Showing papers on "Mammography published in 1992"
TL;DR: Analysis of 320 cancers found in a screened population between August 1985 and May 1990 revealed 77 cancers that were "missed" at screening mammography, which occurred in women with denser breasts, were less likely to demonstrate malignant microcalcifications, and were more likely to demonstrating a developing opacity as an indication of cancer.
Abstract: Analysis of 320 cancers found in a screened population between August 1985 and May 1990 revealed 77 cancers that were "missed" at screening mammography. The missed lesions consisted of cancers incorrectly diagnosed after mammography (false-negative results) but visible in retrospect (n = 19); cancers correctly diagnosed after mammography but visible in retrospect on an earlier mammogram (n = 47); and cancers that went undetected by the first of two readers (n = 11). Missed lesions were categorized according to type of miss, reason for the miss, breast density, lesion features, and lesion location. The missed lesion were compared with 121 cancers that were correctly diagnosed at screening mammography. The missed cancers occurred in women with denser breasts (P = .046), were less likely to demonstrate malignant microcalcifications, and were more likely to demonstrate a developing opacity as an indication of cancer (P = .005). An understanding of the characteristics of missed lesions may be a valuable aid in...
865 citations
Journal Article•
TL;DR: Screening with yearly mammography and physical examination of the breasts detected considerably more node-negative, small tumours than usual care, but it had no impact on the rate of death from breast cancer up to 7 years' follow-up from entry.
Abstract: OBJECTIVES: To evaluate the efficacy of the combination of annual screening with mammography, physical examination of the breasts and the teaching of breast self-examination in reducing the rate of death from breast cancer among women aged 40 to 49 years on entry. DESIGN: Individually randomized controlled trial. SETTING: Fifteen urban centres in Canada with expertise in the diagnosis and treatment of breast cancer. PARTICIPANTS: Women with no history of breast cancer and no mammography in the previous 12 months were randomly assigned to undergo either annual mammography and physical examination (MP group) or usual care after an initial physical examination (UC group). The 50,430 women enrolled from January 1980 through March 1985 were followed for a mean of 8.5 years. DATA COLLECTION: Derived from the participants by initial and annual self-administered questionnaires, from the screening examinations, from the patients9 physicians, from the provincial cancer registries and by record linkage to the Canadian National Mortality Data Base. Expert panels evaluated histologic and death data. MAIN OUTCOME MEASURES: Rates of referral from screening, rates of detection of breast cancer from screening and from community care, nodal status, tumour size, and rates of death from all causes and from breast cancer. RESULTS: Over 90% of the women in each group attended the screening sessions or returned the annual questionnaires, or both, over years 2 to 5. The characteristics of the women in the two groups were similar. Compared with the Canadian population, the participants were more likely to be married, have fewer children, have more education, be in a professional occupation, smoke less and have been born in North America. The rate of screen-detected breast cancer on first examination was 3.89 per 1000 in the MP group and 2.46 per 1000 in the UC group; more node-positive tumours were found in the MP group than in the UC group. During years 2 through 5 the ratios of observed to expected cases of invasive breast cancer were 1.26 in the MP group and 1.02 in the UC group. Of the women with invasive breast cancer through to 7 years, 191 and 157 women in the MP and UC groups respectively had no node involvement, 55 and 43 had one to three nodes involved, 47 and 23 had four or more nodes involved, and 38 and 49 had an unknown nodal status. There were 38 deaths from breast cancer in the MP group and 28 in the UC group. The ratio of the proportions of death from breast cancer in the MP group compared with those in the UC group was 1.36 (95% confidence interval 0.84 to 2.21). The survival rates were similar in the two groups. The highest survival rate occurred among women whose cancer had been detected by mammography alone. CONCLUSION: The study was internally valid, and there was no evidence of randomization bias. Screening with yearly mammography and physical examination of the breasts detected considerably more node-negative, small tumours than usual care, but it had no impact on the rate of death from breast cancer up to 7 years9 follow-up from entry.
767 citations
Journal Article•
TL;DR: Analysis of survival showed that relative to the control group, the cancers detected at prevalence screen, incidence screens, and in the interval between screens had a good prognosis, whereas cancers detected in those who had refused screening had a very poor prognosis.
715 citations
433 citations
TL;DR: Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services.
Abstract: OBJECTIVE--To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN--A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS--Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS--The education intervention consisted of a day long physician meeting directed at improving knowledge, attitudes, and skills relevant to cancer prevention and early detection. The office system intervention consisted of assistance from a project facilitator in establishing routines for providing needed services. These routines included division of responsibilities for providing services among physicians and their staff and the use of medical record flow sheets. MAIN OUTCOME MEASURES--The proportions of patients provided the cancer prevention and early detection services indicated annually according to the US National Cancer Institute. RESULTS--Based on cross sectional patient surveys, the office system intervention was associated with an increase in mammography, the recommendation to do breast self examination, clinical breast examination, faecal occult blood testing, advice to quit smoking, and the recommendation to decrease dietary fat. Education was associated only with an increase in mammography. Record review for a patient cohort confirmed cross sectional survey findings regarding the office system for mammography and faecal occult blood testing. CONCLUSION--Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services.
238 citations
TL;DR: Of 21,855 consecutive women prospectively studied with mammography, physical examination, and high-resolution ultrasonography when appropriate, 558 received a diagnosis of nonpalpable, probably benign lesions; nine patients ultimately proved to have carcinoma; two had noninvasive carcinoma, and two had axillary node metastases.
Abstract: Of 21,855 consecutive women prospectively studied with mammography, physical examination, and high-resolution ultrasonography when appropriate, 558 received a diagnosis of nonpalpable, probably benign lesions. Follow-up mammography was recommended for these patients. Characteristically benign lesions and palpable masses were excluded from analysis. The positive predictive value for detection of a nonpalpable, probably benign breast lesion was 0.017. Nine patients ultimately proved to have carcinoma; two of them had noninvasive carcinoma, and two had axillary node metastases. The positive predictive value for detection of a nonpalpable, probably malignant lesion was 0.47. The policy of recommending mammographic surveillance for nonpalpable, probably benign lesions, a viable option for radiologists, has the capability of lowering the rate and therefore the costs of biopsy procedures with negative results.
223 citations
TL;DR: In this article, the authors investigated motivational and cognitive processes of behavior change with respect to mammography screening and found that positive perceptions of mammography (pros) and avoidance of mammograms (cons) were associated with the stage of screening adoption.
Abstract: We investigated motivational and cognitive processes of behavior change with respect to mammography screening. One hundred forty-two women (ages 40 and older) recruited from three worksites answered a 41-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors: a six-item component representing positive perceptions of mammography (Pros) and a six-item component representing avoidance of mammography (Cons). Analysis of variance showed that Pros, Cons, and a derived Decisional Balance measure (Pros minus Cons) were associated with stage of mammography adoption. Results are consistent with applications of the model to smoking cessation. The model is also discussed as it relates to other theories of behavior change and as a general strategy for analyzing perceptual data pertinent to health-related actions and intentions for behavioral change.
213 citations
TL;DR: The results indicate that biologic factors are associated with failure to detect some breast cancers by mammography and indicate directions for future research in breast imaging.
Abstract: BACKGROUND Although mammography is widely used to detect breast cancer, it is recognized that not all cancers can be seen on mammographic images. PURPOSE Our purpose was to examine factors associated with failure to detect breast cancer by mammography. METHODS A case-control study was carried out in which subjects in whom histologically verified breast cancer was not detected by mammography (false negatives) were contrasted with subjects in whom breast cancer had been detected by mammography (true positives). Mammograms from individuals with histologically confirmed breast cancer were classified independently by two radiologists who were unaware of the clinical or other characteristics of the subjects. Histologic slides of all tumors were reviewed by one pathologist. RESULTS Three variables were found to be independently and significantly associated with failure to detect breast cancer by mammography. Breast cancer was less likely to be detected by mammography in the presence of extensive parenchymal densities (odds ratio [OR] = 9; 95% confidence interval [CI] = 1.8-44.3), a tumor of lobular histology (OR = 7; 95% CI = 2.2-22.1), and tumors of small size (OR = 0.10; 95% CI = 0.0-0.9). CONCLUSION Our results indicate that biologic factors are associated with failure to detect some breast cancers by mammography and indicate directions for future research in breast imaging.
211 citations
Journal Article•
TL;DR: It is shown that subjects with mammographic densities have an increased risk of breast cancer relative to those without densities, and the ability to recognize individuals within the population at different risks for breast cancer could be exploited in studies of potential etiological factors.
208 citations
192 citations
Journal Article•
TL;DR: Carefully tailored mammographic studies will promote the dual goal of early detection of local tumor recurrence and avoidance of misinterpreting postoperative and irradiation changes as malignancy.
TL;DR: The results suggest that the radiological patterns referred to as mammographic dysplasia may influence breast cancer risk by virtue of their association with high-risk histological changes in the breast epithelium.
Abstract: Background Information on breast cancer risk can be obtained both from the histological appearance of the breast epithelium in biopsy specimens and from the pattern of parenchymal densities in the breast revealed by mammography. It is not understood, however, how parenchymal densities influence breast cancer risk or whether these densities are associated with histological risk factors. Purpose We have estimated, in a large cohort of women, the relative risk of detecting carcinoma in situ, atypical hyperplasia, hyperplasia without atypia, or nonproliferative disease in biopsy specimens from women with different extents of mammographic density. We also examined the association between these histological classifications and radiological features present specifically at the biopsy site. Methods The source of study material was a population of women aged 40-49 years who were enrolled in the Canadian National Breast Screening Study (NBSS). Mammograms from women who had undergone a biopsy (n = 441) and from a comparison group of women (n = 501) randomly selected from the mammography arm of the NBSS were classified according to the extent of mammographic density. The corresponding histological slides were independently classified by a review pathologist. Results Compared with women showing no mammographic densities, women with the most extensive densities (i.e., occupying greater than 75% of the breast volume) had a 9.7 times greater risk of developing carcinoma in situ or atypical hyperplasia (95% confidence interval [CI] = 1.75-53.97), a 12.2 times greater risk of developing hyperplasia without atypia (95% CI = 2.97-50.14), and a 3.1 times greater risk of developing non-proliferative disease (95% CI = 1.20-8.11). The gradients in risk were not monotonic across the five classifications of mammographic density. The association could not be explained by the presence of mammographic densities at the biopsy site, but calcification at the biopsy site was strongly associated with high-risk histological changes (relative risk = 24; 95% CI = 5.0-156.0). Conclusions These results suggest that the radiological patterns referred to as mammographic dysplasia may influence breast cancer risk by virtue of their association with high-risk histological changes in the breast epithelium. Implications Identification of the factors responsible for high-risk histological changes may offer new insights into the etiology of breast cancer and potentially lead to the development of methods for its prevention.
TL;DR: The relative influence of Health Belief Model (HBM) constructs on prior mammography usage and the intention to obtain mammograms with data from a sample of 1,057 women over the age of 35 years residing in an urban community in the United States is assessed.
Abstract: Regular screening mammograms for asymptomatic women are the most effective method for early detection of breast cancer. This study assessed the relative influence of Health Belief Model (HBM) constructs on prior mammography usage and the intention to obtain mammograms with data from a sample of 1,057 women over the age of 35 years residing in an urban community in the United States. Covariance structure analysis with latent variables was used initially to perform a confirmatory factor analysis of indicators of Socioeconomic Status (SES), Perceived Susceptibility, Perceived Barriers, Perceived Benefits, Cues to Action, Prior Mammography, and Future Intentions. Once a plausible factor structure was confirmed, a predictive path model was tested with Future Intentions and Prior Mammography as the outcome variables. Cues to Action, operationalized as a physician influence variable, particularly impacted Prior Mammography, and Perceived Susceptibility was the most powerful predictor of Future Intentions. SES only related significantly to Perceived Barriers, and Cues to Action, and did not directly influence Prior Mammography and Future Intentions. HBM predictor variables alone accounted for the relationship between previous mammography experience and intentions to obtain mammograms in the future. Health education implications and an applied outreach program are discussed.
TL;DR: Self-reported use is more accurate regarding whether a woman has had a mammogram than when she had it, but self-reports accurately measure change over time.
Abstract: Population studies often estimate mammography use using women's self-reports. In one North Carolina county, we compared self-report surveys with a second method--counting mammograms per population--for 1987 and 1989. Estimates from self-reports (35% in 1987, 55% in 1989) were considerably higher than those from mammogram counts (20% in 1987, 36% in 1989). We then confirmed 66% of self-reports in the past year. Self-reported use is more accurate regarding whether a woman has had a mammogram than when she had it, but self-reports accurately measure change over time.
TL;DR: This study demonstrated that women of different racial/ethnic backgrounds can be successfully recruited to participate in a patient‐initiated, community‐based program, however, this programmatic approach requires augmentation with other intervention strategies designed to reach low‐income women because women with more years of education and higher family income were overrepresented in all three groups.
Abstract: Data from a multiethnic sample of women participating in the American Cancer Society 1987 Texas Breast Screening Project was used to compare attitudes and behaviors related to breast cancer screening for whites, blacks, and Hispanics. In general, similar patterns of association were observed across racial/ethnic groups between a number of demographic and risk factors and prior mammography and recent clinical breast examination (CBE), although the magnitude of the associations varied somewhat across groups. Reasons for not having had prior mammography also were similar across groups, with lack of physician referral and cost cited as the two most important reasons. However, Hispanics were less likely than blacks or whites to report prior breast cancer screening, including mammography, CBE, and breast self-examination (BSE). This study demonstrated that women of different racial/ethnic backgrounds can be successfully recruited to participate in a patient-initiated, community-based program. However, this programmatic approach requires augmentation with other intervention strategies designed to reach low-income women because women with more years of education and higher family income were overrepresented in all three groups.
TL;DR: It is suggested that dedicated mammography courses can help improve radiologists' performance and alter their interpretive approach.
Abstract: The authors conducted a complete audit of results of 38,633 mammographic examinations performed by 12 general radiologists during a 2-year period with a computerized reporting system. During this period, 11 group members attended 17 dedicated mammography courses. Audit results were analyzed for each radiologist and the entire group. In the 2nd year, the number of breast cancers diagnosed increased 50% (from 121 to 181), with a 6.5% increase in patient volume. Sensitivity increased from 80% to 87%, and there was no change in the positive predictive value of 32%. Median tumor size and node positivity decreased. Most major variables of population and technical factors were unchanged. Diagnostic approach was altered during the 2nd year, as shown by a 50% increase in the use of spot compression, magnification views, and sonography. Analysis of each radiologist's performance before and after attending mammography courses showed similar changes. These data suggest that dedicated mammography courses can help impr...
TL;DR: The results of a cost utility analysis of breast cancer screening using an approach to measuring outcome, Healthy Year Equivalents, are presented to resolve methodological issues and the approach developed here can be applied more generally.
TL;DR: Comparison of tumor size measurements in mammography and MRI showed that MRI had the most accurate correlation to the measured size of the tumor specimens, compared with clinical findings and histopathology.
Abstract: Contrast-enhanced magnetic resonace imaging (MRI) of 28 patients with known breast tumors was compared with clinical findings and histopathology, and for 12 of the patients also with mammography The dynamic measurements performed in 18 patients showed that signal intensity in gradient echo (FFE) images increased rapidly in malignant tumors after contrast injection and reached a plateau level at 1-3 min postcontrast Fibroadenomas showed slower contrast enhancement continuing throughout the whole examination period of 10 min The most enhancing parts of the tumors were selected for intensity measurements The differentiation between malignant and benign tumors in dynamic contrast-enhanced MRI was in accordance with the histopathological findings in all cases The tumor diameter as measured by MRI showed very good agreement with the size of the tumor specimens Comparison of tumor size measurements in mammography and MRI showed that MRI had the most accurate correlation to the measured size of the tumor sp
TL;DR: Increases in the use of mammography since 1982 provide the most plausible explanation for the incidence increase over the long-term secular trend, and the observed increases in mammography utilization are generally concordant with increases in incidence, even in the older age groups.
Abstract: Largely unexplained increases in breast cancer incidence of about 1% per year have been documented back to the 1940s. Since 1982, breast cancer incidence in women aged 40 years and above has been increasing at a faster rate than this long-term secular trend, especially in women aged 60 years and above. Increases in the use of mammography since 1982 (which have been documented in population surveys of women) provide the most plausible explanation for the incidence increase over the long-term secular trend. A study by White et al. (J Natl Cancer Inst 1990;82:1546-52) found that, for women aged 45-64 years, the increase in mammography utilization could explain the incidence increase, while for women aged 65-74 years, it could account for only half the increase. The authors have developed an alternative model to that of White et al. that incorporates estimates of differential lead time (time from screen detection to clinical detection in the absence of screening) by age group. Using this model, the authors show that if older women have longer lead times, than similar increases in mammography utilization across age groups will lead to a larger incidence increase in older women. Thus, the observed increases in mammography utilization are generally concordant with increases in incidence, even in the older age groups.
Patent•
23 Sep 1992
TL;DR: In this paper, an apparatus for use in performing medical procedures on a breast of a patient is disclosed, which includes a frame assembly (12) for supporting the patient having an opening (22) therein through which the patient's breasts are permitted to protrude.
Abstract: An apparatus (10) for use in performing medical procedures on a breast of a patient is disclosed. The apparatus (10) includes a frame assembly (12) for supporting the patient having an opening (22) therein through which the patient's breasts are permitted to protrude, an imaging system (18) for identifying any suspicious lesions within the patient's breasts, and a biopsy assembly (20) for use in performing a biopsy on the patient's breasts. The frame assembly (12) is tiltable from a vertical position to a non-vertical position to facilitate mammography and the mammographic biopsy procedure. In addition, the imaging system (18) and biopsy assembly (20) are moveable across the patient's chest from one breast to the other. The imaging system (18) is also rotatable and tiltable relative to the patient's breasts to obtain oblique views of the breasts.
TL;DR: With intensive public education about breast cancer and the growing acceptance of routine self-examination of the breasts, particularly by young women, an increasing number of women can be expected to seek consultation for the evaluation of breast masses.
Abstract: CANCER of the breast is newly diagnosed in about 180,000 women per year in the United States.1 In the majority of these cases the cancer presents as a palpable mass, usually found by the patient. With intensive public education about breast cancer and the growing acceptance of routine self-examination of the breasts, particularly by young women, an increasing number of women can be expected to seek consultation for the evaluation of breast masses. A study by the Physician Insurers Association of America in 1990 found that failure to diagnose breast cancer was the second most frequent reason for claims brought . . .
Journal Article•
TL;DR: Because mammographically detected calcifications are frequently the only sign of breast cancer, the breast radiography equipment, screen-film imaging package, and film processing should be optimized to detect such calcifications.
Journal Article•
TL;DR: Most nonspecific circumscribed masses should be followed rather than biopsied as they are commonly present on mammograms and have a change of malignancy of less than 5%, and most small circumscribed cancers will not have metastasized to the regional nodes.
TL;DR: Findings are used to highlight the critical importance of physician behavior in the secondary prevention of breast cancer in older women and to identify types of patients whose needs for screening are most likely to be overlooked by physicians.
TL;DR: The author proposed to form the National Digital Mammography Development Group, which will stimulate research in digital mammography and its integration with related technologies: image processing for improved lesion contrast, automated computer-aided diagnosis for enhanced breast cancer detection and characterization, and teleradiology for facilitated radiologic consultation with recognized experts in the field.
Abstract: The National Cancer Institute held a workshop entitled "Breast Imaging: State-of-the-Art and Technologies of the Future" in September 1991. This article describes some of the presentations given at the workshop as well as relevant data in the literature and discusses their implications. The workshop faculty identified digital mammography as the evolving technology with the greatest potential impact on management of breast cancer. On the basis of the workshop findings and literature review, the author proposed to form the National Digital Mammography Development Group, which will stimulate research in digital mammography and its integration with related technologies: image processing for improved lesion contrast, automated computer-aided diagnosis for enhanced breast cancer detection and characterization, and teleradiology for facilitated radiologic consultation with recognized experts in the field. It is expected that the National Digital Mammography Development Group will facilitate transfer of advanced ...
TL;DR: Some aspects of lexical decision performance suggested that some components of word identification, especially those involved in semantic activation, are relatively exempt from age-related slowing.
Abstract: Routine screening by mammography and physical examination can detect breast cancers earlier at all ages. In women over age 65 the sensitivity of mammography is increased, and the positive predictive value for mammography is higher than in younger women. There are no direct data that can be used to determine at what age screening is no longer of value. This question must be evaluated on an individual basis and should take into account the quality of life and competing causes of death. The medical benefit from screening for a given individual should be considered separately from society's cost/benefit goal to reduce health care expenditures, because the two are likely to produce contradictory recommendations.
Journal Article•
TL;DR: The results suggest that Medicare coverage alone will not increase mammography use sufficiently to achieve year 2000 objectives, however, the addition of access enhancing and health education interventions boosts utilization dramatically.
Abstract: Mammography use decreases with age although the risk of breast cancer increases with age. Medicare now provides biennial coverage for screening mammography. This study was designed to simulate the Medicare condition by subsidizing mammography among women in eight retirement communities in the metropolitan Philadelphia area. The study also measured the impact of health education interventions and the presence of a mobile mammography van on increased use of mammography. Retirement communities were assigned randomly to the control (cost subsidy alone) or experimental group (cost subsidy, mammography van, and tailored health education interventions). A total of 412 women ages 65 and older who had not had mammograms in the previous year were surveyed at baseline and 3 months later. Analytic techniques reflected the cluster nature of the randomization. Women in the experimental group were significantly more likely than the control group women to have obtained mammograms. Forty-five percent of the experimental group women compared with 12 percent of the control group women subsequently had mammograms in the 3 months after the baseline interview (P less than .001). Logistic regression analysis for mammography use indicated an odds ratio of 6.1 associated with being in the experimental group. For women in the experimental group, a separate logistic regression for mammography use showed an odds ratio of 7.8 associated with attendance at the educational presentation. The results suggest that Medicare coverage alone will not increase mammography use sufficiently to achieve year 2000 objectives. However, the addition of access enhancing and health education interventions boosts utilization dramatically.
Journal Article•
TL;DR: The medical audit is an important component of a comprehensive mammography quality assurance program and provides a direct assessment of one's ability to detect otherwise occult breast cancer, the ultimate indicator of mammography performance.
TL;DR: Between 1977 and 1989, 102 of 1,145 patients treated with lumpectomy and radiation as an alternative to mastectomy required subsequent biopsy for suspected ipsilateral recurrence, and a follow-up algorithm for the ongoing evaluation of these patients was developed.
Abstract: Between 1977 and 1989, 102 of 1,145 patients treated with lumpectomy and radiation as an alternative to mastectomy required subsequent biopsy for suspected ipsilateral recurrence. The authors reviewed the mammograms of 58 of those patients for whom at least two sets of mammograms were available, including one set obtained within 3 months of the subsequent repeated biopsy. Of 38 biopsy-proved recurrences, 13 (34%) were detected with mammography alone, 17 (45%) with palpation alone, and eight (21%) with both mammography and palpation. While standard mammographic criteria for biopsy were followed, distortions and calcifications inherent to posttreatment appearances necessitated judicious modifications. As anticipated, sensitivities and positive predictive values showed more impairment within the lumpectomy quadrant. In addition, all cases of purely in situ cancer were detected solely with mammography. Mammography plays an important complementary role to physical examination in posttreatment follow-up. On the...