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Showing papers on "Mammography published in 1997"


Journal ArticleDOI
TL;DR: Tomosynthesis may improve the specificity of mammography with improved lesion margin visibility and may improve early breast cancer detection, especially in women with radiographically dense breasts.
Abstract: PURPOSE: To describe and evaluate a method of tomosynthesis breast imaging with a full-field digital mammographic system. MATERIALS AND METHODS: In this tomosynthesis method, low-radiation-dose images were acquired as the x-ray source was moved in an arc above the stationary breast and digital detector. A step-and-expose method of imaging was used. Breast tomosynthesis and conventional images of two imaging phantoms and four mastectomy specimens were obtained. Three experienced readers scored the relative lesion visibility, lesion margin visibility, and confidence in the classification of six lesions. RESULTS: Tomosynthesis image-reconstruction algorithms allow tomographic imaging of the entire breast from a single arc of the x-ray source and at a radiation dose comparable with that in single-view mammography. Except for images of a large mass in a fatty breast, the tomosynthesis images were superior to the conventional images. CONCLUSION: Digital mammographic systems make breast tomosynthesis possible. T...

814 citations


Journal ArticleDOI
TL;DR: Screening effectiveness in community practice today could exceed that estimated in trials because the technical and interpretative quality of mammography has improved since the trials were performed and the level of efficacy in trials may not pertain to community practice.
Abstract: M ammography is the primary method of detecting early stage breast cancer and has been shown in randomized clinical trials to reduce breast cancer mortality, especially among women 50 years old and older [1-5]. Authorities in cancer screening have bong recognized that the level of efficacy of screening demonstrated in randomized clinical trials may not pertain to community practice for several reasons [6]. These reasons include possible differences in the population groups receiving screening, lower accuracy of screening mammography in the community, and lower compliance with diagnostic follow-up and treatment in community practice, which may result in more adverse outcomes. Screening effectiveness in community practice today could exceed that estimated in trials because the technical and interpretative quality of mammography has improved since the trials were performed. Furthermore, clinical trial efficacy has been estimated on the basis of assignment to receive screening; to the extent that women assigned to screening were not screened or that women in the control groups were screened, efficacy in trials may have been underestimated. To optimally evaluate the performance of mammography in a community setting, the screening prevalence and patterns and the associated sensitivity, specificity, and predictive value of mammography in community screening programs should be determined by linkage with cancer outcomes [7, 8]. A program of monitoring should also provide data on specific populations, such as rural and minority subgroups, that are traditionally underserved by screening programs and that may have different breast cancer mortality rates [9]. Before the Mammography Quality Standards Act (MQSA) of 1992, most mammography facilities in the United States did not maintain records that could provide reliable and comprehensive data to evaluate the performance of screening mammography [10]. The concept of a medical audit of outcomes data had been proposed [ 1 1 ] but has not been routinely practiced in the community. The interim regulations of the MQSA mandated maintaining mammography data and performing a medical outcomes audit [12]. In practical terms, the medical audit requirement of the MQSA was limited to an analysis of patients with tests interpreted as “suspicious abnormality” or “highly suggestive for malignancy,” which permits evaluation of the positive predictive value of such interpretations. However, the MQSA does not require linkage to populationbased cancer registry data or another source of pathology data, without which it is impossible to accurately assess the outcomes of patients with mammograms interpreted as having normal findings. To understand the full effect of

399 citations


Journal ArticleDOI
TL;DR: The initial clinical results show that the frequency-domain scanner, even at the present stage of development, has the potential to be a useful tool in mammography.
Abstract: We present a novel approach to optical mammography and initial clinical results. We have designed and developed a frequency-domain (110-MHz) optical scanner that performs a transillumination raster scan of the female breast in approximately 3 min. The probing light is a dual-wavelength (690 and 810 nm, 10-mW average power), 2-mm-diameter laser beam, and the detection optical fiber is 5 mm in diameter. The ac amplitude and phase data are processed with use of an algorithm that performs edge effect corrections, thereby enhancing image contrast. This contrast enhancement results in a greater tumor detectability compared with simple light intensity images. The optical mammograms are displayed on a computer screen in real time. We present x-ray and optical mammograms from two patients with breast tumors. Our initial clinical results show that the frequency-domain scanner, even at the present stage of development, has the potential to be a useful tool in mammography.

371 citations


Journal ArticleDOI
TL;DR: An excellent sensitivity can be achieved for the combination of mammography and MRI and if appropriately applied and used for selected indications, contrast-enhanced MRI may allow a significant diagnostic gain.

313 citations


Journal ArticleDOI
TL;DR: A substantial reservoir of DCIS is undetected during life, and how hard pathologists look for the disease and, perhaps, their threshold for making the diagnosis are potentially important factors in determining how many cases ofDCIS are diagnosed.
Abstract: Purpose: To determine how many cases of breast cancer might be found if women not known to have the disease were thoroughly examined (the disease “reservoir”). Data Sources: MEDLINE search from 196...

281 citations


Journal ArticleDOI
01 Dec 1997-Cancer
TL;DR: Mammographic screening can reduce mortality from breast carcinoma in women ages < 50 years if high quality mammography is used and an 18-month interscreening interval is strictly adhered to.
Abstract: BACKGROUND. The effect of mammography screening on breast carcinoma mortality in women ages < 50 years remains unclear. METHODS. A randomized trial of invitation to breast carcinoma screening with mammography was performed in the city of Gothenburg, Sweden. The purpose was to estimate the effect of mammographic screening on breast carcinoma mortality in women ages < 50 years. Randomization was initially by day-of-birth cluster (18% of subjects), and subsequently by individual (82% of subjects). Between September 1983 and April 1984, 11,724 women ages 39-49 years were randomized to the study group. This group was invited to mammographic screening every 18 months. Two-view mammography was used at each screen unless the density of the breast at the previous screen indicated that single view was adequate. Fourteen thousand two hundred and seventeen women in the same age range were randomized to a control group that was not invited to undergo screening until the fifth screen of the study group (between 6 and 7 years after randomization). Women with breast carcinoma diagnosed up to the time immediately after the first screen of the control group were followed for death from breast carcinoma until the end of December 1994. RESULTS. A 45% reduction in mortality from breast carcinoma was observed in the study group compared with the control group (relative risk [RR] = 0.55, P = 0.035, 95% confidence interval [CI], 0.31-0.96). A conservative estimate based on removal of the tumors detected at the first screen of the control group gave a mortality reduction of 44% (RR = 0.56, P = 0.046, 95% CI, 0.31-0.99). In both cases, the effect was statistically significant. CONCLUSIONS. Mammographic screening can reduce mortality from breast carcinoma in women ages < 50 years. The mortality reduction can be substantial if high quality mammography is used and an 18-month interscreening interval is strictly adhered to.

257 citations


Journal ArticleDOI
TL;DR: The cost-effectiveness of screening in women 50 years of age and older was calculated by comparing the first strategy with the second strategy and the actual delay times before the onset of benefits, and the transition probabilities were both age- and strategy-dependent.
Abstract: Background: Screening mammography is recommended for women 50 to 69 years of age because of its proven efficacy and reasonable cost-effectiveness. Extending screening recommendations to include wom...

255 citations


Journal ArticleDOI
TL;DR: The findings of the first breast cancer screening trial are summarized, which found that to a large extent the difference among the 40-49-year-olds occurred in the subgroup with breast cancer diagnosed after these women had passed their 50th birthday, and utility of screening women in their forties is questionable.
Abstract: This paper summarizes the findings of the first breast cancer screening trial, which was initiated in December 1963 to explore the efficacy of screening. Women aged 40-64 years were selected from enrollees in the Health Insurance Plan (HIP) of Greater New York and were randomly assigned to study and control groups. Study group women were invited for screening, an initial examination, and three annual reexaminations. Screening consisted of film mammography (cephalocaudal and lateral views of each breast) and clinical examination of breasts. Breast cancer and mortality from breast cancer were examined by treatment group (study vs. control) and by entry-age subgroup. By the end of 18 years from entry, the study group had about a 25% lower breast cancer mortality among women aged 40-49 and 50-59 at time of entry than did the control group. However, to a large extent the difference among the 40-49-year-olds occurred in the subgroup with breast cancer diagnosed after these women had passed their 50th birthday, and utility of screening women in their forties is questionable.

244 citations


Journal ArticleDOI
TL;DR: Results show that after 2 years, a low-fat, high-carbohydrate diet reduced the area of mammographic density, a radiographic feature of the breast that is a risk factor for breast cancer.
Abstract: Background: The appearance of breast tissue on mammography varies according to its composition. Fat is radiolucent and appears dark on mammography, while stromal and epithelial tissue has greater optical density and appears light. Extensive areas of radiologically dense breast tissue seen on mammography are associated with an increased risk of breast cancer. Purpose: The purpose of the present study was to determine whether the adoption of a low-fat, high-carbohydrate diet for 2 years would reduce breast density. Methods: Women with radiologic densities in more than 50% of the breast area on mammography were recruited and randomly allocated to an intervention group taught to reduce intake of dietary fat (mean, 21% of calories) and increase complex carbohydrate (mean, 61% of calories) or to a control group (mean, 32% of calories from fat and 50% of calories from carbohydrates). Mammographic images from 817 subjects were taken at baseline and compared with those taken 2 years after random allocation by use of a quantitative image analysis system, without knowledge of the dietary group of the subjects or of the sequence in which pairs of images had been taken. The effects of the intervention on the mammographic features of breast area, area of dense tissues in the breast, and the percent of the breast occupied by dense tissue were examined using t tests. Multiple regression was used to examine these effects while accounting for age at trial entry, weight change, and menopausal status. Results: After 2 years, the total area of the breast was reduced by an average of 233.7 mm 2 (2.4%) (95% confidence interval [CI] = 106.9-360.6) in the intervention group compared with an average increase of 26.3 mm 2 (0.3%) (95% CI = -108.0-160.5) in the control group (P = .01). The area of density was reduced by 374.4 mm 2 (6.1%) (95% CI = 235.1-513.8) in the intervention group compared with an average of 127.7 mm 2 (2.1%) (95% CI = 8.6-246.7) in the control group (P = .01). Weight loss was associated with a reduction in breast area. The effect of the intervention on breast area was only marginally statistically significant after weight change, menopausal status, and age at trial entry were taken into account (P = .06). Greater weight loss and becoming postmenopausal were associated with statistically significant reductions in the area of density on the mammographic image at 2 years (P = .04 and P<.001, respectively). Age at entry into the trial was marginally significant in the same direction (P =.06). The effect of the intervention on area of density remained statistically significant after controlling for weight loss, age at entry, and menopausal status (P =.03). The change in the percentage of dense tissue in the mammographic image was not significantly different between the two groups (P =.71). Conclusions and Implications: These results show that after 2 years, a low-fat, high-carbohydrate diet reduced the area of mammographic density, a radiographic feature of the breast that is a risk factor for breast cancer. Longer observation of a larger number of subjects will be required to determine whether these effects are associated with changes in risk of breast cancer.

238 citations


Journal ArticleDOI
TL;DR: Breast MR imaging enables identification of the site of primary tumor in most patients suspected of having occult primary breast cancer, and MR findings can influence surgical treatment.
Abstract: PURPOSE: To evaluate the utility of contrast material-enhanced magnetic resonance (MR) imaging of the breast for localization of the site of primary breast carcinoma in patients with isolated ipsilateral axillary metastasis, without other focal findings at physical examination or mammography. MATERIALS AND METHODS: Twelve women with biopsy-proved metastatic adenocarcinoma to axillary lymph nodes and occult primary tumor underwent MR imaging at 1.5 T with a three-dimensional spoiled gradient-echo pulse sequence before and after administration of gadopentetate dimeglumine. Enhancing areas were correlated with histopathologic findings at mastectomy (n = 8) or breast-conserving treatment (n = 4). RESULTS: In nine (75%) of the 12 patients, enhancement was seen on MR images that represented the site of the primary tumor at surgery. Eight had focal masses, and one had an area of regional enhancement. Two patients had negative MR findings, and no tumor was found at mastectomy. One patient with regional enhancemen...

199 citations


Journal ArticleDOI
TL;DR: Fatty and fibroglandular tissue can be differentiated on MR images of the breast with high precision and accuracy, therefore allowing assessment of breast density, and the conclusions of researchers who used mammographic density patterns should be reassessed.
Abstract: A method for segmenting MR images of the breast was applied to determine fatty and fibroglandular tissue volumes in breasts of women in different age groups. The results were compared with subjective assessments of breast density from X-ray mammograms in the same patients.Two experienced mammographers assessed the percentage of fat in the breasts of 40 women who were 20-83 years old. MR images were obtained on a 1.0-T scanner equipped with a bilateral receive-only breast coil. Images were acquired using a three-dimensional T1-weighted gradient-echo sequence with a 1.25 x 1.4 x 2.5 mm resolution. On average, breast parenchyma appeared in 30 images in each breast. Image segmentation was based on a semiautomated, two-compartmental (fatty and fibroglandular tissue) model that accounts for partial volume effects. To validate the accuracy of the MR imaging segmentation technique, we performed a phantom study using an identical imaging sequence.The accuracy of the MR imaging segmentation of the phantom was of th...

Journal Article
TL;DR: Quantification of FDG uptake in breast tumors provided objective criteria for differentiation between benign and malignant tissue with similar diagnostic accuracy as compared with visual analysis.
Abstract: This study evaluated various quantitative criteria for analysis of breast imaging with PET using the radiolabeled glucose analog 18F-fluorodeoxyglucose (FDG). Methods: In a prospective study, 73 patients with abnormal mammography or palpable breast masses scheduled for biopsy were investigated with PET. A total of 97 breast tumors were evaluated by histology, including 46 benign and 51 malignant tumors. Using a whole-body PET scanner, attenuation-corrected images were acquired between 40 and 60 min after tracer injection. For Patlak analysis, dynamic data acquisition was obtained in 24 patients. To differentiate between benign and malignant breast tumors, receiver operating characteristic curves were calculated using incrementally increasing threshold values for tumor/nontumor ratios based on average and maximum activity values per region of interest, standardized uptake values (corrected for partial volume effect, normalized to blood glucose, partial volume effect and blood glucose, using the lean body mass as well as the body surface area) and calculating the FDG influx rate (K) assessed by Patlak analysis. Results: Quantification of FDG uptake in breast tumors provided objective criteria for differentiation between benign and malignant tissue with similar diagnostic accuracy as compared with visual analysis. Applying correction for partial volume effect and normalization by blood glucose yielded the highest diagnostic accuracy. Conclusions: These quantitative methods provided accurate evaluation of PET data for differentiating benign from malignant breast tumors. Quantitative assessment is recommended to complement visual image interpretation with the potential benefit of reduced interobserver variability.

Journal ArticleDOI
TL;DR: In this paper, the mammographic and histopathologic features of carcinomas not diagnosed at stereotactic core biopsy were evaluated and a mammography-based approach was recommended in all 28 cases.
Abstract: PURPOSE: To evaluate the mammographic and histopathologic features of carcinomas not diagnosed at stereotactic core biopsy. MATERIALS AND METHODS: A retrospective review revealed 144 surgically confirmed carcinomas preoperatively sampled with stereotactic core biopsy. Diagnosis at stereotactic core biopsy was carcinoma in 116 (81%) lesions, atypical hyperplasia in 21 (15%), and benign findings discordant with those from mammography in seven (5%). Mammographic and histopathologic findings in the latter 28 cases were reviewed. RESULTS: Prompt repeat biopsy was recommended in all 28 cases. The frequency with which a cancer yielded atypical hyperplasia at stereotactic core biopsy was higher for calcifications than masses (30% vs 5%, P < .0001), ductal carcinoma in situ (DCIS) than infiltrating carcinoma (33% vs 7%, P = .0002), and noncomedo than comedo DCIS (60% vs 9%, P = .0008). No significant difference was observed in the likelihood of benign core biopsy findings without atypia in malignant calcifications...

Journal Article
TL;DR: Physical examination is the best noninvasive predictor of the real size of locally advanced primary breast cancer, whereas sonography correlates better with the real dimensions of axillary lymph nodes.
Abstract: The purpose of this study was to correlate physical examination and sonographic and mammographic measurements of breast tumors and regional lymph nodes with pathological findings and to evaluate the effect of neoadjuvant chemotherapy on clinical Tumor-Node-Metastasis stage by noninvasive methods This was a retrospective analysis of 100 patients with locally advanced breast cancer registered and treated in prospective trials of neoadjuvant chemotherapy All patients received four cycles of a doxorubicin-containing regimen and had noninvasive evaluation of the primary tumor and regional lymph nodes before and after neoadjuvant chemotherapy by physical examination, sonography, and mammography and underwent breast surgery and axillary dissection within 5 weeks after completion of neoadjuvant chemotherapy The correlations between clinical and pathological measurements were determined by Spearman rank correlation analysis A proportional odds model was used to examine predictive values Eighty-three patients had both a clinically detectable primary tumor and lymph node metastases Sixty-four patients had a decrease in Tumor-Node-Metastasis stage after chemotherapy For 54% of patients, there was concordance in clinical response between the primary tumor and lymph node compartment; for the rest, results were discordant Physical examination correlated best with pathological findings in the measurement of the primary tumor (P = 00003), whereas sonography was the most accurate predictor of size for axillary lymph nodes (P = 00005) The combination of physical examination and mammography worked best for assessment of the primary tumor (P = 0003), whereas combining physical examination with sonography gave optimal evaluation of regional lymph nodes (P = 00001) In conclusion, physical examination is the best noninvasive predictor of the real size of locally advanced primary breast cancer, whereas sonography correlates better with the real dimensions of axillary lymph nodes The combination of physical examination with either mammography or sonography significantly improves the accuracy of noninvasive assessment of tumor dimensions

Journal ArticleDOI
TL;DR: For the present, women considering screening mammography should be told the likelihood of being diagnosed with DCIS and that only some DCIS cases may be clinically significant but almost all will be treated surgically.
Abstract: The increased use of screening mammography has resulted in a marked increase in detected cases of ductal carcinoma in situ (DCIS) of the breast since the early 1980s. In 1993, there were an estimated 23,275 newly diagnosed cases of DCIS in the United States, of which 4,676 were in women aged 40-49. DCIS accounted for 14.7% of all newly diagnosed breast cancers in women aged 40-49 in 1993, and perhaps 40% of all mammographically detected breast cancers in this age group are DCIS. Among women aged 40-49, an estimated 1,890 mastectomies and 2,707 lumpectomies (with or without radiation) were performed for DCIS in 1993. There is an urgent need to better understand the relationship of mammographically detected DCIS to invasive and potentially life-threatening breast cancer. Better information about the appropriate treatment of DCIS is also needed to reduce the confusion and uncertainty many women and their physicians currently experience in the face of a DCIS diagnosis. For the present, women considering screening mammography should be told the likelihood of being diagnosed with DCIS and that only some DCIS cases may be clinically significant but almost all will be treated surgically.

Journal ArticleDOI
TL;DR: By learning how to perform a directional, vacuum-assisted biopsy with either stereotactic or US guidance, the radiologist has an additional, valuable tool for bringing accurate breast biopsy to his or her community.
Abstract: A recently developed method of minimally invasive breast biopsy involves use of a directional, vacuum-assisted instrument. Use of this instrument requires some changes in techniques and applications of breast biopsy, but it enables confident biopsy of breast lesions under both ultrasound (US) and stereotactic guidance. The device uses vacuum to pull tissue into the probe and to remove the specimen without withdrawing the probe each time. For stereotactic biopsy, to target the lesion, the probe is placed anterior or posterior to the lesion and stereotactic positioning views are obtained; for a US-guided procedure, the probe is advanced posterior to the lesion. Next, the direction that the probe aperture must be rotated to face the lesion is determined. Tissue samples are obtained at consecutive clock positions of 1 1/2-hour intervals to achieve contiguous sampling. At least 15 samples are obtained with an 11-gauge probe to acquire a minimum of 1,500 mg of tissue. If postbiopsy images reveal that the lesion has been removed, a percutaneous clip is placed to mark the biopsy site for follow-up examination and possible further treatment. Patients are examined the next day and given the biopsy results and treatment considerations, if needed; they are followed up approximately 1 week later to detect any complications (eg, discomfort, ecchymosis). By learning how to perform a directional, vacuum-assisted biopsy with either stereotactic or US guidance, the radiologist has an additional, valuable tool for bringing accurate breast biopsy to his or her community.

Journal ArticleDOI
TL;DR: This study identified variables associated with the breast cancer screening behaviors of mammography utilization and breast self-examination in a convenience sample of low income African American women that significantly predicted either frequency or proficiency of BSE.
Abstract: Breast cancer mortality is significantly greater in African American women than in their Caucasian counterparts. The purpose of this study was to identify variables associated with the breast cancer screening behaviors of mammography utilization and breast self-examination (BSE) in a convenience sam

Journal ArticleDOI
TL;DR: Although MR imaging has an important role in the evaluation of breast lesions and, primarily, in ruling out malignancy, one should be aware of the fact that false-negative MR findings do occur.
Abstract: In this study we analyze MR-negative malignant lesions of the breast. A total of 204 patients with palpable and/or mammographic lesions were studied. The MR technique consisted of the turbo FLASH and MP-RAGE subtraction techniques. All patients underwent surgical biopsy and/or mastectomy and all specimens were examined by the correlative radiologic-histologic mapping technique. A total of 208 lesions were evaluated; 145 turned out to be malignant and 63 proved to be benign. Six malignant lesions were misinterpreted as benign on MR imaging; thus, suspicious contrast enhancement was present in 96 % of the lesions detected by mammography, US, or clinical examination. Especially 4 of the 17 ductal carcinoma in situ (DCIS) lesions were misinterpreted (23.5 %). Despite optimal technique, 6 malignant lesions were not identified by MR imaging. The highest prevalence of these MR occult lesions was in the group of DCIS. Although MR imaging has an important role in the evaluation of breast lesions and, primarily, in ruling out malignancy, one should be aware of the fact that false-negative MR findings do occur.

Journal ArticleDOI
TL;DR: The absolute benefit of screening women aged 40 to 49 years is small and there is concern that the harms are substantial, the focus should be to help these women make informed decisions about screening mammography by educating them of their true risk of breast cancer and the potential benefits and risks of screening.
Abstract: In randomized controlled trials, screening mammography has been shown to reduce mortality from breast cancer about 25% to 30% among women aged 50 to 69 years after only five to six years from the initiation of screening. Among women aged 40 to 49 years, trials have reported no reduction in breast cancer mortality after seven to nine years from the initiation of screening; after 10 to 14 years there is a 16% reduction in breast cancer mortality. Given that the incidence of breast cancer for women aged 40 to 49 years is lower and the potential benefit from mammography screening smaller and delayed, the absolute number of deaths prevented by screening women aged 40 to 49 years is much less than in screening women aged 50 to 69 years. Because the absolute benefit of screening women aged 40 to 49 years is small and there is concern that the harms are substantial, the focus should be to help these women make informed decisions about screening mammography by educating them of their true risk of breast cancer and the potential benefits and risks of screening.

Journal ArticleDOI
TL;DR: A preliminary result indicates that computerized texture analysis can extract mammographic information that is not apparent by visual inspection, and may be used to assist in mammographic interpretation, with the potential to reduce biopsies of benign cases and improve the positive predictive value of mammography.
Abstract: We investigated the feasibility of using texture features extracted from mammograms to predict whether the presence of microcalcifications is associated with malignant or benign pathology. Eighty-six mammograms from 54 cases (26 benign and 28 malignant) were used as case samples. All lesions had been recommended for surgical biopsy by specialists in breast imaging. A region of interest (ROI) containing the microcalcifications was first corrected for the low-frequency background density variation. Spatial grey level dependence (SGLD) matrices at ten different pixel distances in both the axial and diagonal directions were constructed from the background-corrected ROI. Thirteen texture measures were extracted from each SGLD matrix. Using a stepwise feature selection technique, which maximized the separation of the two class distributions, subsets of texture features were selected from the multi-dimensional feature space. A backpropagation artificial neural network (ANN) classifier was trained and tested with a leave-one-case-out method to recognize the malignant or benign microcalcification clusters. The performance of the ANN was analysed with receiver operating characteristic (ROC) methodology. It was found that a subset of six texture features provided the highest classification accuracy among the feature sets studied. The ANN classifier achieved an area under the ROC curve of 0.88. By setting an appropriate decision threshold, 11 of the 28 benign cases were correctly identified (39% specificity) without missing any malignant cases (100% sensitivity) for patients who had undergone biopsy. This preliminary result indicates that computerized texture analysis can extract mammographic information that is not apparent by visual inspection. The computer-extracted texture information may be used to assist in mammographic interpretation, with the potential to reduce biopsies of benign cases and improve the positive predictive value of mammography.

Journal ArticleDOI
TL;DR: The significance of cost factors for Caucasian and low-income women suggest that access barriers remain despite increased use of mammography, and racial differences in perceived barriers to mammography provide direction for health education efforts.
Abstract: This study examined the effect of race, income, and education on perceived susceptibility to and control over breast cancer, perceived benefits of and barriers to mammography, and knowledge about breast cancer and mammography use, in addition to determining if predictors for mammography use differed between races. Self-reported mailed survey data were obtained from a convenience sample of 1083 church women (78% Caucasian, 22% African-American) > or = 50 years with no history of breast cancer. ANOVA identified higher susceptibility and lower knowledge scores for African-American women; higher knowledge scores for upper income women of both races; interactions between race and income for benefits and perceived control; and interactions between race and education for barriers. African-American women were more likely to regard fear of radiation as a barrier to mammography (OR = .34; CI = .20, .57) and were more likely to worry about getting breast cancer (OR = .50; CI = .30, .82). Caucasian women were more likely to regard cost as a barrier (OR = 2.36, CI = 1.27, 4.40). For both races, variables predictive of ever having a mammogram were perceived control (White: OR = .69, CI = .54, .88; Black: OR = .50, CI = .38, .92), perceived barriers (White: OR = .88, CI = .83, .95; Black: OR = .75, CI = .64, .88), and knowledge (White: OR = 1.18, CI = 1.04, 1.33; Black: OR = 1.28, CI = 1.02, 1.61). Perceived benefits was predictive only for Caucasians (OR = 1.71, CI = 1.42, 2.06). Racial differences in perceived barriers to mammography and findings about the knowledge differences related to race, income, and education provide direction for health education efforts. The significance of cost factors for Caucasian and low-income women suggest that access barriers remain despite increased use of mammography.

Journal ArticleDOI
TL;DR: Analysis of variance supported the associations between readiness to obtain screening and opinions about mammography previously found in research using smaller samples from another geographic region, and it is recommended that future research examine whether opinions regarding the cons of mammography are more individually specific than the pros.
Abstract: This investigation extends prior research to apply decision-making constructs from the transtheoretical model (TTM) of behavior change to mammography screening. Study subjects were 8,914 women ages 50-80, recruited from 40 primarily rural communities in Washington State. Structural equation modeling showed that favorable and unfavorable opinions about mammography (i.e., pros and cons) fit the observed data. Analysis of variance supported the associations between readiness to obtain screening (i.e., stage of adoption) and opinions about mammography (i.e., decisional balance) previously found in research using smaller samples from another geographic region. This report extends these earlier studies by using structural equation modeling, opinion scales based both on principal component analyses and on a priori definitions, a developmental sample and a confirmatory sample, and by sampling from a different geographic region. It is recommended that future research examine whether opinions regarding the cons of mammography are more individually specific than the pros.

Journal ArticleDOI
TL;DR: The preliminary findings suggest that, in this cohort of women at risk of breast cancer, mammographic breast density may be genetically influenced.
Abstract: Background: The appearance of the female breast viewed by mammography varies considerably from one individual to another because of underlying differences in the relative proportions of fat, connective tissue, and glandular epithelium that combine to create a characteristic pattern of breast density. An association between mammographic patterns and family history of breast cancer has previously been reported. However, this association has not been found in all studies, and few data are available on possible genetic components contributing to mammographic breast density. Purpose : Our purpose was to estimate familial correlations and perform complex genetic segregation analyses to test the hypothesis that the transmission of a major gene influences mammographic breast density. Methods: As part of a cohort study (initiated in 1944) of families with a history of breast cancer, the probands' female relatives who were older than 40 years were asked to obtain a routine mammogram. The mammograms of 1370 women from 258 independent families were analyzed. The fraction of the breast volume occupied by radiographically dense tissue was estimated visually from video displays of left or right mediolateral oblique views by one radiologist experienced in mammography who had no knowledge of individual relationships to the probands. Data on breast cancer risk factors were obtained through telephone interviews and mailed questionnaires. Unadjusted and adjusted familial correlations in breast density were calculated, and complex genetic segregation analyses were performed. Results: Sister-sister correlations in breast density (unadjusted and adjusted for age and either body mass index, menopausal status, hormone replacement therapy, waist-to-hip ratio, number of live births, alcohol consumption, or cigarette smoking status) were all statistically significant (r = .16-.27; all P<.05 [two-sided]). Estimated mother-daughter correlations were smaller in magnitude (r =.01-.17) and not statistically significant. Segregation analyses indicate that a major autosomal gene influences breast density. The mendelian transmission of a dominant gene provided the best fit to the data; however, hypotheses involving the inheritance of either a recessive gene or a codominant gene could not be ruled out. The mendelian dominant hypothesis, accounting for 29% of the variability in breast density, suggests that approximately 12% of the population would be expected to carry at least one variant allele of this putative gene. Women who inherit the variant allele would have a mean breast density about twice that of the rest of the population. Conclusions: Our preliminary findings suggest that, in this cohort of women at risk of breast cancer, mammographic breast density may be genetically influenced.

Journal ArticleDOI
18 Jan 1997-BMJ
TL;DR: Reducing the frequency ofoutine follow up has so far proved popular among patients with breast cancer at standard risk in this cohort, and a multicentre study is needed to determine the effectiveness and cost-effectiveness of routine follow up with respect to disease outcomes.
Abstract: OBJECTIVE: To compare the experiences of patients with breast cancer who were conventionally monitored with those in whom routine follow up was restricted to the time of mammography. DESIGN: Randomisation to conventional schedule of clinic visits or to visits only after mammography. Both cohorts received identical mammography and were invited to telephone for immediate appointments if they detected symptoms. SETTING: Combined breast clinic, Chelsea and Westminster Hospital. SUBJECTS: 211 eligible outpatients with a history of breast cancer. MAIN OUTCOME MEASURES: Acceptability of randomisation, interim use of telephone and general practitioner, satisfaction with allocation to follow up. RESULTS: Of 211 eligible patients, 196 (93%) opted for randomisation in the study. Of these, 55 were under 50 years, 78 were diagnosed fewer than five years before, 90 had stage T2-4 tumours, and 71 had involved axillary nodes. Patients who did not participate were more likely to be under 50 years, to be two to five years after diagnosis, and to have had aggressive primary disease. Twice as many patients in both groups expressed a preference for reducing rather than increasing follow up. No increased use of local practitioner services or telephone triage was apparent in the cohort randomised to less frequent follow up by specialists. CONCLUSIONS: Reducing the frequency of routine follow up has so far proved popular among patients with breast cancer at standard risk in this cohort. A multicentre study is needed to determine the effectiveness and cost-effectiveness of routine follow up with respect to disease outcomes.

Journal ArticleDOI
01 Jul 1997-Cancer
TL;DR: In this paper, the authors evaluated the direct association between breast carcinoma risk and quantitative image features derived from automated analysis of digitized film mammograms, and found that both the skewness and fractal parameters were significantly related to risk of developing breast cancer.
Abstract: BACKGROUND There is considerable evidence that one of the strongest risk factors for breast carcinoma can be assessed from the mammographic appearance of the breast. However, the magnitude of the risk factor and the reliability of the prediction depend on the method of classification. Subjective classification requires specialized observer training and suffers from inter- and intraobserver variability. Furthermore, the categoric scales make it difficult to distinguish small differences in mammographic appearance. To address these limitations, automated analysis techniques that characterize mammographic density on a continuous scale have been considered, but as yet, these have been evaluated only for their ability to reproduce subjective classifications of mammographic parenchyma. METHODS In this study, using a nested case-control design, the authors evaluated the direct association between breast carcinoma risk and quantitative image features derived from automated analysis of digitized film mammograms. Two parameters, one describing the distribution of breast tissue density as reflected by brightness of the mammogram (regional skewness) and the other characterizing texture (fractal dimension), were calculated for images from 708 subjects identified from the Canadian National Breast Screening Study. RESULTS These parameters were evaluated for their ability to distinguish cases (those women who developed breast carcinoma) from controls. It was found that both the skewness and fractal parameters were significantly related to risk of developing breast carcinoma. CONCLUSIONS Although the relative risk estimates were moderate (typically ≥ 2.0) and less than those from subjective classification or for an interactive computer method the authors have previously described, they are comparable to other risk factors for the disease. The observer independence and reproducibility of the automated methods may facilitate their more widespread use. Cancer 1997; 80:66-74. ©; 1997 American Cancer Society.

Journal ArticleDOI
TL;DR: Missed cancers were statistically significantly lower in density and more often seen on only one of two views than detected cancers.
Abstract: PURPOSE: To determine whether breast cancers missed at screening mammography have distinguishing characteristics from those of detected cancers. MATERIALS AND METHODS: The mammograms of 146 women with mammographically identifiable breast cancer were viewed independently by two radiologists who were blinded as to whether the cancer had been missed or detected (group 1 lesions, missed cancers; group 2 lesions, detected cancers) at screening. The mammographic lesions were characterized as to location, size, density, type, and visibility on two views. RESULTS: A significant difference between missed and detected cancers was found for diameter (P = .03), number of views (P < .0017), and density (P = .0007). Stepwise multivariable logistic regression showed that density (P = .01) and the number of views (P = .03) but not diameter (P = .27) were independently significant in distinguishing the groups. No statistically significant difference was found between the two groups for lesion type (P = .32 for reader 1 an...

Book
15 Jan 1997
TL;DR: Application of imaging in the diagnosis of breast disease: screening problem-solving of screening deteced and clinically symptomatic lesions.
Abstract: 1.Patient History and Communication with the Patient 2.Clinical Findings 3.Mammography 4.Sonography 5.Magnetic Resonance Imaging (MRI) 6.Breast Imaging Techniques under Investigation 7.Percutaneous Biopsy 8.Preoperative Localization 9.The Normal Breast 10.Benign Breast Disorders 11.Cysts 12.Benign Tumors 13.Inflammatory Conditions 14.Carcinoma in situ 15.Invasive Carcinoma 16.Lymph Nodes 17.Other Semi-malignant and Malignant Tumors 18.Post-traumatic, Post-surgical, and Post-therapeutic Changes 19.Skin Changes 20.The Male Breast 21.Screening 22.Additional Diagnostic Evaluation of Screening Findings and Solving of Problems in Symptomatic Patients

Journal ArticleDOI
TL;DR: Although some patients with Paget's disease might be well treated by breast conservation therapy, many patients have underlying multifocal carcinoma (including invasive cancer), which can be inapparent by examination and mammography.
Abstract: Background: Management of patients with mammary Paget's disease is controversial; recent recommendations range from primary radiotherapy to modified radical mastectomy. This review correlates associated breast findings with disease stage and outcome to help guide evaluation and treatment. Methods: Retrospective review of clinical, mammographic and pathologic data from 38 women with mammary Paget's disease treated between 1979 and 1995 was performed. Mastectomies were performed on all but two patients with the entire breast and lymph nodes evaluated for histopathologic evidence of carcinoma. Results: Underlying carcinoma (ductal carcinoma in situ and/or invasive ductal cancer) was found in most patients (92%) even when no palpable mass was evident (85%); this carcinoma is often multifocal (73%). Mammography fails to identify the underlying disease in many patients with no palpable mass and multifocal underlying disease (64%). Patients with Paget's disease and a palpable mass have a much greater incidence of invasive cancer, multifocal lesions, and positive lymph nodes, and have worse survival. Conclusions: Although some patients with Paget's disease might be well treated by breast conservation therapy, many patients have underlying multifocal carcinoma (including invasive cancer), which can be inapparent by examination and mammography. Selecting candidates with disease amenable to complete excision without mastectomy is problematic.

Journal ArticleDOI
TL;DR: Breast cancer management appears compromised in elderly patients (older than 65 years of age) and frequency of mammography screening is significantly less in elderly women older than 65 age, which may further reduce the opportunity to detect potentially curable cancers.
Abstract: Objective The suggestion that breast cancer management is compromised in elderly patients had prompted our review of the results of policies regarding screening and early detection of breast cancer and the adequacy of primary treatment in older women (<65 years of age) compared to younger women (40 to 64 years of age). Background Data Although breast cancer in elderly patients is considered biologically less aggressive than similar staged cancer in younger counterparts, outcome still is a matter of stage and adequate treatment of primary cancer. For many reasons, physicians appear reluctant to treat elderly patients according to the same standards used for younger patients. There is even government-mandated alterations in early detection programs. Thus, since 1993, Medicare has mandated screening mammography on a biennial basis for women older than 65 years of age compared to the current accepted standard of yearly mammograms for women older than 50 years of age. Using State Health Department and tumor registry data, the authors reviewed screening practice and management of elderly patients with primary breast cancer to determine the effects of age on screening, detection policies (as reflected in stage at diagnosis), treatment strategies, and outcome. Methods Data were analyzed from 5962 patients with breast cancer recorded in the state-wide Tumor Registry of the Hospital Association of Rhode Island between 1987 and 1995. The focus of the data collection was nine institutions with established tumor registries using AJCC classified tumor data. Additional data were provided by the State Health Department on screening mammography practice in 2536 women during the years 1987, 1989, and 1995. Results The frequency of mammographic screening for all averaged 40% in 1987, 52% in 1987, and 63% in 1995. In the 65-year-old and older patients, the frequency of screening was 34% in 1987, 45% in 1989, and 48% in 1995, whereas in the 40- to 49-year-old age group, the frequency of mammography was 47% in 1987, 61% in 1989, and 74% in 1995 (p < 0.001). There was a lower detection rate of preinvasive cancer in the 65-year-old and older patients, 8.8% versus 13.7% in patients within the 40- to 64-year-old age group (p < 0.001). There was a higher percentage of treatment by limited surgery among elderly patients with highly curable Stage IA and IB cancer with 26.6% having lumpectomy alone versus 9.4% in the younger patients. Five-year survival in that group was significantly worse (63%) than in patients treated by mastectomy (80%) or lumpectomy with axillary dissection and radiation (95%, p < 0.001). A similar effect was seen in patients with Stage II cancer. Conclusions Breast cancer management appears compromised in elderly patients (older than 65 years of age). Frequency of mammography screening is significantly less in elderly women older than 65 years of age. Early detection of preinvasive (curative cancers) is significantly less than in younger patients. The recent requirement by Medicare of mammography every other year may further reduce the opportunity to detect potentially curable cancers. Approximately 20% of patients had inferior treatment of favorable stage early primary cancer with worsened survival. Detection and treatment strategy changes are needed to remedy these deficiencies.

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TL;DR: The theoretical radiation risk from screening mammography is extremely small compared with the established benefit from this life-saving procedure and should not unduly distract women under age 50 who are considering screening.
Abstract: Although direct evidence of carcinogenic risk from mammography is lacking, there is a hypothetical risk from screening because excess breast cancers have been demonstrated in women receiving doses of 0.25-20 Gy. These high-level exposures to the breast occurred from the 1930s to the 1950s due to atomic bomb radiation, multiple chest fluoroscopies, and radiation therapy treatments for benign disease. Using a risk estimate provided by the Biological Effects of Ionizing Radiation (BEIR) V Report of the National Academy of Sciences and a mean breast glandular dose of 4 mGy from a two-view per breast bilateral mammogram, one can estimate that annual mammography of 100,000 women for 10 consecutive years beginning at age 40 will result in at most eight breast cancer deaths during their lifetime. On the other hand, researchers have shown a 24% mortality reduction from biennial screening of women in this age group; this will result in a benefit-to-risk ratio of 48.5 lives saved per life lost and 121.3 years of life saved per year of life lost. An assumed mortality reduction of 36% from annual screening would result in 36.5 lives saved per life lost and 91.3 years of life saved per year of life lost. Thus, the theoretical radiation risk from screening mammography is extremely small compared with the established benefit from this life-saving procedure and should not unduly distract women under age 50 who are considering screening.