scispace - formally typeset
Search or ask a question

Showing papers on "Mammography published in 1977"


Journal ArticleDOI
01 Jun 1977-Cancer
TL;DR: Based on current findings in the HIP study, there appears to be strong support for periodic screening at ages 50 years and over with clinical examination and mammography; to justify screening under 50, new information from other studies is required.
Abstract: Results in the breast cancer screening project of the Health Insurance Plan of Greater New York that started the end of 1963 have been updated through December 31, 1975. The HIP study is a randomized trial designed to test whether periodic screening with clinical examination and mammography results in reduced breast cancer mortality among women aged 40–64 years at the start. Study women were offered screening examinations; 65% appeared for initial examinations and a large majority of these women had at least one of the three additional screenings at annual intervals. The control group of women continued to receive their usual medical care. New data support earlier reported results on benefits. During the nine years following date of entry there were 128 breast cancer deaths in the control group as compared with 91 in the study group (screenees plus refusers). The impact of the screening program continues to be confined to women 50 years of age and over with no benefit at ages 40–49 years. Seven-year case fatality rates show similar relationships. Several issues related to screening benefit are considered. Of major importance is the observation of no reduction among women under 50 in breast cancer mortality. The possibility that under different screening conditions (e.g., with current mammography equipment) a benefit would be found needs to be investigated. There is a clear need for rapidly determining whether a new randomized trial is the only way to answer the question and whether experience in the 27 NCI-ACS demonstration projects can provide useful data. Another critical issue concerns the incremental value of mammography in a screening program. Over an eight-year period after diagnosis, breast cancer cases that were positive only on mammography when screened had a case fatality rate of 14%; this compares with 32% for cases positive only in the clinical examination and 41% for cases positive on both modalities. Excluding mammography would have reduced the benefit of screening by an estimated one-third. With regard to risk associated with screening, it is concluded that the increment in risk resulting from radiation exposure in mammography does not offset the benefits of screening above 50 years of age. Below that age, although the risk increment is small, the risk-benefit balance is negative because of the absence of a demonstrated benefit. Another source of risk is related to the possible increase in biopsies. Assessment of the HIP experience suggests that only timing of biopsies was affected, but the potential for considerable variation if screening is adopted widely exists. Based on current findings in the HIP study, there appears to be strong support for periodic screening at ages 50 years and over with clinical examination and mammography; to justify screening under 50, new information from other studies is required.

515 citations


Journal ArticleDOI
TL;DR: Clinical detection decreased strikingly for lesions with negative lymph nodes, in situ and microinvasive lesions, deeply situated lesions, and lesions where microcalcifications were the sole mammographic finding.
Abstract: Findings by xeromammography and clinical examination were compared in 16,000 self-selected women aged 45-64 who participated in a voluntary breast cancer screening program. A total of 138 malignancies were detected: 108 (78%) by mammography and 78 (57%) by clinical examination. Mammography was more effective for large breasts, fatty breasts, and in older women. Conversely, clinical examination was more effective for small breasts, dense breasts, and retroareolar lesions. Clinical detection decreased strikingly for lesions with negative lymph nodes, in situ and microinvasive lesions, deeply situated lesions, and lesions where microcalcifications were the sole mammographic finding.

138 citations


Journal ArticleDOI
TL;DR: No case can be made at present for screening well women under the age of 50 years, when such screening includes mammography, although it is likely that those women under 50 with the associated “risk factors” are better managed by careful attention to breast self‐examination and more frequent physical examinations.
Abstract: The early diagnosis of breast cancer by screening is a relatively new development in medical practice and its enthusiastic acceptance needs to be tempered by an appraisal of the costs, the risks and the potential benefits. No case can be made at present for screening well women under the age of 50 years, when such screening includes mammography. With the exception of women who have already had cancer in one breast, it is likely that those women under 50 with the associated "risk factors" are better managed by careful attention to breast self-examination and more frequent physical examinations. Provided that the radiation dose is less than one rad per examination, the benefits to women over 50 outweigh the risks of radiation-induced breast cancer. Against this must be placed the very large cost to the community of screening programmes and the relatively low additional benefits gained by incorporation of mammography into the screening process.

108 citations


Journal ArticleDOI
01 Nov 1977-Cancer
TL;DR: Dense fibroglandular tissue delays detection of breast cancer by mammography, and apparent increase in cancer risk in such breasts is due to this delay.
Abstract: Mammography studies, from 1963 through 1972, on 5,918 women over age 30 years with 327 breast cancer on initial studies, were prospectively categorized on a scale of 1 to 4 of increasing amounts of fibroglandular tissue. Approximately 60% of the cancers occurred in classes 1 and 2 breasts, about one-third of the patients, while 40% of the cancer were in the remaining two-thirds, comprising classes 3 and 4. There were 54 cancers that developed in breast that previously were free of symptoms, clinical signs, and x-ray abnormality. Up to 36 months one cancer was found in class 1, while 26 cancers were detected in class 4 breasts; two cancers developed in class 2 and seven in class 3. Cancers developing 38 to 88 months after normal examination had an incidence of 0.23% in combined classes 1 and 2 and an incidence of 0.21% in classes 3 and 4. Dense fibroglandular tissue delays detection of breast cancer by mammography. Apparent increase in cancer risk in such breasts is due to this delay. More than a 3-year follow-up is required to assess the life history of breast cancer by mammography.

106 citations


Journal ArticleDOI
TL;DR: The greatest effectiveness of mammography vs. clinical examination was seen in detection of early breast cancers (small lesions with negative axillary lymph nodes), and thermography was less effective than it was in patients with larger lesions and lymph node metastases.
Abstract: Breast cancer screening detected 139 biopsy-proved malignancies in 16,000 slef-selected women (8.7/1,000). In these, xeroradiography detected 78% (109), clinical examination 55% (76), and thermography 39% (54). In all 16,000 women, the thermogram was interpreted as positive in 17.9% (2,864). The greatest effectiveness of mammography vs. clinical examination was seen in detection of early breast cancers (small lesions with negative axillary lymph nodes). In this group, thermography was less effective than it was in patients with larger lesions and lymph node metastases.

83 citations


Journal ArticleDOI
01 Oct 1977-Cancer
TL;DR: Biopsy of the contralateral breast at the time of initial mastectomy has detected a significant number of minimal breast cancers, most being detected before diagnosis was possible by careful physical examination or adequate mammographic examination.
Abstract: The bilateral nature of breast cancer is becoming increasingly evident. Recently 455 patients treated by the extended radical mastectomy more than 10 years ago were reviewed. Nine percent of the original patients had developed a clinically apparent cancer in the second breast within that time interval; this corresponds to 15% of the surviving patients. Since the stage of disease at the time of primary surgical therapy is the most important prognostic factor, it is imperative to detect these lesions as early as possible when they are most apt to be localized to the breast. Although some simultaneous, second primary breast cancers can be diagnosed clinically or by mammography, the great majority are not detected by these methods at the time of primary therapy of the dominant primary cancer. We have performed contralateral breast biopsy at the time of primary surgery for a known breast cancer in one breast routinely for the last 12 years. Twelve and one half percent of the contralateral breasts biopsied contain carcinoma, most at the “minimal” stage. A total of 954 biopsies were performed in 1204 patients. In 28 cases, carcinoma was suspected in the second breast on the basis of positive preoperative physical and/or mammographic findings. Twenty of these lesions proved to be infiltrating cancers, two non-infiltrating cancers, and six were benign. In 625 patients, equivocal thickenings or densifications were noted in the opposite breast; 74 carcinomas were found in these breasts after biopsy of the dominant thickening, with 30 infiltrating and 44 noninfiltrating cancers. In 301 patients, no abnormal findings were noted in the opposite breast, either by mammogram or physical examination. Twenty-three cancers were detected in this group by contralateral biopsy, five infiltrating and 18 noninfiltrating. This gives a total of 119 cancers found in the second breast by 954 biopsies in 1204 patients: 12.5% simultaneous bilateral breast cancer in the patients whose second breast were biopsied, and 10% simultaneous bilateral breast cancer in the overall group. Furthermore, 10% of the benign biopsies of the second breast demonstrated atypical ductal or lobular hyperplasia, a precancerous lesion. Further follow up of these patients at 6 years demonstrates on 8.8% incidence of subsequent development of breast cancer. Biopsy of the contralateral breast at the time of initial mastectomy has detected a significant number of minimal breast cancers, most being detected before diagnosis was possible by careful physical examination or adequate mammographic examination. The technique of contralateral breast biopsy is described; when a suspicious area or dominant thickening is present in the second breast, this is excised widely. Otherwise, in the absence of any specific finding, a large segment of breast tissue, including 20 to 25% of the breast parenchyma, is excised from the tail of the breast, as well as the mirror image location of the dominant cancer, in order to afford sufficient material for adequate histopathologic examination. When bilateral breast cancers are diagnosed by positive preoperative physical or mammographic signs, the second primary lesion is not at a particularly early stage of development; 20 of 22 cancers found were infiltrating and 45% of them had positive axillary nodes. However, the occult cancer found by contralateral biopsy in the absence of positve preoperative findings were almost universally at a “minimal” stage: 60% noninfiltrating cancer, and only 8.5% of the infiltrating cancers had positive axillary nodes, usually of a minimal degree. Contralateral breast biopsy at the time of mastectomy for a known cancer represents an additional method for the early detection of carcinoma in a very high risk group.

77 citations




Journal ArticleDOI
01 Jun 1977-Cancer
TL;DR: Breast cancer screening programs have been improved significantly since criticisms were first publicized in mid‐1975, and future improvements should further define the optimum design and application of breast cancer Screening programs.
Abstract: Health benefits and risks of breast cancer screening programs have been both criticized and defended. This paper summarizes and evaluates those arguments, discusses changes that have already occurred, and looks at prospects for further improvement. Early detection of breast cancer can undoubtedly reduce mortality. X-ray mammography also undoubtedly carries a risk of causing breast cancer at some future time. Both benefits and risks can be estimated. In terms of breast cancer mortality, adding mammography to a program of annual breast examinations of average U.S. women is questionable for women under age 55 but likely to be beneficial for older women. However, the break-even point is closely related to the average radiation exposure of breast tissue, and might be as early as age 50 in a few centers now using optimum techniques and equipment. For women with below-average risks of breast cancer the age would be higher, and for a few women with a high probability of developing breast cancer it would be lower. The break-even point should be significantly exceeded before mammographic screening becomes worth the time, trouble, and other costs. Breast cancer screening programs have been improved significantly since criticisms were first publicized in mid-1975. Partial improvements include reduction in radiation exposure (at least in some centers), guidelines from the National Cancer Institute (NCI) and the American Cancer Society (ACS) for restricting the screening of women under 50, and changes in the patient consent form signed by screenees in the NCI-ACS program. There has been a rapid and marked increase in both professional and public awareness of the need to balance the benefits of screening with its risks and costs. Future improvements should further define the optimum design and application of breast cancer screening programs.

57 citations


Journal ArticleDOI
TL;DR: CT may be capable of diagnosing early cancer or a precancerous lesion in women with dysplastic breasts or patients who have had radiation therapy or surgery, whereas some of these lesions cannot be diagnosed by mammography because the breast is too dense.
Abstract: Initial studies indicate that computed tomography can detect both benign and malignant breast disease in both fatty and dense, thick breasts. CT may also be capable of diagnosing early cancer or a precancerous lesion in women with dysplastic breasts or patients who have had radiation therapy or surgery, whereas some of these lesions cannot be diagnosed by mammography because the breast is too dense.

55 citations


Journal ArticleDOI
01 Jun 1977-Cancer
TL;DR: The present state of the art would indicate that the risk, if any, is minimal as contrasted with the natural incidence of breast cancer and the results of early diagnosis and treatment.
Abstract: Various biophysical methods have been utilized in the diagnosis of breast cancer. To date the best results have been obtained with x-ray mammography. Ultrasound and thermography have great appeal as non-destructive techniques but, in the present state of development, are of limited use. The spatial resolution presently obtainable in ultrasonograms is inadequate for the detection of subclinical cancer and thermography is also of questionable reliability. While an overall true positive rate of 70% to 75% may be anticipated with thermography, the bulk of false negatives would seem to occur in those tumors most amenable to therapy, i.e., subclinical cancers. The "false positive" rate of thermography is also excessive, but would be acceptable for establishing a high risk group if true positive rates could be improved. At present thermography finds its greatest use as an adjunct to mammography and physical examination; it should not be used as the sole modality in a screening program. The efficacy of mammography can be readily demonstrated but the propriety of its use as a screening device has been questioned. This is primarily related to the possible carcinogenic effect of radiation at diagnostic levels. Although the carcinogenic effect is unproven, the dose in radiologic procedures should be kept to a minimum consistent with adequate images. The present state of the art would indicate that the risk, if any, is minimal as contrasted with the natural incidence of breast cancer and the results of early diagnosis and treatment.

Journal ArticleDOI
07 Mar 1977-JAMA
TL;DR: The method of discovery of breast tumors in young women was determined for 106 patients less than 45 years of age treated for breast cancer from 1967 through 1975, with a report of a normal roentgonogram contributing to a decision to defer surgical treatment in 15 instances.
Abstract: The method of discovery of breast tumors in young women was determined for 106 patients less than 45 years of age treated for breast cancer from 1967 through 1975. The patients detected 84% of the tumors themselves. Physical examinations by physicians detected 14% of the tumors. Two percent were noted on mammography in the absence of clinical findings. Fifty-two patients had roentgenographic examination of their breasts prior to biopsy. Sixty-three percent of these examinations failed to demonstrate the cancer. The report of a normal roentgenogram contributed to a decision to defer surgical treatment in 15 instances. These 15 patients had more advanced tumors at operation. ( JAMA 237:967-969, 1977)

Journal ArticleDOI
Gary H. Glover1
TL;DR: Two-dimensional velocity distributions in tomographic slices transaxial to the breast are reconstructed from transmission time-of-flight projections to explore the possibility of differential diagnosis of pathologies on the basis of velocity.
Abstract: A new approach to ultrasonic breast imaging is reported. Two-dimensional velocity distributions in tomographic slices transaxial to the breast are reconstructed from transmission time-of-flight projections. The data are displayed both as video images and in numeric format. Results of a clinical investigation in which both malignant and benign lesions have been observed are presented. The possibility of differential diagnosis of pathologies on the basis of velocity is discussed.

Journal ArticleDOI
TL;DR: The combined mammographic-sonographic evaluation of breast masses was more accurate than either method alone and helpful in differentiating between diffuse and discrete lesions.
Abstract: Palpable breast masses which have a nondiagnostic appearance on the mammogram often require a biopsy to rule out malignancy. Contact B-scan ultrasonography of such masses were performed in an effort to improve the diagnostic accuracy of mammography and reduce the number of unnecessary biopsies. A total of 200 patients with breast masses of 1-8 cm were examined by both methods. The results of this combined evaluation were compared to those of mammography alone. Of 115 pathologically proven lesions, 44 were fluid-filled cysts. Sonography correctly diagnosed all 44 cysts, while mammography was equivocal in 27 (61%) of them. Of the remaining 71 solid masses, 38 were benign and 33 malignant. Mammography alone correctly diagnosed 31 carcinomas (94%), whereas sonography correctly diagnosed 26 (78.8%). While the infiltrating carcinomas have a typical sonographic appearance, circumscribed carcinomas may have the same sonographic features as fibroadenomas; the value of sonography here was to establish whether the m...

Journal ArticleDOI
TL;DR: Relationship between these findings and epidemiology of breast cancer are discussed and suggestions made for utilizing parenchymal patterns to guide examination frequency.
Abstract: An investigation of the relationship between breast parenchymal patterns and breast cancer prevalence in a large referral population is presented. Mammograms were assigned to one of four categories according to our interpretation of Wolfe's classification. Cancer prevalence for the four patterns was similar when uncorrected for age,, and was very high compared to that in the general population. Under age 50, the prominent duct pattern (P2) was associated with a very high relative cancer risk and DY carried a smaller increased risk. After age 50, prevalences for the patterns were nearly equal. Relationship between these findings and epidemiology of breast cancer are discussed and suggestions made for utilizing parenchymal patterns to guide examination frequency.

Journal ArticleDOI
TL;DR: Clinical study revealed that the superior magnification image is useful in distinguishing malignant from benign breast disease, in selected cases.
Abstract: Direct radiographic magnification (1.5 ×) of the breast with a microfocus x-ray tube was compared with conventional contact mammography. Measurements of modulation transfer functions, Wiener spectra, scattered radiation, and dosimetry permitted quantitative comparisons of resolution, noise, contrast, and patient exposure. Images of surgical specimens of the breast, and the breasts of 125 patients, were qualitatively compared. Magnification images were superior (increased resolution, reduced noise) to conventional mammography images, at the expense of increased radiation dose. Clinical study revealed that the superior magnification image is useful in distinguishing malignant from benign breast disease, in selected cases.

Journal Article
TL;DR: The purpose of this paper is to report the extant observations at the Ellis Fischel State Cancer Hospital-Cancer Research Center and in the literature on the gross rates of growth of human mammary cancer as measured for primary cancers in the breast by mammography and for metastatic cancer in the skin and lymph nodes by direct measurements.
Abstract: Summary The purpose of this paper is to report the extant observations at the Ellis Fischel State Cancer Hospital-Cancer Research Center and in the literature on the gross rates of growth of human mammary cancer as measured for primary cancers in the breast by mammography and for metastatic cancer in the skin and lymph nodes by direct measurements. From these measurements, the gross or net rates of growth for the cancers have been calculated and reported as actual doubling times. Cytokinetic variables contribute to the observed growth, and the data are used to estimate the potential acuteness or chronicity of breast cancer.

Journal ArticleDOI
TL;DR: It was found that 27 cases were visible in the oblique view only at mammography, and it would seem reasonable to include this view in a standard diagnostic mammography.
Abstract: On review of 392 cases of mammary carcinoma it was found that 27 cases were visible in the oblique view only at mammography. It would seem reasonable to include this view in a standard diagnostic mammography.

Journal Article
TL;DR: A benign chondrolipomatous breast tumor occurred in a 66-year-old woman and was composed of benign mature fibrous stroma, fat, breast ducts, and islands of mature cartilage.
Abstract: A benign chondrolipomatous breast tumor occurred in a 66-year-old woman. The preoperative diagnosis, based on mammography and xeroradiography, was fibroadenoma. Grossly, the demarcated lesion resembled a fibroadenoma with islands of cartilage projecting from its cut surface. Histologically, it was composed of benign mature fibrous stroma, fat, breast ducts, and islands of mature cartilage. Most cartilage-containing tumors of the human breast are associated with primary mammary malignant neoplasms. A few of the benign cartilage-containing tumors reported in the literature are discussed. The last case was published in 1909.

Journal ArticleDOI
TL;DR: Evidence that significant numbers of breast cancers are found in this age period on the basis of x-ray examination alone is presented, and mammography is recommended as a tool for diagnosis of nonpalpable carcinomas of the breast.
Abstract: Controversy surrounds the use of mammography in asymptomatic women 35–49 years of age. There is agreement that routine mammography is useful beyond 50 years. By extrapolating data from relatively high radiation exposures, a radiation carcinogenic risk at diagnostic levels has been calculated by some workers. Benefit for asymptomatic women in the 35–49 year age group has been questioned. This paper presents evidence that significant numbers of breast cancers are found in this age period on the basis of x-ray examination alone. Data also indicate absorbed dose from modern-day mammography is half to one quarter of that previously assumed. Based on these data, mammography is recommended as a tool for diagnosis of nonpalpable carcinomas of the breast.

Journal ArticleDOI
TL;DR: Percutaneous needle localisation is reported, being the first to report difficulty with a localisation technique and will analyse possible reasons.

Journal ArticleDOI
21 Feb 1977-JAMA
TL;DR: It is prudent to regard the carcinogenic effect of radiation on the breast as proportional to dose without a threshold, and Mammography in young women should be ordered only selectively, not for screening.
Abstract: This communication reports cases of 16 women in whom cancer of the breast developed after radiation therapy for acne or hirsutism, suggesting another group at higher risk than is generally expected for cancer of the breast. It is prudent to regard the carcinogenic effect of radiation on the breast as proportional to dose without a threshold. Mammography in young women should be ordered only selectively, not for screening. ( JAMA 237:789-790, 1977)

Journal ArticleDOI
TL;DR: Tentative conclusions are that starting screening at age 40 has little advantage over starting at age 50, while there is some advantage to a screening interval of 12 months rather than 24 months.
Abstract: A steady state mathematical analysis of periodic mass screening programs to detect chronic diseases is extended to the transient state. One can now calculate the screening effectiveness, the number of cases, both discovered and undiscovered, and the extent of disease in these cases at any time after the screening program is started. A previously developed mathematical model for the growth and spread of human breast cancer is joined with this screening model to evaluate alternative screening strategies for breast cancer in large populations of asymptotic women. The screening effectiveness is calculated for examinations with different levels of detection sensitivity, for different intervals between examinations, and for different ages when screening begins. Tentative conclusions are that starting screening at age 40 has little advantage over starting at age 50, while there is some advantage to a screening interval of 12 months rather than 24 months.

Journal ArticleDOI
TL;DR: In this article, the authors introduced an additional aspect in the consideration of benefit vs risk, the interval cancer, which reduced the accuracy of mammography and physical examination by trained nurses in screening for breast cancer to 73%.
Abstract: Mammography is of real assistance to the surgeon in evaluating breast problems not associated with a breast mass. Use of mammography in the detection of early breast cancer in breast demonstration projects has brought forth the time honored value judgement of benefit vs risk. This report introduces an additional aspect in the consideration of benefit vs risk, the interval cancer. From the demonstration project at KUMC, 326 biopsies were performed and 65 proved to be cancer. However, 24 additional women developed cancer before their next recommended screening date. This reduces the accuracy of mammography and physical examination by trained nurses in screening for breast cancer to 73%.

Journal Article
TL;DR: Any suspicion of malignancy, either on cytologic clinical or mammography examinations, must be further investigated by means of biopsy, and evidence of necrosis, even without other cytologic evidence of malignment, has proved coincidental with mammary cancer.
Abstract: 1. Two hundred and twenty-two cases of cytologic breast specimens were correlated with clinical and radiological findings. 2. False negative and no-cell incidence were respectively 2.7 and 2.2 per cent. 3. By means of a thorough clinical and radiological approach the cytologic failures (misdiagnosed and acellular smears) could be corrected: no cancer escaped diagnosis. 4. Cytology diagnosed three clinical and radiological undetected breast cancers, an incidence of 1.3 per cent. 5. Any suspicion of malignancy, either on cytologic clinical or mammography examinations, must be further investigated by means of biopsy. 6. In our experience, evidence of necrosis, even without other cytologic evidence of malignancy, has proved coincidental with mammary cancer.

01 Mar 1977
TL;DR: An initial report of the first clinical study using computerized tomographic mammography (CTM) and conventional mammographic techniques in patients who subsequently undergo breast biopsy, and the experience with 160 breast lesions found in Patients who were examined using CTM without contrast material.
Abstract: This is an initial report of the first clinical study using computerized tomographic mammography (CTM). A study is being conducted comparing CTM and conventional mammographic techniques in patients who subsequently undergo breast biopsy. This report analyzes the experience with 160 breast lesions found in patients who were examined using CTM without contrast material. One hundred lesions were benign and 60 were malignant. Mammography correctly identified 54 of the malignant lesions while CTM identified 41. Five lesions were missed by both modalities. The report also analyzes results experienced with 79 lesions found in patients who were examined with CTM both before and after the intravenous injection of contrast material. Forty-six of these lesions were benign and 33 were malignant. Mammography correctly identified 28 of the malignant lesions while CTM identified 27. Only one lesion was missed by both modalities. It is planned to continue this study, especially to enlarge our experience with the use of contrast material in breast scanning.


Journal Article
TL;DR: The hypothesis that two of four mammographic patterns show a marked predisposition to develop breast cancer was examined in a retrospective study and the conclusion of Wolfe was not supported.
Abstract: The hypothesis that two of four mammographic patterns show a marked predisposition to develop breast cancer was examined in a retrospective study Four hundred patients with breast carcinoma were randomly chosen The xeromammograms of the opposite breasts in these patients had been done and were studied The conclusion of Wolfe was not supported by our findings

Journal ArticleDOI
TL;DR: Among patients undergoing mammography at a hospital in Detroit, Michigan, the prevalence of breast cancer was higher in women receiving thyroid hormone therapy than in those who were not receiving treatment for breast cancer.
Abstract: Excerpt Among patients undergoing mammography at a hospital in Detroit, Michigan, the prevalence of breast cancer was higher in women receiving thyroid hormone therapy than in those who were not (1...