Showing papers on "Mammography published in 1976"
TL;DR: A restrospective study of 7,214 patients placed into one of four groups of risk for developing carcinoma of the breast found that there was a 37 times greater incidence for those at highest risk compared to the low risk group.
Abstract: The radiographic appearance of the breast parenchyma provides a method of predicting who will develop a breast cancer. This paper describes a restrospective study of 7,214 patients. On the basis of the radiographic appearance of the breast parenchyma, patients were placed into one of four groups of risk for developing carcinoma of the breast. Follow-up studies revealed a stepwise progression in the incidence of developing carcinoma of the breast at least 6 months after the radiographic examination. In one of the two substudies, there was a 37 times greater incidence for those at highest risk compared to the low risk group. The classifications presented are thought to be of value in the everyday practice of mammography as well as in planning screening programs.
899 citations
TL;DR: A classification of risk for developing breast cancer has been devised based solely on the appearance of the breast parenchyma by mammography by reviewing the mammograms of all women over the age of 30 who had been examined at Hutzel Hospital, Detroit.
Abstract: A classification of risk for developing breast cancer has been devised based solely on the appearance of the breast parenchyma by mammography. Four groups of patients were isolated. The study encompassed a five-year period and was done by reviewing the mammograms of all women over the age of 30 who had been examined at Hutzel Hospital, Detroit. The average time of followup would be approximately 2 1/2 years. Four groups had an incidence of developing breast cancer of 0.1, 0.4, 1.7, and 2.2. These parenchymal patterns are described and criteria for their identification are given.
819 citations
TL;DR: There is good evidence that annual history, physical examination, and mammography can reduce short-term and midrange breast cancer mortality by about one third and promotion of mammography as a general public health measure is premature.
Abstract: Experimental and clinical data on mammography as a tool for population screening are reviewed. The conclusions are that [1] there is good evidence that annual history, physical examination, and mammography can reduce short-term and midrange breast cancer mortality by about one third; [2] the evidence that mammography alone plays a significant role in this reduction is weak and indirect; [4] data on long-term effects of mammography are lacking; [4] no satisfactory investigations of associated radiation hazards have been published; and [5] the possible benefits of mammography have received more emphasis in the clinical literature than have its defects. Promotion of mammography as a general public health measure is premature.
229 citations
TL;DR: The simple, rapid technic described below for the preoperative localization of radiologically suspicious breast lesions by means of a self-retaining radiopaque marker has been found reliable.
Abstract: Biopsy of radiologically suspicious breast lesions that are not palpable clinically or even at operation has become commonplace since the introduction of modern mammographic technics. Surgical localization of such lesions can be difficult because the position and shape of the breast are altered by the vertical and horizontal compression employed during mammography. The simple, rapid technic described below for the preoperative localization of such lesions by means of a self-retaining radiopaque marker has been found reliable. Method The localizing procedure is done immediately before operation in the radiology department with the patient supine in the position to be assumed in . . .
172 citations
TL;DR: M Mammography, biopsies of the second breast, and prophylactic mastectomy in certain high-risk patients should improve survival rates.
Abstract: Primary carcinoma of breast was treated in 967 patients from 1962 through 1972. Thirty-five of these patients had a second primary tumor of which 50% were discovered simultaneously. A family history for cancer was recorded in 26% of the patients with bilateral cancer. Patients found their tumor more often than the physician except in the simultaneous cases where the physician was more successful. Pathological examination showed 10% of the tumors were comedo, lobular carcinoma in situ, papillary, or tubular cancers. In the metachronous group, 50% of the axillae were involved on both sides. In the simultaneous cases the axilla was less frequently involved. Mammography, biopsies of the second breast, and prophylactic mastectomy in certain high-risk patients should improve survival rates. ( JAMA 236:278-280, 1976)
89 citations
Journal Article•
TL;DR: Six hundred and two mammary tumors were examined clinically, by mammography and cytology, with a histologic checkup following surgical biopsy, showing that their combined use can improve the diagnosis.
Abstract: Six hundred and two mammary tumors were examined clinically, by mammography and cytology, with a histologic checkup following surgical biopsy. There were 247 cases of malignoma and 355 benign cases. The limited reliability of the individual methods is demonstrated, and it is shown that their combined use can improve the diagnosis. More malignomas are detected, and preoperative diagnosis is made more safely. If all three methods yield identical results, as was the case in 50.2% of the malignant and 32.7% of the benign lesions, the probability of diagnostic error is less than one per cent. With a malignoma thus established, surgical treatment may follow immediately, or irradiation can be started. In benign cases a surgical biopsy may be foregone and further developments may be awaited with due provision for regular control. If the three methods yield conflicting or doubtful results, elucidation by surgical biopsy and histology is indicated.
76 citations
TL;DR: In 1974 a new approach to breast cancer screening was introduced–‐the single view mammography method, which has been possible to reduce the radiation dose, while the patient flow is increased and the costs are decreased to an acceptable level.
Abstract: In 1974 a new approach to breast cancer screening was introduced--the single view mammography method. An urban nonselected population of 6845 women of more than 34 years of age were screened with one roentgenogram of each breast. By this method it has been possible to reduce the radiation dose, while the patient flow is increased and the costs are decreased to an acceptable level. Forty cases of breast carcinoma were detected (6.7/1000). Twenty cases were preclinical.
74 citations
TL;DR: While mammography was responsible for detecting the majority of in situ or minimal cancers, 13 were found on physical examination, six of which were found only by physical examination.
Abstract: As a result of screening of 8100 consecutive volunteers, 67 breast cancers have been detected. Fourteen percent of these cancers were found in women aged 35-44 years. Eighty percent of the cancers found in this age group were minimal breast cancer. This percentage decreased significantly in each subsequent decade until age 65 years, or older, when it began to rise once more. While mammography was responsible for detecting the majority of in situ or minimal cancers, 13 were found on physical examination, six of which were found only by physical examination.
40 citations
TL;DR: Breast cancer patients need close follow‐up for at least 6 years after the first primary carcinoma; and 4 years past the second primary signals a more optimistic prognosis, as well as reliable in differentiating a second primary from metastatic carcinoma.
Abstract: From 1963 to 1973, at Emory Clinic, out of a total of 1112 patients with breast carcinoma studied with mammography, 83 had carcinoma in both breasts. The carcinoma in the second breast was primary in 67 patients and metastatic in 16 patients; in 18 patients there were simultaneous bilateral primary carcinomas. Mammography proved highly effective in detecting the second carcinoma and was reliable in differentiating a second primary from metastatic carcinoma. Forty-one of the second primary carcinomas were not associated with a palpable mass; 31 of these were having mammography as a routine check-up. The second nonsimultaneous carcinoma was considerably smaller than the first and fewer axillary lymph node metastasis. The second primary occurred within 6 years of the first in 86% of the cases with the remaining 14% scattered evenly up to 23 years. At 4 years after the diagnosis of the second primary, 25 of 27 deaths had occurred and only 1 patient was alive with cancer. Breast cancer patients need close follow-up for at least 6 years after the first primary carcinoma; and 4 years past the second primary signals a more optimistic prognosis.
39 citations
TL;DR: The Guttman Institute, founded in 1968 to develop practical methods for large scale screening, is operating a tandem approach using interview, clinical examination, improved mammography, and thermography for greatest yield, which emphasizes substantial percentage of cancers detected on only one modality.
Abstract: Detection of earlier breast cancer, especially in its preclinical stage, offers the only method available today for reducing mortality from this disease. The Health Insurance Plan study, conducted since 1963 under contract with the National Institutes of Health, has achieved a one-third reduction in death rate in a study group compared to a matched control which has persisted in 7 years of follow-up. The Guttman Institute, founded in 1968 to develop practical methods for large scale screening, is operating a tandem approach using interview, clinical examination, improved mammography, and thermography for greatest yield. Emphasis is placed on motivation to accept the examination, teaching and encouragement of breast self-examination, and emphasis on periodic reexaminations. At the present time, almost 300 women receive this complete examination per day at the Institute's fixed facility. Periodic examinations leads to marked increase in number of cancers detected free of axillary nodal involvement. The tandem approach emphasizes substantial percentage of cancers detected on only one modality, two-thirds of which are without nodal involvement. Breast self-examination is necessary to detect "interval" cancers in more localized stage.
39 citations
TL;DR: In this mass screening program, a higher proportion of localized breast cancer with no nodal involvement than is the case in general medical practice has been found, pointing up the potential of mass screening not only in increasing survival from the disease, but in increasing salvage.
Abstract: MASS screening for detection of earlier breast cancer by palpation and mammography is the only method that has produced a notable reduction in mortality from this disease. A onethird reduction in death rate has been achieved in a seven-year follow-up in the mass-screening program conducted by the Health Insurance Plan of Greater New York under contract with the National Cancer Institute. This has led to the creation of the Guttman Breast Diagnostic Institute in New York City, whose major objective has been to develop practical methods for mass screening. In this program, a higher proportion of localized breast cancer with no nodal involvement than is the case in general medical practice has been found. These findings point up the potential of mass screening not only in increasing survival from the disease, but in increasing salvage. BACKGROUND Mass-screening programs for breast cancer detection were conducted in the 1940s and 1950s by
TL;DR: Serial mammography may be particularly important in the evaluation of patients with locally advanced disease who require extensive radiation therapy and in whom physical examination is inadequate for the assessment of tumor response.
Abstract: The role of mammography in evaluating tumor response was examined in 27 patients undergoing definitive radiation therapy for breast cancer Radiographic changes observed after treatment included progressive skin thickening, fibrosis of the subcutaneous tissue, and breastretraction The persistence of a mass more than six months after irradiation suggests treatment failure Serial mammography may be particularly important in the evaluation of patients withlocally advanced disease whorequire extensive radiation therapy and in whom physical examination is inadequate for the assessment of tumor response
TL;DR: The measured x-ray spectra from a molybdenum anode Senographe mammography unit and a tungsten anode unit were used to calculate the x- Ray energy spectra transmitted through various thicknesses of fat and water (breast-equivalent materials) and the dependence of subject contrast and patient exposure on these spectra was predicted.
Abstract: The measured x-ray spectra from a molybdenum anode Senographe mammography unit and a tungsten anode unit were used to calculate the x-ray energy spectra transmitted through various thicknesses of fat and water (breast-equivalent materials). The dependence of subject contrast and patient exposure on (a) x-ray spectra, (b) attenuation properties of two breast-equivalent materials, and (c) thickness of breast-equivalent material was predicted. Radiographs of resected breast tissue confirmed these predictions and demonstrated the general relative effects of x-ray beam quality on image contrast in mammography.
TL;DR: Time to accept that, despite limitations, it does save lives.
Abstract: The feasibility of mass population screening for breast cancer by clinical examination and x-ray mammography was studied. The results indicate that such a programme could be conducted effectively by non-medical staff and be safe from the dangers of irradiation. The response rate of women invited for screening suggests that such a service is acceptable to the general public. The additional work load produced by screening would not overburden the existing surgical services.
TL;DR: Calculations indicate that a semiannual clinical‐mammographic program can be expected to result in about 37% fewer positive node cases than those observed in the National Breast Project and substantially smaller tumors.
Abstract: A mathematical model is developed to obtain prospective estimates of average tumor sizes and the expected proportion of positive regional lymph node cases for periodic breast cancer examination programs. Semiannual, annual, and biannual programs, with or without mammography, are evaluated and compared with results from the National Breast Poject. Calculations indicate that a semiannual clinical-mammographic program can be expected to result in about 37% fewer positive node cases than those observed in the National Breast Project and substantially small tumors. The expected reduction in positive node cases from a similar annual program is about 30%, and from a biannual program, even without mammography, about 20%. Calculations also indicate the important role of diligent patient self-examination in such programs, especially for the detection of fast-growing tumors.
TL;DR: Mammographic examination should be performed before contemplated breast operations and in women at high risk for the development of breast cancer, especially those who have had previous neoplastic breast disease.
Abstract: In response to recent public demand for mammographic examination after the discovery of breast cancer in two women of national prominence, the Ad Hoc Committee on Mammography of the Massachusetts Radiological Society reviewed the present indications, benefits, and risks of radiologic technics used in the detection of neoplastic breast disease. Either low-dose film mammography or xeromammography can provide diagnostic information with minimal radiation hazard, and thermography is a sensitive though nonspecific technic for interim follow-up observations and for screening of large groups of well patients. Mammographic examination should be performed before contemplated breast operations and in women at high risk for the development of breast cancer, especially those who have had previous neoplastic breast disease. Routine mammographic studies on well women may be initiated after the age of 35 years, the frequency of periodic re-examination being determined by clinical and mammographic findings.
TL;DR: The spot method of localization is applied to nonpalpable breast lesions detected at mammography to facilitate surgical excision of the smallest amount of breast tissue for microscopic examination.
Abstract: The spot method of localization is applied to nonpalpable breast lesions detected at mammography. This percutaneous procedure is easy to perform, comfortable for the patient, and highly accurate in facilitating surgical excision of the smallest amount of breast tissue for microscopic examination.
TL;DR: A specimen of breast tissue containing a carcinoma with multiple calcifications was used as a test object and examined by a range of mammographic techniques, and Xeroradiography and Kodak Crystallex film clearly excelled other imaging methods.
Abstract: A specimen of breast tissue containing a carcinoma with multiple calcifications was used as a test object and examined by a range of mammographic techniques. The images were compared with a photograph of the actual specimen which was cleared and stained for calcium salts. A quantitative method of evaluating the discriminating ability of each technique is described and used to compare these images. Xeroradiography and Kodak Crystallex film clearly excelled other imaging methods. The value of using a biological test object is discussed.
TL;DR: On August 23, the National Cancer Institute and the American Cancer Society terminated the routine use of x-ray mammography for women under age 50 who are enrolled in a five-year joint NCI-ACS scheme.
Abstract: On August 23, the National Cancer Institute and the American Cancer Society terminated the routine use of x-ray mammography for women under age 50 who are enrolled in a five-year joint NCI-ACS nati...
01 Jan 1976
TL;DR: Evaluation of the best system or technique for obtaining a breast image is discussed in terms of the compromise between diagnostic certainty and cost or risk.
Abstract: In mammography, image quality is a function of the shape, size, and x-ray absorption properties of the anatomic part to be radiographed and of the lesion to be detected; it also depends on geometric unsharpness, and the resolution, characteristic curve and noise properties of the recording system. X-ray energy spectra, modulation transfer functions, Wiener spectra, characteristic and gradient curves, and radiographs of a breast phantom and of a resected breast specimen containing microcalcifications are used in a review of some current considerations of the factors, and the complex relationship among factors, that affect image quality in mammography. Image quality and patient radiation exposure in mammography are interrelated. An approach to the problem of evaluating the trade-off between diagnostic certainty and the cost or risk of performing a breast imaging procedure is discussed.
Journal Article•
TL;DR: The mammographic features of the intramammary and paramammary lipomata are given and the characteristic xeroradiographic appearance of adenolipomata is described and the question whether adenlipomATA of the breast are true invasive tumours or mixed neoplasms is discussed.
Abstract: Five cases of the relatively uncommon intramammary lipoma and 4 cases of the rare adenolipoma were found in more than 5,000 patients who underwent mammography. The mammographic features of the intramammary and paramammary lipomata are given and the characteristic xeroradiographic appearance of adenolipomata is described. The 4 adenolipomata were only visualised by xeroradiography. The reason for these neoplasms being visible on xerograms and not on film mammograms is not clear, but we surmise that it is owing to the 'edge enhancement' phenomenon inherent in the xeroradiographic process. The question whether adenolipomata of the breast are true invasive tumours or mixed neoplasms is discussed.
Journal Article•
TL;DR: It is apparent that younger women are more likely than older women to develop cancer from exposure to radiation, and the American Cancer Society advises that women under 35 years should have mammography only for medical indication, not for so-called screening.
Abstract: The possible role of radiation as a factor in the causation of breast cancer was investigated. Some variables said to be associated with a high risk of breast cancer include genetic factors, pre-existing breast disease, artificial menopause, family history of breast cancer, failure to breast feed, older than usual age at time of first pregnancy, high socioeconomic status, specific blood groups, fatty diet, obesity, and hormonal imbalances. To this list we must add ionizing radiation as an additional and serious risk factor in the causation of breast cancer. Among the irradiated groups which have an increase in the incidence of cancer of the breast are: tuberculous women subjected to repeated fluoroscopy; women who received localized x-ray treatments for acute post-partum mastitis; atom-bomb survivors; other x-ray exposures involving the breast, including irradiation in children and in experimental animals; and women who were treated with x rays for acne or hirsuitism. The dose of radiation received by the survivors of the atom bomb who subsequently developed cancer of the breast ranged from 80 to 800 rads, the tuberculous women who were fluoroscoped received an estimated 50 to 6,000 rads, the women who were treated for mastitis probably were exposed to 30 tomore » 700 rads, and the patients with acne received 100 to 6,000 rads. These imprecise estimates are compared with mammographic doses in the range of 10s of rads to the breast at each examination, an imprecise estimate depending on technique and equipment. However imprecise these estimates may be, it is apparent that younger women are more likely than older women to develop cancer from exposure to radiation. It is pointed out that the American Cancer Society advises that women under 35 years should have mammography only for medical indication, not for so-called screening.« less
TL;DR: Imaging of the breasts using 111In‐Blm appears to be as accurate as physical examination and mammography for palpable benign and malignant breast tumors, but axillary imaging does not appear to be worthwhile because many axillary metastases are too small for detection with current nuclear medicine instrumentation.
Abstract: 111Indium-Bleomycin (111In-Blm), a new radiopharmaceutical, was administered intravenously to 37 patients with benign and malignant breast lesions. Early and delayed images of both the breasts and axillae were made, and results were correlated with physical examination, histopathology of the excised lesion, mammography, and thermography. In 18 patients with malignant disease, clinical examination of the breast and axilla correlated with histopathology in 78 and 54% of the cases, respectively. Images of the breast were accurate (true positives) in 83% of the cases. Images of the axilla were accurate in 62% of the cases. Mammography was correct and suggested malignancy in 88%, and thermography in 73% of the cases. In 19 patients with benign breast lesions, clinical examination of the breast and axilla correlated with histopathology in 68 and 95% of the cases, respectively. Scans of the breast and axilla were correct (true negative) 79 and 95% of the time, respectively. Mammography was correct, and suggested benignancy, in 53% and thermography in 25% of the cases. Imaging of the breasts using 111In-Blm appears to be as accurate as physical examination and mammography for palpable benign and malignant breast tumors. It is less accurate than mammography for microscopic malignancies. Axillary imaging does not appear to be worthwhile because many axillary metastases are too small for detection with current nuclear medicine instrumentation.
TL;DR: The cost of diagnosis of early tumours from amongst the larger number of non‐malignant disorders found as a result of public education and population screening is likely to be prohibitive, both economically and emotionally as long as admission to hospital for biopsy and possible immediate mastectomy remains the major diagnostic policy.
Abstract: Breast cancer mortality can be reduced by early detection and treatment, but the cost of diagnosis of early tumours from amongst the larger number of non-malignant disorders found as a result of public education and population screening is likely to be prohibitive, both economically and emotionally, as long as admission to hospital for biopsy and possible immediate mastectomy remains the major diagnostic policy. An alternative policy is proposed for the management of women with breast symptoms, which avoids operation on most patients without cancer and detects the smallest tumours, by means of mammography, fine-needle aspiration biopsy, large-needle biopsy and outpatient open biopsy. Such a policy is likely to provide positive reassurance with the least emotional distress for that majority of women with breast symptoms who do not have malignant disease, and this is likely to lead to more positive behaviour in the community such as regular breast self-examination and the early reporting of breast symptoms. Only women with malignant disease need be admitted to hospital for major breast surgery, thorough preoperative investigation could be confined to this group, and they could receive positive counselling to reduce their emotional stress. Such a policy is likely to be economical of health resources so that all women with breast symptoms and other risk factors could be encouraged to undergo annual examination, and any suspicious findings could be adequately investigated. In this way many more cancers could be detected while still small and curable, and a fall in breast cancer mortality in the community might be expected.
Journal Article•
TL;DR: By detecting breast carcinomas at a sub-clinical stage, the method makes possible early and minimally mutilating treatment with the best chances of cure and will be of assistance in suspecting malignancy on the basis of mammography findings in the majority of cases.
Abstract: On the basis of a series of 60 cases, the authors report their experience of excision of grouped microcalcifications detected at mammography in the absence of any clinical sign. The breast zone in which the microcalcifications were located by the radiologist was removed surgically. Per-operatoire X-ray of the excised specimens using a mammography apparatus confirmed that the microcalcifications had been totally removed. In addition it was useful to locate aceuretaly the calcifications in view of a careful histological examination of the area. The technique led to the discovery of 27 carcinomas at a sub-clinical stage. A classification of the various types of microcalcification was established in relation to histology. It will be of assistance in suspecting malignancy on the basis of mammography findings in the majority of cases. Excision can then be reserved for cases of presumed malignancy or where a doubt exists. By detecting breast carcinomas at a sub-clinical stage, the method makes possible early and minimally mutilating treatment with the best chances of cure.
TL;DR: Rec retrospective analysis indicates further investigation is warranted, one-view mammographic screening is not yet recommended, but little savings in technologist time could be anticipated.
Abstract: Repeated mammographic exposures of asymptomatic women in the screening situation has raised questions regarding possible risks. Obtaining only one view, regardless of imaging technique, would approximately halve the exposure. While retrospective analysis indicates further investigation is warranted, one-view mammographic screening is not yet recommended. The lateral view, including the chest wall, would reduce exposure by approximatley 44% but little savings in technologist time could be anticipated.
TL;DR: The results emphasize the importance of discriminating between nonvisualization of a mass and mammographic recognition of either a benign or malignant tumor and the reliability of interpretation for a visualized lesion than a nonvisualized one.
Abstract: To provide insight into the significance of findings reported from screening asymptomatic women for breast cancer, we reviewed 19,928 mammographic studies with the accompanying physical examination and correlated these findings with 554 breast biopsies. Of 83 breast biopsies with suspicious findings on both physical examination and mammography, 72 demonstrated breast cancer (87%). Of 155 biopsies for suspicious changes on mammography alone, 50 (32%) demonstrated breast cancer. The accuracy of suspicious mammography was independent of findings limited to physical examination, 34 (17%) had breast cancer; 31 were in 152 biopsies of patients with mammography interpreted as normal (20%) and three were in biopsies of 52 patients (6%) in whom a visualized mass was interpreted as benign. One hundred and twelve breast biopsies were performed for changes interpreted as normal or benign. Six malignancies were discovered (5%). No cancer was found in 31 biopsies for nonpalpable benign mammographic abnormalities. Our results emphasize the importance of discriminating between nonvisualization of a mass and mammographic recognition of either a benign or malignant tumor. The reliability of interpretation is considerably greater for a visualized lesion than a nonvisualized one.
TL;DR: Mammography is presented for the primarily nonradiologic audience, with a discussion of the various entities which the radiologist can identify on the mammogram.
Journal Article•
TL;DR: A small amount of a mixture of contrast media and visible dye is injected into the breast precisely ventral to the lesion and the site of injection is marked on the skin.
Abstract: A simple method for the preoperative localization of nonpalpable breast tumours detected by mammography is described. A small amount of a mixture of contrast media and visible dye is injected into the breast precisely ventral to the lesion and the site of injection is marked on the skin. Forty patients have been operated upon and all the tumours were found without difficulty.