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At least 1,711 records · Page 95Linked to original sources
PubMed1995

The importance of the non-palpable lesion in women under 50, detected by mammography on self-referral for screening, symptoms or follow up.

Between 1.1.88 and 31.12.91, 349 consecutive patients had an x-ray localization excision of a non-palpable breast lesion less than 10 mm in diameter detected by 2-view mammography performed as a result of self-referral for screening (133), breast symptoms (164), or follow-up for breast disease (52). All lesions greater than 11 mm were excluded. 250 had benign and 99 (28%) had malignant lesions. 37 of 99 (37%) patients with malignancy were aged 49 or under. 133 patients requested screening, 33 (25%) had carcinoma of whom 11 (33%) were aged 49 or less. 164 patients presented with breast symptoms; 47 (29%) had cancer and 15 (32%) of these were aged 49 or less. 52 patients requested follow up for breast diseases including previous cancers, 19 (37%) had carcinoma of which 11 were 49 years or less (58%). 223 had microcalcifications, of which 68 (31%) were positive for cancer, and 126 had no microcalcification, of which 31 (25%) patients had cancer. The specific spiculate radiological lesions yielded 16 carcinomas in 31 cases (52%). Microcalcification was seen in 110 patients under 49 with 27 (25%) carcinomas detected. Microcalcification was a significant diagnostic criterion in the patients aged 49 or less, accounting for 27/37 (73%) patients. Dutal carcinoma in situ accounted for 18/37 (49%) in patients aged 49 or less, and 19/62 (31%) in patients over 50 years. Mammography should not be withheld from patients who are seeking screening, have symptoms, or who wish to be followed up, irrespective of age.

Adult↗
PubMed1996

Management of accidentally found pathological lymph nodes on routine screening mammography.

Normal lymph nodes in the anterior part of the axilla are readily seen on routine mammography. It is important, however, to recognize pathological lymph nodes, characterized by increased attenuation, high density, a round or irregular shape and lack of fat in the hilus, as they often indicate significant diseases. We examined the final diagnosis in 22 patients referred for clinical examination from a mammographic screening programme because of pathological lymph nodes without concomitant breast malignancy. Ten of them were found to have a malignant lesion, and one had sarcoidosis. None of the malignancies had been diagnosed before screening. Among women with abnormal but impalpable nodes, only one malignancy was found (in a woman with previous breast cancer), whereas nine of 13 women with palpable nodes had malignancies. Seven malignant lymphomas were discovered, but among all 60 women of the age group in question with newly diagnosed lymphomas in the region, only 13 had pathological axillary nodes. Mammography cannot therefore be used as a screening method for lymphoma. We conclude that mammographically pathological lymph nodes in the axilla should be examined clinically and propose a simple programme for patient management.

Adult↗
PubMed2003

Reminder letter, tailored stepped-care, and self-choice comparison for repeat mammography.

BACKGROUND: The main benefits of mammography come from regular on-schedule screening. However, few studies have examined interventions to achieve repeat screening. SETTING AND PARTICIPANTS: Participants were women aged 50 to 74, recruited through one setting in Rhode Island and another in North Carolina. Participants had a mammogram already scheduled at recruitment, and had to keep that appointment in order to be eligible for the repeat mammography intervention. A total of 1614 women were in the intervention sample. DESIGN: A four-group randomized design was used: Group 1, a simple reminder letter; Group 2, a 2-month, tailored, stepped intervention delivered 2 months after the completed mammogram; Group 3, a 10-month, tailored, stepped intervention delivered 2 months before the repeat mammogram was due; and Group 4, self-choice of one of the above three strategies. INTERVENTION: The intervention took place between June 1996 and May 1997. The reminder letter and two levels of the stepped intervention were delivered by mail. The third level of the stepped strategy was a counselor telephone call. Groups 2 and 3 were identical, except for timing. OUTCOME MEASURE: Obtaining the next due mammogram within 15 months, based on clinic records. RESULTS: There were no statistically significant differences among the four groups, both in the total sample and at the two sites separately. CONCLUSIONS: On average, a simple reminder may be as effective as more complex strategies for women with a prior on-schedule exam. However, attention is still needed to identify women at risk of lapsing from screening. Some women may require more-intensive interventions.

Aged↗
PubMed2003

The impact of survey nonresponse bias on conclusions drawn from a mammography intervention trial.

BACKGROUND AND OBJECTIVE: This study demonstrates the impact of survey nonresponse bias on conclusions from a mammography trial targeting a disadvantaged population. METHODS: The trial randomized 1558 women to three interventions designed to promote repeat mammography: mailed reminder (minimum group); mailed thank-you card, patient newsletters, and reminder (maximum group); and no mailings (control group). The primary outcome, repeat mammogram within 15 months, was assessed from administrative and phone survey data. RESULTS: Administrative estimates revealed a statistically significant difference of 7% between the maximum and control groups on the primary outcome. Survey estimates (response rate 80%) revealed no significant differences. The differences by data source were traced to a survey nonresponse bias. There was a statistically significant difference of 16% between the maximum and control groups among survey nonrespondents for the primary outcome, but there were no differences among survey respondents. CONCLUSION: The findings reiterate that even a low survey nonresponse rate can bias study conclusions and suggest studies targeting disadvantaged populations should avoid relying solely on survey data for outcome analyses.

Adult↗
PubMedDate not supplied

The evaluation of false negative mammography from malignant and benign breast lesions.

Preoperative mammograms from 395 breast cancers and 132 benign breast lesions were enrolled for this study. The false-negative (FN) rate for breast cancers from preoperative reading was 9.6% with 38 breast cancers missed on mammograms. The statistically significant differences occurred between true-positive (TP) and FN cancers for younger age (P<.025), smaller lesion size (P<.001), denser breast (P<.05), deep retroglandular location (P<.001). None of the FN cancers exhibited calcifications. The FN rate for mammography for benign breast lesions from preoperative reading was 18.9% with 25 lesions misdiagnosed. The statistically significant difference between benign TP and FN lesions occurred for central and subareolar location (P<.025). Exploration of possible factors and imaging features in FN mammograms can help reduce the FN rate for mammography.

Adult↗
PubMed2003

Results from the Swiss mammography screening pilot programme.

The first Swiss mammography screening pilot programme operated between 1993 and 1998. Approximately 15000 women aged 50-69 years and residing in western Switzerland (canton of Vaud) were offered a biennial screening. Quality standard recommendations for screening were met for most performance indicators. Some 4.6%/2.3% (prevalent/incident round) of participants were referred for further assessment, and 84.7%/75.6% of them turned out not to have cancer. Specificity was high (96.1%/98.2%) and the cancer detection rate amounted to 7.0/1000 and 5.9/1000 in the prevalent and incident rounds, respectively. Some 30%/26% of cancers in screened women were interval cancers, which were at a more advanced stage than screen-detected tumours. Screening performances improved with time and age. The objectives of feasibility and acceptability of an organised mammography screening programme in the liberal Swiss healthcare system, where routine opportunistic screening existed, were achieved and contributed to the implementation of screening programmes in two additional Swiss cantons.

Aged↗
PubMed2003

MR mammography of a primary squamous cell carcinoma of the breast: a case report.

A case of a primary squamous cell carcinoma of the breast in a patient with synchronous contralateral invasive ductal adenocarcinoma is reported. To our knowledge, no dynamic MR mammography of this pathology is described in the literature. On MR, it presented as a mainly non-enhancing, partially cystic mass with an enhancing irregular peripheral rim. In the differential diagnosis of a mass with unsharp margins and an irregular border of the cystic or the non-enhancing area on MR mammography, a primary squamous cell carcinoma must be included.

Aged↗
PubMed2004

Detection by screening mammography is a powerful independent predictor of survival in women diagnosed with breast cancer.

Four hundred and sixteen invasive breast cancers, detected initially by mammography, were compared with 929 presenting symptomatically, all treated at a South Australian teaching hospital. Predictable differences included lower stages and grades, less vascular invasion and proliferative activity, and more hormone-receptor expression among the mammographically detected. Unpredicted differences included significantly higher survivals for mammographically detected cases throughout the 9 year follow-up period after adjusting for stage and the Nottingham Prognostic Index. In a multivariable analysis, differences in stage, grade, and hormone receptor expression accounted for only about half the survival advantage of mammographically detected tumours. Accounting for additional person and tumour characteristics had only a marginal effect on this result. This suggests that detection by mammography has independent favourable prognostic significance beyond that explained by conventional indicators. If confirmed, this finding would have important implications for the prognostic advice given to women and may merit further investigation into its underlying biological mechanisms.

Aged↗
PubMed1999

Estimating mean glandular dose using proprietary mammography phantoms.

Screening mammography programs prescribe limits on the radiation dose to the glandular tissue of a compressed breast--the Mean Glandular Dose (MGD)--which may vary between 2 and 3 mGy for a 50% adipose and 50% glandular tissue compressed breast of 4.2 to 5.0 cm thickness. Commercially available breast phantoms offer a choice of equivalent tissue thicknesses and composition ranging typically from 30% adipose and 70% glandular tissue to 50% adipose and 50% glandular tissue. A number of these phantom were compared under clinical conditions and the MGD calculated for each using the factors developed by Wu et al. [Wu, X., Barnes, G.T. and Tucker, D.M. (1991) Spectral dependence of glandular tissue dose in screen film mammography, Radiology 179, 143-148].

Australia↗
PubMed1992

A survey of state Medicaid policies for coverage of screening mammography and Pap smear services.

In the winter of 1990, we surveyed all states and the District of Columbia to ascertain Medicaid policies on screening mammography and Pap smear--two critical preventive cancer screens for women. Forty-four state Medicaid programs cover screening mammography and all 51 jurisdictions cover Pap smear services. However, the extent of coverage and reimbursement rates vary widely across states. Only a small minority of states reported age or frequency limits for screening; five of these are in conflict with nationally recommended guidelines.

Female↗
PubMed1992

Insights into the physician's role in mammography utilization among older women.

Women who receive routine medical care and those who see obstetrician-gynecologists are more likely to get mammograms. However, fewer women see these physicians as they grow older. Results indicate that, as a group, older women see a different mixture of physicians, and the drop in mammography referrals due to obstetrician-gynecologist office visit decline is not replaced by compensating referral patterns from other physician groups. All physicians should recommend mammograms to all of their older female patients; opportunities for doing so exist if they broaden their view of when such recommendations are appropriate. It is particularly important for nongynecologists to remember that their older patients may no longer see a gynecologist and will not receive a mammography recommendation from anyone else.

Adult↗
PubMedDate not supplied

Understanding lesbians' mammography utilization.

Lesbians face unique barriers to health care, and may be at higher risk for breast cancer than are other women. Yet, no research on lesbians and mammography utilization exists. We conducted telephone interviews of 107 lesbians aged 51-80, of whom 68 had had mammograms in the last year and 39 had not. Responses to open-ended questions identified the barriers lesbians face in obtaining mammography, lesbians, reasons for obtaining mammograms, and factors that would help lesbians obtain mammograms. Some issues identified were particular to lesbians; many issues were common to those identified by general samples of women (which include lesbians).

Aged↗
PubMed2002

Computer-aided diagnosis of masses with full-field digital mammography.

RATIONALE AND OBJECTIVES: The authors developed and evaluated a method of computer-aided diagnosis (CAD) for mass detection with full-field digital mammography (FFDM). MATERIALS AND METHODS: The new CAD method for FFDM employs adaptive, nonlinear multiscale processing and hybrid classification methods. The major strategies are (a) to "standardize" the mammographic image before it is input to the analysis modules, (b) to adapt the segmentation of suspicious regions adapt to accommodate different characteristics of masses and mammograms, and (c) to use combined "hard" and "soft" decision making in discriminating between mass and normal tissue regions. Two data sets of diagnostic FFDM mammograms were used. The training data set includes 36 normal and 24 abnormal mammograms (34 masses), and the testing data set includes 24 normal and 10 abnormal mammograms (10 masses). The tumors in this diagnostic database were more subtle and difficult to detect than those in screening databases the authors have used before. RESULTS: With the limited database and a partial optimization, a sensitivity of 91% was obtained in training, with a false-positive rate of 3.21 per image. At this trained operating point of the CAD system, six of 10 subtle masses were detected in testing. CONCLUSION: The CAD algorithms developed in screen-film mammography can be modified for FFDM. More data analysis and system optimization and evaluation will be needed before CAD can be integrated efficiently into the performance of FFDM.

Algorithms↗
PubMed2002

How good is the ACR accreditation phantom for assessing image quality in digital mammography?

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the American College of Radiology (ACR) accreditation phantom for assessing image quality in digital mammography. MATERIALS AND METHODS: Digital images were obtained of an ACR accreditation phantom at varying mAs (constant kVp) and varying kVp (constant mAs). The average glandular dose for a breast with 50% glandularity was determined for each technique factor. Images were displayed on a 5 mega-pixel monitor, with the window width and level settings individually optimized for viewing the fibers, specks, and masses in the ACR phantom. Digital images of the ACR phantom were presented in a random manner to eight observers, each of whom indicated the number of objects visible in each image. RESULTS: Intraobserver variability was greater than interobserver variability for the detection of fibers and specks, but the reverse was true for the detection of masses. As the mAs increased, the number of fibers visible increased from less than one at 5 mAs to all six being visible at 80 mAs. The corresponding number of visible specks increased from 12 to 24, and the number of visible masses increased from 1.25 to about four. Above 26 kVp, object visibility was constant with increasing x-ray tube voltage. Reducing the x-ray tube voltage to 24 kVp, however, reduced the number of visible fibers from six to five, the number of visible specks from 24 to 21.1, and the number of visible masses from four to 3.1. Observer performance was approximately constant for average glandular doses greater than 1.6 mGy, so that the range of lesion detectability in the ACR phantom occurs at doses lower than those normally encountered in clinical practice. CONCLUSION: The current design of the ACR phantom is unsatisfactory for assessing image quality in digital mammography.

Accreditation↗
PubMed2002

Mammographic tissue, breast cancer risk, serial image analysis, and digital mammography. Part 1. Tissue and related risk factors.

This work is presented as a sequence of two parts. In this leading section, a review of the breast tissue-risk research is provided. Although controversy remains, there is substantial evidence indicating that dense mammographic tissue (a) is a breast cancer risk factor that is at least similar, if not greater, in magnitude with the other known breast cancer risk factors and (b) may be a partial biomarker for some of the other risk factors. Understanding these influences may provide a mechanism for measuring the dynamics of breast cancer risk. The totality of this work is to provide support for an automated serial mammography study under way at the authors' institution, where digital mammographic images are acquired with a full-field digital mammography system. This is a filmless imaging system, where the image is acquired in digital format. This electronic imaging acquisition system provides a prime opportunity to easily couple and manipulate the image data with patient information such as risk probability analysis or other pertinent personal history data for improved automated decision making. In this leading section, the main focus is on understanding elements that will assist in fusing risk probability analysis with automated computer-aided diagnosis. The evidence indicates that there are many factors that influence breast tissue at any given time and thus have the ability to alter the associated radiographic image appearance over time. At the initiation of the serial study it was clear that the authors did not fully understand the nature of the problem: automatically comparing similar mammographic scenes acquired at different times. In the second part of this sequence, the more time-related tissue influences are reviewed.

Breast↗
PubMed2002

Mammographic tissue, breast cancer risk, serial image analysis, and digital mammography. Part 2. Serial breast tissue change and related temporal influences.

The work presented herein is the second part of a review of breast tissue-related cancer-risk research. Briefly, in part 1, the tissue-risk research is discussed. In this part, factors that influence temporal breast tissue change are reviewed. Since breast composition is correlated with some of the known risk factors, understanding these influences may provide a mechanism for measuring the dynamics of breast cancer risk. The purpose of this work is to provide support for an automated serial mammography study under way at the authors' institution, where the digital mammographic images are acquired with a full-field digital mammography imaging system. At the initiation of the serial study, it was clear that the authors did not fully understand the nature of the problem: automatically comparing similar mammographic scenes acquired at different times. The evidence indicates that there are many factors that influence breast tissue at any given time and thus have the ability to alter the associated radiographic appearance over time. In general, the topics considered herein include aging; involution; breast development; exogenous and endogenous hormonal interactions such as hormone replacement therapy, oral contraceptive use, and menstrual timing; screening sensitivity issues and interval cancers; tumor growth rates; sojourn times; and lifestyle factors such as diet and exercise. Throughout this work, commentaries and suggestive strategies for automated serial image analysis are provided.

Aging↗
PubMed2002

Decreasing rate of fatty involution at screening mammography.

RATIONALE AND OBJECTIVES: This study was performed to document the perceived decrease in fatty involution at screening mammography during the past decade and evaluate the influence of hormone replacement therapy (HRT). MATERIALS AND METHODS: In December 1996, the mammograms of 261 consecutive screening patients with a comparison study obtained 5 years earlier were evaluated, and their breasts were categorized according to Breast Imaging Reporting and Data System categories for breast density. The women, aged 50-59 years, included 119 who had been receiving HRT for 0.25-15 years (mean, 3 years). From the files, 261 age-matched screening mammograms from 1986 were obtained; these patients also had comparison mammograms from 1981. Analysis of variance was used to determine differences between the 1980s group, the 1990s group receiving HRT, and the 1990s group not receiving HRT. Scheffé tests were used for post hoc comparisons. Stepwise regression analysis was used to evaluate the relative influence of age, decade, score of the first mammogram, and HRT. RESULTS: Breast density for the 1991 mammograms did not differ significantly from that in 1981 (P < .05). Initial breast density was the best predictor of final breast density in both decades (P < .001), regardless of HRT status. The change in breast density (toward fatty) over the 5-year interval in the 1980s (mean, 0.48) was significantly greater than that in both 1990s groups (mean for HRT group, 0.11; no HRT, 0.30; P < .05). CONCLUSION: These results confirm that breast density at screening mammography in the 1990s did not decrease with age at the same rate as in the 1980s, even in patients not receiving HRT.

Adipose Tissue↗