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PubMed2003

Normal mammography and ultrasonography in the setting of palpable breast cancer.

BACKGROUND: Each year thousands of women present to general surgeons with palpable breast masses, some of which are clinically ambiguous and the majority of which are benign. In addition, surgeons are frequently faced with the question of whether to biopsy those palpable abnormalities in the setting of normal radiographic studies. One might propose that such lesions could be safely observed rather than immediately biopsied. If these lesions were not biopsied, how many cancers would escape detection? To address this issue, a population of patients with known, palpable breast cancer was retrospectively examined to determine the frequency of normal or benign findings on both mammography and ultrasonography. METHODS: Between January 1998 and December 2001, 351 women with breast carcinoma presented initially with palpable tumors. The medical records of these remaining 351 cases were retrospectively reviewed to examine the radiographic characteristics of the palpable carcinomas. RESULTS: Of the 351 cases in the study group, 13 (3.7%) patients with palpable breast cancers had mammogram and sonogram examinations that were both normal, benign, or nonspecific in appearance. CONCLUSIONS: The results of this study indicate that nearly 4% of women with breast cancer who present with palpable lumps will have normal or benign findings on both mammography and ultrasonography. These data support prior studies of similar false negative rates and may provide some reassurance to surgeons and patients regarding clinical breast lumps, as the decision of whether to biopsy still rests in the surgeon's hands. However, inappropriate reliance on these tests for an evaluation of a palpable abnormality will result in a number of missed tumors.

Biopsy↗
PubMed1993

Mammography in the assessment of response to medical treatment of large primary breast cancer.

The sequential mammograms of 48 patients (median age: 54 years, range: 24-84 years) undergoing primary medical treatment for large operable breast cancer at this institution were reviewed, and compared to the findings at clinical assessment. Twenty-six patients underwent endocrine therapy using tamoxifen, and 22 chemotherapy (CMF or MMM). All had more than two mammograms which were reviewed blindly by two independent radiologists. Response to treatment by both evaluation modalities was recorded using WHO definitions (NC, PR, CR, PD). Some 81% of patients achieved an objective clinical response to treatment, whilst 63% showed mammographic response. Overall comparison of clinical examination with mammography showed agreement in 38 patients (79%) and disagreement in 10 (21%). Agreement in type of response but not in its degree was found in 22 cases (46%). The results suggest that in the majority of cases mammography provides a useful adjunct to clinical examination in monitoring response to primary medical treatment for breast cancer. However, radiological factors such as unchanging microcalcification, and the continuing presence of mammographic density contribute to the discrepancy with clinical response in some tumours, and the search for alternative modalities of assessment should continue.

Adult↗
PubMed1988

The accuracy of mammography alone and in combination with clinical examination and cytology in the detection of breast cancer.

The accuracy of mammography alone and in combination with clinical examination and aspiration cytology was assessed in 402 patients who attended the Early Diagnostic Unit of the Royal Marsden Hospital, London. The sensitivities of mammography, clinical examination and cytology in identifying breast cancer were 76.9%, 81.7% and 63.5% respectively; the specificities of each test were 90.0%, 87.6% and 99.3%. The calculated sensitivity was increased to 96.2% if one positive test out of the three was regarded as an indication to undertake breast biopsy. If this approach was adopted the number of breast cancers missed would be two out of 104 and the yield of positive biopsies would be approximately one in four (27.6%). The implications of proceeding to breast biopsy on the basis of a single positive test are discussed.

Aged↗
PubMed1997

The clinical importance of axillary lymphadenopathy detected on screening mammography.

The aim of this study was to determine the incidence and cause of axillary lymphadenopathy detected by screening mammography and to devise a management protocol for this pathology. In a retrospective study of 95,806 consecutive screening mammograms, 37 cases of 'pathological' axillary nodes were identified using two or more of the following criteria: size > 2 cm, replacement of fatty hilum, rounded shape and generalized increased density. In 16 cases with an additional mammographic abnormality, 12 had a mass (10 malignant and two benign) and four had suspicious calcification (all malignant). In 12 of these cases, the lymph nodes showed malignancy (75%). In 21 patients with lymphadenopathy alone on screening, six patients had a known underlying diagnosis and were not recalled from screening. The remaining 15 patients were recalled for further assessment including fine needle aspiration cytology (FNAC). The ultimate diagnosis was benign in 10 cases (48%)--six reactive changes, one healed granulomatous disease, one rheumatoid arthritis, one amyloid and one acute infection--and malignant in 11 cases (52%)--six non-Hodgkin's lymphoma, four metastatic carcinoma and one leukaemia. In conclusion, there is a high incidence of malignant nodal involvement in cases of screen detected lymphadenopathy (62% of cases in our series). We would advise that patients with lymphadenopathy as the sole finding on screening mammography and in whom there is no known underlying cause should undergo FNAC followed by excision biopsy. Fifty per cent of such patients in this study had underlying malignancy.

Aged↗
PubMed2002

New modalities in breast imaging: digital mammography, positron emission tomography, and sestamibi scintimammography.

Digital mammography, PET, and sestamibi scintimammography are three new modalities in breast imaging. DM has advantages over film-screen mammography in image storage, retrieval, and processing and may lower the recall rate. Computer-aided detection may increase the sensitivity of mammographic screening without a substantial reduction in specificity. Whereas PET and sestambi scintimammography are not useful in breast cancer screening, PET may play a role in detecting nodal metastases and monitoring treatment response, and sestamibi scintimammography in selected cases may serve as an adjunct to conventional imaging. The cost-effectiveness of these new modalities remains to be evaluated, but all have the potential to significantly advance the diagnosis and management of women with breast cancer.

Breast Neoplasms↗
PubMed2000

Screen-film and digital mammography. Image quality and radiation dose considerations.

Factors affecting image quality and patient dose in screen-film and digital mammography have been discussed. Some proposed parameters for judging image quality and breast exposure measurements and dose calculations relating to changes in image quality factors have been reviewed. It is important to remember that the goal in making a mammogram is to obtain as much diagnostic information as possible at the lowest dose compatible with that information. As noted previously, this necessitates compromises (i.e., an optimization of factors that affect image quality). These include beam quality, compression, imaging geometry, grids, receptor characteristics, processing of the film or digital image, and display and viewing conditions. If this is done correctly, a high-quality mammogram can be obtained at a reasonably low dose to the patient. The goal is not simply to use as low a dose as possible, because if this is done there is a large risk of degrading the performance of mammography in detecting or accurately characterizing small, node-negative cancers.

Breast↗
PubMed2003

Cognitive motivations associated with screening mammography in Cyprus.

BACKGROUND: This study examined the relationship between cognitive motivations, demographic characteristics, related preventive health behaviors, and intention to obtain a first screening mammogram among Greek Cypriot women. METHODS: This cross-sectional study took place at the outpatient clinics of the General Hospital of Nicosia during the fall of 1999. The participants were 293 women asymptomatic of breast cancer and with no previous mammographic experience. The Theory of Planned Behavior in conjunction with the construct of self-efficacy was used in the development of the questionnaire. The assessment also included demographic information, practice of other preventive health behaviors, and knowledge of breast cancer screening. RESULTS: Self-efficacy was the most significant determinant of initial screening mammography, followed by normative beliefs associated with the physician, family and close friends, and perceived behavioral control beliefs related to barriers to obtaining a mammogram. Educational level, time of last clinical breast examination, and status of breast self-examination were also strongly implicated in the explanation of initial screening mammography. CONCLUSIONS: Insights into specific salient motivational cognitions and certain demographic characteristics or related preventive health behaviors are crucial to the development and implementation of effective intervention strategies.

Adult↗
PubMed2002

Long-term effects of mammography screening: updated overview of the Swedish randomised trials.

BACKGROUND: There has been much debate about the value of screening mammography. Here we update the overview of the Swedish randomised controlled trials on mammography screening up to and including 1996. The Kopparberg part of the Two-County trial was not available for the overview, but the continuation of the Malmö trial (MMST II) has been added. The article also contains basic data from the trials that have not been presented before. Methods The trials (n=247010, invited group 129750, control group 117260) have been followed up by record linkage to the Swedish Cancer and Cause of Death Registers. The relative risks (RR) for breast cancer death and mortality were calculated for the invited and the control groups. The trial-specific as well as the age-specific effects were analysed. RRs were calculated by the density method, with total person-time experience of the cohort by time interval of follow-up as a basis for estimating mortality rates. We calculated weighted RRs and 95% CI with the Mantel-Haenszel procedure. FINDINGS: The median trial time-the time from randomisation until the first round was completed for the control group or if the control group was not invited, until end of follow-up-was 6.5 years (range 3.0-18.1). The median follow-up time, the time from randomisation, to the end of follow-up, was 15.8 years (5.8-20.2). There were 511 breast cancer deaths in 1864770 women-years in the invited groups and 584 breast cancer deaths in 1688440 women-years in the control groups, a significant 21% reduction in breast cancer mortality (RR=0.79, 95% CI 0.70-0.89). The reduction was greatest in the age group 60-69 years at entry (33%). Looking at 5-year age groups, there were statistically significant effects in the age groups 55-59, 60-64, and 65-69 years (RR=0.76, 0.68, and 0.69, respectively). There was a small effect in women 50-54 years at randomisation (RR=0.95). The benefit in terms of cumulative breast cancer mortality started to emerge at about 4 years after randomisation and continued to increase to about 10 years. Thereafter the benefit in absolute terms was maintained throughout the period of observation. The age-adjusted relative risk for the total mortality was 0.98 (0.96-1.00). INTERPRETATION: The advantageous effect of breast screening on breast cancer mortality persists after long-term follow-up. The recent criticism against the Swedish randomised controlled trials is misleading and scientifically unfounded.

Adult↗
PubMed2003

Initiation of population-based mammography screening in Dutch municipalities and effect on breast-cancer mortality: a systematic review.

BACKGROUND: More than a decade ago, a mammography screening programme for women aged 50-69 years was initiated in the Netherlands. Our aim was to assess the effect of this programme on breast-cancer mortality rates. METHODS: We examined data for 27948 women who died of breast-cancer aged 55-74 years between 1980 and 1999 (30560 cases until 2001). We grouped individuals into 93 clusters, depending on where they lived, and analysed data by use of national population statistics. We analysed time trends in breast-cancer mortality, adjusting for gradual implementations at municipality level, taking as year 0 the month and year in which screening began in a particular municipality. We used a Poisson regression model to estimate the time at which the trend started to turn. We assessed indirectly whether this turning point was related to initiation of screening or adjuvant systemic therapy in four clusters defined according to when screening was implemented. FINDINGS: Compared with rates in 1986-88, breast-cancer mortality rates in women aged 55-74 years fell significantly in 1997 and subsequent years as predicted, reaching -19.9% in 2001. Mortality rates had been increasing by an annual 0.3% until screening was introduced; thereafter we noted a decline of 1.7% per year (95% CI 2.39-0.96) in women aged 55-74 years and of 1.2% in those aged 45-54 (2.40 to 0.07). The turning point in mortality trends arose at around year 0. Adjuvant systemic therapy is unlikely to be the cause of this turning point, since the mortality rates continued to rise up to 1 year after implementation in municipalities where screening began after 1995. INTERPRETATION: Routine mammography screening can reduce breast-cancer mortality rates in women aged 55-74 years.

Age Distribution↗
PubMedDate not supplied

Older women and mammography: factors influencing their attitudes.

Breast disease is a leading factor in the morbidity of older women. Unfortunately, this population segment receives less education on breast screening methods and has a lower rate of mammography use than others. This article focuses on the misconceptions concerning elderly breast care and the reasons why mammography use is lowest in this population segment.

Aged↗
PubMed2005

[Understanding CAD (computer-aided diagnosis) in mammography].

Generalization of breast screening programs requires efficient double reading of mammograms, which allows reduction of false negative interpretations, but it may be difficult to achieve. CAD (Computed Aided Detection) systems are dramatically improving and can now assist in the detection of suspicious mammographic lesions, either suspicious microcalcifications, masses or architectural distortion. Characterization of the lesions is improving as well. CAD mammography might complete or substitute to "human" double reading. The aim of this review is to present the main CAD systems commercially available, review the principles of CAD and discuss the results of CAD mammography. Specifically, the role of CAD within breast screening program, according to the results of recent prospective studies will be discussed.

Breast Diseases↗
PubMed1982

Ultrasonic mammography without specialized equipment. Comparison with clinical examination and x-rays.

Ultrasonic mammography has been compared with clinical examination and X-ray mammography. Results for the years 1977-79 are shown. A general purpose compound scanner and a custom made water delay bath are used. Twenty three percent of patients undergoing breast examination had an ultrasonic scan. The lowest limit for cyst detection in 4 mm diameter and for solid tumours about 10 mm. Comparison of the three methods shows an agreement of approx. 87% in benign lesions (i.e. agreement in the type of benign disease), and between 16/18 and 17/18 in malignant lesions (comparison of suspicion of malignancy only). As a result of these findings ultrasound is used in our department as a useful auxiliary method.

Adult↗
PubMed2002

Mammography screening and breast cancer biology in African American women--a review.

This review examines some of the key issues in early detection and breast cancer biology for African American (AA) women which contribute to their diagnoses at more advanced stages than white women, and poorer long-term prognoses. While screening mammography is considered an essential factor in eliminating these disparities, its optimal application for AAs is not fully understood. There is a paucity of information on the success with which mammography screening programs are maintained over time in the AA population, and on screening guidelines with regard to age of initiation and frequency. No randomized clinical trials targeting AA women have been reported. This type of information is critical since breast cancer in AA women occurs at younger ages, and frequently demonstrates aggressive tumor biology at diagnosis. Studies are required to determine the incidence of interval cancers in current screening programs, and the influence of the biological characteristics which are known to differ in the breast tumors of AA and white women. Recognition of molecular and cellular characteristics which identify the potential invasiveness of ductal carcinomas in situ is also required. These studies would assist in establishing the criteria for identifying the subpopulation of younger pre-menopausal AA women who would benefit from early initiation of screening. Finally, the epidemiology and biology of mammographic densities, a risk factor for breast cancer and, perhaps, markers of aggressive disease require further study in both AA and white women.

Black or African American↗
PubMed2002

Evaluation of a "loss-framed" minimal intervention to increase mammography utilization among medically un- and under-insured women.

This study was conducted because mammography is under-utilized, even though it is the most effective early detection screening device for breast cancer. A loss-framed telephonic message based on prospect theory was evaluated for the effects on mammography utilization among medically un- and under-insured women living in demographically similar rural counties in Florida. The sample consisted mostly of White women (approximately 89%) 50-64 years old. Experimental group participants received the loss-framed message telephonically and those in the comparison group received the "usual telephone procedure." Logistic regression analyses revealed that women who received the loss-framed message were six times more likely to obtain a mammogram (OR = 6.6, P < 0.0001). The impact of the loss-framed message persisted even after adjustment for initial versus re-screen mammogram effects. This in-reach, loss-framed, minimal intervention seems to have viability and may serve as an alternative or adjunct program for encouraging women to receive mammograms.

Attitude to Health↗
PubMed1997

The debate over mass mammography: is it beneficial for women?

The authors discuss the controversy about mass screening for breast cancer in order to assess the soundness of a nationwide expansion of such programmes. Mass screening is second best because of the failure of prevention, therapeutic progress or ability to target high risk populations, but its efficacy reducing mortality is not clearly demonstrated and the chances of one woman being saved from participating are very low. Detrimental side-effects such as anxiety, false alarms, unnecessary biopsies, overdiagnosis and overtreatment and deficiency of psychological approach are reported. On the other hand, mass screening may save lives and if no recent study can provide absolute proof of efficacy, inefficacy of systematic mammography cannot be proven either, even concerning 40 49 years old women. Moreover, screening trials have allowed an improvement in medical practice, especially concerning quality and dose in mammography and radiographer's performance. Many questions remain unanswered about mass screening for breast cancer and the best way to achieve it.

Adult↗
PubMed1999

Full field digital mammography scanner.

We describe the key features of a pre-production, slot-scan digital mammography system. A number of these units have been used in clinical studies over the past year for the purpose of demonstrating their equivalence to the conventional film-screen devices. Since the clinical data has not yet been fully analyzed, it is not possible to make definitive claims. However, with hundreds of patients examined, the results appear to leave very little doubt the SenoScan digital mammography system will prove equivalent to the conventional technology. The detector developed for this system has a sensitive area 1.0 cm wide by 22 cm long. It is constructed by abutting four charge-coupled-device (CCD) chips, which are optically coupled to thallium-doped cesium iodide scintillator by means of a thin fiber optic plate. Scanning is accomplished by attaching the detector to a rigid arm that swings in an arc, with the axis of rotation collinear with the X-ray tube focal spot. The total scan time for the 30 cm image width is less than 6 s, with an effective exposure time of either 0.2 or 0.4 s. Two resolution modes are available: 0.054 mm or 0.027 mm square pixel size; in the latter mode both the image length and width are halved, as is the scan velocity, so that the scan time remains the same. To compensate for the low X-ray utilization efficiency of the slot geometry, a tungsten rhenium target X-ray tube is employed. It is rated at 8 kW on the 0.3 mm focal spot; when used with a heat exchanger, it has been found to provide the patient throughput needed in a busy clinical practice.

Breast Diseases↗
PubMed2003

Counselling interventions to address the psychological consequences of screening mammography: a randomised trial.

We examined the effectiveness of offering counselling to women undergoing screening mammography who are recalled for further investigations that do not lead to a diagnosis of cancer. Women were randomised to being offered either face-to-face (n = 66) or telephone counselling (n = 68) or usual care (n = 71) at the recall clinic after being told that their screen-detected abnormality was not cancer. The PCQ (a reliable and valid measure of the psychological consequences of screening mammography) measured the emotional, social and physical functioning of women at the recall clinic (Time 1) and after the counselling intervention (Time 2). Analyses of covariance (ANCOVA) showed no main effects for intervention on Time 2 levels of functioning after adjustment for the respective covariate of Time 1 functioning. Time 1 levels significantly predicted Time 2 levels of functioning. When data were analysed according to whether women actually received any type of counselling versus not receiving counselling, participation in counselling was associated with lower scores on dysfunction scales at Time 2, after adjusting for Time 1 levels.

Adaptation, Psychological↗