Showing papers on "Mammography published in 1989"

Screening for breast cancer.

Abstract: There is very good evidence that screening for breast cancer reduces mortality in women older than 50 years and suggestive but inconsistent evidence that screening is effective in reducing long-term mortality in women younger than 50 years. The probability that an average-risk woman will be diagnosed with breast cancer in the coming 10 years is about 130 in 10,000 for a 40-year-old woman, 230 in 10,000 for a 55-year-old woman, and 280 in 10,000 for a 65-year-old woman. The chance of dying from breast cancer diagnosed in the coming 10 years is about 90 in 10,000, 123 in 10,000, and 120 in 10,000 for women age 40, 55, and 65, respectively. Mathematical models based on data from controlled trials of screening programs indicate that screening annually for 10 years with breast physical examination will decrease the probability of death from breast cancer by about 25 in 10,000 for women in the three age groups and increase life expectancy by about 20 days. Adding annual mammography will decrease the probability of death from breast cancer an additional 25 in 10,000 and increase life expectancy an additional 20 days. The actual reductions in mortality observed in controlled trials are slightly lower. If women are screened annually for 10 years with breast physical examination and mammography, the chance for a false-positive result over the 10-year period is approximately 2500 in 10,000. On the population level, if 25% of women age 40 to 75 are screened annually with both examinations, deaths from breast cancer would be decreased by about 4000 in the year 2000. Net annual costs would be approximately $1.3 billion. Recommending a screening strategy requires weighing the benefits against the risks and costs.

Clinically occult ductal carcinoma in situ detected with mammography: analysis of 100 cases with radiologic-pathologic correlation.

Abstract: One hundred consecutive cases of clinically occult ductal carcinoma in situ (DCIS) detected with mammography were retrospectively analyzed to determine the spectrum of mammographic appearances and to study pathologic correlations. Seventy-two percent of the lesions appeared as microcalcifications, 10% as soft-tissue abnormalities, and 12% as a combination of the two. Six percent of lesions were found incidentally in the biopsy specimen. On the basis of mammographic measurements, 22% of the lesions were 5 mm or smaller, and 75% were 20 mm or smaller. Thirty-five percent of the microcalcification clusters were categorized as predominantly casts (linear), 52% as granular, and 13% as granular with several casts. Related pathologic features included the location of the tumor within the ductal system, pattern of growth (histologic subtype), amount and distribution of calcium formation, and presence or absence of reactive changes. Women aged 49 years or less with DCIS were more likely to have microcalcifications and less likely to have a soft-tissue mass than women aged 50 years or more (P = .04). The authors conclude that there is a wide spectrum of mammographic appearances of clinically occult DCIS.

Why women resist screening mammography: patient-related barriers.

Abstract: Mammography utilization remains below the level needed to achieve the National Cancer Institute's year-2000 goals for reducing breast cancer mortality by 50%. Previous research has identified both patient and physician barriers. The authors interviewed 600 randomly selected women who were offered a free mammographic examination. Interviews were conducted by professional interviewers using a brief, structured questionnaire. Data were analyzed with chi 2 Wilcoxon and Kruskal-Wallis rank-sum statistics and discriminant analysis. Noncompliant subjects reported more barriers than compliant subjects. The former were more likely to believe that mammography is unnecessary in the absence of symptoms and that it is inconvenient. In both the bivariate and multivariate analyses, the woman's belief that her doctor believes in regular mammography was an important predictor of compliance.

Ductal carcinoma in situ: mammographic findings and clinical implications.

Abstract: Mammograms, specimen radiographs, and pathology reports of 51 women with ductal cancer in situ (DCIS) in 54 breasts were retrospectively analyzed. Reason for presentation was known for 44 women, including six with symptoms due to DCIS and 16 who either had been previously treated for or had (contralateral) breast cancer. Mammographic patterns of DCIS were microcalcifications in 37 of 54 (68%) lesions and calcifications within a mass in 16 (30%). Multifocal DCIS, evidenced radiographically by patterns of more than one mass, more than one cluster of microcalcifications, or parallel linear, irregular intraductal calcifications, was seen in 35 of 54 (65%) breasts but only on specimen radiographs in four of these. In 22 (41%) lesions maximum tumor expanse was greater than 2.5 cm, and all were multicentric. Multicentricity of tumor and tumor size greater than 2.5 cm may indicate need for therapies more radical than simple excision. Breast irradiation has been shown to significantly diminish recurrence rates in these patients. Mammography and specimen radiography with magnification may be appropriate in these cases to identify all possible tumor sites in the involved breast.

Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients.

Abstract: The axillary node status is important in the prognosis of breast cancer. To evaluate the accuracy of various preoperative examination methods in detecting metastatic axillary lymph nodes, we compared the findings of clinical examination, axillary ultrasonography, and axillary mammography of 41 breast cancer patients who underwent axillary dissection and histological examination. The sensitivity was 72.7% for ultrasonography, 38.9% for axillary mammography, and 32.3% for clinical examination. Ultrasonography provides good information about the axillary nodal status. The specificity can be increased by fine-needle biopsy under ultrasound guidance.

Nonpalpable breast tumors: diagnosis with stereotaxic localization and fine-needle aspiration.

Abstract: Modern mammography is the most effective means of detecting nonpalpable breast cancers, but correct diagnosis for malignancy is made in only 20%-30% of the cases. The conventional method of lesion localization usually results in approximate placement of the hookwire in the breast. The authors report the results of stereotaxic localization, combined with fine-needle aspiration and cytologic study, performed in 528 cases. Clinically occult breast lesions were localized precisely (within 2 mm 96% of the time), sampled by means of a 23-gauge needle, and marked with either methylene blue or a hookwire for subsequent open excisional biopsy. The results indicate a sensitivity of 95%, specificity of 91%, and accuracy of 92% for the fine-needle aspiration procedure. This technique offers a significantly improved preoperative method of diagnosing small breast lesions with minimal pain, no complications, reduced cost, and no disfigurement or scar interfering with subsequent mammographic follow-up.

Mammographic parenchymal patterns as indicators of breast cancer risk

Abstract: Mammographic parenchymal patterns have been suggested as indicators of breast cancer risk. However, few well-controlled studies have used prediagnostic mammograms to determine the pattern classification. The authors studied 266 cases of breast cancer and 301 controls from 25 screening centers of the Breast Cancer Detection and Demonstration Project, a nationwide screening program conducted between 1973 and 1980 to evaluate the risk associated with mammographic patterns using mammograms taken four years before the detection of breast cancer. Mammograms of the cancerous breast of cases and of the ipsilateral breast in the control matched to each case were blindly assessed by one of the investigators (J.N.W.), originator of the mammographic pattern classification. The breast cancer odds ratio among women with the combined P2 + DY patterns, compared with women with the N1 pattern, was 2.8 (95% confidence interval (CI): 1.6-5.1). This estimate of relative risk was comparable with the risk associated with other recognized breast cancer risk factors. The odds ratio among P2 + DY women with a first-degree family history of breast cancer was 5.5 (95% CI: 2.6-11.8) compared with N1 women without a family history. These data provide additional evidence that mammographic patterns are indicators for subsequent development of breast cancer, particularly among women with a first-degree family history of this malignancy.

Calcium oxalate crystals in breast biopsies. An overlooked form of microcalcification associated with benign breast disease.

Abstract: Two distinct forms of microcalcification are found in breast disease. The more commonly recognized type is basophilic and nonbirefringent and consists predominantly of calcium phosphates (type II). The other type is a birefringent, colorless crystal that is composed of calcium oxalate (type I). It has not been emphasized in the literature that calcium oxalate can produce radiopacities and yet is easily overlooked in tissue sections. In this study, histologic sections taken from 127 randomly selected, mammographically directed biopsies were reviewed and the presence or absence of microcalcifications, the type of microcalcification, and the associated disease process were noted in each case. Seventy-eight of the 127 specimens were obtained because of suspicious calcifications detected by mammography and 9 (11.5%) contained only type I microcalifications, 9 (11.5%) contained both types I and II microcalcifications, and 48 (61.5%) contained only type II microcalcifications; in 12 specimens (15.4%), microcalcifications were not identified. The overall incidence of type I calcifications was 17.3% (22/127), but the incidence in those specimens obtained because of calcifications detected by mammography was 23.1% (18/78). Type I microcalcifications were found only in benign cysts and were not associated with carcinoma or epithelial hyperplasia, whereas type II microcalcifications were associated with benign or malignant lesions. These findings are in keeping with the hypothesis that type I microcalcifications are a product of secretion whereas type II microcalcifications are a result of cellular degeneration or necrosis. In biopsies in which type II microcalcifications are not identified, examination of sections under polarized light may reveal the presence of calcium oxalate crystals.

Nonpalpable breast lesions: stereotaxic fine-needle aspiration cytology

Abstract: The authors reviewed the accuracy of stereotaxic fine-needle aspiration cytology in prediction of the presence of cancer. Seventy-four nonpalpable breast cancers and 144 benign lesions were studied. The rate of obtaining an inadequate sample was 8.1% for cancers and 20.8% for benign lesions. None of the cytology reports were false-positive, whereas the accuracy of cytologic atypia in prediction of cancer was 72%. Sensitivity and specificity after 1 year of follow-up were 83.8% and 96.6%, respectively, with atypia reports being assumed positive. In patients strongly suspected of having cancer at mammography, the decision to perform biopsy must be independent of the cytologic report, as false-negative cytologic findings are expected. In patients with a low suspicion at mammography, abnormal cytologic findings were the determining factor for a request for biopsy of six cancers and of two benign lesions. Negative cytologic results contributed to the recommendation of follow-up of two lesions that turned out t...

Evaluation of Overdiagnosis of Breast Cancer in Screening with Mammography: Results of the Nijmegen Programme

Abstract: After 12 years of screening for breast cancer in Nijmegen (1975-86), during which period six mammographic examination rounds were carried out, the extent of overdiagnosis was evaluated. Overdiagnosis is defined as a histologically established diagnosis of invasive or intraductal breast cancer that would never have developed into a clinically manifest tumour during the patient's normal life expectancy if no screening examination had been carried out. The whole 12-year period shows an excess of 11% of breast cancer cases in Nijmegen, compared with the neighbouring city of Arnhem, where no mass screening was performed. The incidence of breast cancers in Nijmegen in the period 1975-78 is higher, compared with the incidence rates in Arnhem; the rate ratio is 1.30. For the time-intervals 1979-82 and 1983-86 the rate ratios are 1.03 and 1.01 respectively with (0.89; 1.18) and (0.86; 1.16) as 95% confidence intervals. This leads to the conclusion that there is no evidence that screening programmes using modern mammography constitute a significant risk for overdiagnosis of breast cancers.

In situ carcinoma of the breast.

Abstract: The optimal management of ductal carcinoma in situ of the breast is controversial. With the introduction of the National Mammographic Breast Screening Programme the condition will be encountered more frequently. We have reviewed 76 patients from a 12-year period treated by one surgeon (R.W.B.) at the Nottingham City Hospital. Fifty-nine patients had either ductal carcinoma in situ or lobular carcinoma in situ; 17 patients had Paget's disease. The mean age at diagnosis was 54 years and the commonest mode of presentation was with a palpable breast lump. Pre-operative mammography was performed in 31 patients with ductal carcinoma in situ and 28 were reported as showing malignancy. Patients with a lesion in the breast parenchyma were treated either by mastectomy (simple, subcutaneous or 'wedge'--see text) or by lumpectomy and radiotherapy. Patients with Paget's disease were treated by simple mastectomy, wedge mastectomy or a cone excision of the nipple and underlying tissue. The mean follow-up period was 65 months. Patients treated by any of the procedures less than simple mastectomy had a significant chance of developing local recurrence. A detailed histological review was made and grade, microinvasion, calcification, necrosis and completeness of excision were assessed for each tumour. None of these factors was correlated with subsequent local recurrence.

Medullary carcinoma of the breast: mammographic and US appearance.

Abstract: Medullary carcinoma of the breast is an uncommon tumor, which may mimic a benign mass at both mammography and ultrasonography (US). A total of 24 medullary carcinomas visible at mammography appeared as round or oval, noncalcified masses with varying degrees of marginal lobulation. In six of the 24 patients, US demonstrated well-defined masses with an inhomogeneous, hypoechoic texture. There was no attenuation of sound, and all lesions showed enhanced through transmission.

Nonpalpable breast lesions: diagnosis with slightly overpenetrated screen-film mammography and hook wire-directed biopsy in 1,014 cases.

Abstract: Slightly overpenetrated screen-film mammography and hook wire-directed localization were used in 1,014 breast biopsies performed for nonpalpable, mammographically detected breast abnormalities. One lymphoma and 205 breast cancers (20%) were found; 115 breast cancers (56%) were noninvasive, and 90 (44%) were invasive. Mastectomy was performed in 69 breast cancers (34%); 136 (66%) were treated conservatively, 28 with biopsy only and 108 with lumpectomy, node dissection, and radiation therapy. All patients with noninvasive breast cancers treated with axillary dissection had uninvolved lymph nodes. Of the 90 invasive breast cancers, six (7%) had metastases to axillary nodes, which, to the authors' knowledge, is lower than percentages reported in other studies of wire-directed breast biopsies. The authors believe that the slightly overpenetrated technique is a valuable adjunct to screen-film mammography.

Breast cancer risk and participation in mammographic screening.

Abstract: Within the context of an organized breast cancer screening program we conducted a prospective evaluation of the relation between breast cancer risk and participation in mammographic screening. The influence on participation of known breast cancer risk factors, as well as a summary risk label, (i.e. "high", or "moderate") were examined. The overall participation rate was 71 percent among 2,422 women, 50 to 79 years of age, invited to a centralized clinic. Multivariate analyses showed participation to be somewhat decreased among women with late menopause and definitely increased among women with any of the following factors: 1) increased age; 2) a family history of breast cancer; and 3) a previous breast biopsy. Women in the high-risk group were most likely to participate but the effect of the label was stronger among women ages 50 to 59 compared to women ages 60 to 79. The study results are generally consistent with previous findings that participants in screening programs have higher rates of breast cancer. The results also suggest the possibility that providing breast cancer risk information may encourage participation in screening.

Low-cost screening mammography: report on finances and review of 21,716 consecutive cases.

Abstract: A review of the results of 21,716 mammograms obtained at a low-cost screening center is presented, along with a report on the finances of that center. A total of 142 cancers were discovered, 12 of which gave false-negative results at mammography. The sensitivity was 91.5% and the specificity 90%. The positive predictive value for lesions categorized as "suspicious for malignancy" was 54%. Thirty-one percent of the cancers were "minimal," in other words, in situ or less than 1 cm in diameter and with no tumor-positive lymph nodes. An average of 42 examinations were performed each day at a cost of +28 each. Nonphysician expenses were +16 for each examination, leaving +12 per examination as professional revenue. This project demonstrates that high-quality, low-cost screening mammography can be provided if the volume is adequate and if there is sufficient attention to detail.

Improving the utilization of screening mammography in primary care practices.

Abstract: • Screening mammography is underutilized in many primary care practices. We designed a prospective, controlled trial to evaluate two strategies for improving the utilization of mammography in an academic general medicine clinic. We assigned teams of house officers to (1) physician audit with periodic feedback, (2) a visit-based strategy directed at both patient and physician, or (3) a no intervention concurrent control arm. After 6 months, the percentage of 50- to 74-year-old women meeting the standard of an annual mammogram was 36% for patients in the control arm, 62% for patients of feedback residents, and 54% for patients of the arm receiving the visit-based strategy. Patients of female providers were slightly more likely to meet the standard, but no effects were detected for patient race, new as opposed to follow-up patient, or higher frequency of clinic visits. We conclude that audit with feedback and a new visit-based strategy of a patient cue associated with a simplification of the ordering process each greatly improved the rate of utilization of screening mammography. Practitioners could reasonably choose the strategy most suited to their own situation. (Arch Intern Med. 1989;149:2087-2092)

Asymmetric breast tissue.

Abstract: A prospective study was undertaken to evaluate the significance of asymmetric breast tissue (asymmetric volume of breast tissue, asymmetrically dense breast tissue with preserved architecture, or asymmetrically prominent ducts) on mammograms. Of 8,408 mammograms obtained in 1985, 221 (3%) demonstrated asymmetric breast tissue. Follow-up was 36-42 months after the initial mammographic study. During this time none of the patients underwent biopsy on the basis of mammographic findings, although 20 underwent excisional biopsy because of clinical findings. Breast cancer was diagnosed in two patients and breast lymphoma in one patient. Biopsy specimens from the remaining 17 patients were benign. At mammography, all three malignant lesions had a palpable abnormality associated with the asymmetric tissue. Breast cancer was not found in any of the remaining 201 patients. Therefore, an asymmetric volume of breast tissue, asymmetrically dense breast tissue, or asymmetrically prominent ducts that do not form a mass, do not contain microcalcifications, or do not produce architectural distortion should be viewed with concern only when associated with a palpable asymmetry and are otherwise normal variations.

Effects of age, education, and physician advice on utilization of screening mammography.

Abstract: We investigated the utilization of mammography as a screening test for breast cancer in a middle-income Connecticut suburban community of 30,000 people. The sampling frame was community-dwelling women aged 30 years and over who had telephones. Random digit telephone survey methods were used to identify a sample of 470 eligible subjects. Of those eligible to be included, 350 or 74.4% completed the interview. Analysis of data from the 171 respondents aged 50 years or greater indicated that women aged 65-80 years had a significantly lower rate of screening mammography than did women aged 50-64 years (means 2 = 6.6, P = .01). When further analysis was done to take into account the effects of education and of income on these rates, the association of age with mammography utilization was no longer statistically significant. Among women who recalled their physician advising a mammogram, 88% had had one performed. Among women who could not recall their physician advising a mammogram, 7% had had one. The impact of physician advice was statistically significant (means 2 = 110.3, P less than .001). Physicians recommended screening mammography less for patients with low level of education (means 2 = 21.6, P less than .001), low income (X2 = 7.8, df = 2, P = .02) and greater age (means 2 = 14.2, P = .003). We conclude that utilization of screening mammography in the community studied is related more strongly to education and to income than to age. The bivariate association of mammography utilization with age may be attributable to a cohort effect, rather than an age effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitudes, beliefs, and knowledge about mammography among women over forty years of age.

Abstract: In this study, the relative impact of health beliefs and physician request in predicting previous mammography experience among women over age 40 was examined. Responses from a sample of 201 women were analyzed using multiple regression techniques. The variable that accounted for the largest proportion (56%) of variance between women who had a mammogram or intended to and those who had not had the test and did not intend to was physician request for mammography. Women's perceptions about the benefits of mammography and perceived barriers were also significant, but the relative strength of these variables was low. Among women who had been asked by a physician to have a mammogram, 89.6% had done so, while only 10.4% of women who had not been asked to have a mammogram had done so. Implications for cancer education are discussed.

Enhanced risk from low-energy screen--film mammography X rays.

Abstract: Modern screen–film mammography with molybdenum-anode X rays results in tissue doses being delivered primarily by photons with an energy of <20 keV. Such photons interact with tissue predominantly through the photoelectric effect, producing low-energy electrons that have different patterns of energy deposition at the cellular level compared with those from higher-energy X rays. These differences result in low doses of typical molybdenum-based mammography X rays having an estimated radiobiological effectiveness of ∼1.3 compared with 80 kVp or 250 kVp X rays, and ∼2 compared with higher-energy γ rays. Thus the risk from mammography could be higher, by such factors, than previously estimated. This would result in the optimal age for beginning mammographic screening, derived from risk–benefit ratios, being increased by at least 1–2 years and possibly by as many as 10 years.

Detection of early breast cancer: an overview and future prospects.

Abstract: Detection and treatment of breast cancer at an early stage is the only method with proven potential for lowering the death rate from this disease Detection of early breast cancer is promoted by the American Cancer Society, American College of Radiology, and Canadian Association of Radiologists by encouraging the regular use of three types of screening: breast self-examination, clinical breast examination, and mammography When all factors are considered, it has been convincingly demonstrated that the potential benefits of mammography far outweigh the minimal, clinically undetected radiation risk incurred by the examination New technologies, such as computed tomography, magnetic resonance imaging, transillumination diaphanography, ultrasound, thermography, and digital subtraction angiography might offer a wide selection for patient examination However, none of these procedures, in its present form, is expected to replace mammography as the first-line imaging technique for the detection and diagnosis of benign and malignant breast lesions Breast cancer is detected now, in most cases, via casual or informed breast self-examination This first-line of detection is not sufficient, since most tumors may metastasize before they reach a palpable size Mammography generally shows up tumors no smaller than 1-cm diameter, which in many cases have already metastasized The more advanced imaging modalities in their current forms suffer from a number of drawbacks that give them a lower overall detection rate than mammography Understandably, improving breast imaging modalities is a great challenge to diagnostic radiology The purpose of this article is to provide a comprehensive overview of the detection of early breast cancer It briefly discusses the understanding of breast cancer, its incidence, and the mortality and survival of patients with breast cancer, as well as screening programs for breast cancer We review the developments in mammography and other breast imaging modalities over the last several years Prospects for digital mammography, digital image enhancement, and three-dimensional digital subtraction mammography, which may someday supplant film mammography, are also discussed

Isolated breast metastases from gastrointestinal carcinomas (report of two cases)

Abstract: Two patients with metastatic gastrointestinal adenocarcinoma in the breast are reported. Metastases in the breast are usually painless upper outer quadrant masses. On mammography they are typically well-circumscribed lesions without microcalcifications. A breast mass in a patient with a history of cancer, even if clinically or mammographically benign, should raise suspicion of a metastasis. Pathological features include a histologic pattern similar to the primary neoplasm and an absence of in situ carcinoma which characterizes primary breast cancer. Surgical excision for local control and systematic therapy is the most appropriate treatment.

Alexithymia and breast cancer. Survey of 200 women undergoing mammography.

Abstract: The Schalling Sifneos Personality Scale (SSPS) and the Middlesex Hospital Questionnaire (MHQ) have been used in 381 women just before mammography at the Breast Center of the Radiology Institute, Unive

Nonpalpable breast lesions: evaluation by means of fine-needle aspiration cytology.

Abstract: A prospective study was undertaken to assess the utility of fine-needle aspiration (FNA) cytology in women with nonpalpable suspicious microcalcifications or masses detected at mammography. Ninety-six breast lesions were aspirated during wire localization with standard mammographic technique. Cytologic results were compared with surgical pathology results. Sixty-one of the 96 aspirates were adequate for diagnosis. Nine were positive for malignant cells; seven, suspicious; 12, atypical; and 33, negative. All lesions demonstrating positive or suspicious cytologic findings were found to be malignant at biopsy; five of the 12 with atypical cytologic findings were malignant. Of 33 lesions deemed negative by means of cytology, two were biopsy-proved carcinomas. Cytologic examination permitted accurate diagnosis of 21 of the 23 (91%) carcinomas in which an adequate sample was obtained. Insufficient cellular material was obtained from 35 lesions, 16 of which showed marked fibrosis at histologic examination. The authors conclude that FNA cytology can aid in establishing a diagnosis in many cases in which nonpalpable breast lesions are detected at mammography.

Radiolucent breast implant

Abstract: A radiolucent breast implant is comprised of a silicon envelope filled with any biocompatible triglyceride such as peanut oil or sunflower seed oil, or any other material having an effective atomic number of 5.9 which is the effective atomic number of fat, the major component of a human breast. Such a breast implant is radiolucent in that it duplicates the photoelectric interaction of fat which is the major effect producing subject contrast at low radiation levels as used in mammography. A radiolucent breast implant dramatically improves the usefullness of mammography in detecting tumors in patients having breast implants and may also result in a lower radiation dose for each examination.

Detroit's avoidable mortality project: breast cancer control for inner-city women.

Abstract: Mammography remains substantially under-used in low-income minority populations despite its well-established efficacy as a means of breast cancer control. The Metropolitan Detroit Avoidable Mortality Project is a 2-year controlled clinical trial of coordinated interventions which seek to improve the use of early breast cancer detection services at five clinical sites providing primary health care services to inner-city women. Baseline assessment for two of the five participating clinic populations demonstrated that only one-quarter of women who visited these clinics were referred for mammography in 1988, and only half of those who were referred were able to complete the procedure. Patient characteristics including age, marital status, ethnicity, and insurance status were not associated with use of mammography during the baseline period. Each of the project's intervention components is a cue to action: a physician prompt for mammography referral within the medical record of procedure-due women, a reminder postcard for scheduled appointments, and a telephone call to encourage rescheduling of missed appointments. The interventions are initiated by a computerized information management system in the existing network of health care services. The patient's out-of-pocket mammography expense has been eliminated in three of the five sites. Although their efficacy as individual interventions has been well established, a controlled trial of computer prompts to physicians, reduced expense for patients, and patient appointment reminders as an integrated system in inner-city medical care settings has not been previously described. We have implemented the prompting, facilitated rescheduling procedures, and eliminated patient expense for mammography at three of five eventual clinical sites. This report provides an overview of the study's design, data management system, and methodology for evaluation.

Cancer screening in the elderly.

Abstract: Cancer screening in the elderly presents several unique challenges. There are no prospective trials of any cancer screening exam that have conclusively demonstrated efficacy in this age group. Any assessment of cancer screening in the elderly must include measuring an improvement in quality of life and functional status as well as decreased mortality from early cancer detection. Older patients usually prefer improved quality over quantity of life; they may be less interested in a trade-off of months or years of life in exchange for the side effects of cancer treatment. The elderly may need more home assistance during the treatment of the detected cancers; physicians should arrange for this. All of these variables must be included in studies of cancer screening in the elderly; the need for these studies is great. The following recommendations are probably the most reasonable in view of the currently inadequate knowledge base. Screening for breast cancer has demonstrated efficacy, with growing evidence for a cumulative effect from monthly breast self-examination, yearly breast examination by a physician, and yearly or biennial mammography. There may be no need to screen for cervical cancer in women after age 65 who have had regular Pap smear screening; however, older women who have never had Pap smears should have regular Pap smears for several years. Finally, because of the high frequency of colorectal and prostate cancers in the elderly, physicians should probably perform yearly rectal examinations with stool guaiac and regular sigmoidoscopy in this age group until definitive data support continuing or discontinuing these screening examinations. Physicians should educate their elderly patients to the importance of regular cancer screening and cancer risk-factor modification and should offer cancer screening examinations and counseling to elderly patients on a regularly scheduled basis.

Automatic Detection Of Microcalcifications In Digital Mammograms Using Local Area Thresholding Techniques

Abstract: In this study the automatic detection of clusters of microcalcifications in digital mammograms was investigated. A local area thresholding technique was employed to segment all potential microcalcifications from the normal breast structure. These objects were then analysed using size, shape and gradient measures to extract clusters of microcalcifications. The results for a set of 25 mammographic regions, each 5.76 X 5.76 cm2 in area, show that the computer system can achieve 100% true positive cluster detection with a false positive rate of 12%. 1 INTRODUCTION Breast cancer is the commonest cancer affecting women, and the United Kingdom has the highest mortality rate for breast cancer in the world.Mammography is an X-ray technique which has been specially developed for taking images of the breast and is able to detect clinically occult early breast cancer. On mammograms between 30 and 50% of breast carcinomas exhibit microcalcifications (1) and between 60 and 80% of breast carcinomas show calcifications upon histologic analysis (2). Following the publication of the Forrest report in 1986 (3), the Department of Health and Social Securuity in the U.K. is setting up a National Breast Screening Programme for all women aged between 50 and 64. The report recommends that single-view mammography, with an interval of three years between consecutive mammograms, is the best method to employ for basic screening in a mass population screening programme. This could result in 1,440,000 screening mammography patients per year and double this number of films to be reported. The success of the screening programme may be enhanced if an automatic computer method could be employed to detect microcalcifications. Other workers in this field, in particular Chan et al (4,5), have developed a computer system which can achieve a true positive