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PubMed2000

Role of ultrasonography in the detection of intraductal spread of breast cancer: correlation with pathologic findings, mammography and MR imaging.

The purpose of this study was to assess the role of US in the detection of intraductal spread of breast cancer in comparison with mammography (MMG) and MRI. In 46 patients with breast cancer, US features of the intraductal component were classified as ductal type or distorted type. Histopathologically, 29 of 46 (63%) cases had intraductal components, and the sensitivity, specificity, and accuracy rates in detection of intraductal spread were 89, 76, and 85%, respectively. Each US pattern demonstrated good correspondence to the histologic components, and the distorted type correlated well with comedo-type carcinoma. Mammography was performed in all cases, and the sensitivity, specificity, and accuracy rates in detection of intraductal spread were 55, 100, and 72%, respectively. In comedo type, MMG could diagnose the extent of intraductal spread more accurately compared with US examination. Magnetic resonance imaging comparison was available in 25 cases. Magnetic resonance imaging depicted intraductal extension as an enhanced area during the early phase of a contrast enhancement study with a sensitivity of 93%. Ultrasound and MRI were closely related in terms of morphologic characteristics: the ductal type of US image correlated well with linear enhancement on MRI, whereas the distorted type correlated with regional or segmental enhancement. Current US examination is useful in depicting the intraductal spread of breast cancer; however, US has a tendency to underestimate intraductal component of comedo type compared with MMG and MRI.

Breast↗
PubMed2001

Two cases of metastases to the breast on MR mammography.

We report appearance of two cases of metastases to the breast on MR mammography. Metastasis from cervical cancer displayed a hypointense tumor with a central area of high signal intensity on T2-weighted images and rapid annular enhancement with persistent central contrast enhancement. The metastases from rhabdomyosarcoma were characterized by multiple tumors with high signal intensity on T2-weighted images and fast annular contrast enhancement. We show unusual malignant breast lesions for possible identification in dynamic MR mammography.

Breast Neoplasms↗
PubMed1997

Nonpalpable, well-defined, probably benign breast nodule: management by fine-needle aspiration biopsy and long-interval follow-up mammography.

The management of nonpalpable, well-defined breast nodules by short-interval, 6-month follow-up mammography is widely accepted. We have, however, been managing these type of lesions with fine-needle aspiration biopsy (FNAB), guided by sonography or stereotaxic approach, in order to reduce the number of follow-up mammograms. We recommended surgical biopsy only in cases with malignant or suspicious cytology. Patients with benign cytology or inadequate sample were included in a 12-month-interval mammography surveillance program. In the series we present, two carcinomas were diagnosed among 145 lesions (1.38 %). Both had shown malignancy in FNAB. Another two cases, suspicious of malignancy in FNAB, finally resulted benign in histology. The remaining 141 nodules, monitored for at least 2 years, or surgically removed at the patient's request, have not shown signs of malignancy, regardless of a diagnosis of either benign or inadequate sample in FNAB. Sensitivity and negative predictive value of FNAB have therefore been 100 % in this series. No notable differences were observed between stereotaxic and sonographic guidance, except the percentage of inadequate samples (20.3 % by sonography; 25.9 % by stereotaxic sampling). We conclude that stereotaxic or sonographic FNAB is a very accurate diagnostic method in lesions of this type, allowing long-interval surveillance of the nodules with nonsuspicious cytological results.

Biopsy, Needle↗
PubMed2000

Dosimetric considerations in mammography.

The aim of this study was to measure the absorbed dose to seven organs other than the breast in mammography in order to calculate their contribution to the effective dose. The absorbed dose to these organs was measured using a lucite upper body anthropomorphic phantom containing thermoluminescent dosimeters (TLD) at appropriate locations, exposed as in a mammographic examination. In addition, the dependence of the absorbed dose on kVp, mAs and breast thickness was examined. The absorbed dose due to scattered radiation was found to be negligible to all organs except to the sternum red bone marrow (SRBM) and the thyroid. The mean doses to the SRBM and the thyroid, for a set of four exposures, one craniocaudal and one 90 degrees mediolateral per breast, simulating a complete breast screening examination, varied between 0.40 and 1.27 and 0.05-0.17 microGy mAs(-1), respectively, depending on the breast thickness and the kVp selection. Effective dose from mammography was also calculated based on the absorbed dose to the breast, the SRBM and the thyroid and tissue-weighting factors. The effective dose was found to vary between 0.66 and 0.85 microSv mAs(-1) depending on the breast thickness and the kVp value selected. The radiation dose to the breast contributes over 98% to the effective dose.

Humans↗
PubMed2004

A perceptual evaluation of JPEG 2000 image compression for digital mammography: contrast-detail characteristics.

In this investigation the effect of JPEG 2000 compression on the contrast-detail (CD) characteristics of digital mammography images was studied using an alternative forced choice (AFC) technique. Images of a contrast-detail phantom, acquired using a clinical full-field digital mammography system, were compressed using a commercially available software product (JPEG 2000). Data compression was achieved at ratios of 1:1, 10:1, 20:1, and 30:1 and the images were reviewed by seven observers on a high-resolution display. Psychophysical detection characteristics were first computed by fitting perception data using a maximum-likelihood technique from which CD curves were derived at 50%, 62.5%, and 75% threshold levels. Statistical analysis indicated no significant difference in the perception of mean disk thickness up to 20:1 compression except for disk diameter of 1 mm. All other compression combinations exhibited significant degradation in CD characteristics.

Algorithms↗
PubMed2006

A multisite telemammography system for remote management of screening mammography: an assessment of technical, operational, and clinical issues.

OBJECTIVE: This paper describes a high-quality, multisite telemammography system to enable "almost real-time" remote patient management while the patient remains in the clinic. One goal is to reduce the number of women who would physically need to return to the clinic for additional imaging procedures (termed "recall") to supplement "routine" imaging of screening mammography. MATERIALS AND METHODS: Mammography films from current and prior (when available) examinations are digitized at three remote sites and transmitted along with other pertinent information across low-level communication systems to the central site. Images are automatically cropped, wavelet compressed, and encrypted prior to transmission to the central site. At the central site, radiologists review and rate examinations on a high-resolution workstation that displays the images, computer-assisted detection results, and the technologist's communication. Intersite communication is provided instantly via a messaging "chat" window. RESULTS: The technologists recommended additional procedures at 2.7 times the actual clinical recall rate for the same cases. Using the telemammography system during a series of "off-line" clinically simulated studies, radiologists recommended additional procedures at 1.3 times the actual clinical recall rate. Percent agreement and kappa between the study and actual clinical interpretations were 66.1% and 0.315, respectively. For every physical recall potentially avoided using the telemammography system, approximately one presumed "unnecessary" imaging procedure was recommended. CONCLUSION: Remote patient management can reduce the number of women recalled by as much as 50% without performing an unreasonable number of presumed "unnecessary" procedures.

Ambulatory Care Facilities↗
PubMed2006

The association between the pre-diagnosis mammography screening interval and advanced breast cancer.

BACKGROUND: While screening has been demonstrated to reduce breast cancer mortality, the optimal screening interval is unknown. We designed a study to determine the risk of an advanced breast cancer diagnosis by varying the interval between mammograms. METHODS: We reviewed a single state's mammography records of women diagnosed with breast cancer between 1994 and 2002. The pre-diagnosis screening interval was the number of days between the last two eligible mammograms preceding a cancer diagnosis. The interval was classified as annual (0.75-1.49 years), biennial (1.5-2.49 years) or longer (exceeding 2.49 years). Advanced breast cancer was >or=stage IIB, tumor size >2 cm, or >or=one lymph node with cancer. RESULTS: The probability of an advanced breast cancer diagnosis did not differ between women with an annual pre-diagnosis screening interval and women with a biennial interval (21.1% vs. 23.7%, P=0.262). A longer pre-diagnosis screening interval was weakly associated with advanced breast cancer (21.8% for intervals 0.75-2.49 years vs. 26.8% for longer intervals, P=0.070). In multivariate analysis, we found an interaction between the pre-diagnosis screening interval and age. Among women 50 years or older, the risk of an advanced breast cancer diagnosis risk was higher for women with a pre-diagnosis screening interval exceeding 2.49 years compared to women with shorter screening intervals (OR 1.99 [1.02-3.90]). CONCLUSIONS: We found no difference in advanced breast cancer rates between women using mammography annually or biennially. Among women 50 years or older, the advanced breast cancer rate increased when the pre-diagnosis screening interval exceeded 2.49 years.

Adult↗
PubMed2006

Impact of women's experiences during mammography on adherence to rescreening (United States).

OBJECTIVE: To examine the relationship between womens' experiences during mammography and their likelihood of being rescreened after receiving a negative or benign mammogram. METHODS: Telephone interview and medical record data were collected from a random sample of enrollees from four states in a national screening program targeting uninsured and underinsured women at least 30 months after they had undergone an index mammogram in 1997. We calculated 30-month rescreening rates by prior mammography characteristics including pain and embarrassment, worry, convenience of appointment time, treatment by staff, and financial considerations. RESULTS: Of the 2,000 women in the sampling frame, 1,895 (93.6%) were located, 1,685 (88.6%) were interviewed and 1,680 provided data required for our analysis. Overall, 81.5% of the women had undergone rescreening. More than 90% of the women reported being 'satisfied' or 'very satisfied' with treatment by facility staff, facility location and wait time during the appointment. Statistically significant decreased rescreening rates were seen for women who reported feeling embarrassed and for women reporting dissatisfaction with ability to schedule a convenient appointment time. CONCLUSION: These results suggest that providing additional reassurance and privacy may increase rescreening rates.

Aged↗
PubMed2005

Inadequate follow-up of abnormal screening mammograms: findings from the race differences in screening mammography process study (United States).

OBJECTIVE: Despite relatively high mammography screening rates, there are reports of inadequate follow-up of abnormal results. Our objective was to identify factors associated with inadequate follow-up, and specifically, to determine if this outcome differed by race/ethnicity. METHODS: We studied 176 subjects with abnormal or inconclusive mammograms identified from a prospective cohort study of African-American (n = 635) and White (n = 816) women who underwent screening in five hospital-based facilities in Connecticut, October 1996 through January 1998. Using multivariate logistic regression, we identified independent predictors of inadequate follow-up of an abnormal mammogram. RESULTS: Over 28% of women requiring immediate or short-term follow-up did not receive this care within three months of the recommended return date. African-American race/ethnicity, pain during the mammogram, and lack of a usual provider were significant independent predictors of inadequate follow-up. Although many factors were examined, the observed race difference was unexplained. CONCLUSIONS: While inadequate follow-up of abnormal exams undermines the potential benefits of mammography screening for all women, the observed race difference in this study may have implications for the persistent race difference in breast cancer stage at diagnosis and survival. More research is needed to identify factors that contribute to poor follow-up among African-American women.

Adult↗
PubMed2006

Women's patterns of participation in mammography screening in Denmark.

The objective of the study is to analyse individual women's participation patterns in mammography screening in Denmark. The study is set in the capital of Copenhagen and the county of Fyn representing around 95,000 women aged 50-69. The Central Population Register (CPR) was used to define the total target group, and supply information on migrations and deaths. Invitation and participation data came from the mammography screening programmes in Copenhagen (1991-1999) and Fyn (1993-2001), containing personal identification number, data on invitation date, participation and examination date for each screening round. In Copenhagen the coverage went from 70.5% in the first round to 63.1% in the fourth round, and the equivalent data for Fyn is 84.6% in the first round and 82.8% in the fourth round. Of the women eligible for at least three invitation rounds, 52.6% in Copenhagen and 76.4% in Fyn were faithful users, i.e. had participated in all screenings they were invited to. The conclusion is that the programme participation rates tend to overestimate the protection of the individual women covered by the programme. Behind the urban-rural gradient in programme participation is an even greater gradient in programme protection.

Aged↗
PubMed2006

Efforts to locate low-income women for a study on mammography rescreening: implications for public health practice.

Public health practice often requires locating individuals in the community. This article presents information on the methods and amount of time and effort required to locate over 2300 low-income and minority women in Maryland, New York, Ohio, and Texas for a mammography rescreening study. In 1999, we identified 2528 low-income women who had a mammogram in 1997 funded by the National Breast and Cervical Cancer Early Detection Program. Starting 30 months after that mammogram, we made numerous attempts to locate each woman while recording the number of calls, letters, and tracing attempts used and the date she was found. More than 93% of the women were located. On average, it took 73.8 days (range 1-492 days) and 7.2 calls and letters (range 1-48) to reach each woman. Locating women in racial and ethnic minority groups required more time and effort. About 10% of all located women were found only after our subject tracing protocol was implemented. The percentage of located women increased markedly with more months of effort and additional calls and letters. Because women who were more difficult to locate were less likely to have been rescreened, the mammography rescreening percentages at the end of the study were slightly lower than they would have been had we terminated location efforts after 1-3 months. Locating low-income women in the community is difficult, particularly when obtaining a high response rate from all groups is important. Terminating data collection prematurely may decrease minority group representation and introduce bias.

Aged↗
PubMed1987

Screening mammography: a surgeon's strategy for dealing with abnormal mammographic findings.

Screening mammography is a valuable tool in the detection of breast cancer at an early stage. Large numbers of patients are being referred to surgeons for biopsies on the basis of mammographic abnormalities alone. As mammograms are complex studies and the findings often subtle, variation in terms of interpretation and recommendations for biopsy can leave the surgeon in a difficult position. We have reported a systematic method for evaluating patients and mammograms. Eighty-eight patients were referred to a single surgeon solely for an abnormal mammographic finding. Physical examination was repeated and the mammogram reviewed with a single consulting radiologist using specific criteria to define a mammographic abnormality. Through this evaluation, biopsy was avoided in 42 of 88 patients, with follow-up mammograms and physical examinations finding no suspicion of malignancy. By becoming educated in regard to mammographic abnormalities, establishing specific criteria with a consistent radiologist, and following patients carefully who are not biopsied, the surgeon can deal effectively with screening mammography.

Adult↗
PubMed1994

Screening mammography in British Columbia: 1988-1993.

Breast carcinoma continues to be the most common cause of death due to malignancy for women in Canada. The Screening Mammography Program of British Columbia, the first provincial screening program in Canada, was established in 1988 with funding from the Ministry of Health to diagnose the disease as early as possible. The program has grown rapidly, increasing from 7,100 examinations in a pilot project in 1988 to 89,390 examinations between April 1, 1992 and March 31, 1993 for a cumulative total of 201,937 examinations of 128,325 women, and it now offers free screening mammography throughout the province. The program has maintained quality control standards and low cost per mammogram while developing different operational models for the differing requirements of the various areas of the province. Similar proportions of women older or younger than age 50 have favourable characteristics such as small size of tumor (median: 15 to 16 mm) and negative lymph nodes (86% to 89%).

Breast Neoplasms↗
PubMed1992

Mammography knowledge and intentions among insured women.

UNLABELLED: METHOD. A survey was conducted among 1,113 randomly selected insured state university employees to evaluate knowledge of the American Cancer Society mammography guidelines, awareness of insurance coverage for screening mammograms, previous guideline adherence, and future mammography intentions. RESULTS: The survey, which included two mailings with follow-up phone cells of nonresponders, had a refusal rate of 6%. Respondents were relatively more likely to know the guideline for older age groups; 77% knew the guidelines for women 50+. Over one-third of the responders were not aware that their insurance policy covered screening mammograms. For women who had never had a mammogram, insurance knowledge was significantly related to intentions to have a mammogram in the future. Previous screening adherence, as well as future intentions, was positively related to the age of the respondent. The results are contrasted with those of previous studies, and the implications for the content of future breast cancer screening campaigns are discussed.

Adult↗
PubMed1993

Breast cancer screening with mammography: overview of Swedish randomised trials.

Despite encouraging results from screening trials the efficacy of mammography in reducing mortality remains somewhat controversial. Five studies have been done in Sweden. This overview, based on 282,777 women followed for 5-13 years in randomised trials in Malmö, Kopparberg, Ostergötland, Stockholm, and Gothenburg, reveals a 24% (95% confidence interval 13-34%) significant reduction of breast cancer mortality among those invited to mammography screening compared with those not invited. To avoid the potential risk of differential misclassification causes of death were assessed by an independent end-point committee after a blinded review of all fatal breast cancer cases. The mortality reduction was similar, irrespective of the end-point used for evaluation ("breast cancer as underlying cause of death" or "breast cancer present at death"). There was a consistent risk reduction associated with screening in all studies, although the point estimate of the relative risk for all ages varied non-significantly between 0.68 and 0.84. The cumulative breast cancer mortality by time since randomisation was estimated at 1.3 per 1000 within 6 years in the invited group compared with 1.6 in the control group. The corresponding figures after 9 years are 2.6 and 3.3 and after 12 years 3.9 and 5.1. The largest reduction of breast cancer mortality (29%) was observed among women aged 50-69 at randomisation. Among women 40-49 there was a non-significant 13% reduction. In this younger age group cumulative breast cancer mortality was similar in the invited and control group during the first 8 years of follow-up. After 8 years there was a difference in favour of the invited women. There was no evidence of any detrimental effect of screening in terms of breast cancer mortality in any age group. Among women aged 70-74 years screening seems to have had only a marginal impact.

Adult↗
PubMed1991

A test of an expanded theory of reasoned action to predict mammography participation.

This paper presents the results of a prospective study testing an expanded theory of reasoned action (TRA) to predict mammography participation. A questionnaire was developed to measure each of the expanded TRA model components. A sample was identified of 946 women age 40 and above who were invited to obtain a mammogram at the Group Health Cooperative of Puget Sound Breast Cancer Screening Program (BCSP). The sample was stratified by risk category as determined by the screening program. The study questionnaire was administered to all women in the sample within 2 weeks after they were sent the invitation to obtain a mammogram. Mammography participation was obtained from the BCSP data base 6 months after the invitation. Regression analyses found attitude, affect, subjective norm, and facilitating conditions to all be significantly associated with participation. The expanded TRA model explained 39% of the variance in women's intentions and 20% of the variance in participation behavior. A stepwise hierarchical regression found that no other psychosocial measures were able to improve the model predictions of behavior. An interaction between habit and intention was found such that women with larger numbers of previous mammograms were less likely to carry out their intentions than women with fewer previous mammograms. Contrary to expectations, some demographic characteristics did significantly improve prediction. The need for further work investigating the roles of fear and experience is discussed.

Adult↗
PubMed1992

A cost utility analysis of mammography screening in Australia.

Cost utility analysis is the preferred method of analysis when quality of life instead is an important outcome of the project being appraised. However, there are several methodological issues to be resolved in implementing cost utility analysis, including whether to use generalised measures or direct disease specific outcome assessment, the choice of measurement technique, and the combination of different health states. Screening for breast cancer meets this criterion as mammographic screening has been shown to reduce mortality; and it is said that earlier treatment frequently results in less radical surgery so that women are offered the additional benefit of improved quality of life. Australia, like many other countries, has been debating whether to introduce a national mammographic screening programme. This paper presents the results of a cost utility analysis of breast cancer screening using an approach to measuring outcome, Healthy Year Equivalents, developed within this study to resolve these problems. Descriptions of breast cancer quality of life were developed from surveys of women with breast cancer, health professionals and the published literature. The time trade off technique was then used to derive values for breast cancer treatment outcomes in a survey of women in Sydney, Australia. Respondents included women with breast cancer and women who had not had breast cancer. Testing of (i) the effect of prognosis on the value attached to a health scenario; and (ii) whether the value attached to a health scenario remains constant over time has been reported. The estimate of the net costs of screening are reported. The costs of breast cancer screening include the screening programme itself, the further investigations and the subsequent treatment of breast cancer cases. Breast cancer is treated in the absence of screening, many commentators claim earlier treatment is costly but there is little evidence. Therefore we have investigated current patterns of breast cancer treatment, current use of investigations for women presenting with symptoms and current use of covert mammography screening. The results are extrapolated to obtain estimates of the costs and outcomes presented as cost per healthy year equivalent. This analysis produces important information for the Australian policy debate over mammography. It also contributes to the development of cost utility analysis and the approach developed here can be applied more generally.

Australia↗
PubMed1994

The psychosocial impact of implementing a mammography screening campaign in an Australian community.

We examined the psychosocial impact of implementing a generalised campaign to promote mammography screening in an Australian inner city community. Prior to the campaign, telephone interviews were conducted with 628 randomly selected women aged 45-70, 285 in central Sydney (where the screening programme operated) and 343 from the rest of Sydney. A second cross-sectional survey was conducted two years after the campaign commenced. The campaign achieved an estimated 21% attendance rate in an eligible population of 43,000 women over a period of 22 months. Overall the campaign reached a large section of the eligible community, with 70% of women being aware of the van's existence. In addition, the proportion of women who reported being exposed to 'a moderate amount' or 'quite a lot' of information about screening increased by almost 20%. However, two thirds of women still reported being exposed to 'only a little' or no information at all. Attendance was achieved largely in the absence of improvements in knowledge and attitudes. Where change did happen, it occurred in the community overall, rather than being confined to the campaign's target area. Changes were most likely due to general electronic and print media messages, which were largely positive in their tone of reporting on screening. The campaign in one area of central Sydney, Drummoyne, which was much more intense, was successful in encouraging greater awareness of the van and mammography screening, plus greater attendance than in the rest of central Sydney, but had no impact on knowledge or attitudes. There was no demonstrable impact on psychological morbidity.

Adult↗