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PubMed2001

The role of physicians in mammography referral for older Caribbean women in Canada.

BACKGROUND: Despite the fact that the proportion of immigrant and minority women who consult a general practitioner about their health is similar to that of their Canadian-born counterparts, studies suggest that they are less likely to be screened for breast cancer. This study examines physician characteristics associated with mammography referral and perceived barriers to mammography among family physicians serving the Caribbean community of Toronto. METHODS: The study consisted of a mail-back family physician survey. RESULTS: Among the 64 physicians who responded to the survey, over half reported that they were "very likely" to refer women for mammography during a regular preventive check-up. Among physician variables, only the amount of time spent on patient education was significantly associated with the likelihood of referral. Regarding perceived barriers, for male physicians, patient refusal and intervention causing patient discomfort were significantly associated with referral. For female physicians, only forgetting to provide service was identified as a significant barrier to referral. INTERPRETATION: An increased emphasis on patient education may help to increase screening referral among all physicians. Gender differences in perceived barriers to referral suggest that the gender of the physician is of major importance to the Caribbean community.

Aged↗
PubMed2001

[Conventional or digital mammography].

Digital techniques have been applied in many fields of diagnostic radiology, but they were not accepted in mammography. The technological base of direct digital mammography was the development of CCD-chips. Clinical experiences with this system are promising and may lead to replacement of conventional techniques in the future. With intraindividual correlation studies it was shown that microcalcifications were detected better than with conventional techniques. Patients' dose is equal with both system and the reporting time could be reduced. Moreover, digital mammography is important for the use of software programmes of computer assisted diagnosis (CAD).

Breast Neoplasms↗
PubMed2001

Comparison of image quality indicators among mammography facilities in Ontario.

OBJECTIVE: To compare the technical aspects of image quality of mammography machines in facilities across Ontario. METHODS: Eight mammographic physics consultants took measurements and calculated accreditation phantom scores, mean glandular dose, entrance exposure, average optical density, half value layer and the limiting resolution of the imaging chain for 100 mammography machines across Ontario. RESULTS: Of the 100 machines, 39 were affiliated with the Ontario Breast Screening Program (OBSP), and the remaining 61 were applying to become OBSP affiliates. All of the OBSP facilities and 32 of the applicants were accredited with the Mammography Accreditation Program (MAP) of the Canadian Association of Radiologists (CAR). All OBSP facilities had passing phantom scores, and 84% of the applicants with CAR accreditation and 79% of those without had passing phantom scores. The mean glandular dose was 1.5 (range 1.0-1.9, standard deviation [SD] 0.22) mGy for OBSP facilities, 1.3 (0.8-1.8, SD 0.29) mGy for CAR accredited and 1.4 (0.9-1.9, SD 0.24) mGy for nonaccredited applicants. Mean entrance exposures were 798 (540-1280, SD 135) mR, 717 (430-980, SD 153) mR and 770 (520-930, SD 116) mR for the OBSP, accredited and nonaccredited facilities respectively. There were no appreciable differences in the mean optical densities (approx. 1.62 OD), mean half-value layers (approx. 0.34 mm Al) or mean resolutions measured with the large focal spot (nominal size of 0.3 mm) either parallel (approx. 16 line pairs/mm) or perpendicular (approx. 14 line pairs/mm) to the cathode-anode axis of the x-ray tube, among the 3 types of facilities. CONCLUSION: Image quality is increased and variability is decreased in facilities participating in a province-wide screening program.

Accreditation↗
PubMed2001

[Mortality of breast cancer and frequency of mammography in Hungary].

The Hungarian breast cancer mortality is above the European average. Because of the lack of effective primary prevention, the control has to be based on the improving results of treatment which is much more successful in the case of early detected cancers. Beyond the patients collaboration and the application of the recommended diagnostic protocols, the population based screening programs have high importance in achieving earlier diagnosis. This study aimed to describe the regional differences of mammography's application as an indicator of diagnostic and screening performance. The records of the outpatient services' reports containing the code for native X-ray examination of the breast were analysed in the period of 01/07/1998 to 30/04/2000. The age specific and the age standardised relative frequencies of mammographical examination were determined for the Hungarian counties and Budapest. The observed age specific frequency of mammography for the whole country was 17, 21, 11 and 4% for the age group of 40-49, 50-59, 60-69 and 70-74 years, respectively. The lowest observed values were 10 times smaller than the highest ones in every studied age group. The age standardised relative frequency of mammographical examination was higher than the national average in Tolna (2.52), Borsod-Abaúj-Zemplén (1.48), Zala (1.41), Baranya (1.33), and Csongrád (1.27) counties and in Budapest (1.35). The described data demonstrates that the Hungarian practice of mammography is far from acceptable considering the frequency of application. On the other hand, it was also explored that serious geographical differences exist within the country. It seems that there are providers that can achieve relative successes in diagnosing the breast cancers in as early stage as it is possible. The evaluation and utilisation of the experiences of these providers could increase the efficacy of interventions organised to improve the Hungarian epidemiological status of breast cancer.

Adult↗
PubMed1975

The assets and liabilities of mammography.

Anyone using mammography should perform it seriously with one or two radiologists in any group as the primary physicians. It is only by being exposed to a high patient volume day after day and having a thorough knowledge of all the pathologic conditions that one can truly appreciate the subtle mammographic patterns present. In only this way is the diligent radiologist optimally helpful to the surgeon and pathologist, and this best serves patient welfare. Conversely, the part-time mammographer, although not necessarily besmirching his professional competence, will tend to give the examination a bad reputation by unnecessary hedges and reporting uncertainties characterized by long winded reports. Patients undergoing mammography should undergo a physical examination by the radiologist. Thus, accuracy rates for the detection of cancer can approach, 98 per cent. Liabilities consequent to mammography can be minimized by the professional competence of the radiologist, understanding the limitations of the examination and the expertise of the reporting style.

Breast Diseases↗
PubMed2002

Disparities in adherence to recommended followup on screening mammography: interaction of sociodemographic factors.

OBJECTIVE: The objective of this study was to examine disparities in adherence to screening mammography and, specifically, to investigate whether race/ethnicity, education, age, health insurance, and family history of breast cancer (FHBC), as unique factors and in interactions, influence adherence to recommended follow up on screening mammography. DESIGN: The study involved retrieval and analyses of data collected by the Colorado Mammography Project (CMAP) for 167,232 diverse (82.8% White, 3.4% Black, 11% Hispanic, 1.6% Asian, 0.6% Native American, and 0.6% "other") screening participants during the 1990-1997 study period. METHODS: Subjects' first mammograms captured by CMAP were tracked in the database to identify women who received follow-up recommendations, women who adhered within 12 months and those that did not. Analyses included comparisons of adherence rates among women with various sociodemographic characteristics. RESULTS: Of the 17,358 women who received follow-up recommendations, 80.7% adhered. Overall, non-White women in each of the racial/ethnic groups were less likely to adhere to recommendations than were White women (P<.05). Also less likely to adhere were the younger, less educated, uninsured/underinsured, and women who reported not having FHBC. CONCLUSION: Race/ethnicity appeared to interact with age, education, health insurance, and FHBC to influence the probability of adherence, suggesting the need to explore further cultural, psychosocial, and situational factors.

Adult↗
PubMed2002

Digital mammography.

Digital mammography, using novel detector technology, has been shown to be at least as sensitive as screen-film mammography for detecting early breast cancer. However, there are barriers to overcome, particularly in soft-copy display, workstation design, and equipment cost. These problems are actively being addressed and are solvable, eventually allowing digital mammography to assume a "prime time" role.

Breast Neoplasms↗
PubMed2001

Mammography rescreening among older California women.

This is the first study to focus on Medicare mammography rescreening using a relatively large population of older women over a long followup period. To assess correlates of regular mammography, we followed all women age 65 or over enrolled continuously in Medicare fee-for-service (FFS) (n = 515,746) over a 7-year period. Data were drawn from the CMS claims data for the period 1992-1998. Irregular mammography intervals were more commonly found among vulnerable Medicare subpopulations--women who were older, minority, living in low income and lower education areas, and who were enrolled in both Medicare and Medicaid. Health care providers must communicate clearly to older women the breast cancer rescreening message: Not just once, but for a lifetime.

Aged↗
PubMed2002

Privacy or life: how do women find out about screening mammography services?

AIM: This study investigated how women found out about the Waikato pilot breast cancer screening programme and what influenced them to participate. METHODS: A sample of 1085 women who had undergone screening mammography were sent survey questionnaires in 1999 to investigate how they had found out about the programme and what had influenced them to participate. Data from 599 completed questionnaires were analysed. RESULTS: The most common external sources of information about the availability of screening mammography were: letters of invitation (42%), family doctors (42%), television (32%), and newspapers (27%). The most important external sources of influence for attending screening were: letter of invitation (28%), and knowing someone with breast cancer (27%). CONCLUSIONS: Letters of invitation from the programme provide an important source of influence for attending screening mammography clinics. Up-to-date databases are needed to ensure that women receive information from the screening programme. There was an inconsistency between the government policy to provide a population-based screening programme and the operation of the Privacy Act 1993, which prevents use of other sources of information to update addresses for population groups most likely to benefit from screening. The high gone, no address rate reduced ongoing screening among women who depend on receiving regular recall notices.

Breast Neoplasms↗
PubMed2003

[What kind of information do German health information pamphlets provide on mammography screening?].

To make an informed decision on participation in mammography screening, women have to be educated about all the risks and benefits of the procedure in a manner that is detailed and understandable. But an analysis of 27 German health pamphlets on mammography screening shows that many relevant pieces of information about the benefits, the risks, and especially the meaning of screening results are only insufficiently communicated. Many statements were presented narratively rather than as precise statistics. Depending on content, 17 to 62% of the quantifiable statements were actually given as numerical data. To provide comprehensive information and to avoid misunderstandings, it is necessary to supplement the currently available health pamphlets and make the information on mammography screening more precise.

Breast Neoplasms↗
PubMed2002

[Mammography -a guidance level and the present situation of mammographic dose-].

Mammography practiced for the detection of breast carcinomas requires an appropriate X-ray equipment which can meet the performance standard. Also it is necessary to meet the requirements for the exposure dose as well as image quality. Factors affecting the exposure dose are X ray equipment, especially target-filter combination, recording systems, compression of breast, structural characteristics of breast and etc. The current guidance for the mammography adopts 3mGy as a dose level for standard breast for a direction which is recommended by IAEA. However, the average glandular dose for the mammography was 1.5mGy according to the image evaluation survey of medical institution as of December, 2001. This figure is almost equal to the result given by the national survey conducted from 1997 to 1998. The exposure reduction depends on the technique of radiological technologists. It is needed for them to optimize affecting factors. When reducing breast thickness by at least 1cm, the exposure does can be reduced by 50%.

Female↗
PubMed2003

[Evaluation of scintimammography as an additional test to conventional mammography in detection of breast cancer].

OBJECTIVES AND DESIGN: Scintimammography using Tc-99m MIBI is becoming established as a second line diagnostic test for the detection of breast cancer in patients with suspected primary disease. Though most published clinical studies compare scintimammography (SMM) with mammography (XMM), in clinical practice they are likely to be used sequentially with the scintimammography following the mammography. MATERIALS AND METHODS: To determine the possible accuracy of such an approach, receiver operator characteristic (ROC) curves were produced for SMM, XMM and a combination of both studies performed over 2 years period on 162 suspicious lesions in 154 patients with no previous history of breast cancer. Each scan was reported in 5 grades: 1-normal or definitely benign; 2-possibly normal or possibly benign; 3-equivoval; 4-probably cancer; 5-definitely cancer. The results have been verified by pathological examination of biopsy material obtained from each suspicious mass. RESULTS: There were 102 malignant breast tumours and 60 non-malignant breast lesions. SMM correctly diagnosed 89 breast cancers, and was false negative in 13 cases. It was true negative in 36 benign breast lesions. The sensitivity of SMM was 87%, specificity 65%, PPV 81% and NPV 75%. XMM diagnosed correctly 70 malignant tumours. The sensitivity, specificity, PPV and NPV for XMM were respectively: 69%, 72%, PPV 81% and NPV 57%. However, if a combination of the two methods is used the overall diagnostic accuracy was as follows: 92%, 80%, 89% and 86%. Evaluation of index area under ROC curve allows in both diagnostic methods XMM and SMM results as follows: 0.79 and 0.83. Additional sequence imaging allows 0.94. Combined XMM and SMM in suspected primary breast cancer patients has higher diagnostic accuracy than each method separately (p < 0.05). CONCLUSION: This study shows that the combination of mammography and scintimammography produces more accurate results than either modality alone this is how these test should be performed in clinical practice.

Adult↗
PubMedDate not supplied

[Mammography].

Mammography is the most important method for the diagnosis and the screening of breast diseases. Sensitivity and accuracy of mammography are very high in the detection of breast cancer. The use of the stereotaxic localization and fine-needle aspiration of nonpalpable breast lesions improve its effectiveness. The American Breast Cancer Detection Demonstration Project (BCDDP) has demonstrated the benefits of breast screening for women over 40 years of age. Many American medical associations and societies have adopted the guidelines based on the BCDDP results, promoting breast cancer screening for these women. However, recently released results of some randomized breast screening studies demonstrated only a 5% reduction in mortality from breast cancer in women 40-49 years of age, and a 40% reduction for women aged over 50 years. There is no explanation for this dilemma at the present time. However, screening mammography should stay available for women over 40 years of age.

Adult↗
PubMed1992

Screening mammography in women over age 65.

Routine screening by mammography and physical examination can detect breast cancers earlier at all ages. In women over age 65 the sensitivity of mammography is increased, and the positive predictive value for mammography is higher than in younger women. There are no direct data that can be used to determine at what age screening is no longer of value. This question must be evaluated on an individual basis and should take into account the quality of life and competing causes of death. The medical benefit from screening for a given individual should be considered separately from society's cost/benefit goal to reduce health care expenditures, because the two are likely to produce contradictory recommendations.

Aged↗
PubMedDate not supplied

Mammography screening: a current controversy.

Breast cancer is the most commonly occurring cancer in women in the United States and the second leading cause of cancer deaths. Over the past several decades, there has been a concerted effort to detect and diagnose breast cancer in women at early stages using mammography, and a simultaneous increase in lawsuits filed against physicians for a delay in the diagnosis of the disease. Even though mammography screening has become a standard of care for middle-aged and older women, recent questions have been raised about the efficacy of breast cancer screening. After carefully reviewing the literature on this subject, I conclude that routine screening mammography in women older than 50 is an effective means of identifying early breast cancers and significantly reduces mortality.

Breast Neoplasms↗
PubMed1992

Attitude or access: reasons for not attending mammography in Northern Ireland.

Maximizing the uptake of mammography among the eligible population will be critical to the success of the national breast cancer screening programme. Although compliance may vary for different reasons from area to area, it has been suggested that making screening clinics more accessible may be an effective means of enhancing uptake. In the present study we undertook 600 interviews with women who had been invited for mammography to determine the main reasons given by women in Northern Ireland for not attending for mammography when invited, how these may have related to access factors and to discover their views on how the service might be improved. The most frequently cited reasons for non-attendance were related to feelings of indifference or ignorance of screening issues and to fear of pain or embarrassment. Although more non-attenders did not have access to private transport, few women (23/600) expressed a preference for more accessible clinics. The fact that non-attenders were more likely not to have had a recent cervical smear, adds weight to the notion that attitudes rather than access played the predominant role in influencing uptake in this sample. We have concluded that investment in flexible mobile screening units cannot replace the continued need for delivering effective advocacy to eligible women.

Breast Neoplasms↗
PubMed1992

[Mammography and echography in the study of breast prosthesis].

Between October 1990 and December 1991, the authors studied 58 women with breast implants (46 monolateral and 12 bilateral prostheses) by means of clinical examination, mammography, and US. The patients' age ranged 31-56 years (mean: 32). Thirty women had undergone subpectoral implantation, 22 subcutaneous and 18 retroglandular. In the group of subpectoral prostheses, 4 women had periprosthetic fibrosis and 3 presented benign calcifications; in 1 case both fibrosis and calcifications were observed. In the depiction of retroglandular implants, US appeared to be very useful: indeed, it detected 3 fibroadenomas and 5 cysts that had been missed at mammography. The only 2 breast carcinoma recurrences (1 non-palpable lesion, confirmed at surgery) were observed in patients with retrocutaneous prostheses. Both mammography and US currently play a major role in the follow-up of women with breast implants. Benign complications and breast cancers can be promptly detected even in patients with no palpable findings.

Adult↗
PubMedDate not supplied

New CR system with pixel size of 50 microm for digital mammography: physical imaging properties and detection of subtle microcalcifications.

PURPOSE: To investigate the physical imaging properties and detection of simulated microcalcifications of a new computed radiography (CR) system with a pixel size of 50 microm for digital mammography. MATERIALS AND METHODS: New and conventional CR were employed in this study. The new CR system included a high-resolution imaging plate coupled with the FCR5000MA (50 microm pixel pitch) including transparent support and a dual-sided reader. The conventional CR system was coupled with the FCR9000 (100 microm pixel pitch). Modulation transfer functions (MTFs) and Wiener spectra (WS) of the new and conventional CR systems were measured. Observer performance tests were conducted to compare the effects of pixel size (50 microm vs. 100 microm) on the diagnostic accuracy of CR systems in the detection of simulated microcalcifications. RESULTS: The presampling MTF of the new CR system was higher at high frequencies than the conventional CR system. The WS of the new CR system was comparable to that of the conventional CR system at all frequencies. The area under the receiver operating characteristic (ROC) curve (Az) obtained with the new CR and the conventional CR systems were 0.84 and 0.79, respectively. Results showed that the detection of simulated clustered microcalcifications was significantly improved by use of the new CR system compared with the conventional CR system (p<0.05). CONCLUSION: The new CR mammography system improved physical imaging properties and detection of simulated microcalcifications over conventional CR mammography.

Animals↗