Topic
Mammography
About: Mammography is a research topic. Over the lifetime, 20643 publications have been published within this topic receiving 513679 citations.
Papers published on a yearly basis
Papers
More filters
TL;DR: The data support the clinical implementation of DBT in breast cancer screening; however, larger prospective trials are needed to validate the findings in specific patient subgroups.
Abstract: Screening mammography, despite ongoing controversy regarding its risk-benefit ratio, remains the mainstay of early breast cancer detection (1,2) Digital breast tomosynthesis (DBT), a relatively new x-ray technology (3,4) that images the breast in 3-D, has shown promise in addressing some limitations of conventional mammography by alleviating the effect of superimposed structures that can lead to erroneous interpretations (5–8) This new technology is increasingly implemented in breast clinics across the country, despite relatively little data on its clinical outcomes and effectiveness in specific patient populations (9)
Early enthusiasm for DBT is based mostly on retrospective reader studies that compared DBT combined with digital mammography (DM) imaging vs DM alone These studies demonstrated reductions of up to 30% to 40% in false-positives, with similar or slightly improved cancer detection (6,10–12) In the United States, Food and Drug Administration (FDA) approval was granted to a single vendor in 2011 (Hologic, Inc, Bedford, MA) based on a large multicenter retrospective reader study that demonstrated statistically significant improvement in performance when DBT was combined with DM (13,14)
More recently, two prospective European trials have also shown improvements in screening outcomes with DBT An interim analysis from the Oslo Screening Trial (n = 12631) and the final results from the Italian Screening with Tomosynthesis or Standard Mammography Trial (STORM, n = 7292) have demonstrated reductions in recalls of 15% to 17% and improvements in cancer detection of 33% to 53% (15,16) Furthermore, in the Oslo trial there was a 40% increase in the detection of invasive cancers with a stable rate of in situ cancer detection However, in both of these trials subject compliance with screening invitations was less than 100%, and there were complex reading protocols requiring at least two readers per case, which is uncommon in clinical practices in the United States
More recently, two separate US centers have reported early results from DBT screening (17,18) These data again demonstrate improvements in outcomes with reductions in recalls up to 37% and increases in cancer detection up to 35% At both sites, however, there was concurrent screening with DM alone and, therefore, a potential for bias in the selection of patients screened with DBT and potentially imaged with DBT at recall In a recent report from a consortium of 13 US practices, a 15% reduction in recall rate and a 29% increase in cancer detection were seen with DBT screening compared with DM alone screening However, no patient-level data was reported, and eleven of the thirteen sites had concurrent DM screening, leading to possible biases in selection of patients for DBT (19)
Here we report the patient-level outcomes of implementing DBT screening for the entire screening population at our institution beginning October 2011 We compare outcomes for the cohort screened with DBT over a period of 17 months to the cohort screened with DM alone during the 12 months prior to DBT implementation All women presenting for routine screening were imaged with DBT after its implementation, and radiologist readers remained the same over the DM and DBT cohorts, providing a “pre and post” comparison of DBT to DM-alone screening
179 citations
TL;DR: The effectiveness of a lay health worker intervention to increase breast and cervical cancer screening among low-income Hispanic women and significantly increased Pap test self-efficacy, perceived benefits of having a Pap test, subjective norms, and perceived survivability of cancer.
Abstract: Objectives. We tested the effectiveness of a lay health worker intervention to increase breast and cervical cancer screening among low-income Hispanic women.Methods. Participants were women 50 years and older who were nonadherent to mammography (n = 464) or Papanicolaou (Pap) test (n = 243) screening guidelines. After the collection of baseline data, lay health workers implemented the Cultivando la Salud (CLS; Cultivating Health) intervention. Data collectors then interviewed the participants 6 months later.Results. At follow-up, screening completion was higher among women in the intervention group than in the control group for both mammography (40.8% vs 29.9%; P < .05) and Pap test (39.5% vs 23.6%; P < .05) screening. In an intent-to-treat analysis, these differences remained but were not significant. The intervention increased mammography self-efficacy, perceived susceptibility, perceived survivability, perceived benefits of mammography, subjective norms, and processes of change. The intervention also s...
179 citations
TL;DR: The observations of increase in cancer detection rates, particularly for invasive cancers, and the reduction in false-positive rates with DBT in prospective trials indicate its benefit for breast cancer screening.
Abstract: If digital breast tomosynthesis (DBT) is performed on the basis of an abnormal screening mammogram, then the sensitivity of DBT cannot exceed that of mammography.
178 citations
TL;DR: North American screening programs appear to interpret a higher percentage of mammograms as abnormal than programs from other countries without evident benefit in the yield of cancers detected per 1000 screens, although an increase in DCIS detection was noted.
Abstract: Substantial intra- and interobserver variability has been noted among radiologists interpreting screening mammograms in research situations (1–3). This variability is similar to that seen in other areas of medicine where observation and interpretation are subjective (4,5). Several studies in the United States (6–8) have suggested that variation in mammography interpretation also exists among radiologists in community-based facilities. One review (6) of U.S. screening programs found that the percentage of screening mammograms for which additional work-up is recommended (i.e., percentage of mammograms judged to be abnormal, often referred to as the recall rate) ranged from approximately 2% to more than 50%, with an average of 11%. Another study (7) found that the positive predictive value of a biopsy performed (PPVB) (i.e., the percentage of women who were actually found to have breast cancer among those referred for biopsy following screening mammography) ranged from 17% for radiologists practicing in the community to 26% for radiologists practicing at an academic center. A recent study by Elmore et al. (8) reported that radiologists varied widely in their false-positive rates for interpretation of screening mammograms, even after controlling for patient, radiologist, and testing characteristics.
Variability in screening mammography interpretations may have important clinical and economic implications. Although clinicians do not wish to miss breast cancers, it is important to minimize unnecessary follow-up diagnostic procedures, costs, and patient anxiety associated with false-positive screening mammograms.
In this article, we compare published data from community-based mammography screening programs in North America with similar screening programs in other countries to address two important questions: 1) To what extent is variability in mammographic interpretation in community-based screening mammography programs observed between programs in North America and other countries? and 2) Is variability in mammographic interpretation associated with different intermediate measures of breast cancer outcome (i.e., percentage of breast cancer cases with ductal carcinoma in situ [DCIS] and/or minimal disease)? Based on our findings, we discuss possible explanations for variability in mammography interpretations and of the implications that this variability might have on future research, health policy, and patient care.
178 citations
TL;DR: Data show that sonography is the more accurate imaging test in women 45 years old or younger who present with breast symptoms and may be an appropriate initial imaging examination based on the woman's age.
Abstract: OBJECTIVE. We examined the age-specific sensitivity and specificity of mammography and sonography in symptomatic women to determine the age below which sonography may be the more accurate imaging test, which may guide the choice of initial breast imaging examination based on the woman's age.MATERIALS AND METHODS. Four hundred eighty subjects were sampled from all women consecutively attending a symptomatic breast clinic between 1994 and 1996 and ranging in age from 25 to 55 years. We included all 240 women shown to have breast cancer (thus avoiding selection bias) and 240 age-matched women shown not to have cancer. Mammograms and sonograms were prospectively interpreted independently and without knowledge of age by two radiologists in a blinded manner, with a third radiologist arbitrating disagreements. Sensitivity and specificity of each imaging test in relation to age were examined using logistic regression modeling, and accuracy was compared using the chi-square test for paired proportions.RESULTS. Sen...
178 citations