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PubMed1994

[Early detection of breast cancer by mass screening using mammography].

A mass screening trial for breast cancer using mammography was carried out in Tokushima Prefecture, either itinerant screening in the communities or center screening at the workplace. Craniocaudal and lateral oblique imagings of the breast using two-view film mammography were performed at the first stage of screening. In addition, physical examination of the breast was also performed on subjects independently. A total of 8 cases with breast cancer were found in these trials by mammography alone, and no cases with breast cancer were detected by physical examination. The detection rates were 0.19% in itinerant screening, and 0.92% in center screening, respectively. This was much higher than the level (0.10%) obtained by mass screening using physical examination alone in Japan. Moreover, in elderly patients (age over 50 years), the detection rates were higher (0.54%, 1.21%). The number of clinical stage for cases with breast cancer detected by these screening were 5 cases in TIS and 3 in stage I. Thus, all cases were patients with early-stage breast cancer. From these results, mass screening using mammography should be mandatory for elderly women (over 50 years) with asymptomatic breasts.

Adult↗
PubMedDate not supplied

Mass mammography screening: using an information system to track participation and identify target populations.

This article describes the 1991 American Cancer Society Greater Tampa Bay Breast Screening Program and an information system developed to track participants from the point of inquiry to mammography results. Information from three sources was linked to create a comprehensive data base, including participant demographics, mammography history, perceived risks of breast cancer, barriers to mammography, and mammography results. This comprehensive data base allowed investigators to describe the 11,134 participants and to assess the program's impact. The analysis suggested that women older than 65 years are underrepresented in this voluntary program. Black women were less likely to participate, as were women in lower income and education groups. To reduce mortality effectively, leaders of mass screening programs need to develop creative strategies for reaching these high-risk groups. Effective information systems can identify program weaknesses and track the impact of changes.

Adult↗
PubMed1994

Is cost a barrier to screening mammography for low-income women receiving Medicare benefits? A randomized trial.

BACKGROUND: In 1991, Medicare began covering screening mammograms subject to copayment and deductible. This study evaluated the effectiveness of Medicare in removing financial barriers to screening mammography among low-income older women. METHODS: In an inner-city public hospital's General Medicine Clinic, 119 consecutive, eligible, and consenting Medicare-enrolled women without known risk factors for breast cancer other than age, and no mammogram in the previous 2 years, were entered into a randomized controlled trial with follow-up after 2 months. The mean age was 71 years; 77% were black, 92% had an annual income below $10,000, and 52% had had a previous mammogram. All patients were counseled concerning indications for screening mammograms and Medicare coverage, and all were referred to a low-cost mammography facility. Sixty-one subjects were randomly assigned a voucher for a free screening mammogram at the referral facility. Obtaining a mammogram within 60 days of study entry was the main outcome measure. RESULTS: Of the women given vouchers, 27 (44%) obtained screening mammograms, compared with six (10%) of those without vouchers (P < .001). Adjustment by multiple logistic regression confirmed this association, yielding an adjusted odds ratio of 7.4 (95% confidence interval, 2.5 to 21.4). Knowledge concerning mammography and breast cancer increased significantly overall (and within randomization groups) between initial interview and follow-up; fear did not change. For women without the voucher, the main reason for not obtaining a mammogram was financial; the main reason for women with the voucher was transportation. CONCLUSION: In a low-income, inner-city population of older women, financial barriers to screening mammography persist despite Medicare coverage.

Aged↗
PubMedDate not supplied

Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease Prevention.

Achieving and maintaining high rates of screening mammography are major public health priorities. This report examines data from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention on the utilization of mammography among women ages 40-75. Results show that progress is being made in some areas--57.7 percent of women "ever had" a mammogram; 50.3 percent, in previous 2 years. However, those not having repeated regular screening appear to be a sizable proportion. Only 28.6 percent of women ages 40-75 had been both screened on the recommended age-specific schedule and expressed an intention to continue screening; another 29.2 percent indicated no intention to have a mammogram in the near future. Income, clinical breast examination, and Pap (Papanicolaou's) test, having no regular source of care, region of the country and residential variables, smoking status, not exercising, not knowing how to do breast self-examination, and race were among the variables having the strongest associations with mammography status. Several groups in the population therefore remain at risk of not receiving regular screening. The combination of mammography status to date and future intention to have the examination provides an important perspective on efforts to reach public health screening objectives and appears to provide a strategy for targeting interventions.

Adult↗
PubMedDate not supplied

Impact of an HMO-based intervention to increase mammography utilization.

A health maintenance organization (HMO)-based program designed to increase breast cancer screening was evaluated, focusing on changes in mammography utilization. The program consisted of a multistage intervention aimed at women members and primary care physicians of the HMO. This report examines the effect of the intervention on mammography utilization. The program was evaluated using a quasiexperimental design in which a random sample of women aged 50-74 from the HMO (intervention) was compared to a similarly aged geographic control group selected through random digit dialing. From 1988 to 1990, 450 intervention women and 450 control women were sampled (without replacement) each year and surveyed about breast cancer screening practices and related knowledge. A clear increase in self-reported mammography utilization was associated with the intervention. The percentage of women who reported a mammogram in the 12 months prior to the survey increased from 41% in 1988 (baseline) to 68% in 1990 among HMO women, compared to a change from 39% to 49% among control women. Comparing postintervention rates of mammography in HMO versus control women yielded a rate ratio (RR) of 1.4. However, this effect was strongly modified by income and race. Women with annual incomes of $31,000 or more showed little (whites, RR = 1.2) or no (blacks, RR = 1.0) effect of the intervention. Among women with incomes less than $31,000, the effect among whites (RR = 1.9) was much stronger than among blacks (RR = 1.2).

Black or African American↗
PubMed1995

Technical quality control in mammography screening: first results in Belgium.

In this paper the first results of the application in Belgium of the European protocol for the technical quality control of mammography screening are presented. Twelve mammography screening units were submitted to an acceptance test: one fourth complied with the criteria after a second visit. A daily quality control procedure has been run since eighteen months. The most important detected problems are given and discussed. The European Commission, in the framework of "Europe Against Cancer", recently published the "European Guidelines for Quality Assurance in Mammography Screening" (1). In another contribution (2), a brief overview of the important appendix "European Protocol for the Quality Control of the Technical Aspects of Mammography Screening" was given. In this paper the first results for the application of this protocol in Belgium are presented.

Female↗
PubMed1996

[The procedures and results of a quality control program in mammography carried out on a regional basis].

In 1990 the region of Tuscany instituted a quality control program for mammography, in order to check the working conditions of mammography centers in the region, to investigate the feasibility of applying some working standards in line with European recommendations, and to promote the training of personnel. The program involves the following: a test of newly acquired mammographic equipment to establish that it meets the required standards; an annual test of generators, X-ray beams, grid, AEC, screen-film system, film processing, dose and image quality; daily test (phantom radiography and film sensitometry) performed by the personnel of each mammographic Unit; and a sustained advisory service for the technical problems occurring between checks. Thirty-nine of 57 centers participated on a voluntary basis, and 135 checks were performed annually. The results of the program show a performance below the recommended standard in relation to AEC, film sensitometry and the adequacy of lights in dark rooms in 40%, 50% and 63%, respectively, of the centers. Entrance exposure was over 1500 mR, with a maximum value of 3450 mR, in 6 cases in the first round. 5 cases in second, and only 1 case in the third. In general, the results are slightly improving, but mammography optimization is still a long way off. It is necessary to carry out suitable programs for quality control in mammography on a regional basis and to establish precise guidelines for individual mammographic Units to follow in order to meet the European standards.

Breast↗
PubMed1996

Trends in mammography use and their relation to physician and other factors.

This study examines trends and factors (e.g., physician utilization) affecting mammography use from 1988 to 1990 among women residing in an area of high breast cancer incidence. Mail surveys of independent random samples of over 2000 women 50 to 75 years of age residing on Long Island were conducted each of the three study years, and responses were compared. Statistically significant increases in reported mammography use occurred over the 3-year period within all age, income, and educational subgroups. These were accompanied by a decline in reporting that the doctor did not recommend it, as a reason for not having a mammogram, and by a statistically significant increase in reported physician recommendation among those who visit a doctor annually, particularly those using a gynecologist. Clinical breast examination was the strongest predictor of mammography use, with knowledge of the recommended screening frequency also strong associated. Despite a regionally high incidence of breast cancer, screening mammography use corresponded to national rates. Access and visits to a regular physician were critical factors and substantiated the need for education of women, family practitioners, and internists about breast cancer screening guidelines.

Aged↗
PubMedDate not supplied

Screening behaviors and long-term compliance with mammography guidelines in a breast cancer screening program.

INTRODUCTION: Screening for breast cancer is generally underused. In an effort to remove common barriers to screening, a free breast cancer screening and education program was created for the employees of a large hospital, incorporating mammography, clinical breast examination (CBE), and breast self-examination (BSE). METHODS: The present study was conducted to evaluate the screening behaviors and long-term compliance of asymptomatic women over age 50 who participated in the program. Data were obtained from questionnaires administered at the time of enrollment (time 1) and annual reenrollment, as well as from radiology records. (Time 2 represents the most recent data.) Long-term compliance with mammography guidelines was measured by calculating a compliance quotient (CQ) for each participant. RESULTS: From time 1 to time 2, subjects significantly increased their use of mammography, CBE, and BSE. At time 2, 89.5% of women had ever received a mammogram, 42.7% had gotten one in the last year, nearly all women (94.6%) had received at least one CBE, 58.0% reported annual CBE, and 44.6% of women practiced monthly BSE. CQ was higher among women who remained in the program longer, were still active in the program at the time of the study, and used screening prior to enrollment. It was also higher in Caucasians and women with a family history of breast cancer. CONCLUSIONS: These results show that a worksite program that eliminates common barriers to screening can significantly increase use of early detection practices. It also demonstrates one method of quantifying long-term compliance with mammography guidelines.

Age Factors↗
PubMed1996

Trends in mammography utilization, 1981 to 1994.

From 1981 to 1994, the annual number of mammograms performed in Canada increased from less than 200,000 to more than 1.4 million. By 1994, about three in five women aged 40 and over reported having had a mammogram at some time in their lives. Most of the increase that occurred between 1985 and 1991 was because of greater use of mammography for breast screening. In the early 1990s, the annual numbers and rates stabilized as the number of mammograms performed on a fee-for-service basis declined slightly, while those conducted by provincial/territorial breast screening programs rose. Mammography is increasingly targeted to women aged 50-69 for whom screening is considered to be most effective. About 30% of Canadian women aged 50-69 have had a mammograms within the past year, although just one-fifth of these mammograms were obtained through provincial/territorial breast screening programs. Most mammography in Canada is provided through the fee-for-service system, although about 80% of fee-for-service mammograms are done for screening purposes, and the remaining 20% for diagnostic assessment. This article is based on administrative data provided by provincial/territorial departments of health and by breast screening programs, as well as on data from the National Population Health Survey. Some implications of mammography utilization for breast cancer incidence and mortality rates are assessed, but because of the long lead time between detection and death, it may be too early to reach definitive conclusions.

Adult↗
PubMed1997

Mammography diffusion and trends in late-stage breast cancer: evaluating outcomes in a population.

The purpose of this study was to assess mammography diffusion in a population offered an organized breast cancer screening program, using intervals of 1-3 years, and to evaluate its effect on the late-stage cancer (tumors > or = 3 cm2) rates compared to rates in the surrounding community. We measured "ever-use" of mammography (1986-1992) among women enrollees of a consumer-controlled health care organization (n > or = 60,000/year; ages > or = 40), Group Health Cooperative of Puget Sound (GHC). Among these same women and the surrounding community (n = > or = 745,000/year), we measured late-stage cancer rates. Using unconditional logistic regression, we compared annual rates of ever-use among GHC women ages 40-49 and > or = 50 (1986-1992) and late-stage breast cancer (1983/84-1991/92) among all women. Among all GHC women ages 40 to 49, and 50 years of age and older, 67.4 and 82.8%, respectively, ever-used mammography by 1992. By 1992, approximately one-third of the mammograms among GHC women occurred in each of the three previous years. The rate of late-stage tumors declined significantly in the GHC and non-GHC populations among women 50 years of age and older (P < 0.001) but not among women ages 40 to 49. In conclusion, implementing a system of automated reminders was not sufficient to maximize mammography use in a population. Reductions in late-stage disease occurred among women ages > or = 50, even when regular" was not synonymous with "annual."

Adult↗
PubMedDate not supplied

Physicians' reactions to change in recommendations for mammography screening.

INTRODUCTION: In December 1993 the National Cancer Institute (NCI) decided to replace its mammography screening guidelines with a Statement of Evidence on Breast Cancer Screening. The Statement of Evidence represented a departure from the institute's previous policy of recommending routine mammography screening in women 40-49 and annual screening in women 50 and over. This study assesses knowledge of and attitudes toward the Statement of Evidence among primary care physicians. In addition, we explore the extent to which physicians changed their individual clinical policies on mammography screening in response to the Statement of Evidence. METHODS: Between October 1994 and June 1995, 545 randomly selected North Carolina primary care physicians completed a mailed questionnaire (overall survey response rate = 42%). RESULTS: Awareness of the Statement of Evidence was high (83%), but attitudes toward it were negative, with a majority of physicians stating that the change in policy was confusing to women and physicians. About 8% of physicians who were aware of the Statement of Evidence changed their practice accordingly. Most physicians reported recommending routine mammography screening in women 40-49 and annual screening in women 50 and over. A majority stated they believe scientific evidence supports these practices. CONCLUSIONS: When faced with a new policy in which guidelines are no longer provided and evidence supporting less use of an established technology is conveyed, physicians demonstrated disinclination to change. The impact of changes in recommendations on physician practice is an important consideration for those who develop and promote screening policies.

Adult↗
PubMed1998

A comparison of digital luminescence mammography and conventional film - screen system: preliminary results of clinical evaluation.

The objective of this study was to determine if digital luminescence mammography can be used as a diagnostic tool. We investigated twenty-two patients with mammographically suspicious findings using a conventional film-screen system and a digital phosphor storage plate in order to compare these two techniques. Four radiologists experienced in mammography reviewed each pair of images. Our results indicate that detectability of microcalcifications and solid masses with digital systems is superior to conventional film-screen mammography due to the increased contrast enhancement associated with digital systems. We did, however, find that characterization of morphological details is inferior with the digital system, presumably due to reduced spatial resolution. In addition, we found no statistically significant difference in the differentiation of benign from malignant lesions with both techniques. The accuracy of mammographic diagnosis was investigated in a receiver operating characteristic study and similar values were found with both techniques. Our results indicate that digital mammography will become an acceptable diagnostic tool although improvement, especially in spatial resolution, is desirable.

Aged↗
PubMedDate not supplied

[Diagnosis of breast tumors by scintigraphy versus mammography].

OBJECTIVE: To compare the efficacy of the breast scintigraphy with 99mTc-MIBI in the detection of breast lesions versus mammography. DESIGN: Cross sectional study. SETTING: A concentration oncologic hospital in Mexico City. PATIENTS: 56 women with a biopsy performed due to radiologic suspicion of mammary cancer were included as well as 10 normal women. MAIN PROCEDURES: Mammography, breast scintigraphy with 99mTc-MIBI, and biopsy were performed. RESULTS: Sensitivity of breast scintigraphy was 100% specificity 94.6%, PPV 90% and NPV 100%; sensitivity of the mammography was 100%, specificity 54% PPV 52.7%, and NPV 100%. CONCLUSIONS: Breast scintigraphy with 99mTc-MIBI showed a higher sensitivity and specificity than those of mammography. It was highly reliable for the diagnosis of mammary gland malignant lesions.

Adult↗
PubMed1998

The role of mammography in the diagnostic approach of breast hamartomas.

PURPOSE: Hamartomas are rare benign breast tumors which surfaced with the entrance of mammography in the diagnostic algorithm of breast lesions. In the present study the mammography findings of breast hamartomas were analyzed in relation to the histologic confirmation of the diagnosis. PATIENTS AND METHODS: During the seven-year period between January 1990 and January 1997 we studied 45 patients, aged from 32 to 66 years, with a clinical and/or mammographic finding of a breast lump, highly suspicious of hamartoma. In 29 (64.4%) the tumor was found in the left breast and in the remaining 16 (35.6%) in the right breast. RESULTS: The preoperative mammography of 41 patients revealed a nodular opaque mass of a nonhomogeneous composition and only four had the typical hamartoma picture. The tumor diameter ranged between 0.7-6.5 cm. All tumors were excised and the histological reports confirmed the diagnosis of hamartoma. CONCLUSION: Mammography helps in the diagnosis of hamartomas. Nevertheless, the final diagnosis must be based on the histological analysis of the tumor.

Adult↗
PubMed1998

Mammography in the evaluation of masses in breasts reconstructed with TRAM flaps.

Patients with transverse rectus abdominis musculocutaneous (TRAM) flaps may develop physical findings, such as palpable masses, irregularities, and areas of increased tenderness that are suggestive of fat necrosis or recurrent malignancy. The purpose of this study was to evaluate these findings with mammography in an attempt to rule out recurrent malignancy in the autogenously reconstructed breast. Fifteen patients on whom mammography was performed as an aid in the evaluation of suspicious post-TRAM flap findings were reviewed. Common mammographic findings included calcifications believed to demonstrate fat necrosis, benign dermal calcifications, calcified hematoma, and clustered microcalcifications. Areas of increased or decreased density without calcifications were also identified and appeared to be related to surgical changes and fat necrosis. Twenty percent of patients had clustered microcalcifications, and 20% had detectable masses on mammography. One patient had a suspicious mass associated with clustered microcalcifications, leading to a biopsy that revealed fat necrosis. The majority of findings were consistent with normal fat within the TRAM flaps. This study supports mammography as a useful diagnostic tool in patients who have undergone TRAM flap breast reconstruction and who present postoperatively with suspicious physical findings.

Breast Neoplasms↗
PubMed1998

[Improvement of detectability of microcalcifications by magnification digital mammography].

Our aim in this study was to evaluate the potential utility of magnification mammography with a CR system by investigating the basic imaging parameters and detectability of microcalcifications in comparison with those of conventional screen-film systems. The basic imaging parameters were evaluated by measuring scatter fraction, modulation transfer function (MTF), Wiener spectrum, and incident dose for the various magnification factors. The detection of simulated microcalcifications in radiographs of a mammographic phantom and breast specimens were evaluated subjectively and quantitatively for screen-film and CR techniques with various magnification factors. The scatter fraction of digital magnification mammography decreased with increasing magnification factor. MTF of magnification digital mammography improved with increasing magnification factor. The detectability of microcalcifications with the CR system was significantly improved by magnification technique. From the above results, it is expected that the use of magnification mammography with a CR system will improve the detectability of microcalcification.

Breast Diseases↗
PubMed1997

[Contribution of mammography and echography to the diagnosis of breast cancer in Dakar: apropos of 25 cases].

The authors studied mammographic features of 25 patients with malignant breast disease. 24 of them had ultrasonographic (US) exploration. The study appreciates epidemiological, mammographic and US aspects; It also appreciates the correlation between images and histology. The mean age is 40. Six women (26%) had family history cancer. The mean reason of the exploration is a mass in 76%. At mammography, contours of cancerous opacities are irregular in 56%, regular in 16%. In 20%, the cancer showed no opacity. At US, we find a lack that appears irregular in 48%, regular in 24%, without traduction in 4%, non precised in 24%. Mammography sensitivity was 80%, false negative rate 28% and false positive rate 8% against respectively 96%, 32% et 12% for echography. This study shows that US is more sensitive but less specific than mammography. However, we recommend the use of mammography and echography together because in Senegal, cancer happens at an earlier age at with breast is easier to analyze at US.

Adult↗