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PubMed1977

Cancer of the breast--induction by radiation and role of mammography.

Conflict in the management of cancer of the breast exists. Diagnosis by x-ray mammography provides early effective treatment, but x-ray exposure to the breast is cancerogenic. Prudence requires the use of low dose x-rays in mammography, and limits the use of x-ray mammography in the young. Guide lines for the indications for mammography are changing, and large scale population exposure to radiation should await results of demonstration projects in the United States.

Acne Vulgaris↗
PubMed2003

[Results of preventive mammography before initiation of hormone replacement therapy].

INTRODUCTION: Breast cancer is the most common neoplasm among women, with a peak incidence at an age between 40 and 60. The contemporary guidelines for prophylactic breast cancer screening emphasize on performing an annual mammography, starting at the age of 40. OBJECTIVE: To analyze the results of the prophylactic mammography and clinical examination in a group of climacteric women before initiation of HRT. MATERIAL AND METHODS: 108 women were screened for a period of 12 months. The average age of participants was 51.4 +/- 3.67 years. RESULTS: In two patients in the absence of evidence for breast cancer from the clinical exam the mammogram was evaluated as indicative for breast neoplasm. In both of the cases the diagnosis was confirmed hystologically. DISCUSSION: The results from the selected group of patients represents a 2% incidence of breast cancer, unrecognized by the clinical exam. The mammography proves its high effectiveness and the recommendation for timely prophylactic mammography referring the climacteric women is in concordance with the latest world standards for breast cancer screening.

Breast Neoplasms↗
PubMed2003

Mammography screening and breast self-examination among minority women in public housing projects: the impact of physician recommendation.

This exploratory study examined the impact of physician recommendations and other factors on mammography screening and breast-self examination (BSE) among African American and Hispanic women in public housing communities. We surveyed a randomly selected sample of low-income households from three low-income communities (n = 291), which included both African Americans and Hispanic women. Data for this paper are reported only on women who were 40 years and older head of the households (n = 120 women, including 74 Hispanics and 46 African Americans), since they meet the age criterion for mammography screening. Our analyses indicated that only 46% of women obtained mammography in the previous 12 months, with no significant differences between the Hispanic and African American women in mammography rates. Physicians' recommendations were among the most significant and substantial predictors of obtaining a mammogram or performing BSE. Further, odds were also higher for those who had insurance coverage. In addition, our data also indicated that almost one out of four women, aged 40 and older participants in this study, claimed that their health care providers never told them they needed a mammogram or never told them that they should perform BSE, with no significant differences between Hispanic and African Americans. Our analyses points to an urgent need for intervention to inform and motivate the service providers in underserved communities to motivate breast cancer screening (BCS) among minority women. Additionally, our examination points to the need for urgent interventions targeting minority women, particularly women with no medical insurance for breast cancer screening.

Adult↗
PubMedDate not supplied

Digital mammography: quality and dose control.

PURPOSE: For almost 3 years, Radiologists and Physicists from Padova and Ferrara Universities have collaborated together, with the aim of collecting and comparing experimental data useful to define the most significant parameters for quality controls in digital mammography. Successively, radiologists and physicists working in other sites where a digital mammography unit was installed joined the work-group. MATERIALS AND METHODS: In this study we report the results obtained from measurements of linearity, uniformity, short- and long-term reproducibility, AEC stability performed on 5 digital equipment by using a simple test object. X-ray beam quality and tube yield were preliminarily checked in such a way that possible uncertainties of digital system responses could be separated from those due to differences among X-ray tubes. RESULTS: Results showed that the equipment considered, comparable in terms of both beam quality (HVL) and tube yield, always displayed linear response and reproducibility errors lower than 5%. Uniformity was very good and the grey level compensation as a function of exposure parameters remained within 5%. Differences in choice of parameters by exposure control system (AOP) were emphasised, especially for crossing between track/filter combinations (from Mo/Mo to Mo/Rh and from Mo/Rh to Rh/Rh); those differences were attributed to the +/-2 mm tolerance of breast thickness measurement (mechanically obtained) greater than the AOP tolerance (+/-1 mm). DISCUSSION AND CONCLUSIONS: Obtained results can be useful, as comparison and reference values, for users employing a digital mammography unit of the same kind reported in this paper. Moreover, the same results could be used as "orientation" also by other users having different digital mammography technologies, whose operation should be nevertheless specifically studied and understood in order to find the most useful parameters for quality controls. The acquired experience clearly showed us that years of investigations will be necessary in order to be able to write reliable protocols. This should induce people to contemplate the necessity of not improvising "theoretical" protocols, that are unreliable and dangerous for their negative clinical implications.

Humans↗
PubMed1992

[1989 Basel Mammography Action].

To evaluate the compliance for a breast cancer screening program in the region of Basel, a mammography and a clinical examination has been offered free of charge to women between 40 and 60 years of age, especially to women with familial breast cancer. From September to November 1989, 602 women participated. Results were obtained from an epidemiologic questionnaire and a two-view mammography. The median age was 55.1 years. 70.2% of the women never had a mammography before. 28.8% indicated a history of familial breast cancer. So far 444 women have been evaluated. No pathological results were obtained in 84.8% In 10.7% a second examination has been recommended in the near future. In 4.5% the mammography led to an aspiration biopsy or surgical lumpectomy where 5 (1.2%) neoplasms have been detected. Due to the limited duration of the campaign and the invitation especially addressed to women at risk, our results are not comparable with large-scale screening campaigns known from the literature. Nevertheless, we succeeded to sensitize the female population for this kind of breast care. The overwhelming success shows that the basis for a large-scale screening program may exist.

Adult↗
PubMed2004

[Overdiagnosis in mammography screening].

BACKGROUND: In Norway and Sweden, the introduction of mammography screening programmes has been associated with about a 50% increase in breast cancer incidence for the screened age groups and almost stable incidence in higher age groups. This suggests that mammography screening results in a substantial degree of overdiagnosis. MATERIAL AND METHODS: In a prospective cohort study of the Norwegian mammography programme we recorded the incidence of breast cancer among women aged 50 to 69 years offered mammography screening as well as the incidence of interval cancer among those attending, and breast cancer among those not attending. We used these data to calculate the incidence of cancer detected by screening among those screened. RESULTS: The incidence of invasive cancer at second and third screening is 2.4 times higher than expected. We estimated that only 42% of the screening-detected invasive cancers would have developed into clinical disease in the absence of a screening programme. When ductal carcinoma in situ is added, only 34% of the screening-detected cancers would have developed into clinical disease. INTERPRETATION: Two thirds of breast cancers detected by screening are overdiagnosed.

Aged↗
PubMed2005

Monochromatic x-rays in digital mammography.

RATIONALE AND BACKGROUND: The emission spectrum of an x-ray tube is determined by the anode and filter materials as well as by the high voltage being used. For mammography, typical anode materials are molybdenum (Mo), rhodium (Rh), and tungsten (W); molybdenum, rhodium, and aluminum are favored for filters. Mammography is a soft tissue imaging modality demanding a high spatial resolution as well as a high detector sensitivity. Low-energy photons are only absorbed in tissue and have no contribution to the image; nevertheless, they increase the dose. High-energy photons mostly penetrate soft tissue and generate a background noise as a result of strong scattering that deteriorates the image quality. For mammography, the optimal energy window is in a range from 17 and 25 keV. From a theoretical perspective, one would favor monoenergetic x-rays (eg, the Mo-emission line at 17.5 keV). This article presents the realization of imaging with monochromatic x-rays using a diagnostic mammography unit. METHODS: Basically, a monochromatic module was added to a conventional mammographic system. The monochromatic module can be mounted at the end of the x-ray tube and it consists of a curved HOPG (highly oriented pyrolytic graphite) crystal and a slit collimator. For image generation, the object is moved through the fan-shaped monochromatic radiation field. In addition to the conventional polychromatic 2-dimensional case, the polychromatic irradiation was also able to be performed under similar conditions. For image acquisition, image plates or a linear array detector were used. Exposure doses were measured for both poly- and monochromatic radiation. The initial evaluation of the system performance was carried out by imaging a contrast-detail phantom and biologic specimens. RESULTS: The monochromatic x-ray beam has a size of approximately 35 mm x 200 mm in the object plane. The photon flux of the monochromatic x-rays is considerably lower than the photon flux of the polychromatic x-rays but adequate for initial studies of phantoms, biologic tissue, or small animals. The comparison of the results obtained with the monochromatic and polychromatic imaging modalities reveal a conspicuous increase of image contrast in the monochromatic case. CONCLUSION: The results suggest that the experimental setup for monochromatic excitation shows clear potentials for improvements of the image in comparison to the conventional polychromatic case.

Equipment Design↗
PubMed2005

[Stereotactic vacuum-assisted breast biopsy (Mammotome biopsy) for non-palpable microcalcification on mammography].

PURPOSE: The purpose of this study was to assess the benefits of stereotactic vacuum-assisted breast biopsy in patients with non-palpable microcalcification detected on mammography. METHODS: Between October 2001 and November 2003, stereotactic Mammotome biopsies were performed for 150 microcalcified lesions on mammography using the prone-type stereotactic vacuum-assisted breast biopsy system (Mammotest and Mammovision, Fischer, Denver, USA) . The mammography findings were classified according to the guidelines of The Japan Radiological Society/The Japan Association of Radiological Technologists. Ninety-eight cases were category 3, 38 were category 4, and 14 were category 5. RESULTS: All cases were determined to be cases of microcalcification by specimen radiography or histology. Complications were negligible. One hundred twenty of the cases were mastopathy, and 30 of them were breast cancer (14 were ductal carcinoma in situ, 7 were ductal carcinoma in situ with microinvasion, and 9 were invasive ductal carcinoma). Twenty-seven breast cancers were diagnosed as category 4 or 5 (51.9%) on mammography. The operative stages of 27 cases were as follows: 7 were stage 0, 17 were stage 1, and 3 were stage 2A. Twenty-four of 27 (88.9%) were early breast cancers. CONCLUSION: Mammotome biopsy is a safe and useful modality for the histological diagnosis of non-palpable microcalcifications.

Adult↗
PubMed2005

Digital mammography: a world without film?

OBJECTIVES: eDiaMoND is a next generation Internet ("Grid") multidisciplinary research project funded by the UK e-Science Programme with the following objectives; the development of a next generation Internet enabled prototype to demonstrate the potential benefits of a national infrastructure to support digital mammography; the exploration of potential benefits for digital mammography systems, with particular emphasis being placed on selected applications, namely, screening, training, computer-aided detection and appropriate support for epidemiological studies. METHODS: EDiaMoND has worked in conjunction with selected clinical partners to enable the collection of valuable mammography information and the design of applications based upon extensive requirements gathering exercises. The clinical partners validated both the immediate needs and assisted with defining future needs of such an architecture to support the UK Health Service. RESULTS: The project has succeeded in invoking the interest of clinical partners and representatives of the UK NHS Breast Screening Programme in our vision of a world without film, albeit a long way off. The project has also succeeded in identifying the barriers to adopting this approach with the current limitations within the NHS, and has developed a blueprint for working towards this strategy. CONCLUSIONS: A UK national digital mammography archive has the potential to provide major benefits for the UK. For example, such an archive could: ensure that previous mammograms are always available, and could link up seamlessly the screening, assessment and symptomatic clinics; it could provide a huge teaching and training resource; it could be a huge resource for epidemiological studies.

Archives↗
PubMedDate not supplied

MR imaging of the breast with Gd-DTPA enhancement: comparison with mammography and ultrasonography.

The accuracy of MR imaging with Gd-DTPA enhancement was compared with mammography and ultrasonography in 52 patients with clinically palpable benign and malignant breast masses (36 carcinomas, 2 malignant phyllodes tumors, 7 fibroadenomas, 7 cysts). On dynamic MR imaging, carcinomas and fibroadenomas were discriminated by their different dynamic enhancement profiles. In carcinomas, signal intensity increased rapidly, reaching a peak or plateau within 2 min after the injection of contrast medium. In fibroadenomas, signal intensity showed a much slower continuous increase without ceasing until about 8 min after injection. Malignant phyllodes tumors showed a dynamic enhancement profile identical to that of benign fibroadenomas. MR imaging correctly identified 84% of malignant tumors, 86% of fibroadenomas, and 100% of cysts, and was substantially more accurate in tissue characterization than mammography. The results of ultrasonography were highly similar to those of MR imaging. However, no single modality was infallible, and the three modalities were complementary rather than competitive. Considering the high cost and long examination time of MR imaging, mammography supplemented by ultrasonography seems to be the method of choice in the diagnosis of breast lesions. Nevertheless, MR imaging can add important information when the results of mammography and ultrasonography are insufficient or contradictory.

Adenofibroma↗
PubMed1991

Mammography of breast carcinoma: experience of 108 cases.

Mammography is the radiographic imaging of the breast and includes screen-film mammography and xeromammography. From September 1987 to March 1990, 108 patients with breast carcinoma received mammographic examinations at Chang Gung Memorial Hospital. The spectrum of mammographic appearance included mass abnormalities (50.9%), calcifications (10.2%), a combination of mass abnormalities and calcifications (25%), asymmetrical increased density (4.6%), and parenchymal distortion (1.9%). The remaining 7.4% of the lesions lacked any radiologic sign of malignancy and primarily appeared as dense breast on the mammogram. In this series, mammography had a sensitivity of 86.1%, a specificity of 77.3% and a positive predictive value of 67.4%. Recognition of these mammographic appearances is beneficial in detecting breast carcinoma and in establishing a correct diagnosis. In addition, knowing the abilities, as well as limitations, of mammography will optimize the efficacy of this examining modality.

Adult↗
PubMed1992

Quality assurance. How to audit your own mammography practice.

The medical audit is an important component of a comprehensive mammography quality assurance program. It provides a direct assessment of one's ability to detect otherwise occult breast cancer, the ultimate indicator of mammography performance. Audits must be properly planned, executed, interpreted, and used. The audit that shows successful clinical results can be used to build and maintain a high state of morale among mammography personnel as well as to encourage new and repeat referrals to a mammography practice. The audit that uncovers a deficiency in clinical performance can be instrumental in helping to plan remedial measures that correct the problem.

Breast Neoplasms↗
PubMed1991

Mammography: evaluation following breast augmentation.

Mammography is invaluable for evaluating the breast parenchyma, and this is equally true for patients who have had breast augmentation. Early detection of breast cancer is the major indication, and mammography is the single best test for this task. Although the sensitivity of mammography may be lower in patients with augmentation, routine screening should be carried out in these patients according to standard guidelines. Physical examination of the breast continues to be an important complementary procedure. Mammography is also important in the diagnostic evaluation of symptomatic women. Other imaging techniques such as ultrasound, computed tomography, and magnetic resonance imaging are often necessary as adjunctive studies in patients with prostheses.

Breast Diseases↗
PubMed1991

Mammography and early breast cancer detection.

Screening mammography has been shown to reduce breast cancer mortality. Both film-screen mammography and xeromammography are highly sensitive and specific. Mammography accreditation programs assure physicians and patients that a facility provides mammography of the highest quality, using the lowest possible radiation dose. Mammographic signs of early cancer include a small mass, calcifications, architectural distortion and a neodensity. Dense tissue may result in a false-negative examination even when a cancer is palpable, with adverse effects if biopsy is delayed.

Adult↗
PubMedDate not supplied

[Role of mammography in women under 35 years of age].

The detection of breast cancer in women under 35 is quite an uncommon event, accounting only for 3.2-3.4% of all breast cancers. To determine the indications for mammography in women under 35, the authors correlated clinical, mammographic, and US findings with fine-needle aspiration/surgical biopsy and follow-up results in 1040 symptomatic women examined at the Center of Senology of the Institute of Radiology-University of Perugia, Italy, from 1984 to June 1990. Of 1040 women, 482 (41.6%) had normal findings; benign disease was diagnosed in 558 (53.7%) cases, and malignant disease in 49 (4.7%). Mammography was very useful to diagnose malignancy in palpable breast lesions, as well as to suggest the need for biopsy, to detect metachronous cancers and to define lesion sizes. In inflammatory process--e.g., mastitis and abscesses--both mammography and US were capable of evaluating the real extent of the process, as well as its remission after therapy. Galactography had a specific role in the evaluation of the mammary duct and demonstrated intraductal pathologic conditions. In the authors' experience, mammography never showed occult breast cancers in women with no palpable breast lesions or hematic nipple discharge.

Adult↗
PubMed1990

The use of state-of-the-art mammography in the detection of nonpalpable breast carcinoma.

Between November 4, 1984, and September 1, 1988, a total of 16,439 patients were evaluated at the Comprehensive Breast Center at Mount Sinai Medical Center (MSMC) of Miami Beach with clinical examination, state-of-the-art mammography, and, when indicated, complimentary ultrasound mammography. As a result of this, 547 patients had open surgical biopsy, 207 carcinomas were detected in 207 patients, 183 carcinomas (80% of total malignancies) were clinically occult and detected only with breast imaging. Since 207 malignancies were found out of 547 areas examined, our rate was 1 carcinoma in every 2.6 biopsies. One hundred seventy-nine malignant lesions had preoperative needle localization and specimen radiography. Eighty-seven (47%) clinically occult carcinomas were identified because of microcalcifications by mammography alone. Two hundred twenty-six (98%) of the carcinomas were called malignant or suspicious for malignancy with only three (2.4%) false negatives. Twenty-two (10%) patients had axillary lymph-node metastasis. While recent large series report a 15 to 30 per cent rate of carcinoma for nonpalpable, mammographically detected breast biopsy specimens, it is our experience at MSMC with the use of physical exam and mammography, complemented by ultrasound when indicated, that rates of detection of carcinoma are more significantly improved than what the recent literature suggests; therefore, our approach to achieve this better detection will be discussed.

Adult↗
PubMed1990

[Evaluation of the role of mammography and echography in breast diseases in a controlled caseload].

Data concerning patients who underwent mammography and breast ultrasonography and then breast surgery were collected and analyzed with a computer archive system. In previous papers the authors reported both design and implementation of the computer archive and analyzed the results concerning uncontrolled collected data; in the present paper data concerning controlled cases are evaluated, distinguishing between symptomatic and asymptomatic cases. Asymptomatic patients represented 92% of the whole evaluated population. However only one third of the patients who underwent surgery for breast cancer was included in this group. Breast cancer was discovered in 65% of the patients who underwent diagnostic procedures and then surgery because of a palpable nodule. This percentage was lower (52%) in asymptomatic patients. Mammographic accuracy was about 90% in symptomatic patients and 81% in asymptomatic patients. Breast ultrasonography was performed as a subsequent step and always detected the lesion when palpable. Its sensitivity was 86% in asymptomatic patients. In patients who underwent surgery the false positive rate for cancer was higher with ultrasonography (59%) than with mammography (45%). Focal dysplasis were responsible for the majority of false positive diagnoses with both procedures. However, the false positive rate is low referring to the whole investigated population and is reshuffled by guided bioptic procedures. Ultrasonography was a useful tool when mammography had limitations: in fact ultrasonography detected a focal lesion in all patients with a surgically proven cancer and a previous negative mammography. The sets of data available from the continuous updating of the computer archive immediately clarified the differences between symptomatic and asymptomatic patients and stressed the diagnostic capabilities of the different procedures.

Breast Diseases↗
PubMed1990

Screening mammography: increasing the effort toward breast cancer detection.

Mammography is the only modality with the potential for detecting a breast cancer while it is non-palpable and at a stage of high curability. Early detection of breast cancer is important because survival is directly related to tumor size and lymph node status, and prognosis is best for small lesions without axillary node metastasis. Many studies have indicated that screening mammography is tremendously underused. This article focuses on the effectiveness of mammography and the importance of detecting a breast cancer at an early stage. Health care providers have a responsibility to inform their clients about the benefits of mammography. In addition, women need to be taught breast self-examination and undergo regular clinical breast examinations by a health care professional. The American Cancer Society guidelines for screening breast cancer are given.

Adult↗