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PubMedDate not supplied

Efficacy of mammography for detecting early breast cancer in women under 50.

Screening mammography (MMG) for women aged 50 years and older has been widely accepted all over the world. However, the efficacy of screening mammography for women aged under 50 years has not been established. We compared mammographic findings of the patients under age 50 (the younger group) and those of patients 50 and older (the older group). From 1992 to 1997, 107 patients with early breast cancer (non-invasive and Stage I) were treated in our hospital. There was no difference between the groups in background. Of 53 patients in the younger group, 40 (75.5%) were diagnosed as having cancer using mammography, while 44 of 54 (81.5%) of the older group were diagnosed as having cancer. A total of 46 (86.8%) patients in the younger group were diagnosed using MMG and physical examination (PE), and 50 (92.6%) in the older group were diagnosed as cancer using MMG and PE. There was no difference in the successful diagnosis rate using mammography in the two groups. Breast cancer screening using MMG may also be useful for women aged under 50.

Adult↗
PubMed1998

Misconceptions and mammography use among Filipino-and Korean-American women.

Face-to-face interviews were conducted with a convenience sample of 218 Filipino and 229 Korean women residing in Los Angeles County. This paper describes the women's knowledge and misconceptions regarding breast cancer risk factors, their utilization of traditional and westernized preventive health care, and the relationship of these variables to mammography utilization. Sixty-six percent of Filipino women and 49% of Korean women ever had a mammogram. Both Filipino- and Korean-American women share many of the same misconceptions about breast cancer risk factors. More instructive, however, is that these beliefs do not affect mammography utilization. Acculturation and modesty were associated with mammography utilization in both groups. Use of traditional medicine was negatively related and use of westernized preventive health care was positively related to mammography screening only among Filipino women. Practicing health care professionals should use these findings as they develop culturally sensitive breast cancer control programs.

Acculturation↗
PubMed1996

Breast cancer measurements with magnetic resonance imaging, ultrasonography, and mammography.

BACKGROUND: Accurate measurement of the size of breast cancers becomes more important as breast cancer therapy advances. This study reports the accuracy of magnetic resonance imaging (MRI), ultrasonography and mammography for measuring the largest breast cancer diameter in comparison to the pathology measurement. MATERIALS AND METHODS: Fourteen breast cancers were examined in 13 women with MRI, ultrasonography and mammography. The age range was 31-73 (mean 56). Six of the cancers were in premenopausal women. The MRI was performed with the intravenous injection of gadolinium based contrast agent and a three dimensional fast spoiled gradient echo sequence with fat suppression. The largest cancer diameter was measured with each imaging technique and compared to the largest cancer diameter measured at pathology. RESULTS: At pathological examination cancers ranged from 0.6 to 6 cm (mean 2.2) in largest diameter. MRI measurements had the highest correlation coefficient (r = 0.98) and the smallest standard error (0.34). Ultrasonography measurements had a correlation coeffient of r = 0.45 and a standard error of 0.78. Mammography measurements had a correlation coefficient of r = 0.46 and a standard error of 1.04. CONCLUSIONS: MRI was more accurate than ultrasonography and mammography in measuring the largest cancer diameters in this group of women. This was particularly evident for several larger cancers, and a postchemotherapy cancer.

Adenocarcinoma↗
PubMed1998

Granular Cell Tumor of the Breast: A Case Report Describing Dynamic MR Mammography.

A case of granular cell tumor of the breast in a 36-year-old woman is reported. The patient presented with a hard mass,1.5 cm in diameter in the upper-outer quadrant of the left breast. Physical examination and ultrasonography suggested the presence of breast carcinoma. An aspiration biopsy cytology(ABC)specimen wasevaluated as class II, and dynamic magnetic resonance(MR)mammography indicated a benign tumor. Granular cell tumor was finally diagnosed on examination of an excisional biopsy specimen. Granular cell tumor of the breast can mimic breast carcinoma on physical examination, mammography, ultrasonography, and even gross inspection. Dynamic MR mammography has the potential distinguish this condition from carcinoma. Awareness of this disease and prudent use of diagnostic procedures, including MR mammography, will help prevent misdiagnosis and unnecessary surgery.

Journal Article↗
PubMed2003

Clinical and diagnostic value of preoperative MR mammography and FDG-PET in suspicious breast lesions.

Dynamic enhanced magnetic resonance (MR) mammography and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) of the breast were directly compared preoperatively in suspicious breast lesions. Forty-two breast lesions in 40 patients were examined with a three-dimensional dynamic MR imaging series and FDG-PET. The MR and PET examinations were evaluated separately and the results were compared with the histological findings. The sensitivity and specificity of each method were calculated. The diagnostic value of both modalities as single diagnostic tool and in combination was investigated. Nineteen malignant and 23 benign breast lesions were proven histologically. Magnetic resonance mammography and FDG-PET showed a sensitivity of 89 and 63%, respectively. The specificity was 74 and 91%, respectively. The combination of both imaging methods decreased the not-required biopsies from 55 to 17%. Only one false-negative finding-a patient pre-treated with chemotherapy-was observed in both methods. The combination of MR mammography and FDG-PET can help to decrease biopsies of benign breast lesions. Because of their high cost, these modalities should only be used in problematic cases to either rule out or to demonstrate malignancy. The best diagnostic strategy is achieved using MR mammography first. If the diagnosis is still questionable, FDG-PET can be performed.

Breast↗
PubMed2000

Sonographic Evaluation of Clinically Palpable Breast Cancers Invisible on Mammography.

The purpose of this study was to determine the utility of sonography in the evaluation of palpable breast cancers invisible on mammography. A retrospective review of the pathology department's database was used to identify patients with palpable breast cancers. Consecutive patients that had excision between January 1992 and September 1997 were included. Mammograms and breast ultrasounds were reviewed retrospectively and correlated with pathologic and surgical findings. During the study period 298 women presented with a palpable breast cancer for imaging at our institution. Of these, 38 cancers (12.8%) were not seen on mammography. In 32 patients where no mammographic abnormality was found, ultrasound was able to detect a mass corresponding to the area of clinical concern. Histologic tumor types included 30 invasive ductal carcinomas, 5 ductal carcinomas in situ, and 3 invasive lobular carcinomas. Mammographic density was mild with scattered fibroglandular densities in 2 (5%), heterogeneously dense in 12 (32%), and extremely dense in 24 (63%). Thirty-one masses (97%) were hypoechoic and 1 (3%) was echogenic. Lesion margins were irregular in 23 (72%), lobulated in 5 (16%), and well-circumscribed in 4 (12%). In this group of patients the combination of mammography and ultrasound of the mass demonstrated 99% of the palpable cancers. In patients presenting with a breast mass on physical examination in whom mammography fails to demonstrate an abnormality, supplemental ultrasound is helpful in most instances to further characterize the lesion.

Journal Article↗
PubMed2000

[Typical and unusual findings in MR mammography].

In recent years, MR mammography has gained increasing importance in breast diagnostics. The main advantage of this technique is its high sensitivity for invasive breast cancer. The two main indications for MR mammography are preoperative staging of breast cancer and the differentiation between postoperative changes and recurrent tumor. In addition, MR mammography is increasingly used for problem solving in cases of questionable clinical, mammographic or sonographic findings. At this it is important to know not only the different manifestations of breast cancer, but also important benign and malignant diagnostic alternatives. Furthermore, it is necessary to be familiar with therapy-related changes. The most important criterion to differentiate between benign and malignant lesions in MR mammography is the extent and temporal course of contrast enhancement. In addition, the lesion morphology and the signal intensity on T2-weighted images can be used to distinguish between different disease entities. The following review article will discuss typical and unusual findings in breast MRI, including rare entities as well as changes after breast conserving therapy and chemotherapy.

Breast↗
PubMed2002

[Criteria of dignity in ultrasound mammography using a 10-MHz-transducer, also with regard to tumor size].

AIM: Ongoing technical progress has increased the accuracy of imaging in ultrasound mammography. Using a 10-MHz-transducer, eight different criteria of dignity were evaluated for validity, also with regard to the size of a tumor. MATERIALS AND METHODS: Over a period of three years, 446 breast tumors were ultrasonographically examined by two experienced medical doctors. The study comprised only suspicious lesions detected by mammography and/or manual palpation. Diagnostic validity was quantified by means of sensitivity, specificity, positive and negative predictive value, as well as the ODDS-ratio. RESULTS: Ultrasound mammography demonstrated a sensitivity of 94.0 %, specificity of 91.4 %, positive predictive value of 95.9 %, and a negative predictive value of 99.1 %. Eight different sonographic criteria were validated separately. The most important signs of malignancy were (in descending order): a highly echogenic halo, spikes, jagged contour, posterior acoustic shadowing, and discontinuity of tissue structure. Features of benign disease were: smooth edge, posterior acoustic enhancement, displacement margin, bilateral acoustic shadowing and continuity of tissue structure. Furthermore, it appeared that the size of a tumor only had consequences on posterior shadowing (p = 0.017). All other features did not show significant variation in relation to tumor size. CONCLUSION: We were able to prove that ultrasound mammography is an excellent medium for the differentiation of benign and malignant breast lesions, when precise indication criteria were adhered to, even in cases of small tumor size.

Adolescent↗
PubMed1996

[Ductal carcinoma in situ in dynamic MR-mammography at 1.5 T].

PURPOSE: To define the value of contrast-enhanced MR mammography in ductal carcinoma in situ (DCIS). MATERIAL AND METHODS: In a group of 35 patients with DCIS, the results of MR imaging were compared to histopathology and immunohistochemistry in a retrospective study. RESULTS: In 35 patients with DCIS, a signal enhancement was found in 25 cases (72%). In 15 of these cases, the signal time curve was typical for malignancy. The other 10 patients had non-specific signal curves. Six of 35 patients (11%) had no enhancement within the tumour region. Four of 35 patients (11%) had bilateral diffuse signal increase, and regions of DCIS could not be identified clearly. Three DCIS were visualised exclusively by MR mammography. The configuration of signal enhancement was sharp (32%), unsharp (48%) or dendritic (20%). DCIS of the comedo type showed a significantly higher enhancement than the non-comedo type. A significant correlation between the grade of vascularisation in immunohistochemistry and signal enhancement in MR mammography could not be demonstrated. CONCLUSION: Dynamic MR mammography does not reliably visualise DCIS.

Adult↗
PubMed1996

[MR-mammography assessment of tumor response after neoadjuvant radiochemotherapy of locally advanced breast carcinoma].

PURPOSE: We investigated the role of magnetic resonance mammography in monitoring tumour response of locally advanced breast cancer (LABC) after neoadjuvant radiochemotherapy. MATERIAL AND METHODS: 17 patients with LABS had a magnetic resonance mammography and ultrasonography before and after neoadjuvant radiochemotherapy. RESULTS: After neoadjuvant radiochemotherapy 14 patients showed in MR-mammography less pronounced and prolonged enhancement without washout. After treatment three patients had signal intensity-time curves still characteristic for tumour. Ultrasonography was true negative in two patients, true positive in 12 and false positive in three patients. CONCLUSION: Magnetic resonance mammography is suitable for monitoring tumour response after radiochemotherapy of LABC. However, a negative MRI does not exclude a residual tumour. Ultrasonography is of limited value in monitoring therapy of LABC.

Adult↗
PubMed2003

New contrast media designed for x-ray energy subtraction imaging in digital mammography.

RATIONALE AND OBJECTIVES: In contrast-enhanced dual-energy subtraction imaging 2 images acquired postcontrast media administration at different energies are subtracted to highlight structures hidden in the absence of contrast media. X-ray spectra of the newly developed digital full-field mammography units (GE Senographe 2000 D) are dominated by the emission lines of the Mo or Rh anodes. The K-edge of Zirconium (Zr) is flanked by these 2 emission lines. Thus, the attenuation of Zr should experience a pronounced change of attenuation in parallel with a change of anodes. Under clinically relevant conditions, the contrasting behavior of Zr should be compared with that of other elements having K-edge energies outside the window spanned by the 2 anode emission lines. METHODS: Solutions containing the contrasting elements Br, Y, Zr, I, and Gd were investigated for dual-energy subtraction in digital mammography with the 2 anode/filter settings (Mo/Mo and Rh/Rh). These solutions were investigated in phantom studies in the energy range conventionally used in mammography. Additionally, the contrasting behavior of Zr and I was compared in an in vivo study in rats. RESULTS: The sweeping over the K-edge by alternating between the Mo and Rh anodes increases the detection of Zr in energy subtraction imaging at constant high voltage. This procedure does not lead to sufficient contrast enhancement for iodine-based contrast media which become detectable by increasing the high voltage to 40-49 kV. CONCLUSION: The instrumental and physical data outlined predestine Zr as contrasting element with a high potential for energy subtraction imaging in digital mammography in the energy range conventionally applied.

Animals↗
PubMed1998

Bringing down the barriers to mammography: a review of current research and interventions.

Although mammography screening is effective in reducing breast cancer mortality, major challenges still remain in increasing rates of initial mammography and in improving subsequent adherence to mammography screening. Behavioral science theories offer insights into the potential for individual, organizational, community, and population-level interventions to address these challenges. In this review, we draw on social ecological approaches to health promotion to suggest a conceptual framework for such interventions. After discussing theories of who is and is not screened regularly, and why, we consider selected barriers to mammography and corresponding interventions to overcome them. We conclude with an illustration of the North Carolina Breast Cancer Screening Program (NC-BCSP), a series of interventions informed by the social ecological perspective.

Journal Article↗
PubMed2001

Update on digital mammography.

On January 28, 2000, the U.S. Food and Drug Administration (FDA) approved the first full-field digital mammography unit for clinical use. The approval occurred approximately ten years after a National Cancer Institute (NCI) expert panel determined that, of all emergent technologies, digital mammography held the greatest potential for improving breast cancer detection [1,2]. Currently, four types of digital mammographic systems are under clinical evaluation. This article will review the information from the early clinical trials on digital mammography and will attempt to define the potential impact of digital mammography on the clinical practice of breast imaging.

Journal Article↗
PubMed2000

Diagnostic accuracy of mammography and scintimammography in detection of primary breast cancer related size of the tumour.

BACKGROUND: The detection of breast cancer relies on physical examination and mammography (XMM). The sensitivity of conventional imaging is lesions-size dependent. However, mammography has good sensitivity in small tumours when microcalcification is present, but the sensitivity is relatively low in other small tumours. The use of scintimammography with Tc-99m sestaMIBI (SMM) may be helpful in this situation. The aim of this study is to compare the diagnostic accuracy of mammography and scintimammography across all groups with different sizes of lesions. METHODS: Data for 273 patients aged 26 to 84 years (mean 52; SD 12) with 298 lesions were analysed. All lesions were removed and final histology and pathological size of the tumours were retrospectively reviewed (mean size 2.9 cm, SD 2.4 cm). All patients had XMM and SMM. Each imaging study was graded using five grades of certainty. SMM images were reviewed by an independent specialist blinded to clinical presentation and XMM results. The diagnostic accuracy of each test, overall and by each lesions size subgroup, was compared using receiver operating characteristic curve (ROC) analysis. RESULTS: The sensitivity of scintimammography was consistently high across all size groups; overall 89% (82?100%) compared with 68% (51?88%) for mammography. In those tumours below 2 cm, the area under the ROC was significantly larger with SMM than XMM (p < 0.05), with 80% certainty indicative of greater diagnostic accuracy. Also in all patients the area under the ROC was significantly larger with SMM than XMM (p < 0.05), with 90% certainty indicative of greater diagnostic accuracy. In other groups of lesions size the area under ROC for SMM was larger in lesions size between 2 and 4 cm and slightly smaller in lesions over 4 cm, but it was not significant. CONCLUSION: Scintimammography using Tc-99m sestaMIBI seems to be a sensitive and consistently reliable diagnostic test for breast cancer independent of the size of the tumour.

Journal Article↗
PubMed1993

[MR mammography].

For a favorable prognosis breast cancer must be diagnosed as early as possible. Among the available imaging modalities (mammography, sonography, DSA, thermography, CT) only mammography has been able to demonstrate a significant reduction in mortality, but unfortunately only for women above 50 years of age. Magnetic resonance mammography (MRM) has been under technical and clinical evaluation for more than 10 years. Special surface coils and a variety of measurement sequences have been tested. By using "dynamic MRM," i.e., repetitive imaging of the same slices before and at short time intervals after the injection of a contrast medium, high sensitivity (98.9%) and specificity (97.2%) was found in detecting breast cancers of different histologies. In this study, especially clinically or mammographically difficult cases were included in order to test the efficacy of dynamic MRM. Breast cancer can be proven or excluded with a very high degree of confidence. A vast number of false-positive findings that plague conventional mammography will no longer require biopsy. The remarkable uniformity of the maximum rate of signal enhancement in carcinomas may be explained by the altered vascularization of malignant tumors based on early tumor angiogenesis. This change in vascularization can be detected by combining the use of contrast medium with a highly sensitive measurement technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗
PubMedDate not supplied

Mammography, clinical breast exam, and pap testing: correlates of combined screening.

This study examines the correlates of screening for both breast and cervical cancer combined in a single indicator. Data used were from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention. We used two indices to characterize the receipt of breast and cervical cancer screening among women 50-75 years of age. The first measure compared women who had three screening exams--clinical breast examination (CBE), mammography, and Pap test--in the past two years with those who had not received all three exams. The second measure compared women who had a Pap test and at least one breast screening exam (i.e., mammogram or CBE) in the previous two years with women who were underscreened. Age, level of education, smoking status, and access to health care were associated with both outcome measures. Black women were more likely to use screening services in the office setting (i.e., CBE and Pap), without a corresponding use of mammography. Nevertheless, more black than white women received a routine Pap test in combination with a CBE, a very positive trend with respect to the successful diffusion of at least two screening procedures among older black women. The data suggest that barriers to mammography screening remain even among women who are screened by CBE and Pap. Perhaps the biggest challenge is to educate primary care physicians and their patients to view different components of preventive health--CBE, Pap smear testing, breast self-examination, and mammographic screening--as equally necessary and interrelated. Medical Subject Headings (MeSH): screening, mammography, cervical cancer, Pap, breast exam.

Black or African American↗
PubMedDate not supplied

Do physicians do as they say? The case of mammography.

OBJECTIVE: To assess the utility of survey-based physician policy in predicting actual mammography ordering behavior, as measured by medical record abstraction. DESIGN: Cross-sectional survey of practicing community physicians. Responses were correlated with data abstracted from the medical records of patients in the practices of the participating physicians. PARTICIPANTS: Family and general practitioners in Washington State. Medical records of female patients aged 40 to 80 years provided data on actual mammography performance. MAIN OUTCOME MEASURES: The proportions of female patients aged 40 to 49 and 50 to 80 years who had received a screening mammogram within the previous 2 years. RESULTS: Of the more than 100 potential predictors available, only 4 were significantly associated with screening rates for women younger than 50 years and only 3 were associated with screening rates for older women. Regression models explained only 21% to 25% of the variance in screening rates. Physician estimates of screening rates were poorly correlated with actual screening rates. CONCLUSIONS: Practicing physicians do not know how well they screen their patients using mammography. Extensive survey data, including direct estimates of behavior, demographics, policy measures, and case scenario responses, were of limited use in predicting actual screening rates. Our results underscore the importance of using data rather than proxy measures to study physician performance.

Adult↗
PubMed2003

Reported pain following mammography screening.

BACKGROUND: Mammography screening for asymptomatic older women has been shown to be effective in reducing breast cancer mortality. Physicians and patients report pain as a major barrier for many women in the screening process; however, few studies report both the degree and type of pain women experience during the screening. METHODS: Two hundred women 40 years and older were interviewed immediately following screening mammography. They were questioned about the pain they experienced, the difference between their experience and their expectations, and the most stressful part of the entire procedure. RESULTS: Seventy-two percent of the women reported the pain to rank 4 or less on a scale of 0 to 10 (mean +/- SD score, 2.95 +/- 2.09). The highest level of pain reported resulted from the compression of the breasts (3.25 +/- 2.43). Ninety-six percent reported that the pain was "less than" or "about as expected." Most (94%) said they were "very likely or somewhat likely to get a mammogram next year." The most stressful part of the procedure was waiting for the results, according to 39% of the women. CONCLUSIONS: The relatively low level of pain reported is useful information for both patients and practitioners. Adherence to screening recommendations is more likely to occur when both parties are able to anticipate the most painful and stressful elements of mammography.

Adult↗