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PubMed1987

Evaluating the success of mammography at the local level: how to conduct an audit of your practice.

Mammography is a single radiologic skill with a single goal, detection of a single disease, breast cancer. Periodic self-assessment of mammography interpretations strengthens patient care through allowing comparison with past performances and current national standards and enhancing mammographers' skills through review of proven cases. This article emphasizes five useful audit measurements for the success of a mammography program.

Breast Neoplasms↗
PubMed1979

Cancer of the breast. Mammography and thermography.

Quality mammography with knowledgeable interpretation is now a widely utilized and reliable procedure. It permits clinically occult lesions to be detected and clinically obvious or indeterminate lesions to be managed more intelligently. Abnormal mammographic signs are well defined, as are their differential diagnoses. Thermography of the breast is a younger science than mammography and must mature before its full potential can be realized. It is clear that thermography today cannot be considered an adequate prescreening technique to obviate further examination, as was once anticipated. Used in conjunction with physical examination and mammography it can serve to reinforce suspicions, and the high acceptability of the examination is an impetus to further clarify its role in detection.

Adult↗
PubMed1986

[Additional images and subsequent palpation--indispensable conditions for efficient diagnosis using mammography].

As adjuvant to standard two-view mammography with craniocaudad and oblique projection additional mammographic views are required to definitely establish a diagnosis in about 30% of patients. These are further views of the entire breast in other planes, repetition of standard mammographic projections, special views of parts of the breast and of the axillary region and tangential spot films. In case of nonpalpable mammographic abnormalities additional views help to study the constancy of the findings (superimposition effect?), the diagnostic significance (occult carcinoma?, parenchymal asymmetry?, benign or malignant microcalcification?) and to determine the topographical position of the lesion. Not uncommonly palpatory findings can be picked up mammographically only by special views, often they require further views in other planes for better delineation of the lesion. The important correlation of palpatory and mammographic findings is frequently possibly only with tangential spot films. Only personal physical examination by the mammographist will ensure the appropriate use of additional mammographic views. This concomitant palpation should be carried out immediately before mammography and especially after completion of mammography while viewing the mammographic images. Additional mammographic views make it possible to improve the diagnostic accuracy of numerous malignant and benign lesions of the breast and of the axilla. Conclusive proof of the benignity of a lesion and thus prevention of an unnecessary biopsy is mostly only possible by means of additional special views. This includes superimposition effects, tumorlike asymmetry, lipomas, fibroadenolipomas and oil cysts all of which amount to 12% of all patients in our material.

Breast Neoplasms↗
PubMed1979

Sensitivity of mammography and physical examination of the breast for detecting breast cancer.

Mammography and physical examination of the breast are evaluated as screening instruments for detecting breast cancer based on local biopsy data obtained from women enrolled in a national breast cancer screening program. One hundren thirteen cancers (15.5%) of women who underwent biopsy) were detected. The individual sensitivities of mammography and physical examination for detecting breast cancer are 62% and 24%, respectively. The sensitivity of the two methods combined is 75% (85 of 113). Thirty-seven cancers were in situ or minimally invasive (less than or equal to 1 cm in greatest dimension). Eighty-one percent (30 of 37) of these small cancers were detected by screening, and they comprised 35% (30 of 85) of all cancers detected by mammography, physical examination, or both. Improved survival is anticipated due to this high rate of discovery of small cancers.

Adult↗
PubMed1978

Mammography in the detection, diagnosis and management of carcinoma of the breast.

Mammography is a major advance and essential in the earlier detection, diagnosis and management of carcinoma of the breast and should be more widely applied. Although mammography is at least as important as palpation and the only means of detecting nonpalpable lesions, both examinations are most effective as complementary procedures. A breast operation for suspected carcinoma should never be done without preoperative mammography. Mammographic needle localization and biopsy roentgenography are extremely useful, if not essential, in the surgical management of nonpalpable lesions.

Adult↗
PubMed1983

[The consistency of thermographic findings in the breast (with a proposal for lowering the radiation load in repeated mammographies)].

Thermography is a valuable complementary method in breast examination, but is not a suitable screening method. However, the results of control investigations in 200 females who were reexamined after at least two years, showed no change in the thermographic pattern in 87.5% of the women. In 10.5% the change in thermogram was due to pathological changes, whilst no explanation could be found in only 2% of cases. This high stability rate of the thermograms permits an alternative procedure: If, one year after a basic examination which includes clinical investigation, mammography and thermography, the thermographic pattern is identical with the first, no mammography is necessary. On the occasion of the next control, mammography should be carried out again at the time of the subsequent control examination. This schedule permits a reduction in irradiation without reducing the security of diagnosis.

Adult↗
PubMed1984

The risk of developing breast cancer in relation to mammography findings.

Several studies have shown that it is possible to use the parenchymal patterns disclosed by mammography to differentiate various groups with a high risk of developing breast cancer. Accordingly, a patient series of 597 women who had undergone mammography during the period 1971-1975 was examined and classified according to Wolfe's system. A follow-up of 513 patients five to nine years after the mammography revealed no statistical difference in the tendency to develop breast cancer using Wolfe's parenchymal pattern method. The study shows that those in the group with pronounced fibroadenomatous changes, which were primarily studies radiologically, have an incidence of breast cancer three times as high as that found in the population as a whole.

Adult↗
PubMed1983

Use and abuse of mammography in the early diagnosis of breast cancer.

In the 8 years before 1980, 3958 women were examined in the St. Michael's Hospital breast clinic in Toronto. Of 302 women with breast cancer, 87 (29%) had normal mammograms. Breast cancer was found in 34 after at least one clinical and mammographic examination had given normal results. Of these, 6 (18%) cancers were detected only by mammography while, paradoxically, 23 (68%) were detected only by clinical examination. Normal mammograms are significantly (p less than 0.001) more frequent in young women with breast cancer and in those with small palpable breast cancers. Mammography is most productive when used as a routine study in older women who have clinically normal breasts. All women should start having them around the age of 40 to 45 years. How often they should be repeated is debatable. There is no evidence that they should be repeated annually. Under 35 years of age mammography for any reason is unrewarding. Biopsy of a breast lump that is solid on aspiration should never be delayed because of a normal mammogram. Biopsy of a radiologically suspicious lesion in the breast should never be delayed because the findings on clinical examination are normal.

Adult↗
PubMed1995

Quality control in mammography.

This article describes the essential elements of an effective quality control program in mammography. Quality Control tests recently updated in the 1994 ACR Mammography Quality Control Manual, such as the darkroom fog and limiting spatial resolution tests, are described in detail. The article goes on to describe some common problems in mammography quality control, including processor sensitometry and image quality problems.

Artifacts↗
PubMed1995

The Mammography Quality Standards Act of 1992. History and philosophy.

The Mammography Quality Standards Act (MQSA) of 1992 established a precedent in the practice of mammography by creating federal quality standards for all parts of the mammography system. Heralded by some as crucial so all US women can reap the full benefits of early detection of breast cancer, MQSA implementation was delegated to the Food and Drug Administration (FDA) on June 2, 1993. In this article the major historical forces that surrounded MQSA's enactment as well as the FDA's philosophy on regulation development, inspections, and compliance under MQSA is summarized.

Female↗
PubMed1995

Mammography: who, when, and why?

Breast cancer screening includes two equally important components: mammography and routine physical examination. Screening mammography reduces breast cancer mortality by about 40% in women over age 50, but its role in younger women remains controversial. In roughly 40% of patients, the mammogram will be the only screening modality that detects a cancer. Mammography only detects about 90% of cancers; it misses 10%. Therefore, a suspicious region detected during a physical examination should never be ignored, even if the mammogram is interpreted as normal.

Breast Neoplasms↗
PubMed1995

Mammography use--Wisconsin, 1980-1993.

In the United States, efforts to reduce mortality from breast cancer focus primarily on secondary prevention (i.e., early detection and treatment). Since 1980, private, public, and voluntary organizations in Wisconsin have promoted screening mammography as a means for reducing the death rate from breast cancer. To assess the effectiveness of these efforts, the Division of Health, Wisconsin Department of Health and Social Services (DOH), analyzed data from annual statewide surveys of mammography providers during 1989-1993 and data about self-reported mammography use from the Behavioral Risk Factor Surveillance System (BRFSS) during 1987-1993. This report summarizes these analyses and trends in the number of mammograms performed annually in Wisconsin during 1980-1993.

Breast Neoplasms↗
PubMed1995

Combined assessment (aspiration cytology and mammography) of clinically suspicious breast masses.

We examined the safety and utility of the combined assessment of aspiration cytology and mammography in 705 women who had clinically suspicious or malignant palpable breast masses. Histological assessment confirmed 176 benign and 529 malignant lesions. There were no incorrect (false positive) diagnoses made in the 176 benign masses when combined assessment was used (specificity 1.0; predictive value 0.86); in isolation, however, there was a false positive cytological diagnosis ('papillary carcinoma') and 3 false positive mammographic diagnoses. Benign disease (false negative) was incorrectly diagnosed by combined assessment in 4 of the 529 malignant masses (sensitivity 0.99; predictive value 0.98): cytological diagnoses were of fat necrosis (2) and benign cells on cytospin (1) and aspiration biopsy (1); mammographic diagnoses were of benign disease (2) and normality (2). Indeterminate ('atypical', 'suspicious') diagnoses were problematic and frequent (overall 223 (31.6%), malignant masses 137 (25.9%), benign masses 86 (48.9%); cytology 117 (16.6%), mammography 141 (20%). Thus, with the combined assessment of mammography and cytology in clinically suspicious breast masses, a decisive diagnosis was made in about two-thirds of cases allowing the safe commencement of therapy; the balance of patients required core or excision biopsy.

Adult↗
PubMed1995

Initial and repeat mammography screening in a low income multi-ethnic population in Los Angeles.

Low income, older, minority women are at high risk for underutilization of screening mammography. One strategy for increasing utilization is to conduct interventions targeting local and state health departments where a majority of these women seek health care. A prerequisite for conducting effective screening programs is to obtain current and accurate information on baseline screening rates to understand the nature and scope of the problem and to plan appropriate intervention strategies. The sample consisted of 3240 women who were 50+ years of age from 2 hospitals and 2 comprehensive health centers operated by the Los Angeles County Department of Health Services. Reviews of medical records indicated that only 21% of the sample had received a mammogram in the 12 months prior to the clinic visit on which they were sampled and 23% of the sample received a mammogram in the following 9 months. Approximately 5% of the total sample received a repeat mammogram in the 21-month period over which they were tracked. Prospective independent predictors of screening were age, number of visits to primary care clinics, number of visits to specialty care clinics, and history of breast abnormalities. The results underscore the importance of implementing programs to increase mammography implementing programs to increase mammography screening within public facilities serving low income multiethnic women. An important finding is that a large number of older women are seen in specialty clinics, which represents an untapped resource for increasing screening in this population. Innovative interventions targeting such specialty clinics could substantially contribute to increasing screening rates. A comprehensive approach targeting system, physician, and patient barriers is recommended.

Age Factors↗
PubMed1993

Who's monitoring the quality of mammograms? The Mammography Quality Standards Act of 1992 could finally provide the answer.

Breast cancer remains a leading cause of death among American women, yet little is known about its etiology and prevention. Screening mammography is currently the best preventative measure available to women, but comprehensive oversight of this procedure is necessary in order to minimize and, ultimately, eliminate "errors" that compromise quality and accuracy and give too many women a false sense of security. This Note describes our nation's battle against breast cancer, emphasizes the need for uniform, mandatory quality and safety standards for screening mammography, and outlines The Mammography Quality Standards Act of 1992, which seeks to provide the framework necessary to implement such standards and restore the preventative power of this procedure. This Note analyzes the terms of the Act and concludes that the Act could provide women with the true sense of security that has eluded so many women-too many women-for so long.

Breast Neoplasms↗
PubMedDate not supplied

Exploring environmental barriers to participation in mammography screening in an HMO.

Despite an upward trend in mammography screening rates, rates among some demographic subgroups and rates of annual mammography remain low. Behavioral-based interventions which move beyond invitational strategies to help women overcome their personal barriers may be necessary to increase participation. We developed a heuristic model based on the Health Belief Model and Social Learning Theory with the central hypothesis that the relative importance of environmental barriers in predicting screening behavior is a function of the woman's perceived risk, preventive orientation, and/or concerns about mammography. We completed telephone interviews with 313 women who did not obtain a mammogram and 350 women who had a mammogram within 365 days of an invitation from a Health Maintenance Organization-based breast cancer screening program. Results of multivariate analyses indicated that perceived risk did not mitigate the influence of logistic inconveniences associated with obtaining a mammogram. Preventive orientation as measured by smoking status interacted with belief that symptoms are a necessary prerequisite to a mammogram as a powerful predictor of participation; the greatest negative impact of concerns on participation was found among smokers. A similar relationship between concerns and participation, although only marginally significant, was observed among those who perceived it to be difficult to get to the screening center. Implications of the results for development of behavioral interventions and additional research are discussed.

Breast Neoplasms↗
PubMed1993

[Physics, dosimetry, and quality control in mammography].

The diagnostic value of mammography, especially in the early diagnosis of breast cancer, is closely related to examination optimization in terms of high-quality images with the lowest possible dose to the organ. Currently, "optimal" beams are produced by X-ray tubes with a Molybdenum anode, their voltage reaching 35 kV, using the K fluorescence line at 17.48 keV and absorption of photons with > 20 keV energy, through Mo filtration. The dose delivered with a mammographic examination is expressed differently in the literature reports on the subject: air exposure, skin exposure, dose at the midplane and mean dose; currently, it is recommended to specify the dose as "average glandular tissue dose", considering beam quality and the ratio between transmissions in perspex and tissues respectively. Threshold values for the average dose to the glandular tissue range 1.8 to 3 mGy with a grid and 0.9 to 1.5 mGy without the grid. The high quality standard of mammography requires quality assurance programs including the mammographic unit and the image acquisition and treatment systems. In Italy the "Dose and Quality in Mammography" program is in progress. According to the acceptance quality criteria established in the program and on the basis of the investigation of 272 centers, an acceptable dose-quality ratio was seen in 37.5% of the centers, low quality was found in 24.5%, high dose in 23.7% and high dose plus low quality in 14.1% of the whole of centers.

Breast Neoplasms↗
PubMed1993

Direct digital mammography using a scanned-slot CCD imaging system.

In this paper, the rationale for digital mammography is presented in terms of the limitations of conventional mammography. Various approaches to digital image acquisition are discussed and the design of a scanned-slot digital mammography system currently under development is described. Preliminary results including an image of an anthropomorphic breast phantom are presented.

Equipment Design↗