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Showing papers on "Mammography published in 1995"


Journal ArticleDOI
TL;DR: Increases in the level of breast tissue density as assessed by mammography are associated with increases in risk for breast cancer, and these results show that increases in theLevel of breast cancer risk associated with increasing mammographic density is shown.
Abstract: BACKGROUND The radiographic appearance of the female breast varies from woman to woman depending on the relative amounts of fat and connective and epithelial tissues present. Variations in the mammographic density of breast tissue are referred to as the parenchymal pattern of the breast. Fat is radiologically translucent or clear (darker appearance), and both connective and epithelial tissues are radiologically dense (lighter appearance). Previous studies have generally supported an association between parenchymal patterns and breast cancer risk (greater risk with increasing densities), but there has been considerable heterogeneity in risk estimates reported. PURPOSE Our objective was to determine the level of breast cancer risk associated with varying mammographic densities by quantitatively classifying breast density with conventional radiological methods and novel computer-assisted methods. METHODS From the medical records of a cohort of 45,000 women assigned to mammography in the Canadian National Breast Cancer Screening Study (NBSS), a multicenter, randomized trial, mammograms from 354 case subjects and 354 control subjects were identified. Case subjects were selected from those women in whom histologically verified invasive breast cancer had developed 12 months or more after entering the trial. Control subjects were selected from those of similar age who, after a similar period of observation, had not developed breast cancer. The mammogram taken at the beginning of the NBSS was the image used for measurements. Mammograms were classified into six categories of density, either by radiologists or by computer-assisted measurements. All radiological classification and computer-assisted measurements were made using one craniocaudal view from the breast contralateral to the cancer site in case subjects and the corresponding breast of control subjects. All P values represent two-sided tests of statistical significance. RESULTS For all subjects, there was a 43% increase in the relative risk (RR) between the lower and the next higher category of density, as determined by radiologists, and there was a 32% increase as determined by the computer-assisted method. For all subjects, the RR in the most extensive category relative to the least was 6.05 (95% confidence interval [CI] = 2.82-12.97) for radiologists and 4.04 (95% CI = 2.12-7.69) for computer-assisted methods. Statistically significant increases in breast cancer risk associated with increasing mammographic density were found by both radiologists and computer-assisted methods for women in the age category 40-49 years (P = .005 for radiologists and P = .003 for computer-assisted measurements) and the age category 50-59 years (P = .002 for radiologists and P = .001 for computer-assisted measurements). CONCLUSION These results show that increases in the level of breast tissue density as assessed by mammography are associated with increases in risk for breast cancer.

1,128 citations


Journal ArticleDOI
11 Jan 1995-JAMA
TL;DR: Screening mammography may be effective in reducing breast cancer mortality in women aged 40 to 49 years after 10 to 12 years of follow-up, but the same benefit could probably be achieved by beginning screening at menopause or 50 years of age.
Abstract: Objective. —To determine the efficacy of screening mammography by age, number of mammographic views per screen, screening interval, and duration of follow-up. Design. —Literature review and meta-analysis. Data Identification and Analysis. —Literature search of English-language studies reported from January 1966 to October 31, 1993, using MEDLINE, manual literature review, and consultation with experts. A total of 13 studies were selected, and their results were combined using meta-analytic techniques based on the assumption of fixed effects. Main Results. —The overall summary relative risk (RR) estimate for breast cancer mortality for women aged 50 to 74 years undergoing screening mammography compared with those who did not was 0.74 (95% confidence interval [CI], 0.66 to 0.83). The magnitude of the benefit in this age group was similar regardless of number of mammographic views per screen, screening interval, or duration of follow-up. In contrast, none of the summary RR estimates for women aged 40 to 49 years was significantly less than 1.0, irrespective of screening intervention or duration of follow-up. The overall summary RR estimate in women aged 40 to 49 years was 0.93 (95% CI, 0.76 to 1.13); the summary RR estimate for those studies that used two-view mammography was 0.87 (95% CI, 0.68 to 1.12) compared with 1.02 (95% CI, 0.73 to 1.44) for those studies that used one-view mammography, and for those studies with 7 to 9 years of follow-up, the summary RR estimate was 1.02 (95% CI, 0.82 to 1.27) compared with 0.83 (95% CI, 0.65 to 1.06) for those studies with 10 to 12 years of follow-up. Conclusion. —Screening mammography significantly reduces breast cancer mortality in women aged 50 to 74 years after 7 to 9 years of follow-up, regardless of screening interval or number of mammographic views per screen. There is no reduction in breast cancer mortality in women aged 40 to 49 years after 7 to 9 years of follow-up. Screening mammography may be effective in reducing breast cancer mortality in women aged 40 to 49 years after 10 to 12 years of follow-up, but the same benefit could probably be achieved by beginning screening at menopause or 50 years of age. (JAMA. 1995;273:149-154)

1,097 citations


Journal ArticleDOI
TL;DR: M mammographic features were associated with known breast cancer risk factors, however, the high-density parenchymal pattern effects were independent of family history, age at first birth, alcohol consumption, and benign breast disease.
Abstract: Background : Mammographic images from women with a high proportion of epithelial and stromal breast tissues are described as showing high-density parenchymal patterns. Most past studies that noted an increase in breast cancer risk associated with mammographic parenchymal patterns showing high density either 1) lacked information on other breast cancer risk factors, 2) were too small, or 3) included insufficient follow-up time to adequately resolve persisting doubts whether mammographic features are independent measures of breast cancer risk and not a detection artifact. Purpose : The purpose of this study was twofold : 1) to evaluate the associations between mammographic features and other breast cancer risk factors and 2) to assess effects of mammographic features on breast cancer risk by time, age, and menopause status. Methods : To address these questions, we analyzed detailed information from a large, nested case-control study with 16 years of follow-up. This study used information from both screening and follow-up phases of the Breast Cancer Detection Demonstration Project, a nationwide program that offered annual breast cancer screening for more than 280 000 women from 1973 to 1980. Mammographic features were assessed from the base-line screening mammographic examination for 1880 incident case subjects and 2152 control subjects. Control subjects were randomly selected from women of the same age and race as each case subject. Control subjects attended the same screening center as the case subject and were free of breast cancer at the case subject's date of diagnosis. Odds ratios (ORs) with 95% confidence intervals (CIs) provided estimates of the relative risk of breast cancer. Results : Mammographic features were associated with known breast cancer risk factors. However, the high-density parenchymal pattern effects were independent of family history, age at first birth, alcohol consumption, and benign breast disease. The increased risk for women with Wolfe's two high-density parenchymal patterns, P2 (OR = 3.2 ; 95% CI = 2.5-4.0) and Dy (OR = 2.9 ; 95% CI = 2.2-3.9), was explained primarily by measured percent of the breast with dense mammographic appearance. Compared with women with no visible breast density, women who had a breast density of 75% or greater had an almost fivefold increased risk of breast cancer (95% CI = 3.6-7.1). These effects persisted for 10 or more years and were noted for both premenopausal and postmenopausal women of all ages. Conclusions : Of the breast cancer risk factors assessed in the participants, high-density mammographic parenchymal patterns, as measured by the proportion of breast area composed of epithelial and stromal tissue, had the greatest impact on breast cancer risk. Of the breast cancers in this study, 28% were attributable to having 50% or greater breast density.

865 citations


Journal ArticleDOI
TL;DR: MR imaging was the most accurate of the three preoperative imaging modalities in assessing the size and number of malignant lesions in the breast.
Abstract: PURPOSE: To evaluate the comparative accuracy of magnetic resonance (MR) imaging relative to mammography and ultrasonography (US) for assessing the extent of breast tumors. MATERIALS AND METHODS: Histologic results and preoperative imaging findings (mammography, US, MR imaging) were analyzed regarding tumor size and multifocality of 61 tumors in 60 women undergoing mastectomy for carcinoma. RESULTS: In 10% of cases, the index tumor was not seen at mammography. With US, 15% of the index tumors were not recognized, while MR imaging missed 2% of the index tumors. On mammographic and US images, tumor size was underestimated significantly (P < .005), by 14% and 18%, respectively, while MR imaging showed no significant difference in size compared with that found in a pathologic evaluation. Mammography showed 31% of the additional invasive lesions, while US showed 38% and MR imaging showed 100%. CONCLUSION: MR imaging was the most accurate of the three preoperative imaging modalities in assessing the size and nu...

515 citations


Journal ArticleDOI
TL;DR: It is suggested that loss-framed messages may have an advantage in the promotion of detection behaviors such as mammography.
Abstract: This experiment compared the effectiveness of gain-versus loss-framed messages to persuade women to obtain mammography screening. One hundred and thirty-three women 40 years and older and not adhering to current guidelines for obtaining mammography screening were assigned randomly to view either gain-framed (emphasizing the benefits of obtaining mammography) or loss-framed (emphasizing the risks of not obtaining mammography) persuasive videos that were factually equivalent. Attitudes and beliefs were measured before and immediately following the intervention. Mammography utilization was assessed 6 and 12 months later. Consistent with predictions based on prospect theory, women who viewed the loss-framed message were more likely to have obtained a mammogram within 12 months of the intervention. These findings suggest that loss-framed messages may have an advantage in the promotion of detection behaviors such as mammography.

434 citations


Journal ArticleDOI
TL;DR: MR imaging allows detection of mammographically and clinically occult foci of carcinoma in patients with suspected breast cancer.
Abstract: PURPOSE: To investigate the effect of contrast material-enhanced magnetic resonance (MR) imaging on staging of breast cancer in patients with mammographically or clinically suspected tumor. MATERIALS AND METHODS: One hundred seventy-six patients underwent breast MR imaging at 1.5 T before excisional biopsy of a suspicious mammographic or palpable abnormality. Diagnostic imaging studies in patients with biopsy-proved or presumed breast carcinoma were reviewed. RESULTS: Sixty-four patients met the study criteria. MR imaging enabled detection of all 57 invasive breast cancers and nine of 15 in situ cancers. In 22 patients (34%), MR imaging depicted one or more cancers not visible at mammography, 13 (20%) of which were unsuspected multifocal or diffuse disease. As a result of the increased sensitivity of MR imaging compared with that of mammography, clinical staging and subsequent treatment were altered in seven patients (11%). CONCLUSION: MR imaging allows detection of mammographically and clinically occult ...

404 citations


Journal ArticleDOI
TL;DR: Use of mammography doubled between 1987 and 1992 while Pap smear use changed very little, and use of the three colorectal cancer screening modalities increased but levels remained low.
Abstract: This report describes trends in reported breast, cervical, and colorectal cancer screening within the US population from 1987 to 1992. Data from the 1987 and 1992 Cancer Control Supplements of the National Health Interview Survey were analyzed to determine use of Pap smears by women aged 18+; of mammography and clinical breast examination by women aged 50+; and of proctoscopy, digital rectal examination, and fecal occult blood testing among men and women aged 50+. Use of mammography doubled between 1987 and 1992 while Pap smear use changed very little. Use of the three colorectal cancer screening modalities increased but levels remained low. Usage trends were also assessed in relation to several sociodemographic factors. Disparities in screening reported in 1987 according to income and education persisted in 1992.

352 citations


Proceedings ArticleDOI
26 Jun 1995
TL;DR: An alternative approach is explored in which a description of normality is attempted using the large number of available mammograms which do not show any evidence of mass-like structures to try and identify candidate masses in previously unseen images analysis and interpretation.
Abstract: Breast cancer is the major cause of death amongst women in the 35 to 55 age group. Mammography is the only feasible imaging modality for screening large numbers of women. With the present screening policy, there are three million mammograms to be analysed each year in the UK; there is therefore a need (as yet unmet) for an automated analysis system which could highlight areas of interest. In the first instance, the areas of interest might simply be any mass-like structures and this is indeed the approach reported on in this paper. Mammography is typical of many problems in medicine: the class of real interest is under-represented in the database of available examples and hence its prior probability will be very low. As a result of this, there are very few examples of abnormalities in any of the existing databases. If a neural network classifier is trained using the standard approach of minimising the mean-squared error (MSE) at the output, the under-represented class will be ignored. We have been exploring an alternative approach in which we attempt to learn a description of normality using the large number of available mammograms which do not show any evidence of mass-like structures. The idea is then to test for novelty against this description in order to try and identify candidate masses in previously unseen images analysis and interpretation and present a sample of the results which we have so far obtained on a standard database.

326 citations


01 Jan 1995
TL;DR: In this paper, a neural network classifier is trained using the standard approach of minimising the mean-squared error (MSE) at the output, the underrepresented class will be ignored.
Abstract: Breast cancer is the major cause of death amongst women in the 35 to 55 age group. Mammography is the only feasible imaging modality for screening large numbers of women. With the present screening policy, there are three million mammograms to be analysed each year in the UK; there is therefore a need (as yet unmet) for an automated analysis system which could highlight areas of interest. In the first instance, the areas of interest might simply be any mass-like structures and this is indeed the approach reported on in this paper. Mammography is typical of many problems in medicine: the class of real interest is under-represented in the database of available examples and hence its prior probability will be very low. As a result of this, there are very few examples of abnormalities in any of the existing databases. If a neural network classifier is trained using the standard approach of minimising the mean-squared error (MSE) at the output, the under-represented class will be ignored. We have been exploring an alternative approach in which we attempt to learn a description of normality using the large number of available mammograms which do not show any evidence of mass-like structures. The idea is then to test for novelty against this description in order to try and identify candidate masses in previously unseen images analysis and interpretation and present a sample of the results which we have so far obtained on a standard database.

319 citations


Journal ArticleDOI
TL;DR: The algorithm was notably successful in the detection of minimal cancers manifested by masses, and an extensive study of the effects of the algorithm's parameters on its sensitivity and specificity was performed in order to optimize the method for a clinical, observer performance study.
Abstract: A technique is proposed for the detection of tumors in digital mammography. Detection is performed in two steps: segmentation and classification. In segmentation, regions of interest are first extracted from the images by adaptive thresholding. A further reliable segmentation is achieved by a modified Markov random field (MRF) model-based method. In classification, the MRF segmented regions are classified into suspicious and normal by a fuzzy binary decision tree based on a series of radiographic, density-related features. A set of normal (50) and abnormal (45) screen/film mammograms were tested. The latter contained 48 biopsy proven, malignant masses of various types and subtlety. The detection accuracy of the algorithm was evaluated by means of a free response receiver operating characteristic curve which shows the relationship between the detection of true positive masses and the number of false positive alarms per image. The results indicated that a 90% sensitivity can be achieved in the detection of different types of masses at the expense of two falsely detected signals per image. The algorithm was notably successful in the detection of minimal cancers manifested by masses /spl les/10 mm in size. For the 16 such cases in the authors' dataset, a 94% sensitivity was observed with 1.5 false alarms per image. An extensive study of the effects of the algorithm's parameters on its sensitivity and specificity was also performed in order to optimize the method for a clinical, observer performance study. >

304 citations


Journal ArticleDOI
01 Apr 1995-Cancer
TL;DR: Eight randomized controlled trials of screening mammography were conducted involving women ages 40 to 49 years at entry and current data gathered for periods ranging from 7 to 18 years of follow‐up are available from these trials.
Abstract: Background. Eight randomized controlled trials (RCTs) of screening mammography were conducted involving women ages 40 to 49 years at entry. Current data gathered for periods ranging from 7 to 18 years of follow-up are available from these trials. Methods. Meta-analyses were performed using a Mantel-Haenszel estimator method to combine current follow-up data from the eight RCTs of mammography that included women ages 40 to 49 years. Results. Combining all current data on women ages 40 to 49 years at entry into the trials yielded a 14% benefit from screening mammography, without statistical significance at the 95% confidence level. Combining all data on women ages 40 to 49 years at entry, excluding results from the Canadian National Breast Screening Study, yielded a 23% benefit to women invited for screening, with statistical significance at the 95% confidence level. Conclusions. These results suggest that screening mammography in women ages 40 to 49 years at entry can reduce mortality from breast cancer when combined with adequate follow-up. Cancer 1995;75:1619-26.

Journal ArticleDOI
Jan Blustein1
TL;DR: The use of mammography was substantially below recommended levels during the first two years of Medicare coverage for screening mammography and women lacking supplemental health insurance were at particularly high risk of failing to undergo mammography.
Abstract: Background On January 1, 1991, the Medicare program began offering reimbursement for screening mammography every two years. This study examined the use of mammography in women covered by Medicare during the first two years that the screening benefit was offered. Methods Medicare bills for 1991 and 1992 from a nationally representative sample of 4110 women 65 years of age or older were examined to determine the degree of compliance with recognized guidelines for screening mammography and the extent to which the use of mammography was associated with having supplemental insurance, which shields patients from the out-of-pocket costs associated with using Medicare benefits. Results A total of 36.9 percent of older U.S. women had mammography during the first two years of the Medicare benefit for screening mammography. Only 14.4 percent of the women lacking supplemental insurance had mammography, as compared with 44.7 percent of those with employer-sponsored supplemental insurance, 40.1 percent of those with se...

Journal ArticleDOI
15 Aug 1995-Cancer
TL;DR: The authors attempted to appraise the ability of high resolution, real‐time ultrasound to find malignant breast masses that are nonpalpable and undetectable by high quality mammography in women with radiographically dense breasts.
Abstract: Background. The authors attempted to appraise the ability of high resolution, real-time ultrasound to find malignant breast masses that are nonpalpable and undetectable by high quality mammography in women with radiographically dense breasts, who were referred because of palpable or mammographically detected lesions. Methods. The records of breast ultrasound examinations of 12,706 women were retrospectively reviewed. All lesions were classified according to clinical and mammographic status as palpable or nonpalpable and as visible or nonvisible, respectively. Solid masses were sampled percutaneously by fine needle aspiration biopsy (FNAB) using ultrasound guidance and either were excised surgically or followed by sequential imaging. Results. There were 1575 solid masses detected sonographically that were nonpalpable and nonvisible by mammography; percutaneous biopsies (FNABs) were performed on 279 of these. Cytologic interpretation was definitely malignant in 22, suspicious in 18 (6 confirmed cancers), and benign in 183 (no false negatives). Surgery confirmed malignancy in 44 of the 1575 solid masses (2.8%), including 16 in patients with multifocal cancers. Conclusions. Ultrasound can detect unsuspected, mammographically occult cancers in radiographically dense breasts and can alter treatment planning when a second cancer is found in a breast that otherwise was considered appropriate for conservative surgery. The authors recommend that any solid lesion detected incidentally during breast sonography either should be biopsied percutaneously under ultrasound guidance and/or closely followed with sequential scans. Cancer 1995; 76:626–30.

Journal ArticleDOI
TL;DR: Improvements in image contrast for multiscale imageprocessing algorithms were superior to those obtained using existing competitive algorithms and suggest that wavelet based image processing algorithms could play an important role in improving the imaging performance of digital mammography.
Abstract: Multiresolution representations provided an adaptive mechanism for the local emphasis of features of importance to mammography In general, improvements in image contrast for multiscale image processing algorithms were superior to those obtained using existing competitive algorithms These initial results are encouraging and suggest that wavelet based image processing algorithms could play an important role in improving the imaging performance of digital mammography In part 2, features blended into the mammograms were "idealized" representations of the types of objects that are of primary interest to mammographers The resultant mammographic images were appropriate for the purpose of demonstrating improved image contrast made possible by wavelet based image processing algorithms These images were also useful for comparing multiscale wavelet based algorithms with existing image processing algorithms The test results obtained in this study, however, cannot be directly extrapolated to clinical mammography In addition, it is also important to study possible image artifacts introduced by new wavelet filters, which may increase the false positive rate >

Journal ArticleDOI
TL;DR: The BI-RADS lexicon provides a standardized language between mammographers and an ANN that can improve the PPV of breast biopsy and was significantly greater than the specificity of radiologists.
Abstract: PURPOSE: To determine if an artificial neural network (ANN) to categorize benign and malignant breast lesions can be standardized for use by all radiologists. MATERIALS AND METHODS: An ANN was constructed based on the standardized lexicon of the Breast Imaging Recording and Data System (BI-RADS) of the American College of Radiology. Eighteen inputs to the network included 10 BI-RADS lesion descriptors and eight input values from the patient's medical history. The network was trained and tested on 206 cases (133 benign, 73 malignant cases). Receiver operating characteristic curves for the network and radiologists were compared. RESULTS: At a specified output threshold, the ANN would have improved the positive predictive value (PPV) of biopsy from 35% to 61% with a relative sensitivity of 100%. At a fixed sensitivity of 95%, the specificity of the ANN (62%) was significantly greater than the specificity of radiologists (30%) (P < .01). CONCLUSION: The BI-RADS lexicon provides a standardized language between...

Journal ArticleDOI
TL;DR: Although it is premature to recommend the routine use of breast MR imaging, contrast-enhanced MR imaging has potential as a comprehensive platform for the detection, localization, biopsy, and treatment of breast cancers.
Abstract: Studies suggest that magnetic resonance (MR) imaging may have a variety of roles in the detection and management of breast disease. However, because study methods and imaging techniques are not standard, there is still a great deal of uncertainty about its place in clinical practice. The authors review the current state of breast MR imaging and address a number of issues, including the basis for contrast material-enhanced imaging, techniques, and possible clinical roles, including treatment planning, evaluation of the posttreatment breast, evaluation of breast implants, characterization of breast masses, MR imaging-guided biopsy, and the potential for cancer screening. Although it is premature to recommend the routine use of breast MR imaging, contrast-enhanced MR imaging has potential as a comprehensive platform for the detection, localization, biopsy, and treatment of breast cancers.

Journal ArticleDOI
TL;DR: The positive predictive value for examinations with abnormal findings and the yield for diagnostic procedures performed as a result of abnormal findings in 50 community radiologic facilities were higher than those reported in some earlier studies, a fact that raised concern about the induced cost of screening mammography.
Abstract: The purpose of this study was to gather from 50 community mammography practices that were included in the National Survey of Mammography Facilities data concerning abnormal findings on screening mammograms to determine the frequency of various recommendations made for patients who had abnormal findings and to compare these recommendations with the frequency with which the procedures were actually performed. We also determined the positive predictive value of screening mammograms (the number of cancers detected per 100 abnormal findings) and the yield (the number of cancers detected per 100 procedures done) of various diagnostic procedures done because of abnormal findings.We identified 1717 screening mammograms done in the last half of 1991 that had abnormal findings. Radiologic recommendations and follow-up procedures, including repeat standard (screening) mammography, additional mammographic views, sonography, clinical breast examination, needle aspiration, needle biopsy, and open biopsy, were identifie...

Journal ArticleDOI
TL;DR: It is concluded that scintimammography is a sensitive test that can improve the detection of breast carcinoma.
Abstract: PURPOSE: To evaluate the complementary role of technetium-99m sestamibi scintimammography in improvement of the sensitivity and specificity of mammography in detection of carcinoma of the breast. MATERIALS AND METHODS: At 5 and 60 minutes after intravenous injection of Tc-99m sestamibi, scintimammograms were obtained in 147 women (age range, 18-73 years; mean age, 47.9 years +/- 10.2 [standard deviation]) with 153 lesions that warranted breast biopsy (102 lesions) or fine-needle aspiration cytologic analysis (51 lesions). There were 113 palpable and 40 nonpalpable lesions. Lesion size on mammograms was 0.8 x 0.6 cm to 15.0 x 11.0 cm (mean, 2.82 cm +/- 1.71 x 2.39 cm +/- 1.56). RESULTS: Scintimammographic findings were true-positive in 47 biopsy-confirmed carcinomas, true-negative in 91 benign lesions, false-positive in 11 lesions with benign histopathologic findings (fibrocystic disease [n = 8] or fibroadenoma [n = 3]), and false-negative in four lesions of infiltrating ductal carcinoma. The sensitivity o...

Journal Article
TL;DR: Scintimammography is a highly sensitive test that improves the specificity of conventional mammography for the detection of breast carcinoma.
Abstract: UNLABELLED Mammography and physical examination combined have a sensitivity of 85% for the detection of breast carcinoma. Mammography also has a positive predictive value of 15%-30%. The aim of this study was to evaluate the usefulness of scintimammography using 99mTc-sestamibi as a complementary technique to mammography for the detection of breast carcinoma to improve mammography's sensitivity and specificity. METHODS We studied 100 consecutive patients (mean age 48.3 +/- 10.8 yr) who had 106 lesions warranting biopsy (67 lesions) or fine needle aspiration cytology (FNA) (39 lesions) of the breast. There were 85 palpable and 21 nonpalpable lesions. The size of the lesions on the mammograms were moderate (2.3 +/- 1.8 x 1.9 +/- 1.5 cm). Each patient received 20 mCi 99mTc-sestamibi intravenously. Five and 60 min postinjection, planar breast images in the lateral prone position were obtained. An anterior erect projection was then obtained to visualize the axilla and, if needed, a posterior oblique prone projection. RESULTS Scintimammography was true-positive in 30 lesions with biopsy-confirmed breast carcinoma; it was true-negative in 65 lesions subsequently proved to be benign. There were nine breast lesions with benign findings in which the scintimammography result was positive (false-positive scintimammography) for cancer. Finally, two lesions with pathologically proven carcinomas demonstrated a negative scintimammographic result. Therefore, in this group, the sensitivity of scintimammography was 93.7% with a specificity of 87.8%; the positive predictive value was 76.9%. The negative predictive value was 97%. CONCLUSION Scintimammography is a highly sensitive test that improves the specificity of conventional mammography for the detection of breast carcinoma.

Journal ArticleDOI
TL;DR: Patients undergoing mammography and visiting their obstetrician-gynecologist were asked whether they would take a breast cancer 1 (BRCA1) test to detect a genetic susceptibility to breast cancer, and if shown to have inherited a susceptibility, many reported that they would be very anxious, would want the test repeated, and would want mammography more often than yearly.
Abstract: Four hundred eighty-four patients undergoing mammography and 498 patients visiting their obstetrician-gynecologist were asked whether they would take a breast cancer 1 (BRCA1) test to detect a genetic susceptibility to breast cancer. More than 90% in both groups said they would take the test. Women were more likely to accept if they were regularly having breast examinations by a physician, believed that mammography effectively detects early breast cancer, and believed that early breast cancer is curable. If shown to have inherited a susceptibility, many reported that they would be very anxious, would want the test repeated, would examine their breasts more often than monthly, and would want mammography more often than yearly. Many also reported that they would recommend testing to relatives.

Journal ArticleDOI
01 Aug 1995
TL;DR: Positron emission mammography (PEM) will provide a highly efficient high spatial resolution and low cost positron imaging system whose metabolic images are co-registered with conventional mammography.
Abstract: We are developing a high specificity technique for detecting the increased metabolic rate of breast tumours. The glucose analog FDG is known to concentrate in breast tumours rendering them easily detectable in conventional PET scans. Since PET is a relatively expensive imaging technique it has not been used routinely in the detection of breast cancer. Positron emission mammography (PEM) will provide a highly efficient high spatial resolution and low cost positron imaging system whose metabolic images are co-registered with conventional mammography. Coincidences between two BGO blocks cut into 2/spl times/2 mm squares coupled to two 7.5 cm square imaging PMTs are detected and back-projected to form real-time multiple plane images. The design is about 20 times more sensitive than a conventional multi-slice PET body scanner, so much less radio-pharmaceutical can be used, reducing the patient dose and cost per scan. Prototype detectors have been made and extensive measurements done. The device is expected to have an in-plane spatial resolution about 2 mm FWHM. Besides the application as a secondary screening tool the device may be beneficial in measuring a tumour's response to radio-therapy or chemo-therapy, as well as aiding the surgeon in optimizing the removal of malignant tissue. >

Journal ArticleDOI
04 Nov 1995-BMJ
TL;DR: Two view mammography is medically more effective than one view; it detects more cancers and reduces recall rates; it is also similarly cost effective financially.
Abstract: Objective: To compare one view (oblique) and two view (oblique and craniocaudal) mammography in breast cancer screening. Design: Randomised controlled trial. Setting: Nine breast screening centres in England. Subjects: 40163 women aged 50-64 attending their first breast screening examination. Interventions: Women were randomised to have one view mammography, two view mammography, or two view mammography in which one view was read by one reader and both views were read by another. Main outcome measures: Prevalence of cancer detected, recall rates, cost per cancer detected, and marginal cost per extra cancer detected. Results: Two view mammography detected 24% more women with breast cancer (95% confidence interval 16% to 31%) than one view mammography. Prevalence of detected cancer was 6.84 with two view mammography and 5.52 per 1000 women with one view. The proportion of women recalled for assessment was 15% lower (95% confidence interval 6% to 23%) with two view (6.97%) than with one view (8.16%) mammography. The cost of two view screening was higher (pounds sterling26.46 compared with pounds sterling22.00 per examination) but the average cost per cancer detected was similar (pounds sterling5330 compared with pounds sterling5310) and the marginal cost per extra cancer detected with two views was similar to the average cost (pounds sterling5400). Conclusion: Two view mammography is medically more effective than one view; it detects more cancers and reduces recall rates; it is also similarly cost effective financially.

Journal ArticleDOI
TL;DR: Although the results of the present study confirmed that mammographic parenchymal patterns and densities were important predictors of breast cancer risk, their practical use in screening seems limited due to the high prevalence of high risk patterns.
Abstract: The relations of Wolfe mammographic patterns, quantitative mammographic densities, and mammographically estimated breast size to breast cancer risk were investigated prospectively in a case-control study nested in the New York University Women's Health Study, a cohort of 14,291 women in New York City, NY (United States). The archived mammograms of 197 breast cancer cases who were identified during the first 5.5 years of the study and of 521 individually matched controls from the same cohort were retrieved and classified according to Wolfe parenchymal patterns and mammographic densities by two expert radiologists. Breast size and volume were estimated on the mammogram's cranio-caudal projection. In both premenopausal and postmenopausal subjects, the risk of breast cancer increased progressively with increasing density and percent density area. A significantly increased risk was found also for Wolfe pattern DY in premenopausal women and P2 pattern in postmenopausal subjects. In premenopausal women, mammographically determined breast volume and breast height also were associated positively with breast cancer risk. Although the results of the present study confirmed that mammographic parenchymal patterns and densities were important predictors of breast cancer risk, their practical use in screening seems limited due to the high prevalence of high risk patterns.

Journal ArticleDOI
TL;DR: Results confirm and extend previous reports of high levels of non‐specific distress and intrusive thoughts in women at familial risk for breast cancer and highlight the need for further studies to determine the sources of this distress and its possible negative consequences for individuals at risk for cancer.
Abstract: In the present study women at familial risk for breast cancer (N = 26, risk group) underwent psychological assessments on two occasions: immediately prior to mammography screening and a month after notification of their normal results. Assessments included standardized measures of: acute distress; non-specific distress; intrusive thoughts; and avoidance about breast cancer. Normal risk women not undergoing mammography (N = 27, comparison group) completed the same measures, to provide an indication of concurrent levels of distress in women recruited from the same community. Results revealed that, prior to mammography, the risk group had high levels of acute distress, which were reduced to the level of the comparison group following notification of normal mammography results. On the other hand, despite notification of normal results, the risk group continued to have higher levels of non-specific distress, avoidance and intrusive thoughts about breast cancer. These results confirm and extend previous reports of high levels of non-specific distress and intrusive thoughts in women at familial risk for breast cancer. The findings highlight the need for further studies to determine the sources of this distress and its possible negative consequences for these individuals at risk for cancer.

Journal ArticleDOI
TL;DR: The study supports the use of official health statistics in the evaluation of randomized breast screening trials in Sweden by finding that 'breast cancer as underlying cause of death' according to Statistics Sweden resulted in relative risk estimates very similar to those based on the classification by the EPC.
Abstract: Between 1976 and 1982, four randomized mammography screening trials started in five screening centres in Sweden, involving 282 777 women (156 911 invited and 125 866 controls) with the aim to study if invitation to screening reduced the breast cancer mortality. An overview of the trials was performed to reduce the confidence intervals for the relative risk estimates. All 1 296 deaths occurring in women with breast cancer detected after randomization were evaluated by an independent endpoint committee (EPC), consisting of four physicians who reviewed collected medical information that was blinded regarding mammography screening. If there was disagreement between the EPC members at the initial individual evaluation the final classification was made at concensus meetings. In only 6.9% (n = 89) of the cases was there disagreement as to whether breast cancer was or was not the underlying cause of death. It was also found that ‘breast cancer as underlying cause of death' and ‘breast cancer as underlying or cont...

Journal ArticleDOI
15 Feb 1995-Cancer
TL;DR: An unexpected excess of patients with breast cancer with four or more positive lymph nodes was observed in mammographically screened women who were younger than the age of 50 years at enrollment into the Canadian National Breast Screening Study.
Abstract: Background. An unexpected excess of patients with breast cancer with four or more positive lymph nodes was observed in mammographically screened women who were younger than the age of 50 years at enrollment into the Canadian National Breast Screening Study (NBSS). It has been suggested that this excess is consistent with prior screening trials evaluating mammography. Methods. A quantitative evaluation of the distribution of patients with breast cancer with four or more positive lymph nodes in the NBSS was undertaken, and the percentages of patients with breast cancer who were at an advanced state at diagnosis in the NBSS and in previous randomized screening trials were compared. The validity of mortality analyses after eliminating advanced cases detected by physical examination at the initial screening visit is examined. Results. The excess of patients with cancer with four or more positive lymph nodes in the 40-49-year mammography age group of the NBSS was statistically significant, even when expressed as a percentage of all invasive cancers diagnosed. Such an excess is inconsistent with published data on extent of disease at diagnosis from previous studies. Analysis of NBSS mortality data after eliminating advanced cases detected by physical examination at the initial visit should result in minimal, if any, bias. Conclusions. Mortality analyses eliminating advanced cases detected by physical examination at the initial screening visit may be less susceptible to bias caused by possible nonrandom allocation of study participants and should be considered in future evaluations of the NBSS cohort after longer follow-up periods and in meta-analyses that may include the NBSS in assessments of the efficacy of mammography. Cancer 1995;75:997-1003.

Journal ArticleDOI
TL;DR: The work reported here suggests the incorporation of additional steps of image processing in an attempt to improve the performance of filters in the quantitation of lesions, by deriving approximate outlines, which are used to identify suspicious regions.
Abstract: In mammography, national breast screening programmes have lead to a large increase in the number of mammograms needing to be studied by radiologists. Lesion indicators can be pointlike as in microcalcifications or extended as in stellate (spiculate) lesions or regular masses. Texture analysis has been proposed as a promising method for studying radiographic images in relation to the quantitation of extended objects. Filters have been designed, which may be used to segment or classify an image using textural features, and these have been reported as being of value in automatic mammographic glandular tissue classification. The work reported here suggests the incorporation of additional steps of image processing in an attempt to improve the performance of these filters in the quantitation of lesions. By deriving approximate outlines, which are used to identify suspicious regions, the investigation illustrates the properties of one of the filters. After applying the method to a small prediagnosed database of stellate lesions and regular masses, the results show that the filter is able to outline the malignant masses in all cases presented. The erroneous areas extracted are small for the initial part of the work, which deals with 256 x 256 pixel image extracts, though slightly larger in some cases when the whole mammogram is considered. Simple methods for the removal of these artefacts are proposed. For each non-suspicious case studied, the sum of any false positive areas is statistically insignificant when compared with the regions correctly outlined in the prediagnosed instances.

Journal ArticleDOI
TL;DR: Breast MR imaging is a slightly more sensitive modality than mammography but not a highly specific technique for evaluating breast lesions, and has utility in several clinical situations but should not be used as a substitute for biopsy or general screening.
Abstract: PURPOSE: To evaluate the clinical utility of dynamic gadolinium-enhanced magnetic resonance (MR) imaging of the breast with commercially available techniques in patients scheduled for excisional biopsy. MATERIALS AND METHODS: A total of 91 breast abnormalities, 70 benign and 21 malignant, were evaluated. Thin-section three-dimensional gradient-echo images were obtained before and 2, 4, and 7 minutes after injection of contrast material. Three radiologists prospectively evaluated the mammograms and MR images. RESULTS: The areas under the receiver operating characteristic curves were 0.820 for mammography and 0.893 for MR imaging (P = .67). Sensitivity of MR imaging was 82.5%, compared with 74.6% for mammography. Specificity of MR imaging was 82.5%, compared with 79.1% for mammography. Enhancement profiles showed early intense enhancement in malignancies but considerable overlap with enhancement of benign disease. CONCLUSION: Breast MR imaging is a slightly more sensitive modality than mammography but not a...

Journal ArticleDOI
TL;DR: The algorithm described provides a fully automated method for the segmentation of individual microcalcifications in an area of the mammogram known to contain a cluster.
Abstract: This paper presents a computerized method for the automated segmentation of individual microcalcifications in a region of interest (ROI) known to contain a cluster in digital mammograms.Mammographic parenchyma can be accurately modeled with the fractal approach, but not areas with microcalcifications. The digitized image is divided into 16×16‐pixel overlapping windows and those accurately modeled by the fractal model are eliminated. The next steps include local thresholding of the ROIs using an iterative method, the elimination of some of the artifacts and identification of the clustered microcalcifications using a clustering algorithm. The evaluation was performed on 81 simulated clusters superimposed on normal mammographic backgrounds and on a representative database of 408 real mammograms. Microcalcification locations were identified by two radiologists independently. These locations were compared to those found by the computer algorithm. An average of 59% of the simulated microcalcifications and 69% of the microcalcifications common to both radiologists were detected. The algorithm described provides a fully automated method for the segmentation of individual microcalcifications in an area of the mammogram known to contain a cluster.

Journal ArticleDOI
TL;DR: The role of mammography in the diagnosis and treatment of women with breast cancer, including recommendations for when to obtain mammograms, and to present the spectrum of findings that may occur are discussed.
Abstract: The woman with breast cancer who undergoes breast-conserving treatment (lumpectomy with or without radiation) is a challenge for the mammographer. The preoperative mammograms of women undergoing breast-conserving treatment, unlike those of women who will be treated by mastectomy, must be evaluated for the extent of tumor to determine if limited surgery can be done with good cosmetic results. In some cases, postoperative mammographic assessment of the breast is done to determine whether any residual tumor exists in the breast. Finally, there is the long-term follow-up of the treated breast to detect any new or recurrent cancer as early as possible. These tasks require knowledge of the mammographic patterns of breast cancer and scar formation, an appreciation of the alterations that occur in the mammogram after breast irradiation, and an understanding of the benign changes that can mimic new breast cancer in these women. The purpose of this review is to discuss the role of mammography in the diagnosis and treatment of these women, including recommendations for when to obtain mammograms, and to present the spectrum of findings that may occur.