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PubMed1991

Enhancing early breast cancer screening: an expanded role for mammography facilities is needed.

Registered mammography facilities in Connecticut were surveyed in 1988 to determine the capacity and scope of services provided to women. A total of 112 responses were analyzed. Early cancer screening service other than mammography are not routinely provided. Less than 50% of facilities offer instruction on breast self-exams or provide physical breast examinations in conjunction with mammograms. Only one in three facilities have mechanisms in place to notify women of their need for periodic screening. We conclude that efforts to expand the scope of screening services offered by mammography facilities may enhance our capacity to detect early breast cancer in women.

Breast Neoplasms↗
PubMed1991

Ultrasonography of breast lesions detected in mammography screening.

Mammography screening was carried out in 18,012 women (aged 50-59) of whom 579 (3.21%) had to be recalled for clinical mammography. After completion of the clinical mammography each woman also had ultrasonography (US) with a hand-held real-time apparatus using a 7.5 MHz probe. There were 79 verified breast cancers; 32 of these were palpable and were also depicted at US, but only 29 (61.7%) of non-palpable breast cancers (n = 47) were found at US. Twenty-two of the non-palpable breast cancers were seen at US as a tumor-like lesion, 2 because of local echo-architecture distortion, and 5 only because of acoustic shadowing. The US image did not help to differentiate between malignant and benign lesions.

Breast Neoplasms↗
PubMed1990

Breast screening compliance following a statewide low-cost mammography project.

Public health educational campaigns can attract large numbers of one-time participants, but the impact on subsequent behavior remains unstudied. The American Cancer Society Texas Division, Inc. sponsored a statewide $50.00 mammography screening project in early 1987. More than 64,000 mammograms were completed at 306 centers; 37,000 screenees answered a 31-item questionnaire. Attitudes toward screening were assessed, and screening history was recorded. Eighteen months after the project, a follow-up questionnaire was sent to 1000 screenees; 411 women returned the questionnaires. In the year following the project, 51% of the women 50 years and older reported having a subsequent mammogram. Among the women in this group who had never had a mammogram prior to 1987, 42% had screening mammography repeated in the following year. These data show that media-based public education projects can be effective mechanisms for improving and maintaining compliance with mammography screening recommendations.

Adult↗
PubMed1990

[Breast biopsy of nonpalpable lesions after mammography-guided wire localization].

Mammography is used increasingly for diagnosis and screening. Its advantage is its ability to discover very small and often nonpalpable mammary lesions. While its sensitivity in detecting pathological changes in the breast is high, differentiation between benign and malignant lesions is less precise, so biopsy is necessary. To ensure removal of the entire lesion with minimal damage to breast tissue, precise localization is mandatory. The accepted technique is the needle-wire method. 39 of 167 biopsies guided by mammography performed during 3 years for nonpalpable lesions detected by mammography were malignant. In 24 of them the histological diagnosis was atypical epithelial proliferation, considered a transition to carcinoma.

Biopsy↗
PubMed1990

The role of mammography in women under 30.

The authors report on a consecutive series of 305 women under age 30 undergoing mammography because of a solid palpable mass. The presence of diffuse parenchymal density impairing radiologic interpretation was observed in 71% of cases. Cancer was not demonstrated at mammography in 5 of 18 cases. Radiologic suspicion did not improve the cumulative sensitivity for cancer and did not influence clinical management in cancer cases. Mammographic contribution in reducing unnecessary biopsies of benign lesions was also poor and parallelled that of aspiration cytology. Mammography is not recommended in the differential diagnosis of palpable masses in women under 30 and should be limited to the preoperative assessment of cases with a strong suspicion of cancer.

Adolescent↗
PubMedDate not supplied

Improving mammography recommendation: a nurse-initiated intervention.

We attempted to improve our compliance with recommendations for screening mammography, according to the American Cancer Society (ACS) guidelines, for eligible women patients seen by family practice residents by using a multipart intervention designed to eliminate identified barriers of knowledge and behavior on the part of the residents. Copies of the ACS cancer screening guidelines were posted in all examination and conference rooms and were provided to all residents. The intervention addressing the behavioral barriers had three components: (1) identification by the nursing staff of eligible women who were overdue for a mammogram as they presented for care, (2) completion of a checklist by residents indicating whether a mammogram was or was not recommended and why, and (3) a nurse-initiated backup reminder system for patients who escaped the primary checklist system. An audit of 200 preintervention and 270 postintervention charts showed statistically and clinically significant increases in mammograms recommended or done. Similar statistically significant increases were found in a cohort of 111 charts of patients in both the pre- and the postintervention audits. Results indicate that an intervention designed to eliminate identified resident-dependent barriers to compliance with screening mammography guidelines can be effective in increasing recommended mammography rates.

Appointments and Schedules↗
PubMed1990

Mammography in Connecticut: current estimates of capacity and usage.

All 124 registered mammography facilities in Connecticut were surveyed in 1988 to determine the availability, quality, and usage of mammography services. A total of 112 responses (90% return) were analyzed. By the measures considered here, capacity and quality of mammography in Connecticut is very good to excellent. Services are available in Connecticut in a wide array of locales, times, and settings. Since 1985, 95 new dedicated machines have been put into service. We estimate that current capacity may exceed 400,000 annual studies. Utilization is below current capacity; roughly 155,000 examinations were completed in 1988. Continued recognition of the procedure's effectiveness, particularly in screening women for evidence of early disease, can help reduce the burden of breast cancer.

Connecticut↗
PubMed1989

[Risk-benefit analysis for mass screening of breast cancer utilizing mammography as a screening test].

Incidence of breast cancers in Japanese women is increasing steadily. Mass screening of breast cancer was started in Japan under auspices of Adult Health Promotion Act of the Japanese Government from 1987. As the first screening method, the palpation of breasts is employed at present, but it is expected to be replaced by the mammography. In this report, the risk-benefit analysis is presented between risk of breast carcinogenesis due to radiation and benefit of mass screening of breast cancer. The benefit of mass screening is taken as the net elongation of average life expectancy of women due to survival from breast cancers. The risk of mammography is taken as the net loss of average life expectancy of women due to breast carcinogenesis. In the latter, the latency time and plateau period of radiation carcinogenesis were taken into consideration in the calculation. The results show that the ages at which the benefit and risk become equal are between 30 and 35 years old when dose equivalent of mammography is between 10 and 20 mSv, that are conventionally used. However, the critical age will be reduced to 20 years old if the dose equivalent becomes 1 mSv. Therefore, it is strongly recommended that a low dose mammographic system should be developed in order to achieve 1 mSv for the mass screening of breast cancer of Japanese women. In author's opinion, this is quite feasible by employing a new digital radiography with imaging plate.

Adolescent↗
PubMed1989

Mammography: a critical evaluation of its role in breast cancer screening, especially in developing countries.

Screening for breast cancer using mammography alone, or mammography plus physical examination of the breasts, reduces mortality from breast cancer in women age 50-69. The evidence for effectiveness in older women is less clear. If effective in younger women, benefit is delayed compared to that seen in women age 50 or more. The increasing incidence of breast cancer in developing countries, and the late stage at diagnosis of most disease, supports efforts to introduce screening for breast cancer. However, the requirements of mammography in terms of technology and skilled personnel make it difficult to apply in most developing countries at present. There is a need to evaluate simpler screening tests, such as physical examination of the breasts and breast self-examination, as they can be applied by existing health personnel, and more readily integrated into medical care.

Adult↗
PubMedDate not supplied

Physician compliance with mammography guidelines: a retrospective chart review.

Annual mammography is recommended by the American Cancer Society as an effective technique for the early detection of breast cancer in women aged 50 and older. This paper reports on a study conducted in a large group family practice in an urban academic setting to examine the frequency with which physicians were ordering mammograms for one age-appropriate group of female patients. The charts of a random sample of 88 females over age 55 who had been patients in the practice for at least five years were abstracted for information on mammography and breast examination as well as background clinical history. Within this sample, 56% had no mammograms recorded over the five-year study period, and only 19% had a mammogram within the most recently completed year. The average interval between mammograms over five years for subjects with one or more mammograms was 3.5 years. For 18% of all ordered mammograms the results could not be located in the chart. These findings suggest that family physicians need to improve adherence to recommended guidelines for mammography and to improve documentation of screening activities in the medical record.

Breast Neoplasms↗
PubMed1989

Improving the utilization of screening mammography in primary care practices.

Screening mammography is underutilized in many primary care practices. We designed a prospective, controlled trial to evaluate two strategies for improving the utilization of mammography in an academic general medicine clinic. We assigned teams of house officers to (1) physician audit with periodic feedback, (2) a visit-based strategy directed at both patient and physician, or (3) a no intervention concurrent control arm. After 6 months, the percentage of 50- to 74-year-old women meeting the standard of an annual mammogram was 36% for patients in the control arm, 62% for patients of feedback residents, and 54% for patients of the arm receiving the visit-based strategy. Patients of female providers were slightly more likely to meet the standard, but no effects were detected for patient race, new as opposed to follow-up patient, or higher frequency of clinic visits. We conclude that audit with feedback and a new visit-based strategy of a patient cue associated with a simplification of the ordering process each greatly improved the rate of utilization of screening mammography. Practitioners could reasonably choose the strategy most suited to their own situation.

Aged↗
PubMedDate not supplied

Optical spectroscopy. Pre-mammography marker.

Non-invasive optical spectroscopy consistently delineates compositional and physiologic properties of breast tissues serving as a pre-mammography risk marker for cancer or yielding a high assurance of no such risk. We believe this new non-imaging approach depends on biochemistry of tissues rather than on the macroscopic physical properties involved with most breast imaging modalities. After establishing the procedure as inexpensive, physician independent, simple, requiring only a few minutes and appealing to women, it was carried out in two institutions on 1739 women referred for routine mammography. Of 166 breast biopsies on these women 77 were cancer by histology. An automated computerized analysis of the spectroscopic data yielded a sensitivity of 87 per cent, a specificity of 74 per cent and a negative predictive value of 99 per cent. Optical spectroscopy shows promise in identifying women at a higher risk for developing cancer, cases of non-infiltration carcinomas where dense breasts limit mammographic detection, and even clustered calcifications not associated with a mass. The relative risk of breast cancer was 16.5 times as great with a positive spectroscopic value at a sensitivity range of 87 per cent. Placement of 87 per cent of all breast cancer cases in a subset of 28.7 per cent of all women will yield a population of women in whom mammography will be approximately four times as efficient.

Adult↗
PubMed1988

Transformation of the female breast during compression at mammography with special reference to the importance for localization of a lesion.

The effects of compression during mammography were studied in 187 breasts. The aims of this study were to investigate: 1) How the skin moves, 2) how the gland tissue is transformed, 3) if there is a relationship between outer and inner alterations and 4) the practical implications for aspiration biopsy. In this study, several experiments were carried out to investigate the effects of compression during clinical mammography in adult female breasts. The transformation of the breast during compression was investigated by means of external skin markings and internal markings using the biopsy needle and the hookwire at preoperative localization. The extent of the mammary gland was measured in the different standard projections during mammography. The calculation of the depth of a lesion during cranio-caudal compression was performed on the latero-medial radiographs. The result was checked with water-soluble radiographic contrast medium. The mean value of differences between observed and calculated depth was 3.7 mm. 1. The breast transforms during compression. 2. The biopsy needle in the breast and the barium markings on the skin incline ventrally in 96 per cent during latero-medial compression. The preoperative hookwire inclines ventrally in 92 per cent. 3. The extension of the gland parenchyma (the longest diagonal) is almost equal in all standard projections, including the medio-lateral oblique one. 4. The skin in the inframammary sulcus is firmly attached to the thoracic wall. This form of fixation determines principally the movements of the breast and limits the transformation during compression. 5. The movements of the skin are connected to the movements of the dense tissue, gland parenchyma. There is a connection between the ventral and descending inclination. These inclinations are caused by the same transformation of the breast. 6. Due to the regular movements of the breast during different compression directions, it is possible to predict the location of a lesion in three dimensions from standard mammograms.

Adult↗
PubMed1977

Clinical evaluation of computerized tomographic mammography.

This is an initial report of the first clinical study using computerized tomographic mammography (CTM). A study is being conducted comparing CTM and conventional mammographic techniques in patients who subsequently undergo breast biopsy. This report analyzes the experience with 160 breast lesions found in patients who were examined using CTM without contrast material. One hundred lesions were benign and 60 were malignant. Mammography correctly identified 54 of the malignant lesions while CTM identified 41. Five lesions were missed by both modalities. The report also analyzes results experienced with 79 lesions found in patients who were examined with CTM both before and after the intravenous injection of contrast material. Forty-six of these lesions were benign and 33 were malignant. Mammography correctly identified 28 of the malignant lesions while CTM identified 27. Only one lesion was missed by both modalities. It is planned to continue this study, especially to enlarge our experience with the use of contrast material in breast scanning.

Breast Neoplasms↗
PubMed1987

The role of mammography in the detection of breast cancer.

Attempts to reach a tissue diagnosis of breast masses by the use of X-rays (mammography) proved unsuccessful and, as a consequence, the popularity of the method waned. A more natural and less radical surgical approach to the treatment of breast cancer, coupled with statistical evidence that more favourable results were obtained in early cases (stage I and II) resulted in mammography, which is one of the known methods of detecting early lesions, regaining some of its lost status. Screening programmes of asymptomatic well women by mammography in an attempt to detect early breast lesions has been instituted in many countries and the early results (5 years) have been promising. Newer techniques, including the use of special film screen combinations, microfocus tubes with enlargement techniques and grid carbonfilter cassettes, have all contributed to the improvement in diagnostic accuracy. These advances and the place of mass screening programmes in attempts to control this disease are discussed.

Breast Neoplasms↗
PubMed1988

Is mammography painful? A multicenter patient survey.

Anecdotal reports of pain experienced during mammography have been a source of anxiety and concern for some women considering screening. To determine what asymptomatic women actually experience during mammography, a survey of 1847 women was performed at seven breast-imaging centers. Women recorded their experience on a six-point scale ranging from no discomfort to severe pain. Eighty-eight percent of the women experienced no discomfort (49%) or mild discomfort (39%). Only 9% experienced moderate discomfort; 1%, severe discomfort; and 1%, moderate pain. No woman had pain so severe that it would make her reconsider having a mammogram again. The degree of discomfort was slightly greater in women who complained of breast tenderness within three days prior to the mammogram but was not strongly related to age, menstrual status, or week of the menstrual cycle. We conclude that in a vast majority of women mammography causes no or mild physical discomfort and that actual pain is an uncommon occurrence.

Adult↗
PubMed1988

Mammography and breast implants.

Recent recommendations by the American Cancer Society have focused attention on the value of screening mammography in the detection of occult breast cancers. This has resulted in a proliferation of "walk in" and mobile mammography screening clinics and a barrage of publicity aimed at women aged 40 and over. Among these are more than a half million women who have had an augmentation mammaplasty; at least another half million are still under 40 but entering this age group incrementally. Opinion is divided as to the value of this procedure because of uncertainty as to the amount of breast tissue obscured by the implant. Calibrated planimetry was used to measure the area of the implant and the glandular portion of the breasts in six sets of mammograms. Utilizing solid geometric calculations, it was found that the percentage of glandular tissue obscured by the implant varied from 22 to 83 percent. This wide variation casts serious doubt on the reliability of routine film screen mammography in these patients.

Breast↗
PubMed1988

Correlates of screening mammography in a family practice setting.

The medical records of 243 asymptomatic women aged 50 years or older were reviewed at a community-based family practice center to determine the proportion who had been referred for a screening mammogram and to identify correlates of mammography referral. Patient demographic characteristics, breast cancer risk factors, and characteristics of past patient-physician encounters were considered. Between July 1, 1981, and July 1, 1987, 40 (16 percent) of the women had received a mammography referral from their currently assigned physician. All but two of the women had actually obtained the mammogram. The primary predictors of mammography referral were the known risk factors for breast cancer: a family history of breast cancer (prevalence rate ratio [PRR] = 9.3, P = .001) and a history of benign breast disease (PRR = 7.9, P = .002). Other predictors included having a Papanicolaou test performed by the current physician (PRR = 4.1, P = .03), having a test for stool occult blood returned by the patient (PRR = 10.2, P = .003), having been instructed in smoking cessation by the current physician (PRR = 10.0, P = .05), and, possibly, being a former smoker (PRR = 4.6, P = .09). Patient demographic characteristics, other known breast cancer risk factors (age, obesity, alcohol use, and pregnancy history), and the sex of the physician were not predictive.

Aged↗