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PubMed2006

(99M)Technetium-sestamibi scintimammography in non-palpable breast lesions found on screening X-ray mammography.

OBJECTIVE: The sensitivity and specificity of (99m)Tc-sestamibi scintimammography in patients with non-palpable breast lesions diagnosed by screening mammography and the value of (99m)Tc-sestamibi to detect axillary lymph node metastases was determined. METHODS: Between September 2000 and December 2003, 103 females with non-palpable breast lesions were included for further evaluation. X-ray mammography was repeated and 99mTc-sestamibi scintimammography performed within one-week. Anterior, and left and right lateral images were obtained. The scintimammography was analysed by 2 experienced observers who were blinded to the clinical, pathological, and radiological results. The sensitivity and specificity of scintimammography to diagnose non-palpable lesion(s), including the axillary regions, was compared with histopathology, clinical, and radiological follow up. RESULTS: Two patients (one non-small lung cancer and one non-Hodgkin's disease) were excluded. Both showed (99m)Tc-sestamibi avid lesions in the breast and axillary region. In the remaining 101 patients, 37 true positive (TP), 4 false positive (FP), 52 true negative (TN), and 8 false negative (FN) breast carcinomas were found. The specificity was 92.8%, sensitivity 82.2%, positive predictive value (PPV) 90.2%, and negative predictive value (NPV) 86.6%. (99m)Tc-sestamibi scintimammography showed axillary lesions in 5/15 (33%) patients with axillary lymph node metastasis. CONCLUSION: In patients with non-palpable lesions diagnosed by screening- X-ray-mammography, (99m)Tc-sestamibi scintimammography provided high specificity and PPV. Furthermore, (99m)Tc-sestamibi scintimammography detected 33% of patients with axillary lymph node metastases. Therefore, (99m)Tc-sestamibi scintimammography could be of incremental value in the surgical work-up of these patients.

Aged↗
PubMed2005

In a randomized controlled trial, patients preferred electronic data collection of breast cancer risk-factor information in a mammography setting.

BACKGROUND AND OBJECTIVE: We evaluated patient acceptance of an electronic questionnaire to collect breast cancer risk-factor data in a mammography setting. METHODS: We developed an electronic questionnaire on a tablet computer incorporating prefilled answers and skip patterns. Using a randomized controlled study design, we tested the survey in a mammography clinic that administers a paper risk-factor questionnaire to every woman at her screening mammogram. We randomized 160 women to use the electronic survey (experimental group, n = 86) or paper survey (control group, n = 74). We evaluated patient acceptance and data completeness. RESULTS: Overall, 70.4% of the experimental group women thought the survey was very easy to use, compared to 55.6% of women in the control group. Ninety percent of experimental group women preferred using the tablet, compared to the paper questionnaire. Preference for the tablet did not differ by age; however, women > or = 60 years did not find the tablet as easy to use as did women < 60 years. The proportion of missing data was significantly lower on the tablet compared to the paper questionnaire (4.6% vs. 6.2%, P = .04). CONCLUSION: Electronic questionnaires are feasible to use in a mammography setting, can improve data quality, and are preferred by women regardless of age.

Adult↗
PubMed2004

Screening mammography practice essentials.

A successful screening mammography practice has three directives. The first directive is quality mammography interpretation, which results in detection of a high percentage of early stage breast cancers, an acceptable recall rate, and an acceptable biopsy rate and yield. The second directive is providing a cost-efficient service. The third directive is access for as many eligible women as possible. Strategies that have helped improve screening mammography access for underserved women are discussed in this article.

Female↗
PubMedDate not supplied

Loss-framed minimal intervention increases mammography use.

INTRODUCTION: Although mammography is the most effective early detection breast cancer screening technology available, it is underutilized. This study was conducted to test the effectiveness of a loss-framed minimal intervention to increase mammography use. Loss-frame refers to a communication strategy in which messages are framed from the perspective of what a person has to lose by not taking a particular behavioral action. METHODS: Participants were medically un- and underinsured women 50-64 years old who called one of two urban clinics randomly selected based on demographic statistical equivalency. The women who participated telephoned to inquire about a mammogram during the 6-month study period. The group randomly designated as the experimental group received a loss-framed message conveyed by trained staff telephonically. Members of the comparison group received the "usual" communication, also conveyed telephonically. In the experimental group, 31 of 112 (27%) women who inquired received mammograms, whereas 157 of the 992 (16%) comparison group women who inquired received mammograms. RESULTS: The odds of a mammogram, adjusted for race and breast cancer symptoms, significantly increased for the experimental (odds ratio [OR] = 1.914, chi2 = 7.48, p = .0063, 95% confidence interval [CI] 1.20-3.05) versus comparison group. CONCLUSIONS: A loss-framed, in-reach, minimal intervention approach holds promise as a mammography promotion strategy.

Breast Neoplasms↗
PubMed2004

Likelihood of additional work-up among women undergoing routine screening mammography: the impact of age, breast density, and hormone therapy use.

BACKGROUND: Mammography screening can involve subsequent work-up to determine a final screening outcome. Understanding the likelihood of different events that follow initial screening is important if women and their health care providers are to be accurately informed about the screening process. METHODS: We conducted an analysis of additional work-up following screening mammography to characterize use of supplemental imaging and recommendations for biopsy and/or surgical consultation and the factors associated with their use. We included all events following screening mammography performed between 1/1/1998 and 12/31/1999 on a population-based sample of 37,632 New Hampshire women. We calculated adjusted odds ratios (OR) and 95% confidence intervals (CI) for supplemental imaging and recommended biopsy and/or surgical consultation as function of age, menopausal status and HRT use, breast density, and family history of breast cancer. RESULTS: Ninety-one percent of women (n = 34,445) did not require supplemental imaging. Among those who did (n = 3187), 84% had additional views, 9% ultrasound, and 7% received both. Supplemental imaging was affected by age (OR 0.84; 95% CI = 0.76-0.94 for 50-59; OR = 0.66; 95% CI = 0.58-0.75 for > or = 60 versus < 50), menopausal status, and HRT use (OR = 1.33; 95% CI = 1.21-1.47 for peri- or post-menopausal HRT users; OR = 1.14; 95% CI = 1.01-1.29 for premenopausal versus peri- or post-menopausal non-HRT users), breast density (OR = 1.43; 95% CI = 1.33-1.55 for dense versus fatty breasts) and family history (OR = 1.15; 95% CI = 1.06-1.25 for any versus none). In women with supplemental imaging, age (OR = 1.80; 95% CI = 1.11-2.90 for > or = 60, relative to <50) and imaging type (OR = 3.23; 95% CI = 2.38-4.38 for ultrasound with or without additional views versus additional views only) were significantly associated with biopsy and/or surgical consultation recommendation. In those with no supplemental imaging, breast density was associated with recommended biopsy and/or surgical consultation (OR = 1.53; 95% CI = 1.13-2.07 for dense versus fatty breasts). CONCLUSIONS: Breast density and HRT use are both independent predictors of use of supplemental imaging in women. With advancing age (age 60 and older), women were less likely to require follow-up imaging but more likely to receive a recommendation for biopsy and/or surgical consultation. This information should be used to inform women about the likelihood of services received as part of the screening work-up.

Breast Neoplasms↗
PubMed2004

Where's Maria? A video to increase awareness about breast cancer and mammography screening among low-literacy Latinas.

BACKGROUND: The need exists to educate and motivate medically disadvantaged Latinas to engage in regular mammography screening to reduce their high breast cancer (BC) mortality risk due to the illness' late detection. METHODS: Qualitative research methods [e.g., focus groups, key informants] were primarily used during the basic and formative research phases in preproducing and producing a breast cancer educational video for low-literacy Latinas. RESULTS: An 8-min video was created in an Entertainment-Education soap opera format. The purpose of the video is to create awareness about breast cancer and to motivate low-literacy Latinas who are at the precontemplation stage of behavior change to consider engaging in mammography screening. Thus, the video presents a compelling story of a Latina with whom the target audience can identify and become involved with the unfolding events of her story as she realizes her risk for breast cancer and struggles with the decision to engage in mammography. The content and format of the video include culturally relevant clues and modeling to influence Latinas' cognitive and subjective processes involved in making the decision to change. CONCLUSIONS: Complex attitudinal and behavioral issues can be effectively targeted to decrease the influence that psychological barriers exert in Latinas low breast cancer screening rates.

Aged↗
PubMed2005

Increasing mammography screening among low-income African American women with limited access to health information.

BACKGROUND: Previous research showed low-income African American women with limited access to breast screening information through mass media to have a low likelihood of obtaining screening. This report describes a controlled evaluation of a component of a community-based breast screening promotion program focused on increasing screening among low-income African American women. METHODS: A direct-contact screening promotion component tailored to the needs of low-income African American women was conducted between 1990 and 1997 in one of two matched Florida study areas. Before and after assessments of breast screening, behavior and psychosocial mediators of screening were examined using logistic regression analyses for 1201 women with differing levels of exposure to media information about breast screening. RESULTS: Recent/repeat mammography use increased significantly in the program area for women with limited access to media information, although there was no significant program impact on hypothesized psychosocial mediators of screening. CONCLUSIONS: The program led to increased mammography use among low-income African Americans having limited access to screening information through the media. For these women, using direct contact to deliver educational messages and facilitation of access to services may be the best method available to promote regular mammography.

Adult↗
PubMed2006

Test-retest reliability of self-reported mammography in women veterans.

BACKGROUND: Mammography self-report is used to monitor screening and evaluate intervention trends; however, few studies have examined reliability. METHODS: Reliability of self-reported lifetime number of mammograms, most recent mammogram date, and predictors of reliability were assessed using data from Project H.O.M.E. The study population was 2,494 women 52 years and over, listed in the U.S. National Registry of Women Veterans, with no history of breast cancer, who completed both baseline (2000-2002) and year 1 (2002-2003) surveys. RESULTS: Reliability of lifetime number of mammograms was 60.9% for exact consistency and 79.9% for consistency within one mammogram. Thirty-five percent was exactly consistent in reporting mammogram date; 55.6% was consistent within 3 months. Completing both surveys by mail and reporting fewer lifetime mammograms at baseline were positively associated with consistency of reporting lifetime number. White race/ethnicity, having a Bachelor's degree, reporting a health care provider's recommendation for a mammogram, having a screening mammogram, completing both surveys by mail, and being in the maintenance or action stages of change were associated with consistency in reporting date. CONCLUSIONS: Reliability varies with the measure of self-reported mammography. Likewise, predictors show different patterns of association with different definitions. Our findings call attention to the need for explicit definitions and measures of mammography use.

Adult↗
PubMed2006

Body mass index and use of mammography screening in the United States.

BACKGROUND: Obese and underweight women may be less likely to seek cancer screening because of health status, self-perception, and body image related to non-desirable weight. This study examined the relationship between body mass index (BMI) and mammography screening, using the data from the year 2000 United States National Health Interview Survey. METHODS: This study included 7692 white and 1496 black female participants aged 40-80, who were randomly selected. Body mass index (kg/m2), based on self-reported weight and height, was compared between women with and without a mammogram in the past 2 years using logistic regression. RESULTS: Compared to women with normal body mass index, underweight and extremely obese women were more likely to have no screening mammograms in the past 2 years (odds ratio (OR) = 1.8, 95% confidence interval (CI), 1.2-2.6 for underweight women; odds ratio = 1.3, 95% confidence interval, 1.0-1.8 for extremely obese women). When data were analyzed by race, the odds ratio estimates were 1.8 for underweight white women (95% confidence interval, 1.3-2.7) and 1.4 for extremely obese white women (95% confidence interval, 1.0-1.9). The corresponding odds ratio estimates were close to 1.0 for black women. CONCLUSIONS: Underweight and extreme obesity may increase the risk of underusing screening mammography. The association between body mass index especially underweight and underuse of mammography might exist primarily in white women.

Adult↗
PubMed1995

Interval mammography after needle localization biopsy of breast abnormalities that are pathologically benign.

BACKGROUND: Needle localization biopsy is commonly performed for the diagnosis of mammographic abnormalities. Routine specimen radiography is generally recommended, but the value of routine short-interval postbiopsy mammography has not been analyzed. PATIENTS AND METHODS: We performed a retrospective review of 299 consecutive localized biopsies in 286 women from March 1989 to November 1993. Of these biopsies, 217 from the basis for this study; all yielded a benign pathologic diagnosis and had both specimen radiography and 3-month interval mammograms performed. RESULTS: A total of 192 (88%) of postbiopsy mammograms were interpreted as negative, while 22 (10%) were suspicious. Three patients had second biopsies and all had benign diagnoses, 16 had follow-up mammograms that were interpreted as normal or stable, and 3 patients were lost to follow-up. A suspicious postbiopsy mammogram had no significant relationship to initial mammographic abnormality or pathologic diagnosis, but did correlate with specimen radiograph interpretation (P = 0.02) by chi-square comparison). CONCLUSIONS: In a series of needle localization biopsies with intraoperative specimen radiography, postbiopsy mammography failed to reveal any missed cancers. Short-interval follow-up mammography is unnecessary to assess for residual abnormalities when specimen radiography confirms excision of the abnormality.

Biopsy, Needle↗
PubMed1990

Mammography in the pre-operative assessment and post-operative surveillance of patients treated by excision and radiotherapy for primary breast cancer.

To evaluate the place of mammography in the selection of patients for excision and radiotherapy for primary breast cancer a detailed analysis of pre-operative mammograms was performed in (i) a study group of 37 patients who developed local recurrence; (ii) a matched control group with a median local recurrence free survival of 57 months. There were significantly more multifocal tumours in the study group. Tumours were significantly larger (P = 0.02) and closer to the nipple (P = 0.008) in the study group compared to the control group. Regular follow-up mammograms were available in 26 of the study group. Twenty-one patients had mammographic evidence of either residual or recurrent tumour. We conclude that pre-operative mammography is essential in the selection of patients for excision and radiotherapy. Following treatment, mammography is useful in detecting residual or recurrent disease.

Adult↗
PubMed1993

Wire localized biopsy of breast lesions: a review of 425 cases found in screening or clinical mammography.

A total of 425 wire localized biopsies for non-palpable breast lesions found by screening (n = 169) or clinical (n = 256) mammography between 1986-1990 are reviewed with reference to the biopsy success rate with different localization techniques, the positive predictive value of the mammographic findings and the staging and treatment of carcinomas in the clinical and screening groups. Specimen radiographs were available for review in 371 cases and confirmed the removal of the lesion in 90.6%, were indeterminate in 4.8% and were negative in 4.6%. Some 95% of the failures occurred in mammography-guided localizations using the Kopans hookwire. In later years this wire was replaced with th Homer retractable needle/wire system, with a 99% success rate. The Kopans wire was found to be accurate in ultrasound (US)-guided procedures, which were tolerated very well with no complications, as compared with a 10.2% rate of vasovagal reactions in mammography-guided procedures. The success rate of the localizations performed under general anaesthesia was 93.7%, as compared with 80.2% of the localizations performed under local anaesthesia. A more clearcut improvement of the success rate (from 66.7% in 1986-1987 to 99% in 1990) was seen over the years with growing experience and the development of teamwork between radiologists, surgeons and pathologists. The histological diagnosis was malignant in 27% of cases. The positive predictive value for malignancy improved from 21% to 32% from 1986 to 1990, due mainly to an increase in the screening group. A total of 71% of the carcinomas found were of stage 0 (TisN0M0) or I (TIN0M0) indicating a good prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Ductal carcinoma in situ presenting as a stellate lesion on mammography.

Ductal carcinoma in situ (DCIS) usually manifests as microcalcification on mammography, but several other unusual forms of presentation on mammography are also described. One such atypical appearance is the stellate mass without calcification. This may occur with DCIS alone or when DCIS is associated with a complex sclerosing lesion (CSL). We retrospectively analysed the histopathological specimens and mammograms of women who were referred for biopsy from two large breast screening programmes, and were found to have DCIS as the dominant histological lesion. Of 677 women referred for surgical biopsy, 86 (13%) showed histological evidence of DCIS as the predominant lesion, and of these, seven (8%) showed a stellate appearance on mammography without associated calcification. In three cases the mammographic appearance was due to DCIS alone, and four were due to a CSL with associated DCIS. Only one case showed microinvasion (< 1 mm), and this was not large enough to account for the stellate lesion. We advocate biopsy of all radial lesions which are not surgical scars, as malignancy associated with benign lesions such as CSLs could be missed by cytological sampling errors.

Aged↗
PubMed2004

Comparison of endoscopic procedures for colorectal cancer screening in women with mammography and Pap smear.

BACKGROUND: This study compared the experiences of women who underwent endoscopic screening for colorectal cancer vs. their experiences with breast and cervical cancer screening by mammography and Pap smear, respectively. METHODS: Women who had either flexible sigmoidoscopy or colonoscopy as a screening procedure for colorectal cancer were asked to return a questionnaire by mail. In the questionnaire, they were asked about the procedure they had just undergone and to compare it with recent mammograms and Pap smears. Flexible sigmoidoscopy was performed without sedating the patient; colonoscopy was performed with the patient under deep sedation (midazolam, fentanyl, and propofol administered by an anesthesiologist). RESULTS: Responses were obtained from 258 women (88%). Of these, 152 had colonoscopy and 106 had flexible sigmoidoscopy. A total of 72% of respondents found colonoscopy to be a comfortable test. Only 26% found flexible sigmoidoscopy uncomfortable, which was similar to mammography and Pap smear, at 22%. In terms of the test considered to be the most embarrassing, the highest response rate (38%) was for the Pap smear. Most women had no preference as to the gender of the endoscopist, but 46% preferred a woman doctor for a Pap smear (p < 0.001). Preparation was regarded as the worst part of the colonoscopy procedure; for flexible sigmoidoscopy, the procedure itself and the preparation were equivalent. CONCLUSIONS: Women found flexible sigmoidoscopy or colonoscopy comfortable and less embarrassing than a Pap smear or a mammography. There was no preference with respect to the gender of the physician who performed the colorectal screening procedures, unlike the Pap smear. Most respondents would have the procedure again and would recommend it to others.

Adult↗
PubMed2000

Ductal carcinoma in situ. Implications for screening mammography.

Ductal carcinoma in situ (DCIS) now represents 20% of all newly diagnosed breast cancers because of increased detection by screening mammography. Twenty year relative survival rates are 97%. Postsurgical and histological studies and recent molecular biological studies indicate that most cases of DCIS will progress to invasive carcinoma if not detected by mammography. Screening mammography studies support the need for annual versus less frequent screenings to detect DCIS before further progression.

Breast Neoplasms↗
PubMed1995

Patient selection for breast conservation therapy with magnification mammography.

BACKGROUND: Breast-conserving therapy (BCT) is an appropriate treatment for women with breast carcinoma of limited extent. This study was undertaken to determine the ability of microfocal spot magnification mammography to identify women with multifocal or multicentric breast carcinoma who were unlikely to have all gross carcinoma removed with a limited breast resection. METHODS: Two hundred sixty-three women with mammographically visible ductal carcinoma in situ and stage 1 and 2 carcinoma who were clinical candidates for BCT were evaluated with magnification mammography before undergoing definitive local therapy. Biopsy specimens of additional abnormalities thought to have a greater than 2% risk of malignancy were obtained. RESULTS: Forty-seven women had other abnormalities in the index breast requiring intervention, and 216 had only the primary tumor identified. Mean age, cancer presentation, disease stage, and histologic tumor type did not differ between groups. BCT was successful in 97.2% of women without mammographic abnormalities versus 38% of women with abnormalities (p = 0.001). Clinical characteristics did not differ between patients undergoing successful BCT and those requiring mastectomy. Synchronous contralateral carcinoma was identified in 2.4% of women at risk. CONCLUSIONS: Magnification mammography allows accurate preoperative identification of patients requiring mastectomy or quadrantectomy and should be performed before diagnostic biopsy is done.

Adult↗
PubMed2003

The effect of adding Pap smear information to a mammography reminder system in an HMO: results of randomized controlled trial.

BACKGROUND: While reminders can promote cancer screening in primary care, little is known about the potential interaction between multiple reminders. METHODS: We conducted a randomized controlled trial to compare the effect of combined Pap smear plus mammogram reminders and mammogram-only reminders among 2471 women 40 years of age or older enrolled in a health maintenance organization serving a predominantly Medicaid-eligible population. Reminders included both a mailed letter for the woman and a medical record prompt. RESULTS: Intervention assignment was unassociated with differences in rates of visitation to family medicine or internal medicine or completion of mammography during the study year. Compared to women assigned to mammogram-only reminder treatment, those assigned to the combined Pap smear plus mammogram reminder intervention were more likely to visit a gynecologist (34% compared to 29%, adjusted odds ratio = 1.33, 95% confidence interval 1.08-1.63) and to complete a Pap smear (30% compared to 23%, adjusted odds ratio = 1.39, 95% confidence interval 1.07-1.89). CONCLUSIONS: In the study setting, the addition of Pap smear to mammography reminders has a procedure-specific effect, increasing gynecology visits and Pap smear use while neither increasing nor decreasing other primary care visits or mammography. We find no evidence of reinforcement or competition between these reminders.

Adult↗
PubMed1994

Breast screening: the case for physical examination without mammography.

Many studies have shown that screening for breast cancer can reduce mortality from the disease. Mammography has come to be regarded as the screening method of choice, but evidence suggests that physical examination (PE) is at least as effective in reducing mortality. Mammography detects many non-infiltrating and small, non-palpable tumours, but we do not know whether these would ever cause symptoms or threaten the woman's life. It is doubtful whether the time gained by early mammographic detection confers any survival benefit over PE detection. PE has substantial advantages over mammography in terms of human and economic costs. The question we should be asking is not how to refine mammographic screening but whether we need it at all.

Adult↗