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PubMed1998

The National Breast and Cervical Cancer Early Detection Program: report on the first 4 years of mammography provided to medically underserved women.

OBJECTIVE: We describe results from 284,503 mammographic examinations and associated diagnostic workups provided to medically underserved women in an ongoing nationwide breast cancer early detection program. MATERIALS AND METHODS: We report the results of mammographic examinations and diagnostic workups on 230,143 medically underserved women 40 years old or older who underwent at least one mammographic examination from July 1991 through June 1995. Mammograms were obtained in hundreds of mammography and clinical facilities throughout the United States, including community health centers, health department clinics, private practitioners' offices, university based facilities, and mobile mammography units. Our analysis included rates of mammograms with abnormal findings (reported according to the categories of the American College of Radiology Breast Imaging Reporting and Data System), breast cancer detection rates, numbers of diagnostic procedures performed, stage and size distribution of breast cancers, and positive predictive value of mammograms and biopsies with abnormal findings--all presented according to screening round and 10-year age intervals. RESULTS: Mammograms with abnormal findings constituted 5% of mammograms in the first round and 4% in subsequent rounds, both proportions declining by approximately one third from the youngest (40-49 years) to the oldest (70 years and older) age group. Breast cancer detection rates per 1000 mammographic examinations were 5.1 for the first round and 2.0 for subsequent rounds; from the youngest to the oldest age group, the first-round rates doubled and the subsequent-round rates tripled. Early-stage cancers accounted for 54% of first-round cancers and 81% of subsequent-round cancers. Percentage of invasive cancers at least 2 cm in size declined from 51% in the first round to 33% in subsequent rounds: however, we found little change in the proportion of lesions smaller than 1 cm. Positive predictive values declined from 9.5 cancers per 100 mammograms with abnormal findings in the first round to 5.6 cancers per 100 mammograms with abnormal findings in the subsequent rounds. CONCLUSION: A large nationwide breast cancer early detection program conducted through hundreds of diverse facilities has provided results that, although not a statistically representative sample of mammography services, are probably the best available characterization of the current state of breast cancer screening practices as they actually occur in the 1990s in the United States. These results should be useful to clinicians, researchers, and public health personnel in counseling patients, planning new studies, and improving efforts to control breast cancer.

Adult↗
PubMed1999

Significance of follow-up mammography in estimating the effect of tamoxifen in breast cancer patients who have undergone surgery.

OBJECTIVE: We evaluated mammographic changes to assess the effect of tamoxifen in breast cancer patients who had undergone surgery. MATERIALS AND METHODS: We reviewed the mammograms of 102 breast cancer patients treated with tamoxifen (20 mg per day); these patients were subgrouped into tamoxifen-only patients and patients treated with tamoxifen in combination with another therapy (chemotherapy, radiotherapy, or both). The control group was made up of 50 breast cancer patients who did not undergo tamoxifen therapy and 20 healthy women who had an age distribution and menstruation status similar to those of the breast cancer patients. Two radiologists evaluated parenchymal patterns on mammograms of the contralateral breast in the breast cancer patients and of the left breast in the healthy women. Parenchymal changes before and after surgery were also analyzed. RESULTS: Follow-up mammography showed decreased breast parenchyma in 59.8% of the tamoxifen group, 87.0% of the premenopausal tamoxifen-treated women, 36.0% of the nontamoxifen patients, and 10.0% of the healthy women. CONCLUSION: On follow-up mammography of breast cancer patients, breast parenchyma was shown to be decreased after tamoxifen therapy. Mammography can be a useful method for evaluating breast parenchymal changes after tamoxifen treatment.

Antineoplastic Agents, Hormonal↗
PubMed2000

Effect of obesity on screening mammography: outcomes analysis of 88,346 consecutive examinations.

OBJECTIVE: We determined differences in the rates of recall, biopsy, and cancer detection for screening mammography as a function of adiposity. MATERIALS AND METHODS: Eighty-eight thousand three hundred forty-six consecutive screening mammography examinations were performed from April 1985 to August 1997. Patient weights were normalized to ideal weight correcting for height and were subdivided into adiposity cohorts including underweight by greater than 10%; ideal weight +/- 10%; overweight by 11-24%; overweight by 25-39%; and overweight by greater than 40%. The rates of recall, biopsy, cancer detection, and cancer stage were calculated and were analyzed using the chi-square test for trend. Cancer size was analyzed using linear regression analysis. RESULTS: Reliable (p < 0.05) and meaningful differences were seen between cohorts of increasing adiposity for rates of recall, biopsy, and cancer detection. An increase in recall rate occurred with progressively increasing adiposity (3.88%, 4.89%, 5.11%, 5.47%, 5.55% [p < 0.0001]). The rate of biopsy also increased with increasing adiposity (0.98%, 1.31%, 1.35%, 1.59%, 1.65% [p < 0.0002]), as did the rate of screening-detected cancer (number of cases of cancer per 1000 women screened) (3.74, 4.29, 5.34, 4.70, 6.04 [p < 0.015]). Finally, increased adiposity also correlated with increased median cancer size (p < 0.02) and with more advanced stage at diagnosis (p = 0.046). CONCLUSION: Increasing adiposity correlates with progressive increases in the rates of recall, biopsy, and cancer detection for women undergoing screening mammography. Increasing adiposity also correlates with increased cancer size and stage, providing further support for obesity as a risk factor for breast cancer.

Biopsy, Needle↗
PubMed2000

Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging.

OBJECTIVE: When multiple bilateral partially circumscribed masses having a similar appearance are detected on screening mammography, some radiologists recommend recall examination to identify imaging features suggestive of malignancy that are not evident on standard screening views. This study assesses the need for such recall imaging. SUBJECTS AND METHODS: Cases of multiple masses were identified by reviewing the mammographic reports of 84,615 consecutive screening examinations. Each case of multiple masses was prospectively interpreted as benign, with recommendations for follow-up mammography in 1 year and for aspiration of any palpable masses if clinically indicated. Subsequently diagnosed cancers were identified through data linkage with our regional tumor registry and through our institution's computer-based outcomes tracking system. RESULTS: Among 84,615 consecutive screening examinations, we identified 1440 (1.7%) cases of multiple masses. Among the multiple-masses cohort, two interval cancers were found. Both were early-stage (T1bN0M0; T1cN0M0) and low-grade (histologic grade 1) cancers. The interval cancer rate among the multiple-masses cohort was 0.14%, which is somewhat lower than the age-matched United States incident cancer rate of 0.24%. CONCLUSION: The frequency of cancer development and the stage at cancer diagnosis among nonrecalled cases of multiple masses are similar to those observed in the general screening mammography population. Therefore, recall imaging for women with multiple masses does not appear to be justified.

Aged↗
PubMed2003

Sydney Breast Imaging Accuracy Study: Comparative sensitivity and specificity of mammography and sonography in young women with symptoms.

OBJECTIVE: We examined the age-specific sensitivity and specificity of mammography and sonography in symptomatic women to determine the age below which sonography may be the more accurate imaging test, which may guide the choice of initial breast imaging examination based on the woman's age. MATERIALS AND METHODS: Four hundred eighty subjects were sampled from all women consecutively attending a symptomatic breast clinic between 1994 and 1996 and ranging in age from 25 to 55 years. We included all 240 women shown to have breast cancer (thus avoiding selection bias) and 240 age-matched women shown not to have cancer. Mammograms and sonograms were prospectively interpreted independently and without knowledge of age by two radiologists in a blinded manner, with a third radiologist arbitrating disagreements. Sensitivity and specificity of each imaging test in relation to age were examined using logistic regression modeling, and accuracy was compared using the chi-square test for paired proportions. RESULTS: Sensitivity and specificity of each test were not linearly associated with age; however, the sensitivity of mammography increased substantially in women older than 50 years. Sonographic sensitivity of 81.7% was not significantly greater than mammographic sensitivity of 75.8% (chi(2)(1) = 2.06, p = 0.15). However, in women 45 years old or younger, the sensitivity of sonography was 13.2% (95% confidence interval, 2.1-24.3%) greater than that of mammography. The specificity of both tests was approximately 88.0%. CONCLUSION: These data show that sonography is the more accurate imaging test in women 45 years old or younger who present with breast symptoms and may be an appropriate initial imaging examination.

Adult↗
PubMed2003

Stereotactic core needle biopsy of nonpalpable breast lesions using a conventional mammography unit with an add-on device.

OBJECTIVE: The purpose of this prospective study was to assess the accuracy of an add-on stereotactic unit for core needle biopsy of mammographic lesions. SUBJECTS AND METHODS. Between September 1994 and February 2001, 506 stereotactic core needle biopsies of mammographic lesions in 492 patients were performed in our center on a mammography unit with add-on stereotactic equipment. Of the initial 92 patients, 80 underwent stereotactic core needle biopsy and surgical excision simultaneously. In subsequent cases, surgical biopsy was performed after core biopsy in patients who had malignant or atypical histologic results or discordance between mammographic and pathologic findings. Follow-up mammography was advised for all patients whose core biopsy results were diagnosed as benign lesions. RESULTS: Histologic results for 506 lesions undergoing stereotactic core needle biopsy were as follows: 113 (22.3%) were malignant; 369 (72.9%), benign; and 24 (4.7%), atypical. Of 113 malignant lesions identified at stereotactic core needle biopsy, 111 were confirmed as malignant, whereas two showed no evidence of malignancy at surgical excision. Of 369 lesions diagnosed as benign at stereotactic core needle biopsy, 172 (46.6%) showed no change on follow-up mammography, 114 (30.9%) were lost to follow-up, and 83 (22%) underwent surgical excision. Of 24 lesions with atypical histology, 23 had surgical follow-up, six were malignant, nine were benign, and eight were confirmed as showing atypical histology. Stereotactic core needle biopsy of the 506 lesions was complicated by five (1.0%) cases of vasovagal attack and four (0.8%) cases of bleeding. The resulting sensitivity, specificity, and positive and negative predictive values were 98.3%, 93.0%, 86.0%, and 99.2% respectively. CONCLUSION: Biopsy with an add-on unit is safe, reliable, accurate, and cost-effective with results comparable to those reported for dedicated prone biopsy devices.

Adult↗
PubMed2005

Relaxation techniques for reducing pain and anxiety during screening mammography.

OBJECTIVE: The purpose of this study was to determine whether listening to a relaxation audiotape before and during mammography decreases subjective reports of pain and anxiety. CONCLUSION: Listening to a relaxation or music audiotape before and during mammography does not reduce subjective reports of anxiety or pain. Women undergoing screening mammography report minimal levels of distress.

Anxiety↗
PubMed2005

Screening mammography reduces morbidity of breast cancer treatment.

OBJECTIVE: This commentary discusses the retrospective cohort study by Barth et al. studying the effect of screening mammography on morbidity of breast cancer treatment. CONCLUSION: Barth et al. found that cancers identified at screening mammography (versus those detected by physical examination) were smaller and more frequently node-negative. Hence, the former group of breast cancer patients was more likely to be treated with less morbid therapy. This evidence-based study contributes to the clinical practice of screening mammography.

Adult↗
PubMed1994

The general mammography screening program in Stockholm. Organisation and first-round results.

This presentation describes the organization and first-round results of the Stockholm mass mammography screening program, and discusses ways of checking the quality of an ongoing screening program. The Stockholm mammography screening program started in 1989 at five independent screening units, and comprises more than 150,000 women aged 50 to 69 years. The first round was completed in June 1991. Compliance during the studied period was 70.6%, and the recall rate was 3.0% of the attending women. Breast cancer was diagnosed in 676 women, of whom 90 (13.3%) had a cancer in situ. The cancer prevalence rate was thus 6.3 cancers per 1,000 screened women. Surgery was performed on 925 women, of whom 249 had benign lesions, giving a benign/malignant ratio of 0.37 to 1. Fifty-two per cent of the cancer patients were operated with breast conserving surgery. The median size of the invasive cancers was 12 mm; almost 80% were node-negative. Experience from the first two years of this mass mammography screening program shows that it meets the major quality requirements. One of the main future goals is to maintain the high quality of the program. Another important goal is a further increase in compliance.

Aged↗
PubMed2003

"To see today with the eyes of tomorrow": A history of screening mammography.

Mammography represents an interesting chapter in the history of American medical technology. Throughout much of the 20th century, physicians showed little interesting in using x-rays to help diagnose breast cancer. But beginning in the 1960s, with the growing interest in early detection, the professionalization of radiology and cancer activism, and the increasing allure of visual imagery in medicine, screening mammograms became the centerpiece of efforts to lower mortality from breast cancer. Despite its popularity, however, mammography remains highly controversial as physicians, statisticians and the public have continued to debate its actual clinical value. Mammography well exemplifies how cultural, ideological and political factors influence both the dissemination and evaluation of medical technologies.

Diagnosis↗
PubMed1990

The role of mammography on breast cancer patients in a hospital setting.

From Oct. 1, 1983 to May 31, 1988, 6198 mammograms were taken and 443 mastectomies were performed at the Yonsei University Hospital, Seoul, Korea. Of these, 191 cases had preoperative mammography performed prior to surgery (study group) and 252 cases underwent mastectomies without preoperative mammography (control group). There were no significant differences between the two groups in pathological stages, axillary lymph node metastasis and size of the tumor, suggesting that little benefit is derived from the preoperative mammography in the hospital setting. However, there were a number of other findings, including a 14% incidence of multiple foci and localization of non-palpable cancer in 3% of cases, that could help us to make therapeutic plans and strategies for these patients.

Breast Neoplasms↗
PubMed1998

99mTc MIBI prone scintimammography in patients with suspicious breast cancer: relationship with mammography and tumor size.

99mTc MIBI prone scintimammography (PSM) is reported to be a specific examination in order to assess the nature of breast lesions. Fifty-three patients whose mammography was stratified according to the breast imaging reporting and data system (BI-RADS), the five category classification of mammography approved by the American college of radiology, were studied with prone scintimammography, with the aim of assessing the accuracy of this exam and its usefulness in clinical practice. Thirty-five out of forty-one patients with BI-RADS category V (high probability of cancer) showed cancer at histology. Thirty-one of them had positive PSM. Three out of the six patients with mammo-graphic features of category IV indicated malignancy. PSM was positive in all of them and negative in the three benign lesions. One of the five patients with category III mammography showed cancer and positive PSM. The PSM was negative in 12/13 patients with benign patology (specificity 92.3%). When the cancers were stratified for T-category significant differences were found between the sensitivity for tumors larger or smaller than 1 cm. The sensitivity was 50% for the cancers smaller than 1 cm and 96.9% for those larger than 1 cm. PSM is a very specific method to determine the nature of breast lesions. Its sensitivity is also high but has to be improved when tumors smaller than 1 cm have to be detected. From a clinical point of view PSM can at the moment be considered as an accurate method for the study of borderline lesions of IV and also of III BI-RADS category. In this case a positive PSM indicates an impact in clinical decision making.

Breast Diseases↗
PubMedDate not supplied

Preventive health behaviors and mammography use among urban older women.

A cross-sectional survey of 610 low income women between the ages of 60 and 84 who attended community meal sites in Los Angeles was conducted to determine health behaviors associated with mammography use among urban community dwellers. Preventive practices that require women to take an active role and recurrent participation were positively associated with a current mammography, while services that are clinician-initiated were associated with ever having a mammography.

Aged↗
PubMedDate not supplied

Demographic and health factors associated with mammography utilization.

PURPOSE: The purpose of this study was to determine the frequency of mammography utilization among women in 2002 and to compare it with Healthy People 2010 targets. Relationships between demographic and health factors and utilization were explored. METHODS: This study used data from 93,657 women completing the 2002 Behavioral Risk Factor Surveillance Survey, a population-based telephone survey measuring behavioral risk factors. Relationships between demographic and health factors and mammography utilization were explored by bivariate and logistic regression analyses. RESULTS: Seventy-six percent of women reported having had a mammogram within the past 2 years. Utilization was significantly associated with age; ethnicity; race; education; income; employment; perceived health; health insurance coverage; access to physicians; and receipt of basic, preventive health care services. When controlling for other factors, women who had a personal doctor, had health insurance, had higher incomes, and were older had the greatest odds of having received a mammogram within the past 2 years. CONCLUSIONS: This assessment indicates that, overall, the Healthy People 2010 mammography utilization target is being met. However, though utilization is improving for some at-risk groups, women without health insurance; women without a personal doctor; and women not receiving basic, preventive care fall short of the Healthy People 2010 target.

Adult↗
PubMed1998

[Mammography or ultrasound in the breast cancer diagnosis].

Indications to ultrasound examination and mammography are discussed in this article. Ultrasound is useful in women younger than 35 and mammography on the contrary after this age. As far as screening is concerned obly mammography is a proper tool for recognition.

Adult↗
PubMed1990

Medicare program; Medicare coverage of screening mammography--HCFA. Interim final rule with comment.

This interim final rule implements section 4163 of the Omnibus Budget Reconciliation Act of 1990 (Pub. L. 101-508), which provides limited coverage for screening mammography services. It amends current Medicare regulations to set forth payment limitations and conditions for coverage of screening mammography. The conditions consist of quality standards to assure the safety and accuracy of screening mammography services performed by qualified physicians and other suppliers of these services.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

Medical devices; Mammography Quality Standards Act of 1992; inspection fees--FDA. Notice.

The Food and Drug Administration (FDA) is announcing the fees it will assess for inspections of mammography facilities during fiscal year 1995 (FY 95). The Mammography Quality Standards Act of 1992 (MQSA) requires FDA to assess and collect fees from mammography facilities to cover the costs of annual inspections required by the MQSA. This notice explains which facilities are subject to payment of inspection fees, provides information on the costs included in developing inspection fees, and provides information on the inspection, billing, and collection processes.

Ambulatory Care Facilities↗
PubMed1995

Medicare program; Medicare coverage of screening mammography; correction--HCFA. Correcting amendment.

This document corrects a technical error that appeared in the final regulations published in the Federal Register on September 30, 1994 (59 FR 49826). Those regulations, in part, established conditions for coverage of diagnostic mammography that are similar to those we had established for screening mammography. This correcting amendment restates the applicability of diagnostic mammography to men as well as to women.

Ambulatory Care Facilities↗