. Women who were eligible to undergo free mammography at a military treatment facility (MTF) responded to a mail survey by indicating whether their last mammograms were performed at an MTF (for free) or at a civilian medical facility (for a fee). The distance from each respondent's home to the MTF was also recorded. Analyses indicated that a majority of the women who traveled to the MTF for a mammogram lived within 20 miles of the facility. Results of this study suggest that, even if mammography screening is offered free of charge, women may not use the service if they must travel more than 20 miles to receive it. Furthermore, any MTF trying to increase its TRI-CARE market share may want to focus its marketing efforts on individuals who live within a 20-mile radius.

Adult↗
PubMed2001

[Screening lowers breast cancer mortality. Motivate your patients for mammography].

Breast cancer is the most common malignant disease in women under 70, and the most common cause of death in those under 50. Causal prophylaxis is unknown. Only early diagnosis prior to the onset of lymphogenic or hematogenic metastasization improves the prognosis. Since the early nineteen-sixties, large-scale studies have shown that screening mammography can reduce mortality. Furthermore, early diagnosis enables breast-conserving treatment in up to 70% of cases. Disadvantages of screening mammography currently under discussion are the radiation burden, the number of false-positive diagnoses prompting biopsy and incurring costs. In Germany, the cost of screening mammography in women with no relevant history or clinical symptoms is not borne by the state-affiliated health insurance carriers. Currently, ongoing pilot projects are investigating quality-controlled early diagnosis with mammography.

Adult↗
PubMed2001

A randomized intervention to improve ongoing participation in mammography.

OBJECTIVE: To test the effectiveness of interventions intended to increase rates of regular breast cancer screening, according to recommended guidelines. STUDY DESIGN: A randomized controlled trial of 2 outreach interventions (a mail reminder and a telephone reminder plus appointment scheduling) compared with a routine publicity campaign to encourage continued participation in mammography screening. PARTICIPANTS AND METHODS: Participants were 1908 women aged 50 to 75 years continuously enrolled in a large group-model HMO during the study who underwent a bilateral mammogram during the first quarter of 1994 and no subsequent mammogram during the next 18 to 21 months. Data were obtained from health plan administrative data files supplemented by medical chart review. Women were randomly assigned to receive (1) a mail reminder, (2) a telephone reminder, or (3) routine publicity on mammography for all women. The outcome measure was a mammogram received after the intervention period and within 2 years of the initial mammogram date. RESULTS: Bivariate and multivariate statistical analyses showed that participation was significantly higher for women contacted by telephone than through routine publicity. Mail reminders were no more effective than a routine publicity campaign. Primary care physician and gynecologist visits increased the likelihood of a subsequent mammogram for women in all intervention groups. CONCLUSIONS: Telephone contact by regular health plan staff was more successful than publicity in encouraging continued participation in mammography screening in women enrolled in a group-model managed health care plan. Because mailings did not influence participation in mammography screening, health plans should be cautious about investing in member mailings without first evaluating their effectiveness in the context of existing outreach efforts.

Aged↗
PubMed2002

The effectiveness of interventions to promote mammography among women with historically lower rates of screening.

This study examines mammography-enhancing intervention studies that focus on women in groups with historically lower rates of mammography use than the general population. These groups consist of women who are disproportionately older, poorer, of racial-ethnic minorities, have lower levels of formal education, and live in rural areas. We refer to them as diverse populations. The purpose of this report is to determine which types of mammography-enhancing interventions are most effective for these diverse populations. For this report, United States and international studies with concurrent controls that reported actual receipt of mammograms (usually based on self-report) as an outcome were eligible for inclusion. Intervention effects were measured by differences in intervention and control group screening rates postintervention and were weighted to reflect the certainty of each study's contribution. These effects differed significantly (Q = 218, 34 df), and the variation between studies was best explained by indicators of the use of access-enhancing approaches. Combined intervention effects were estimated for different categories of intervention types using random effects models for subgroups of studies. The strongest combination of approaches used access-enhancing and individual-directed strategies and resulted in an estimated 27% increase in mammography use (95% confidence interval, 9.9-43.9, nine studies). Additionally impressive was the access-enhancing and system-directed combination (20% increase and 95% confidence interval, 8.2-30.6, five studies). Access-enhancing strategies are an important complement to individual- and system-directed interventions for women with historically lower rates of screening.

Aged↗
PubMed2001

Experimental investigations of image quality in X-ray mammography with conventional screen film system (SFS), digital phosphor storage plate in/without magnification technique (CR) and digital CCD-technique (CCD).

Comparison of image quality in X-ray mammography between conventional film screen film system (SFS), digital phosphor storage plate in and without magnification technique (CR) and digital CCD-technique (CCD). Radiograms of an RMI-mammography phantom were acquired using a conventional screen film system, three digital storage plate systems and two digital systems in CCD-technique. Additionally, the radiograms of one digital phosphor storage plate system were post-processed regarding contrast and included in the comparison. The detectability of details was best with the digital mammography in CCD-technique. After confirming these promising results in clinical studies, digital mammography should be able to replace conventional screen film technique.

Breast Neoplasms↗
PubMed2002

[Digital mammography and computer assisted diagnosis].

Until recently, the film has remained the only medium of information in mammography. The film is used to record, to exploit, to store and to transmit the image. Computerization of images allows to dissociate and to optimize these different functions. Among classical factors of image quality (spatial resolution, contrast, noise), new factors should be added like the detective quantum efficiency and the conversion factor. Radioluminescent screens, then digital sensors for breast stereotactic imaging have been marketed. Manufacturers are now testing full field digital mammographs. Digital imaging allows many applications (computed-aided diagnostic, 3D imaging.) and permits the easy transfer of images for diagnosis and teaching. Three parts are presented in this chapter. The first one describes the different imaging modalities and gives a reminder of the different elements related to image quality. The second one is related to the practical aspects of full field mammography, the reading of mammograms on a review station, ergonomy in full field mammography and to possible changes for screening mammography. The third part is devoted to computed aided diagnosis and its possible application in screening.

Diagnosis, Computer-Assisted↗
PubMed2002

Self-reported mammography screening among Oklahoma women age 50 and older: Oklahoma Behavioral Risk Factor Surveillance System 1997-2001.

PURPOSE: To examine which factors were associated with mammography screening among women age 50 and older in Oklahoma from 1997-2001. METHODS: Using data from 4,338 women age 50 and older interviewed for the 1997-2001 Oklahoma Behavioral Risk Factor Surveillance System, this study examines the proportion of women receiving mammography screening services and assesses the associations between covariates of interest and mammography screening. RESULTS: Among Oklahoma women age 50 and older, 17.5% had never received a mammogram and 14.9% of those who had received a mammogram had not done so in the past two years. Women without health insurance coverage, those of lower socioeconomic status and those engaging in risky health behaviors were more likely to never have had a mammogram and, if they were screened, to have not had a mammogram in the past two years. CONCLUSIONS: These results show a need to focus mammography screening programs on women with lower socioeconomic status.

Aged↗
PubMed2002

Racial and age-related disparities in obtaining screening mammography: results of a statewide database.

BACKGROUND: This study compared mammography rates in Arkansas, based on race and age, to identify any disparities in obtaining mammography. METHODS: The Arkansas Mammography Data Collection Project contained data on 133,549 women, 87,680 of them aged 40 to 64 and 45,869 aged 65 years or older. Race data were available on 64,526 women. Mammography rates were compared by patient age and race. RESULTS: Women aged 65 years and older were less likely to obtain mammograms than younger women: 21.67% versus 23.30%. Mammograms were more likely to be classified as diagnostic in older women and as screening in younger women. Older African American women were less likely to obtain mammograms than younger women of the same race (7.23% vs 8.02%), while older white women were more likely to obtain mammograms than younger white women (11.64% vs 11.31%). African Americans were less likely to obtain mammograms in both age groups. CONCLUSIONS: Older African American women are less likely to obtain mammograms than white and younger women. The reasons for this disparity warrant further evaluation.

Adult↗
PubMed2002

[Mammography use among women aged 35 to 75 years].

The aim of the study was to evaluate mammography use and indications (diagnosis or screening) among 19,253 women aged 35 to 75 attending a health screening centre. The data were collected by a self-administered questionnaire completed after by an interview with a nurse. Mammography use is frequent in women attending a health screening centre, even before the age of 50: 79.1% had undergone at least one mammography during their life and for 47.3% a screen had been performed within the last three years. Nevertheless mammography was only used by 65.2% of the women aged 50-69 years, target age group of the screening programme. A logistic regression model adjusting for multiple variables was used to examine factors associated with women who underwent a screen within the last three years. Women more likely to be screened were aged 50-69 (vs age 35-49: OR=3.1), used regular gynaecological care (OR=4.5), had a family history of breast cancer (OR=1.45), had in their district a breast cancer screening campaign (OR=1.93). The study indicated that women under 50 years of age with a family history of breast cancer and women aged 70 and over were under-screened. When a campaign for breast cancer screening was organised in the district the screening rates were higher in the target population (71,4% vs 60,1%) although only 64% of the women reported having attended. Current recommendations for breast cancer screening should be reviewed in the light of these results.

Adult↗
PubMed2003

[Mammography screening of breast cancer in Tunisia. Results of first experience].

This article reports the results of a mammography screening program of breast cancer, realized in the department of Radiology, Charles Nicolle hospital. A free screening mammography with two incidences was offered to women aged from 40 to 70 years old. 2200 mammographies were realized from May 1995 till July 1997. Women having a positive test benefited of a diagnostic explorations in the same unity. The positive test rate was 24%. Predictive positive value was 31%. This program allowed to detect 10 subclinical cancers, corresponding to a rate of detection of 4.5 cancers for 1000 women. This program is a first experience which demonstrated the feasibility of the mammography screening to wide scale and allowed the medical and paramedical team to acquire an experience.

Adolescent↗
PubMed2002

[Mammography: consideration about radiation from the point of a radiologist's view].

Mammography is becoming popular rapidly in Japan because it is now admitted as a modality for breast screening. Radiation will not cause any adverse effect if mammography screening is done for women over 50 years old, every other year and by only MLO (medio-lateral oblique) view as this is recommended by the government. Radiation for one view is regulated to be less than 3mGy. Radiation by mammography may become problem if it is done for younger women, by more views (i.e. cranio-caudal, other additional views) and more often especially for follow up. Radiation may be more if the system is not adequate. In Japan mammograms are read by surgeons in many institutions and there are not enough medical physicists in each hospital. Cooperation between medical physicists, radiographers and radiologists will be necessary to achieve good quality mammography with adequate radiation.

Breast Neoplasms↗
PubMed2002

[X-ray phase imaging using a X-ray tube with a small focal spot -improvement of image quality in mammography-].

Phase contrast X-ray imaging has been studied intensively using X-rays from synchrotron radiation and micro-focus X-ray tubes. However, these studies have revealed the difficulty of this technique's application to practical medical imaging. We have created a phase contrast imaging technique using a molybdenum X-ray tube with a small focal spot size for mammography. We identified the radiographic conditions in phase contrast magnification mammography with a screen-film system, where edge effect due to phase contrast overcomes geometrical unsharpness caused by the 0.1mm-focal spot of a molybdenum X-ray tube. The edge enhancement due to phase imaging was observed in an image of a plastic tube, and then geometrical configuration of the X-ray tube, the object and the screen-film system was determined for phase imaging of mammography. In order to investigate a potential for medical application of this method, we conducted evaluation of the images of ACR 156 mammography phantom. We obtained higher scores for phase imaging using high speed screen-film systems without any increase of X-ray dose than the score for contact imaging using a standard speed screen-film system.

Female↗
PubMed2003

[Benefits and limitations of mammography].

The literature on screening mammography provides ample opportunity for doubt (the sceptics) and dogma (the screening zealots), and can be interpreted to prove both benefit and harm. The benefit of mammography screening, if any, is modest and the balance between beneficial (potentially, a 20% relative reduction in breast cancer mortality with no significant benefit on all-cause mortality) and harmful (physical and psychological morbidity related to the 15-40% missed cancers and the 80-90% false-positive diagnoses) effects is still delicate. The mammogram alone is a modest weapon. Concurrent clinical breast examination is mandatory. Women that are concerned about breast cancer should be fully informed of the potential benefits and risks of screening mammography. These women should benefit from mammography with concurrent clinical breast examination, and possible whole-breast ultrasound in heterogeneously dense and extremely dense breast patterns.

Age Factors↗