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PubMed1990

Mammography referral patterns among Rhode Island physicians.

In 1987, the Rhode Island Department of Health conducted a survey of Rhode Island primary care physicians to determine their attitudes and practices regarding breast cancer screening, particularly their use of clinical breast exam (CBE) and referral for screening mammography, and compared the data with information obtained from primary care physicians in the US in 1984 and 1989. The survey showed that the same percentage of Rhode Island physicians (71%) and physicians nationally (72%) agree with American Cancer Society (ACS) guidelines for breast cancer screening, but Rhode Island physicians refer for mammography (43 vs 37%) and perform CBE (97 vs 80%) according to ACS guidelines more frequently. Cost, reliability and availability were of greater concern to physicians nationally than in Rhode Island. Despite better use of breast cancer screening by Rhode Island physicians, only 43% reported referring for mammography according to guidelines. Since studies indicate that the recommendation of her physician is a key determinant of a woman's decision to have a screening mammogram, physician referral needs to increase in order to meet the Year 2000 Objectives of 80% for screening mammography for women 40 and older.

Adult↗
PubMed1990

Effect of mass screening mammography on staging of carcinoma of the breast in women.

In 1980, our institution began a screening mammography program. A retrospective review was done to document whether or not implementation of this program significantly changed the method of discovery of carcinoma of the breast and the stage of carcinoma of the breast at presentation in the patients we studied. Women diagnosed with carcinoma of the breast during a three year period, prior to the institution of the screening program (group 1) were compared with a similar set of patients diagnosed after establishment of the program (group 2). There were 165 patients in group 1 and 181 in group 2. The vast majority of cancers for those in group 1, 84.2 per cent, were discovered at self-examination, as compared with 46.3 per cent for those in group 2. Forty-eight per cent of the cancers for those in group 2 were first discovered by mammography as compared with 6.1 per cent in group 1. There was no statistical difference in the number of patients presenting with stage O, III and IV disease. The percentage of patients presenting with stage I disease rose significantly after the establishment of the mammography program (16.4 per cent in group 1 to 41.5 per cent in group 2). Findings from this study confirm that a mammographic screening program can have a marked effect on lowering the stage of carcinoma of the breast at presentation. The current recommendations for screening mammography should be implemented. Doing so will result in earlier detection and improved survival in this group of patients.

Breast↗
PubMed1986

[Mammary echography. Comparison with mammography].

The analysis of 249 cases of mammary pathologic conditions, confirmed by cytologic and/or histological examinations, comparatively studied by echography and mammography, shows a better diagnostic accuracy of US compared with mammography in benign pathology. The authors emphasize that US, although displaying lower diagnostic accuracy than mammography in malignancies, allow to correct some diagnostic mistakes of mammography, showing complementarity of both techniques, at least in women aged 30 to 50 years; in women under 30, US may be the first choice examination, while showing considerable limits in the fatty breasts of old women.

Abscess↗
PubMed1985

Mammography, sonomammography, and diaphanography (lightscanning). A prospective, comparative study with histologic correlation.

While mammography has become a routine method both for the screening and preoperative assessment of breast disease, the role of this modality, especially when compared with newer techniques of breast imaging, needs continued assessment. Recent advances using sonographic principles and diaphanography (light transillumination) must be compared with mammography to define specificity, sensitivity, and accuracy in assessing breast lesions. During a 16-month period between November 1982 and February 1984, 467 women with clinically apparent breast disease (symptoms or palpable lesions) were each studied using all three imaging techniques of mammography, sonomammography, and diaphanography. Of 168 women recommended for biopsy on the basis of these techniques, 84 women had histologic confirmation during this study period. Benign breast disease was diagnosed histologically in 38 women, while carcinoma was found in 46 patients. These techniques showed no significant differences in predicting benign or malignant disease when rates of sensitivity, accuracy, and specificity are computed. Diaphanography (lightscanning), allowed for consistently correct interpretation of cases proven to be histologically malignant and showed a false-negative rate comparable with x-ray mammography. We conclude that diaphanography is a sensitive indicator of both benign and malignant breast disease while serving as a reliable predictor of clinically apparent breast lesions without the potential problems of radiation exposure.

Adult↗
PubMed1984

[Comparative estimation of the limitations of mammography and echography in senologic practice].

Mammography and breast ultrasonography are complementary examinations. The combination of the two examinations can provide an accurate diagnosis, which mammography alone is unable to do. Ultrasonography is particularly important in the examination of dense breasts, especially for the visualization of sonolucent or hypoechogenic formations. However, ultrasonography should not be performed alone, as it is unable to visualize microcalcifications. It can not be used as a screening test and it would be a professional error to perform only a clinical examination and ultrasonography, as a large number of diagnoses would be missed. Two essential points should be stressed: 30% of carcinomas have microcalcifications; amongst these 30%, many lesions are small and impalpable and they may not be seen on ultrasonography in a fatty breast. 40% of occult cancers are detected by the microcalcifications identified on mammography, which remains the key to breast investigations. Ultrasonography compensates for some of the deficiencies of radiography and can be very useful in dense breasts, in cystic or hypoechogenic structures. It can also be used to guide aspiration biopsy of non palpable lesions and for the pre-operative localization of impalpable lesions with abnormal echostructure, which are not visible on mammography.

Adenofibroma↗
PubMed1983

Indications for and comparative diagnostic value of combined ultrasound and X-ray mammography.

A standardised method of ultrasound mammography is described. In order to achieve the same position, form, and shape of the breast as during röntgen mammography a Lucite plate in horizontal, and vertical position is used. Ultrasound contact scanning of the whole breast is carried out in cranio-caudal as well as in medio-lateral direction of the ultrasound beam. Ultrasound scanning is performed with the compression of the breast corresponding to the compression during röntgen mammography. It was found that the ultrasound breast examination combined with X-ray mammography optimizes the differentiation benign and malignant masses and therefore may reduce the incidence of breast biopsy. A combined use of both examination modalities in the evaluation of the breast is advocated.

Abscess↗
PubMed1984

Guidelines for detection of breast cancer: an update on investigative methods. A report of the ad hoc committee on mammography of The Canadian Association of Radiologists.

The high incidence of breast cancer and its mortality make it imperative that women over 25 years of age have a clinical examination of their breasts at least every three years up to age 40 and annually thereafter. Before the age of 25, mammography is seldom indicated and then it should usually be limited to a spot film of a potential lesion. After 25, mammography is indicated for any woman with breast symptoms, women with metastases from cancer of an unknown primary site, and before any breast surgery. Women with a strong family history and those with large breasts should also have a mammogram between the ages of 25 and 35. Between the ages of 35 and 39 we recommend a baseline mammogram for asymptomatic women. After 39 and up to age 50, women should consult their physicians yearly to determine if, and how often, mammography should be performed. Finally, after age 50, annual mammography is suggested. In each of the above contexts, the radiologic examination should be coupled with clinical palpation of the breasts. A trained and experienced mammographer should recommend biopsy when mammograms show a typical spiculated mass; an ill-defined or even well defined mass that cannot be said to be benign; a suspicious distortion of local architecture; or a cluster of suspicious microcalcifications. Any cyst the nature of which is uncertain after puncture, or abnormal ducts on a galactogram also should make a biopsy mandatory. On the other hand, a normal mammogram should not prevent biopsy of a lesion of the nipple or of a lump detected clinically.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1978

[Critical notes on risk calculations in mammography (author's transl)].

Since 1971 a Mammography Screening Study was carried out in Hamburg. This project shows that mammography is the only method to detect a high percentage of minimal breast cancer. The chance to cure these patients (10-years-survival) then is 80% and more. With mean literature values for parenchym dose, incidence rate and induction period the risk of cancer induction by mammography as a function of age was calculated. It is shown that benefit exceeds risk not only for women over 50 years of age. Even for younger women the use of mammography seems justified, if longer inspection periods from 2 to 5 years are considered.

Adult↗
PubMed1983

Current perspectives on indications and limitations of mammography.

Women have a 7 percent natural lifetime risk of developing breast cancer, which is the leading cause of death in women aged 40 to 50 years. Most data suggest that the earlier the disease is diagnosed, the better the chance for cure. Women with "minimal breast cancer" have an actuarial 20-year survival rate of 93.2 percent. The majority of these breast cancers are diagnosed by mammography. The radiation doses from this technique have been dramatically decreased over the last ten years to about 0.1 to 0.6 rads per study. The two largest breast cancer screening studies, the Health Insurance Plan of Greater New York and the Breast Cancer Detection Demonstration Project, have shown conclusively that women over 50 years old can benefit from annual mammography and that certain groups can benefit from mammography at close intervals before the age of 50 years. This article describes the development of mammography and outlines current perspectives on its indications and limitations.

Adult↗
PubMed1982

[Daylight development and mammography (author's transl)].

A "daylight" development system adapted for mammography has been employed over a period of 18 months. Rigid MR 50 Agfa-Gevaert cassettes were adapted for use in th Gévamatic L modular system. Compatibility of this mammography cassette with the unloading module of the Gévamatic system was ensured by the employ of an intermediate metallic frame, adaptable to the cassette and modifying its opening system. The modified apparatus appears to give reliable results which should incite manufacturers to adopt their "daylight" development systems to mammography examinations. Wider diffusion of these systems is probably limited by their current inability to be employed for mammography.

Humans↗
PubMed1981

[The value of mammography in 1203 breast cancers (author's transl)].

The value of clinical mammography is reviewed on 1203 consecutive cases of histologically proven breast malignancies examined from 1971 to 1978 at the Istituto Nazionale Tumori, Milan, and at the Radiological Department, University of Milan. The diagnostic effectiveness of mammography in this case-list corresponds to approximately 80%: the influences of the histotype and of the tumor's size on these results are reviewed and discussed. The main radiographic signs of malignancy are presented and their importance in reaching a correct diagnosis is outlined. The advantages and drawbacks of mammography are discussed and, amongst these latter, emphasis is given to structurally dense breasts as an intrinsic factor limiting the effectiveness of mammography.

Adolescent↗
PubMed1981

The XERG-mammography system: a solution to the dose-quality problem?

The XERG (Xonics-Electron-Radio-Graphy) system is the first ionographic system (High-Pressure-Gas-Iono-graphy) suitable for clinical application which became available for testing. The basic principle, the function and imaging qualities of the XERG system are described and first clinical experiences reported. The XERG mammogram is a transparent X-ray negative image, the image quality of which is characterized by good general image contrast, a moderate edge-effect and a high quantum-noise level but giving an extremely low dose rate (4.5% compared to screenless mammography film). Although the XERG quality is not satisfactory in contact technique, it yields results which are equal in quality, when using a 1.5-fold magnification technique, to the results obtained with screenless film mammography at one-tenth of the dose, and is superior to any commercially available film-screen system. Hence, in our opinion, the XERG mammography system is a step forward towards high-quality low-dose mammography.

Chlorofluorocarbons, Methane↗
PubMed1980

Combination of clinical examination, mammography and aspiration cytology in the diagnosis of carcinoma of the breast (179 cases).

In 179 histologically confirmed cases of carcinoma of the breast the diagnostic values of clinical examination, mammography and aspiration biopsy were compared. The effect of combining these three diagnostic methods was evaluated. Clinical examination and mammography each produced a positive diagnosis in 89% of the cases, and in 88% aspiration biopsy. A combination of these three methods enabled a positive diagnosis of carcinoma of the breast in 99% of the cases. Fine needle biopsy and mammography carried out by the clinician seem to be as effective as when done by the cytologist and diagnostic radiologist. A combination of clinical examination, mammography and aspiration biopsy increases the diagnostic accuracy of breast cancer.

Adult↗
PubMed1995

Mammography and ultrasound in the diagnosis of contralateral breast cancer.

Forty-nine (5%) of 956 women referred for follow-up imaging after breast cancer treatment had a malignancy in both breasts. The mammograms and ultrasonograms or US reports, and histologic slides or pathologic reports of 31 of these patients were reviewed. Mammography was more sensitive than clinical examination or US in detecting contralateral breast cancer, the sensitivity of mammography being 81%. Thirty-nine percent of the contralateral cancers were nonpalpable, and all were first detected at mammography. No cancers were depicted by US alone. US provided complementary information about palpable masses in 50% of the cases in which the mammographic finding was difficult to interpret. The mammographic appearance and the difficulties in detecting a contralateral cancer were similar to those known to be characteristic for first primaries. Distinguishing a new primary from a metastasis from the first breast cancer was not always possible by means of mammography or US.

Adult↗
PubMed1995

[Mammography of the reconstructed breast--a comparison of different methods of reconstruction].

The choice of a breast reconstruction technique is considerably influenced by the possibility of detecting recurrence. Mammography is the most important diagnostic aid in detecting a tumor. We have compared the mammographic evaluation of different reconstruction methods. 41 patients were investigated and divided into three subgroups: Group I (n = 10): Reconstruction with autologous tissue (TRAM-flap); group II (n = 22): Reconstruction with silicone gel-filled implants, muscle and soft tissue replacement (latissimus flap or submuscular expander technique and silicone gel prostheses); group III (n = 9): Reconstruction with silicone gel-filled implants. Evaluation was performed employing a scoring system. The mammographic appearance of autologous breast reconstructions consisting of skin, subcutaneous fat and muscle is comparable to involuted breasts. One mammography in this group was of poor, one of acceptable, and eight of good quality. Autologous reconstruction is associated with the highest chance of recurrence detection. Within group II and III, parts of the reconstructed breast are covered by the X-ray absorbing silicone gel prosthesis. In group II, seven mammographies were considered poor, 14 acceptable, and one good; in group III it was two, four und three respectively. The interpretation depended on the implant soft tissue ratio. If thin soft tissue layers cover the prosthesis, inspection and palpation become increasingly important, nevertheless it is not possible to achieve comparable data as with mammography.

Adult↗
PubMed1995

Enhancing compliance with screening mammography recommendations: a clinical trial in a primary care office.

BACKGROUND AND OBJECTIVES: Despite consensus that screening mammography is an appropriate preventive tool, many women do not receive this examination. This study was undertaken to evaluate the relative efficacy and cost-effectiveness of three interventions designed to increase mammography rates. METHODS: A total of 151 women, aged 50-59, were randomized into four groups: control, physician telephone call, medical assistant telephone call, and physician letter. RESULTS: The women in the medical assistant telephone call group (16 of 37 = 43%) and the physician telephone call group (11 of 38 = 29%) responded significantly better than those in the control group (4 of 38 = 11%) (P < .05). None of the 10 widows in the entire study obtained a mammogram, compared with 38 of 141 (27%) women in all other marital groups (P < .05). The cost per intervention and cost per mammogram obtained were, respectively, physician telephone call: $15, $51.82; physician letter: $2.50, $13.57; medical assistant call: $1.30, $3. CONCLUSIONS: Medical assistant telephone callers are a cost-effective strategy to encourage mammography adherence. Widows appear particularly resistant to all screening mammography interventions.

Appointments and Schedules↗
PubMed1995

Legislative and regulatory mandates for mammography quality assurance.

The current practice of screening mammography in the United States has been the focus of numerous legislative and regulatory mandates at the state and federal levels, both in terms of increasing access to age-eligible women and elevating the quality of mammographic imaging. Several parameters have emerged as central to a comprehensive mammography quality assurance program: (1) equipment specifications, (2) equipment performance testing including radiation dose limits, (3) facility quality assurance procedures, and (4) personnel qualifications. In 1992, Congress enacted the Mammography Quality Standards Act (MQSA) (P.L. 102-539) to address the problem of differences in mandated standards across states. By October 1994, all facilities will be required to comply with interim MQSA regulations which were released in December 1993. However, depending upon the specific requirements of applicable state standards, the extent and nature of modifications of existing quality assurance procedures will differ for facilities across states as they attempt to come into compliance with uniform Federal standards. In addition, because some provisions within state standards are likely to be more stringent than Federal standards, some level of variation will persist. This paper reviews the components of mandated standards established by states and the standards established by other organizations, including the Federal Government, prior to the MQSA interim regulations. This review will provide an understanding of the highly technical and complicated requirements surrounding mammography quality assurance.

Ambulatory Care Facilities↗
PubMedDate not supplied

Accreditation of mammography facilities by the American College of Radiology: results of a national survey.

Mammographic screening for the early detection of breast cancer is rapidly becoming an increasingly common practice in the United States. With more than 20 million mammograms estimated to be performed annually by more than 11,000 units, ongoing quality assurance and evaluative programs have gained importance. Recent federal legislative and regulatory efforts augment a patchwork of state mandates establishing or encouraging specific quality control requirements for mammography facilities, personnel, equipment, and radiation exposure. Many of these requirements are based on the American College of Radiology's (ACR) voluntary accreditation program that has been offering facility certification since 1987. The ACR collects and maintains detailed data on the characteristics of accredited facilities; however, little is known about facilities not participating in the ACR program. This article describes national results from the 1992 National Mammography Facilities Survey, a representative sample of 1,057 mammography facilities. We found statistically significant (P < .05) differences between accredited and nonaccredited facilities in type of mammography practices, cost, personnel standards, variables linked to accessibility, and corollary screening practices (availability of breast self-examination instruction and breast physical examination). Other variables showed minor or little variation between accredited and nonaccredited facilities. The results of this study suggest that, although all facilities engage in various components of "good" quality assurance practices, ACR-accredited facilities reported conducting these programs more frequently. Further, despite the substantially increased costs associated with these programs, ACR-accredited facilities reported lower average charges for screening mammograms and were more likely to participate in reduced fee programs.

Accreditation↗