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PubMed2004

Completion of colorectal cancer screening in women attending screening mammography.

RATIONALE AND OBJECTIVES: The American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF) recommend colorectal cancer (CRC) screening to begin at age 50 in individuals at average risk for CRC. To estimate rate at which women eligible for CRC screening at the time of screening mammography attendance later completed in CRC screening, we retrospectively evaluated CRC screening utilization in women who underwent screening mammography at our institution. MATERIALS AND METHODS: We retrospectively identified 3357 women between the ages of 50 to 75 who received screening mammography in 1998 at a single academic medical center using the institution's Radiology Information System (RIS). Additional information collected from the institution's Health System Data Warehouse and the Radiology department's mammography quality assurance data included mammography results, Breast Imaging Reporting and Database System (BI-RADS) classification of mammography findings, recommendation for screening mammography follow-up, insurance status, and CRC screening utilization after screening mammography. After excluding women who were current with CRC screening at the time of mammography, we determined the proportion of eligible women who completed CRC screening after mammography. Age, insurance type, BI-RADS code, and recommendation code were evaluated as potential predictors of CRC screening completion in eligible women. RESULTS: Of the 3357 women between the ages of 50 and 75 who received screening mammography in 1998, only 414 (12.3%) were current with CRC screening at the time of screening mammography. Of the remaining 2943 women who were eligible for CRC screening at the time of screening mammography, 142 (4.8%) subsequently completed CRC screening. Average time to completion of CRC screening after screening mammography is 35.4 months (range, 0.27-64.9). Managed care insurance was the only significant predictor of CRC screening completion after screening mammography in eligible women after adjusting for other variables (adjusted OR 1.73, 95% CI 1.21-2.47, P < .0001). Neither BI-RADS classification nor postmammography recommendations were significantly associated with CRC screening completion. CONCLUSIONS: Prevalence studies have demonstrated that women who were compliant with screening mammography were more compliant with CRC screening. Our data suggest that despite this increased compliance, overall incidence of CRC screening is low in the screening mammography population.

Aged↗
PubMed2004

Relation between intervention exposures, changes in attitudes, and mammography use in the North Carolina Breast Cancer Screening Program.

OBJECTIVE: Many past interventions have been based on the assumption that improving attitudes about mammography can increase mammography use. We studied changes in breast cancer and mammography attitudes over time in mediating the effect of intervention exposures on mammography use in the North Carolina Breast Cancer Screening Program. Data came from interviews with a cohort of 331 black women who said they had heard of mammography at baseline interview. METHODS: We created scores and score changes for mammography (7 items) and breast cancer (11 items) attitudes at baseline (1993-1994) and follow-up interviews (1996-1997). We modeled intervention exposures, attitude changes, and mammography use in linear risk and logistic regression. Intervention exposures were defined for mammography discussion with a project lay health advisor ("LHA advice"), mammography discussion with anyone besides a doctor or nurse, and project awareness. RESULTS: Positive change in mammography attitudes was associated with intervention exposures and mammography use and appeared to account for a large percentage (34-98%) of the effect of mammography discussion variables on increased mammography use. Greatest effect of attitude improvement was found for women without a recent mammogram at baseline and with the least positive baseline attitude scores. CONCLUSION: Using cohort data enabled us to examine the role of attitude change over time on mammography use. Breast cancer screening programs should target women with the most negative mammography attitudes and the least mammography use to start with and concentrate their messages on improving attitudes specific to mammography rather than improving attitudes about breast cancer risk.

Adult↗
PubMedDate not supplied

Technetium-99m sestamibi scintimammography complements mammography in the detection of breast cancer.

Mammography remains the technique of choice for the detection of early breast cancer. The sensitivity of mammography is 85%, but is decreased in patients with dense breasts. Sestamibi scintimammography (SCM) has been suggested as an adjunctive modality to improve the detection of breast cancer. We conducted a study to determine the impact of SCM in patient management. A prospective study was conducted in 95 patients presenting with palpable masses and/or abnormal mammography scheduled for biopsy. Injection of 20-30 mCi of technetium-99m (Tc-99m) sestamibi into a pedal vein was performed. Ten-minute images of the breast and axilla were obtained in multiple projections. The mammography and SCM were correlated with pathology and clinical findings. The median age was 44 years (range 28-86 years). The total number of lesions was 104, as eight patients had bilateral lesions and one patient had two lesions in the same breast. Fifty-nine patients presented with palpable lesions and 45 patients with nonpalpable lesions (42 with abnormal mammography only and 3 with nipple discharge). A comparison of sensitivity, specificity, positive and negative predictive values, and overall accuracy of SCM and mammography were performed. The sensitivity and specificity for SCM were 83% and 83%, respectively, and for mammography were 65%, and 72%, respectively. The sensitivity and specificity for combined SCM and mammography were 87% and 94%, respectively. The p-value for mammography versus combined SCM and mammography was 0.0003 and that for SCM versus SCM and mammography was 0.0098. There were 80 (77%) benign and 24 (23%) malignant lesions. Of the 24 malignancies, SCM missed six (25%), versus eight (33%) by mammography. In two patients (9%) SCM detected malignancy in the breast that was not visualized by mammography or found on clinical examination. Sestamibi SCM improves the sensitivity of mammography and it detects up to 9% of malignancies not detected by mammography or clinical examination. This testing could impact the management of 16,500 patients in the United States every year. More studies are needed to better define its role in breast cancer detection.

Adult↗
PubMed1998

Strategies to encourage mammography use among women in senior citizens' housing facilities.

BACKGROUND: This randomized trial evaluated the impact of mammography-enhancing interventions implemented in 40 senior citizens' housing facilities in Pennsylvania and North Carolina. METHODS: After stratification of the facilities according to the socioeconomic status and racial backgrounds of their residents, they were randomly assigned to one of four groups to receive the following: 1) standard care--a Medicare mammography benefit flier; 2) education--the flier and a community education program; 3) access--the flier, mammography appointments, and transportation; 4) combined--all interventions. Telephone surveys, conducted prior to any intervention, identified mammography-eligible women, who were re-surveyed six months later to ascertain mammography use. RESULTS: Logistic regression analyses identified mammography intention, age, and the interaction between ever having had mammography and being in the combined intervention group to be significant predictors of mammography use at six months. However, no significant main effect was found for any of the interventions. CONCLUSIONS: These results suggest that the combination of community-directed mammography education and access to mammography appointments encourages mammography use primarily by women who are already predisposed to having mammography. However, individually targeted and tailored interventions may be needed to encourage mammography use among women who have never had mammography and/or express no intention of having it done.

Aged↗
PubMed2006

Can Medicare billing claims data be used to assess mammography utilization among women ages 65 and older?

BACKGROUND: Medicare data may be a useful source for determining the utilization of mammography among elderly women, but the accuracy of these data has not been established. OBJECTIVE: We determined whether Medicare physician billing claims are an accurate reflection of mammography utilization among women ages 65 and older and whether they can be used to assess the use of screening as compared with diagnostic mammography. DATA SOURCES: Mammography use was assessed using Medicare billing claims and radiology reports from 2 mammography registries; the San Francisco Mammography Registry and the New Mexico Mammography Registry. METHODS: Completeness of the Medicare data was assessed by comparing mammography use based on Medicare, with radiology reports from the mammography registries, which served as the referent standard. Capture rates for Medicare claims for individual mammograms were examined, and women were characterized as having undergone at least 1 mammogram within each 2-year period based on the Medicare data, and these rates were compared with the referent standard. To determine whether Medicare data can distinguish between screening and diagnostic mammography, we performed a classification analysis using the mammography registries screening/diagnostic designation as the referent standard (dependent variable) and Medicare claim information as the independent/predictor variable. On the basis of the mammogram level classification analysis, women were categorized as having been frequently screened (at least 2 screening mammograms spaced by 12 to 36 months), screened (at least 1 screening mammogram), or not screened. SUBJECTS: Women ages 65 and older, diagnosed with breast cancer between 1992-1999, who had at least 1 mammogram between 1992-1999 were examined. RESULTS: A total of 3340 mammograms were obtained in 1371 women between 1992 and 1999. Overall, 83% of mammograms obtained by these women had a corresponding billing claim in Medicare. This increased from 65% in 1992 to 90% in 1999. Of women who underwent at least 1 mammogram during each 2-year period per the referent standard, 94% of women were accurately classified by Medicare claims as also having undergone mammography during the same 2-year period. In multivariable analysis, a mammogram was more likely to be associated with a billing claim over time, for women 80 years or older, and for white and Asian as compared with Hispanic women. Neither socioeconomic status nor screening/diagnostic designation affected the likelihood that a mammogram would be associated with a billing claim. The Medicare data accurately categorized a given mammogram as screening or diagnostic for 87.5% of mammograms. Lastly, there was moderate to substantial agreement in the categorization of women as frequently screened, screened or not screened between the 2 data sets (weighted kappa 0.74, 95% confidence interval 0.70-0.78). CONCLUSION: Medicare administrative claims are reliable for assessment of mammography utilization and have become more accurate over time. Medicare claims data also provide a mechanism for designating mammography as screening or diagnostic, which subsequently may allow accurate description of a woman's screening history.

Age Distribution↗
PubMed1999

Continuing screening mammography in women aged 70 to 79 years: impact on life expectancy and cost-effectiveness.

CONTEXT: Mammography is recommended and is cost-effective for women aged 50 to 69 years, but the value of continuing screening mammography after age 69 years is not known. In particular, older women with low bone mineral density (BMD) have a lower risk of breast cancer and may benefit less from continued screening. OBJECTIVE: To compare life expectancy and cost-effectiveness of screening mammography in elderly women based on 3 screening strategies. DESIGN: Decision analysis and cost-effectiveness analysis using a Markov model. PATIENTS: General population of women aged 65 years or older. INTERVENTIONS: The analysis compared 3 strategies: (1) Undergoing biennial mammography from age 65 to 69 years; (2) undergoing biennial mammography from age 65 to 69 years, measurement of distal radial BMD at age 65 years, discontinuing screening at age 69 years in women in the lowest BMD quartile for age, and continuing biennial mammography to age 79 years in those in the top 3 quartiles of distal radius BMD; and (3) undergoing biennial mammography from age 65 to 79 years. MAIN OUTCOME MEASURES: Deaths due to breast cancer averted, life expectancy, and incremental cost-effectiveness ratios. RESULTS: Compared with discontinuing mammography screening at age 69 years, measuring BMD at age 65 years in 10000 women and continuing mammography to age 79 years only in women with BMD in the top 3 quartiles would prevent 9.4 deaths and add, on average, 2.1 days to life expectancy at an incremental cost of $66773 per year of life saved. Continuing mammography to age 79 years in all 10000 elderly women would prevent 1.4 additional breast cancer deaths and add only 7.2 hours to life expectancy at an incremental cost of $117689 per year of life saved compared with only continuing mammography to age 79 years in women with BMD in the top 3 quartiles. CONCLUSIONS: This analysis suggests that continuing mammography screening after age 69 years results in a small gain in life expectancy and is moderately cost-effective in those with high BMD and more costly in those with low BMD. Women's preferences for a small gain in life expectancy and the potential harms of screening mammography should play an important role when elderly women are deciding about screening.

Aged↗
PubMedDate not supplied

Colorectal cancer screening behavior in women attending screening mammography: longitudinal trends and predictors.

PURPOSE: Nationally representative surveys demonstrate that the adherence to screening mammography guidelines are associated with increased prevalence of colorectal cancer (CRC) screening; however, the incidence of CRC screening in the screening mammography population is unknown. Our purpose was to describe non-fecal occult blood test (FOBT) CRC screening utilization by women prior to and subsequent to screening mammography at a large academic medical center. MATERIALS AND METHODS: Using the institutional administrative data base, 17,790 women aged 50 and older who underwent screening mammography between 1998 and 2002 were retrospectively identified. We determined that women were current with non-FOBT CRC screening at the time of mammography if they had undergone flexible sigmoidoscopy or double-contrast barium enema in the 5 years or colonoscopy since 1995, the earliest for which data are available. We excluded FOBT as a form of CRC screening because the administrative data base did not adequately capture episodes of FOBT. Women who were not current were considered eligible for non-FOBT CRC screening. We then assessed the number of women who underwent flexible sigmoidoscopy, barium enema, or colonoscopy within 12 months following mammography. Age, insurance status, Breast Imaging Reporting and Data System classification, recommendations after screening mammography and year of mammography were examined as potential predictors of non-FOBT CRC screening completion. RESULTS: At the time of mammography, 13.3% women were current with non-FOBT CRC screening. Of women eligible for non-FOBT CRC screening at the time of mammography, 1.1% completed non-FOBT CRC screening within 12 months after mammography. The rate of non-FOBT CRC screening completion increased over time. After multivariate analysis, being insured by a commercial managed care organization or by Medicaid remained significant predictors of non-FOBT CRC screening. CONCLUSION: The prevalence of non-FOBT CRC screening is low in the population of women undergoing screening mammography, with an incidence of 1.0%. Future studies should examine whether delivering CRC screening interventions at a screening mammography visit increase adherence to non-FOBT CRC screening.

Aged↗
PubMed1991

The value of ultrasound mammography in palpable breast masses.

Between January 1987 and May 1988 a prospective study was carried out on 232 women with a palpable breast mass. They underwent physical examination, x-ray mammography and ultrasound mammography. The results of each study were interpreted independently by separate observers, and consensus was achieved. From all solid tumours histology was available. Compared to x-ray mammography, ultrasound mammography proved to be significantly (p less than 0.025) more sensitive in diagnosing malignant palpable breast masses (98.7% versus 86.8%). However there was no statistical significant difference in specificity between ultrasound mammography and x-ray mammography. Using ultrasound mammography we classified 9 histological proven malignant tumours as such which were negative on plain x-ray mammography. Despite the good results of ultrasound mammography in diagnosing palpable breast lesions it can never replace x-ray mammography in cases of malignancy, because the results of ultrasound mammography with non-palpable synchronous tumours with or without microcalcifications are poor. In some cases of benign lesions diagnosed with ultrasound mammography no x-ray mammography is necessary.

Adolescent↗
PubMed2006

Correlates of repeat and recent mammography for women ages 45 to 75 in the 2002 to 2003 Health Information National Trends Survey (HINTS 2003).

BACKGROUND: Most national-level mammography data are for ever-had and most-recent screening. There are few national-level data on rates of repeat, on-schedule mammography, and on the prevalence and correlates of repeat mammography. It is also important to investigate the similarity of correlates for repeat and recent mammography. METHODS: Analyses were from data for women ages 45 to 75 in the 2002 to 2003 Health Information and National Trends Survey (HINTS 2003; N = 1,581). The two dependent variables were self-report of repeat mammography (two exams on schedule, based on an every-other-year interval) and recent mammography only (one mammogram within the past 2 years). RESULTS: The prevalence of recent mammography was 81.6% (95% confidence interval, 79.1-84.1) and for repeat mammography was 72.2% (95% confidence interval, 69.0-75.4). An access to care variable combining insurance coverage and regular source of care was the strongest sociodemographic correlate of both mammography indicators. Most other sociodemographic variables were not associated with mammography status. Five psychosocial/behavioral variables were associated with both mammography indicators (smoking status, attention to health information, knowledge of screening interval, worry about breast cancer, and recent mood status). Correlates were very similar for repeat and recent mammography. CONCLUSIONS: Although access to care had the strongest association with mammography, psychosocial and behavioral variables did better as a group than the sociodemographic variables. A standard set of such variables should be considered for all national surveys.

Aged↗
PubMed1998

Mammography use helps to explain differences in breast cancer stage at diagnosis between older black and white women.

BACKGROUND: Older black women are less likely to undergo mammography and are more often given a diagnosis of advanced-stage breast cancer than older white women. OBJECTIVE: To investigate the extent to which previous mammography explains observed differences in cancer stage at diagnosis between older black and white women with breast cancer. DESIGN: Retrospective cohort study using the Linked Medicare-Tumor Registry Database. SETTING: Population-based data from three geographic areas of the United States included in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program (Connecticut; metropolitan Atlanta, Georgia; and Seattle-Puget Sound, Washington). PARTICIPANTS: Black and white women 67 years of age and older in whom breast cancer was diagnosed between 1987 and 1989. MEASUREMENTS: Medicare claims were used to classify women according to mammography use in the 2 years before diagnosis as nonusers (no previous mammography), regular users (> or =2 mammographies done at least 10 months apart), or peri-diagnosis users (mammography done only within 3 months before diagnosis). Information on mammography use was linked with SEER data to determine cancer stage at diagnosis. Stage was classified as early (in situ or local) or late (regional or distant). RESULTS: Black women were more likely to not undergo mammography (odds ratio [OR], 3.00 [95% CI, 2.41 to 3.75]) and to be given a diagnosis of late-stage disease (OR, 2.49 [CI, 1.59 to 3.92]) than white women. When women were stratified by previous mammography use, the black-white difference in cancer stage occurred only among nonusers (adjusted OR, 2.54 [CI, 1.37 to 4.71]). Among regular users, cancer was diagnosed in black and white women at similar stages (adjusted OR, 1.34 [CI, 0.40 to 4.51]). In logistic modeling, previous mammography alone explained about 30% of the excess late-stage disease in black women. In a separate model, previous mammography explained 12% of the excess late-stage disease among black women after adjustment for sociodemographic and comorbidity information. CONCLUSION: Differences in breast cancer stage at diagnosis between older black and white women are related to previous mammography use. Increased regular use of mammography may result in a shift toward earlier-stage disease at diagnosis and narrow the observed differences in stage at diagnosis between older black and white women.

Black or African American↗
PubMed1992

The value of ultrasonic examination to detect and diagnose breast carcinomas. Analysis of the results obtained in 125 tumors using radiographic and ultrasound mammography.

A series of 125 breast carcinomas studied by both radiological and ultrasound mammography, and which were observed in 102 patients, is presented. Of the lesions, 76.5% were less than 20 mm in diameter, and 16.8% had a diameter 10 mm or less. Sixteen lesions were in situ or microinvasive. Analysis of the results shows a 40.8% rate of false-negative results with radiological mammography, when only 'highly suspicious' and 'suspicious' images are considered. This figure is reduced to 28% when 'benign-appearing' masses are included in the computation. Using similar diagnostic categories, the false-negative rates obtained with ultrasound mammography were 14.4% and 12.8%, respectively. Combining radiological and ultrasound mammography resulted in a dramatic decrease in the false-negative rate to 4% The number of false-negative results observed with either radiological or ultrasound mammography was in the higher range of reported values when compared to selected studies. However, they may, in fact, closely reflect the real performance of these investigations, as they are available to patients in everyday clinical practice. Analysis of the data shows that radiological mammography is less efficient in younger patients. The mean age of the patients in the radiological mammography positive group was 54.3 +/- 1.2 years, as opposed to 47.5 +/- 2.1 (p = 0.004) in the radiological mammography negative group. In contrast, the efficiency of ultrasound mammography is independent of the patient's age, and consequently of breast density. In this series, no obvious size effect was apparent on tumor visibility using either imaging modality. The present study shows that the false-negative rate of radiological as well as ultrasound mammography is higher than usually perceived. Given the complementarity of radiological and ultrasound mammography, their combination proves highly sensitive and highly specific. However, this conclusion will only apply when both breasts are examined completely, but not when ultrasound examination of the breasts is restricted to the imaging of an anomaly detected with radiological mammography. The time needed to perform a complete breast examination reduces its potential use in a screening program. On the other hand, its use appears of major relevance in patients with breasts where the performance of radiological mammography is questionable, such as younger women, or women with dense breasts.

Journal Article↗
PubMed2000

Women's understanding of the mammography screening debate.

BACKGROUND: The fractious public debate over mammography screening recommendations for women aged 40 to 49 years has received extensive attention in medical journals and in the press. OBJECTIVE: To learn how women interpret the mammography screening debate. METHODS: We mailed a survey to a random sample of American women 18 years and older, oversampling women of screening age (40-70 years). Sixty-six percent of women completed the survey (n = 503). MAIN OUTCOME MEASURES: The main outcome measures were women's reactions to the debate, their suggestion for the starting age for mammography screening, and their understanding of the source of the debate. RESULTS: Almost all women (95%) said that they had paid some attention to the recent discussion about mammography screening. Only 24% said the discussion had improved their understanding of mammography, while 50% reported being upset by the public disagreement among screening experts. Women's beliefs about mammography differed from those articulated by experts in the debate. Eighty-three percent believed that mammography had proven benefit for women aged 40 to 49 years, and 38% believed that benefit was proven for women younger than 40 years. Most women suggested that mammography screening should begin before age 40 years, while only 5% suggested a first mammogram should be performed at 50 years or older. In response to an open-ended question about why mammography has been controversial, 15% cited concerns about the potential harms of radiation and another 12% cited questions about efficacy. Nearly half (49%), however, identified costs as the major source of debate (eg, "Health maintenance organizations [HMOs] don't want to pay for mammography"). CONCLUSIONS: Most women paid attention to the recent debate about routine mammography screening for women aged 40 to 49 years, but many believed the debate was about money rather than the question of benefit. Policy makers issuing recommendations about implementation of large-scale mammography screening services need to consider how to effectively disseminate their message.

Adolescent↗
PubMed1996

Likelihood ratios for modern screening mammography. Risk of breast cancer based on age and mammographic interpretation.

OBJECTIVE: To determine the sensitivity, specificity, and likelihood ratios (LRs) for modern screening mammography by decade of age and mammographic interpretation. DESIGN: Cross-sectional. SETTING: Nine counties in northern California. PARTICIPANTS: A total of 26,057 women aged 30 years and older who underwent a total of 41,747 first and subsequent screening mammographic examinations at the Mobile Mammography Screening Program of the University of California, San Francisco, from April 1985 to September 1991. MEASUREMENTS: Breast cancer risk profile, 2 standard mammographic views per breast, and follow-up of abnormal and normal mammograms of contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results tumor registry. False-negative examinations were normal examinations that occurred within 13 months of a diagnosis of invasive breast cancer or ductal carcinoma in situ. RESULTS: The sensitivity of first screening mammography increased with age: 77.3% for ages 30 to 39 years, 86.7% for ages 40 to 49 years, 93.6% for ages 50 to 59 years, 94.1% for ages 60 to 69 years, and 91.2% for ages 70 years and older (P = .04). Specificity was similar for all ages, ranging from 92.6% to 95.2%. Of all abnormal first screening examinations, 92.9% were reported as "additional evaluation needed." The LRs for that category ranged from 5.2 to 8.8 and did not vary with age. Based on the risk of breast cancer before mammography, which increases with age, the risk of breast cancer after mammography associated with these LRs were 0.01 for ages 30 to 39 years, 0.02 for ages 40 to 49 years, 0.05 for ages 50 to 59 years, 0.07 for ages 60 to 69 years, and 0.07 for ages 70 years and older. The LRs for mammography reported as "suspicious for malignancy" ranged from 88 to 144 and did not vary across age groups. These LRs were associated with a risk of breast cancer about 10 times greater than when mammography was reported as "additional evaluation needed." CONCLUSION: Most abnormal first screening mammography are interpreted as "additional evaluation needed" and are associated with LRs of about 7. Given this low LR, the risk of breast cancer after mammography is primarily influenced by a woman's age-specific risk of breast cancer before mammography. The LRs for screening mammography interpreted as "suspicious for malignancy" are high (about 124) and are associated with a substantial increase in the risk of breast cancer irrespective of age, but these interpretations comprise only a small proportion of abnormal mammography.

Adult↗
PubMed1999

Screening mammography and late-stage breast cancer: a population-based study.

BACKGROUND: Among 50- to 69-year-old women, randomized clinical trials show breast cancer mortality reductions from screening mammography. However, few studies examine the long-term health effects and outcomes from screening mammography in community practice. The purpose of this study was to evaluate one approach for determining the effectiveness of screening mammography, as it is practiced in community settings, and to measure the prevalence of prior screening mammography among women with incident breast cancer. METHODS: This study was a population-based survey of the general community. Participants were 406 women with breast cancer diagnosed in 1993. The main outcome measure was breast cancer, late stage at diagnosis or fatal within 2 to 3 years of diagnosis. RESULTS: Sixty-four (57.7%) of 111 women with late-stage and 123 (42.1%) of 292 women with early-stage breast cancer did not have a screening mammogram in the 4 calendar years (1989-1992) before diagnosis. Relative to women with early-stage breast cancer, mammography nonuse in 1989-1992 was significantly more frequent among women with late-stage breast cancer (age-adjusted odds ratio 2.3, 95% confidence interval 1.3-4.3). Prior mammography was particularly infrequent among 42 women with breast cancer incident in 1993 and fatal before January 1996. CONCLUSIONS: Prior mammography among women with late-stage or fatal breast cancer was relatively infrequent. Late-stage or fatal breast cancer lacking prior mammography constitutes a missed public health opportunity. Also, this population-based study showed the expected association between prior mammography and late-stage or fatal breast cancer. These results are consistent with the effective practice of mammography in a community setting. The results illustrate and validate a public health approach that uses prior mammography histories among women with incident breast cancer to evaluate mammography penetration and quality in defined communities.

Aged↗
PubMed2002

The gynecologist's role in mammography screening in absence of a public health program.

This study examined the role of the gynecologist in a woman's adoption of mammography screening in a population that does not benefit from an organized program of breast cancer screening. We surveyed 486 women ages 50-69 years, randomly selected from the population of Geneva (Switzerland) about recent mammography use, attitudes toward mammography screening (decisional balance), whether they received a recommendation to undergo mammography from their gynecologist and/or family practitioner, visits to gynecologist and family practitioner, and sociodemographic variables. In multivariate analysis, on-schedule mammography was associated with a recent visit to a gynecologist (odds ratio (OR) 4.8, 95% confidence interval (CI) 2.1-10.9), a gynecologist's recommendation for mammography (OR 15.8, 95% CI 6.5-38.6), a positive attitude toward mammography screening (positive score of decisional balance, OR 1.7, 95% CI 1.0-3.0), and being married (OR 2.0, 95% CI 1.2-3.3). Higher decisional balance scores were associated with a recent visit to a gynecologist ( P=0.001), a gynecologist's recommendation for mammography (P=0.001), and income ( P=0.01). Both a recent visit to a gynecologist and a gynecologist's recommendation for mammography were more frequent in women of higher income. This study suggests that gynecologists--but not family practitioners--play a key role both in referring women for mammography and in fashioning women's perceptions of mammography screening. Our data also indicate that a lack of access to a gynecologist and not receiving a gynecologist's recommendation for mammography may explain why low-income women are less likely to get a screening mammogram.

Aged↗
PubMed2006

The influence of type and severity of mental illness on receipt of screening mammography.

BACKGROUND: Women with mental illness may be at risk for failure to receive recommended preventive services such as mammography. Little is known about whether the type or severity of mental illness influences receipt of preventive services. OBJECTIVE: To measure the influence of type and severity of mental illness on receipt of mammography. DESIGN: Retrospective study of administrative claims data, 1996 to 2001. SUBJECTS: Privately insured women age 40 to 64 years, with and without claims for mental illness, and who were eligible for mammography between 1996 and 2001. MEASUREMENT: Odds ratios (OR) for receipt of screening mammography, any mammography, and follow-up mammography, adjusted for age, rural location, utilization of nonmental health services, and severity and type of the mental disorder. Severity measures were based on utilization of outpatient and inpatient mental health services and presence of comorbid substance use disorder. RESULTS: Women with any mental disorder were significantly less likely to receive mammography than controls. This was strongly influenced by severity of mental illness (any mammography: moderate severity OR 0.62; confidence interval [CI] 0.59 to 0.66: high severity OR 0.38; CI 0.33 to 0.43). Whereas severity contributed to lower receipt of mammography among women with mood and anxiety disorders, women with psychotic, alcohol, and substance abuse disorders had decreased odds for receipt of mammography regardless of severity. CONCLUSIONS: Women with mental disorders are at risk for failure to receive mammography, a recommended preventive service. Women with severe mental illness or psychotic and substance abuse disorders should be targeted to ensure delivery of mammography.

Adult↗
PubMed1996

Variability in mammography use among older women.

OBJECTIVE: To determine rates of and explore factors associated with mammography use among older women. DESIGN: Retrospective review of part B (physician) bills submitted to Medicare during 1990. SETTING: Health Care Financing Administration (HCFA) data, including sociodemographic information and part B physician bills for all services delivered to Medicare-eligible women in 1990. PATIENTS/PARTICIPANTS: Women age 65 or older as of January 1, 1990, residing in one of 10 states with part B coverage through December 31, 1990. MEASUREMENTS AND MAIN RESULTS: The outcome was receipt of a mammogram (yes/no). We explored factors associated with mammography use within three age groups: 65 to 74, 75 to 84, and 85+. The factors considered were race, state, median income of ZIP Code of residence (from the 1990 US Census, and used to divide the population into quintiles within each state), and number of primary care visits (0, 1, 2, and 3+). Overall, 15% of women had a mammogram: 20% of women age 65 to 74, 12% of women age 75 to 84, and 4% of women age 85 and older. Mammography use was lowest in Oklahoma and highest in Washington. However, in each state the older the age category, the less the mammography use (e.g., 9% vs 5% vs 2% in Oklahoma and 25% vs 16% vs 5% in Washington for women 65-74, 75-84, and 85+, respectively). Mammography use was lower for black than for white women age 65 to 74 (14% vs 21%, P < .001) and 75 to 84 (9% vs 12%, P < .001). Women in each of these two age groups had lower mammography use if they resided in the lowest income quintile and highest if they resided in the highest income quintile (17% vs 23% 65-74, and 10% vs 13% 75-84, P values < .001). Among the oldest women (those 85+), mammography use was low (4%) and varied minimally by race and income (P = .907 and .003, respectively). In all age groups, mammography use was lowest among women who did not have a primary care visit, was greater among women who had at least one visit, and continued to rise with increasing numbers of visits (all P values < .001). For example, among women age 75 to 84, mammography use increased from 5% to 10%, 14%, and 17% for those with 0, 1, 2, and 3+ visits. CONCLUSIONS: We found that mammography use was less for women who were older, of black race, who did not visit a primary care provider, and who lived in areas with lower median income and certain geographic locations (states). Similar factors influenced mammography use in women age 65 to 74, where there is greater consensus as to who should receive a mammogram, and women age 75 to 84, where there is neither consensus nor data. Surprisingly, neither race nor income had much influence on mammography use among women age 85 or older.

Black or African American↗
PubMed2005

Detection of primary breast carcinoma with a dedicated, large-field-of-view FDG PET mammography device: initial experience.

PURPOSE: To prospectively assess a dedicated, large field of view positron emission tomography (PET) mammographic device for imaging primary breast carcinoma. MATERIALS AND METHODS: Institutional review board approval was obtained for this study, and all patients provided written informed consent prior to participation. Subjects were recruited from a cohort of patients in whom diagnostic mammography and/or ultrasonography demonstrated lesions that were highly suggestive of malignancy. Twenty-three patients who met the inclusion criteria were subsequently imaged by using a dedicated PET mammography unit that was developed in conjunction with the Thomas Jefferson National Accelerator Facility (Newport News, Va). One hour after administration of 2.0-2.5 mCi (74.0-93.5 MBq) of fluorodeoxyglucose, 5-minute PET mammography of the affected breast was performed. Images were processed and reconstructed in the transverse craniocaudal and coronal planes. For each lesion, image-guided core-needle biopsy was performed immediately after PET mammography. Conventional mammography results and histologic findings were correlated with PET mammography images. The sensitivity, specificity, negative predictive value, and positive predictive value of PET mammography for demonstrating malignant lesions were calculated. RESULTS: PET mammography demonstrated 20 focal abnormalities, of which 18 were malignant and two were benign. Both benign lesions represented areas of fat necrosis. Three of 20 malignant lesions demonstrated at conventional mammography were not demonstrated at PET mammography. The overall sensitivity of PET mammography for malignancy was 86% (95% confidence interval: 65%, 95%), with a positive predictive value of 90% (95% confidence interval: 70%, 97%). The calculated specificity was 33% (95% confidence interval: 2%, 79%), and the negative predictive value was 25% (95% confidence interval: 1%, 70%). CONCLUSION: These pilot data suggest that PET mammography can demonstrate small primary breast malignancies.

Adenocarcinoma↗