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PubMed2004

[Mammography-related pain and anxiety].

PURPOSE: To investigate whether informing patients about mammographic compression changed the anxiety and pain that they experience during mammography. MATERIALS AND METHODS: Five hundred and one patients were enrolled in the study. Two hundred and fifty seven (51.3%) were informed before the procedure by written forms explaining the necessity of compression. The remaining 244 (48.7%) didn't get any pre-procedural information. All participants completed demographic form and Spielberger's State Anxiety Inventory while they were waiting for mammography. They marked the level of pain due to compression on a 100-mm visual analog scale (VAS) after the procedure. Chi square, Pearson's correlation and Student's t tests were used for statistical analyses. RESULTS: We didn't find any significant difference between the anxiety scores of the informed (41.4+/-7.9) and uninformed (40.9+/-7.7) women, but the pain level was significantly lower in the informed group (16.5+/-22.4) than in the uninformed group (24.5+/-28.1). There was no statistically significant relationship between the anxiety and pain levels. Women who had recently felt tense and nervous or had a fear of breast cancer diagnosis had higher anxiety levels. CONCLUSION: Our data shows that informing patients about examination decreases the level of pain due to mammographic compression, but does not alter the anxiety level. The main cause of anxiety appears to be the fear of a malignant diagnosis. Any intervention to decrease this fear may increase the compliance rates for screening mammography.

Adult↗
PubMed2004

The role of emotion in mammography screening of African-American women.

Dominant theories that are used to predict health behavior ignore the role played by emotion in peoples decisions to seek preventive health care. This exploratory study describes how the fears of African-American women and their other emotions influence their response to mammography screening interventions. Thirty-seven (N = 37) African-American women in Central and North Texas completed face-to-face interviews and paper and pencil emotion scales. Findings from this study suggest that fear of breast cancer was the predominant emotional theme that emerged. Further findings from this study also suggest that women who had previously had mammograms expressed both stronger negative and positive feelings and emotions than women who had never had mammograms. In addition, women who had never had a mammogram expressed fear of radiation from the mammography equipment, and potential pain related to the procedure, as well as fear of finding out that they might have cancer. Feedback from these African-American study participants suggests that simply to hear a message promoting breast cancer screening is not sufficient to motivate African-American women to seek mammography.

Adult↗
PubMedDate not supplied

Evaluation of a media-based mammography program.

Reports indicate that only 15%-20% of women 50 years of age and older have had a mammogram. To promote screening mammography, the San Diego County Unit of the American Cancer Society sponsored a community-wide program that featured (1) discounted mammograms through participating clinics, (2) program promotion through television news, and (3) availability of a phone bank for obtaining referrals for mammography. Pre- and postintervention random sample phone surveys indicated that women's intentions to obtain a mammogram increased significantly after the media campaign, particularly in those aware of the program. Women's intentions after the media campaign predicted mammography compliance in the following year. A total of 3,102 women received mammograms directly through the program, with a "suspicious finding" rate of 4%. Participant satisfaction with the program was high.

Adult↗
PubMedDate not supplied

CE-Magnetic Resonance Mammography for the evaluation of the contralateral breast in patients with diagnosed breast cancer.

PURPOSE: To evaluate the role of contrast-enhanced Magnetic Resonance Mammography (MRM) in the evaluation of the contralateral breast in patients with recently diagnosed breast cancer. MATERIALS AND METHODS: Fifty patients with proved unilateral breast cancer, with a negative contralateral breast at physical examination, ultrasound and mammography, were studied with a 1.5 T magnet (Siemens, Vision Plus, Germany). A bilateral breast surface coil was used. Dynamic 3D Flash T1-weighted sequences were acquired in the axial plane before and 0, 2, 4, 6 and 8 minutes after the administration of 0.1 mmol/kg of Gd-BOPTA at a flow rate of 2 ml/s followed by 10 ml of saline. The level of suspicion was reported on a scale from 0 to 5 following the BI-RADS classification, based on lesion morphology and kinetic features. The results were compared with the histological findings after biopsy or surgery. RESULTS: Fourteen out of 50 patients (28%) had contralateral lesions identified on MRM. Biopsy was performed in four of them for suspicious lesions (BI-RADS 4) while 10 patients underwent surgery because of highly suggestive malignant lesions (BI-RADS 5). Histology diagnosed three fibroadenomas, 5 ductal carcinomas in situ, 2 lobular carcinomas in situ, 3 invasive ductal carcinomas and 1 invasive lobular carcinoma. Contrast-enhanced MRM yielded no false negative and three false positives. CONCLUSIONS: Our results demonstrate a very good accuracy of Magnetic Resonance Mammography in the detection of synchronous contralateral cancer in patients with newly diagnosed breast cancer. Therefore, contrast-enhanced MRM could be introduced to screen patients with proven breast cancer before they undergo surgery.

Adult↗
PubMedDate not supplied

Screening mammography participation and invitational strategy: the Quebec Breast Cancer Screening Program, 1998-2000.

In the Quebec Breast Cancer Screening Program, a personalized letter signed by a regional program physician is sent to every woman in the province 50 to 69 years of age, inviting her to have a screening mammogram. A reminder letter is also frequently sent. The aim of this study was to evaluate the influence of this screening invitational strategy on rates of participation. The population studied was comprised of 684,028 women in Quebec aged 50-69. The baseline (expected) monthly mammography screening rate was estimated from the rate of screening mammograms recorded between the date a woman became eligible for screening and the mailing date of her personalized invitational letter; the observed monthly mammography screening rate was calculated after the mailing of the letter. Compared to baseline (expected) screening rates, observed rates were substantially increased (p<.05). The ratios of observed to expected rates were respectively 3.05 and 2.23 in the second and fourth months, respectively, after the letter mailing, coinciding with the mailing of the initial and reminder letters. In the twelve months after the mailing, the ratio of observed to expected rates was 1.68 (95% CI: 1.67-1.69). Twelve months following the mailing, 30 percent of the women who were letter recipients had undergone a screening mammography, compared to an expected cumulative probability of 20 percent for women not receiving a letter. The strength of this effect was similar to one seen in randomised controlled trials.

Aged↗
PubMed2006

[Diagnosis of early stage of breast cancer by mammography].

The incidence of small breast carcinoma especially of non-palpable lesion is increasing after introduction of mammography screening. The tumor of which diameter is less than 2 cm, non invasive carcinoma, and Paget's disease are included in early stage of breast cancer. This article introduces the rate of early stage breast cancer in the mammography screening and the feature of these mammographic findings. Furthermore, we are going to reevaluate mammographical findings, occurrence of invasion, and evaluation the size of the lesion by mammography which are thought to be important for the diagnosis of early stage of breast cancer.

Breast Neoplasms↗
PubMed2006

Artifacts in mammography: ways to identify and overcome them.

High-quality mammography images enhance a radiologist's ability to interpret mammograms because they have greater sensitivity and specificity. Artifacts may create pseudo-lesions or mask abnormalities leading to misinterpretation. Familiarity with the numerous artifacts encountered will enable radiologists to provide accurate diagnoses. We reviewed all the artifacts in mammography encountered at our centres and classified the causes of these artifacts into four categories. They are: 1. patient-related; 2. technologist-related; 3. related to the mammographic unit; and 4. related to processing and the processor. Implementation of a well-organised quality control programme will reduce the occurrence of artifacts. Recognition of artifacts in mammography is instructive and will help to improve the mammographic diagnostic quality.

Artifacts↗
PubMed2006

Factors associated with adherence to recommendations for screening mammography among American Indian women in Colorado.

OBJECTIVE: To compare adherence to screening mammography recommendations of American Indian and non-Hispanic White women in the Denver, Colorado, area. DESIGN/SETTING/PARTICIPANTS: This study retrospectively examined adherence patterns in 229 American Indian and 60,197 non-Hispanic White women > or = 40 years and older, with at least one screening mammogram in the Colorado Mammography Project (CMAP), from January 1, 1999, to December 31, 2003. The CMAP was a prospective study of women receiving mammograms at participating clinics around Denver. MAIN OUTCOME MEASURES: Using logistic mixed models, we defined two dependent variables as annual and biennial adherence from the intervals between screening mammograms for each woman. RESULTS: Biennial adherence was substantially higher than annual adherence for both American Indian and non-Hispanic White women in our analyses. American Indian women were less likely than non-Hispanic White women to adhere to biennial recommendations in multivariate models controlling for age, family history of breast cancer, and economic status (zip code): odds ratio (OR) .4 and 95% confidence interval (CI) .2-.6. The association between American Indian race/ethnicity and annual adherence was similar, although not as strong (OR .5, 95% CI .3-.8). CONCLUSIONS: American Indian women in the CMAP cohort were less likely than non-Hispanic White women to adhere to recommendations for screening mammography, both annually and biennially. Additional research is needed to explore the effect of biennial screening and other barriers among American Indian women.

Adult↗
PubMed2006

Digital mammography: an update.

(1) Digital mammography can improve breast-image quality and storage through the digital capture of x-ray images. (2) Large comparative studies indicate that the overall accuracy of full-field digital mammography (FFDM) is similar to that of conventional filmscreen mammography (FSM). (3) Recent evidence suggests that FFDM is more accurate than FSM for diagnosing cancer in women younger than 50 years, those with dense breasts, and pre- or peri-menopausal women. (4) The costs of FFDM are higher than those for FSM. (5) The quality control of FFDM systems offers advantages compared to that of FSM, but it is more complex, and it is associated with a long learning curve.

Breast Neoplasms↗
PubMedDate not supplied

Non-palpable breast lesions in asymptomatic women: diagnostic value of initial ultrasonography and comparison with mammography.

AIM: This prospective double-blind study was designed to assess (i) if primary breast screening by ultrasonography is capable of detecting breast cancer independent of tissue density and (ii) if the rate of unnecessary biopsies remains acceptable when diagnostics are based on ultrasonography. PATIENTS AND METHODS: Bilateral breast ultrasonography was performed in 448 asymptomatic women as the initial diagnostic method. Sonograms were interpreted using a set of standardized diagnostic criteria. Subsequently, mammograms were obtained. The radiologists reading the mammograms were blinded to the sonographic results. RESULTS: Overall, 3 non-palpable breast cancers were detected by ultrasound and mammography. All 3 ultrasonographically detected breast cancers were smaller than 1 cm (0.7, 0.7, 0.6 cm). All 3 carcinomas were correctly detected by both methods. For ultrasonography, the false positive rate was 1.1% (n=5) and for mammography 0.6% (n=3). When both methods were combined, the rate of unnecessary open biopsies was 1.6% (n=7). The ratio of benign to malignant lesions was 3.7/1. CONCLUSION: Without prior mammography, primary high-resolution breast ultrasonography is capable of detecting non-palpable breast carcinomas in asymptomatic women at an early stage. The rate of unnecessary open biopsies is low and the ratio of benign to malignant biopsies acceptable.

Adult↗
PubMedDate not supplied

[Methodological features of magnetic resonance imaging mammography].

By studying 211 females by currently available radiation techniques, such as X-ray study, ultrasonography, and magnetic resonance imaging mammography (MRIM), the authors consider that the specificity of contrast-enhanced MRIM (CE MRIM) is greater than that of MRIM without administering magnetic resonance contrast agents (MRCA). CE MRIM reveals clinically suspicious early-stage breast lesions and defines the stage of a tumorous process, the patients being unexposed to ionizing irradiation. CE MRIM as an auxiliary technique becomes one of the most informative ones, particularly in girls, early reproductive-age females with developed glandular tissue, and pregnant females. In the authors' opinion, the total algorithm of a breast study in this group of patients in specialized medical centers where trained physicians work should differ from the generally accepted algorithm: instead of applying X-ray mammography (XRM) as a basic method of primary diagnosis, ultrasound mammography using Doppler color mapping, followed by MRIM or XRM should be employed.

Adolescent↗
PubMed1992

A screening mammography program. Staying alive and making it work.

The success of a mammography screening program requires thorough planning. A dependably high volume and a streamlined efficient operation are essential to survival of the program. Factors that warrant consideration prior to designing such a program include the following: Distinction between screening and diagnostic mammography examinations. Selection of a site that will meet the needs of the community and yet provide a consistently high volume. Low examination cost for screening mammography coupled with a detailed financial analysis and reappraisal on an ongoing basis. A customized marketing program that incorporates methods to increase awareness, compliance, and utilization by women and referring physicians. Well-trained, efficient, and dedicated personnel. An operation that is designed for rapid throughput and expeditious patient flow. An efficient plan for film handling, interpretation, reporting, and storage. Timely communication of examination results. A reliable mechanism for follow-up evaluation and outcome data collection. Establishment of a consistent and reliable quality assurance program and the production of high quality mammograms.

Advertising↗
PubMed1991

[Film-screen combinations for mammography].

Optimizing and standardizing mammography as well as its quality assurance are gaining in importance with regard to the screening programmes that are being initiated for the early detection of breast cancer. In Germany, the guidelines of the Bundesärztekammer, the directives implementing section 4 and section 16 of the Röntgenverordnung and the standards DIN 6868, Part 7 and 52 are available. The data in these standards concerning tolerances and guide values for physical variables of the imaging system are only partially consistent. This also applies to the comparison with the document "Quality criteria for x-ray exposures in medical diagnostics" of the Commission of the European Communities. The different statements concerning the switch-off value of the dose in particular, reflect an uncertainty as to how unsharpness and noise of the image receptor impair the medical value of the images. With regard to the increased demands for visual resolution capacity, it can be stated that the "Medical quality requirements" and the "Radiographic guide-lines" harmonize with one another only inadequately. Contrast is one of the most important image quality parameters in mammography. Practically no statement is made on this in the available documents. One reason for the present unsatisfactory situation is certainly the especially high demands placed on image quality in mammography. In the present paper, these points of criticism are discussed in detail and proposals for closer specification and better delineation of the physical image quality parameters are submitted.

Breast Neoplasms↗
PubMed1991

Compliance with screening mammography. Survey of primary care physicians.

A survey of primary care physicians in the greater Tampa Bay metropolitan area was conducted to determine compliance with screening mammography and associated physician characteristics. Information requested included their age, sex, specialty, and board certification status, and the ages and frequencies that they recommend screening mammography for their patients. A total of 565 physicians responded. Even though 88% indicated they follow American Cancer Society recommendations when advising screening mammography, only 62% were actually in full compliance. A significantly greater percentage of obstetricians/gynecologists were compliant (74%) compared to other specialties (family practice, 57%, p = .006; internal medicine, 56%, p = .007; general practice, 53%, p = .003). Women physicians were more likely to be compliant than men (83% versus 58%, p less than .001), and younger physicians more likely than older physicians (72% versus 49%, p less than .001). There was no significant difference in compliance rates between board certified and noncertified physicians.

Adult↗
PubMed1991

[Diagnostic errors in mammography. I. False negative results].

The authors evaluate 1455 consecutive breast cancers detected 1985-1987, undergoing mammography 6 months before diagnosis at the most. One hundred and seventy-eight cases reported as negative/benign were assumed as false negatives. Overall sensitivity was 88%, and was influenced by tumor stage (TIS = 80%, T1 = 83%, T2 = 91%, T3-4 = 95%) and patients' age (less than 40 = 76%, 40-49 = 78%, 50-59 = 91%, greater than 59 = 94%). Sensitivity varied also with readers' experience full- or part-time involved in reading mammograms (total cases = 92% vs 88%, T1 cases = 86% vs 74%). No correlations were evidenced between mammographic sensitivity and histologic type of cancer. Palpation and cytology allowed the correct identification of 98% of mammographic false negatives. One hundred and seventy-eight false negatives and 142 more cases showing evidence of a mammographic error more than 6 months before diagnosis were reviewed to assess the most common types of radiologic fault. A benign-like lesion was the most frequent finding (49.4%), whereas suspicious signs were infrequent at review (16.6%). Failure to encompass the lesion in the mammographic field or poor technique accounted for 3.8 or 1.3% of cases, respectively. 29% of false-negative subjects (mostly young or with a dense breast) showed no lesion even at review. This study confirms the good sensitivity of mammography but suggests a less confident diagnostic approach in younger women, stresses the need for other tests whenever a minimal doubt is present, and encourages the radiologist's full-time involvement in mammography and breast diagnosis to achieve greater experience and improve his diagnostic sensitivity.

Adult↗
PubMed1991

The impact of physician compliance on screening mammography for older women.

Screening mammography is underutilized, even for women older than 50 years for whom there is a general consensus that regular annual screening is appropriate and necessary. To evaluate reasons for this underutilization, we studied a random sample of 517 women in Los Angeles, Calif who were older than 50 years. All women were found to be underscreened, especially women older than 65 years. For example, approximately 35% of women 50 to 64 years old and 47% of women aged 65 years and older never had had even one mammogram. Analyses revealed that the most important factor that predicted whether a women ever had had a mammogram was whether her physician had talked to her about mammography. Women were between four and 12 times more likely, depending on their age group, to have had a mammogram at some time if their physicians discussed it with them. The discussions did not need to be lengthy or complex. These results indicate that physicians need to know that discussing screening mammography with their patients has a major impact on breast cancer screening behaviors.

Breast Neoplasms↗
PubMed1991

[Mammography--watch out for false negatives].

Patients with breast tumours should be examined by a combination of physical examination, mammography and fine needle aspiration biopsy. The authors discuss the history of four patients with palpable breast lesions. All of these patients had tumours which had not been discovered by mammography. The diagnosis was delayed 2,11,12 and 12 months respectively. Patients with palpable lesions must not be referred to mammography performed under "screening conditions", but must be examined in a clinical context, preferably by the "triple-test".

Adult↗
PubMed1991

Digital luminescence mammography. Early clinical experience.

In a pilot study, mammography using digital luminescence was compared to conventional film-screen mammography regarding detectability of micro-calcifications and malignant tumors. The data processing algorithms were designed by the manufacturer to produce an image with characteristics close to conventional mammograms. Three observers reviewed 99 digital and their corresponding conventional mammograms. There was no difference in the detectability of micro-calcifications between digital and conventional mammography. On the digital mammograms, however, artifacts were misjudged as micro-calcifications. In an ROC analysis regarding malignant breast tumors, no significant difference was found between the 2 systems. There was a slight, but not significant, difference between the results of different observers regarding the digital system.

Adult↗