European radiographers' challenges from mammography education and clinical practice - an integrative review.

PubMed

Metsälä, Eija; Richli Meystre, Nicole; Pires Jorge, José; Henner, Anja; Kukkes, Tiina; Sá Dos Reis, Cláudia

2017-06-01

This study aims to identify European radiographers' challenges in clinical performance in mammography and the main areas of mammography that require more and better training. An extensive search was performed to identify relevant studies focused on clinical practice, education and training in mammography published between January 2010 and December 2015 in the English language. The data were analysed by using deductive thematic analysis. A total of 27 full text articles were read, evaluating their quality. Sixteen articles out of 27 were finally selected for this integrative review. The main challenges of radiographers' mammography education/training can be divided into three groups: training needs, challenges related to radiographers, and challenges related to the organization of education. The most common challenges of clinical performance in mammography among European radiographers involved technical performance, the quality of practices, and patient-centeredness. The introduction of harmonized mammography guidelines across Europe may serve as an evidence-based tool to be implemented in practice and education. However, the variability in human and material resources as well as the different cultural contexts should be considered during this process. • Radiographers' awareness of their professional identity and enhancing multiprofessional cooperation in mammography. • Radiographers' responsibilities regarding image quality (IQ) and optimal breast imaging performance. • Patient-centred mammography services focusing on the psychosocial needs of the patient. • Challenges: positioning, QC-testing, IQ-assessment, optimization of breast compression, communication, teamwork, and patient-centred care. • Introduction of evidence-based guidelines in Europe to harmonize mammography practice and education.

Mammography Clinical Image Quality and the False Positive Rate in a Canadian Breast Cancer Screening Program.

PubMed

Guertin, Marie-Hélène; Théberge, Isabelle; Zomahoun, Hervé Tchala Vignon; Dufresne, Michel-Pierre; Pelletier, Éric; Brisson, Jacques

2018-05-01

The study sought to determine if mammography quality is associated with the false positive (FP) rate in the Quebec breast cancer screening program in 2004 and 2005. Mammography quality of a random sample of screen-film mammograms was evaluated by an expert radiologist following the criteria of the Canadian Association of Radiologists. For each screening examination, scores ranging from 1 (poor quality) to 5 (excellent quality) were attributed for positioning, compression, contrast, exposure level, sharpness, and artifacts. A final overall quality score (lower or higher) was also given. Poisson regression models with robust estimation of variance and adjusted for potential confounding factors were used to assess associations of mammography quality with the FP rate. Among 1,209 women without cancer, there were 104 (8.6%) FPs. Lower overall mammography quality is associated with an increase in the FP rate (risk ratio [RR], 1.4; 95% confidence interval [CI], 1.0-2.1; P = .07) but this increase was not statistically significant. Artifacts were associated with an increase in the FP rate (RR, 2.1; 95% CI, 1.3-3.3; P = .01) whereas lower quality of exposure level was related to a reduction of the FP rate (RR, 0.4; 95% CI, 0.1-1.0; P = .01). Lower quality scores for all other quality attributes were related to a nonstatistically significant increase in the FP rate of 10%-30%. Artifacts can have a substantial effect on the FP rate. The effect of overall mammography quality on the FP rate may also be substantial and needs to be clarified. Copyright © 2017 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

A multiparametric automatic method to monitor long-term reproducibility in digital mammography: results from a regional screening programme.

PubMed

Gennaro, G; Ballaminut, A; Contento, G

2017-09-01

This study aims to illustrate a multiparametric automatic method for monitoring long-term reproducibility of digital mammography systems, and its application on a large scale. Twenty-five digital mammography systems employed within a regional screening programme were controlled weekly using the same type of phantom, whose images were analysed by an automatic software tool. To assess system reproducibility levels, 15 image quality indices (IQIs) were extracted and compared with the corresponding indices previously determined by a baseline procedure. The coefficients of variation (COVs) of the IQIs were used to assess the overall variability. A total of 2553 phantom images were collected from the 25 digital mammography systems from March 2013 to December 2014. Most of the systems showed excellent image quality reproducibility over the surveillance interval, with mean variability below 5%. Variability of each IQI was 5%, with the exception of one index associated with the smallest phantom objects (0.25 mm), which was below 10%. The method applied for reproducibility tests-multi-detail phantoms, cloud automatic software tool to measure multiple image quality indices and statistical process control-was proven to be effective and applicable on a large scale and to any type of digital mammography system. • Reproducibility of mammography image quality should be monitored by appropriate quality controls. • Use of automatic software tools allows image quality evaluation by multiple indices. • System reproducibility can be assessed comparing current index value with baseline data. • Overall system reproducibility of modern digital mammography systems is excellent. • The method proposed and applied is cost-effective and easily scalable.

The professional quality criteria of Italian breast screening radiologists: results from a national survey comparing the programmes started in 2000-2012 versus the ones started in 1990-1999.

PubMed

Morrone, Doralba; Giordano, Livia; Artuso, Franca; Bernardi, Daniela; Fedato, Chiara; Frigerio, Alfonso; Giorgi, Daniela; Naldoni, Carlo; Saguatti, Gianni; Severi, Daniela; Taffurelli, Mario; Terribile, Daniela; Ventura, Leonardo; Bucchi, Lauro

2017-01-01

In Italy, due to increasing healthcare budget and staff shortages, the recently created regional mammography screening programmes were established under worse radiology practice quality criteria than the previously created programmes. Using available data from a national questionnaire survey conducted at the end of 2013 and involving 222 responder radiologists, we compared the main professional quality standards of radiologists working in the screening programmes established during the period 2000-2012 with those working in the screening programmes created from 1990 to 1999. The former reported more years of clinical experience in breast imaging and a greater clinical mammogram reading volume than the latter. Conversely, they dedicated less working time to breast imaging, were less likely to participate in the diagnostic assessment of screen-detected lesions, to work in large-staffed screening centres, and to have a screening and a total mammogram reading volume (SMRV and TMRV) ≥ 5000 per year. The level of most professional quality criteria of Italian mammography screening radiologists has decreased over time. As SMRV and TMRV are important predictors of diagnostic accuracy, we can expect a lower interpretation performance of radiologists working in the recently created screening programmes.

A special ionisation chamber for quality control of diagnostic and mammography X ray equipment.

PubMed

Costa, A M; Caldas, L V E

2003-01-01

A quality control program for X ray equipment used for conventional radiography and mammography requires the constancy check of the beam qualities in terms of the half-value layers. In this work, a special double-faced parallel-plate ionisation chamber was developed with inner electrodes of different materials, in a tandem system. Its application will be in quality control programs of diagnostic and mammography X ray equipment for confirmation of half-value layers previously determined by the conventional method. Moreover, the chamber also may be utilised for measurements of air kerma values (and air kerma rates) in X radiation fields used for conventional radiography and mammography. The chamber was studied in relation to the characteristics of saturation, ion collection efficiency, polarity effects, leakage current, and short-term stability. The energy dependence in response of each of the two faces of the chamber was determined over the conventional radiography and mammography X ray ranges (unattenuated beams). The different energy response of the two faces of the chamber allowed the formation of a tandem system useful for the constancy check of beam qualities.

Implementation of a clinical quality control program in a mammography screening service of Brazil.

PubMed

DE Souza Sabino, Silvia Maria Prioli; Silva, Thiago Buosi; Watanabe, Anapaula Hidemi Uema; Syrjänen, Kari; Carvalho, André Lopes; Mauad, Edmundo Carvalho

2014-09-01

To evaluate the effect of a clinical quality control program on the final quality of a mammography screening service. We conducted retrospective assessment of the clinical quality of 5,000 mammograms taken in a Mammography Screening Program between November 2010 and September 2011, following the implementation of a Clinical Quality Control Program based on the European Guidelines. Among the 105,000 evaluated quality items, there were 8,588 failures (8.2%) - 1.7 failures per examination. Altogether, 89% of the failures were associated with positioning. The recall rate due to a technical error reached a maximum of 0.5% in the early phase of the observation period and subsequently stabilized (0.09%). The ongoing education and monitoring combined with personalized training increased the critical thinking of the involved professionals, reducing the technical failures and unnecessary exposure of patients to radiation, with substantial improvement in the final quality of mammography. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Eight years of quality control in Bulgaria: impact on mammography practice.

PubMed

Avramova-Cholakova, S; Lilkov, G; Kaneva, M; Terziev, K; Nakov, I; Mutkurov, N; Kovacheva, D; Ivanova, M; Vasilev, D

2015-07-01

The requirements for quality control (QC) in diagnostic radiology were introduced in Bulgarian legislation in 2005. Hospital medical physicists and several private medical physics groups provide QC services to radiology departments. The aim of this study was to analyse data from QC tests in mammography and to investigate the impact of QC introduction on mammography practice in the country. The study was coordinated by the National Centre of Radiobiology and Radiation Protection. All medical physics services were requested to fill in standardised forms with information about most important parameters routinely measured during QC. All QC service providers responded. Results demonstrated significant improvement of practice since the introduction of QC, with reduction of established deviations from 65 % during the first year to 7 % in the last year. The systems that do not meet the acceptability criteria were suspended from use. Performance of automatic exposure control and digital detectors are not regularly tested because of the absence of requirements in the legislation. The need of updated guidance and training of medical physicists to reflect the change in technology was demonstrated. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

21 CFR 900.12 - Quality standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MAMMOGRAPHY... to mammography. The training shall include instruction in radiation physics, including radiation physics specific to mammography, radiation effects, and radiation protection. The mammographic...

Attitude and Practice Regarding Breast Cancer Early Detection among Iranian Women: A Systematic Review

PubMed Central

Badakhsh, Mahin; Balouchi, Abbas; Taheri, Safiyeh; Bouya, Salehoddin; Ahmadidarehsima, Sudabeh; Aminifard, Mohammadnaem

2018-01-01

Objectives: To determining attitudes and practice regarding breast cancer early detection techniques (breast self-examination (BSE), clinical breast examination (CBE) and mammography) among Iranian woman. Methods: International (PubMed, ISI, and Google Scholar) and national (SID and Magiran) databases were reviewed up to September 2017 to identify articles related to the attitudes and practices of Iranian women concerning breast cancer screening behavior with reference to BSE , CBE and mammography. The screening steps, analysis of quality of the studies and extraction of the papers were performed by two reviewers. Results: Of the 532 studies included initially, 21 performed on 10,521 people were considered eligible. Subjects with a positive attitude toward BSE in various studies were 13.5% to 94.0% with an average of 47.6%. Positive attitudes to CBE and mammography were found in 21.0% and 26.4%, respectively. Participant performance of BSE ranged from 2.6% to 84.7%, with an average of 21.9%. The respective figures for CBE and mammography were 15.8% and 16.7%. Conclusion: Considering the poor performance and low rates for positive attitudes, it is suggested that educational programs should be conducted across the country. PMID:29373873

21 CFR 900.11 - Requirements for certification.

Code of Federal Regulations, 2010 CFR

2010-04-01

....11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MAMMOGRAPHY QUALITY STANDARDS ACT MAMMOGRAPHY Quality Standards and Certification § 900.11 Requirements for... FDA, facilities are required to meet the quality standards in § 900.12 and to be accredited by an...

Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness.

PubMed

Schousboe, John T; Kerlikowske, Karla; Loh, Andrew; Cummings, Steven R

2011-07-05

Current guidelines recommend mammography every 1 or 2 years starting at age 40 or 50 years, regardless of individual risk for breast cancer. To estimate the cost-effectiveness of mammography by age, breast density, history of breast biopsy, family history of breast cancer, and screening interval. Markov microsimulation model. Surveillance, Epidemiology, and End Results program, Breast Cancer Surveillance Consortium, and the medical literature. U.S. women aged 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years with initial mammography at age 40 years and breast density of Breast Imaging Reporting and Data System (BI-RADS) categories 1 to 4. Lifetime. National health payer. Mammography annually, biennially, or every 3 to 4 years or no mammography. Costs per quality-adjusted life-year (QALY) gained and number of women screened over 10 years to prevent 1 death from breast cancer. Biennial mammography cost less than $100,000 per QALY gained for women aged 40 to 79 years with BI-RADS category 3 or 4 breast density or aged 50 to 69 years with category 2 density; women aged 60 to 79 years with category 1 density and either a family history of breast cancer or a previous breast biopsy; and all women aged 40 to 79 years with both a family history of breast cancer and a previous breast biopsy, regardless of breast density. Biennial mammography cost less than $50,000 per QALY gained for women aged 40 to 49 years with category 3 or 4 breast density and either a previous breast biopsy or a family history of breast cancer. Annual mammography was not cost-effective for any group, regardless of age or breast density. Mammography is expensive if the disutility of false-positive mammography results and the costs of detecting nonprogressive and nonlethal invasive cancer are considered. Results are not applicable to carriers of BRCA1 or BRCA2 mutations. Mammography screening should be personalized on the basis of a woman's age, breast density, history of breast biopsy, family history of breast cancer, and beliefs about the potential benefit and harms of screening. Eli Lilly, Da Costa Family Foundation for Research in Breast Cancer Prevention of the California Pacific Medical Center, and Breast Cancer Surveillance Consortium.

Characterizing the Mammography Technologist Workforce in North Carolina.

PubMed

Henderson, Louise M; Marsh, Mary W; Benefield, Thad; Pearsall, Elizabeth; Durham, Danielle; Schroeder, Bruce F; Bowling, J Michael; Viglione, Cheryl A; Yankaskas, Bonnie C

2015-12-01

Mammography technologists' level of training, years of experience, and feedback on technique may play an important role in the breast-cancer screening process. However, information on the mammography technologist workforce is scant. In 2013, we conducted a survey mailed to 912 mammography technologists working in 224 facilities certified by the Mammography Quality Standards Act in North Carolina. Using standard survey methodology, we developed and implemented a questionnaire on the education and training, work experiences, and workplace interactions of mammography technologists. We aggregated responses using survey weights to account for nonresponse. We describe and compare lead (administrative responsibilities) and nonlead (supervised by another technologist) mammography technologist characteristics, testing for differences, using t-tests and χ(2) analysis. A total of 433 mammography technologists responded (survey response rate = 47.5%; 95% confidence interval [CI]: 44.2%-50.7%), including 128 lead and 305 nonlead technologists. Most mammography technologists were non-Hispanic, white women; their average age was 48 years. Approximately 93% of lead and nonlead technologists had mammography-specific training, but <4% had sonography certification, and 3% had MRI certification. Lead technologists reported more years of experience performing screening mammography (P = .02) and film mammography (P = .03), more administrative hours (P < .0001), and more workplace autonomy (P = .002) than nonlead technologists. Nonlead technologists were more likely to report performing diagnostic mammograms (P = .0004) or other breast imaging (P = .001), discuss image quality with a peer (P = .013), and have frequent face-to-face interaction with radiologists (P = .03). Our findings offer insights into mammography technologists' training and work experiences, highlighting variability in characteristics of lead versus nonlead technologists. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Characterizing the mammography technologist workforce in North Carolina

PubMed Central

Henderson, Louise M.; Marsh, Mary W.; Benefield, Thad; Pearsall, Elizabeth; Durham, Danielle; Schroeder, Bruce F.; Bowling, J. Michael; Viglione, Cheryl A.; Yankaskas, Bonnie C.

2016-01-01

Background Mammography technologists’ level of training, years of experience, and feedback on technique may play an important role in the breast cancer screening process. However, very little information on the mammography technologist workforce exists. Methods In 2013, we conducted a mailed survey to 912 mammography technologists working in 224 Mammography Quality Standards Act accredited facilities in North Carolina. Using standard survey methodology we developed and implemented a questionnaire focused on the education and training, work experiences, and workplace interactions of mammography technologists. We aggregated responses using survey weights to account for non-response. We describe and compare lead (administrative responsibilities) and non-lead (supervised by another technologist) mammography technologist characteristics, testing for differences using t-tests and chi-square tests. Results A total of 433 mammography technologists responded (survey response rate=47.5%; 95% confidence interval:44.2%-50.7%), including 128 lead and 305 non-lead technologists. Most mammography technologists were non-Hispanic, white, females and the average age was 48 years. Approximately 93% of lead and non-lead technologists had mammography specific training but <4% had sonography certification and 3% had MRI certification. Lead technologists reported more years performing screening mammography (p-value=0.02) and film mammography (p-value=0.03), more administrative hours (p-value<0.0001), and more workplace autonomy (p-value=0.002) than non-lead technologists. Non-lead technologists were more likely to report performing diagnostic mammograms (p-value=0.0004) or other breast imaging (p-value=0.001), discuss image quality with a peer (p-value=0.013), and have frequent face-to-face interaction with radiologists (p-value=0.03). Conclusion Our findings offer insights into mammography technologists’ training and work experiences, highlighting variability in technologist characteristics between lead and non-lead technologists. PMID:26614888

The clinical effectiveness and cost-effectiveness of different surveillance mammography regimens after the treatment for primary breast cancer: systematic reviews registry database analyses and economic evaluation.

PubMed

Robertson, C; Arcot Ragupathy, S K; Boachie, C; Dixon, J M; Fraser, C; Hernández, R; Heys, S; Jack, W; Kerr, G R; Lawrence, G; MacLennan, G; Maxwell, A; McGregor, J; Mowatt, G; Pinder, S; Ternent, L; Thomas, R E; Vale, L; Wilson, R; Zhu, S; Gilbert, F J

2011-09-01

Following primary breast cancer treatment, the early detection of ipsilateral breast tumour recurrence (IBTR) or ipsilateral secondary cancer in the treated breast and detection of new primary cancers in the contralateral breast is beneficial for survival. Surveillance mammography is used to detect these cancers, but the optimal frequency of surveillance and the length of follow-up are unclear. To identify feasible management strategies for surveillance and follow-up of women after treatment for primary breast cancer in a UK setting, and to determine the effectiveness and cost-effectiveness of differing regimens. A survey of UK breast surgeons and radiologists to identify current surveillance mammography regimens and inform feasible alternatives; two discrete systematic reviews of evidence published from 1990 to mid 2009 to determine (i) the clinical effectiveness and cost-effectiveness of differing surveillance mammography regimens for patient health outcomes and (ii) the test performance of surveillance mammography in the detection of IBTR and metachronous contralateral breast cancer (MCBC); statistical analysis of individual patient data (West Midlands Cancer Intelligence Unit Breast Cancer Registry and Edinburgh data sets); and economic modelling using the systematic reviews results, existing data sets, and focused searches for specific data analysis to determine the effectiveness and cost-utility of differing surveillance regimens. The majority of survey respondents initiate surveillance mammography 12 months after breast-conserving surgery (BCS) (87%) or mastectomy (79%). Annual surveillance mammography was most commonly reported for women after BCS or after mastectomy (72% and 53%, respectively). Most (74%) discharge women from surveillance mammography, most frequently 10 years after surgery. The majority (82%) discharge from clinical follow-up, most frequently at 5 years. Combining initiation, frequency and duration of surveillance mammography resulted in 54 differing surveillance regimens for women after BCS and 56 for women following mastectomy. The eight studies included in the clinical effectiveness systematic review suggest surveillance mammography offers a survival benefit compared with a surveillance regimen that does not include surveillance mammography. Nine studies were included in the test performance systematic review. For routine IBTR detection, surveillance mammography sensitivity ranged from 64% to 67% and specificity ranged from 85% to 97%. For magnetic resonance imaging (MRI), sensitivity ranged from 86% to 100% and specificity was 93%. For non-routine IBTR detection, sensitivity and specificity for surveillance mammography ranged from 50% to 83% and from 57% to 75%, respectively, and for MRI from 93% to 100% and from 88% to 96%, respectively. For routine MCBC detection, one study reported sensitivity of 67% and specificity of 50% for both surveillance mammography and MRI, although this was a highly select population. Data set analysis showed that IBTR has an adverse effect on survival. Furthermore, women experiencing a second tumour measuring >20 mm in diameter were at a significantly greater risk of death than those with no recurrence or those whose tumour was <10 mm in diameter. In the base-case analysis, the strategy with the highest net benefit, and most likely to be considered cost-effective, was surveillance mammography alone, provided every 12 months at a societal willingness to pay for a quality-adjusted life-year of either £20,000 or £30,000. The incremental cost-effectiveness ratio for surveillance mammography alone every 12 months compared with no surveillance was £4727. Few studies met the review inclusion criteria and none of the studies was a randomised controlled trial. The limited and variable nature of the data available precluded any quantitative analysis. There was no useable evidence contained in the Breast Cancer Registry database to assess the effectiveness of surveillance mammography directly. The results of the economic model should be considered exploratory and interpreted with caution given the paucity of data available to inform the economic model. Surveillance is likely to improve survival and patients should gain maximum benefit through optimal use of resources, with those women with a greater likelihood of developing IBTR or MCBC being offered more comprehensive and more frequent surveillance. Further evidence is required to make a robust and informed judgement on the effectiveness of surveillance mammography and follow-up. The utility of national data sets could be improved and there is a need for high-quality, direct head-to-head studies comparing the diagnostic accuracy of tests used in the surveillance population. The National Institute for Health Research Health Technology Assessment programme. © Queen’s Printer and Controller of HMSO 2011.

[Prevalence in the performance of mammographies in Spain: Analysis by Communities 2006-2014 and influencing factors].

PubMed

Carmona-Torres, Juan Manuel; Cobo-Cuenca, Ana Isabel; Martín-Espinosa, Noelia María; Piriz-Campos, Rosa María; Laredo-Aguilera, José Alberto; Rodríguez-Borrego, María Aurora

2018-04-01

To determine the frequency of the performance of mammography with preventive purpose of the screening of breast cancer in Spanish women, the evolution between the years 2006-2014, the sociodemographic profile of the women who undergo the mammography and to analyze the factors that influence in their adhesion. Transversal study. Spain. A total of 53.628 women over 15 years old that are surveyed in the National Health Survey in Spain 2006 and 2011/12 and the European Health Survey in Spain 2009 and 2014. The following variables were used: mammography, frequency of mammography performance and the reason for the realization, as well as sociodemographic variables. Social class was obtained from the last occupation of the main family supporter. A logistic regression analysis was performed with sociodemographic variables. The prevalence of mammography has been increasing from 2006 to 2014, and also for the reason that the participants had received a letter, they were telephoned or offered in their Health Center to undergo this test. There are significant differences in the performance of mammography in the different autonomous communities. Performing mammography has increased significantly from 2006 to 2014, although there are still differences between autonomous communities, with Ceuta and Melilla being the least percentage of performed mammography. The factors that are related to greater performed mammography are: higher educational level, higher social class, married civil status, Spanish nationality and age. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

21 CFR 900.17 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false [Reserved] 900.17 Section 900.17 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MAMMOGRAPHY QUALITY STANDARDS ACT MAMMOGRAPHY Quality Standards and Certification § 900.17 [Reserved] ...

MASTOS: Mammography Simulation Tool for design Optimization Studies.

PubMed

Spyrou, G; Panayiotakis, G; Tzanakos, G

2000-01-01

Mammography is a high quality imaging technique for the detection of breast lesions, which requires dedicated equipment and optimum operation. The design parameters of a mammography unit have to be decided and evaluated before the construction of such a high cost of apparatus. The optimum operational parameters also must be defined well before the real breast examination. MASTOS is a software package, based on Monte Carlo methods, that is designed to be used as a simulation tool in mammography. The input consists of the parameters that have to be specified when using a mammography unit, and also the parameters specifying the shape and composition of the breast phantom. In addition, the input may specify parameters needed in the design of a new mammographic apparatus. The main output of the simulation is a mammographic image and calculations of various factors that describe the image quality. The Monte Carlo simulation code is PC-based and is driven by an outer shell of a graphical user interface. The entire software package is a simulation tool for mammography and can be applied in basic research and/or in training in the fields of medical physics and biomedical engineering as well as in the performance evaluation of new designs of mammography units and in the determination of optimum standards for the operational parameters of a mammography unit.

Mammography use and its demographic correlates among women in South Korea.

PubMed

Suh, Eunyoung E; Park, Sunhee

2009-06-01

This study aimed to investigate the mammography rate and its demographic correlates among Korean women in order to provide basic understanding of factors related to the performance of mammography as a method of breast cancer screening. A descriptive secondary analysis was conducted using a national data set from the Korean National Health and Nutrition Examination Survey (KNHNES III) in South Korea. A total number of 2,602 women over 40 years of age were chosen for the analysis. Main research variables included the use of mammography, monthly income, residential area, age, marriage, education, insurance, smoking habits, drinking habits, job type, current health status, and other cancer screening results. Only 30.59% of women adhered to the national guidelines. Monthly income, age, education, insurance, and smoking habits had statistically significant effects on breast cancer screening performance. The demographic correlates of the performance of mammography highlight the fact that not all Korean women, at this stage, are in a socioeconomic or societal position to undergo biannual mammography screening. Targeted and tailored nursing intervention should be implemented in middle- and senior-aged women who lack the ability to access medical resources in South Korea. This will make it possible for marginalized women to utilize cancer screening tests and in turn promote their health.

Health-related quality of life, anxiety and depression related to mammography screening in Norway.

PubMed

Hafslund, Bjorg; Espehaug, Birgitte; Nortvedt, Monica Wammen

2012-11-01

To measure health-related quality of life, anxiety and depression ahead of mammography screening and to assess any differences in health-related quality of life compared to reference population. The study of health-related quality of life among attendees prior to mammography screening has received little attention, and increased knowledge is needed to better understand the overall health benefits of participation. A two-group cross-sectional comparative study was performed. The samples comprised 4,249 attendees to mammography screening and a comparison group of 943 women. We used the SF-36 Health Survey to assess health-related quality of life. Linear regression was used to study any differences between the groups with adjustment for age, level of education, occupation, having children and smoking status. Other normative data were also used. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Attendees scored statistically significant higher on the SF-36 than the comparison group but were in line with normative data. Attendees had anxiety mean 4·1 and depression mean 2·6. The majority of the attendees have a high health-related quality of life, low anxiety and depression ahead of screening. Anxiety and depression were less than shown in normative data from Norway. Despite a high health-related quality of life, low anxiety and depression among the majority, healthcare workers should pay special attention to the few women who are anxious and depressed, and have a lower health-related quality of life. Omitted from mammography screening may be women who are unemployed, have lower socioeconomic status, are anxious and are depressed. Further research should be performed with non-attendees and subgroups to improve the screening programme. It is important to identify which patients have the greatest need for support and caring in an organised mammography screening and who may be overlooked. © 2012 Blackwell Publishing Ltd.

Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey.

PubMed

Sardanelli, Francesco; Aase, Hildegunn S; Álvarez, Marina; Azavedo, Edward; Baarslag, Henk J; Balleyguier, Corinne; Baltzer, Pascal A; Beslagic, Vanesa; Bick, Ulrich; Bogdanovic-Stojanovic, Dragana; Briediene, Ruta; Brkljacic, Boris; Camps Herrero, Julia; Colin, Catherine; Cornford, Eleanor; Danes, Jan; de Geer, Gérard; Esen, Gul; Evans, Andrew; Fuchsjaeger, Michael H; Gilbert, Fiona J; Graf, Oswald; Hargaden, Gormlaith; Helbich, Thomas H; Heywang-Köbrunner, Sylvia H; Ivanov, Valentin; Jónsson, Ásbjörn; Kuhl, Christiane K; Lisencu, Eugenia C; Luczynska, Elzbieta; Mann, Ritse M; Marques, Jose C; Martincich, Laura; Mortier, Margarete; Müller-Schimpfle, Markus; Ormandi, Katalin; Panizza, Pietro; Pediconi, Federica; Pijnappel, Ruud M; Pinker, Katja; Rissanen, Tarja; Rotaru, Natalia; Saguatti, Gianni; Sella, Tamar; Slobodníková, Jana; Talk, Maret; Taourel, Patrice; Trimboli, Rubina M; Vejborg, Ilse; Vourtsis, Athina; Forrai, Gabor

2017-07-01

EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 % for women aged 50-69 years taking up the invitation while the probability of false-positive needle biopsy is <1 % per round and overdiagnosis is only 1-10 % for a 20-year screening. Mortality reduction was also observed for the age groups 40-49 years and 70-74 years, although with "limited evidence". Thus, we firstly recommend biennial screening mammography for average-risk women aged 50-69 years; extension up to 73 or 75 years, biennially, is a second priority, from 40-45 to 49 years, annually, a third priority. Screening with thermography or other optical tools as alternatives to mammography is discouraged. Preference should be given to population screening programmes on a territorial basis, with double reading. Adoption of digital mammography (not film-screen or phosphor-plate computer radiography) is a priority, which also improves sensitivity in dense breasts. Radiologists qualified as screening readers should be involved in programmes. Digital breast tomosynthesis is also set to become "routine mammography" in the screening setting in the next future. Dedicated pathways for high-risk women offering breast MRI according to national or international guidelines and recommendations are encouraged. • EUSOBI and 30 national breast radiology bodies support screening mammography. • A first priority is double-reading biennial mammography for women aged 50-69 years. • Extension to 73-75 and from 40-45 to 49 years is also encouraged. • Digital mammography (not film-screen or computer radiography) should be used. • DBT is set to become "routine mammography" in the screening setting in the next future.

Cost and cost-effectiveness of digital mammography compared with film-screen mammography in Australia.

PubMed

Wang, Shuhong; Merlin, Tracy; Kreisz, Florian; Craft, Paul; Hiller, Janet E

2009-10-01

A systematic review assessed the relative safety and effectiveness of digital mammography compared with film-screen mammography. This study utilised the evidence from the review to examine the economic value of digital compared with film-screen mammography in Australia. A cost-comparison analysis between the two technologies was conducted for the overall population for the purposes of breast cancer screening and diagnosis. In addition, a cost-effectiveness analysis was conducted for the screening subgroups where digital mammography was considered to be more accurate than film-screen mammography. Digital mammography in a screening setting is $11 more per examination than film-screen mammography, and $36 or $33 more per examination in a diagnostic setting when either digital radiography or computed radiography is used. In both the screening and diagnostic settings, the throughput of the mammography system had the most significant impact on decreasing the incremental cost/examination/year of digital mammography. Digital mammography is more expensive than film-screen mammography. Whether digital mammography represents good value for money depends on the eventual life-years and quality-adjusted life-years gained from the early cancer diagnosis. The evidence generated from this study has informed the allocation of public resources for the screening and diagnosis of breast cancer in Australia.

Comparison of the NIST and PTB Air-Kerma Standards for Low-Energy X-Rays.

PubMed

O'Brien, Michelle; Bueermann, Ludwig

2009-01-01

A comparison has been made of the air-kerma standards for low-energy x rays at the National Institute of Standards and Technology (NIST) and the Physikalisch-Technische Bundesanstalt (PTB). The comparison involved a series of measurements at the PTB and the NIST using the air-kerma standards and two NIST reference-class transfer ionization chamber standards. Results are presented for the reference radiation beam qualities in the range from 25 kV to 50 kV for low energy x rays, including the techniques used for mammography dose traceability. The tungsten generated reference radiation qualities, between 25 kV and 50 kV used for this comparison, are new to NIST; therefore this comparison will serve as the preliminary comparison for NIST and a verification of the primary standard correction factors. The mammography comparison will repeat two previously unpublished comparisons between PTB and NIST. The results show the standards to be in reasonable agreement within the standard uncertainty of the comparison of about 0.4 %.

21 CFR 900.14 - Suspension or revocation of certificates.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Suspension or revocation of certificates. 900.14 Section 900.14 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MAMMOGRAPHY QUALITY STANDARDS ACT MAMMOGRAPHY Quality Standards and Certification § 900.14...

75 FR 68364 - Guidance for Industry and Food and Drug Administration Staff; Class II Special Controls Guidance...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-05

... European Protocol for the Quality Control of the Physical and Technical Aspects of Mammography Screening... entitled ``Physical Laboratory Testing, Breast Compression System'' to follow the Mammography Quality...] Guidance for Industry and Food and Drug Administration Staff; Class II Special Controls Guidance Document...

Web-based mammography audit feedback.

PubMed

Geller, Berta M; Ichikawa, Laura; Miglioretti, Diana L; Eastman, David

2012-06-01

Interpreting screening mammography accurately is challenging and requires ongoing education to maintain and improve interpretative skills. Recognizing this, many countries with organized breast screening programs have developed audit and feedback systems using national performance data to help radiologists assess and improve their skills. We developed and tested an interactive Website to provide screening and diagnostic mammography audit feedback with comparisons to national and regional benchmarks. Radiologists who participate in three Breast Cancer Surveillance Consortium registries in the United States were invited during 2009 and 2010 to use a Website that provides tabular and graphical displays of mammography audit reports with comparisons to national and regional performance measures. We collected data about the use and perceptions of the Website. Thirty-five of 111 invited radiologists used the Website from one to five times in a year. The most popular measure was sensitivity for both screening and diagnostic mammography, whereas a table with all measures was the most visited page. Of the 13 radiologists who completed the postuse survey, all found the Website easy to use and navigate, 11 found the benchmarks useful, and nine reported that they intended to improve a specific outcome measure that year. An interactive Website to provide customized mammography audit feedback reports to radiologists has the potential to be a powerful tool in improving interpretive performance. The conceptual framework of customized audit feedback reports can also be generalized to other imaging tests.

Does Distance Matter? Distance to Mammography Facilities and Stage at Diagnosis of Breast Cancer in Kentucky

ERIC Educational Resources Information Center

Huang, Bin; Dignan, Mark; Han, Daikwon; Johnson, Owen

2009-01-01

Background: National and regional data indicate that breast cancer early detection is low in Kentucky, especially rural regions, perhaps because access to mammography services can be problematic. Objective: This study examined the distance between residences of women diagnosed with breast cancer and the nearest mammography facility, as a risk…

Automatic assessment of the quality of patient positioning in mammography

NASA Astrophysics Data System (ADS)

Bülow, Thomas; Meetz, Kirsten; Kutra, Dominik; Netsch, Thomas; Wiemker, Rafael; Bergtholdt, Martin; Sabczynski, Jörg; Wieberneit, Nataly; Freund, Manuela; Schulze-Wenck, Ingrid

2013-02-01

Quality assurance has been recognized as crucial for the success of population-based breast cancer screening programs using x-ray mammography. Quality guidelines and criteria have been defined in the US as well as the European Union in order to ensure the quality of breast cancer screening. Taplin et al. report that incorrect positioning of the breast is the major image quality issue in screening mammography. Consequently, guidelines and criteria for correct positioning and for the assessment of the positioning quality in mammograms play an important role in the quality standards. In this paper we present a system for the automatic evaluation of positioning quality in mammography according to the existing standardized criteria. This involves the automatic detection of anatomic landmarks in medio- lateral oblique (MLO) and cranio-caudal (CC) mammograms, namely the pectoral muscle, the mammilla and the infra-mammary fold. Furthermore, the detected landmarks are assessed with respect to their proper presentation in the image. Finally, the geometric relations between the detected landmarks are investigated to assess the positioning quality. This includes the evaluation whether the pectoral muscle is imaged down to the mammilla level, and whether the posterior nipple line diameter of the breast is consistent between the different views (MLO and CC) of the same breast. Results of the computerized assessment are compared to ground truth collected from two expert readers.

A study on mastectomy samples to evaluate breast imaging quality and potential clinical relevance of differential phase contrast mammography.

PubMed

Hauser, Nik; Wang, Zhentian; Kubik-Huch, Rahel A; Trippel, Mafalda; Singer, Gad; Hohl, Michael K; Roessl, Ewald; Köhler, Thomas; van Stevendaal, Udo; Wieberneit, Nataly; Stampanoni, Marco

2014-03-01

Differential phase contrast and scattering-based x-ray mammography has the potential to provide additional and complementary clinically relevant information compared with absorption-based mammography. The purpose of our study was to provide a first statistical evaluation of the imaging capabilities of the new technique compared with digital absorption mammography. We investigated non-fixed mastectomy samples of 33 patients with invasive breast cancer, using grating-based differential phase contrast mammography (mammoDPC) with a conventional, low-brilliance x-ray tube. We simultaneously recorded absorption, differential phase contrast, and small-angle scattering signals that were combined into novel high-frequency-enhanced images with a dedicated image fusion algorithm. Six international, expert breast radiologists evaluated clinical digital and experimental mammograms in a 2-part blinded, prospective independent reader study. The results were statistically analyzed in terms of image quality and clinical relevance. The results of the comparison of mammoDPC with clinical digital mammography revealed the general quality of the images to be significantly superior (P < 0.001); sharpness, lesion delineation, as well as the general visibility of calcifications to be significantly more assessable (P < 0.001); and delineation of anatomic components of the specimens (surface structures) to be significantly sharper (P < 0.001). Spiculations were significantly better identified, and the overall clinically relevant information provided by mammoDPC was judged to be superior (P < 0.001). Our results demonstrate that complementary information provided by phase and scattering enhanced mammograms obtained with the mammoDPC approach deliver images of generally superior quality. This technique has the potential to improve radiological breast diagnostics.

Quality assurance and quality control in mammography: a review of available guidance worldwide.

PubMed

Reis, Cláudia; Pascoal, Ana; Sakellaris, Taxiarchis; Koutalonis, Manthos

2013-10-01

Review available guidance for quality assurance (QA) in mammography and discuss its contribution to harmonise practices worldwide. Literature search was performed on different sources to identify guidance documents for QA in mammography available worldwide in international bodies, healthcare providers, professional/scientific associations. The guidance documents identified were reviewed and a selection was compared for type of guidance (clinical/technical), technology and proposed QA methodologies focusing on dose and image quality (IQ) performance assessment. Fourteen protocols (targeted at conventional and digital mammography) were reviewed. All included recommendations for testing acquisition, processing and display systems associated with mammographic equipment. All guidance reviewed highlighted the importance of dose assessment and testing the Automatic Exposure Control (AEC) system. Recommended tests for assessment of IQ showed variations in the proposed methodologies. Recommended testing focused on assessment of low-contrast detection, spatial resolution and noise. QC of image display is recommended following the American Association of Physicists in Medicine guidelines. The existing QA guidance for mammography is derived from key documents (American College of Radiology and European Union guidelines) and proposes similar tests despite the variations in detail and methodologies. Studies reported on QA data should provide detail on experimental technique to allow robust data comparison. Countries aiming to implement a mammography/QA program may select/prioritise the tests depending on available technology and resources. •An effective QA program should be practical to implement in a clinical setting. •QA should address the various stages of the imaging chain: acquisition, processing and display. •AEC system QC testing is simple to implement and provides information on equipment performance.

[Implementation of performance indicators in the Czech Breast Cancer Screening Programme -  results of the regular monitoring].

PubMed

Májek, O; Bartoňková, H; Daneš, J; Skovajsová, M; Dušek, L

2014-01-01

The Czech organised breast cancer screening programme was initiated in 2002. Collection of data on screening mammography examinations, subsequent diagnostic procedures, and final dia-gnosis is an indispensable part of the programme. Data collection is obligatory for all accredited centres, in accordance with regulations issued by the Czech Ministry of Health. This contribution aims to demonstrate the recent results of quality monitoring of the accredited centres. Quality indicators, whose definition complies with international standards, involve the women's participation, the volume of performed examinations, the accuracy of screening mammography, the use of preoperative diagnostics, and the proportion of early detected tumours. Our evaluation documents a continuous improvement in quality of the Czech mammography screening programme, which is thereby in full agreement with international recommendations on quality assurance.

Quality assurance in mammography: College of Radiology Survey in Malaysia.

PubMed

Ho, E L M; Ng, K H; Wong, J H D; Wang, H B

2006-06-01

Malaysia's mammography QA practice was surveyed based on the Malaysian Ministry of Health and the American College of Radiology (ACR) requirements. Data on mammography unit, processor, image receptor, exposure factors, mean glandular dose (MGD), sensitometry, image quality and viewbox luminance were obtained. Mean developer temperature and cycle time were 34.1 +/- 1.8degreesC and 107.7 +/- 33.2 seconds. Mean base+fog level, speed index and contrast index were 0.20+/-0.01, 1.20+/-0.01 and 1.33+/-0.26 respectively. Eighty-six percent of the fifty centres passed the image quality test while 12.5% complied with ACR recommended viewbox luminance. Average MGD was 1.0+/-0.4 mGy. Malaysia is on the right track for QA but with room for total quality improvement.

21 CFR 900.13 - Revocation of accreditation and revocation of accreditation body approval.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Revocation of accreditation and revocation of accreditation body approval. 900.13 Section 900.13 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MAMMOGRAPHY QUALITY STANDARDS ACT MAMMOGRAPHY Quality Standards and...

MO-E-217A-01: Contrast-Enhanced Spectral Mammography - Physical Aspects and QA.

PubMed

Yaffe, M; Hill, M

2012-06-01

To describe the current state of dual energy contrast-enhanced digital mammography, to discuss those aspects of its operation that require evaluation or monitoring and to propose elements of a program for quality assurance of such systems. The principles of dual-energy contrast imaging will be discussed and tools and techniques for assessment of performance will be described. Many of the elements affecting image quality and dose performance in digital mammography (eg noise, system linearity, consistency of x-ray output and detector performance, artifacts) remain important. In addition, the ability to register images can influence the resultant image quality. The maintenance of breast compression thickness during the imaging procedure and calibration of the system to allow quantification of iodine in the breast represent new challenges to quality assurance. CESM provides a means of acquiring new information regarding tumor angiogenesis and may reveal some cancers that will not be detectable on digital mammography. It may also better demonstrate the extent of disease. The medical physicist must understand the dependence of image quality on physical factors. Implementation of a relevant QA program will be required if the promise of this new modality is to be delivered. © 2012 American Association of Physicists in Medicine.

Potential Cost Savings of Contrast-Enhanced Digital Mammography.

PubMed

Patel, Bhavika K; Gray, Richard J; Pockaj, Barbara A

2017-06-01

The purpose of this article is to discuss whether the sensitivity and specificity of contrast-enhanced digital mammography (CEDM) render it a viable diagnostic alternative to breast MRI. That CEDM couples low-energy images (comparable to the diagnostic quality of standard mammography) and subtracted contrast-enhanced mammograms make it a cost-effective modality and a realistic substitute for the more costly breast MRI.

A comparison of the performance of modern screen-film and digital mammography systems.

PubMed

Monnin, P; Gutierrez, D; Bulling, S; Lepori, D; Valley, J-F; Verdun, F R

2005-06-07

This work compares the detector performance and image quality of the new Kodak Min-R EV mammography screen-film system with the Fuji CR Profect detector and with other current mammography screen-film systems from Agfa, Fuji and Kodak. Basic image quality parameters (MTF, NPS, NEQ and DQE) were evaluated for a 28 kV Mo/Mo (HVL = 0.646 mm Al) beam using different mAs exposure settings. Compared with other screen-film systems, the new Kodak Min-R EV detector has the highest contrast and a low intrinsic noise level, giving better NEQ and DQE results, especially at high optical density. Thus, the properties of the new mammography film approach those of a fine mammography detector, especially at low frequency range. Screen-film systems provide the best resolution. The presampling MTF of the digital detector has a value of 15% at the Nyquist frequency and, due to the spread size of the laser beam, the use of a smaller pixel size would not permit a significant improvement of the detector resolution. The dual collection reading technology increases significantly the low frequency DQE of the Fuji CR system that can at present compete with the most efficient mammography screen-film systems.

Advanced Breast Cancer as Indicator of Quality Mammography

NASA Astrophysics Data System (ADS)

Gaona, Enrique

2003-09-01

Breast cancer is the most frequently diagnosed cancer and is the second leading cause of cancer death among women in the Mexican Republic. Mammography is the more important screening tool for detecting early breast cancer. Screening mammography involves taking x-rays from two views from each breast, typically from above (cranial-caudal view, CC) and from an oblique or angled view (mediolateral-oblique, MLO). The purpose of this study was to carry out an exploratory survey of the issue of patients with advanced breast cancer who have had a screening mammography. A general result of the survey is that 22.5% of all patients (102) with advanced breast cancer that participated in the study had previous screening mammography. But we should consider that 10% of breast cancers are not detected by mammography. Only 70% of the family doctors prescribed a diagnostic mammography when the first symptoms were diagnosed.

Dosimetry in x-ray-based breast imaging

PubMed Central

Dance, David R; Sechopoulos, Ioannis

2016-01-01

The estimation of the mean glandular dose to the breast (MGD) for x-ray based imaging modalities forms an essential part of quality control and is needed for risk estimation and for system design and optimisation. This review considers the development of methods for estimating the MGD for mammography, digital breast tomosynthesis (DBT) and dedicated breast CT (DBCT). Almost all of the methodology used employs Monte Carlo calculated conversion factors to relate the measurable quantity, generally the incident air kerma, to the MGD. After a review of the size and composition of the female breast, the various mathematical models used are discussed, with particular emphasis on models for mammography. These range from simple geometrical shapes, to the more recent complex models based on patient DBCT examinations. The possibility of patient-specific dose estimates is considered as well as special diagnostic views and the effect of breast implants. Calculations using the complex models show that the MGD for mammography is overestimated by about 30% when the simple models are used. The design and uses of breast-simulating test phantoms for measuring incident air kerma are outlined and comparisons made between patient and phantom-based dose estimates. The most widely used national and international dosimetry protocols for mammography are based on different simple geometrical models of the breast, and harmonisation of these protocols using more complex breast models is desirable. PMID:27617767

Dosimetry in x-ray-based breast imaging

NASA Astrophysics Data System (ADS)

Dance, David R.; Sechopoulos, Ioannis

2016-10-01

The estimation of the mean glandular dose to the breast (MGD) for x-ray based imaging modalities forms an essential part of quality control and is needed for risk estimation and for system design and optimisation. This review considers the development of methods for estimating the MGD for mammography, digital breast tomosynthesis (DBT) and dedicated breast CT (DBCT). Almost all of the methodology used employs Monte Carlo calculated conversion factors to relate the measurable quantity, generally the incident air kerma, to the MGD. After a review of the size and composition of the female breast, the various mathematical models used are discussed, with particular emphasis on models for mammography. These range from simple geometrical shapes, to the more recent complex models based on patient DBCT examinations. The possibility of patient-specific dose estimates is considered as well as special diagnostic views and the effect of breast implants. Calculations using the complex models show that the MGD for mammography is overestimated by about 30% when the simple models are used. The design and uses of breast-simulating test phantoms for measuring incident air kerma are outlined and comparisons made between patient and phantom-based dose estimates. The most widely used national and international dosimetry protocols for mammography are based on different simple geometrical models of the breast, and harmonisation of these protocols using more complex breast models is desirable.

Good reasons to implement quality assurance in nationwide breast cancer screening programs in Croatia and Serbia: results from a pilot study.

PubMed

Ciraj-Bjelac, Olivera; Faj, Dario; Stimac, Damir; Kosutic, Dusko; Arandjic, Danijela; Brkic, Hrvoje

2011-04-01

The purpose of this study is to investigate the need for and the possible achievements of a comprehensive QA programme and to look at effects of simple corrective actions on image quality in Croatia and in Serbia. The paper focuses on activities related to the technical and radiological aspects of QA. The methodology consisted of two phases. The aim of the first phase was the initial assessment of mammography practice in terms of image quality, patient dose and equipment performance in selected number of mammography units in Croatia and Serbia. Subsequently, corrective actions were suggested and implemented. Then the same parameters were re-assessed. Most of the suggested corrective actions were simple, low-cost and possible to implement immediately, as these were related to working habits in mammography units, such as film processing and darkroom conditions. It has been demonstrated how simple quantitative assessment of image quality can be used for optimisation purposes. Analysis of image quality parameters as OD, gradient and contrast demonstrated general similarities between mammography practices in Croatia and Serbia. The applied methodology should be expanded to larger number of hospitals and applied on a regular basis. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

The Influence of Breast Self-Examination on Subsequent Mammography Participation

PubMed Central

Jelinski, Susan E.; Maxwell, Colleen J.; Onysko, Jay; Bancej, Christina M.

2005-01-01

Objectives. We evaluated whether breast self-examination (BSE) influences subsequent mammography participation. Methods. We evaluated associations between BSE and subsequent mammography participation, adjusting for baseline screening behaviors and sociodemographic, health, and lifestyle characteristics, among women aged 40 years and older using data from the longitudinal Canadian National Population Health Survey. Results. Regular performance of BSE at baseline was not associated with receipt of a recent mammogram at follow-up among all women (adjusted odds ratio [OR]=1.01; 95% confidence interval [CI]= 0.75, 1.35) or with mammography uptake among the subgroup of women reporting never use at baseline (adjusted OR=0.78; 95% CI=0.50, 1.22). Conclusions. The lack of association between performance of BSE and subsequent mammography participation suggests that not recommending BSE is unlikely to influence mammography participation. PMID:15727985

Feasibility study on an integrated AEC-grid device for the optimization of image quality and exposure dose in mammography

NASA Astrophysics Data System (ADS)

Kim, Kyo-Tae; Yun, Ryang-Young; Han, Moo-Jae; Heo, Ye-Ji; Song, Yong-Keun; Heo, Sung-Wook; Oh, Kyeong-Min; Park, Sung-Kwang

2017-10-01

Currently, in the radiation diagnosis field, mammography is used for the early detection of breast cancer. In addition, studies are being conducted on a grid to produce high-quality images. Although the grid ratio of the grid, which affects the scattering removal rate, must be increased to improve image quality, it increases the total exposure dose. While the use of automatic exposure control is recommended to minimize this problem, existing mammography equipment, unlike general radiography equipment, is mounted on the back of a detector. Therefore, the device is greatly affected by the detector and supporting device, and it is difficult to control the exposure dose. Accordingly, in this research, an integrated AEC-grid device that simultaneously performs AEC and grid functions was used to minimize the unnecessary exposure dose while removing scattering, thereby realizing superior image quality.

Radiation-Induced Breast Cancer Incidence and Mortality From Digital Mammography Screening: A Modeling Study.

PubMed

Miglioretti, Diana L; Lange, Jane; van den Broek, Jeroen J; Lee, Christoph I; van Ravesteyn, Nicolien T; Ritley, Dominique; Kerlikowske, Karla; Fenton, Joshua J; Melnikow, Joy; de Koning, Harry J; Hubbard, Rebecca A

2016-02-16

Estimates of risk for radiation-induced breast cancer from mammography screening have not considered variation in dose exposure or diagnostic work-up after abnormal screening results. To estimate distributions of radiation-induced breast cancer incidence and mortality from digital mammography screening while considering exposure from screening and diagnostic mammography and dose variation among women. 2 simulation-modeling approaches. U.S. population. Women aged 40 to 74 years. Annual or biennial digital mammography screening from age 40, 45, or 50 years until age 74 years. Lifetime breast cancer deaths averted (benefits) and radiation-induced breast cancer incidence and mortality (harms) per 100,000 women screened. Annual screening of 100,000 women aged 40 to 74 years was projected to induce 125 breast cancer cases (95% CI, 88 to 178) leading to 16 deaths (CI, 11 to 23), relative to 968 breast cancer deaths averted by early detection from screening. Women exposed at the 95th percentile were projected to develop 246 cases of radiation-induced breast cancer leading to 32 deaths per 100,000 women. Women with large breasts requiring extra views for complete examination (8% of population) were projected to have greater radiation-induced breast cancer risk (266 cancer cases and 35 deaths per 100,000 women) than other women (113 cancer cases and 15 deaths per 100,000 women). Biennial screening starting at age 50 years reduced risk for radiation-induced cancer 5-fold. Life-years lost from radiation-induced breast cancer could not be estimated. Radiation-induced breast cancer incidence and mortality from digital mammography screening are affected by dose variability from screening, resultant diagnostic work-up, initiation age, and screening frequency. Women with large breasts may have a greater risk for radiation-induced breast cancer. Agency for Healthcare Research and Quality, U.S. Preventive Services Task Force, National Cancer Institute.

The influence of software filtering in digital mammography image quality

NASA Astrophysics Data System (ADS)

Michail, C.; Spyropoulou, V.; Kalyvas, N.; Valais, I.; Dimitropoulos, N.; Fountos, G.; Kandarakis, I.; Panayiotakis, G.

2009-05-01

Breast cancer is one of the most frequently diagnosed cancers among women. Several techniques have been developed to help in the early detection of breast cancer such as conventional and digital x-ray mammography, positron and single-photon emission mammography, etc. A key advantage in digital mammography is that images can be manipulated as simple computer image files. Thus non-dedicated commercially available image manipulation software can be employed to process and store the images. The image processing tools of the Photoshop (CS 2) software usually incorporate digital filters which may be used to reduce image noise, enhance contrast and increase spatial resolution. However, improving an image quality parameter may result in degradation of another. The aim of this work was to investigate the influence of three sharpening filters, named hereafter sharpen, sharpen more and sharpen edges on image resolution and noise. Image resolution was assessed by means of the Modulation Transfer Function (MTF).In conclusion it was found that the correct use of commercial non-dedicated software on digital mammograms may improve some aspects of image quality.

Cost-effectiveness of digital mammography breast cancer screening.

PubMed

Tosteson, Anna N A; Stout, Natasha K; Fryback, Dennis G; Acharyya, Suddhasatta; Herman, Benjamin A; Hannah, Lucy G; Pisano, Etta D

2008-01-01

The DMIST (Digital Mammography Imaging Screening Trial) reported improved breast cancer detection with digital mammography compared with film mammography in selected population subgroups, but it did not assess the economic value of digital relative to film mammography screening. To evaluate the cost-effectiveness of digital mammography screening for breast cancer. Validated, discrete-event simulation model. Data from DMIST and publicly available U.S. data. U.S. women age 40 years or older. Lifetime. Societal and Medicare. All-film mammography screening; all-digital mammography screening; and targeted digital mammography screening, which is age-targeted digital mammography (for women <50 years of age) and age- and density-targeted digital mammography (for women <50 years of age or women > or =50 years of age with dense breasts). Cost per quality-adjusted life-year (QALY) gained. All-digital mammography screening cost $331,000 (95% CI, $268,000 to $403,000) per QALY gained relative to all-film mammography screening but was more costly and less effective than targeted digital mammography screening. Targeted digital mammography screening resulted in more screen-detected cases of cancer and fewer deaths from cancer than either all-film or all-digital mammography screening, with cost-effectiveness estimates ranging from $26,500 (CI, $21,000 to $33,000) per QALY gained for age-targeted digital mammography to $84,500 (CI, $75,000 to $93,000) per QALY gained for age- and density-targeted digital mammography. In the Medicare population, the cost-effectiveness of density-targeted digital mammography screening varied from a base-case estimate of $97,000 (CI, $77,000 to $131,000) to $257,000 per QALY gained (CI, $91,000 to $536,000) in the alternative-case analyses, in which the sensitivity of film mammography was increased and the sensitivity of digital mammography in women with nondense breasts was decreased. Results were sensitive to the cost of digital mammography and to the prevalence of dense breasts. Results were dependent on model assumptions and DMIST findings. Relative to film mammography, screening for breast cancer by using all-digital mammography is not cost-effective. Age-targeted screening with digital mammography seems cost-effective, whereas density-targeted screening strategies are more costly and of uncertain value, particularly among women age 65 years or older.

Supplemental Screening for Breast Cancer in Women With Dense Breasts: A Systematic Review for the U.S. Preventive Services Task Force.

PubMed

Melnikow, Joy; Fenton, Joshua J; Whitlock, Evelyn P; Miglioretti, Diana L; Weyrich, Meghan S; Thompson, Jamie H; Shah, Kunal

2016-02-16

Screening mammography has lower sensitivity and specificity in women with dense breasts, who experience higher breast cancer risk. To perform a systematic review of reproducibility of Breast Imaging Reporting and Data System (BI-RADS) density categorization and test performance and clinical outcomes of supplemental screening with breast ultrasonography, magnetic resonance imaging (MRI), and digital breast tomosynthesis (DBT) in women with dense breasts and negative mammography results. MEDLINE, PubMed, EMBASE, and Cochrane database from January 2000 to July 2015. Studies reporting BI-RADS density reproducibility or supplemental screening results for women with dense breasts. Quality assessment and abstraction of 24 studies from 7 countries; 6 studies were good-quality. Three good-quality studies reported reproducibility of BI-RADS density; 13% to 19% of women were recategorized between "dense" and "nondense" at subsequent screening. Two good-quality studies reported that sensitivity of ultrasonography for women with negative mammography results ranged from 80% to 83%; specificity, from 86% to 94%; and positive predictive value (PPV), from 3% to 8%. The sensitivity of MRI ranged from 75% to 100%; specificity, from 78% to 94%; and PPV, from 3% to 33% (3 studies). Rates of additional cancer detection with ultrasonography were 4.4 per 1000 examinations (89% to 93% invasive); recall rates were 14%. Use of MRI detected 3.5 to 28.6 additional cancer cases per 1000 examinations (34% to 86% invasive); recall rates were 12% to 24%. Rates of cancer detection with DBT increased by 1.4 to 2.5 per 1000 examinations compared with mammography alone (3 studies). Recall rates ranged from 7% to 11%, compared with 7% to 17% with mammography alone. No studies examined breast cancer outcomes. Good-quality evidence was sparse. Studies were small and CIs were wide. Definitions of recall were absent or inconsistent. Density ratings may be recategorized on serial screening mammography. Supplemental screening of women with dense breasts finds additional breast cancer but increases false-positive results. Use of DBT may reduce recall rates. Effects of supplemental screening on breast cancer outcomes remain unclear. Agency for Healthcare Research and Quality.

21 CFR 900.12 - Quality standards.

Code of Federal Regulations, 2014 CFR

2014-04-01

... to mammography. The training shall include instruction in radiation physics, including radiation physics specific to mammography, radiation effects, and radiation protection. The mammographic... ensure that medical physicists certified by the body are competent to perform physics survey; and (B)(1...

21 CFR 900.12 - Quality standards.

Code of Federal Regulations, 2013 CFR

2013-04-01

... to mammography. The training shall include instruction in radiation physics, including radiation physics specific to mammography, radiation effects, and radiation protection. The mammographic... ensure that medical physicists certified by the body are competent to perform physics survey; and (B)(1...

21 CFR 900.12 - Quality standards.

Code of Federal Regulations, 2012 CFR

2012-04-01

... to mammography. The training shall include instruction in radiation physics, including radiation physics specific to mammography, radiation effects, and radiation protection. The mammographic... ensure that medical physicists certified by the body are competent to perform physics survey; and (B)(1...

21 CFR 900.12 - Quality standards.

Code of Federal Regulations, 2011 CFR

2011-04-01

... to mammography. The training shall include instruction in radiation physics, including radiation physics specific to mammography, radiation effects, and radiation protection. The mammographic... ensure that medical physicists certified by the body are competent to perform physics survey; and (B)(1...

Is Mammography Useful in Older Women

DTIC Science & Technology

1999-06-01

mammography in women age 70 and older . Using the Linked Medicare-SEER Tumor Registry Database, created by the National Cancer Institute and the Health Care... Health Interview Survey) have documented that mammography use decreases with advancing age (11,21,22). In 1993, only 25% of women age 65 and older ...related health services research. The linked database contains cancer information on patients 65 years of age and older from NCI’s SEER Program and

Transition from film to digital mammography: impact for breast cancer screening through the national breast and cervical cancer early detection program.

PubMed

van Ravesteyn, Nicolien T; van Lier, Lisanne; Schechter, Clyde B; Ekwueme, Donatus U; Royalty, Janet; Miller, Jacqueline W; Near, Aimee M; Cronin, Kathleen A; Heijnsdijk, Eveline A M; Mandelblatt, Jeanne S; de Koning, Harry J

2015-05-01

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides mammograms and diagnostic services for low-income, uninsured women aged 40-64 years. Mammography facilities within the NBCCEDP gradually shifted from plain-film to digital mammography. The purpose of this study is to assess the impact of replacing film with digital mammography on health effects (deaths averted, life-years gained [LYG]); costs (for screening and diagnostics); and number of women reached. NBCCEDP 2010 data and data representative of the program's target population were used in two established microsimulation models. Models simulated observed screening behavior including different screening intervals (annual, biennial, irregular) and starting ages (40, 50 years) for white, black, and Hispanic women. Model runs were performed in 2012. The models predicted 8.0-8.3 LYG per 1,000 film screens for black women, 5.9-7.5 for white women, and 4.0-4.5 for Hispanic women. For all race/ethnicity groups, digital mammography had more LYG than film mammography (2%-4%), but had higher costs (34%-35%). Assuming a fixed budget, 25%-26% fewer women could be served, resulting in 22%-24% fewer LYG if all mammograms were converted to digital. The loss in LYG could be reversed to an 8%-13% increase by only including biennial screening. Digital could result in slightly more LYG than film mammography. However, with a fixed budget, fewer women may be served with fewer LYG. Changes in the program, such as only including biennial screening, will increase LYG/screen and could offset the potential decrease in LYG when shifting to digital mammography. Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.

The U.S. Online News Coverage of Mammography Based on a Google News Search.

PubMed

Young Lin, Leng Leng; Rosenkrantz, Andrew B

2017-12-01

To characterize online news coverage relating to mammography, including articles' stance toward screening mammography. Google News was used to search U.S. news sites over a 9-year period (2006-2015) based on the search terms "mammography" and "mammogram." The top 100 search results were recorded. Identified articles were manually reviewed. The top 100 news articles were from the following sources: local news outlet (50%), national news outlet (24%), nonimaging medical source (13%), entertainment or culture news outlet (6%), business news outlet (4%), peer-reviewed journal (1%), and radiology news outlet (1%). Most common major themes were the screening mammography controversy (29%), description of a new breast imaging technology (23%), dense breasts (11%), and promotion of a public screening initiative (11%). For the most recent year, article stance toward screening mammography was 59%, favorable; 16%, unfavorable; and 25%, neutral. After 2010, there was an abrupt shift in articles' stances from neutral to both favorable and unfavorable. A wide range of online news sources addressed a range of issues related to mammography. National, rather than local, news sites were more likely to focus on the screening controversy and more likely to take an unfavorable view. The controversial United States Preventive Services Task Force guidelines may have influenced articles to take a stance on screening mammography. As such online news may impact public perception of the topic and thus potentially impact guideline adherence, radiologists are encouraged to maintain awareness of this online coverage and to support the online dissemination of reliable and accurate information. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

A Standard Mammography Unit - Standard 3D Ultrasound Probe Fusion Prototype: First Results.

PubMed

Schulz-Wendtland, Rüdiger; Jud, Sebastian M; Fasching, Peter A; Hartmann, Arndt; Radicke, Marcus; Rauh, Claudia; Uder, Michael; Wunderle, Marius; Gass, Paul; Langemann, Hanna; Beckmann, Matthias W; Emons, Julius

2017-06-01

The combination of different imaging modalities through the use of fusion devices promises significant diagnostic improvement for breast pathology. The aim of this study was to evaluate image quality and clinical feasibility of a prototype fusion device (fusion prototype) constructed from a standard tomosynthesis mammography unit and a standard 3D ultrasound probe using a new method of breast compression. Imaging was performed on 5 mastectomy specimens from patients with confirmed DCIS or invasive carcinoma (BI-RADS ™ 6). For the preclinical fusion prototype an ABVS system ultrasound probe from an Acuson S2000 was integrated into a MAMMOMAT Inspiration (both Siemens Healthcare Ltd) and, with the aid of a newly developed compression plate, digital mammogram and automated 3D ultrasound images were obtained. The quality of digital mammogram images produced by the fusion prototype was comparable to those produced using conventional compression. The newly developed compression plate did not influence the applied x-ray dose. The method was not more labour intensive or time-consuming than conventional mammography. From the technical perspective, fusion of the two modalities was achievable. In this study, using only a few mastectomy specimens, the fusion of an automated 3D ultrasound machine with a standard mammography unit delivered images of comparable quality to conventional mammography. The device allows simultaneous ultrasound - the second important imaging modality in complementary breast diagnostics - without increasing examination time or requiring additional staff.

Digital information management: a progress report on the National Digital Mammography Archive

NASA Astrophysics Data System (ADS)

Beckerman, Barbara G.; Schnall, Mitchell D.

2002-05-01

Digital mammography creates very large images, which require new approaches to storage, retrieval, management, and security. The National Digital Mammography Archive (NDMA) project, funded by the National Library of Medicine (NLM), is developing a limited testbed that demonstrates the feasibility of a national breast imaging archive, with access to prior exams; patient information; computer aids for image processing, teaching, and testing tools; and security components to ensure confidentiality of patient information. There will be significant benefits to patients and clinicians in terms of accessible data with which to make a diagnosis and to researchers performing studies on breast cancer. Mammography was chosen for the project, because standards were already available for digital images, report formats, and structures. New standards have been created for communications protocols between devices, front- end portal and archive. NDMA is a distributed computing concept that provides for sharing and access across corporate entities. Privacy, auditing, and patient consent are all integrated into the system. Five sites, Universities of Pennsylvania, Chicago, North Carolina and Toronto, and BWXT Y12, are connected through high-speed networks to demonstrate functionality. We will review progress, including technical challenges, innovative research and development activities, standards and protocols being implemented, and potential benefits to healthcare systems.

21 CFR 900.3 - Application for approval as an accreditation body.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SERVICES (CONTINUED) MAMMOGRAPHY QUALITY STANDARDS ACT MAMMOGRAPHY Accreditation § 900.3 Application for... Internal Revenue Service requirements as a nonprofit organization); (ii) Detailed description of the... that the applicant develops, sells, or distributes; (xi) Description of the applicant's consumer...

21 CFR 900.3 - Application for approval as an accreditation body.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SERVICES (CONTINUED) MAMMOGRAPHY QUALITY STANDARDS ACT MAMMOGRAPHY Accreditation § 900.3 Application for... Internal Revenue Service requirements as a nonprofit organization); (ii) Detailed description of the... that the applicant develops, sells, or distributes; (xi) Description of the applicant's consumer...

Frequency and determinants of screening for breast cancer in primary care group practice.

PubMed

Love, R R; Brown, R L; Davis, J E; Baumann, L J; Fontana, S A; Sanner, L A

1993-09-27

Many studies reporting the frequency of breast cancer screening have been based only on physician and patient surveys or on data from quality assurance studies and do not assess the reliability of information obtained from these various sources. To obtain more complete data we studied mammography performed in a 3-year period, 1988 through 1991, in 24 nonacademic primary care group practices by both auditing the medical records and obtaining questionnaire responses from 1819 women aged 53 to 62 years and from their 98 physicians in the nonmetropolitan Midwest. Medical record data indicated that mammography was performed in all 3 years in 16.7%, in at least two of 3 years in 49.8%, and in at least one of 3 years in 81.7% of women. While patient reports of a family history of breast cancer, health insurance coverage for mammography, and greater annual household income were each significant predictors, a patient report that a clinic staff member had discussed mammography was the strongest predictor of greater frequency of mammography. In this study of self-selected physicians and their patients, record-documented mammographic examinations were considerably more frequent than has been reported in some studies, but occurred at rates consistent with quality assurance data for the region. These data suggest that clinic staff initiatives with screening mammography have a large impact.

Signal uniformity of mammography systems and its impact on test results from contrast detail phantoms

NASA Astrophysics Data System (ADS)

Kaar, M.; Semturs, F.; Hummel, J.; Hoffmann, R.; Figl, M.

2015-03-01

Technical quality assurance (TQA) procedures for mammography systems usually include tests with a contrast-detail phantom. These phantoms contain multiple objects of varying dimensions arranged on a flat body. Exposures of the phantom are then evaluated by an observer, either human or software. One well-known issue of this method is that dose distribution is not uniform across the image area of any mammography system, mainly due to the heel effect. The purpose of this work is to investigate to what extent image quality differs across the detector plane. We analyze a total of 320 homogeneous mammography exposures from 32 radiology institutes. Systems of different models and manufacturers, both computed radiography (CR) and direct radiography (DR) are included. All images were taken from field installations operated within the nationwide Austrian mammography screening program, which includes mandatory continuous TQA. We calculate signal-to-noise ratios (SNR) for 15 regions of interest arranged to cover the area of the phantom. We define the 'signal range' of an image and compare this value categorized by technologies. We found the deviations of SNR greater in anterior-posterior than in lateral direction. SNR ranges are significantly higher for CR systems than for DR systems.

A screening mammography program. Staying alive and making it work.

PubMed

Monsees, B S; Destouet, J M

1992-01-01

The success of a mammography screening program requires thorough planning. A dependably high volume and a streamlined efficient operation are essential to survival of the program. Factors that warrant consideration prior to designing such a program include the following: Distinction between screening and diagnostic mammography examinations. Selection of a site that will meet the needs of the community and yet provide a consistently high volume. Low examination cost for screening mammography coupled with a detailed financial analysis and reappraisal on an ongoing basis. A customized marketing program that incorporates methods to increase awareness, compliance, and utilization by women and referring physicians. Well-trained, efficient, and dedicated personnel. An operation that is designed for rapid throughput and expeditious patient flow. An efficient plan for film handling, interpretation, reporting, and storage. Timely communication of examination results. A reliable mechanism for follow-up evaluation and outcome data collection. Establishment of a consistent and reliable quality assurance program and the production of high quality mammograms.

Contrast-enhanced Spectral Mammography: Modality-Specific Artifacts and Other Factors Which May Interfere with Image Quality.

PubMed

Bhimani, Chandni; Li, Luna; Liao, Lydia; Roth, Robyn G; Tinney, Elizabeth; Germaine, Pauline

2017-01-01

Contrast-enhanced spectral mammography (CESM) uses full field digital mammography with the added benefit of intravenous contrast administration to significantly reduce false-positive and false-negative results and improve specificity while maintaining high sensitivity. For CESM to fulfill its purpose, one should be aware of possible artifacts and other factors which may interfere with image quality, and attention should be taken to minimize these factors. This pictorial demonstration will depict types of artifacts detected and other factors that interfere with image acquisition in our practice since CESM implementation. Many of the artifacts and other factors we have encountered while using CESM have simple solutions to resolve them. The illustrated artifacts and other factors interfering with image quality will serve as a useful reference to anyone using CESM. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Mammography Patient Information at Hospital Websites: Most Neither Comprehensible Nor Guideline Supported.

PubMed

Sadigh, Gelareh; Singh, Kush; Gilbert, Kirven; Khan, Ramsha; Duszak, Abigail M; Duszak, Richard

2016-11-01

Ongoing controversy regarding screening mammography guidelines has created confusion for many patients. Given recommendations that patient educational material be prepared at or below the 7th grade reading level of average Americans, the purpose of this study was to assess the readability of online mammography information offered by hospitals nationwide. During 2015, online mammography patient educational materials were identified for all Medicare-recognized hospitals nationwide for which screening mammography metrics were publicly available. Patient educational materials were assessed using six validated readability score algorithms. All references to official screening guidelines were captured. Of 4105 hospitals nationwide, 3252 had websites and confirmable screening mammography services. Of those, 1753 (54%) offered mammography information material online. Only 919 (28%) referenced any professional society guidelines. After excluding information not formatted in HTML and shorter than 100 words (to improve algorithm reliability), 1524 hospital mammography webpages were assessed for grade level scores. Nationally, the mean of each readability score for all hospitals varied between the 10th and 14th grade levels, all higher than the recommended 7th grade level (p < 0.001). At the individual hospital level, only 14 hospitals (0.4%) had mean scores at or below the 7th grade level. Of U.S. hospitals that offer screening mammography and have websites, only 54% provide online mammography educational material. Of those, only 0.4% present information at a reading level comprehensible to average Americans, and only 28% offer specific information to help patients reconcile conflicting guidelines. Health systems offering mammography should strive to better meet women's health information and literacy needs.

Audit of mammography requests in Abakaliki, South-East Nigeria.

PubMed

Eni, U E; Ekwedigwe, K C; Sunday-Adeoye, I; Daniyan, Abc; Isikhuemen, M E

2017-03-07

Breast cancer is the leading cancer in women in both developed and developing countries. Screening mammography detects breast cancer even before a lump can be palpated, with better prognosis. The introduction of mammographic technique for screening breast cancer, despite its importance, has been slow to adopt and virtually non-existent in many parts of Sub-Saharan Africa including Nigeria. For this reason, the indications of mammography have not been well defined in our setting. The aim of this study was to audit our mammography requests, with a view to improving its application in our setting. This is a descriptive study carried out on 69 female patients who had mammography at the National Obstetric Fistula Centre, Abakaliki, from January 2014 to December 2015. Findings on clinical examination were entered in a proforma. Mammography was performed in craniocaudal and mediolateral views using the Lorad M-IV (film-screen) mammography machine. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 21. All 69 patients were females. Their mean age was 42.1 ± 11 years. Majority of the patients (69.6%) were between 30 and 49 years. The commonest indication for mammography was breast lump which was found in 46 patients (66.7%). Breast pain was present in 36 (52.2%) of patients. The different Breast Imaging Reporting and Data System (BIRADS) categories were BIRADS 0: 20 (28.99%), BIRADS 1: 8 (11.59%), BIRADS 2: 9 (13.04%), BIRADS 3: 4 (5.8%), BIRADS 4: 19 (27.54%) and BIRADS 5: 9 (13.04%). Diagnostic mammography remains the commonest indication for mammography in our setting. Public awareness, poverty reduction and ready availability of mammography facilities are required to improve screening mammography in our setting.

Mammography usage with relevant factors among women with mental disabilities in Taiwan: a nationwide population-based study.

PubMed

Yen, Suh-May; Kung, Pei-Tseng; Tsai, Wen-Chen

2015-02-01

Women with mental illness are at increased risk of developing and dying from breast cancer and are thus in urgent need of breast cancer preventive care. This study examined the use of screening mammography by Taiwanese women with mental disabilities and analyzed factors affecting this use. 17,243 Taiwanese women with mental disabilities aged 50-69 years were retrospectively included as study subjects. Linked patient data were obtained from three national databases in Taiwan (the 2008 database of physically and mentally disabled persons, the Health Promotion Administration's 2007-2008 mammography screening data, and claims data from the National Health Insurance Research Database). Besides descriptive statistics and bivariate analysis, logistic regression analysis was also performed to examine factors affecting screening mammography use. The 2007-2008 mammography screening rate for Taiwanese women with mental disabilities was 8.79% (n=1515). Variables that significantly influenced screening use were income, education, presence of catastrophic illness/injury, severity of mental disability, and usage of other preventive care services. Screening was positively correlated with income and education. Those with catastrophic illness/injury were more likely to be screened (odds ratio [OR], 1.40; 95% CI=1.15-1.72). Severity of disability was negatively correlated with screening, with very severe, severe, and moderate disability being associated with 0.34-0.69 times the odds of screening as mild disability. In Taiwan, women with mental disabilities receive far less mammography screening than women in general. Copyright © 2014 Elsevier Ltd. All rights reserved.

Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme

PubMed Central

Dibden, A; Offman, J; Parmar, D; Jenkins, J; Slater, J; Binysh, K; McSorley, J; Scorfield, S; Cumming, P; Liao, X-H; Ryan, M; Harker, D; Stevens, G; Rogers, N; Blanks, R; Sellars, S; Patnick, J; Duffy, S W

2014-01-01

Background: The introduction of two-view mammography at incident (subsequent) screens in the National Health Service Breast Screening Programme (NHSBSP) has led to an increased number of cancers detected at screen. However, the effect of two-view mammography on interval cancer rates has yet to be assessed. Methods: Routine screening and interval cancer data were collated from all screening programmes in the United Kingdom for women aged 50–64, screened between 1 April 2003 and 31 March 2005. Interval cancer rates were compared based on whether two-view mammography was in use at the last routine screen. Results: The reduction in interval cancers following screening using two-view mammography compared with one view was 0.68 per 1 000 women screened. Overall, this suggests the introduction of two-view mammography at incident screen was accompanied by a 15–20% reduction in interval cancer rates in the NHSBSP. Conclusion: The introduction of two-view mammography at incident screens is associated with a reduction in incidence of interval cancers. This is consistent with previous publications on a contemporaneous increase in screen-detected cancers. The results provide further evidence of the benefit of the use of two-view mammography at incident screens. PMID:24366303

Clinical Evaluation of a Digital Mammography Based on Micro-Lithography (Breast Cancer)

DTIC Science & Technology

1994-01-20

7-9, Mannheim. Schnetztor - V flag; 1992: 90-91. 2. Panizza P., Del Maschio A. Digital Luminescence Mammography. Digital Radiography Workshop: Quality...Assurance and Radiation Protection. May 7-9, Mannheim. Schnetztor - Verlag; 1992:66-67. 3. Panizza P., Cattaneo M., Rodighiero M.G., et al. Course on

External validation of Medicare claims codes for digital mammography and computer-aided detection.

PubMed

Fenton, Joshua J; Zhu, Weiwei; Balch, Steven; Smith-Bindman, Rebecca; Lindfors, Karen K; Hubbard, Rebecca A

2012-08-01

While Medicare claims are a potential resource for clinical mammography research or quality monitoring, the validity of key data elements remains uncertain. Claims codes for digital mammography and computer-aided detection (CAD), for example, have not been validated against a credible external reference standard. We matched Medicare mammography claims for women who received bilateral mammograms from 2003 to 2006 to corresponding mammography data from the Breast Cancer Surveillance Consortium (BCSC) registries in four U.S. states (N = 253,727 mammograms received by 120,709 women). We assessed the accuracy of the claims-based classifications of bilateral mammograms as either digital versus film and CAD versus non-CAD relative to a reference standard derived from BCSC data. Claims data correctly classified the large majority of film and digital mammograms (97.2% and 97.3%, respectively), yielding excellent agreement beyond chance (κ = 0.90). Claims data correctly classified the large majority of CAD mammograms (96.6%) but a lower percentage of non-CAD mammograms (86.7%). Agreement beyond chance remained high for CAD classification (κ = 0.83). From 2003 to 2006, the predictive values of claims-based digital and CAD classifications increased as the sample prevalences of each technology increased. Medicare claims data can accurately distinguish film and digital bilateral mammograms and mammograms conducted with and without CAD. The validity of Medicare claims data regarding film versus digital mammography and CAD suggests that these data elements can be useful in research and quality improvement. ©2012 AACR.

Cost-effectiveness analysis of mammography and clinical breast examination strategies

PubMed Central

Ahern, Charlotte Hsieh; Shen, Yu

2009-01-01

Purpose Breast cancer screening by mammography and clinical breast exam are commonly used for early tumor detection. Previous cost-effectiveness studies considered mammography alone or did not account for all relevant costs. In this study, we assessed the cost-effectiveness of screening schedules recommended by three major cancer organizations and compared them with alternative strategies. We considered costs of screening examinations, subsequent work-up, biopsy, and treatment interventions after diagnosis. Methods We used a microsimulation model to generate women’s life histories, and assessed screening and treatment impacts on survival. Using statistical models, we accounted for age-specific incidence, preclinical disease duration, and age-specific sensitivity and specificity for each screening modality. The outcomes of interest were quality-adjusted life years (QALYs) saved and total costs with a 3% annual discount rate. Incremental cost-effectiveness ratios were used to compare strategies. Sensitivity analyses were performed by varying some of the assumptions. Results Compared to guidelines from the National Cancer Institute and the U.S. Preventive Services Task Force, alternative strategies were more efficient. Mammography and clinical breast exam in alternating years from ages 40 to 79 was a cost-effective alternative compared to the guidelines, costing $35,500 per QALY saved compared with no screening. The American Cancer Society guideline was the most effective and the most expensive, costing over $680,000 for an added QALY compared to the above alternative. Conclusion Screening strategies with lower costs and benefits comparable to those currently recommended should be considered for implementation in practice and for future guidelines. PMID:19258473

Assessment of automatic exposure control performance in digital mammography using a no-reference anisotropic quality index

NASA Astrophysics Data System (ADS)

Barufaldi, Bruno; Borges, Lucas R.; Bakic, Predrag R.; Vieira, Marcelo A. C.; Schiabel, Homero; Maidment, Andrew D. A.

2017-03-01

Automatic exposure control (AEC) is used in mammography to obtain acceptable radiation dose and adequate image quality regardless of breast thickness and composition. Although there are physics methods for assessing the AEC, it is not clear whether mammography systems operate with optimal dose and image quality in clinical practice. In this work, we propose the use of a normalized anisotropic quality index (NAQI), validated in previous studies, to evaluate the quality of mammograms acquired using AEC. The authors used a clinical dataset that consists of 561 patients and 1,046 mammograms (craniocaudal breast views). The results show that image quality is often maintained, even at various radiation levels (mean NAQI = 0.14 +/- 0.02). However, a more careful analysis of NAQI reveals that the average image quality decreases as breast thickness increases. The NAQI is reduced by 32% on average, when the breast thickness increases from 31 to 71 mm. NAQI also decreases with lower breast density. The variation in breast parenchyma alone cannot fully account for the decrease of NAQI with thickness. Examination of images shows that images of large, fatty breasts are often inadequately processed. This work shows that NAQI can be applied in clinical mammograms to assess mammographic image quality, and highlights the limitations of the automatic exposure control for some images.

Does performance of breast self-exams increase the probability of using mammography: evidence from Malaysia.

PubMed

Dunn, Richard A; Tan, Andrew; Samad, Ismail

2010-01-01

Breast self-examination (BSE) was evaluated to see if it is a significant predictor of mammography. The decisions of females above age 40 in Malaysia to test for breast cancer using BSE and mammography are jointly modeled using a bivariate probit so that unobserved attributes affecting mammography usage are also allowed to affect BSE. Data come from the Malaysia Non-Communicable Disease Surveillance-1, which was collected between September 2005 and February 2006. Having ever performed BSE is positively associated with having ever undergone mammography among Malay (adjusted OR=7.343, CI=2.686, 20.079) and Chinese (adjusted OR=3.466, CI=1.330, 9.031) females after adjusting for household income, education, marital status and residential location. Neither relationship is affected by jointly modelling the decision problem. Although the association is also positive for Indian females when mammography is modelled separately (adjusted OR=5.959, CI=1.546 - 22.970), the relationship is reversed when both decisions are modelled separately. De-emphasizing BSE in Malaysia may reduce mammography screening among a large proportion of the population. Previous work on the issue in developed countries may not apply to nations with limited resources.

Implementation of the qualities of radiodiagnostic: mammography

NASA Astrophysics Data System (ADS)

Pacífico, L. C.; Magalhães, L. A. G.; Peixoto, J. G. P.; Fernandes, E.

2018-03-01

The objective of the present study was to evaluate the expanded uncertainty of the mammographic calibration process and present the result of the internal audit performed at the Laboratory of Radiological Sciences (LCR). The qualities of the mammographic beans that are references in the LCR, comprises two irradiation conditions: no-attenuated beam and attenuated beam. Both had satisfactory results, with an expanded uncertainty equals 2,1%. The internal audit was performed, and the degree of accordance with the ISO/IEC 17025 was evaluated. The result of the internal audit was satisfactory. We conclude that LCR can perform calibrations on mammography qualities for end users.

Maintaining quality in the UK breast screening program

NASA Astrophysics Data System (ADS)

Gale, Alastair

2010-02-01

Breast screening in the UK has been implemented for over 20 years and annually nearly two million women are now screened with an estimated 1,400 lives saved. Nationally, some 700 individuals interpret screening mammograms in almost 110 screening centres. Currently, women aged 50 to 70 are invited for screening every three years and by 2012 this age range will increase to 47 - 73 years. There is a rapid ongoing transition from using film mammograms to full field digital mammography such that in 2010 every screening centre will be partly digital. An early, and long running, concern has been how to ensure the highest quality of imaging interpretation across the UK, an issue enhanced by the use of a three year screening interval. To partly address this question a self assessment scheme was developed in 1988 and subsequently implemented nationally in the UK as a virtually mandatory activity. The scheme is detailed from its beginnings, through its various developments to current incarnation and future plans. This encompasses both radiological (single view screening, two view screening, mammographic film and full field digital mammography) as well as design changes (cases reported by means of: form filling; PDA; tablet PC; iPhone, and the internet). The scheme provides a rich data source which is regularly studied to examine different aspects of radiological performance. Overall it aids screening radiologists by giving them regular access to a range of difficult exemplar cases together with feedback on their performance as compared to their peers.

Quality assurance in mammography: artifact analysis.

PubMed

Hogge, J P; Palmer, C H; Muller, C C; Little, S T; Smith, D C; Fatouros, P P; de Paredes, E S

1999-01-01

Evaluation of mammograms for artifacts is essential for mammographic quality assurance. A variety of mammographic artifacts (i.e., variations in mammographic density not caused by true attenuation differences) can occur and can create pseudolesions or mask true abnormalities. Many artifacts are readily identified, whereas others present a true diagnostic challenge. Factors that create artifacts may be related to the processor (eg, static, dirt or excessive developer buildup on the rollers, excessive roller pressure, damp film, scrapes and scratches, incomplete fixing, power failure, contaminated developer), the technologist (eg, improper film handling and loading, improper use of the mammography unit and related equipment, positioning and darkroom errors), the mammography unit (eg, failure of the collimation mirror to rotate, grid inhomogeneity, failure of the reciprocating grid to move, material in the tube housing, compression failure, improper alignment of the compression paddle with the Bucky tray, defective compression paddle), or the patient (e.g., motion, superimposed objects or substances [jewelry, body parts, clothing, hair, implanted medical devices, foreign bodies, substances on the skin]). Familiarity with the broad range of artifacts and the measures required to eliminate them is vital. Careful attention to darkroom cleanliness, care in film handling, regularly scheduled processor maintenance and chemical replenishment, daily quality assurance activities, and careful attention to detail during patient positioning and mammography can reduce or eliminate most mammographic artifacts.

Translating Research into Policy: Reducing Breast Cancer Disparities in Illinois

Cancer.gov

Dr. Carol Ferrans is internationally recognized for her work in disparities in health care and quality of life outcomes. She has a distinguished record of research that includes major grants funded by three institutes of the National Institutes of Health (National Cancer Institute, National Institute for Minority Health and Health Disparities, and National Institute for Nursing Research).    Dr. Ferrans’ work has been instrumental in reducing the disparity in breast cancer mortality Chicago, which at its peak was among the worst in the nation.  Efforts led by Dr. Ferrans and colleagues led directly to statewide legislation, to address the multifaceted causes of black/white disparity in deaths from breast cancer.  She was one of the founders of the Metropolitan Chicago Breast Cancer Task Force (MCBCTF), leading the team focusing on barriers to mammography screening, to identify reasons for the growing disparity in breast cancer mortality. Their findings (citing Ferrans’ research and others) and recommendations for action were translated directly into the Illinois Reducing Breast Cancer Disparities Act and two additional laws strengthening the Act.  These laws and other statewide efforts have improved access to screening and quality of mammography throughout the Illinois. In addition, Dr. Ferrans and her team identified cultural beliefs contributing to later stage diagnosis of breast cancer in African American and Latino women in Chicago, and most importantly, showed that these beliefs can be changed.  They reached more than 8,000 African American women in Chicago with a short film on DVD, which was effective in changing beliefs and promoting screening.  Her team’s published findings were cited by the American Cancer Society in their guidelines for breast cancer screening.  The Chicago black/white disparity in breast cancer deaths has decreased by 35% since the MCBCTF first released its report, according to data from the Illinois Department of Public Health Vital Records.

[Controversial attitude to mammography screening in asymptomatic women between 40 and 50 years of age].

PubMed

Frischbier, H J

1994-01-01

The results of screening studies conducted in the United States and in Europe in females between the ages of 40 and 50 are analysed. It is shown, that the results of this study on mortality reduction are less favourable, the poorer the technique of mammography (foregoing of general two-view mammography) and the longer the time interval between two mammography screenings. Arguments are presented, that are brought forward when declining to perform general mammography screening in this age group. The author's own results, obtained in the Hamburg mammography screening study, which included from 1971 to 1986 also premenopausal women, show, that the survival rates of patients below 50 years of age with mammographically detected carcinomas of the breast do not differ from those in patients older than 50 years, according to a relevant age group classification. The advances in the technique of mammography in recent years are analysed on the basis of the author's own patient material. It is evident, that the positive predictive value has been doubled, especially in the age group between 40 and 50. An analysis of the distribution of diagnosed noninvasive carcinomas compared with the invasive carcinomas reveals, that particularly this age group has the highest percentage of identification of prognostically favourable carcinoma stages. Further analyses show, why the randomised European mammography studies could not yield a significant mortality rate improvement. A prerequisite for the inclusion of mammography screening in the legally prescribed early detection of carcinoma examinations, however, are the quality controls, whose realisation, in our health system, will have to be confirmed by the German mammography study.

High dynamic range CMOS-based mammography detector for FFDM and DBT

NASA Astrophysics Data System (ADS)

Peters, Inge M.; Smit, Chiel; Miller, James J.; Lomako, Andrey

2016-03-01

Digital Breast Tomosynthesis (DBT) requires excellent image quality in a dynamic mode at very low dose levels while Full Field Digital Mammography (FFDM) is a static imaging modality that requires high saturation dose levels. These opposing requirements can only be met by a dynamic detector with a high dynamic range. This paper will discuss a wafer-scale CMOS-based mammography detector with 49.5 μm pixels and a CsI scintillator. Excellent image quality is obtained for FFDM as well as DBT applications, comparing favorably with a-Se detectors that dominate the X-ray mammography market today. The typical dynamic range of a mammography detector is not high enough to accommodate both the low noise and the high saturation dose requirements for DBT and FFDM applications, respectively. An approach based on gain switching does not provide the signal-to-noise benefits in the low-dose DBT conditions. The solution to this is to add frame summing functionality to the detector. In one X-ray pulse several image frames will be acquired and summed. The requirements to implement this into a detector are low noise levels, high frame rates and low lag performance, all of which are unique characteristics of CMOS detectors. Results are presented to prove that excellent image quality is achieved, using a single detector for both DBT as well as FFDM dose conditions. This method of frame summing gave the opportunity to optimize the detector noise and saturation level for DBT applications, to achieve high DQE level at low dose, without compromising the FFDM performance.

Evolution of mammographic image quality in the state of Rio de Janeiro*

PubMed Central

Villar, Vanessa Cristina Felippe Lopes; Seta, Marismary Horsth De; de Andrade, Carla Lourenço Tavares; Delamarque, Elizabete Vianna; de Azevedo, Ana Cecília Pedrosa

2015-01-01

Objective To evaluate the evolution of mammographic image quality in the state of Rio de Janeiro on the basis of parameters measured and analyzed during health surveillance inspections in the period from 2006 to 2011. Materials and Methods Descriptive study analyzing parameters connected with imaging quality of 52 mammography apparatuses inspected at least twice with a one-year interval. Results Amongst the 16 analyzed parameters, 7 presented more than 70% of conformity, namely: compression paddle pressure intensity (85.1%), films development (72.7%), film response (72.7%), low contrast fine detail (92.2%), tumor mass visualization (76.5%), absence of image artifacts (94.1%), mammography-specific developers availability (88.2%). On the other hand, relevant parameters were below 50% conformity, namely: monthly image quality control testing (28.8%) and high contrast details with respect to microcalcifications visualization (47.1%). Conclusion The analysis revealed critical situations in terms of compliance with the health surveillance standards. Priority should be given to those mammography apparatuses that remained non-compliant at the second inspection performed within the one-year interval. PMID:25987749

Mammography Use Among Medicare Beneficiaries After Elimination of Cost Sharing.

PubMed

Sabatino, Susan A; Thompson, Trevor D; Guy, Gery P; de Moor, Janet S; Tangka, Florence K

2016-04-01

We examined mammography use before and after Medicare eliminated cost sharing for screening mammography in January 2011. Using National Health Interview Survey data, we examined changes in mammography use between 2010 and 2013 among Medicare beneficiaries aged 65-74 years. Logistic regression and predictive margins were used to examine changes in use after adjusting for covariates. In 2013, 74.7% of women reported a mammogram within 2 years, a 3.5 percentage point increase (95% confidence interval, -0.3, 7.2) compared with 2010. Increases occurred among women aged 65-69 years, unmarried women, and women with usual sources of care and 2-5 physician visits in the prior year. After adjustment, mammography use increased in 2013 versus 2010 (74.8% vs. 71.3%, P=0.039). Interactions between year and income, insurance, race, or ethnicity were not significant. There was a modest increase in mammography use from 2010 to 2013 among Medicare beneficiaries aged 65-74 years, possibly consistent with an effect of eliminating Medicare cost sharing during this time. Findings suggest that eliminating cost sharing might increase use of recommended screening services.

Computational assessment of mammography accreditation phantom images and correlation with human observer analysis

NASA Astrophysics Data System (ADS)

Barufaldi, Bruno; Lau, Kristen C.; Schiabel, Homero; Maidment, D. A.

2015-03-01

Routine performance of basic test procedures and dose measurements are essential for assuring high quality of mammograms. International guidelines recommend that breast care providers ascertain that mammography systems produce a constant high quality image, using as low a radiation dose as is reasonably achievable. The main purpose of this research is to develop a framework to monitor radiation dose and image quality in a mixed breast screening and diagnostic imaging environment using an automated tracking system. This study presents a module of this framework, consisting of a computerized system to measure the image quality of the American College of Radiology mammography accreditation phantom. The methods developed combine correlation approaches, matched filters, and data mining techniques. These methods have been used to analyze radiological images of the accreditation phantom. The classification of structures of interest is based upon reports produced by four trained readers. As previously reported, human observers demonstrate great variation in their analysis due to the subjectivity of human visual inspection. The software tool was trained with three sets of 60 phantom images in order to generate decision trees using the software WEKA (Waikato Environment for Knowledge Analysis). When tested with 240 images during the classification step, the tool correctly classified 88%, 99%, and 98%, of fibers, speck groups and masses, respectively. The variation between the computer classification and human reading was comparable to the variation between human readers. This computerized system not only automates the quality control procedure in mammography, but also decreases the subjectivity in the expert evaluation of the phantom images.

Supplemental Screening for Breast Cancer in Women with Dense Breasts: A Systematic Review for the U.S. Preventive Services Task Force

PubMed Central

Melnikow, Joy; Fenton, Joshua J.; Whitlock, Evelyn P.; Miglioretti, Diana L.; Weyrich, Meghan S.; Thompson, Jamie H.; Shah, Kunal

2016-01-01

Background Screening mammography has lower sensitivity and specificity in women with dense breasts, who experience higher breast cancer risk. Purpose Systematic review of: reproducibility of BI-RADS density categorization; test performance and clinical outcomes of supplemental screening with breast ultrasound, magnetic resonance imaging (MRI), and digital breast tomosynthesis (DBT) in women with dense breasts and negative mammography. Data Sources MEDLINE, PubMed, Embase, and Cochrane January 2000–July 2015. Study Selection Studies reporting BI-RADS density reproducibility or supplemental screening results for women with dense breasts. Data Extraction Quality assessment and abstraction of twenty-four studies from seven countries; six were good quality. Data Synthesis Three good-quality studies reported reproducibility of BI-RADS density; 13–19% of women were re-categorized between “dense” and “non-dense” at subsequent screening. Two good-quality studies reported ultrasound sensitivity for women with negative mammography ranging from 80–83%; specificity 86–94%; and positive predictive value (PPV) 3–8%. MRI sensitivity ranged from 75–100%, specificity 78–94%, and PPV 3–33% (3 studies). Ultrasound additional cancer detection rates were 4.4 per 1,000 exams (89–93% invasive); recall rates were 14%. MRI detected 3.5–28.6 additional cancers per 1,000 exams (34–86% invasive); recall rates were 12–24 %. DBT cancer detection rates increased by 1.4–2.5 per 1000 exams compared to mammography alone (3 studies). Recall rates ranged from 7–11%, compared to 7–17% with mammography alone. No studies examined breast cancer outcomes. Limitations Good quality evidence was sparse. Studies were small and confidence intervals were wide. Definitions of recall were absent or inconsistent. Conclusions Density ratings may be re-categorized on serial screening mammograms. Supplemental screening of women with dense breasts finds additional breast cancers, but increases false-positives. DBT may reduce recall rates. Supplemental screening impacts on breast cancer outcomes remain unclear. Primary Funding Source Agency for Healthcare Research and Quality PMID:26757021

Guidelines for breast cancer screening in Lebanon Public Health Communication.

PubMed

Adib, Salim M; El Saghir, Nagi S; Ammar, Walid

2009-01-01

The accumulation of national epidemiological data since the late 1990s has led to the adoption of evidence-based guidelines for breast cancer screening in Lebanon (2006). Almost 50% of breast cancer patients in Lebanon are below the age of 50 years and the age-adjusted incidence rate is estimated at 69 new cases per 100,000 per year (2004). This official notification calls for breast self-examination (BSE) every month starting age 20, and a clinical breast examination (CBE) performed by a physician every three years between the ages of 20 and 40 years. Starting age 40, and for as long as a woman is in good health, an annual CBE and mammography are recommended. Women with known genetic family history of breast cancer should start screening 10 years earlier than the first young patient in the family, or earlier depending on medical advice. The Breast Cancer National Task Force (BCNTF) recommends certification of mammography centers and continued training of personnel to assure high quality mammograms, and to minimize unnecessary investigations and surgeries.It recommends that a national program should record call-backs of women for annual screening and follow-up data on abnormal mammograms. BCNTF encourages the adoption of these guidelines and monitoring of their results, as well as follow-up of breast cancer epidemiology and registry in Lebanon, and scientific progress in early breast cancer detection to determine needs for modifications in the future.

Breast cancer mammographic diagnosis performance in a public health institution: a retrospective cohort study.

PubMed

Mello, Juliana M R B; Bittelbrunn, Fernando P; Rockenbach, Marcio A B C; May, Guilherme G; Vedolin, Leonardo M; Kruger, Marilia S; Soldatelli, Matheus D; Zwetsch, Guilherme; de Miranda, Gabriel T F; Teixeira, Saone I P; Arruda, Bruna S

2017-12-01

To evaluate the quality assurance of mammography results at a reference institution for the diagnosis and treatment of breast cancer in southern Brazil, based on the BIRADS (Breast Imaging Reporting and Data System) 5th edition recommendations for auditing purposes. Retrospective cohort and cross-sectional study with 4502 patients (9668 mammographies)) who underwent at least one or both breast mammographies throughout 2013 at a regional public hospital, linked to a federal public university. The results were followed until 31 December 2014, including true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), positive predictive values (PPVs), negative predictive value (NPV), sensitivity and specificity, with a confidence interval of 95%. The study showed high quality assurance, particularly regarding sensitivity (90.22%) and specificity (92.31%). The overall positive predictive value (PPV) was 65.35%, and the negative predictive value (NPV) was 98.32%. The abnormal interpretation rate (recall rate) was 12.26%. The results are appropriate when compared to the values proposed by the BIRADS 5th edition. Additionally, the study provided self-reflection considering our radiological practice, which is essential for improvements and collaboration regarding breast cancer detection. It may stimulate better radiological practice performance and continuing education, despite possible infrastructure and facility limitations. • Accurate quality performance rates are possible despite financial and governmental limitations. • Low-income institutions should develop standardised teamwork to improve radiological practice. • Regular mammography audits may help to increase the quality of public health systems.

More than just a mammogram: breast cancer screening perspectives of relatives of women with intellectual disability.

PubMed

Greenwood, Nechama W; Dreyfus, Deborah; Wilkinson, Joanne

2014-12-01

Women with intellectual disability (ID) have similar rates of breast cancer as the general public, but higher breast cancer mortality and lower rates of regular screening mammography. Screening rates are lowest among women who live with their families. Though women with ID often make decisions in partnership with their relatives, we lack research related to family member perspectives on mammography. We conducted a qualitative study of family members of women with ID, with an interview guide focused on health care decision making and experiences, and breast cancer screening barriers, facilitators, and beliefs as related to their loved ones. Sixteen family members underwent semistructured interviews. Important themes included mammography as a reference point for other social and cultural concerns, such as their loved one's sexuality or what it means to be an adult woman; fear of having to make hard decisions were cancer to be diagnosed acting as a barrier to screening; a focus on quality of life; and desire for quality health care for their loved one, though quality care did not always equate to regular cancer screening. Adults with ID are valued members of their families, and their relatives are invested in their well-being. However, families fear the potentially complicated decisions associated with a cancer diagnosis and may choose to forgo screening due to misinformation and a focus on quality of life. Effective interventions to address disparities in mammography should focus on adults with ID and their families together, and incorporate the family context.

A conversion method of air kerma from the primary, scatter, and leakage radiations to effective dose for calculating x-ray shielding barriers in mammography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kharrati, Hedi

2005-05-01

In this study, a new approach has been introduced for derivation of the effective dose from air kerma to calculate shielding requirements in mammography facilities. This new approach has been used to compute the conversion coefficients relating air kerma to the effective dose for the mammography reference beam series of the Netherlands Metrology Institute Van Swinden Laboratorium, National Institute of Standards and Technology, and International Atomic Energy Agency laboratories. The results show that, in all cases, the effective dose in mammography energy range is less than 25% of the incident air kerma for the primary and the scatter radiations andmore » does not exceed 75% for the leakage radiation.« less

[Organized breast cancer screening].

PubMed

Rouëssé, Jacques; Sancho-Garnier, Hélèn

2014-02-01

Breast screening programs are increasingly controversial, especially regarding two points: the number of breast cancer deaths they avoid, and the problem of over-diagnosis and over-treatment. The French national breast cancer screening program was extended to cover the whole country in 2004. Ten years later it is time to examine the risk/benefit ratio of this program and to discuss the need for change. Like all forms of cancer management, screening must be regularly updated, taking into account the state of the art, new evidence, and uncertainties. All screening providers should keep themselves informed of the latest findings. In the French program, women aged 50-74 with no major individual or familial risk factors for breast cancer are offered screening mammography and clinical breast examination every two years. Images considered non suspicious of malignancy by a first reader are re-examined by a second reader. The devices and procedures are subjected to quality controls. Participating radiologists (both public and private) are required to read at least 500 mammographies per year. The program's national participation rate was 52.7 % in 2012. When individual screening outside of the national program is taken into account (nearly 15 % of women), coverage appears close to the European recommendation of 65 %. Breast cancer mortality has been falling in France by 0.6 % per year for over 30 years, starting before mass screening was implemented, and by 1.5 % since 2005. This decline can be attributed in part to earlier diagnosis and better treatment, so that the specific impact of screening cannot easily be measured. Over-treatment, defined as the detection and treatment of low-malignancy tumors that would otherwise not have been detected in a person's lifetime, is a major negative effect of screening, but its frequency is not precisely known (reported to range from 1 % to 30 %). In view of these uncertainties, it would be advisable to modify the program in order to increase its efficiency, by targeting populations at a higher risk than the women currently included, and to reduce the number of mammograms done outside the program, as they are not subject to the same quality controls. Risks could be reduced by increasing the sensitivity of mammography and the specificity of the readings. Moreover, it is mandatory to inform women of both the benefits and risks of screening, in compliance with the principle of enabling patients to make a free and informed choice.

Validation of no-reference image quality index for the assessment of digital mammographic images

NASA Astrophysics Data System (ADS)

de Oliveira, Helder C. R.; Barufaldi, Bruno; Borges, Lucas R.; Gabarda, Salvador; Bakic, Predrag R.; Maidment, Andrew D. A.; Schiabel, Homero; Vieira, Marcelo A. C.

2016-03-01

To ensure optimal clinical performance of digital mammography, it is necessary to obtain images with high spatial resolution and low noise, keeping radiation exposure as low as possible. These requirements directly affect the interpretation of radiologists. The quality of a digital image should be assessed using objective measurements. In general, these methods measure the similarity between a degraded image and an ideal image without degradation (ground-truth), used as a reference. These methods are called Full-Reference Image Quality Assessment (FR-IQA). However, for digital mammography, an image without degradation is not available in clinical practice; thus, an objective method to assess the quality of mammograms must be performed without reference. The purpose of this study is to present a Normalized Anisotropic Quality Index (NAQI), based on the Rényi entropy in the pseudo-Wigner domain, to assess mammography images in terms of spatial resolution and noise without any reference. The method was validated using synthetic images acquired through an anthropomorphic breast software phantom, and the clinical exposures on anthropomorphic breast physical phantoms and patient's mammograms. The results reported by this noreference index follow the same behavior as other well-established full-reference metrics, e.g., the peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM). Reductions of 50% on the radiation dose in phantom images were translated as a decrease of 4dB on the PSNR, 25% on the SSIM and 33% on the NAQI, evidencing that the proposed metric is sensitive to the noise resulted from dose reduction. The clinical results showed that images reduced to 53% and 30% of the standard radiation dose reported reductions of 15% and 25% on the NAQI, respectively. Thus, this index may be used in clinical practice as an image quality indicator to improve the quality assurance programs in mammography; hence, the proposed method reduces the subjectivity inter-observers in the reporting of image quality assessment.

Are women getting relevant information about mammography screening for an informed consent: a critical appraisal of information brochures used for screening invitation in Germany, Italy, Spain and France.

PubMed

Gummersbach, Elisabeth; Piccoliori, Giuliano; Zerbe, Cristina Oriol; Altiner, Attila; Othman, Cecile; Rose, Christine; Abholz, Heinz-Harald

2010-08-01

The aim was to find out if information brochures on mammography screening in Germany, Italy, Spain and France contain more information to facilitate informed consent than in similar studies carried out over the last few years in Sweden, Canada, USA and the UK, countries with different medical cultures. We generated a list of essential information items on mammography screening for the purpose of informed consent. We mostly used the same items of information as had been used in previous studies and analysed the information brochures of major national initiatives in Germany and France, and three brochures each from regionalized programmes in Italy and Spain. We cross-checked which of our items were covered in the brochures and if correct numbers were given. We found that the information brochures contained only about half of the information items we defined. Six of the eight brochures mentioned the reduction in breast-cancer fatalities. Four of the eight provided information on false positives, and four of the brochures highlighted the side-effects of radiation. The information on side-effects and risks provided by the brochures was generally of poor quality, and none of them referred to over diagnosis. When numbers were given, they were only indicated in terms of relative numbers. The information brochures currently being used in Germany, Italy, Spain and France are no better than the brochures analysed some years ago. Our results suggest that the providers of mammography screening programmes continue to conceal information from women that is essential when making an informed decision.

Mobile measurement setup according to IEC 62220-1-2 for DQE determination on digital mammography systems

NASA Astrophysics Data System (ADS)

Greiter, Matthias B.; Hoeschen, Christoph

2010-04-01

The international standard IEC 62220-1-2 defines the measurement procedure for determination of the detective quantum efficiency (DQE) of digital x-ray imaging devices used in mammography. A mobile setup complying to this standard and adaptable to most current systems was constructed in the Helmholtz Zentrum München to allow for an objective technical comparison of current full field digital mammography units employed in mammography screening in Germany. This article demonstrates the setup's capabilities with a focus on the measurement uncertainties of all quantities contributing to DQE measurements. Evaluation of uncertainties encompasses results from measurements on a Sectra Microdose Mammography in clinical use, as well as on a prototype of a Fujifilm Amulet system at various radiation qualities. Both systems have a high spatial resolution of 50 μm × 50 μm. The modulation transfer function (MTF), noise power spectrum (NPS) and DQE of the Sectra MDM are presented in comparison to results previously published by other authors.

Comparative Effectiveness of Digital Versus Film-Screen Mammography in Community Practice in the United States

PubMed Central

Kerlikowske, Karla; Hubbard, Rebecca A.; Miglioretti, Diana L.; Geller, Berta M.; Yankaskas, Bonnie C.; Lehman, Constance D.; Taplin, Stephen H.; Sickles, Edward A.

2013-01-01

Background Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice. Objective To determine whether the interpretive performance of digital and film-screen mammography differs. Design Prospective cohort study. Setting Mammography facilities in the Breast Cancer Surveillance Consortium. Participants 329 261 women aged 40 to 79 years underwent 869 286 mammograms (231 034 digital; 638 252 film-screen). Measurements Invasive cancer or ductal carcinoma in situ diagnosed within 12 months of a digital or film-screen examination and calculation of mammography sensitivity, specificity, cancer detection rates, and tumor outcomes. Results Overall, cancer detection rates and tumor characteristics were similar for digital and film-screen mammography, but the sensitivity and specificity of each modality varied by age, tumor characteristics, breast density, and menopausal status. Compared with film-screen mammography, the sensitivity of digital mammography was significantly higher for women aged 60 to 69 years (89.9% vs. 83.0%; P = 0.014) and those with estrogen receptor-negative cancer (78.5% vs. 65.8%; P = 0.016); borderline significantly higher for women aged 40 to 49 years (82.4% vs. 75.6%; P = 0.071), those with extremely dense breasts (83.6% vs. 68.1%; P= 0.051), and pre- or perimenopausal women (87.1% vs. 81.7%; P = 0.057); and borderline significantly lower for women aged 50 to 59 years (80.5% vs. 85.1%; P = 0.097). The specificity of digital and film-screen mammography was similar by decade of age, except for women aged 40 to 49 years (88.0% vs. 89.7%; P< 0.001). Limitation Statistical power for subgroup analyses was limited. Conclusion Overall, cancer detection with digital or film-screen mammography is similar in U.S. women aged 50 to 79 years undergoing screening mammography. Women aged 40 to 49 years are more likely to have extremely dense breasts and estrogen receptor-negative tumors; if they are offered mammography screening, they may choose to undergo digital mammography to optimize cancer detection. Primary Funding Source National Cancer Institute. PMID:22007043

National Performance Benchmarks for Modern Diagnostic Digital Mammography: Update from the Breast Cancer Surveillance Consortium.

PubMed

Sprague, Brian L; Arao, Robert F; Miglioretti, Diana L; Henderson, Louise M; Buist, Diana S M; Onega, Tracy; Rauscher, Garth H; Lee, Janie M; Tosteson, Anna N A; Kerlikowske, Karla; Lehman, Constance D

2017-04-01

Purpose To establish contemporary performance benchmarks for diagnostic digital mammography with use of recent data from the Breast Cancer Surveillance Consortium (BCSC). Materials and Methods Institutional review board approval was obtained for active or passive consenting processes or to obtain a waiver of consent to enroll participants, link data, and perform analyses. Data were obtained from six BCSC registries (418 radiologists, 92 radiology facilities). Mammogram indication and assessments were prospectively collected for women undergoing diagnostic digital mammography and linked with cancer diagnoses from state cancer registries. The study included 401 548 examinations conducted from 2007 to 2013 in 265 360 women. Results Overall diagnostic performance measures were as follows: cancer detection rate, 34.7 per 1000 (95% confidence interval [CI]: 34.1, 35.2); abnormal interpretation rate, 12.6% (95% CI: 12.5%, 12.7%); positive predictive value (PPV) of a biopsy recommendation (PPV 2 ), 27.5% (95% CI: 27.1%, 27.9%); PPV of biopsies performed (PPV 3 ), 30.4% (95% CI: 29.9%, 30.9%); false-negative rate, 4.8 per 1000 (95% CI: 4.6, 5.0); sensitivity, 87.8% (95% CI: 87.3%, 88.4%); and specificity, 90.5% (95% CI: 90.4%, 90.6%). Among cancers detected, 63.4% were stage 0 or 1 cancers, 45.6% were minimal cancers, the mean size of invasive cancers was 21.2 mm, and 69.6% of invasive cancers were node negative. Performance metrics varied widely across diagnostic indications, with cancer detection rate (64.5 per 1000) and abnormal interpretation rate (18.7%) highest for diagnostic mammograms obtained to evaluate a breast problem with a lump. Compared with performance during the screen-film mammography era, diagnostic digital performance showed increased abnormal interpretation and cancer detection rates and decreasing PPVs, with less than 70% of radiologists within acceptable ranges for PPV 2 and PPV 3 . Conclusion These performance measures can serve as national benchmarks that may help transform the marked variation in radiologists' diagnostic performance into targeted quality improvement efforts. © RSNA, 2017 Online supplemental material is available for this article.

PubMed Central

Schulz-Wendtland, Rüdiger; Jud, Sebastian M.; Fasching, Peter A.; Hartmann, Arndt; Radicke, Marcus; Rauh, Claudia; Uder, Michael; Wunderle, Marius; Gass, Paul; Langemann, Hanna; Beckmann, Matthias W.; Emons, Julius

2017-01-01

Aim The combination of different imaging modalities through the use of fusion devices promises significant diagnostic improvement for breast pathology. The aim of this study was to evaluate image quality and clinical feasibility of a prototype fusion device (fusion prototype) constructed from a standard tomosynthesis mammography unit and a standard 3D ultrasound probe using a new method of breast compression. Materials and Methods Imaging was performed on 5 mastectomy specimens from patients with confirmed DCIS or invasive carcinoma (BI-RADS ™ 6). For the preclinical fusion prototype an ABVS system ultrasound probe from an Acuson S2000 was integrated into a MAMMOMAT Inspiration (both Siemens Healthcare Ltd) and, with the aid of a newly developed compression plate, digital mammogram and automated 3D ultrasound images were obtained. Results The quality of digital mammogram images produced by the fusion prototype was comparable to those produced using conventional compression. The newly developed compression plate did not influence the applied x-ray dose. The method was not more labour intensive or time-consuming than conventional mammography. From the technical perspective, fusion of the two modalities was achievable. Conclusion In this study, using only a few mastectomy specimens, the fusion of an automated 3D ultrasound machine with a standard mammography unit delivered images of comparable quality to conventional mammography. The device allows simultaneous ultrasound – the second important imaging modality in complementary breast diagnostics – without increasing examination time or requiring additional staff. PMID:28713173

Full-field digital mammography image data storage reduction using a crop tool.

PubMed

Kang, Bong Joo; Kim, Sung Hun; An, Yeong Yi; Choi, Byung Gil

2015-05-01

The storage requirements for full-field digital mammography (FFDM) in a picture archiving and communication system are significant, so methods to reduce the data set size are needed. A FFDM crop tool for this purpose was designed, implemented, and tested. A total of 1,651 screening mammography cases with bilateral FFDMs were included in this study. The images were cropped using a DICOM editor while maintaining image quality. The cases were evaluated according to the breast volume (1/4, 2/4, 3/4, and 4/4) in the craniocaudal view. The image sizes between the cropped image group and the uncropped image group were compared. The overall image quality and reader's preference were independently evaluated by the consensus of two radiologists. Digital storage requirements for sets of four uncropped to cropped FFDM images were reduced by 3.8 to 82.9 %. The mean reduction rates according to the 1/4-4/4 breast volumes were 74.7, 61.1, 38, and 24 %, indicating that the lower the breast volume, the smaller the size of the cropped data set. The total image data set size was reduced from 87 to 36.7 GB, or a 57.7 % reduction. The overall image quality and the reader's preference for the cropped images were higher than those of the uncropped images. FFDM mammography data storage requirements can be significantly reduced using a crop tool.

National program of breast cancer early detection in Brod-Posavina County (East Croatia).

PubMed

Jurišić, Irena; Kolovrat, Ana; Mitrečić, Drago; Cvitković, Ante

2014-09-01

Results of the National Program of Breast Cancer Early Detection in Brod-Posavina County during the 2006-2012 period are presented. Response rate in two National Program cycles, cancers detected according to factors such as first and last menstruation, age at cancer detection, deliveries and mammography findings according to the Breast Imaging Reporting and Data System (BI-RADS) before diagnosis verification were analyzed. Data were obtained from the software connecting Public Health Institutes via Ministry of Health server and questionnaires filled out by the women presenting for screening and processed by the method of descriptive statistics. Mammography findings were classified according to the BI-RADS classification. In two National Program cycles during the 2006-2012 period, women aged 50-69 were called for mammography screening. In the first cycle, the response rate in Brod-Posavina County was 53.2%, with 71 cancers detected at a mean age of 61.3 years. In the second cycle, the response rate was 57.0%, with 44 cancers detected at a mean age of 62.5 years. In the first and second cycles, there were 21.1% and 14.3% of mammography findings requiring additional work-up (BI-RADS 0), respectively. Particular risk factors such as early menarche, late menopause, parity, positive family history and presence of benign breast lesions were not demonstrated in women with verified cancer. There was no increase in the incidence of breast cancer per 100,000 inhabitants in the Brod-Posavina County following implementation of the National Program. In conclusion, efforts should be focused on increasing public health awareness, ensuring appropriate professional staff engaged in screening, and improving medical care in order to reduce the time elapsed from establishing suspicion to confirming the diagnosis of breast cancer.

Perspectives of Mobile Versus Fixed Mammography in Santa Clara County, California: A Focus Group Study.

PubMed

Chen, Yi-Ren; Chang-Halpenny, Christine; Kumarasamy, Narmadan A; Venegas, Angela; Braddock Iii, Clarence H

2016-02-12

Our aim was to examine underserved women's perceptions on mobile versus fixed mammography in Santa Clara, California through a focus group study.  Research has shown that medically underserved women have higher breast cancer mortality rates correlated with under-screening and a disproportional rate of late-stage diagnosis. The Community Health Partnership in Santa Clara County, California runs the Community Mammography Access Project (CMAP) that targets nearly 20,000 medically underserved women over the age of 40 in the county through the collaborative effort of an existing safety net of healthcare providers. However, little data exists on the advantages or disadvantages of mobile mammography units from the patient perspective.   We assessed underserved women's perspectives on mammography services in Santa Clara County through two focus groups from women screened at mobile or fixed site programs. Patients were recruited from both CMAP clinics and a county hospital, and focus group data were analyzed using content analysis.  We found that women from both the mobile and fixed sites shared similar motivating factors for getting a mammogram. Both groups recognized that screening was uncomfortable but necessary for good health and had positive feedback about their personal physicians. However, mobile participants, in particular, appreciated the atmosphere of mobile screening, reported shorter wait times, and remarked on the good communication from the clinic staff and empathetic treatment they received. However, mobile participants also expressed concern about the quality of films at mobile sites due to delayed initial reading of the films.   Mobile mammography offers a unique opportunity for women of underserved populations to access high satisfaction screenings, and it encourages a model similar to CMAP in other underserved areas. However, emphasis should be placed on providing a warm and welcoming environment for patients and ensuring the quality of mammography images.

Community Partnerships, Food Pantries, and an Evidence-Based Intervention to Increase Mammography among Rural Women

ERIC Educational Resources Information Center

Bencivenga, Marcyann; DeRubis, Susan; Leach, Patricia; Lotito, Lisa; Shoemaker, Charles; Lengerich, Eugene J.

2008-01-01

Context: Multiple national agencies and organizations recommend that women age 40 years and older have an annual screening mammogram. Women who are poor, less educated, lack a usual source of care, and reside in rural Appalachia are less likely to have had a recent mammogram. Purpose: To increase use of mammography among a rural Appalachian…

Early detection of breast cancer in Brazil: data from the National Health Survey, 2013

PubMed Central

Silva, Gulnar Azevedo e; de Souza-Júnior, Paulo Roberto Borges; Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann

2017-01-01

ABSTRACT OBJECTIVE To analyze whether the actions of early detection of breast cancer, initiated with the medical request for mammography, differ between users of the Brazilian Unified Health System (SUS) and those who have private health insurance. METHODS From the data collected in the National Health Survey, we estimated the proportions of women who had medical request for mammography according to presence or absence of private health insurance. For assessing the factors related to having mammography medical request, we estimated crude and adjusted odds ratios and respective 95%CI by logistic regression. We also analyzed the main reasons reported for not having performed mammography after medical request, as well as the time between examination and result. RESULTS Of the women interviewed, 66.7% had a medical request for mammography (59.4% among SUS users and 83.9% among those with private health insurance). Having private health insurance, higher education level, and being white were positively associated with having the medical request. Only 5.4% (95%CI 4.8–6.0) of women who received medical request failed to perform mammography – 7.6% were SUS users and 1.7% had health insurance. The most reported reasons for not being able to perform the examination were: not thinking it was necessary; having the test scheduled, but not yet performed; and not being able to schedule it. More than 70% of women received the result with less than one month from its execution. CONCLUSIONS The barriers to access a medical request for mammographic screening for breast cancer are higher among women who depend exclusively on SUS. PMID:28591356

Mammography in females with an implanted medical device: impact on image quality, pain and anxiety.

PubMed

Paap, Ellen; Witjes, Marloes; van Landsveld-Verhoeven, Cary; Pijnappel, Ruud M; Maas, Angela H E M; Broeders, Mireille J M

2016-10-01

To assess the image quality of mammograms in females with an implanted medical device (IMD), to evaluate pain and anxiety during mammography in these females and to investigate the experience of radiographers. Image quality was evaluated by two radiographers and one radiologist in the images of females with an IMD participating in the Dutch screening programme (clients). Pain and anxiety were scored using a Numeric Rating Scale in both clients visiting a screening organization and patients from the Isala Hospital, Zwolle. Experience of screening radiographers was collected with a questionnaire. Images of the breast with IMD showed reduced contrast in craniocaudal (CC) and mediolateral-oblique (MLO) views [by both the radiographers and radiologist (range: 11-29%)], less projected breast tissue [only radiographers; CC lateral side: 25.5%, 95% confidence interval (CI): 18.7-32.2] and reduced projection of the pectoral muscle (only radiographers; MLO width pectoral muscle: 31.5%, 95% CI: 24.4-38.7). Clients experienced more pain and anxiety during mammography in the breast with IMD compared to the breast without IMD in the breast (pain difference CC: 0.48 ± 0.16, p = 0.003; pain difference MLO: 0.46 ± 0.16, p = 0.004; anxiety difference 1.30 ± 0.22; p < 0.001). Patients experienced more pain (1.05 ± 0.12; p < 0.001) and anxiety (1.22 ± 0.15; p < 0.001) after placement of IMD. Radiographers are more cautious, more anxious and use less compression during mammography of breasts with IMD. Image quality in a breast with an IMD could be improved by projecting more breast tissue on the mammogram, thereby including (part of) the IMD between the paddles, if required. In addition, radiographers should pay sufficient attention to reducing discomfort both before and during the screening examination. Little is known about the quality of mammography in females with an IMD or how these females and radiographers experience the screening examination. The results of our study showed that having an IMD could result in a suboptimal mammogram and increased discomfort.

Construction of mammographic examination process ontology using bottom-up hierarchical task analysis.

PubMed

Yagahara, Ayako; Yokooka, Yuki; Jiang, Guoqian; Tsuji, Shintarou; Fukuda, Akihisa; Nishimoto, Naoki; Kurowarabi, Kunio; Ogasawara, Katsuhiko

2018-03-01

Describing complex mammography examination processes is important for improving the quality of mammograms. It is often difficult for experienced radiologic technologists to explain the process because their techniques depend on their experience and intuition. In our previous study, we analyzed the process using a new bottom-up hierarchical task analysis and identified key components of the process. Leveraging the results of the previous study, the purpose of this study was to construct a mammographic examination process ontology to formally describe the relationships between the process and image evaluation criteria to improve the quality of mammograms. First, we identified and created root classes: task, plan, and clinical image evaluation (CIE). Second, we described an "is-a" relation referring to the result of the previous study and the structure of the CIE. Third, the procedural steps in the ontology were described using the new properties: "isPerformedBefore," "isPerformedAfter," and "isPerformedAfterIfNecessary." Finally, the relationships between tasks and CIEs were described using the "isAffectedBy" property to represent the influence of the process on image quality. In total, there were 219 classes in the ontology. By introducing new properties related to the process flow, a sophisticated mammography examination process could be visualized. In relationships between tasks and CIEs, it became clear that the tasks affecting the evaluation criteria related to positioning were greater in number than those for image quality. We developed a mammographic examination process ontology that makes knowledge explicit for a comprehensive mammography process. Our research will support education and help promote knowledge sharing about mammography examination expertise.

Baptist Memorial Hospital for Women: quality lifelines for a lifetime.

PubMed

Beard, Cindy; Lilly, Kristen; Poynter, Joni; Thetford, Carol; Thompson, Rosalee; Vaughn, Anita

2006-10-01

At Baptist Women's, a not-for-profit, 140-bed free-standing hospital, the Institute of Medicine's six quality dimensions are embedded into the quality blueprint and strategic plan. Quality initiatives and dashboards are shared through an established shared drive, which is accessible for all employees, to track performance on identified dashboards. IMPROVING MAMMOGRAPHY CYCLE TIME AT THE WOMEN'S HEALTH CENTER: Cycle time (arrival to departure) for mammography was identified as the top improvement priority. Increasing the percentage of patients who had preregistered reduced admission time, and process changes were made to move the patient through the center more efficiently. For example, patients with orders for additional films were flagged to ensure that these exams were completed before a new patient's exam. The ultrasound schedule was blocked during peak times to ensure that add-on exams could be performed in a timely manner. The cycle time was reduced for screening mammography (from 2 hours in 2003 to 30 minutes in April 2006) and diagnostic screenings, including review of films and reports with radiologist at departure, decreased from > 3 hours in 2003 to 2.5 hours in April 2006. Expectations of teamwork, proactive problem resolution, communication on all levels, and customer service are the cornerstone of Baptist Women's culture of quality.

Ultrasound as an Adjunct to Mammography for Breast Cancer Screening: A Health Technology Assessment

PubMed Central

Nikitovic-Jokic, Milica; Tu, Hong Anh; Palimaka, Stefan; Higgins, Caroline; Holubowich, Corinne

2016-01-01

Background Screening with mammography can detect breast cancer early, before clinical symptoms appear. Some cancers, however, are not captured with mammography screening alone. Ultrasound has been suggested as a safe adjunct screening tool that can detect breast cancers missed on mammography. We investigated the benefits, harms, cost-effectiveness, and cost burden of ultrasound as an adjunct to mammography compared with mammography alone for screening women at average risk and at high risk for breast cancer. Methods We searched Ovid MEDLINE, Ovid Embase, EBM Reviews, and the NHS Economic Evaluation Database, from January 1998 to June 2015, for evidence of effectiveness, harms, diagnostic accuracy, and cost-effectiveness. Only studies evaluating the use of ultrasound as an adjunct to mammography in the specified populations were included. We also conducted a cost analysis to estimate the costs in Ontario over the next 5 years to fund ultrasound as an adjunct to mammography in breast cancer screening for high-risk women who are contraindicated for MRI, the current standard of care to supplement mammography. Results No studies in average-risk women met the inclusion criteria of the clinical review. We included 5 prospective, paired cohort studies in high-risk women, 4 of which were relevant to the Ontario context. Adjunct ultrasound identified between 2.3 and 5.9 additional breast cancers per 1,000 screens. The average pooled sensitivity of mammography and ultrasound was 53%, a statistically significant increase relative to mammography alone (absolute increase 13%; P < .05). The average pooled specificity of the combined test was 96%, an absolute increase in the false-positive rate of 2% relative to mammography screening alone. The GRADE for this body of evidence was low. Additional annual costs of using breast ultrasound as an adjunct to mammography for high-risk women in Ontario contraindicated for MRI would range from $15,500 to $30,250 in the next 5 years. Conclusions We found no evidence that evaluated the comparative effectiveness or diagnostic accuracy of screening breast ultrasound as an adjunct to mammography among average-risk women aged 50 years and over. In women at high risk of developing breast cancer, there is low-quality evidence that screening with mammography and adjunct ultrasound detects additional cases of disease, with improved sensitivity compared to mammography alone. Screening with adjunct ultrasound also increases the number of false-positive findings and subsequent biopsy recommendations. It is unclear if the use of screening breast ultrasound as an adjunct to mammography will reduce breast cancer–related mortality among high-risk women. The annual cost burden of using adjunct ultrasound to screen high-risk women who cannot receive MRI in Ontario would be small. PMID:27468326

The evaluation of a clinical thermometer for measuring developer temperature in automatic film processors.

PubMed

Wilson, W B; Haus, A G; Nierman, C; Lillie, R; Batz, T; Moore, R

1993-01-01

In medical imaging, the temperature of the developer solution in the film processor affects film speed (radiation dose), film contrast, and film base plus fog. The National Council on Radiation Protection and Measurement (NCRP) Report 99 on Quality Assurance, and the American College of Radiology (ACR) Mammography Quality Control Manual for Radiologic Technologists, indicate that the developer temperature should be within +/- 0.5 degree F (+/- 0.3 degree C) of that recommended by the manufacturer for the specific film/developer combination being used. The accuracy and repeatability of the thermometer is most important. This paper describes the requirements of a thermometer for measuring the temperature of the developer solution and suggests an inexpensive but accurate device for doing so.

Initial Image Quality and Clinical Experience with New CR Digital Mammography System: A Phantom and Clinical Study

NASA Astrophysics Data System (ADS)

Gaona, Enrique; Alfonso, Beatriz Y. Álvarez; Castellanos, Gustavo Casian; Enríquez, Jesús Gabriel Franco

2008-08-01

The goal of the study was to evaluate the first CR digital mammography system (® Konica-Minolta) in Mexico in clinical routine for cancer detection in a screening population and to determine if high resolution CR digital imaging is equivalent to state-of-the-art screen-film imaging. The mammograms were evaluated by two observers with cytological or histological confirmation for BIRADS 3, 4 and 5. Contrast, exposure and artifacts of the images were evaluated. Different details like skin, retromamillary space and parenchymal structures were judged. The detectability of microcalcifications and lesions were compared and correlated to histology. The difference in sensitivity of CR Mammography (CRM) and Screen Film Mammography (SFM) was not statistically significant. However, CRM had a significantly lower recall rate, and the lesion detection was equal or superior to conventional images. There is no significant difference in the number of microcalcifications and highly suspicious calcifications were equally detected on both film-screen and digital images. Different anatomical regions were better detectable in digital than in conventional mammography.

Initial Image Quality and Clinical Experience with New CR Digital Mammography System: A Phantom and Clinical Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gaona, Enrique; Enriquez, Jesus Gabriel Franco; Alfonso, Beatriz Y. Alvarez

2008-08-11

The goal of the study was to evaluate the first CR digital mammography system ( registered Konica-Minolta) in Mexico in clinical routine for cancer detection in a screening population and to determine if high resolution CR digital imaging is equivalent to state-of-the-art screen-film imaging. The mammograms were evaluated by two observers with cytological or histological confirmation for BIRADS 3, 4 and 5. Contrast, exposure and artifacts of the images were evaluated. Different details like skin, retromamillary space and parenchymal structures were judged. The detectability of microcalcifications and lesions were compared and correlated to histology. The difference in sensitivity of CRmore » Mammography (CRM) and Screen Film Mammography (SFM) was not statistically significant. However, CRM had a significantly lower recall rate, and the lesion detection was equal or superior to conventional images. There is no significant difference in the number of microcalcifications and highly suspicious calcifications were equally detected on both film-screen and digital images. Different anatomical regions were better detectable in digital than in conventional mammography.« less

Participation rate or informed choice? Rethinking the European key performance indicators for mammography screening.

PubMed

Strech, Daniel

2014-03-01

Despite the intensive controversies about the likelihood of benefits and harms of mammography screening almost all experts conclude that the choice to screen or not to screen needs to be made by the individual patient who is adequately informed. However, the "European guideline for quality assurance in breast cancer screening and diagnosis" specifies a participation rate of 70% as the key performance indicator for mammography screening. This paper argues that neither the existing evidence on benefits and harms, nor survey research with women, nor compliance rates in clinical trials, nor cost-effectiveness ratios justify participation rates as a reasonable performance indicator for preference-sensitive condition such as mammography screening. In contrast, an informed choice rate would be more reasonable. Further research needs to address the practical challenges in assessing informed choice rates. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Radiation protection program for early detection of breast cancer in a mammography facility

NASA Astrophysics Data System (ADS)

Villagomez Casimiro, Mariana; Ruiz Trejo, Cesar; Espejo Fonseca, Ruby

2014-11-01

Mammography is the best tool for early detection of Breast Cancer. In this diagnostic radiology modality it is necessary to establish the criteria to ensure the proper use and operation of the equipment used to obtain mammographic images in order to contribute to the safe use of ionizing radiation. The aim of the work was to implement at FUCAM-AC the radiation protection program which must be established for patients and radiation workers according to Mexican standards [1-4]. To achieve this goal, radiation protection and quality control manuals were elaborated [5]. Furthermore, a quality control program (QCP) in the mammography systems (analog/digital), darkroom included, has been implemented. Daily sensitometry, non-variability of the image quality, visualizing artifacts, revision of the equipment mechanical stability, compression force and analysis of repetition studies are some of the QCP routine tests that must be performed by radiological technicians of this institution as a set of actions to ensure the protection of patients. Image quality and patients dose assessment were performed on 4 analog equipment installed in 2 mobile units. In relation to dose assessment, all equipment passed the acceptance criteria (<3 mGy per projection). The image quality test showed that most images (70%)- presented artifacts. A brief summary of the results of quality control tests applied to the equipment and film processor are presented. To maintain an adequate level of quality and safety at FUCAM-AC is necessary that the proposed radiation protection program in this work is applied.

Response costs of mammography adherence: Iranian women's perceptions.

PubMed

Khodayarian, Mahsa; Mazloomi-Mahmoodabad, Seyed Saied; Lamyian, Minoor; Morowatisharifabad, Mohammad Ali; Tavangar, Hossein

2016-01-01

Mammography as the most common secondary prevention method has known to be helpful in detecting breast cancer at the early stages. Low level of participation among women toward mammography uptake due to cultural beliefs is a great concern. This study aimed at exploring the perceptions of women about response costs of mammography adherence (MA) in Yazd, Iran. A qualitative study using semi-structured interviews was performed. Fourteen women,one oncology nurse, and a breast cancer survivor were purposefully interviewed. Interviews were transcribed verbatim and analyzed by directed content analysis method based on protection motivation theory (PMT). One main theme was emerged from the analysis namely called "response costs".Two main categories were also emerged from the data; (1) psychological barriers with six subcategories including "embarrassment," "worry about being diagnosed with cancer," "preoccupation with underlying disease," "misconception about mammography," "need for an accompanying person," and "internalizing the experiences of the others," and (2) maladaptive coping modes which encompassed three subcategories: "religious faith," "fatalism," and"avoidance and denial." Useful information was provided about the response costs of mammography utilization based on the perceptions of women. Cognitive barriers may be decreased by conducting modifications in women's awareness and attitude toward MA as well as changing the national health system infrastructures. Incorporating religious and cultural belief systems into MA educational programs through motivational messages is recommended.

Effect of exposure factors on image quality in screening mammography.

PubMed

Alkhalifah, K; Brindabhan, A; Alsaeed, R

2017-11-01

The aim of this research was to study the effect of exposure factors on image quality for digital screening mammography units in Kuwait which use Tungsten (W) targets with Rhodium (Rh) and Silver (Ag) as filters. Mammography Accreditation Phantom Model 015 was imaged using a Hologic Selenia Digital mammography unit with W targets and Rh and Ag filters. Four images, each at 26, 28, 30, and 32 kVp, were obtained using each target-filter combination (W/Rh and W/Ag). The images were evaluated by five senior technologists for the number of specks, fibers and masses visible on each image. Statistical analysis was carried out using non-parametric tests at p = 0.05 level. There were significant changes in the visibility of fibers and specks between different kVp values with W/Rh (p < 0.001). However, with W/Ag combination, significant differences were observed in the fibers only (p < 0.001). Among the kVp values used, 28 kV emerged as the optimal value. Comparison of images obtained with the two filter materials, led to significant differences in the visibility of fibers and specks (p < 0.008). At 32 kVp, there were significant differences in the visibility of specks only (p < 0.008). A W/Rh target-filter combination provides better image quality than that provided by W/Ag. In particular, 30 and 32 kVp X-ray beams produce higher quality images than the lower kV values. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Mammography screening in six diverse communities in Chicago--a population study.

PubMed

Whitman, Steve; Shah, Ami M; Silva, Abigail; Ansell, David

2007-01-01

Despite the fact that recent studies suggest a narrowing in access to mammography, Black women are much more likely to die from breast cancer than White women. Data at the community level regarding mammography screening can help explain health disparities and inform plans for improved screening efforts. In 2002-2003, a comprehensive household health survey in English or Spanish was conducted in six community areas with 1700 households. The module on mammography was based on a state-based nationwide health survey and included questions on frequency of mammography, repeat screenings, and several demographic variables. The proportion of women >or=40 years (n=482) who received a mammogram in the past 2 years ranged from 74% to 90% across the six communities. The community with the highest screening proportion was predominantly Mexican and included recent immigrants. The screening proportion in the poorest community area, which was all Black, was 77%. Women with health insurance, higher income, and more education were more likely to receive a mammogram. Proportions for women >or=50 years (n=286) were slightly higher but similar. Repeat screening, which is recommended, occurred at lower levels. Access to and utilization of mammography have grown in recent years so that even these vulnerable communities had screening proportions at or even higher than the national average and the Healthy People Year 2010 objective. Nonetheless, repeat screening sequences were lower and may require attention if mammography screening efforts are to have a greater impact on female breast cancer mortality.

Research in action: mammography utilization following breast cancer awareness campaigns in Lebanon 2002-05.

PubMed

Adib, S M; Sabbah, M A; Hlais, S; Hanna, P

2009-01-01

Four consecutive annual surveys of 1200 women each were conducted in Lebanon in connection with the National Breast Cancer Awareness campaigns (2002-05) to measure the prevalence of mammography utilization and the impact of these campaigns, and to highlight regional and demographic differences. The utilization of mammography in the previous 12 months was low and increased only slightly over 4 years (from 11% to 18%). In the 2005 campaign, it was twice as high (25%) in greater Beirut than in mostly rural areas, and among women aged 40-59 years (about 21%) compared with younger (12%) or older (11%) women. In each wave, repeat mammograms were less common than first time screening.

Breast compression in mammography: how much is enough?

PubMed

Poulos, Ann; McLean, Donald; Rickard, Mary; Heard, Robert

2003-06-01

The amount of breast compression that is applied during mammography potentially influences image quality and the discomfort experienced. The aim of this study was to determine the relationship between applied compression force, breast thickness, reported discomfort and image quality. Participants were women attending routine breast screening by mammography at BreastScreen New South Wales Central and Eastern Sydney. During the mammographic procedure, an 'extra' craniocaudal (CC) film was taken at a reduced level of compression ranging from 10 to 30 Newtons. Breast thickness measurements were recorded for both the normal and the extra CC film. Details of discomfort experienced, cup size, menstrual status, existing breast pain and breast problems were also recorded. Radiologists were asked to compare the image quality of the normal and manipulated film. The results indicated that 24% of women did not experience a difference in thickness when the compression was reduced. This is an important new finding because the aim of breast compression is to reduce breast thickness. If breast thickness is not reduced when compression force is applied then discomfort is increased with no benefit in image quality. This has implications for mammographic practice when determining how much breast compression is sufficient. Radiologists found a decrease in contrast resolution within the fatty area of the breast between the normal and the extra CC film, confirming a decrease in image quality due to insufficient applied compression force.

Results of a 2011 national questionnaire for investigation of mean glandular dose from mammography in Japan.

PubMed

Asada, Y; Suzuki, S; Minami, K; Shirakawa, S

2014-03-01

Diagnostic reference levels (DRLs) for mammography have yet to be created in Japan. A national questionnaire investigation into radiographic conditions in Japan was carried out for the purpose of creating DRLs. Items investigated included the following: tube voltage; tube current; current-time product; source-image distance; craniocaudal view; automatic exposure control (AEC) settings; name of mammography unit; image receptor system (computed radiography (CR), flat panel detector (FPD), or film/screen (F/S)); and supported or unsupported monitor diagnosis (including monitor resolution). Estimation of the mean glandular dose (MGD) for mammography was performed and compared with previous investigations. The MGD was 1.58(0.48) mGy, which did not significantly differ from a 2007 investigation. In relation to image receptors, although no difference in average MGD values was observed between CR and FPD systems, F/S systems had a significantly decreased value compared to both CR and FPDs. Concerning digital systems (FPDs), the MGD value of the direct conversion system was significantly higher than the indirect conversion system. No significant difference in MGD value was evident concerning type of monitor diagnosis for either the CR or the FPD digital systems; however, hard copies were used more often in CR. No significant difference in the MGD value was found in relation to monitor resolution. This report suggests ways to lower the doses patients undergoing mammography receive in Japan, and serves as reference data for 4.2 cm compressed breast tissue of 50% composition DRLs. Furthermore, our findings suggest that further optimisation of FPD settings can promote a reduction in the MGD value.

Experience with a proposed teleradiology system for digital mammography

NASA Astrophysics Data System (ADS)

Saulnier, Emilie T.; Mitchell, Robert J.; Abdel-Malek, Aiman A.; Dudding, Kathryn E.

1995-05-01

Teleradiology offers significant improvement in efficiency and effectiveness over current practices in traditional film/screen-based diagnosis. In the context of digital mammography, the increasing number of women who need to be screened for breast cancer, including those in remote rural regions, make the advantages of teleradiology especially attractive for digital mammography. At the same time, the size and resolution of digital mammograms are among the most challenging to support in a cost effective teleradiology system. This paper describes a teleradiology architecture developed for use with digital mammography by GE Corporate Research and Development in collaboration with Massachusetts General Hospital under National Cancer Institute (NCI/NIH) grant number R01 CA60246-01. Experience with a testbed prototype is described. The telemammography architecture is intended to consist of a main mammography diagnostic site serving several remote screening sites. As patient exams become available, they are forwarded by an image server to the diagnostic site over a WAN communications link. A radiologist at the diagnostic site views a patient exam as it arrives, interprets it, and then relays a report back to the technician at the remote site. A secondary future scenario consists of mobile units which forward images to a remote site, which then forwards them to the main diagnostic site. The testbed architecture is based on the Digital Imaging and Communications in Medicine (DICOM) standard, created by the American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA). A specification of vendor-independent data formats and data transfer services for digital medical images, DICOM specifies a protocol suite starting at the application layer downward, including the TCP/IP layers. The current DICOM definition does not provide an information element that is specifically tailored to mammography, so we have used the DICOM secondary capture data format for the mammography images. In conclusion, experience with the testbed is described, as is performance analysis related to selection of network components needed to extend this architecture to clinical evaluation. Recommendations are made as to the critical areas for future work.

MRI and mammography surveillance of women at increased risk for breast cancer: recommendations using an evidence-based approach.

PubMed

Granader, Elon J; Dwamena, Ben; Carlos, Ruth C

2008-12-01

To evaluate breast cancer screening with mammography and magnetic resonance imaging (MRI) in high-risk populations, including women with the BRCA mutation, using an evidence-based approach. The MEDLINE, PubMed, EBM Reviews, ACP Journal Club, Cochrane Database MEDSEARCH, and SCOPUS databases were accessed and searched for articles up to August 2007. Articles were collected using the following terms and medical subject headings (MeSH) that applied to the focused clinical question: "BRCA1" and "BRCA2" with "mammography," "MRI," "prevention," "screening," and "surveillance." References from retrieved articles were also used to identify relevant papers. Abstracts were screened and relevant papers retrieved. Retrieved papers were graded for quality. Summary performance measures were obtained by random effects modeling of study-specific performance estimates and standard errors derived from the multiple 2 x 2 tables. Additionally, studies meeting the Centre for Evidence-Based Medicine level 2b quality were reviewed. In women with an increased risk without the BRCA gene, cancer detection rates by MRI were 0.011 (95% confidence interval [CI] 0.003-0.019), by mammography 0.005 (95% CI 0.002-0.008), and by a combination of both, 0.012 (95% CI 0.004-0.020). False-positive rates by MRI, mammography, or a combination of both were 0.10 (95% CI 0.03-0.18), 0.05 (95% CI 0.03-0.06), and 0.14 (95% CI 0.04-0.24). In BRCA positive women, cancer detection rates by MRI were 0.027 (95% CI 0.015-0.040), by mammography 0.010 (95% CI 0.005-0.016), and by a combination of both 0.031 (95% CI 0.018-0.045). False-positive rates by MRI, mammography, or a combination of both were 0.10 (95% CI 0.01-0.19), 0.05 (95% CI 0.03-0.07), and 0.14 (95% CI 0.04-0.24), respectively. The data support an essential role for screening MRI in women with an increased risk for breast cancer.

Harms of Breast Cancer Screening: Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation.

PubMed

Nelson, Heidi D; Pappas, Miranda; Cantor, Amy; Griffin, Jessica; Daeges, Monica; Humphrey, Linda

2016-02-16

In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years. To review studies of screening in average-risk women with mammography, magnetic resonance imaging, or ultrasonography that reported on false-positive results, overdiagnosis, anxiety, pain, and radiation exposure. MEDLINE and Cochrane databases through December 2014. English-language systematic reviews, randomized trials, and observational studies of screening. Investigators extracted and confirmed data from studies and dual-rated study quality. Discrepancies were resolved through consensus. Based on 2 studies of U.S. data, 10-year cumulative rates of false-positive mammography results and biopsies were higher with annual than biennial screening (61% vs. 42% and 7% vs. 5%, respectively) and for women aged 40 to 49 years, those with dense breasts, and those using combination hormone therapy. Twenty-nine studies using different methods reported overdiagnosis rates of 0% to 54%; rates from randomized trials were 11% to 22%. Women with false-positive results reported more anxiety, distress, and breast cancer-specific worry, although results varied across 80 observational studies. Thirty-nine observational studies indicated that some women reported pain during mammography (1% to 77%); of these, 11% to 46% declined future screening. Models estimated 2 to 11 screening-related deaths from radiation-induced cancer per 100,000 women using digital mammography, depending on age and screening interval. Five observational studies of tomosynthesis and mammography indicated increased biopsies but reduced recalls compared with mammography alone. Studies of overdiagnosis were highly heterogeneous, and estimates varied depending on the analytic approach. Studies of anxiety and pain used different outcome measures. Radiation exposure was based on models. False-positive results are common and are higher for annual screening, younger women, and women with dense breasts. Although overdiagnosis, anxiety, pain, and radiation exposure may cause harm, their effects on individual women are difficult to estimate and vary widely. Agency for Healthcare Research and Quality.

Screening mammography among nursing home residents in the United States: Current guidelines and practice.

PubMed

Mack, Deborah S; Epstein, Mara M; Dubé, Catherine; Clark, Robin E; Lapane, Kate L

2018-06-04

United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening. Copyright © 2018 Elsevier Inc. All rights reserved.

Screening Mammography and Digital Breast Tomosynthesis: Utilization Updates.

PubMed

Boroumand, Gilda; Teberian, Ida; Parker, Laurence; Rao, Vijay M; Levin, David C

2018-05-01

There have been many recent developments in breast imaging, including the 2009 revision of the U.S. Preventive Services Task Force's breast cancer screening guidelines and the approval of digital breast tomosynthesis (DBT) for clinical use in 2011. The objective of this study is to evaluate screening mammography utilization trends among the Medicare population from 2005 to 2015 and examine the volume of DBT studies performed in 2015, the first year for which procedural billing codes for DBT are available. We reviewed national Medicare Part B Physician/Supplier Procedure Summary master files from 2005 to 2015, to determine the annual utilization rate of screening mammography on the basis of procedure codes used for film-screen and digital screening mammography. We also used the Physician/Supplier Procedure Summary master files to determine the volume of screening and diagnostic DBT studies performed in 2015. The utilization rate of screening mammography per 1000 women in the Medicare fee-for-service population increased gradually every year, from 311.5 examinations in 2005 to a peak of 322.9 examinations in 2009, representing a compound annual growth rate of 0.9%. In 2010, the utilization rate abruptly decreased by 4.3% to 309.2 examinations, and it has not since recovered to pre-2010 levels. In 2015, 18.9% of screening and 16.2% of diagnostic digital mammography examinations included DBT as an add-on procedure. In contrast to the annual increase in screening mammography utilization from 2005 to 2009, an abrupt sustained decline in screening occurred beginning in 2010, coinciding with the release of U.S. Preventive Services Task Force recommendations. DBT utilization was somewhat limited in 2015, occurring in conjunction with less than 20% of digital mammography examinations.

Transition From Film to Digital Mammography

PubMed Central

van Ravesteyn, Nicolien T.; van Lier, Lisanne; Schechter, Clyde B.; Ekwueme, Donatus U.; Royalty, Janet; Miller, Jacqueline W.; Near, Aimee M.; Cronin, Kathleen A.; Heijnsdijk, Eveline A.M.; Mandelblatt, Jeanne S.; de Koning, Harry J.

2015-01-01

Introduction The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides mammograms and diagnostic services for low-income, uninsured women aged 40–64 years. Mammography facilities within the NBCCEDP gradually shifted from plain-film to digital mammography. The purpose of this study is to assess the impact of replacing film with digital mammography on health effects (deaths averted, life-years gained [LYG]), costs (for screening and diagnostics), and number of women reached. Methods NBCCEDP 2010 data and data representative of the program’s target population were used in two established microsimulation models. Models simulated observed screening behavior including different screening intervals (annual, biennial, irregular) and starting ages (40, 50 years) for white, black, and Hispanic women. Model runs were performed in 2012. Results The models predicted 8.0–8.3 LYG per 1,000 film screens for black women, 5.9–7.5 for white women, and 4.0–4.5 for Hispanic women. For all race/ethnicity groups, digital mammography had more LYG than film mammography (2%–4%), but had higher costs (34%–35%). Assuming a fixed budget, 25%–26% fewer women could be served, resulting in 22%–24% fewer LYG if all mammograms were converted to digital. The loss in LYG could be reversed to an 8%–13% increase by only including biennial screening. Conclusions Digital could result in slightly more LYG than film mammography. However, with a fixed budget, fewer women may be served with fewer LYG. Changes in the program, such as only including biennial screening, will increase LYG/screen and could offset the potential decrease in LYG when shifting to digital mammography. PMID:25891052

Conflicting national recommendations and the use of screening mammography: does the physician's recommendation matter?

PubMed

Taplin, S H; Urban, N; Taylor, V M; Savarino, J

1997-01-01

This study evaluated whether women's perceptions of the conflicting recommendations for breast cancer screening were associated with decreased use of mammography. We conducted a random-digit-dial telephone survey of 1024 women in four communities of western Washington State. In addition to collecting data for demographics, beliefs about mammography, and insurance coverage, we inquired whether the respondents were aware of any conflicting recommendations about when to begin or how frequently to perform screening mammography, whether their physicians had recommended a mammogram, and whether they were likely to do what their physicians recommended. After grouping women according to whether they perceived conflicting recommendations, we used chi-square statistics to compare the distribution of proportions of women by age, race, household income, education, and insurance coverage. To estimate the odds of their having a mammogram in the previous 2 years (yes or no), we used multivariate logistic regression and included the above variables as covariates. Sixty-two percent of eligible women completed the survey, and 49 percent (479 of 985) perceived conflicting recommendations. The association between perceiving conflict and mammography use was not significant. Eighty-three percent of women who perceived conflicting recommendations reported being more comfortable using their own judgment about getting the procedure. After controlling for whether women perceived conflicting recommendations and all other factors, women who said they followed their physician's advice but did not recall their physician recommending mammography were 71 percent less likely to have received a recent mammogram than were women who reported their physician did recommend it (odds ratio 0.29, confidence interval 0.16-0.51). The conflicting recommendations surrounding breast cancer screening are not influencing women's choices about mammography. The physician recommendation and women's self-reported likeliness to follow it are the most important factors associated with mammography use.

Analyser-based mammography using single-image reconstruction.

PubMed

Briedis, Dahliyani; Siu, Karen K W; Paganin, David M; Pavlov, Konstantin M; Lewis, Rob A

2005-08-07

We implement an algorithm that is able to decode a single analyser-based x-ray phase-contrast image of a sample, converting it into an equivalent conventional absorption-contrast radiograph. The algorithm assumes the projection approximation for x-ray propagation in a single-material object embedded in a substrate of approximately uniform thickness. Unlike the phase-contrast images, which have both directional bias and a bias towards edges present in the sample, the reconstructed images are directly interpretable in terms of the projected absorption coefficient of the sample. The technique was applied to a Leeds TOR[MAM] phantom, which is designed to test mammogram quality by the inclusion of simulated microcalcifications, filaments and circular discs. This phantom was imaged at varying doses using three modalities: analyser-based synchrotron phase-contrast images converted to equivalent absorption radiographs using our algorithm, slot-scanned synchrotron imaging and imaging using a conventional mammography unit. Features in the resulting images were then assigned a quality score by volunteers. The single-image reconstruction method achieved higher scores at equivalent and lower doses than the conventional mammography images, but no improvement of visualization of the simulated microcalcifications, and some degradation in image quality at reduced doses for filament features.

An Exploration of Changes in the Measurement of Mammography in the National Health Interview Survey.

PubMed

Gonzales, Felisa A; Willis, Gordon B; Breen, Nancy; Yan, Ting; Cronin, Kathy A; Taplin, Stephen H; Yu, Mandi

2017-11-01

Background: Using the National Health Interview Survey (NHIS), we examined the effect of question wording on estimates of past-year mammography among racially/ethnically diverse women ages 40-49 and 50-74 without a history of breast cancer. Methods: Data from one-part ("Have you had a mammogram during the past 12 months?") and two-part ("Have you ever had a mammogram"; "When did you have your most recent mammogram?") mammography history questions administered in the 2008, 2011, and 2013 NHIS were analyzed. χ 2 tests provided estimates of changes in mammography when question wording was either the same (two-part question) or differed (two-part question followed by one-part question) in the two survey years compared. Crosstabulations and regression models assessed the type, extent, and correlates of inconsistent responses to the two questions in 2013. Results: Reports of past-year mammography were slightly higher in years when the one-part question was asked than when the two-part question was asked. Nearly 10% of women provided inconsistent responses to the two questions asked in 2013. Black women ages 50 to 74 [adjusted OR (aOR), 1.50; 95% confidence interval (CI), 1.16-1.93] and women ages 40-49 in poor health (aOR, 2.22; 95% CI, 1.09-4.52) had higher odds of inconsistent responses; women without a usual source of care had lower odds (40-49: aOR, 0.42; 95% CI, 0.21-0.85; 50-74: aOR, 0.42; 95% CI, 0.24-0.74). Conclusions: Self-reports of mammography are sensitive to question wording. Researchers should use equivalent questions that have been designed to minimize response biases such as telescoping and social desirability. Impact: Trend analyses relying on differently worded questions may be misleading and conceal disparities. Cancer Epidemiol Biomarkers Prev; 26(11); 1611-8. ©2017 AACR . ©2017 American Association for Cancer Research.

Clinical evaluation of a mobile digital specimen radiography system for intraoperative specimen verification.

PubMed

Wang, Yingbing; Ebuoma, Lilian; Saksena, Mansi; Liu, Bob; Specht, Michelle; Rafferty, Elizabeth

2014-08-01

Use of mobile digital specimen radiography systems expedites intraoperative verification of excised breast specimens. The purpose of this study was to evaluate the performance of a such a system for verifying targets. A retrospective review included 100 consecutive pairs of breast specimen radiographs. Specimens were imaged in the operating room with a mobile digital specimen radiography system and then with a conventional digital mammography system in the radiology department. Two expert reviewers independently scored each image for image quality on a 3-point scale and confidence in target visualization on a 5-point scale. A target was considered confidently verified only if both reviewers declared the target to be confidently detected. The 100 specimens contained a total of 174 targets, including 85 clips (49%), 53 calcifications (30%), 35 masses (20%), and one architectural distortion (1%). Although a significantly higher percentage of mobile digital specimen radiographs were considered poor quality by at least one reviewer (25%) compared with conventional digital mammograms (1%), 169 targets (97%), were confidently verified with mobile specimen radiography; 172 targets (98%) were verified with conventional digital mammography. Three faint masses were not confidently verified with mobile specimen radiography, and conventional digital mammography was needed for confirmation. One faint mass and one architectural distortion were not confidently verified with either method. Mobile digital specimen radiography allows high diagnostic confidence for verification of target excision in breast specimens across target types, despite lower image quality. Substituting this modality for conventional digital mammography can eliminate delays associated with specimen transport, potentially decreasing surgical duration and increasing operating room throughput.

Motivators and barriers to mammography screening uptake by female health-care workers in primary health-care centres: a cross-sectional study.

PubMed

Nazzal, Zaher; Sholi, Hisham; Sholi, Suha B; Sholi, Mohammad B; Lahaseh, Rawya

2018-02-21

Mammography screening is an effective tool for early detection and management of breast cancer. Female health-care workers' awareness of breast cancer screening is important because their beliefs and behaviours could influence other women. The aim of this study was to assess mammography screening uptake by female health-care workers at primary health-care centres and to identify the primary motivators and barriers that affect uptake. This cross-sectional study included all governmental primary health-care centres in the West Bank. Governorates were grouped into three regions as follows: north West Bank (Nablus, Jenin, Tulkarm, Tubas, Qalqiliya, and Salfit), middle West Bank (Jerusalem, Jericho, and Ramallah), and south West Bank (Hebron, and Bethlehem). The study population included all female health-care workers older than 40 years. Those who performed mammography for a suspected mass or other breast abnormalities were excluded. A self-administered questionnaire was used to collect data on demographic characteristics, knowledge about mammography screening, the extent and regularity of mammography screening, and motivators and barriers influencing their mammography screening uptake. The rate of mammography screening uptake was calculated. χ 2 test and t tests were used to assess screening motivators and barriers. The study was approved by the Institutional Review Board of the An-Najah National University. Participation was voluntary, and written consent was obtained from each participant. 299 female health-care workers completed a self-administered questionnaire. The mean age of the participants was 46 years (SD 4·7). 284 (95%) women had adequate knowledge about breast cancer and mammography screening, and 149 (50%) women reported having had at least one mammogram. 62 (21%) women had had regular scheduled mammograms. The most frequent reported motivators were the perceived benefit that early detection of breast cancer is important for its management (269 [90%] women) and the belief that mammography can detect breast cancer before its symptoms appear (251 [84%] women). The most frequent barrier to mammography screening was being busy (140 [47%] women) and the lack of perceived susceptibility (125 [42%] women). Mammography screening was suboptimal in a population of female health-care workers. Educational interventions are needed to remove barriers that limit compliance to recommendations and to emphasise the importance of early detection in breast cancer management. Ensuring the availability and accessibility of screening services, particularly for health-care workers within their work settings, would improve the acceptance and compliance for mammography screening programmes. None. Copyright © 2018 Elsevier Ltd. All rights reserved.

Radiation protection program for early detection of breast cancer in a mammography facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mariana, Villagomez Casimiro, E-mail: marjim10-66@ciencias.unam.mx, E-mail: cesar@fisica.unam.mx; Cesar, Ruiz Trejo, E-mail: marjim10-66@ciencias.unam.mx, E-mail: cesar@fisica.unam.mx; Ruby, Espejo Fonseca

Mammography is the best tool for early detection of Breast Cancer. In this diagnostic radiology modality it is necessary to establish the criteria to ensure the proper use and operation of the equipment used to obtain mammographic images in order to contribute to the safe use of ionizing radiation. The aim of the work was to implement at FUCAM-AC the radiation protection program which must be established for patients and radiation workers according to Mexican standards [1–4]. To achieve this goal, radiation protection and quality control manuals were elaborated [5]. Furthermore, a quality control program (QCP) in the mammography systemsmore » (analog/digital), darkroom included, has been implemented. Daily sensitometry, non-variability of the image quality, visualizing artifacts, revision of the equipment mechanical stability, compression force and analysis of repetition studies are some of the QCP routine tests that must be performed by radiological technicians of this institution as a set of actions to ensure the protection of patients. Image quality and patients dose assessment were performed on 4 analog equipment installed in 2 mobile units. In relation to dose assessment, all equipment passed the acceptance criteria (<3 mGy per projection). The image quality test showed that most images (70%)– presented artifacts. A brief summary of the results of quality control tests applied to the equipment and film processor are presented. To maintain an adequate level of quality and safety at FUCAM-AC is necessary that the proposed radiation protection program in this work is applied.« less

A database for assessment of effect of lossy compression on digital mammograms

NASA Astrophysics Data System (ADS)

Wang, Jiheng; Sahiner, Berkman; Petrick, Nicholas; Pezeshk, Aria

2018-03-01

With widespread use of screening digital mammography, efficient storage of the vast amounts of data has become a challenge. While lossless image compression causes no risk to the interpretation of the data, it does not allow for high compression rates. Lossy compression and the associated higher compression ratios are therefore more desirable. The U.S. Food and Drug Administration (FDA) currently interprets the Mammography Quality Standards Act as prohibiting lossy compression of digital mammograms for primary image interpretation, image retention, or transfer to the patient or her designated recipient. Previous work has used reader studies to determine proper usage criteria for evaluating lossy image compression in mammography, and utilized different measures and metrics to characterize medical image quality. The drawback of such studies is that they rely on a threshold on compression ratio as the fundamental criterion for preserving the quality of images. However, compression ratio is not a useful indicator of image quality. On the other hand, many objective image quality metrics (IQMs) have shown excellent performance for natural image content for consumer electronic applications. In this paper, we create a new synthetic mammogram database with several unique features. We compare and characterize the impact of image compression on several clinically relevant image attributes such as perceived contrast and mass appearance for different kinds of masses. We plan to use this database to develop a new objective IQM for measuring the quality of compressed mammographic images to help determine the allowed maximum compression for different kinds of breasts and masses in terms of visual and diagnostic quality.

The evolving role of new imaging methods in breast screening.

PubMed

Houssami, Nehmat; Ciatto, Stefano

2011-09-01

The potential to avert breast cancer deaths through screening means that efforts continue to identify methods which may enhance early detection. While the role of most new imaging technologies remains in adjunct screening or in the work-up of mammography-detected abnormalities, some of the new breast imaging tests (such as MRI) have roles in screening groups of women defined by increased cancer risk. This paper highlights the evidence and the current role of new breast imaging technologies in screening, focusing on those that have broader application in population screening, including digital mammography, breast ultrasound in women with dense breasts, and computer-aided detection. It highlights that evidence on new imaging in screening comes mostly from non-randomised studies that have quantified test detection capability as adjunct to mammography, or have compared measures of screening performance for new technologies with that of conventional mammography. Two RCTs have provided high-quality evidence on the equivalence of digital and conventional mammography and on outcomes of screen-reading complemented by CAD. Many of these imaging technologies enhance cancer detection but also increase recall and false positives in screening. Copyright © 2011 Elsevier Inc. All rights reserved.

Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies.

PubMed

Mandelblatt, Jeanne S; Stout, Natasha K; Schechter, Clyde B; van den Broek, Jeroen J; Miglioretti, Diana L; Krapcho, Martin; Trentham-Dietz, Amy; Munoz, Diego; Lee, Sandra J; Berry, Donald A; van Ravesteyn, Nicolien T; Alagoz, Oguzhan; Kerlikowske, Karla; Tosteson, Anna N A; Near, Aimee M; Hoeffken, Amanda; Chang, Yaojen; Heijnsdijk, Eveline A; Chisholm, Gary; Huang, Xuelin; Huang, Hui; Ergun, Mehmet Ali; Gangnon, Ronald; Sprague, Brian L; Plevritis, Sylvia; Feuer, Eric; de Koning, Harry J; Cronin, Kathleen A

2016-02-16

Controversy persists about optimal mammography screening strategies. To evaluate screening outcomes, taking into account advances in mammography and treatment of breast cancer. Collaboration of 6 simulation models using national data on incidence, digital mammography performance, treatment effects, and other-cause mortality. United States. Average-risk U.S. female population and subgroups with varying risk, breast density, or comorbidity. Eight strategies differing by age at which screening starts (40, 45, or 50 years) and screening interval (annual, biennial, and hybrid [annual for women in their 40s and biennial thereafter]). All strategies assumed 100% adherence and stopped at age 74 years. Benefits (breast cancer-specific mortality reduction, breast cancer deaths averted, life-years, and quality-adjusted life-years); number of mammograms used; harms (false-positive results, benign biopsies, and overdiagnosis); and ratios of harms (or use) and benefits (efficiency) per 1000 screens. Biennial strategies were consistently the most efficient for average-risk women. Biennial screening from age 50 to 74 years avoided a median of 7 breast cancer deaths versus no screening; annual screening from age 40 to 74 years avoided an additional 3 deaths, but yielded 1988 more false-positive results and 11 more overdiagnoses per 1000 women screened. Annual screening from age 50 to 74 years was inefficient (similar benefits, but more harms than other strategies). For groups with a 2- to 4-fold increased risk, annual screening from age 40 years had similar harms and benefits as screening average-risk women biennially from 50 to 74 years. For groups with moderate or severe comorbidity, screening could stop at age 66 to 68 years. Other imaging technologies, polygenic risk, and nonadherence were not considered. Biennial screening for breast cancer is efficient for average-risk populations. Decisions about starting ages and intervals will depend on population characteristics and the decision makers' weight given to the harms and benefits of screening. National Institutes of Health.

WE-A-12A-01: Medical Physics 1.0 to 2.0, Session 2: Radiography, Mammography and Fluoroscopy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gingold, E; Karellas, A; Strauss, K

Medical Physics 2.0 is a bold vision for an existential transition of clinical imaging physics in face of the new realities of value-based and evidencebased medicine, comparative effectiveness, and meaningful use. It speaks to how clinical imaging physics can expand beyond traditional insular models of inspection and acceptance testing, oriented toward compliance, towards team-based models of operational engagement, prospective definition and assurance of effective use, and retrospective evaluation of clinical performance. Organized into four sessions of the AAPM, this particular session focuses on three specific modalities as outlined below. Radiography 2.0: The development of electronic capture in recent years hasmore » changed the landscape and spurred reinvestment by healthcare providers. The radiography presentation will explore how the diagnostic medical physicist must adapt to these changes to support radiographic imaging, and how she/he can add value in radiography practice over the next 5-10 years. Topics of discussion include new metrology of evaluation, new models of clinical engagement, and effective integration of new technologies. Mammography 2.0: Mammography has been an interesting testing ground on the effectiveness of close involvement of medical physicists with equipment in the past twenty years. The outcomes have clearly shown major improvements in image quality and significant reduction in the average glandular dose. However, the medical physicist's role in mammography has been largely focused to annual surveys and with limited input on operational issues with image artifacts, optimal mammographic acquisition mode and problems with image quality. This mammography presentation will address why and how medical physicists must be prepared to address the new models of practice that include new metrics of performance and the integration of new technologies (DBT, syncretized mammograms, contrast mammography, breast CT) into clinical practice. Fluoroscopy 2.0: Physics support of fluoroscopy should be operationally as opposed to compliance focused. Testing protocols must address new hardware, acquisition methods, and image processing. Future available tools are discussed. Proper configuration of acquisition parameters (focal spot size, voltage and added filter, tube current, pulse width, pulse rate, scatter removal) as a function of patient size from the neonate to bariatric patient is key to providing diagnostic image quality at properly managed radiation doses. Learning Objectives: Appreciate the limitations of the currently available tools and techniques in clinical medical physics in radiography, mammography, and fluoroscopy, and ways to improve upon current deficiencies. Appreciate the changing environment of imaging practice and the need for the medical physicist to be an expert consultant and educator in a capacity that extends beyond the annual survey of equipment. Understand the status of the rapidly changing environment in breast imaging from planar imaging to tomosynthesis and possibly to breast CT. Identify appropriate configuration of acquisition parameters as a function of patient size to manage radiation dose and ensure diagnostic image quality.« less

Breast and cervical cancer screening among Hispanic subgroups in the USA: estimates from the National Health Interview Survey 2008, 2010, and 2013.

PubMed

Shoemaker, Meredith L; White, Mary C

2016-03-01

This study examined patterns in mammography and Pap test use across and within subpopulations of Hispanic women. Based on data from the National Health Interview Survey (2008, 2010, and 2013), we estimated the proportion of Hispanic women reporting testing for breast and cervical cancer for specific subgroups. We examined test use by demographic characteristics using Chi-square tests. Overall, the proportion of women aged 50-74 years who reported a mammogram within the past 2 years did not differ significantly across Hispanic subgroups. Among publically and uninsured women, however, proportions of mammography utilization varied significantly across Hispanic subgroups. The proportion of women aged 21-65 years who received a Pap test within the past 3 years differed significantly across Hispanic subgroups. Among subgroups of Hispanic women, patterns in mammography and Pap test use vary by insurance status, length of US residency, and type of screening. Certain subgroups of Hispanic women may benefit from culturally tailored efforts to promote breast and cervical cancer screening.

Using QRRO survey data to assess compliance with quality indicators for breast and prostate cancer.

PubMed

Owen, Jean B; White, Julia R; Zelefsky, Michael J; Wilson, J Frank

2009-06-01

Quality Research in Radiation Oncology (QRRO) has embarked on a new national process survey to provide benchmark data that will allow radiation oncologists to assess the quality of care in their own practices by measuring quality indicators (QIs) and comparing individual with national practice. Investigators at QRRO developed QIs on the basis of nationally recognized, evidence-based guidelines such as those of the National Comprehensive Cancer Network, as well as additional emerging QIs for processes involving rapidly emerging technology. They specifically defined the QIs as clinical performance measures. Published results of the national survey database for patients treated in 1998 and 1999 were reviewed and additional analyses conducted to assess data adequacy to measure compliance with these clinical performance measures. Examples of workup QIs for breast cancer patients showed that 97% underwent diagnostic bilateral mammography, 96% underwent pathology reviews, 83% underwent the determination of estrogen receptor status, 81% underwent the determination of progesterone receptor status, and 31% underwent the determination of human epidermal growth factor receptor 2 status. Compliance with treatment QIs for field recommendations on the basis of nodal findings can be measured. Of patients with prostate cancer, 90% underwent digital rectal examinations, 99% underwent prostate-specific antigen tests, and 99% had their Gleason scores determined. Compliance with QIs on the basis of prognostic group can also be measured. Benchmarking utilization patterns provides a foundation for assessing the appropriateness of cancer care in the future. The QRRO database is a rich data source, and the new survey will provide contemporary benchmark data for these measures.

Development of terminology for mammographic techniques for radiological technologists.

PubMed

Yagahara, Ayako; Yokooka, Yuki; Tsuji, Shintaro; Nishimoto, Naoki; Uesugi, Masahito; Muto, Hiroshi; Ohba, Hisateru; Kurowarabi, Kunio; Ogasawara, Katsuhiko

2011-07-01

We are developing a mammographic ontology to share knowledge of the mammographic domain for radiologic technologists, with the aim of improving mammographic techniques. As a first step in constructing the ontology, we used mammography reference books to establish mammographic terminology for identifying currently available knowledge. This study proceeded in three steps: (1) determination of the domain and scope of the terminology, (2) lexical extraction, and (3) construction of hierarchical structures. We extracted terms mainly from three reference books and constructed the hierarchical structures manually. We compared features of the terms extracted from the three reference books. We constructed a terminology consisting of 440 subclasses grouped into 19 top-level classes: anatomic entity, image quality factor, findings, material, risk, breast, histological classification of breast tumors, role, foreign body, mammographic technique, physics, purpose of mammography examination, explanation of mammography examination, image development, abbreviation, quality control, equipment, interpretation, and evaluation of clinical imaging. The number of terms that occurred in the subclasses varied depending on which reference book was used. We developed a terminology of mammographic techniques for radiologic technologists consisting of 440 terms.

Method for inserting noise in digital mammography to simulate reduction in radiation dose

NASA Astrophysics Data System (ADS)

Borges, Lucas R.; de Oliveira, Helder C. R.; Nunes, Polyana F.; Vieira, Marcelo A. C.

2015-03-01

The quality of clinical x-ray images is closely related to the radiation dose used in the imaging study. The general principle for selecting the radiation is ALARA ("as low as reasonably achievable"). The practical optimization, however, remains challenging. It is well known that reducing the radiation dose increases the quantum noise, which could compromise the image quality. In order to conduct studies about dose reduction in mammography, it would be necessary to acquire repeated clinical images, from the same patient, with different dose levels. However, such practice would be unethical due to radiation related risks. One solution is to simulate the effects of dose reduction in clinical images. This work proposes a new method, based on the Anscombe transformation, which simulates dose reduction in digital mammography by inserting quantum noise into clinical mammograms acquired with the standard radiation dose. Thus, it is possible to simulate different levels of radiation doses without exposing the patient to new levels of radiation. Results showed that the achieved quality of simulated images generated with our method is the same as when using other methods found in the literature, with the novelty of using the Anscombe transformation for converting signal-independent Gaussian noise into signal-dependent quantum noise.

Magnetic Resonance Imaging as an Adjunct to Mammography for Breast Cancer Screening in Women at Less Than High Risk for Breast Cancer: A Health Technology Assessment

PubMed Central

Nikitovic-Jokic, Milica; Holubowich, Corinne

2016-01-01

Background Screening with mammography can detect breast cancer early, before clinical symptoms appear. Some cancers, however, are not captured with mammography screening alone. Among women at high risk for breast cancer, magnetic resonance imaging (MRI) has been suggested as a safe adjunct (supplemental) screening tool that can detect breast cancers missed on screening mammography, potentially reducing the number of deaths associated with the disease. However, the use of adjunct screening tests may also increase the number of false-positive test results, which may lead to unnecessary follow-up testing, as well as patient stress and anxiety. We investigated the benefits and harms of MRI as an adjunct to mammography compared with mammography alone for screening women at less than high risk (average or higher than average risk) for breast cancer. Methods We searched Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Centre for Reviews and Dissemination (CRD) Health Technology Assessment Database, and National Health Service (NHS) Economic Evaluation Database, from January 2002 to January 2016, for evidence of effectiveness, harms, and diagnostic accuracy. Only studies evaluating the use of screening breast MRI as an adjunct to mammography in the specified populations were included. Results No studies in women at less than high risk for breast cancer met our inclusion criteria. Conclusions It remains uncertain if the use of adjunct screening breast MRI in women at less than high risk (average or higher than average risk) for breast cancer will reduce breast cancer–related mortality without significant increases in unnecessary follow-up testing and treatment. PMID:27990198

Print information to inform decisions about mammography screening participation in 16 countries with population-based programs.

PubMed

Zapka, Jane G; Geller, Berta M; Bulliard, Jean-Luc; Fracheboud, Jacques; Sancho-Garnier, Helene; Ballard-Barbash, Rachel

2006-10-01

To profile and compare the content and presentation of written communications related to informed decision-making about mammography. Materials from 16 screening programs organized at the national or regional level were analyzed according to five major information domains suggested by the international literature. A majority of countries provided information on the program (interval, cost and quality). There was considerable variability in comprehensiveness of elements in the domains, e.g., test characteristics (false positive/negative) and pros and cons of screening. The majority noted the likelihood of recall for further tests, few commented on the risks of additional tests or finding unimportant tumors. The audit also found variation in presentation (words and pictures). Presentation of comprehensive, but balanced information on screening benefits and risks is complex and daunting. Issues such as framing effects, coupled with debate about screening efficacy are challenging to the design of effective information tools. The objective of increasing screening prevalence at the population level must be balanced with objectively presenting complete and clear information. Additional research is needed on how information (and mode of presentation) impact screening decisions. Public health officials need to articulate their objectives and review written communication according to important decision-making domains.

Getting started with protocol for quality assurance of digital mammography in the clinical centre of Montenegro.

PubMed

Ivanovic, S; Bosmans, H; Mijovic, S

2015-07-01

The purpose of this work is (i) to work out a test procedure for quality assurance (QA) in digital mammography with newly released test equipment, including the MagicMax mam multimeter (IBA, Germany) and the anthropomorphic tissue equivalent phantom Mammo AT (IBA, Germany), and (ii) to determine whether a first digital computer radiography (CR) system in Montenegro meets the current European standards. Tested parameters were tube output (µGy mAs(-1)) and output rate (mGy s(-1)), reproducibility and accuracy of tube voltage, half value layer, reproducibility and accuracy of the AEC system, exposure control steps, image receptor's response function, image quality and printer stability test. The evaluated dosimetric quantity is the average glandular dose (AGD) as evaluated from PMMA slabs simulating breast tissue. The main findings are that QA can be organised in Montenegro. (1) All measured parameters are within the range described in European protocols except the tube voltage which deviated more than ± 1 kV. The automatic determination of the HVL was satisfactorily. AGD ranged from 0.66 to 7.02 mGy for PMMA thicknesses from 20 to 70 mm, and is in accordance with literature data. (2) The image quality score as obtained with the anthropomorphic tissue equivalent phantom Mammo AT for the CR system was similar to findings on the authors' conventional screen-film mammography. (3) In clinical practice the mammograms are printed. The CR reader produces images with a pixel size of 43.75 µm, which is compatible with the laser printer (39 µm laser spot spacing). The image processing algorithm embedded in the reader successfully processes mammograms with desirable image brightness and contrast in the printed image. The authors conclude that this first digital mammography system seems a good candidate for breast cancer screening applications. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Digital breast tomosynthesis : technical principles, current clinical relevance and future perspectives].

PubMed

Hellerhoff, K

2010-11-01

In recent years digital full field mammography has increasingly replaced conventional film mammography. High quality imaging is guaranteed by high quantum efficiency and very good contrast resolution with optimized dosing even for women with dense glandular tissue. However, digital mammography remains a projection procedure by which overlapping tissue limits the detectability of subtle alterations. Tomosynthesis is a procedure developed from digital mammography for slice examination of breasts which eliminates the effects of overlapping tissue and allows 3D imaging of breasts. A curved movement of the X-ray tube during scanning allows the acquisition of many 2D images from different angles. Subseqently, reconstruction algorithms employing a shift and add method improve the recognition of details at a defined level and at the same time eliminate smear artefacts due to overlapping structures. The total dose corresponds to that of conventional mammography imaging. The technical procedure, including the number of levels, suitable anodes/filter combinations, angle regions of images and selection of reconstruction algorithms, is presently undergoing optimization. Previous studies on the clinical value of tomosynthesis have examined screening parameters, such as recall rate and detection rate as well as information on tumor extent for histologically proven breast tumors. More advanced techniques, such as contrast medium-enhanced tomosynthesis, are presently under development and dual-energy imaging is of particular importance.

[Customer satisfaction analysis in women attending an organized mammographic screening. Pilot study at Trento].

PubMed

Della Sala, W; Tognotti, F; Pellegrini, M; Bernardi, D; Gentilini, M; Piffer, S

2005-01-01

Present paper reports on the results of a pilot customer satisfaction study carried out on 1.720 consecutive women (18.7 with spontaneous access) attended senology department (Trento and Borgo) in the context of a organized mammography screening programme, started in October 2000. Data were collected by a questionnarie filled by the women after mammography. 4.3% of the invited women reported the receiving the letter late, 0.9% considered it inaccurate, 7.2% had some problems for getting a new date for test, 1.8% of the whole sample reported some problems for external access and 2.2% for internal access to health facilities; 1.9% perceived waiting room as not friendly. The welcoming by the personnel is judged quite well, only 0.6% complained about it. Trento centre, is more efficient than Borgo. In 21.7% of the cases the mammography has been performed within next 30 minutes of the fixed time and in 7.9% besides that. 36.8% of the whole sample perceived mammography as tiresome and 4.1% as painful. The percentage of women reporting mammography disconforting increase, in Trento sample, according the education level as previously reported. The data about perceived quality are satisfactory, on the whole. Anyway it would be opportune to contain the waiting time.

Simulation of breast compression in mammography using finite element analysis: A preliminary study

NASA Astrophysics Data System (ADS)

Liu, Yan-Lin; Liu, Pei-Yuan; Huang, Mei-Lan; Hsu, Jui-Ting; Han, Ruo-Ping; Wu, Jay

2017-11-01

Adequate compression during mammography lowers the absorbed dose in the breast and improves the image quality. The compressed breast thickness (CBT) is affected by various factors, such as breast volume, glandularity, and compression force. In this study, we used the finite element analysis to simulate breast compression and deformation and validated the simulated CBT with clinical mammography results. Image data from ten subjects who had undergone mammography screening and breast magnetic resonance imaging (MRI) were collected, and their breast models were created according to the MR images. The non-linear tissue deformation under 10-16 daN in the cranial-caudal direction was simulated. When the clinical compression force was used, the simulated CBT ranged from 2.34 to 5.90 cm. The absolute difference between the simulated CBT and the clinically measured CBT ranged from 0.5 to 7.1 mm. The simulated CBT had a strong positive linear relationship to breast volume and a weak negative correlation to glandularity. The average simulated CBT under 10, 12, 14, and 16 daN was 5.68, 5.12, 4.67, and 4.25 cm, respectively. Through this study, the relationships between CBT, breast volume, glandularity, and compression force are provided for use in clinical mammography.

Measurement of effective detective quantum efficiency for a photon counting scanning mammography system and comparison with two flat panel full-field digital mammography systems

NASA Astrophysics Data System (ADS)

Wood, Tim J.; Moore, Craig S.; Saunderson, John R.; Beavis, Andrew W.

2018-01-01

Effective detective quantum efficiency (eDQE) describes the resolution and noise properties of an imaging system along with scatter and primary transmission, all measured under clinically appropriate conditions. Effective dose efficiency (eDE) is the eDQE normalised to mean glandular dose and has been proposed as a useful metric for the optimisation of clinical imaging systems. The aim of this study was to develop a methodology for measuring eDQE and eDE on a Philips microdose mammography (MDM) L30 photon counting scanning system, and to compare performance with two conventional flat panel systems. A custom made lead-blocker was manufactured to enable the accurate determination of dose measurements, and modulation transfer functions were determined free-in-air at heights of 2, 4 and 6 cm above the breast support platform. eDQE were calculated for a Philips MDM L30, Hologic Dimensions and Siemens Inspiration digital mammography system for 2, 4 and 6 cm thick poly(methyl methacrylate) (PMMA). The beam qualities (target/filter and kilovoltage) assessed were those selected by the automatic exposure control, and anti-scatter grids were used where available. Measurements of eDQE demonstrate significant differences in performance between the slit- and scan-directions for the photon counting imaging system. MTF has been shown to be the limiting factor in the scan-direction, which results in a rapid fall in eDQE at mid-to-high spatial frequencies. A comparison with two flat panel mammography systems demonstrates that this may limit image quality for small details, such as micro-calcifications, which correlates with a more conventional image quality assessment with the CDMAM phantom. eDE has shown the scanning photon counting system offers superior performance for low spatial frequencies, which will be important for the detection of large low contrast masses. Both eDQE and eDE are proposed as useful metrics that should enable optimisation of the Philips MDM L30.

[Advances in research on automatic exposure control of mammography system].

PubMed

Wang, Guoyi; Ye, Chengfu; Wu, Haiming; Wang, Tainfu; Zhang, Hong

2014-12-01

Mammography imaging is one of the most demanding imaging modalities from the point of view of the bal- ance between image quality (the visibility of small size and/or low contrast structures) and dose (screening of many asymptomatic people). Therefore, since the introduction of the first dedicated mammographic units, many efforts have been directed to seek the best possible image quality while minimizing patient dose. The performance of auto- matic exposure control (AEC) is the manifestation of this demand. The theory of AEC includes exposure detection and optimization and also involves some accomplished methodology. This review presents the development and present situa- tion of spectrum optimization, detector evolution, and the way how to accomplish and evaluate AEC methods.

Smoking, dietary, and breast and cervical cancer screening knowledge and screening practices of employees in an urban medical center.

PubMed

Hyman, R B; Greenwald, E S; Hacker, S

1995-01-01

This paper reports results of a survey of 500 health care workers in a private New York City Hospital that assessed knowledge and behaviors in the areas of smoking and cancer, diet and cancer, and breast and cervical cancer screening. Given the small number of knowledge items, the results indicated good knowledge concerning diet and cancer, smoking and cancer, and mammography and Pap test guidelines. Conformity with American Cancer Society guidelines for Pap testing was comparable to national figures, but with women over 50 as likely to obtain Pap smears as younger women. Conformity with mammography guidelines was excellent, although compliance with breast self-examination recommendations was low (25.4%). Of female employees over age 50, 87.4% had ever had mammography and 77.6% reported yearly mammography. Only 19% of the respondents admitted to current smoking. Although methodologic differences made comparison of knowledge of diet and cancer with the work of others difficult, knowledge of the risks of smoking was comparable to levels found in other studies.

The quality of tumor size assessment by contrast-enhanced spectral mammography and the benefit of additional breast MRI.

PubMed

Lobbes, Marc B I; Lalji, Ulrich C; Nelemans, Patty J; Houben, Ivo; Smidt, Marjolein L; Heuts, Esther; de Vries, Bart; Wildberger, Joachim E; Beets-Tan, Regina G

2015-01-01

Background - Contrast-enhanced spectral mammography (CESM) is a promising new breast imaging modality that is superior to conventional mammography for breast cancer detection. We aimed to evaluate correlation and agreement of tumor size measurements using CESM. As additional analysis, we evaluated whether measurements using an additional breast MRI exam would yield more accurate results. Methods - Between January 1(st) 2013 and April 1(st) 2014, 87 consecutive breast cancer cases that underwent CESM were collected and data on maximum tumor size measurements were gathered. In 57 cases, tumor size measurements were also available for breast MRI. Histopathological results of the surgical specimen served as gold standard in all cases. Results - The Pearson's correlation coefficients (PCC) of CESM versus histopathology and breast MRI versus histopathology were all >0.9, p<0.0001. For the agreement between measurements, the mean difference between CESM and histopathology was 0.03 mm. The mean difference between breast MRI and histopathology was 2.12 mm. Using a 2x2 contingency table to assess the frequency distribution of a relevant size discrepancy of >1 cm between the two imaging modalities and histopathological results, we did not observe any advantage of performing an additional breast MRI after CESM in any of the cases. Conclusion - Quality of tumor size measurement using CESM is good and matches the quality of these measurement assessed by breast MRI. Additional measurements using breast MRI did not improve the quality of tumor size measurements.

The Quality of Tumor Size Assessment by Contrast-Enhanced Spectral Mammography and the Benefit of Additional Breast MRI

PubMed Central

Lobbes, Marc B.I.; Lalji, Ulrich C.; Nelemans, Patty J.; Houben, Ivo; Smidt, Marjolein L.; Heuts, Esther; de Vries, Bart; Wildberger, Joachim E.; Beets-Tan, Regina G.

2015-01-01

Background - Contrast-enhanced spectral mammography (CESM) is a promising new breast imaging modality that is superior to conventional mammography for breast cancer detection. We aimed to evaluate correlation and agreement of tumor size measurements using CESM. As additional analysis, we evaluated whether measurements using an additional breast MRI exam would yield more accurate results. Methods - Between January 1st 2013 and April 1st 2014, 87 consecutive breast cancer cases that underwent CESM were collected and data on maximum tumor size measurements were gathered. In 57 cases, tumor size measurements were also available for breast MRI. Histopathological results of the surgical specimen served as gold standard in all cases. Results - The Pearson's correlation coefficients (PCC) of CESM versus histopathology and breast MRI versus histopathology were all >0.9, p<0.0001. For the agreement between measurements, the mean difference between CESM and histopathology was 0.03 mm. The mean difference between breast MRI and histopathology was 2.12 mm. Using a 2x2 contingency table to assess the frequency distribution of a relevant size discrepancy of >1 cm between the two imaging modalities and histopathological results, we did not observe any advantage of performing an additional breast MRI after CESM in any of the cases. Conclusion - Quality of tumor size measurement using CESM is good and matches the quality of these measurement assessed by breast MRI. Additional measurements using breast MRI did not improve the quality of tumor size measurements. PMID:25561979

Screening for breast cancer in a high-risk series

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woodard, E.D.; Hempelmann, L.H.; Janus, J.

1982-01-01

A unique cohort of women at increased risk of breast cancer because of prior X-ray treatment of acute mastitis and their selected high-risk siblings were offered periodic breast cancer screening including physical examination of the breasts, mammography, and thermography. Twelve breast cancers were detected when fewer than four would have been expected based on age-specific breast cancer detection rates from the National Cancer Institute/American Cancer Society Breast Cancer Demonstration Detection Projects. Mammography was positive in all cases but physical examination was positive in only three cases. Thermography was an unreliable indicator of disease. Given the concern over radiation-induced risk, usemore » of low-dose technique and of criteria for participation that select women at high risk of breast cancer will maximize the benefit/risk ratio for mammography screening.« less

A comparison of the performance of digital mammography systems.

PubMed

Monnin, P; Gutierrez, D; Bulling, S; Guntern, D; Verdun, F R

2007-03-01

An objective analysis of image quality parameters was performed for six digital mammography systems. The presampled modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE) for the systems were determined at different doses, for 28 kVp with a Mo/Mo or W/Al target/filter combination and 2 mm of additional aluminium filtration. The flat-panel units have higher MTF and DQE in the mid to high frequency range than standard CR systems. The highest DQE, over the whole dose range, is for the slit-scanning direct photon counting system. Dual-side read CR can overcome the inherent x-ray absorption and signal collection limitations of standard CR mammography, improving the low-frequency DQE by 40%, to the same level as full-field systems, but it does not improve the poor spatial resolution of phosphor.

Developing a Mass Media Campaign to Promote Mammography Awareness in African American Women in the Nation's Capital.

PubMed

Wallington, Sherrie Flynt; Oppong, Bridget; Iddirisu, Marquita; Adams-Campbell, Lucile L

2017-12-26

This study developed and examined the reach and impact of a culturally appropriate mass media campaign pilot, designed to increase awareness about the importance of mammography screening and the available community mammography services for low-income African American women ages 40 and above. We conducted formative research using focus groups to inform campaign development, resulting in five emergent themes-good breast health, holistic views of healthiness, cancer fatalism, fear of mammogram machines, and mammogram affordability. The campaign targeted specific low-income African American communities in the District of Columbia via print ads in Metro stations and on buses, print ads in the Washington Informer, and online ads on a local TV network website. Data were collected before, during, and after campaign implementation to assess reach and impact. Reach was measured by number of impressions (number of people exposed to the campaign), while impact was assessed via online ad click-through rates, website use and referrals, and mammography center calls. The campaign was successful in reaching the target audience, with a total combined reach from all media of 9,479,386 impressions. In addition, the mammography center received significant increases in new website visitors (1482 during the campaign, compared to 24 during the preceding period) as well as 97 calls to the dedicated phone line. Further research involving a more long-term investment in terms of funding and campaign run time, coupled with a more robust evaluation, is needed to assess if culturally appropriate mass media campaigns can generate increased mammography screening rates and decrease breast-cancer-related mortality.

Readability assessment of internet-based patient education materials related to mammography for breast cancer screening.

PubMed

AlKhalili, Rend; Shukla, Pratik A; Patel, Ronak H; Sanghvi, Saurin; Hubbi, Basil

2015-03-01

The US Department of Health and Human Services (USDHHS) recommends that Internet-based patient education materials (IPEMs) be written below the sixth-grade reading level to target the average American adult. This study was designed to determine the readability of IPEMs regarding mammography for breast cancer screening. Three-hundred mammography-related Web sites were reviewed for IPEMs. Forty-two IPEMs that met the Health on the Net Foundation Code of Conduct were assessed for readability level with four readability indices that use existing algorithms based on word and sentence length to quantitatively analyze Internet sources for language intricacy including the following: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG; GFOG). Results were compared to national recommendations, and intergroup analysis was performed. No IPEMs (0%) regarding mammography were written at or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 49.04 ± 10.62; FKGL, 10.71 ± 2.01; SMOG, 13.33 ± 1.67; and Gunning FOG, 14.32 ± 2.18. These scores indicate that the readability of mammography IPEMs is written at a "difficult" level, significantly above the recommended sixth-grade reading level (P < .05) determined by the USDHHS. IPEMs related to mammography are written well above the recommended sixth-grade level and likely reflect other IPEMs in diagnostic radiology. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

75 FR 11542 - Agency Information Collection Activities; Proposed Collection; Comment Request; Mammography...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-11

...The Food and Drug Administration (FDA) is announcing an opportunity for public comment on the proposed collection of certain information by the agency. Under the Paperwork Reduction Act of 1995 (the PRA), Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension of an existing collection of information, and to allow 60 days for public comment in response to the notice. This notice solicits comments on the estimated reporting and recordkeeping burden associated with the Mammography Quality Standards Act requirements.

Earlier detection of breast cancer by surveillance of women at familial risk.

PubMed

Tilanus-Linthorst, M M; Bartels, C C; Obdeijn, A I; Oudkerk, M

2000-03-01

A positive family history increases the risk for breast cancer which oft en occurs at a much younger age than in the general population. We stud ied whether surveillance of these women resulted in the detection of bre ast cancer in an earlier stage than in symptomatic patients with a famil y history. Between January 1994 and April 1998, 294 women with 15-25% r isk (moderate), mean age:43.3 (22-75) years, were screened with a yearly physical examination and mammography from 5 years before the youngest ag e of onset in the family and 384 women with >25% risk (high) for breast cancer, mean age: 42.9 (20-74) years were screened with a physical examination every 6 months and yearly mammography. From September 1995 breast magnetic resonance imaging (MRI) was also carried out for 109 high risk women where mammography showed over 50% density. 26 breast cancers detected under surveillance were significantly more often found in an early T1N0 stage than the 24 breast cancers in patients with a family history referred in that period because of symptoms: 81 versus 46% (P=0.018). Patients under surveillance were also less frequently node-positive than the symptomatic group: 19 versus 42% (P=0.12). 20 patients with a family history referred by our national screening programme in that period had 21 breast cancers detected, 81% in stage T1N0 and 5% node-positive, which was comparable to the results in our national screening programme T1N0 66%, N+ 24% resulting in a 30% reduction in mortality. The incidence in women under surveillance was 10.1 per 1000 in the 'high' risk group and 13.3 per 1000 in the 'moderate' risk group. Expected incidence in an average risk population aged 40-50 years is 1.5, expected if the group consisted of only gene carriers 15 per 1000. 23% of the breast cancers in the surveillance group were detected at physical examination, but occult at mammography. 38% were detected at mammography and clinically occult. Breast MRI (in the subgroup) detected 3 occult breast cancers. The results of this study show that women with a family history benefit from surveillance as breast cancer was detected significantly more often in a favourable T1N0 stage and a mortality reduction comparable to that obtained in our national screening programme may be expected also in women <50 years of age. Both physical examination and mammography contribute to this result, but the former in this study only contributed in women before menopause. Starting surveillance some years before the youngest age of onset in the family may result in higher detection rates. Screening with MRI can detect breast cancers, still occult at physical examination and mammography.

Validation of electrical impedance tomography qualitative and quantitative values and comparison of the numeric pain distress score against mammography.

PubMed

Juliana, Norsham; Shahar, Suzana; Chelliah, Kanaga Kumari; Ghazali, Ahmad Rohi; Osman, Fazilah; Sahar, Mohd Azmani

2014-01-01

Electrical impedance tomography (EIT) is a potential supplement for mammogram screening. This study aimed to evaluate and feasibility of EIT as opposed to mammography and to determine pain perception with both imaging methods. Women undergoing screening mammography at the Radiology Department of National University of Malaysia Medical Centre were randomly selected for EIT imaging. All women were requested to give a pain score after each imaging session. Two independent raters were chosen to define the image findings of EIT. A total of 164 women in the age range from 40 to 65-year-old participated and were divided into two groups; normal and abnormal. EIT sensitivity and specificity for rater 1 were 69.4% and 63.3, whereas for rater 2 they were 55.3% and 57.0% respectively. The reliability for each rater ranged between good to very good (p<0.05). Quantitative values of EIT showed there were significant differences in all values between groups (ANCOVA, p<0.05). Interestingly, EIT scored a median pain score of 1.51±0.75 whereas mammography scored 4.15±0.87 (Mann Whitney U test, p<0.05). From these quantitative values, EIT has the potential as a health discriminating index. Its ability to replace image findings from mammography needs further investigation.

Cost-effectiveness of targeted versus tailored interventions to promote mammography screening among women military veterans in the United States.

PubMed

Lairson, David R; Chan, Wen; Chang, Yu-Chia; del Junco, Deborah J; Vernon, Sally W

2011-05-01

We conducted an economic evaluation of mammography promotion interventions in a population-based, nationally representative sample of 5500 women veterans. Women 52 years and older were randomly selected from the National Registry of Women Veterans and randomly assigned to a survey-only control group and two intervention groups that varied in the extent of personalization (tailored vs. targeted). Effectiveness measures were the prevalence of at least one self-reported post-intervention mammogram and two post-intervention mammograms 6-15 months apart. Incremental cost-effectiveness ratios (ICERs) were the incremental cost per additional person screened. Uncertainty was examined with sensitivity analysis and bootstrap simulation. The targeted intervention cost $25 per person compared to $52 per person for the tailored intervention. About 27% of the cost was incurred in identifying and recruiting the eligible population. The percent of women reporting at least one mammogram were .447 in the control group, .469 in the targeted group, and .460 in the tailored group. The ICER was $1116 comparing the targeted group to the control group (95% confidence interval (CI)=$493 to dominated). The tailored intervention was dominated (more costly and less effective) by the targeted intervention. Decision-makers should consider effectiveness evidence and the full recruitment and patient time costs associated with the implementation of screening interventions when making investments in mammography screening promotion programs. Identification and recruitment of eligible participants add substantial costs to outreach screening promotion interventions. Tailoring adds substantial cost to the targeted mammography promotion strategy without a commensurate increase in effectiveness. Although cost-effectiveness has been reported to be higher for some in-reach screening promotion interventions, a recent meta-analysis revealed significant heterogeneity in the effect sizes of published health-plan based intervention studies for repeat mammography (i.e., some studies reported null effects compared with control groups). Copyright © 2010 Elsevier Ltd. All rights reserved.

Factors that influence mammography screening behaviour: a qualitative study of Greek women's experiences.

PubMed

Kaltsa, Aikaterina; Holloway, Aisha; Cox, Karen

2013-06-01

To identify the factors that influence mammography screening behaviour in a sample of Greek women. Data were collected in Athens-Greece, from individuals who were members of six women's associations. A subset of 33 women were interviewed about their screening behaviour and experiences out of the 186 women who completed an initial questionnaire. This paper focuses on the findings revealed from the interviews. Women's associations were approached for the recruitment of the interviewees. Influences arising from women's immediate networks, such as family and close friends, appeared to be of essential importance in relation to their screening behaviour, while influences from their broader networks were of moderate impact. Fear acted as a motivator but also as a barrier in relation to mammography screening participation. Experiences that arose from engagement with the mammography screening processes were mostly characterized by having to overcome a variety of obstacles, such as long bureaucratic procedures and distrust in doctors. The interpersonal relationships between women and their social networks appeared to have an important and influential role in relation to breast screening behaviour. The quality of these relationships appeared to determine women's participation in mammography screening. It would appear that future practice needs to focus on these relationships in order to utilize them in a positive way. Future research is needed to explore this further. Copyright © 2012 Elsevier Ltd. All rights reserved.

21 CFR 900.22 - Standards for certification agencies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... accreditation bodies for issues related to mammography image quality and clinical practice. The certification... interest. The certification agency shall establish and implement measures that FDA has approved in...

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans.

PubMed

Trivedi, Amal N; Leyva, Bryan; Lee, Yoojin; Panagiotou, Orestis A; Dahabreh, Issa J

2018-01-18

The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage. In plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, -7.3 to 8.1). The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.).

iPads in Breast Imaging – A Phantom Study

PubMed Central

Hammon, M.; Schlechtweg, P. M.; Schulz-Wendtland, R.; Uder, M.; Schwab, S. A.

2014-01-01

Introduction: Modern tablet PCs as the iPad are becoming more and more integrated into medicine. The aim of this study was to evaluate the display quality of iPads regarding digital mammography. Materials and Methods: Three experienced readers compared the display quality of the iPad 2 and 3 with a dedicated 10 megapixel (MP) mammography liquid crystal display (LCD) screen in consensus using the standardized Contrast Detail Mammography (CDMAM) phantom. Phantom fields without agreement between the readers were classified as “uncertain”, correct 2 : 1 decisions were classified as “uncertain/readable”. In a second step display quality of the three reading devices was judged subjectively in a side by side comparison. Results: The 10 MP screen was superior to both iPads in 4 (phantom-)fields and inferior in 2 fields. Comparing the iPads, version 3 was superior in 4 fields and version 2 was superior in 1 field. However these differences were not significant. Total number of “uncertain” fields did not show significant differences. The number of “uncertain” fields was 15 with the 10 MP screen, 16 with the iPad 2 and 17 with the iPad 3 (p > 0.05), the number of “uncertain/readable” fields was 4, 7 and 8, respectively. Subjective image quality of the iPad 3 and the 10 MP screen was rated superior to the iPad 2. Conclusion: The evaluated iPads, especially in version 3, seem to be adequate to display mammograms in a diagnostic quality and thus could be useful e.g. for patient consultation, clinical demonstration or educational and teaching purposes. However primary mammogram reading should still be performed on dedicated large sized reading screens. PMID:24741126

Evaluation of low-energy contrast-enhanced spectral mammography images by comparing them to full-field digital mammography using EUREF image quality criteria.

PubMed

Lalji, U C; Jeukens, C R L P N; Houben, I; Nelemans, P J; van Engen, R E; van Wylick, E; Beets-Tan, R G H; Wildberger, J E; Paulis, L E; Lobbes, M B I

2015-10-01

Contrast-enhanced spectral mammography (CESM) examination results in a low-energy (LE) and contrast-enhanced image. The LE appears similar to a full-field digital mammogram (FFDM). Our aim was to evaluate LE CESM image quality by comparing it to FFDM using criteria defined by the European Reference Organization for Quality Assured Breast Screening and Diagnostic Services (EUREF). A total of 147 cases with both FFDM and LE images were independently scored by two experienced radiologists using these (20) EUREF criteria. Contrast detail measurements were performed using a dedicated phantom. Differences in image quality scores, average glandular dose, and contrast detail measurements between LE and FFDM were tested for statistical significance. No significant differences in image quality scores were observed between LE and FFDM images for 17 out of 20 criteria. LE scored significantly lower on one criterion regarding the sharpness of the pectoral muscle (p < 0.001), and significantly better on two criteria on the visualization of micro-calcifications (p = 0.02 and p = 0.034). Dose and contrast detail measurements did not reveal any physical explanation for these observed differences. Low-energy CESM images are non-inferior to FFDM images. From this perspective FFDM can be omitted in patients with an indication for CESM. • Low-energy CESM images are non-inferior to FFDM images. • Micro-calcifications are significantly more visible on LE CESM than on FFDM. • There is no physical explanation for this improved visibility of micro-calcifications. • There is no need for an extra FFDM when CESM is indicated.

Evidence-based information on mammography screening in Austria--reality or more pie in the sky?

PubMed

Rásky, É; Groth, S

2013-03-01

Health literacy is gaining increasing importance in prevention and health care. This is the case for patients and for health-care professionals. Information and risk communication should comply with defined criteria and strengthen health literacy as they are a prerequisite for informed decision making. In this study, we analyse the content of the printed information material (brochures and pamphlets) on mammography screening for consumers that were distributed in Austria in 2011. The evaluation of the 11 brochures shows that the content does not comply with the prerequisites for informed decision making. Since the last study - published in 2004 - the situation has only slightly improved. The authors reemphasise the need for a targeted multimodal information campaign. This is particularly important as a systematic national mammography screening program in compliance with the guidelines of the European Commission will be introduced in Austria in 2013. © Georg Thieme Verlag KG Stuttgart · New York.

Can tailored interventions increase mammography use among HMO women?

PubMed

Lipkus, I M; Rimer, B K; Halabi, S; Strigo, T S

2000-01-01

Telephone counseling and tailored print communications have emerged as promising methods for promoting mammography screening. However, there has been little research testing, within the same randomized field trial, of the efficacy of these two methods compared to a high-quality usual care system for enhancing screening. This study addressed the question: Compared to usual care, is tailored telephone counseling more effective than tailored print materials for promoting mammography screening? Three-year randomized field trial. One thousand ninety-nine women aged 50 and older recruited from a health maintenance organization in North Carolina. Women were randomized to 1 of 3 groups: (1) usual care, (2) tailored print communications, and (3) tailored telephone counseling. Adherence to mammography screening based on self-reports obtained during 1995, 1996, and 1997. Compared to usual care alone, telephone counseling promoted a significantly higher proportion of women having mammograms on schedule (71% vs 61%) than did tailored print (67% vs 61%) but only after the first year of intervention (during 1996). Furthermore, compared to usual care, telephone counseling was more effective than tailored print materials at promoting being on schedule with screening during 1996 and 1997 among women who were off-schedule during the previous year. The effects of the intervention were most pronounced after the first intervention. Compared to usual care, telephone counseling seemed particularly effective at promoting change among nonadherent women, the group for whom the intervention was developed. These results suggest that telephone counseling, rather than tailored print, might be the preferred first-line intervention for getting nonadherent women on schedule for mammography screening. Many questions would have to be answered about why the tailored print intervention was not more powerful. Nevertheless, it is clear that additional interventions will be needed to maintain women's adherence to mammography. Medical Subject Headings (MeSH): mammography screening, telephone counseling, tailored print communications, barriers.

Moving beyond the Typologies of Managed Care: The Example of Health Plan Predictors of Screening Mammography

PubMed Central

Tye, Sherilyn; Phillips, Kathryn A; Liang, Su-Ying; Haas, Jennifer S

2004-01-01

Objectives To develop a framework of factors to characterize health plans, to identify how plan characteristics were measured in a national survey, and to apply our findings to an analysis of the predictors of screening mammography. Data Source The primary data were from the 1996 Medical Expenditure Panel Survey. Study Design Women ages 40+, with private insurance, and no history of breast cancer were included in the study (N=2,909). We used multivariate logistic regression to estimate mammography utilization in the past two years relative to health plan and demographic factors. Health plan measures included whether there is a defined provider network, whether coverage is restricted to a network, use of gatekeepers, level of cost containment, copayment and deductible amounts, coinsurance rate, and breadth of benefit coverage. Principal Findings We found no significant difference in reported mammography utilization using a dichotomous comparison of individuals enrolled in managed care versus indemnity plans. However, women in health plans with a defined provider network were more likely to report having received a mammogram in the past two years than those without networks (adjusted OR=1.21, 95 percent CI=1.07–1.36), and women in gatekeeper plans were more likely to report receiving mammography than those without gatekeepers (adjusted OR=1.18, 95 percent CI=1.03–1.36). Restricted out-of-network coverage, use of cost containment, enrollee cost sharing, and breadth of benefit coverage did not appear to affect mammography use. Conclusions It is important to examine the effect of individual health plan components on the utilization of health care, rather than use the traditional broader categorizations of managed versus nonmanaged care or simple health plan typologies. PMID:14965083

Cost effectiveness of mammography screening for Chinese women.

PubMed

Wong, Irene O L; Kuntz, Karen M; Cowling, Benjamin J; Lam, Cindy L K; Leung, Gabriel M

2007-08-15

Although the cost effectiveness of screening mammography in most western developed populations has been accepted, it may not apply to Chinese women, who have a much lower breast cancer incidence. The authors estimated the cost effectiveness of biennial mammography in Hong Kong Chinese women to inform evidence-based screening policies. For the current study, a state-transition Markov model was developed to simulate mammography screening, breast cancer diagnosis, and treatment in a hypothetical cohort of Chinese women. The benefit of mammography was modeled by assuming a stage shift, in which cancers in screened women were more likely to be diagnosed at an earlier disease stage. The authors compared costs, quality-adjusted life years (QALYs) saved, and life years saved (LYS) for 5 screening strategies. Biennial screening resulted in a gain in life expectancy ranging from 4.3 days to 9.4 days compared with no screening at an incremental cost of from US $1,166 to US $2,425 per woman. The least costly, nondominated screening option was screening from ages 40 years to 69 years, with an incremental cost-effectiveness ratio (ICER) of US $61,600 per QALY saved or US $64,400 per LYS compared with no screening. In probabilistic sensitivity analyses, the probability of the ICER being below a threshold of US $50,000 per QALY (LYS) was 15.3% (14.6%). The current results suggested that mammography for Hong Kong Chinese women currently may not be cost effective based on the arbitrary threshold of US $50,000 per QALY. However, clinicians must remain vigilant and periodically should revisit the question of population screening: Disease rates in China have been increasing because of westernization and socioeconomic development.

Fixed-facility workplace screening mammography.

PubMed

Reynolds, H E; Larkin, G N; Jackson, V P; Hawes, D R

1997-02-01

Potential barriers to compliance with screening mammography guidelines include the cost and inconvenience involved with undergoing the procedure. Workplace screening with mobile mammography is one possible approach to the convenience barrier. However, fixed-facility workplace screening is a viable alternative for any company with a large workforce in one location. This paper describes our initial experience with one such fixed facility. The facility was a cooperative venture by a large pharmaceutical company and an academic radiology department to provide convenient, no-cost (to the patient) screening mammography to employees, dependents, and retirees more than 40 years old. The pharmaceutical company built the facility within its corporate headquarters and the academic radiology department provided the equipment and personnel. The company was billed a fixed cost per examination. In the first 22 months of operation, 4210 (of 4559 scheduled) screening mammograms were obtained. The mean age of the population was 53 years old. Ninety percent of the screening mammograms were interpreted as negative or benign; 10% required additional workup. Of the screened population, 62 biopsies were recommended and 60 were performed. Of these, 42 were benign and 18 malignant. The cancer detection rate was 4.3 per 1000 (0.43%). At the time of diagnosis, six patients were stage 0, 10 patients were stage I, one patient was stage II, and one patient was stage III. Eleven of the 18 patients had minimal cancers. Of the patients who completed a satisfaction survey, 97% percent expressed a high degree of satisfaction with the screening process and stated they would use the facility in the future. A fixed facility for workplace screening mammography is a viable way to provide nearly barrier-free access to high-quality mammography. Patient acceptance is high.

Cost-effectiveness of annual versus biennial screening mammography for women with high mammographic breast density.

PubMed

Pataky, Reka; Ismail, Zahra; Coldman, Andrew J; Elwood, Mark; Gelmon, Karen; Hedden, Lindsay; Hislop, Greg; Kan, Lisa; McCoy, Bonnie; Olivotto, Ivo A; Peacock, Stuart

2014-12-01

The sensitivity of screening mammography is much lower among women who have dense breast tissue, compared with women who have largely fatty breasts, and they are also at much higher risk of developing the disease. Increasing mammography screening frequency from biennially to annually has been suggested as a policy option to address the elevated risk in this population. The purpose of this study was to assess the cost-effectiveness of annual versus biennial screening mammography among women aged 50-79 with dense breast tissue. A Markov model was constructed based on screening, diagnostic, and treatment pathways for the population-based screening and cancer care programme in British Columbia, Canada. Model probabilities and screening costs were calculated from screening programme data. Costs for breast cancer treatment were calculated from treatment data, and utility values were obtained from the literature. Incremental cost-effectiveness was expressed as cost per quality adjusted life year (QALY), and probabilistic sensitivity analysis was conducted. Compared with biennial screening, annual screening generated an additional 0.0014 QALYs (95% CI: -0.0480-0.0359) at a cost of $819 ($ = Canadian dollars) per patient (95% CI: 506-1185), resulting in an incremental cost effectiveness ratio of $565,912/QALY. Annual screening had a 37.5% probability of being cost-effective at a willingness-to-pay threshold of $100,000/QALY. There is considerable uncertainty about the incremental cost-effectiveness of annual mammography. Further research on the comparative effectiveness of screening strategies for women with high mammographic breast density is warranted, particularly as digital mammography and density measurement become more widespread, before cost-effectiveness can be reevaluated. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Mobile Versus Fixed Facility: Latinas' Attitudes and Preferences for Obtaining a Mammogram.

PubMed

Scheel, John R; Tillack, Allison A; Mercer, Lauren; Coronado, Gloria D; Beresford, Shirley A A; Molina, Yamile; Thompson, Beti

2018-01-01

Mobile mammographic services have been proposed as a way to reduce Latinas' disproportionate late-stage presentation compared with white women by increasing their access to mammography. The aims of this study were to assess why Latinas may not use mobile mammographic services and to explore their preferences after using these services. Using a mixed-methods approach, a secondary analysis was conducted of baseline survey data (n = 538) from a randomized controlled trial to improve screening mammography rates among Latinas in Washington. Descriptive statistics and bivariate regression were used to characterize mammography location preferences and to test for associations with sociodemographic indices, health care access, and perceived breast cancer risk and beliefs. On the basis of these findings, a qualitative study (n = 18) was used to explore changes in perceptions after using mobile mammographic services. More Latinas preferred obtaining a mammogram at a fixed facility (52.3% [n = 276]) compared with having no preference (46.3% [n = 249]) and preferring mobile mammographic services (1.7% [n = 9]). Concerns about privacy and comfort (15.6% [n = 84]) and about general quality (10.6% [n = 57]) were common reasons for preferring a fixed facility. Those with no history of mammography preferred a fixed facility (P < .05). In the qualitative study, Latinas expressed similar initial concerns but became positive toward the mobile mammographic services after obtaining a mammogram. Although most Latinas preferred obtaining a mammogram at a fixed facility, positive experiences with mobile mammography services changed their attitudes toward them. These findings highlight the need to include community education when using mobile mammographic service to increase screening mammography rates in underserved communities. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 U.S. Preventive Services Task Force Recommendation.

PubMed

Nelson, Heidi D; Fu, Rochelle; Cantor, Amy; Pappas, Miranda; Daeges, Monica; Humphrey, Linda

2016-02-16

In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years. To review studies of the effectiveness of breast cancer screening in average-risk women. MEDLINE and Cochrane databases to 4 June 2015. English-language randomized, controlled trials and observational studies of screening with mammography, magnetic resonance imaging, and ultrasonography that reported breast cancer mortality, all-cause mortality, or advanced breast cancer outcomes. Investigators extracted and confirmed data and dual rated study quality; discrepancies were resolved through consensus. Fair-quality evidence from a meta-analysis of mammography trials indicated relative risks (RRs) for breast cancer mortality of 0.92 for women aged 39 to 49 years (95% CI, 0.75 to 1.02) (9 trials; 3 deaths prevented per 10,000 women over 10 years); 0.86 for those aged 50 to 59 years (CI, 0.68 to 0.97) (7 trials; 8 deaths prevented per 10,000 women over 10 years); 0.67 for those aged 60 to 69 years (CI, 0.54 to 0.83) (5 trials; 21 deaths prevented per 10,000 women over 10 years); and 0.80 for those aged 70 to 74 years (CI, 0.51 to 1.28) (3 trials; 13 deaths prevented per 10,000 women over 10 years). Risk reduction was 25% to 31% for women aged 50 to 69 years in observational studies of mammography screening. All-cause mortality was not reduced with screening. Advanced breast cancer was reduced for women aged 50 years or older (RR, 0.62 [CI, 0.46 to 0.83]) (3 trials) but not those aged 39 to 49 years (RR, 0.98 [CI, 0.74 to 1.37]) (4 trials); less evidence supported this outcome. Most trials used imaging technologies and treatments that are now outdated, and definitions of advanced breast cancer were heterogeneous. Studies of effectiveness based on risk factors, intervals, or other modalities were unavailable or methodologically limited. Breast cancer mortality is generally reduced with mammography screening, although estimates are not statistically significant at all ages and the magnitudes of effect are small. Advanced cancer is reduced with screening for women aged 50 years or older. Agency for Healthcare Research and Quality.

Mammography dosimetry using an in-house developed polymethyl methacrylate phantom.

PubMed

Sharma, Reena; Sharma, Sunil Dutt; Mayya, Y S; Chourasiya, G

2012-08-01

Phantom-based measurements in mammography are well-established for quality assurance (QA) and quality control (QC) procedures involving equipment performance and comparisons of X-ray machines. Polymethyl methacrylate (PMMA) is among the best suitable materials for simulation of the breast. For carrying out QA/QC exercises in India, a mammographic PMMA phantom with engraved slots for keeping thermoluminescence dosemeters (TLD) has been developed. The radiation transmission property of the developed phantom was compared with the commercially available phantoms for verifying its suitability for mammography dosimetry. The breast entrance exposure (BEE), mean glandular dose (MGD), percentage depth dose (PDD), percentage surface dose distribution (PSDD), calibration testing of automatic exposure control (AEC) and density control function of a mammography machine were measured using this phantom. MGD was derived from the measured BEE following two different methodologies and the results were compared. The PDD and PSDD measurements were carried out using LiF: Mg, Cu, P chips. The in-house phantom was found comparable with the commercially available phantoms. The difference in the MGD values derived using two different methods were found in the range of 17.5-32.6 %. Measured depth ranges in the phantom lie between 0.32 and 0.40 cm for 75 % depth dose, 0.73 and 0.92 cm for 50 % depth dose, and 1.54 and 1.78 cm for 25 % depth dose. Higher PSDD value was observed towards chest wall edge side of the phantom, which is due to the orientation of cathode-anode axis along the chest wall to the nipple direction. Results obtained for AEC configuration testing shows that the observed mean optical density (O.D) of the phantom image was 1.59 and O.D difference for every successive increase in thickness of the phantom was within±0.15 O.D. Under density control function testing, at -2 and -1 density settings, the variation in film image O.D was within±0.15 O.D of the normal density setting '0' and at +2 and +1 density setting, it was observed to be within±0.30 O.D. This study indicates that the locally made PMMA TLD slot phantom can be used to measure various mammography QC parameters which are essentially required for better outcomes in mammography.

[Central online quality assurance in radiology: an IT solution exemplified by the German Breast Cancer Screening Program].

PubMed

Czwoydzinski, J; Girnus, R; Sommer, A; Heindel, W; Lenzen, H

2011-09-01

Physical-technical quality assurance is one of the essential tasks of the National Reference Centers in the German Breast Cancer Screening Program. For this purpose the mammography units are required to transfer the measured values of the constancy tests on a daily basis and all phantom images created for this purpose on a weekly basis to the reference centers. This is a serious logistical challenge. To meet these requirements, we developed an innovative software tool. By the end of 2005, we had already developed web-based software (MammoControl) allowing the transmission of constancy test results via entry forms. For automatic analysis and transmission of the phantom images, we then introduced an extension (MammoControl DIANA). This was based on Java, Java Web Start, the NetBeans Rich Client Platform, the Pixelmed Java DICOM Toolkit and the ImageJ library. MammoControl DIANA was designed to run locally in the mammography units. This allows automated on-site image analysis. Both results and compressed images can then be transmitted to the reference center. We developed analysis modules for the daily and monthly consistency tests and additionally for a homogeneity test. The software we developed facilitates the immediate availability of measurement results, phantom images, and DICOM header data in all reference centers. This allows both targeted guidance and short response time in the case of errors. We achieved a consistent IT-based evaluation with standardized tools for the entire screening program in Germany. © Georg Thieme Verlag KG Stuttgart · New York.

A subset polynomial neural networks approach for breast cancer diagnosis.

PubMed

O'Neill, T J; Penm, Jack; Penm, Jonathan

2007-01-01

Breast cancer is a very common and serious cancer for women that is diagnosed in one of every eight Australian women before the age of 85. The conventional method of breast cancer diagnosis is mammography. However, mammography has been reported to have poor diagnostic capability. In this paper we have used subset polynomial neural network techniques in conjunction with fine needle aspiration cytology to undertake this difficult task of predicting breast cancer. The successful findings indicate that adoption of NNs is likely to lead to increased survival of women with breast cancer, improved electronic healthcare, and enhanced quality of life.

78 FR 13681 - Agency Information Collection Activities; Proposed Collection; Comment Request; Mammography...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-28

...The Food and Drug Administration (FDA) is announcing an opportunity for public comment on the proposed collection of certain information by the Agency. Under the Paperwork Reduction Act of 1995 (the PRA), Federal Agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension of an existing collection of information, and to allow 60 days for public comment in response to the notice. This notice solicits comments on the estimated reporting, recordkeeping, and third-party disclosure burden associated with the Mammography Quality Standards Act requirements.

ACA-mandated elimination of cost sharing for preventive screening has had limited early impact.

PubMed

Mehta, Shivan J; Polsky, Daniel; Zhu, Jingsan; Lewis, James D; Kolstad, Jonathan T; Loewenstein, George; Volpp, Kevin G

2015-07-01

The Affordable Care Act eliminated patient cost sharing for evidence-based preventive care, yet the impact of this policy on colonoscopy and mammography rates is unclear. We examined the elimination of cost sharing among small business beneficiaries of Humana, a large national insurer. This was a retrospective interrupted time series analysis of whether the change in cost-sharing policy was associated with a change in screening utilization, using grandfathered plans as a comparison group. We compared beneficiaries in small business nongrandfathered plans that were required to eliminate cost sharing (intervention) with those in grandfathered plans that did not have to change cost sharing (control). There were 63,246 men and women aged 50 to 64 years eligible for colorectal cancer screening, and 30,802 women aged 50 to 64 years eligible for breast cancer screening. The primary outcome variables were rates of colonoscopy and mammography per person-month, with secondary analysis of colonoscopy rates coded as preventive only. There was no significant change in the level or slope of colonoscopy and mammography utilization for intervention plans relative to the control plans. There was also no significant relevant change among those colonoscopies coded as preventive. The results suggest that the implementation of the policy is not having its intended effects, as cost sharing rates for colonoscopy and mammography did not change substantially, and utilization of colonoscopy and mammography changed little, following this new policy approach.

Towards in vivo TLD dosimetry in mammography.

PubMed

Warren-Forward, H M; Duggan, L

2004-05-01

While phantoms are used for quality control assessment of the mammography unit, in vivo dose measurements are necessary to account for the variation in size and composition of the female breast. The use of thermoluminescent dosimeters (TLDs) in mammography has been limited due to TLD visibility. The aim of this current investigation was to access the suitability of a paper-thin LiF:Mg,Cu,P TLD (GR-200F) for in vivo dosimetric mammography measurements. The visibility of GR-200F has been directly compared with LiF:Mg,Cu,P TLDs (GR-200A) using a number of commercially available phantoms. The phantoms of thickness 2-5 cm were imaged over the range of tube potentials (24-28 kVp) used clinically. Both types of TLD were placed on the surface of the phantoms allowing assessment of visibility, entrance surface dose (ESD) and field homogeneity. In vivo assessment of ESD and visibility was also carried out on a volunteer undergoing a routine mammography examination. The positions of the GR-200F TLDs were not identified either on the image of the Leeds TOR(MAM) phantom or the patient mammograms. The average ESD for the Leeds phantom was 8.8 mGy, while the patient ESD was 13 mGy. It is now possible to perform in vivo measurements with the potential of increasing the accuracy of the doses measured for women that do not conform to a standard breast thickness or density.

Performance Measurement and Target-Setting in California's Safety Net Health Systems.

PubMed

Hemmat, Shirin; Schillinger, Dean; Lyles, Courtney; Ackerman, Sara; Gourley, Gato; Vittinghoff, Eric; Handley, Margaret; Sarkar, Urmimala

Health policies encourage implementing quality measurement with performance targets. The 2010-2015 California Medicaid waiver mandated quality measurement and reporting. In 2013, California safety net hospitals participating in the waiver set a voluntary performance target (the 90th percentile for Medicare preferred provider organization plans) for mammography screening and cholesterol control in diabetes. They did not reach the target, and the difference-in-differences analysis suggested that there was no difference for mammography ( P = .39) and low-density lipoprotein control ( P = .11) performance compared to measures for which no statewide quality improvement initiative existed. California's Medicaid waiver was associated with improved performance on a number of metrics, but this performance was not attributable to target setting on specific health conditions. Performance may have improved because of secular trends or systems improvements related to waiver funding. Relying on condition-specific targets to measure performance may underestimate improvements and disadvantage certain health systems. Achieving ambitious targets likely requires sustained fiscal, management, and workforce investments.

[Efficacy of storage phosphor-based digital mammography in diagnosis of breast cancer--comparison with film-screen mammography].

PubMed

Kitahama, H

1991-05-25

The aim of this study is to present efficacy of storage phosphor-based digital mammography (CR-mammography) in diagnosis of breast cancer. Ninety-seven cases with breast cancer including 44 cases less than 2 cm in macroscopic size (t1 cases) were evaluated using storage phosphor-based digital mammography (2000 x 2510 pixels by 10 bits). Abnormal findings on CR-mammography were detected in 86 cases (88.7%) of 97 women with breast cancer. Sensitivity of CR-mammography was 88.7%. It was superior to that of film-screen mammography. On t1 breast cancer cases, sensitivity on CR-mammography was 88.6%. False negative rate in t1 breast cancer cases was reduced by image processing using CR-mammography. To evaluate microcalcifications, CR-mammograms and film-screen mammograms were investigated in 22 cases of breast cancer proven pathologically the existence of microcalcifications and 11 paraffin tissue blocks of breast cancer. CR-mammography was superior to film-screen mammography in recognizing of microcalcifications. As regards the detectability for the number and the shape of microcalcifications, CR-mammography was equivalent to film-screen mammography. Receiver operating characteristic (ROC) analysis by eight observers was performed for CR-mammography and film-screen mammography with 54 breast cancer patients and 54 normal cases. The detectability of abnormal findings of breast cancer on CR-mammography (ROC area = 0.91) was better than that on film-screen mammography (ROC area = 0.88) (p less than 0.05). Efficacy of storage phosphor-based digital mammography in diagnosis of breast cancer was discussed and demonstrated in this study.

Utilization of breast cancer screening methods in a developing nation: results from a nationally representative sample of Malaysian households.

PubMed

Dunn, Richard A; Tan, Andrew K G

2011-01-01

As is the case in many developing nations, previous studies of breast cancer screening behavior in Malaysia have used relatively small samples that are not nationally representative, thereby limiting the generalizability of results. Therefore, this study uses nationally representative data from the Malaysia Non-Communicable Disease Surveillance-1 to investigate the role of socio-economic status on breast cancer screening behavior in Malaysia, particularly differences in screening behaviour between ethnic groups. The decisions of 816 women above age 40 in Malaysia to screen for breast cancer using mammography, clinical breast exams (CBE), and breast self-exams (BSE) are modeled using logistic regression. Results indicate that after adjusting for differences in age, education, household income, marital status, and residential location, Malay women are less likely than Chinese and Indian women to utilize mammography, but more likely to perform BSE. Education level and urban residence are positively associated with utilization of each method, but these relationships vary across ethnicity. Higher education levels are strongly related to using each screening method among Chinese women, but have no statistically significant relationship to screening among Malays. © 2011 Wiley Periodicals, Inc.

Analysis of utilization patterns and associated costs of the breast imaging and diagnostic procedures after screening mammography.

PubMed

Vlahiotis, Anna; Griffin, Brian; Stavros, A Thomas; Margolis, Jay

2018-01-01

Little data exist on real-world patterns and associated costs of downstream breast diagnostic procedures following an abnormal screening mammography or clinical exam. To analyze the utilization patterns in real-world clinical settings for breast imaging and diagnostic procedures, including the frequency and volume of patients and procedures, procedure sequencing, and associated health care expenditures. Using medical claims from 2011 to 2015 MarketScan Commercial and Medicare Databases, adult females with breast imaging/diagnostic procedures (diagnostic mammography, ultrasound, molecular breast imaging, tomosynthesis, magnetic resonance imaging, or biopsy) other than screening mammography were selected. Continuous health plan coverage without breast diagnostic procedures was required for ≥13 months before the first found breast diagnostic procedure (index event), with a 13-month post-index follow-up period. Key outcomes included diagnostic procedure volumes, sequences, and payments. Results reported descriptively were projected to provide US national patient and procedure volumes. The final sample of 875,526 patients was nationally projected to 12,394,432 patients annually receiving 8,732,909 diagnostic mammograms (53.3% of patients), 6,987,399 breast ultrasounds (42.4% of patients), and 1,585,856 biopsies (10.3% of patients). Following initial diagnostic procedures, 49.4% had second procedures, 20.1% followed with third procedures, and 10.0% had a fourth procedure. Mean (SD) costs for diagnostic mammograms of US$349 ($493), ultrasounds US$132 ($134), and biopsies US$1,938 ($2,343) contributed US$3.05 billion, US$0.92 billion, and US$3.07 billion, respectively, to annual diagnostic breast expenditures estimated at US$7.91 billion. The volume and expense of additional breast diagnostic testing, estimated at US$7.91 billion annually, underscores the need for technological improvements in the breast diagnostic landscape.

A national cross-sectional study of adherence to timely mammography use in Malta.

PubMed

Marmarà, Danika; Marmarà, Vincent; Hubbard, Gill

2018-03-27

Routine mammography improves survival. To achieve health benefits, women must attend breast screening regularly at recommended time intervals. Maltese women are routinely invited to undergo mammography at three-year intervals at an organized breast screening programme (MBSP) or can opt to attend a private clinic. Previous research shows that health beliefs, particularly perceived barriers, were the most significant predictors of uptake to the first MBSP invitation. Whether these beliefs and other factors are predictive of adherence with recommended time intervals for mammography at organized or private screening in Malta is unknown. For the first time, this paper explores the predictors for Maltese women screened within or exceeding the recommended three-year frequency in organized or private screening in Malta. Information was obtained from a cross-sectional survey of 404 women, aged 50 to 60 years at the time of their first MBSP invitation, where women's characteristics, knowledge, health beliefs and illness perceptions were compared. The main variable of interest was women's mammography attendance within a three-year interval (ADHERENT) or exceeding three years (NON-ADHERENT). Data were analysed using descriptive statistics, chi-square test, Mann Whitney test, Independent Samples t-test and Shapiro Wilk test. At the time of the survey, 80.2% (n = 324) had been screened within three years (ADHERENT), 5.9% (n = 24) had exceeded the three-year frequency (NON-ADHERENT) while 13.9% (n = 56) never had a mammogram. No significant associations were found between ADHERENT or NON-ADHERENT women in relation to sociodemographic or health status variables (p > 0.05). Knowledge of screening frequency was significantly associated with women's mammography adherence (χ2 = 5.5, p = 0.020). Health beliefs were the strongest significant predictors to describe the variance between ADHERENT and NON-ADHERENT screeners. When Mann Whitney test and Independent Samples t-test were applied on mammography adherence, perceived barriers and cues to action were found to be the most important predictors (p = 0.000, p = 0.039 respectively). To increase routine and timely mammography practices, women who are non-adherent to recommended time frequency guidelines should be targeted, together with their health beliefs, predominantly perceived barriers and cues to action.

Trends in mammography utilization for breast cancer screening in a Middle-Eastern country: Lebanon 2005-2013.

PubMed

Haddad, Fady G; Kourie, Hampig Raphael; Adib, Salim M

2015-12-01

In Lebanon, annual national breast awareness campaigns were started in 2002 during the international breast month of October to promote the utilization of mammography for women aged ≥ 40. The impact of the campaigns has been assessed periodically since 2003. Results of 2003-2005 campaigns have been published previously. To measure the prevalence of two behavioral outcomes of interest: ever-use of mammography, and repeat mammography in the previous 12 months among ever-users. The prevalence was described by region and age group. The aim was to document the effectiveness of the program towards reaching a nationally defined goal of 80% screening coverage. The survey's sampling frame was developed incrementally, and since 2005 it has included women aged ≥ 40 from all areas of Lebanon. The sample size has also increased incrementally from 1200 in 2005 to 2400 in 2013. Results have been tabulated biannually and presented as historical trends with regional and demographic variations covering a 9-year period. In all six consecutive surveys presented here, the mean age of participating women was about 50 years. Year-by-year increases in utilization indicators were detected, with consistent differences in favor of the more urban areas in and around the capital city Beirut and its suburbs (Greater Beirut or GB). By 2013, ever-utilization had reached 43% (41-45) and recent mammography 20% (18-22) nationwide. Utilization was significantly more important in the age group 50-59 compared with the age group 40-49 or ≥ 60. While recent rates have increased nationwide, they have reached a plateau of about 25% in GB and are tending to the same level in other areas. While initial progress was slow, it has been accelerating in the last 4-5 years, indicating that the message is being accepted by a larger audience of targeted women at each iteration. However, concern remains that women between 40 and 50 and those >60 are not responding as well as desired to the screening message, for reasons currently under investigation. Copyright © 2015 Elsevier Ltd. All rights reserved.

National Performance Benchmarks for Modern Screening Digital Mammography: Update from the Breast Cancer Surveillance Consortium.

PubMed

Lehman, Constance D; Arao, Robert F; Sprague, Brian L; Lee, Janie M; Buist, Diana S M; Kerlikowske, Karla; Henderson, Louise M; Onega, Tracy; Tosteson, Anna N A; Rauscher, Garth H; Miglioretti, Diana L

2017-04-01

Purpose To establish performance benchmarks for modern screening digital mammography and assess performance trends over time in U.S. community practice. Materials and Methods This HIPAA-compliant, institutional review board-approved study measured the performance of digital screening mammography interpreted by 359 radiologists across 95 facilities in six Breast Cancer Surveillance Consortium (BCSC) registries. The study included 1 682 504 digital screening mammograms performed between 2007 and 2013 in 792 808 women. Performance measures were calculated according to the American College of Radiology Breast Imaging Reporting and Data System, 5th edition, and were compared with published benchmarks by the BCSC, the National Mammography Database, and performance recommendations by expert opinion. Benchmarks were derived from the distribution of performance metrics across radiologists and were presented as 50th (median), 10th, 25th, 75th, and 90th percentiles, with graphic presentations using smoothed curves. Results Mean screening performance measures were as follows: abnormal interpretation rate (AIR), 11.6 (95% confidence interval [CI]: 11.5, 11.6); cancers detected per 1000 screens, or cancer detection rate (CDR), 5.1 (95% CI: 5.0, 5.2); sensitivity, 86.9% (95% CI: 86.3%, 87.6%); specificity, 88.9% (95% CI: 88.8%, 88.9%); false-negative rate per 1000 screens, 0.8 (95% CI: 0.7, 0.8); positive predictive value (PPV) 1, 4.4% (95% CI: 4.3%, 4.5%); PPV2, 25.6% (95% CI: 25.1%, 26.1%); PPV3, 28.6% (95% CI: 28.0%, 29.3%); cancers stage 0 or 1, 76.9%; minimal cancers, 57.7%; and node-negative invasive cancers, 79.4%. Recommended CDRs were achieved by 92.1% of radiologists in community practice, and 97.1% achieved recommended ranges for sensitivity. Only 59.0% of radiologists achieved recommended AIRs, and only 63.0% achieved recommended levels of specificity. Conclusion The majority of radiologists in the BCSC surpass cancer detection recommendations for screening mammography; however, AIRs continue to be higher than the recommended rate for almost half of radiologists interpreting screening mammograms. © RSNA, 2016 Online supplemental material is available for this article.

Contrast-detail phantom scoring methodology.

PubMed

Thomas, Jerry A; Chakrabarti, Kish; Kaczmarek, Richard; Romanyukha, Alexander

2005-03-01

Published results of medical imaging studies which make use of contrast detail mammography (CDMAM) phantom images for analysis are difficult to compare since data are often not analyzed in the same way. In order to address this situation, the concept of ideal contrast detail curves is suggested. The ideal contrast detail curves are constructed based on the requirement of having the same product of the diameter and contrast (disk thickness) of the minimal correctly determined object for every row of the CDMAM phantom image. A correlation and comparison of five different quality parameters of the CDMAM phantom image determined for obtained ideal contrast detail curves is performed. The image quality parameters compared include: (1) contrast detail curve--a graph correlation between "minimal correct reading" diameter and disk thickness; (2) correct observation ratio--the ratio of the number of correctly identified objects to the actual total number of objects multiplied by 100; (3) image quality figure--the sum of the product of the diameter of the smallest scored object and its relative contrast; (4) figure-of-merit--the zero disk diameter value obtained from extrapolation of the contrast detail curve to the origin (e.g., zero disk diameter); and (5) k-factor--the product of the thickness and the diameter of the smallest correctly identified disks. The analysis carried out showed the existence of a nonlinear relationship between the above parameters, which means that use of different parameters of CDMAM image quality potentially can cause different conclusions about changes in image quality. Construction of the ideal contrast detail curves for CDMAM phantom is an attempt to determine the quantitative limits of the CDMAM phantom as employed for image quality evaluation. These limits are determined by the relationship between certain parameters of a digital mammography system and the set of the gold disks sizes in the CDMAM phantom. Recommendations are made on selections of CDMAM phantom regions which should be used for scoring at different image quality and which scoring methodology may be most appropriate. Special attention is also paid to the use of the CDMAM phantom for image quality assessment of digital mammography systems particularly in the vicinity of the Nyquist frequency.

Breast Cancer Screening and Social Media: a Content Analysis of Evidence Use and Guideline Opinions on Twitter.

PubMed

Nastasi, Anthony; Bryant, Tyler; Canner, Joseph K; Dredze, Mark; Camp, Melissa S; Nagarajan, Neeraja

2018-06-01

There is ongoing debate regarding the best mammography screening practices. Twitter has become a powerful tool for disseminating medical news and fostering healthcare conversations; however, little work has been done examining these conversations in the context of how users are sharing evidence and discussing current guidelines for breast cancer screening. To characterize the Twitter conversation on mammography and assess the quality of evidence used as well as opinions regarding current screening guidelines, individual tweets using mammography-related hashtags were prospectively pulled from Twitter from 5 November 2015 to 11 December 2015. Content analysis was performed on the tweets by abstracting data related to user demographics, content, evidence use, and guideline opinions. Standard descriptive statistics were used to summarize the results. Comparisons were made by demographics, tweet type (testable claim, advice, personal experience, etc.), and user type (non-healthcare, physician, cancer specialist, etc.). The primary outcomes were how users are tweeting about breast cancer screening, the quality of evidence they are using, and their opinions regarding guidelines. The most frequent user type of the 1345 tweets was "non-healthcare" with 323 tweets (32.5%). Physicians had 1.87 times higher odds (95% CI, 0.69-5.07) of providing explicit support with a reference and 11.70 times higher odds (95% CI, 3.41-40.13) of posting a tweet likely to be supported by the scientific community compared to non-healthcare users. Only 2.9% of guideline tweets approved of the guidelines while 14.6% claimed to be confused by them. Non-healthcare users comprise a significant proportion of participants in mammography conversations, with tweets often containing claims that are false, not explicitly backed by scientific evidence, and in favor of alternative "natural" breast cancer prevention and treatment. Furthermore, users appear to have low approval and confusion regarding screening guidelines. These findings suggest that more efforts are needed to educate and disseminate accurate information to the general public regarding breast cancer prevention modalities, emphasizing the safety of mammography and the harms of replacing conventional prevention and treatment modalities with unsubstantiated alternatives.

Can data-driven benchmarks be used to set the goals of healthy people 2010?

PubMed Central

Allison, J; Kiefe, C I; Weissman, N W

1999-01-01

OBJECTIVES: Expert panels determined the public health goals of Healthy People 2000 subjectively. The present study examined whether data-driven benchmarks provide a better alternative. METHODS: We developed the "pared-mean" method to define from data the best achievable health care practices. We calculated the pared-mean benchmark for screening mammography from the 1994 National Health Interview Survey, using the metropolitan statistical area as the "provider" unit. Beginning with the best-performing provider and adding providers in descending sequence, we established the minimum provider subset that included at least 10% of all women surveyed on this question. The pared-mean benchmark is then the proportion of women in this subset who received mammography. RESULTS: The pared-mean benchmark for screening mammography was 71%, compared with the Healthy People 2000 goal of 60%. CONCLUSIONS: For Healthy People 2010, benchmarks derived from data reflecting the best available care provide viable alternatives to consensus-derived targets. We are currently pursuing additional refinements to the data-driven pared-mean benchmark approach. PMID:9987466

Complete internal audit of a mammography service in a reference institution for breast imaging.

PubMed

Badan, Gustavo Machado; Roveda Júnior, Décio; Ferreira, Carlos Alberto Pecci; de Noronha Junior, Ozeas Alves

2014-01-01

Undertaking of a complete audit of the service of mammography, as recommended by BI-RADS(®), in a private reference institution for breast cancer diagnosis in the city of São Paulo, SP, Brazil, and comparison of results with those recommended by the literature. Retrospective, analytical and cross-sectional study including 8,000 patients submitted to mammography in the period between April 2010 and March 2011, whose results were subjected to an internal audit. The patients were followed-up until December 2012. The radiological classification of 7,249 screening mammograms, according to BI-RADS, was the following: category 0 (1.43%), 1 (7.82%), 2 (80.76%), 3 (8.35%), 4 (1.46%), 5 (0.15%) and 6 (0.03%). The breast cancer detection ratio was 4.8 cases per 1,000 mammograms. Ductal carcinoma in situ was found in 22.8% of cases. Positive predictive values for categories 3, 4 and 5 were 1.3%, 41.3% and 100%, respectively. In the present study, the sensitivity of the method was 97.1% and specificity, 97.4%. The complete internal audit of a service of mammography is essential to evaluate the quality of such service, which reflects on an early breast cancer detection and reduction of mortality rates.

Cost-effectiveness of alternative strategies for integrating MRI into breast cancer screening for women at high risk.

PubMed

Ahern, C H; Shih, Y-C T; Dong, W; Parmigiani, G; Shen, Y

2014-10-14

Magnetic resonance imaging (MRI) is recommended for women at high risk for breast cancer. We evaluated the cost-effectiveness of alternative screening strategies involving MRI. Using a microsimulation model, we generated life histories under different risk profiles, and assessed the impact of screening on quality-adjusted life-years, and lifetime costs, both discounted at 3%. We compared 12 screening strategies combining annual or biennial MRI with mammography and clinical breast examination (CBE) in intervals of 0.5, 1, or 2 years vs without, and reported incremental cost-effectiveness ratios (ICERs). Based on an ICER threshold of $100,000/QALY, the most cost-effective strategy for women at 25% lifetime risk was to stagger MRI and mammography plus CBE every year from age 30 to 74, yielding ICER $58,400 (compared to biennial MRI alone). At 50% lifetime risk and with 70% reduction in MRI cost, the recommended strategy was to stagger MRI and mammography plus CBE every 6 months (ICER=$84,400). At 75% lifetime risk, the recommended strategy is biennial MRI combined with mammography plus CBE every 6 months (ICER=$62,800). The high costs of MRI and its lower specificity are limiting factors for annual screening schedule of MRI, except for women at sufficiently high risk.

Modeling and simulation of Positron Emission Mammography (PEM) based on double-sided CdTe strip detectors

NASA Astrophysics Data System (ADS)

Ozsahin, I.; Unlu, M. Z.

2014-03-01

Breast cancer is the most common leading cause of cancer death among women. Positron Emission Tomography (PET) Mammography, also known as Positron Emission Mammography (PEM), is a method for imaging primary breast cancer. Over the past few years, PEMs based on scintillation crystals dramatically increased their importance in diagnosis and treatment of early stage breast cancer. However, these detectors have significant limitations like poor energy resolution resulting with false-negative result (missed cancer), and false-positive result which leads to suspecting cancer and suggests an unnecessary biopsy. In this work, a PEM scanner based on CdTe strip detectors is simulated via the Monte Carlo method and evaluated in terms of its spatial resolution, sensitivity, and image quality. The spatial resolution is found to be ~ 1 mm in all three directions. The results also show that CdTe strip detectors based PEM scanner can produce high resolution images for early diagnosis of breast cancer.

News media coverage of a women's health contraversy: how newspapers and TV outlets covered a recent debate over screening mammography.

PubMed

Steele, Whitney Randolph; Mebane, Felicia; Viswanath, K; Solomon, Janice

2005-01-01

Over the past decade, there have been several highly visible debates about mammography that have captured professional, public and media attention. This paper looks at newspaper and television news coverage of a controversial research letter in The Lancet by Gøtzsche and Olsen (2001) that concluded that screening mammography did not prevent deaths from breast cancer. The news pieces examined for this project were published between October 2001 and March 2002 in one of eight U.S. newspapers or aired on one of six national or cable news networks. The six-month period was divided into one-week segments; the numbers of articles published or stories aired in each week were graphed to examine patterns. Each newspaper article and television transcript was then reviewed to identify its main content area and the amount of coverage for each major event was quantified. The highest number of newspaper articles appeared to result from several events during the end of January through the beginning of February. These events included the publication of another meta-analysis of mammography that disputed the original letter's conclusion and a full-page New York Times advertisement paid for by major medical organizations stating their continued support for mammography. The greatest amount of television news coverage was devoted to the announcement of the official federal guidelines by the Secretary of Health and Human Services in late February. We conclude by discussing how the flow of news coverage of medical controversies can potentially impact the actions and reactions of the public, the medical community and health policy makers.

Configuration of automatic exposure control on mammography units for computed radiography to match patient dose of screen film systems

NASA Astrophysics Data System (ADS)

Yang, Chang-Ying Joseph; Huang, Weidong

2009-02-01

Computed radiography (CR) is considered a drop-in addition or replacement for traditional screen-film (SF) systems in digital mammography. Unlike other technologies, CR has the advantage of being compatible with existing mammography units. One of the challenges, however, is to properly configure the automatic exposure control (AEC) on existing mammography units for CR use. Unlike analogue systems, the capture and display of digital CR images is decoupled. The function of AEC is changed from ensuring proper and consistent optical density of the captured image on film to balancing image quality with patient dose needed for CR. One of the preferences when acquiring CR images under AEC is to use the same patient dose as SF systems. The challenge is whether the existing AEC design and calibration process-most of them proprietary from the X-ray systems manufacturers and tailored specifically for SF response properties-can be adapted for CR cassettes, in order to compensate for their response and attenuation differences. This paper describes the methods for configuring the AEC of three different mammography units models to match the patient dose used for CR with those that are used for a KODAK MIN-R 2000 SF System. Based on phantom test results, these methods provide the dose level under AEC for the CR systems to match with the dose of SF systems. These methods can be used in clinical environments that require the acquisition of CR images under AEC at the same dose levels as those used for SF systems.

An adaptive algorithm for the detection of microcalcifications in simulated low-dose mammography.

PubMed

Treiber, O; Wanninger, F; Führ, H; Panzer, W; Regulla, D; Winkler, G

2003-02-21

This paper uses the task of microcalcification detection as a benchmark problem to assess the potential for dose reduction in x-ray mammography. We present the results of a newly developed algorithm for detection of microcalcifications as a case study for a typical commercial film-screen system (Kodak Min-R 2000/2190). The first part of the paper deals with the simulation of dose reduction for film-screen mammography based on a physical model of the imaging process. Use of a more sensitive film-screen system is expected to result in additional smoothing of the image. We introduce two different models of that behaviour, called moderate and strong smoothing. We then present an adaptive, model-based microcalcification detection algorithm. Comparing detection results with ground-truth images obtained under the supervision of an expert radiologist allows us to establish the soundness of the detection algorithm. We measure the performance on the dose-reduced images in order to assess the loss of information due to dose reduction. It turns out that the smoothing behaviour has a strong influence on detection rates. For moderate smoothing. a dose reduction by 25% has no serious influence on the detection results. whereas a dose reduction by 50% already entails a marked deterioration of the performance. Strong smoothing generally leads to an unacceptable loss of image quality. The test results emphasize the impact of the more sensitive film-screen system and its characteristics on the problem of assessing the potential for dose reduction in film-screen mammography. The general approach presented in the paper can be adapted to fully digital mammography.

An adaptive algorithm for the detection of microcalcifications in simulated low-dose mammography

NASA Astrophysics Data System (ADS)

Treiber, O.; Wanninger, F.; Führ, H.; Panzer, W.; Regulla, D.; Winkler, G.

2003-02-01

This paper uses the task of microcalcification detection as a benchmark problem to assess the potential for dose reduction in x-ray mammography. We present the results of a newly developed algorithm for detection of microcalcifications as a case study for a typical commercial film-screen system (Kodak Min-R 2000/2190). The first part of the paper deals with the simulation of dose reduction for film-screen mammography based on a physical model of the imaging process. Use of a more sensitive film-screen system is expected to result in additional smoothing of the image. We introduce two different models of that behaviour, called moderate and strong smoothing. We then present an adaptive, model-based microcalcification detection algorithm. Comparing detection results with ground-truth images obtained under the supervision of an expert radiologist allows us to establish the soundness of the detection algorithm. We measure the performance on the dose-reduced images in order to assess the loss of information due to dose reduction. It turns out that the smoothing behaviour has a strong influence on detection rates. For moderate smoothing, a dose reduction by 25% has no serious influence on the detection results, whereas a dose reduction by 50% already entails a marked deterioration of the performance. Strong smoothing generally leads to an unacceptable loss of image quality. The test results emphasize the impact of the more sensitive film-screen system and its characteristics on the problem of assessing the potential for dose reduction in film-screen mammography. The general approach presented in the paper can be adapted to fully digital mammography.

Improvement of early detection of breast cancer through collaborative multi-country efforts: Medical physics component.

PubMed

Mora, Patricia; Faulkner, Keith; Mahmoud, Ahmed M; Gershan, Vesna; Kausik, Aruna; Zdesar, Urban; Brandan, María-Ester; Kurt, Serap; Davidović, Jasna; Salama, Dina H; Aribal, Erkin; Odio, Clara; Chaturvedi, Arvind K; Sabih, Zahida; Vujnović, Saša; Paez, Diana; Delis, Harry

2018-04-01

The International Atomic Energy Agency (IAEA) through a Coordinated Research Project on "Enhancing Capacity for Early Detection and Diagnosis of Breast Cancer through Imaging", brought together a group of mammography radiologists, medical physicists and radiographers; to investigate current practices and improve procedures for the early detection of breast cancer by strengthening both the clinical and medical physics components. This paper addresses the medical physics component. The countries that participated in the CRP were Bosnia and Herzegovina, Costa Rica, Egypt, India, Kenya, the Frmr. Yug. Rep. of Macedonia, Mexico, Nigeria, Pakistan, Philippines, Slovenia, Turkey, Uganda, United Kingdom and Zambia. Ten institutions participated using IAEA quality control protocols in 9 digital and 3 analogue mammography equipment. A spreadsheet for data collection was generated and distributed. Evaluation of image quality was done using TOR MAX and DMAM2 Gold phantoms. QC results for analogue equipment showed satisfactory results. QC tests performed on digital systems showed that improvements needed to be implemented, especially in thickness accuracy, signal difference to noise ratio (SDNR) values for achievable levels, uniformity and modulation transfer function (MTF). Mean glandular dose (MGD) was below international recommended levels for patient radiation protection. Evaluation of image quality by phantoms also indicated the need for improvement. Common activities facilitated improvement in mammography practice, including training of medical physicists in QC programs and infrastructure was improved and strengthened; networking among medical physicists and radiologists took place and was maintained over time. IAEA QC protocols provided a uniformed approach to QC measurements. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Comparative effectiveness of incorporating a hypothetical DCIS prognostic marker into breast cancer screening.

PubMed

Trentham-Dietz, Amy; Ergun, Mehmet Ali; Alagoz, Oguzhan; Stout, Natasha K; Gangnon, Ronald E; Hampton, John M; Dittus, Kim; James, Ted A; Vacek, Pamela M; Herschorn, Sally D; Burnside, Elizabeth S; Tosteson, Anna N A; Weaver, Donald L; Sprague, Brian L

2018-02-01

Due to limitations in the ability to identify non-progressive disease, ductal carcinoma in situ (DCIS) is usually managed similarly to localized invasive breast cancer. We used simulation modeling to evaluate the potential impact of a hypothetical test that identifies non-progressive DCIS. A discrete-event model simulated a cohort of U.S. women undergoing digital screening mammography. All women diagnosed with DCIS underwent the hypothetical DCIS prognostic test. Women with test results indicating progressive DCIS received standard breast cancer treatment and a decrement to quality of life corresponding to the treatment. If the DCIS test indicated non-progressive DCIS, no treatment was received and women continued routine annual surveillance mammography. A range of test performance characteristics and prevalence of non-progressive disease were simulated. Analysis compared discounted quality-adjusted life years (QALYs) and costs for test scenarios to base-case scenarios without the test. Compared to the base case, a perfect prognostic test resulted in a 40% decrease in treatment costs, from $13,321 to $8005 USD per DCIS case. A perfect test produced 0.04 additional QALYs (16 days) for women diagnosed with DCIS, added to the base case of 5.88 QALYs per DCIS case. The results were sensitive to the performance characteristics of the prognostic test, the proportion of DCIS cases that were non-progressive in the model, and the frequency of mammography screening in the population. A prognostic test that identifies non-progressive DCIS would substantially reduce treatment costs but result in only modest improvements in quality of life when averaged over all DCIS cases.

Development of a stationary digital breast tomosynthesis system for clinical applications

NASA Astrophysics Data System (ADS)

Tucker, Andrew Wallace

Digital breast tomosynthesis (DBT) has been shown to be a very beneficial tool in the fight against breast cancer. However, current DBT systems have poor spatial resolution compared to full field digital mammography (FFDM), the current gold standard for screening mammography. The poor spatial resolution of DBT systems is a result of the single X-ray source design. In DBT systems a single X-ray source is rotated over an angular span in order to acquire the images needed for 3D reconstruction. The rotation of the X-ray source degrades the spatial resolution of the images. DBT systems which are approved for use in the United States for screening mammography are required to also take a full field digital mammogram with every DBT acquisition in order to compensate for the poor spatial resolution. This double exposure essentially doubles the radiation dose to patients. Over the past few years our research group has developed a carbon nanotube (CNT) based X-ray source technology. The unique nature of CNT X-ray sources allows for multiple X-ray focal spots in a single X-ray source. Using this technology we have recently developed a stationary DBT system (s-DBT) system which is capable of producing a full tomosynthesis image dataset with zero motion of the X-ray source. This system has been shown to have increased spatial resolution over other DBT systems in a laboratory setting. The goal of this thesis work was to optimize the s-DBT system, demonstrate its usefulness over other systems, and finally implement it into the clinic for a clinical trial. The s-DBT system was optimized using different image quality measurements. The optimized system was then used in a breast specimen imaging trial which compared s-DBT to magnified 2D mammography and a conventional single source DBT system. Readers preferred s-DBT to magnified 2D mammography for specimen margin delineation and mass detection, these results were not significant. Using physical measures for spatial resolution the s-DBT system was shown to have improved image quality over conventional single source DBT systems in breast tissue. A separate study showed that s-DBT could be a feasible alternative to FFDM for screening patients with breast implants. Finally, a second s-DBT system was constructed and implemented into the Department of Mammography at UNC hospitals. The first patient was imaged on the system in December of 2013.

21 CFR 900.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... radiographic image of a phantom. (ll) Physical science means physics, chemistry, radiation science (including medical physics and health physics), and engineering. (mm) Positive mammogram means a mammogram that has... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MAMMOGRAPHY QUALITY...

Inequity of healthcare utilization on mammography examination and Pap smear screening in Thailand: Analysis of a population-based household survey

PubMed Central

2017-01-01

Healthcare in Thailand is not equally distributed, and not all people can equally access healthcare resources even if they are covered by health insurance. To examine factors associated with the utilization of mammography examination for breast cancer and Pap smear screening for cervical cancer, data from the national reproductive health survey conducted by the National Statistical Office of Thailand in 2009 was examined. The survey was carried out on 15,074,126 women aged 30–59 years. The results showed that the wealthier respondents had more mammograms than did the lower-income groups. The concentration index was 0.144. The data on Pap smears for cervical cancer also showed that the wealthier respondents were more likely to have had a Pap smear than their lower-income counterparts. The concentration index was 0.054. Determinants of mammography examination were education, followed by health welfare and wealth index, whereas the determinants of Pap smear screening were wealth index, followed by health welfare and education. The government should support greater education for women because education was associated with socioeconomic status and wealth. There should be an increase in the number of screening campaigns, mobile clinics, and low-cost mammograms and continued support for accessibility to mammograms, especially in rural areas and low-income communities. PMID:28282430

Digital mammography: more microcalcifications, more columnar cell lesions without atypia.

PubMed

Verschuur-Maes, Anoek H J; van Gils, Carla H; van den Bosch, Maurice A A J; De Bruin, Peter C; van Diest, Paul J

2011-09-01

The incidence of columnar cell lesions in breast core needle biopsies since full-field digital mammography in comparison with screen-filmed mammography was analyzed. As tiny microcalcifications characterize columnar cell lesions at mammography, we hypothesized that more columnar cell lesions are diagnosed since full-field digital mammography due to its higher sensitivity for microcalcifications. In all, 3437 breast core needle biopsies performed in three hospitals and resulting from in total 55 159 mammographies were revised: 1424 taken in the screen-filmed mammography and 2013 in the full-field digital mammography period. Between the screen-filmed mammography and full-field digital mammography periods, we compared the proportion of mammographies that led to core needle biopsies, the mammographic indication for core needle biopsies (density, microcalcifications, or both) and the proportion of columnar cell lesions with or without atypia. The columnar cell lesions were graded according to Schnitt, and we included atypical ductal hyperplasia arising in the context of columnar cell lesions. Proportions were compared using χ(2) tests and prevalence ratios were adjusted for age and hospital. We found that more core needle biopsies per mammogram were taken in the full-field digital mammography period (7.6%) compared with the screen-filmed mammography period (5.0%, P<0.0001). Microcalcifications were more often diagnosed with full-field digital mammography than with screen-filmed mammography (adjusted prevalence ratio: 1.14, confidence interval 95%: 1.01-1.28). Core needle biopsies from the full-field digital mammography era showed more columnar cell lesions (10.8%) than those from the screen-filmed mammography era (4.9%; adjusted prevalence ratio: 1.93, confidence interval 95%: 1.48-2.51), particularly due to more columnar cell lesions without atypia (8.2% respectively 2.8%) while the proportion of columnar cell lesions with atypia remained nearly constant (2.0 vs 2.6%). In conclusion, since the implementation of full-field digital mammography, more microcalcifications are seen at mammography, more often resulting in core needle biopsies, which especially yields more columnar cell lesions without atypia.

Molecular breast imaging using a dedicated high-performance instrument

NASA Astrophysics Data System (ADS)

O'Connor, Michael K.; Wagenaar, Douglas; Hruska, Carrie B.; Phillips, Stephen; Caravaglia, Gina; Rhodes, Deborah

2006-08-01

In women with radiographically dense breasts, the sensitivity of mammography is less than 50%. With the increase in the percent of women with dense breasts, it is important to look at alternative screening techniques for this population. This article reviews the strengths and weaknesses of current imaging techniques and focuses on recent developments in semiconductor-based gamma camera systems that offer significant improvements in image quality over that achievable with single-crystal sodium iodide systems. We have developed a technique known as Molecular Breast Imaging (MBI) using small field of view Cadmium Zinc Telluride (CZT) gamma cameras that permits the breast to be imaged in a similar manner to mammography, using light pain-free compression. Computer simulations and experimental studies have shown that use of low-energy high sensitivity collimation coupled with the excellent energy resolution and intrinsic spatial resolution of CZT detectors provides optimum image quality for the detection of small breast lesions. Preliminary clinical studies with a prototype dual-detector system have demonstrated that Molecular Breast Imaging has a sensitivity of ~90% for the detection of breast tumors less than 10 mm in diameter. By comparison, conventional scintimammography only achieves a sensitivity of 50% in the detection of lesions < 10 mm. Because Molecular Breast Imaging is not affected by breast density, this technique may offer an important adjunct to mammography in the evaluation of women with dense breast parenchyma.

CR digital mammography: an affordable entry.

PubMed

Fischer, Cathy

2006-01-01

CR full-field digital mammography (FFDM) has been used extensively in other countries, and it was one of the 4 digital mammography technologies employed in the Digital Mammographic Imaging Screening Trial. Affordability and easy integration with pre-existing mammography systems makes CR FFDM an attractive way to secure the advantages of filmless mammography imaging. CR mammography is true digital mammography--it is merely a different way of acquiring the image. The FDA has recently approved the first CR FFDM system for sale in the United States. At Gundersen Lutheran Health System (La Crosse, Wisconsin), CR FFDM is the most practical technology for realizing the potential everyday clinical benefits of filmless mammography imaging.

Breast screening using 2D-mammography or integrating digital breast tomosynthesis (3D-mammography) for single-reading or double-reading--evidence to guide future screening strategies.

PubMed

Houssami, Nehmat; Macaskill, Petra; Bernardi, Daniela; Caumo, Francesca; Pellegrini, Marco; Brunelli, Silvia; Tuttobene, Paola; Bricolo, Paola; Fantò, Carmine; Valentini, Marvi; Ciatto, Stefano

2014-07-01

We compared detection measures for breast screening strategies comprising single-reading or double-reading using standard 2D-mammography or 2D/3D-mammography, based on the 'screening with tomosynthesis or standard mammography' (STORM) trial. STORM prospectively examined screen-reading in two sequential phases, 2D-mammography alone and integrated 2D/3D-mammography, in asymptomatic women participating in Trento and Verona (Northern Italy) population-based screening services. Outcomes were ascertained from assessment and/or excision histology or follow-up. For each screen-reading strategy we calculated the number of detected and non-detected (including interval) cancers, cancer detection rates (CDRs), false positive recall (FPR) measures and incremental CDR relative to a comparator strategy. We estimated the false:true positive (FP:TP) ratio and sensitivity of each mammography screening strategy. Paired binary data were compared using McNemar's test. Amongst 7292 screening participants, there were 65 (including six interval) breast cancers; estimated first-year interval cancer rate was 0.82/1000 screens (95% confidence interval (CI): 0.30-1.79/1000). For single-reading, 35 cancers were detected at both 2D and 2D/3D-mammography, 20 cancers were detected only with 2D/3D-mammography compared with none at 2D-mammography alone (p<0.001) and 10 cancers were not detected. For double-reading, 39 cancers were detected at 2D-mammography and 2D/3D-mammography, 20 were detected only with 2D/3D-mammography compared with none detected at 2D-mammography alone (p<0.001) and six cancers were not detected. The incremental CDR attributable to 2D/3D-mammography (versus 2D-mammography) of 2.7/1000 screens (95% CI: 1.6-4.2) was evident for single and for double-reading. Incremental CDR attributable to double-reading (versus single-reading) of 0.55/1000 screens (95% CI: -0.02-1.4) was evident for 2D-mammography and for 2D/3D-mammography. Estimated FP:TP ratios showed that 2D/3D-mammography screening strategies had more favourable FP to TP trade-off and higher sensitivity, applying single-reading or double-reading, relative to 2D-mammography screening. The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Population-based mammography screening: comparison of screen-film and full-field digital mammography with soft-copy reading--Oslo I study.

PubMed

Skaane, Per; Young, Kari; Skjennald, Arnulf

2003-12-01

To compare screen-film and full-field digital mammography with soft-copy reading in a population-based screening program. Full-field digital and screen-film mammography were performed in 3,683 women aged 50-69 years. Two standard views of each breast were acquired with each modality. Images underwent independent double reading with use of a five-point rating scale for probability of cancer. Recall rates and positive predictive values were calculated. Cancer detection rates determined with both modalities were compared by using the McNemar test for paired proportions. Retrospective side-by-side analysis for conspicuity of cancers was performed by an external independent radiologist group with experience in both modalities. In 3,683 cases, 31 cancers were detected. Screen-film mammography depicted 28 (0.76%) malignancies, and full-field digital mammography depicted 23 (0.62%) malignancies. The difference between cancer detection rates was not significant (P =.23). The recall rate for full-field digital mammography (4.6%; 168 of 3,683 cases) was slightly higher than that for screen-film mammography (3.5%; 128 of 3,683 cases). The positive predictive value based on needle biopsy results was 46% for screen-film mammography and 39% for full-field digital mammography. Side-by-side image comparison for cancer conspicuity led to classification of 19 cancers as equal for probability of malignancy, six cancers as slightly better demonstrated at screen-film mammography, and six cancers as slightly better demonstrated at full-field digital mammography. There was no statistically significant difference in cancer detection rate between screen-film and full-field digital mammography. Cancer conspicuity was equal with both modalities. Full-field digital mammography with soft-copy reading is comparable to screen-film mammography in population-based screening.

Lack of nationwide Danish guidelines on mammography before non-oncological breast surgery.

PubMed

Foged, Thomas; Sørensen, Jens Ahm; Søe, Katrine Lydolph; Bille, Camilla

2015-05-01

Non-oncological breast surgery like breast reduction and mastopexy are often performed in younger patients, i.e. in women who have not yet had mammography. Breast cancer is, however, a very frequent disease that is increasingly prevalent in women below 50 years of age. Occult breast cancer may not be recognised before breast surgery, which may result in several disadvantages for the women. Therefore, detecting a breast cancer before a woman undergoes non-oncological breast surgery is of paramount importance. All public plastic surgery and breast surgery departments and all private clinics or hospitals providing plastic surgery were asked two questions: 1) When do you recommend a mammography prior to non-oncological breast surgery? 2) How old must a mammogram be before it needs to be repeated? Answers were received from all plastic surgery and breast surgery departments, and all but three of the private clinics and hospitals. Overall, information was obtained from 95.5% of the respondents (n = 63). Currently, there are no Danish guidelines on mammography before non-oncological breast surgery. A national guideline could recommend a preoperative mammogram from the age of 40 years stipulating that the mammogram should have been made within the past 12 months; however, the final recommendation should be prepared by a multidisciplinary working group counting experts from plastic surgery, breast surgery, pathology and radiology. not relevant. not relevant.

Toward a standard reference database for computer-aided mammography

NASA Astrophysics Data System (ADS)

Oliveira, Júlia E. E.; Gueld, Mark O.; de A. Araújo, Arnaldo; Ott, Bastian; Deserno, Thomas M.

2008-03-01

Because of the lack of mammography databases with a large amount of codified images and identified characteristics like pathology, type of breast tissue, and abnormality, there is a problem for the development of robust systems for computer-aided diagnosis. Integrated to the Image Retrieval in Medical Applications (IRMA) project, we present an available mammography database developed from the union of: The Mammographic Image Analysis Society Digital Mammogram Database (MIAS), The Digital Database for Screening Mammography (DDSM), the Lawrence Livermore National Laboratory (LLNL), and routine images from the Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen. Using the IRMA code, standardized coding of tissue type, tumor staging, and lesion description was developed according to the American College of Radiology (ACR) tissue codes and the ACR breast imaging reporting and data system (BI-RADS). The import was done automatically using scripts for image download, file format conversion, file name, web page and information file browsing. Disregarding the resolution, this resulted in a total of 10,509 reference images, and 6,767 images are associated with an IRMA contour information feature file. In accordance to the respective license agreements, the database will be made freely available for research purposes, and may be used for image based evaluation campaigns such as the Cross Language Evaluation Forum (CLEF). We have also shown that it can be extended easily with further cases imported from a picture archiving and communication system (PACS).

21 CFR 900.5 - Evaluation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MAMMOGRAPHY QUALITY... each accreditation body. Such evaluation shall include an assessment of the reports of FDA or State inspections of facilities accredited by the body as well as any additional information deemed relevant by FDA...

21 CFR 900.5 - Evaluation.

Code of Federal Regulations, 2011 CFR

2011-04-01

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MAMMOGRAPHY QUALITY... each accreditation body. Such evaluation shall include an assessment of the reports of FDA or State inspections of facilities accredited by the body as well as any additional information deemed relevant by FDA...

The interaction of perceived risk and benefits and its relationship to predicting mammography adherence in African-American women

PubMed Central

Fair, Alecia Malin; Monahan, Patrick O.; Russell, Kathleen; Zhao, Qianqian; Champion, Victoria L.

2013-01-01

PURPOSE/OBJECTIVES To test the interaction of perceived risk and benefits on stage of mammography readiness and adherence. DESIGN Cross-sectional study SETTING Community gathering places and health care clinics across a Midwestern state. SAMPLE 299 African-American women who had not had a mammogram in ≥ 18 months. METHODS In-person interviews were used to collect data on sociodemographics, health belief variables and stage of readiness to undertake mammography screening. Four categories were created to measure the combined magnitude of high/low levels of perceived risk and benefit with health belief variables linked to modifying mammography screening behavior. MAIN RESEARCH VARIABLES Perceived risks and benefits, stage of readiness, mammography adherence. FINDINGS The lowest rate of mammography adherence was in women with a high perceived risk and low benefit towards mammography adherence (25.6) compared to women with a high perceived benefit and low risk towards mammography adherence (46.0). Differences in mammography adherence were statistically significant between these groups p=(0.009). CONCLUSIONS The interaction of high perceived risk and low benefits additively effected readiness to undertake screening mammography. IMPLICATIONS FOR NURSING Reducing disparities in breast cancer diagnosis and survival requires timely and efficient mammography adherence. Minority, medically underserved women with perceived high risk and low benefits exhibit immobilization to move forward with mammography adherence when they experience higher perceived risk. Further interventions to increase the perception of benefit of mammography are recommended to reduce breast cancer mortality. PMID:22201655

Mammography decision making: Trends and predictors of provider communication in the Health Information National Trends Survey, 2011 to 2014.

PubMed

Spring, Laura M; Marshall, Megan R; Warner, Erica T

2017-02-01

In 2009, the US Preventive Services Task Force recommended that the decision to initiate screening mammography before age 50 years should be individualized. Herein, the authors examined whether health care providers are communicating regarding mammography decision making with women and whether communication is associated with screening behavior. Data were drawn from the 2011 to 2014 Health Information National Trends Survey (HINTS). A total of 5915 female respondents aged ≥ 40 years who responded to the following question were included: "Has a doctor or other health professional ever told you that you could choose whether or not to have a mammogram?" We used logistic regression to generate odds ratios (ORs) and 95% confidence intervals (95% CIs) for predictors of provider communication and assessed whether provider communication was associated with mammography in the previous 2 years overall and stratified by age. Fewer than 50% of the women reported provider communication regarding mammogram choice. Women who reported provider communication were not found to be more likely to report no mammogram within the past 2 years (OR, 1.07; 95% CI, 0.87-1.31) compared with those who did not. When stratified by 10-year age group, provider communication was associated with a higher likelihood of no mammogram only among women age ≥70 years (OR, 1.64; 95% CI, 1.15-2.34), and was associated with a lower likelihood of no mammogram only among women aged 40 to 49 years (OR, 0.63; 95% CI, 0.43-0.92). Between 2011 and 2014, less than one-half of women received communication regarding mammogram choice despite recommendations from the US Preventive Services Task Force. Provider communication regarding mammogram choice can influence screening behavior, particularly for younger and older women. Cancer 2017;123:401-409. © 2016 American Cancer Society. © 2016 American Cancer Society.

ACR BI-RADS Assessment Category 4 Subdivisions in Diagnostic Mammography: Utilization and Outcomes in the National Mammography Database.

PubMed

Elezaby, Mai; Li, Geng; Bhargavan-Chatfield, Mythreyi; Burnside, Elizabeth S; DeMartini, Wendy B

2018-05-01

Purpose To determine the utilization and positive predictive value (PPV) of the American College of Radiology (ACR) Breast Imaging Data and Reporting System (BI-RADS) category 4 subdivisions in diagnostic mammography in the National Mammography Database (NMD). Materials and Methods This study involved retrospective review of diagnostic mammography data submitted to the NMD from January 1, 2008 to December 30, 2014. Utilization rates of BI-RADS category 4 subdivisions were compared by year, facility (type, location, census region), and examination (indication, finding type) characteristics. PPV3 (positive predictive value for biopsies performed) was calculated overall and according to category 4 subdivision. The χ 2 test was used to test for significant associations. Results Of 1 309 950 diagnostic mammograms, 125 447 (9.6%) were category 4, of which 33.3% (41 841 of 125 447) were subdivided. Subdivision utilization rates were higher (P < .001) in practices that were community, suburban, or in the West; for examination indication of prior history of breast cancer; and for the imaging finding of architectural distortion. Of 41 841 category 4 subdivided examinations, 4A constituted 55.6% (23 258 of 41 841) of the examinations; 4B, 31.8% (13 302 of 41 841) of the examinations; and 4C, 12.6% (5281 of 41 841) of the examinations. Pathologic outcomes were available in 91 563 examinations, and overall category 4 PPV3 was 21.1% (19 285 of 91 563). There was a statistically significant difference in PPV3 according to category 4 subdivision (P < .001): The PPV of 4A was 7.6% (1274 of 16 784), that of 4B was 22% (2317 of 10 408), and that of 4C was 69.3% (2839 of 4099). Conclusion Although BI-RADS suggests their use, subdivisions were utilized in the minority (33.3% [41 841 of 125 447]) of category 4 diagnostic mammograms, with variability based on facility and examination characteristics. When subdivisions were used, PPV3s were in BI-RADS-specified malignancy ranges. This analysis supports the use of subdivisions in broad practice and, given benefits for patient care, should motivate increased utilization. © RSNA, 2018 Online supplemental material is available for this article.

X-ray light valve (XLV): a novel detectors' technology for digital mammography

NASA Astrophysics Data System (ADS)

Marcovici, Sorin; Sukhovatkin, Vlad; Oakham, Peter

2014-03-01

A novel method, based on X-ray Light Valve (XLV) technology, is proposed for making good image quality yet inexpensive flat panel detectors for digital mammography. The digital mammography markets, particularly in the developing countries, demand quality machines at substantially lower prices than the ones available today. Continuous pressure is applied on x-ray detectors' manufacturers to reduce the flat panel detectors' prices. XLV presents a unique opportunity to achieve the needed price - performance characteristics for direct conversion, x-ray detectors. The XLV based detectors combine the proven, superior, spatial resolution of a-Se with the simplicity and low cost of liquid crystals and optical scanning. The x-ray quanta absorbed by a 200 μm a-Se produce electron - hole pairs that move under an electric field to the top and bottom of a-Se layer. This 2D charge distribution creates at the interface with the liquid crystals a continuous (analog) charge image corresponding to the impinging radiation's information. Under the influence of local electrical charges next to them, the liquid crystals twist proportionally to the charges and vary their light reflectivity. A scanning light source illuminates the liquid crystals while an associated, pixilated photo-detector, having a 42 μm pixel size, captures the light reflected by the liquid crystals and converts it in16 bit words that are transmitted to the machine for image processing and display. The paper will describe a novel XLV, 25 cm x 30 cm, flat panel detector structure and its underlying physics as well as its preliminary performance measured on several engineering prototypes. In particular, the paper will present the results of measuring XLV detectors' DQE, MTF, dynamic range, low contrast resolution and dynamic behavior. Finally, the paper will introduce the new, low cost, XLV detector based, digital mammography machine under development at XLV Diagnostics Inc.

Family/friend recommendations and mammography intentions: the roles of perceived mammography norms and support

PubMed Central

Molina, Yamile; Ornelas, India J.; Doty, Sarah L.; Bishop, Sonia; Beresford, Shirley A. A.; Coronado, Gloria D.

2015-01-01

Identifying factors that increase mammography use among Latinas is an important public health priority. Latinas are more likely to report mammography intentions and use, if a family member or friend recommends that they get a mammogram. Little is known about the mechanisms underlying the relationship between social interactions and mammography intentions. Theory suggests that family/friend recommendations increase perceived mammography norms (others believe a woman should obtain a mammogram) and support (others will help her obtain a mammogram), which in turn increase mammography intentions and use. We tested these hypotheses with data from the ¡Fortaleza Latina! study, a randomized controlled trial including 539 Latinas in Washington State. Women whose family/friend recommended they get a mammogram within the last year were more likely to report mammography intentions, norms and support. Perceived mammography norms mediated the relationship between family/friend recommendations and intentions, Mediated Effect = 0.38, 95%CI [0.20, 0.61], but not support, Mediated Effect = 0.002, 95%CI [−0.07, 0.07]. Our findings suggest perceived mammography norms are a potential mechanism underlying the effect of family/friend recommendations on mammography use among Latinas. Our findings make an important contribution to theory about the associations of social interactions, perceptions and health behaviors. PMID:26324395

Technetium-99m sestamibi scintimammography complements mammography in the detection of breast cancer.

PubMed

Krishnaiah, Gayathri; Sher-Ahmed, Arifa; Ugwu-Dike, Martins; Regan, Patricia; Singer, John; Totoonchie, Adil; Spiegler, Ethan; Sardi, Armando

2003-01-01

Mammography remains the technique of choice for the detection of early breast cancer. The sensitivity of mammography is 85%, but is decreased in patients with dense breasts. Sestamibi scintimammography (SCM) has been suggested as an adjunctive modality to improve the detection of breast cancer. We conducted a study to determine the impact of SCM in patient management. A prospective study was conducted in 95 patients presenting with palpable masses and/or abnormal mammography scheduled for biopsy. Injection of 20-30 mCi of technetium-99m (Tc-99m) sestamibi into a pedal vein was performed. Ten-minute images of the breast and axilla were obtained in multiple projections. The mammography and SCM were correlated with pathology and clinical findings. The median age was 44 years (range 28-86 years). The total number of lesions was 104, as eight patients had bilateral lesions and one patient had two lesions in the same breast. Fifty-nine patients presented with palpable lesions and 45 patients with nonpalpable lesions (42 with abnormal mammography only and 3 with nipple discharge). A comparison of sensitivity, specificity, positive and negative predictive values, and overall accuracy of SCM and mammography were performed. The sensitivity and specificity for SCM were 83% and 83%, respectively, and for mammography were 65%, and 72%, respectively. The sensitivity and specificity for combined SCM and mammography were 87% and 94%, respectively. The p-value for mammography versus combined SCM and mammography was 0.0003 and that for SCM versus SCM and mammography was 0.0098. There were 80 (77%) benign and 24 (23%) malignant lesions. Of the 24 malignancies, SCM missed six (25%), versus eight (33%) by mammography. In two patients (9%) SCM detected malignancy in the breast that was not visualized by mammography or found on clinical examination. Sestamibi SCM improves the sensitivity of mammography and it detects up to 9% of malignancies not detected by mammography or clinical examination. This testing could impact the management of 16,500 patients in the United States every year. More studies are needed to better define its role in breast cancer detection.

The interaction of perceived risk and benefits and the relationship to predicting mammography adherence in African American women.

PubMed

Fair, Alecia Malin; Monahan, Patrick O; Russell, Kathleen; Zhao, Qianqian; Champion, Victoria L

2012-01-01

To test the interaction of perceived risk and benefits and how they impact stage of mammography readiness and adherence. Cross-sectional study. Community gathering centers and healthcare clinics across Indiana. 299 African American women who had not had a mammogram in more than 18 months. In-person interviews were used to collect data on sociodemographics, health belief variables, and stage of readiness to undertake mammography screening. Four categories were created to measure the combined magnitude of high or low levels of perceived risk and benefit, with health belief variables linked to modified mammography screening behavior. Perceived risks and benefits, stage of readiness, and mammography adherence. The lowest rate of mammography adherence was in women with a high perceived risk and low perceived benefit toward mammography adherence (26%). The highest rate of adherence was in women with a high perceived benefit and low perceived risk (46%). Differences in mammography adherence were statistically significant between the groups (p = 0.009). The interaction of high perceived risk and low perceived benefits impacted readiness to undergo screening mammography. Reducing disparities in breast cancer diagnosis and survival requires timely and efficient mammography adherence. African American medically underserved women with high perceived risk and low perceived benefits exhibited a reluctance to move forward with mammography adherence. Interventions are needed to increase the perception of mammography benefit and to subsequently reduce breast cancer mortality rates in that population.

Optimization of contrast-enhanced spectral mammography depending on clinical indication

PubMed Central

Dromain, Clarisse; Canale, Sandra; Saab-Puong, Sylvie; Carton, Ann-Katherine; Muller, Serge; Fallenberg, Eva Maria

2014-01-01

Abstract. The objective is to optimize low-energy (LE) and high-energy (HE) exposure parameters of contrast-enhanced spectral mammography (CESM) examinations in four different clinical applications for which different levels of average glandular dose (AGD) and ratios between LE and total doses are required. The optimization was performed on a Senographe DS with a SenoBright® upgrade. Simulations were performed to find the optima by maximizing the contrast-to-noise ratio (CNR) on the recombined CESM image using different targeted doses and LE image quality. The linearity between iodine concentration and CNR as well as the minimal detectable iodine concentration was assessed. The image quality of the LE image was assessed on the CDMAM contrast-detail phantom. Experiments confirmed the optima found on simulation. The CNR was higher for each clinical indication than for SenoBright®, including the screening indication for which the total AGD was 22% lower. Minimal iodine concentrations detectable in the case of a 3-mm-diameter round tumor were 12.5% lower than those obtained for the same dose in the clinical routine. LE image quality satisfied EUREF acceptable limits for threshold contrast. This newly optimized set of acquisition parameters allows increased contrast detectability compared to parameters currently used without a significant loss in LE image quality. PMID:26158058

Optimization of contrast-enhanced spectral mammography depending on clinical indication.

PubMed

Dromain, Clarisse; Canale, Sandra; Saab-Puong, Sylvie; Carton, Ann-Katherine; Muller, Serge; Fallenberg, Eva Maria

2014-10-01

The objective is to optimize low-energy (LE) and high-energy (HE) exposure parameters of contrast-enhanced spectral mammography (CESM) examinations in four different clinical applications for which different levels of average glandular dose (AGD) and ratios between LE and total doses are required. The optimization was performed on a Senographe DS with a SenoBright® upgrade. Simulations were performed to find the optima by maximizing the contrast-to-noise ratio (CNR) on the recombined CESM image using different targeted doses and LE image quality. The linearity between iodine concentration and CNR as well as the minimal detectable iodine concentration was assessed. The image quality of the LE image was assessed on the CDMAM contrast-detail phantom. Experiments confirmed the optima found on simulation. The CNR was higher for each clinical indication than for SenoBright®, including the screening indication for which the total AGD was 22% lower. Minimal iodine concentrations detectable in the case of a 3-mm-diameter round tumor were 12.5% lower than those obtained for the same dose in the clinical routine. LE image quality satisfied EUREF acceptable limits for threshold contrast. This newly optimized set of acquisition parameters allows increased contrast detectability compared to parameters currently used without a significant loss in LE image quality.

Diagnostic quality of 50 and 100 µm computed radiography compared with screen–film mammography in operative breast specimens

PubMed Central

Pagliari, C M; Hoang, T; Reddy, M; Wilkinson, L S; Poloniecki, J D; Given-Wilson, R M

2012-01-01

Objective To compare reader ratings of the clinical diagnostic quality of 50 and 100 μm computed radiography (CR) systems with screen–film mammography (SFM) in operative specimens. Methods Mammograms of 57 fresh operative breast specimens were analysed by 10 readers. Exposures were made with identical position and compression with three mammographic systems (Fuji 100CR, 50CR and SFM). Images were anonymised and readers blinded to the CR system used. A five-point comparative scoring system (−2 to +2) was used to assess seven quality criteria and overall diagnostic value. Statistical analysis was subsequently performed of reader ratings (n=16 925). Results For most quality criteria, both CR systems were rated as equivalent to or better than SFM. The CR systems were significantly better at demonstrating skin edge and background tissue (p<1×10−5). Microcalcification was best demonstrated on the CR50 system (p<1×10−5). The overall diagnostic value of both CR systems was rated as being as good as or better than SFM (p<1×10−5). Conclusion In this clinical setting, the overall diagnostic performance of both CR systems was as good as or better than SFM, with the CR50 system performing better than the CR100. PMID:22096218

Early Detection and Screening for Breast Cancer.

PubMed

Coleman, Cathy

2017-05-01

To review the history, current status, and future trends related to breast cancer screening. Peer-reviewed articles, web sites, and textbooks. Breast cancer remains a complex, heterogeneous disease. Serial screening with mammography is the most effective method to detect early stage disease and decrease mortality. Although politics and economics may inhibit organized mammography screening programs in many countries, the judicious use of proficient clinical and self-breast examination can also identify small tumors leading to reduced morbidity. Oncology nurses have exciting opportunities to lead, facilitate, and advocate for delivery of high-quality screening services targeting individuals and communities. A practical approach is needed to translate the complexities and controversies surrounding breast cancer screening into improved care outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinical Optimization of Current Digital Mammography Systems (Breast Cancer)

DTIC Science & Technology

1994-01-20

Workshop: Quality Assurance and Radiation Protection. May 7-9, Mannheim. Schnetztor - Verlag; 1992: 90- 91. 2. Panizza P., Del Maschio A. Digital... Panizza P., Cattaneo M., Rodighiero M.G., et al. Course on Digital Radiology and PACS Technology - Clinical Application: Breast (L’Aquila) Scuola

Family/friend recommendations and mammography intentions: the roles of perceived mammography norms and support.

PubMed

Molina, Yamile; Ornelas, India J; Doty, Sarah L; Bishop, Sonia; Beresford, Shirley A A; Coronado, Gloria D

2015-10-01

Identifying factors that increase mammography use among Latinas is an important public health priority. Latinas are more likely to report mammography intentions and use, if a family member or friend recommends that they get a mammogram. Little is known about the mechanisms underlying the relationship between social interactions and mammography intentions. Theory suggests that family/friend recommendations increase perceived mammography norms (others believe a woman should obtain a mammogram) and support (others will help her obtain a mammogram), which in turn increase mammography intentions and use. We tested these hypotheses with data from the ¡Fortaleza Latina! study, a randomized controlled trial including 539 Latinas in Washington State. Women whose family/friend recommended they get a mammogram within the last year were more likely to report mammography intentions, norms and support. Perceived mammography norms mediated the relationship between family/friend recommendations and intentions, Mediated Effect = 0.38, 95%CI [0.20, 0.61], but not support, Mediated Effect = 0.002, 95%CI [-0.07, 0.07]. Our findings suggest perceived mammography norms are a potential mechanism underlying the effect of family/friend recommendations on mammography use among Latinas. Our findings make an important contribution to theory about the associations of social interactions, perceptions and health behaviors. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

The relationship between breast cancer anxiety and mammography: experiential avoidance as a moderator.

PubMed

Miller, Sarah J; O'Hea, Erin L; Lerner, Jennifer Block; Moon, Simon; Foran-Tuller, Kelly A

2011-10-01

Although mammography can aid in the early detection and prevention of breast cancer, many women do not receive annual mammograms. It remains unclear whether anxiety about breast cancer inhibits or promotes mammography rates. The way in which women regulate their anxiety (ie, level of experiential avoidance) may play a role in predicting mammography adherence. A community sample of women (N = 84) completed a questionnaire which assessed mammography rates, experiential avoidance, and breast cancer anxiety. The results suggest that, while controlling for breast cancer anxiety, experiential avoidance (β = .31, p < .01) significantly predicted mammography rates. When examining experiential avoidance as a moderator, a multiple regression analysis approached significance (R2 Δ = .04, p = .07), suggesting that a woman's level of experiential avoidance influences the relationship between anxiety and mammography. These findings will help enable health care practitioners to better identify women at risk of non-adherence to mammography recommendations.

Influence of scatter reduction method and monochromatic beams on image quality and dose in mammography.

PubMed

Moeckli, Raphaël; Verdun, Francis R; Fiedler, Stefan; Pachoud, Marc; Bulling, Shelley; Schnyder, Pierre; Valley, Jean-François

2003-12-01

In mammography, the image contrast and dose delivered to the patient are determined by the x-ray spectrum and the scatter to primary ratio S/P. Thus the quality of the mammographic procedure is highly dependent on the choice of anode and filter material and on the method used to reduce the amount of scattered radiation reaching the detector. Synchrotron radiation is a useful tool to study the effect of beam energy on the optimization of the mammographic process because it delivers a high flux of monochromatic photons. Moreover, because the beam is naturally flat collimated in one direction, a slot can be used instead of a grid for scatter reduction. We have measured the ratio S/P and the transmission factors for grids and slots for monoenergetic synchrotron radiation. In this way the effect of beam energy and scatter rejection method were separated, and their respective importance for image quality and dose analyzed. Our results show that conventional mammographic spectra are not far from optimum and that the use of a slot instead of a grid has an important effect on the optimization of the mammographic process. We propose a simple numerical model to quantify this effect.

Cone-beam volume CT mammographic imaging: feasibility study

NASA Astrophysics Data System (ADS)

Chen, Biao; Ning, Ruola

2001-06-01

X-ray projection mammography, using a film/screen combination or digital techniques, has proven to be the most effective imaging modality for early detection of breast cancer currently available. However, the inherent superimposition of structures makes small carcinoma (a few millimeters in size) difficult to detect in the occultation case or in dense breasts, resulting in a high false positive biopsy rate. The cone-beam x-ray projection based volume imaging using flat panel detectors (FPDs) makes it possible to obtain three-dimensional breast images. This may benefit diagnosis of the structure and pattern of the lesion while eliminating hard compression of the breast. This paper presents a novel cone-beam volume CT mammographic imaging protocol based on the above techniques. Through computer simulation, the key issues of the system and imaging techniques, including the x-ray imaging geometry and corresponding reconstruction algorithms, x-ray characteristics of breast tissues, x-ray setting techniques, the absorbed dose estimation and the quantitative effect of x-ray scattering on image quality, are addressed. The preliminary simulation results support the proposed cone-beam volume CT mammographic imaging modality in respect to feasibility and practicability for mammography. The absorbed dose level is comparable to that of current two-view mammography and would not be a prominent problem for this imaging protocol. Compared to traditional mammography, the proposed imaging protocol with isotropic spatial resolution will potentially provide significantly better low contrast detectability of breast tumors and more accurate location of breast lesions.

Digital mammography--DQE versus optimized image quality in clinical environment: an on site study

NASA Astrophysics Data System (ADS)

Oberhofer, Nadia; Fracchetti, Alessandro; Springeth, Margareth; Moroder, Ehrenfried

2010-04-01

The intrinsic quality of the detection system of 7 different digital mammography units (5 direct radiography DR; 2 computed radiography CR), expressed by DQE, has been compared with their image quality/dose performances in clinical use. DQE measurements followed IEC 62220-1-2 using a tungsten test object for MTF determination. For image quality assessment two different methods have been applied: 1) measurement of contrast to noise ratio (CNR) according to the European guidelines and 2) contrast-detail (CD) evaluation. The latter was carried out with the phantom CDMAM ver. 3.4 and the commercial software CDMAM Analyser ver. 1.1 (both Artinis) for automated image analysis. The overall image quality index IQFinv proposed by the software has been validated. Correspondence between the two methods has been shown figuring out a linear correlation between CNR and IQFinv. All systems were optimized with respect to image quality and average glandular dose (AGD) within the constraints of automatic exposure control (AEC). For each equipment, a good image quality level was defined by means of CD analysis, and the corresponding CNR value considered as target value. The goal was to achieve for different PMMA-phantom thicknesses constant image quality, that means the CNR target value, at minimum dose. All DR systems exhibited higher DQE and significantly better image quality compared to CR systems. Generally switching, where available, to a target/filter combination with an x-ray spectrum of higher mean energy permitted dose savings at equal image quality. However, several systems did not allow to modify the AEC in order to apply optimal radiographic technique in clinical use. The best ratio image quality/dose was achieved by a unit with a-Se detector and W anode only recently available on the market.

77 FR 51807 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-27

... Minimum Data Elements (MDEs) for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP... screening and early detection tests for breast and cervical cancer. Mammography is extremely valuable as an early detection tool because it can detect breast cancer well before the woman can feel the lump, when...

Outcomes of Screening Mammography in Elderly Women

DTIC Science & Technology

2004-10-01

program run by the National Health Service (NHS) provides virtually all mammographic screening for women aged 50 or older . 2,3 There are differences also...government-funded National Health Service Breast Screening Program provides free breast cancer screening in the U.K. for women 50 or older . 3, 10 Women aged ...for Public Release; Distribution Unlimited 13. ABSTRACT (Maximum 200 Words) There is uncertainty about whether women older than age 65 should undergo

Contrast-to-noise ratio in magnification mammography: a Monte Carlo study

NASA Astrophysics Data System (ADS)

Koutalonis, M.; Delis, H.; Spyrou, G.; Costaridou, L.; Tzanakos, G.; Panayiotakis, G.

2007-06-01

Magnification views are a common way to perform a secondary examination when suspicious abnormalities are found in a screening mammogram. The visibility of microcalcifications and breast lesions is restricted by the compromise between the image quality and the absorbed dose. In this study, image quality characteristics in magnification mammography were evaluated based on Monte Carlo techniques. A breast phantom was utilized, simulating a homogeneous mixture of adipose and glandular tissue in various percentages of glandularity, containing inhomogeneities of various sizes and compositions. The effect of the magnification degree, breast glandularity, tube voltage and anode/filter material combination on image quality characteristics was investigated in terms of a contrast-to-noise ratio (CNR). A performance index PIν was introduced in order to study the overall performance of various anode/filter combinations under different exposure parameters. Results demonstrate that CNR is improved with the degree of magnification and degraded as the breast glandularity is increased. Degree of magnification 1.3 offers the best overall performance for most of the anode/filter combinations utilized. Under magnification conditions, the role of dose is demoted against the image quality, as magnification views are secondary, diagnostic examinations and not screening procedures oriented to non-symptomatic women. For decreased image quality weighting, some anode/filter combinations different from Mo/0.030mmMo can be utilized as they offer a similar performance index. However, if the desired weighting for the image quality is high, the Mo/0.030mmMo combination has the best overall performance.

Breast cancer screening using tomosynthesis in combination with digital mammography.

PubMed

Friedewald, Sarah M; Rafferty, Elizabeth A; Rose, Stephen L; Durand, Melissa A; Plecha, Donna M; Greenberg, Julianne S; Hayes, Mary K; Copit, Debra S; Carlson, Kara L; Cink, Thomas M; Barke, Lora D; Greer, Linda N; Miller, Dave P; Conant, Emily F

2014-06-25

Mammography plays a key role in early breast cancer detection. Single-institution studies have shown that adding tomosynthesis to mammography increases cancer detection and reduces false-positive results. To determine if mammography combined with tomosynthesis is associated with better performance of breast screening programs in the United States. Retrospective analysis of screening performance metrics from 13 academic and nonacademic breast centers using mixed models adjusting for site as a random effect. Period 1: digital mammography screening examinations 1 year before tomosynthesis implementation (start dates ranged from March 2010 to October 2011 through the date of tomosynthesis implementation); period 2: digital mammography plus tomosynthesis examinations from initiation of tomosynthesis screening (March 2011 to October 2012) through December 31, 2012. Recall rate for additional imaging, cancer detection rate, and positive predictive values for recall and for biopsy. A total of 454,850 examinations (n=281,187 digital mammography; n=173,663 digital mammography + tomosynthesis) were evaluated. With digital mammography, 29,726 patients were recalled and 5056 biopsies resulted in cancer diagnosis in 1207 patients (n=815 invasive; n=392 in situ). With digital mammography + tomosynthesis, 15,541 patients were recalled and 3285 biopsies resulted in cancer diagnosis in 950 patients (n=707 invasive; n=243 in situ). Model-adjusted rates per 1000 screens were as follows: for recall rate, 107 (95% CI, 89-124) with digital mammography vs 91 (95% CI, 73-108) with digital mammography + tomosynthesis; difference, -16 (95% CI, -18 to -14; P < .001); for biopsies, 18.1 (95% CI, 15.4-20.8) with digital mammography vs 19.3 (95% CI, 16.6-22.1) with digital mammography + tomosynthesis; difference, 1.3 (95% CI, 0.4-2.1; P = .004); for cancer detection, 4.2 (95% CI, 3.8-4.7) with digital mammography vs 5.4 (95% CI, 4.9-6.0) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001); and for invasive cancer detection, 2.9 (95% CI, 2.5-3.2) with digital mammography vs 4.1 (95% CI, 3.7-4.5) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001). The in situ cancer detection rate was 1.4 (95% CI, 1.2-1.6) per 1000 screens with both methods. Adding tomosynthesis was associated with an increase in the positive predictive value for recall from 4.3% to 6.4% (difference, 2.1%; 95% CI, 1.7%-2.5%; P < .001) and for biopsy from 24.2% to 29.2% (difference, 5.0%; 95% CI, 3.0%-7.0%; P < .001). Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes.

Impact of the Introduction of Digital Mammography in an Organized Screening Program on the Recall and Detection Rate.

PubMed

Campari, Cinzia; Giorgi Rossi, Paolo; Mori, Carlo Alberto; Ravaioli, Sara; Nitrosi, Andrea; Vacondio, Rita; Mancuso, Pamela; Cattani, Antonella; Pattacini, Pierpaolo

2016-04-01

In 2012, the Reggio Emilia Breast Cancer Screening Program introduced digital mammography in all its facilities at the same time. The aim of this work is to analyze the impact of digital mammography introduction on the recall rate, detection rate, and positive predictive value. The program actively invites women aged 45-74 years. We included women screened in 2011, all of whom underwent film-screen mammography, and all women screened in 2012, all of whom underwent digital mammography. Double reading was used for all mammograms, with arbitration in the event of disagreement. A total of 42,240 women underwent screen-film mammography and 45,196 underwent digital mammography. The recall rate increased from 3.3 to 4.4% in the first year of digital mammography (relative recall adjusted by age and round 1.46, 95% CI = 1.37-1.56); the positivity rate for each individual reading, before arbitration, rose from 3 to 5.7%. The digital mammography recall rate decreased during 2012: after 12 months, it was similar to the recall rate with screen-film mammography. The detection rate was similar: 5.9/1000 and 5.2/1000 with screen-film and digital mammography, respectively (adjusted relative detection rate 0.95, 95% CI = 0.79-1.13). The relative detection rate for ductal carcinoma in situ remained the same. The introduction of digital mammography to our organized screening program had a negative impact on specificity, thereby increasing the recall rate. The effect was limited to the first 12 months after introduction and was attenuated by the double reading with arbitration. We did not observe any relevant effects on the detection rate.

Mammography: an update of the EUSOBI recommendations on information for women.

PubMed

Sardanelli, Francesco; Fallenberg, Eva M; Clauser, Paola; Trimboli, Rubina M; Camps-Herrero, Julia; Helbich, Thomas H; Forrai, Gabor

2017-02-01

This article summarises the information to be offered to women about mammography. After a delineation of the aim of early diagnosis of breast cancer, the difference between screening mammography and diagnostic mammography is explained. The need to bring images and reports from the previous mammogram (and from other recent breast imaging examinations) is highlighted. Mammography technique and procedure are described with particular attention to discomfort and pain experienced by a small number of women who undergo the test. Information is given on the recall during a screening programme and on the request for further work-up after a diagnostic mammography. The logic of the mammography report and of classification systems such as R1-R5 and BI-RADS is illustrated, and brief but clear information is given about the diagnostic performance of the test, with particular reference to interval cancers, i.e., those cancers that are missed at screening mammography. Moreover, the breast cancer risk due to radiation exposure from mammography is compared to the reduction in mortality obtained with the test, and the concept of overdiagnosis is presented with a reliable estimation of its extent. Information about new mammographic technologies (tomosynthesis and contrast-enhanced spectral mammography) is also given. Finally, frequently asked questions are answered. • Direct digital mammography should be preferred to film-screen or phosphor plates. • Screening (in asymptomatic women) should be distinguished from diagnosis (in symptomatic women). • A breast symptom has to be considered even after a negative mammogram. • Digital breast tomosynthesis increases cancer detection and decreases the recall rate. • Contrast-enhanced spectral mammography can help in cancer detection and lesion characterisation.

Decision making and counseling around mammography screening for women aged 80 or older.

PubMed

Schonberg, Mara A; Ramanan, Radhika A; McCarthy, Ellen P; Marcantonio, Edward R

2006-09-01

Despite uncertain benefit, many women over age 80 (oldest-old) receive screening mammography. To explore decision-making and physician counseling of oldest-old women around mammography screening. Qualitative research using in-depth semi-structured interviews. Twenty-three women aged 80 or older who received care at a large academic primary care practice (13 had undergone mammography screening in the past 2 years) and 16 physicians at the same center. We asked patients and physicians to describe factors influencing mammography screening decisions of oldest-old women. We asked physicians to describe their counseling about screening to the oldest-old. Patients and/or physicians identified the importance of physician influence, patient preferences, system factors, and social influences on screening decisions. Although physicians felt that patient's health affected screening decisions, few patients felt that health mattered. Three types of elderly patients were identified: (1) women enthusiastic about screening mammography; (2) women opposed to screening mammography; and (3) women without a preference who followed their physician's recommendation. However, physician counseling about mammography screening to elderly women varies; some individualize discussions; others encourage screening; few discourage screening. Physicians report that discussions about stopping screening can be uncomfortable and time consuming. Physicians suggest that more data could facilitate these discussions. Some oldest-old women have strong opinions about screening mammography while others are influenced by physicians. Discussions about stopping screening are challenging for physicians. More data about the benefits and risks of mammography screening for women aged 80 or older could inform patients and improve provider counseling to lead to more rational use of mammography.

MRI breast screening in high-risk women: cancer detection and survival analysis.

PubMed

Evans, D Gareth; Gareth, Evans D; Kesavan, Nisha; Nisha, Kesavan; Lim, Yit; Yit, Lim; Gadde, Soujanye; Soujanye, Gadde; Hurley, Emma; Emma, Hurley; Massat, Nathalie J; Maxwell, Anthony J; Ingham, Sarah; Sarah, Ingham; Eeles, Rosalind; Rosalind, Eeles; Leach, Martin O; Howell, Anthony; Anthony, Howell; Duffy, Stephen W; Stephen, Duffy

2014-06-01

Women with a genetic predisposition to breast cancer tend to develop the disease at a younger age with denser breasts making mammography screening less effective. The introduction of magnetic resonance imaging (MRI) for familial breast cancer screening programs in recent years was intended to improve outcomes in these women. We aimed to assess whether introduction of MRI surveillance improves 5- and 10-year survival of high-risk women and determine the accuracy of MRI breast cancer detection compared with mammography-only or no enhanced surveillance and compare size and pathology of cancers detected in women screened with MRI + mammography and mammography only. We used data from two prospective studies where asymptomatic women with a very high breast cancer risk were screened by either mammography alone or with MRI also compared with BRCA1/2 carriers with no intensive surveillance. 63 cancers were detected in women receiving MRI + mammography and 76 in women receiving mammography only. Sensitivity of MRI + mammography was 93 % with 63 % specificity. Fewer cancers detected on MRI were lymph node positive compared to mammography/no additional screening. There were no differences in 10-year survival between the MRI + mammography and mammography-only groups, but survival was significantly higher in the MRI-screened group (95.3 %) compared to no intensive screening (73.7 %; p = 0.002). There were no deaths among the 21 BRCA2 carriers receiving MRI. There appears to be benefit from screening with MRI, particularly in BRCA2 carriers. Extended follow-up of larger numbers of high-risk women is required to assess long-term survival.

Effects of digital mammography uptake on downstream breast-related care among older women.

PubMed

Hubbard, Rebecca A; Zhu, Weiwei; Onega, Tracy L; Fishman, Paul; Henderson, Louise M; Tosteson, Anna N A; Buist, Diana S M

2012-12-01

Digital mammography is the dominant modality for breast cancer screening in the United States. No previous studies have investigated as to how introducing digital mammography affects downstream breast-related care. Compare breast-related health care use after a screening mammogram before and after introduction of digital mammography. Longitudinal study of screening mammograms from 14 radiology facilities contributing data to the Breast Cancer Surveillance Consortium performed 1 year before and 4 years after each facility introduced digital mammography, along with linked Medicare claims. We included 30,211 mammograms for women aged 66 years and older without breast cancer. Rates of false-positive recall and short-interval follow-up were based on radiologists' assessments and recommendations; rates of follow-up mammography, ultrasound, and breast biopsy use were based on Medicare claims. False-positive recall rates increased after the introduction of digital mammography. Follow-up mammography use was significantly higher across all 4 years after a facility began using digital mammography compared with the year before [year 1 odds ratio (OR) = 1.7, 95% confidence interval (CI), 1.4-2.1]. Among women with false-positive mammography results, use of ultrasound decreased significantly in the second through fourth years after digital mammography began (year 2 OR = 0.4, 95% CI, 0.3-0.6). Introduction of a new technology led to changes in health care use that persisted for at least 4 years. Comparative effectiveness research on new technologies should consider not only diagnostic performance but also downstream utilization attributable to this apparent learning curve.

Comparison of software and human observers in reading images of the CDMAM test object to assess digital mammography systems

NASA Astrophysics Data System (ADS)

Young, Kenneth C.; Cook, James J. H.; Oduko, Jennifer M.; Bosmans, Hilde

2006-03-01

European Guidelines for quality control in digital mammography specify minimum and achievable standards of image quality in terms of threshold contrast, based on readings of images of the CDMAM test object by human observers. However this is time-consuming and has large inter-observer error. To overcome these problems a software program (CDCOM) is available to automatically read CDMAM images, but the optimal method of interpreting the output is not defined. This study evaluates methods of determining threshold contrast from the program, and compares these to human readings for a variety of mammography systems. The methods considered are (A) simple thresholding (B) psychometric curve fitting (C) smoothing and interpolation and (D) smoothing and psychometric curve fitting. Each method leads to similar threshold contrasts but with different reproducibility. Method (A) had relatively poor reproducibility with a standard error in threshold contrast of 18.1 +/- 0.7%. This was reduced to 8.4% by using a contrast-detail curve fitting procedure. Method (D) had the best reproducibility with an error of 6.7%, reducing to 5.1% with curve fitting. A panel of 3 human observers had an error of 4.4% reduced to 2.9 % by curve fitting. All automatic methods led to threshold contrasts that were lower than for humans. The ratio of human to program threshold contrasts varied with detail diameter and was 1.50 +/- .04 (sem) at 0.1mm and 1.82 +/- .06 at 0.25mm for method (D). There were good correlations between the threshold contrast determined by humans and the automated methods.

Slot scanning versus antiscatter grid in digital mammography: comparison of low-contrast performance using contrast-detail measurement

NASA Astrophysics Data System (ADS)

Lai, Chao-Jen; Shaw, Chris C.; Geiser, William; Kappadath, Srinivas C.; Liu, Xinming; Wang, TianPeng; Tu, Shu-Ju; Altunbas, Mustafa C.

2004-05-01

Slot scanning imaging techniques allow for effective scatter rejection without attenuating primary x-rays. The use of these techniques should generate better image quality for the same mean glandular dose (MGD) or a similar image quality for a lower MGD as compared to imaging techniques using an anti-scatter grid. In this study, we compared a slot scanning digital mammography system (SenoScan, Fisher Imaging Systems, Denver, CO) to a full-field digital mammography (FFDM) system used in conjunction with a 5:1 anti-scatter grid (SenoGraphe 2000D, General Electric Medical Systems, Milwaukee, WI). Images of a contrast-detail phantom (University Hospital Nijmegen, The Netherlands) were reviewed to measure the contrast-detail curves for both systems. These curves were measured at 100%, 71%, 49% and 33% of the reference mean glandular dose (MGD), as determined by photo-timing, for the Fisher system and 100% for the GE system. Soft-copy reading was performed on review workstations provided by the manufacturers. The correct observation ratios (CORs) were also computed and used to compare the performance of the two systems. The results showed that, based on the contrast-detail curves, the performance of the Fisher images, acquired at 100% and 71% of the reference MGD, was comparable to the GE images at 100% of the reference MGD. The CORs for Fisher images were 0.463 and 0.444 at 100% and 71% of the reference MGD, respectively, compared to 0.453 for the GE images at 100% of the reference MGD.

Change in Breast Cancer Screening Intervals Since the 2009 USPSTF Guideline.

PubMed

Wernli, Karen J; Arao, Robert F; Hubbard, Rebecca A; Sprague, Brian L; Alford-Teaster, Jennifer; Haas, Jennifer S; Henderson, Louise; Hill, Deidre; Lee, Christoph I; Tosteson, Anna N A; Onega, Tracy

2017-08-01

In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended biennial mammography for women aged 50-74 years and shared decision-making for women aged 40-49 years for breast cancer screening. We evaluated changes in mammography screening interval after the 2009 recommendations. We conducted a prospective cohort study of women aged 40-74 years who received 821,052 screening mammograms between 2006 and 2012 using data from the Breast Cancer Surveillance Consortium. We compared changes in screening intervals and stratified intervals based on whether the mammogram at the end of the interval occurred before or after the 2009 recommendation. Differences in mean interval length by woman-level characteristics were compared using linear regression. The mean interval (in months) minimally decreased after the 2009 USPSTF recommendations. Among women aged 40-49 years, the mean interval decreased from 17.2 months to 17.1 months (difference -0.16%, 95% confidence interval [CI] -0.30 to -0.01). Similar small reductions were seen for most age groups. The largest change in interval length in the post-USPSTF period was declines among women with a first-degree family history of breast cancer (difference -0.68%, 95% CI -0.82 to -0.54) or a 5-year breast cancer risk ≥2.5% (difference -0.58%, 95% CI -0.73 to -0.44). The 2009 USPSTF recommendation did not lengthen the average mammography interval among women routinely participating in mammography screening. Future studies should evaluate whether breast cancer screening intervals lengthen toward biennial intervals following new national 2016 breast cancer screening recommendations, particularly among women less than 50 years of age.

The ACA's Zero Cost-Sharing Mandate and Trends in Out-of-Pocket Expenditures on Well-Child and Screening Mammography Visits.

PubMed

Kirby, James B; Davidoff, Amy J; Basu, Jayasree

2016-12-01

Starting in September of 2010, the Patient Protection and Affordable Care Act required most health insurance policies to cover evidence-based preventive care with no cost-sharing (no copays, coinsurance, or deductibles). It is unknown, however, whether declines in out-of-pocket costs for preventive services are large enough to prompt increases in utilization, the ultimate goal of the policy. In this study, we use a nationally representative sample of ambulatory care visits to estimate the impact of the zero cost-sharing mandate on out-of-pocket expenditures on well-child and screening mammography visits. Estimates are made using 2-part interrupted time-series models, with well-woman visits serving as the control group because they were not covered under the zero cost-sharing mandate until after our study period. Results indicate a substantial reduction in out-of-pocket costs attributable to the Affordable Care Act. Between January 2011 and September 2012, the zero cost-sharing mandate reduced per-visit out-of-pocket costs for well-child visits from $18.46 to $8.08 (56%) and out-of-pocket costs for screening mammography visits from $25.43 to $6.50 (74%). No reduction was apparent for well-woman visits. The Affordable Care Act's zero cost-sharing mandate for preventive care has had a large impact on out-of-pocket expenditures for well-child and mammography visits. To increase preventive service use, research is needed to better understand barriers to obtaining preventive care that are not directly related to cost.

Knowledge, attitude and perceptions of breast cancer screening among native and immigrant women in Barcelona, Spain.

PubMed

Pons-Vigués, Mariona; Puigpinós-Riera, Rosa; Serral, Gemma; Pasarín, M Isabel; Rodríguez, Dolors; Pérez, Glòria; Benet, Josep; Casamitjana, Montserrat; Borrell, Carme

2012-06-01

Inequalities between immigrant and native populations in terms of access and use of health services have been described. The objective is to compare knowledge, attitudes, vulnerabilities, benefits and barriers related to breast cancer (BC) and screening mammography among women from different countries resident in Barcelona. A cross-sectional survey carried out in Barcelona in 2009. The study population consisted of female residents in Barcelona between 45 and 69 years of age; participants were Spanish nationals or immigrants from low-income countries. 960 participants were asked 72 questions, mainly with Likert responses. The dependent variables were five quantitative scales: (1) knowledge of BC and early detection, (2) attitude towards health and BC, (3) vulnerability to BC, (4) barriers to mammography, (5) benefits of mammography. The independent variables were country of origin, social class, setting, cohabitation, age, mammography use, length of residence and fluency of the language. Analyses compared scale scores stratified by the independent variables. Multivariable linear regression models were fitted to determine the relationship between the scales and the independent variables. We observed inequalities according to country of origin on all scales after adjustment for independent variables. Chinese women presented the greatest differences with respect to native women, followed by Maghrebi and Filipino women. Inequalities exist on the vulnerability and barriers scales according to social class and urban/rural setting, and on the attitude scale according to social class. Country of origin, social class and urban/rural setting are key contributors to inequality in these scales. Copyright © 2011 John Wiley & Sons, Ltd.

The mammography screening employee inreach program.

PubMed

Robinson, Joanne; Seltzer, Vicki; Lawrence, Loretta; Autz, George; Kostroff, Karen; Weiselberg, Lora; Colagiacomo, Maria

2007-02-01

To determine whether our health care employees were undergoing mammography screening according to American Cancer Society guidelines and to determine whether aggressive outreach, education and streamlining of mammography scheduling could improve compliance. All female employees at North Shore University Hospital (NSUH) and several other health system facilities (SF) were sent mailings to their homes that included breast health education and mammography screening guidelines, a questionnaire regarding their own mammography screening history and the opportunity to have their mammography screening scheduled by the Mammography Screening Employee Inreach Program (MSEIP) coordinator. Of the approximately 2,700 female employees aged 40 and over at NSUH and SF, 2,235 (82.7%) responded to the questionnaire, and 1,455 had a mammogram done via the MSEIP. Of the 1,455, 43% either were overdue for a mammogram or had never had one. During a second year of the MSEIP at NSUH and SF, an additional 1,706 mammograms were done. People employed in health care jobs do not necessarily avail themselves of appropriate health care screening. An aggressive program that utilized education, outreach and assistance with scheduling was effective in increasing compliance with mammography screening.

Performance evaluation of a retrofit digital detector-based mammography system.

PubMed

Marshall, Nicholas W; van Ongeval, Chantal; Bosmans, Hilde

2016-02-01

A retrofit flat panel detector was integrated with a GE DMR+ analog mammography system and characterized using detective quantum efficiency (DQE). Technical system performance was evaluated using the European Guidelines protocol, followed by a limited evaluation of clinical image quality for 20 cases using image quality criteria in the European Guidelines. Optimal anode/filter selections were established using signal difference-to-noise ratio measurements. Only small differences in peak DQE were seen between the three anode/filter settings, with an average value of 0.53. For poly(methyl methacrylate) (PMMA) thicknesses above 60 mm, the Rh/Rh setting was the optimal anode/filter setting. The system required a mean glandular dose of 0.54 mGy at 30 kV Rh/Rh to reach the Acceptable gold thickness limit for 0.1 mm details. Imaging performance of the retrofit unit with the GE DMR+ is notably better than of powder based computed radiography systems and is comparable to current flat panel FFDM systems. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Regulatory perspectives and research activities at the FDA on the use of phantoms with in vivo diagnostic devices

NASA Astrophysics Data System (ADS)

Agrawal, Anant; Gavrielides, Marios A.; Weininger, Sandy; Chakrabarti, Kish; Pfefer, Joshua

2008-02-01

For a number of years, phantoms have been used to optimize device parameters and validate performance in the primary medical imaging modalities (CT, MRI, PET/SPECT, ultrasound). Furthermore, the FDA under the Mammography Quality Standards Act (MQSA) requires image quality evaluation of mammography systems using FDA-approved phantoms. The oldest quantitative optical diagnostic technology, pulse oximetry, also benefits from the use of active phantoms known as patient simulators to validate certain performance characteristics under different clinically-relevant conditions. As such, guidance provided by the FDA to its staff and to industry on the contents of pre-market notification and approval submissions includes suggestions on how to incorporate the appropriate phantoms in establishing device effectiveness. Research at the FDA supports regulatory statements on the use of phantoms by investigating how phantoms can be designed, characterized, and utilized to determine critical device performance characteristics. These examples provide a model for how novel techniques in the rapidly growing field of optical diagnostics can use phantoms during pre- and post-market regulatory testing.

Estimation of mean glandular dose for patients who undergo mammography and studying the factors affecting it

NASA Astrophysics Data System (ADS)

Barzanje, Sana L. N. H.; Harki, Edrees M. Tahir Nury

2017-09-01

The objective of this study was to determine mean glandular dose (MGD) during diagnostic mammography. This study was done in two hospitals in Hawler city in Kurdistan -region /Iraq, the exposure parameters kVp and mAs was recorded for 40 patients under go mammography. The MGD estimated by multiplied ESD with normalized glandular dose (Dn). The ESD measured indirectly by measuring output radiation mGy/mAs by using PalmRAD 907 as a suitable detector (Gigger detector).the results; shown that the mean and its standard deviation of MGD for Screen Film Mammography and Digital Mammography are (0.95±0.18)mGy and (0.99±0.26)mGy, respectively. And there is a significant difference between MGD for Screen Film Mammography and Digital Mammography views (p≤0. 05). Also the mean value and its standard deviation of MGD for screen film mammography is (0.96±0.21) for CC projection and (1.03±0.3) mGy for MLO projection, but mean value and its standard deviation evaluated of MGD for digital mammography is (0.92±0.17) mGy for CC projection and (0.98±0.2) mGy for MLO projection. As well as, the effect of kVp and mAs in MGD were studied, shows that in general as kVp and mAs increased the MGD increased accordingly in both of mammography systems.

The relationship of social support concept and repeat mammography among Iranian women.

PubMed

Farhadifar, Fariba; Taymoori, Parvaneh; Bahrami, Mitra; Zarea, Shamsy

2015-10-24

Breast cancer ranks as the first most common cancer among the Iranian women. The regular repeat of mammography with 1-2 year intervals leads to the increased efficiency of early detection of breast cancer. The present study examined the predictors of repeat mammography. It was hypothesized that higher social support is connected with mammography repeat. A cross-sectional study was carried out among 400 women 50 years and older in Sanandaj, Iran. Data was collected by the questionnaire including information on socio demographical variables and measuring social support level. Data was analyzed by SPSS16 software. Multiple logistic regression was used to determine the predictive power of demographic variables and dimensions of social support for repeat mammography. Women aged 50-55 years had three times odds of repeat mammography compared to women aged 56-60 years) OR, 3.02). Married women had greater odds of repeat mammography compared to single women (P < 0.006). The probability of repeat mammography in women with higher social support was 0.93 times greater than the women with lower social support (OR, 0.93; 95 % CI, 0.91-0.95; P < 0.0001). Iranian women are less likely repeat mammography than other Asian women. Identifying the associations between perceived social support and repeat mammography may offer detailed information to allow for future study and guide the development of interventions not only for Iranian women but also for similar cultural that received pay too little attention to date in the breast cancer literature.

Breast cancer screening in the Czech Republic: time trends in performance indicators during the first seven years of the organised programme

PubMed Central

2011-01-01

Background The Czech Breast Cancer Screening Programme (CBCSP) was initiated in September 2002 by establishing a network of accredited centres. The aim of this article is to describe progress in the programme quality over time after the inception of the organised programme. Methods The CBCSP is monitored using an information system consisting of three principal components: 1) the national cancer registry, 2) a screening registry collecting data on all screening examinations, further assessments and final diagnoses at accredited programme centres, and 3) administrative databases of healthcare payers. Key performance indicators from the European Guidelines have been adopted for continuous monitoring. Results Breast cancer incidence in the Czech Republic has steadily been increasing, however with a growing proportion of less advanced stages. The mortality rate has recently stabilised. The screening registry includes 2,083,285 records on screening episodes between 2002 and 2008. In 2007-2008, 51% of eligible women aged 45-69 were screened. In 2008, the detection rates were 6.1 and 3.7 per 1,000 women in initial and subsequent screening respectively. Corresponding recall rates are 3.9% and 2.2%, however, it is necessary to pay attention to further assessment performed during the screening visits. Benign to malignant open biopsy ratio was 0.1. Of invasive cases detected in screening, 35.6% was less than 10 mm in diameter. Values of early performance indicators, as measured by both crude and standardized estimates, are generally improving and fulfil desirable targets set by European Guidelines. Conclusions Mammography screening in the Czech Republic underwent successful transformation from opportunistic prevention to an organised programme. Values of early indicators confirm continuous improvement in different aspects of process quality. Further stimulation of participation through invitation system is necessary to exploit the full potential of screening mammography at the population level. PMID:21554747

Use of cancer screening services in Greece and associated social factors: results from the nation-wide Hellas Health I survey.

PubMed

Dimitrakaki, Christine; Boulamatsis, Dimitris; Mariolis, Anargiros; Kontodimopoulos, Nick; Niakas, Dimitris; Tountas, Yannis

2009-06-01

This study estimated the rates of age-appropriate screening practices for breast, cervical, colon and prostate cancer within the general population in Greece and explored the influences of social factors on their use. Data were based on the cross-sectional Hellas Health I survey (2006) conducted on a representative sample of 1005 adults, aged 18-69 years. The percentage of women aged 21-69 years having received the papanicolaou smear test within the past 3 years was 59.4%, and the percentage of women aged 50-69 years having received mammography and the faecal occult blood test (FOBT) within the past 3 years was 53.8 and 8.3%, respectively. There were significant effects of age, education and marital status on carrying out the papanicolaou smear test, age on carrying out mammography, and existence of a family doctor on carrying out the FOBT. In men aged 50-69 years, 40.6% had received the prostate-specific antigen test and 10.9% of men had received the FOBT during the past 3 years. The percentage of men aged 50-69 years who had undergone digital rectal examination within the past 5 years was 20.3%. Multivariate analyses showed significant effects of age, social class, smoking status and type of insurance on carrying out the prostate-specific antigen test and of age on carrying out the digital rectal examination. No effects were revealed for the FOBT in men. The percentage of the population in Greece receiving screening services recommended by the European Council is low and seriously affected by social factors. Public health policies should direct their efforts towards introducing good-quality universal cancer screening and find culturally sensitive ways of addressing the barriers that prevent Greek people from adopting poor-quality cancer screening practices.

Inconsistent self-reported mammography history: Findings from the National Population Health Survey longitudinal cohort

PubMed Central

Bancej, Christina M; Maxwell, Colleen J; Snider, Judy

2004-01-01

Background Self-reported information has commonly been used to monitor mammography utilization across populations and time periods. However, longitudinal investigations regarding the prevalence and determinants of inconsistent responses over time and the impact of such responses on population screening estimates are lacking. Methods Based on longitudinal panel data for a representative cohort of Canadian women aged 40+ years (n = 3,537) assessed in the 1994–95 (baseline) and 1996–97 (follow-up) National Population Health Survey (NPHS), we examined the prevalence of inconsistent self-reports of mammography utilization. Logistic regression models were used to estimate the associations between women's baseline sociodemographic and health characteristics and 2 types of inconsistent responses: (i) baseline reports of ever use which were subsequently contradicted by follow-up reports of never use; and (ii) baseline reports of never use which were contradicted by follow-up reports of use prior to 1994–95. Results Among women who reported having a mammogram at baseline, 5.9% (95% confidence interval (CI): 4.6–7.3%) reported at follow-up that they had never had one. Multivariate logistic regression analyses showed that women with such inconsistent responses were more often outside target age groups, from low income households and less likely to report hormone replacement therapy and Pap smear use. Among women reporting never use at baseline and ever use at follow-up, 17.4% (95%CI: 11.7–23.1%) reported their most recent mammogram as occurring prior to 1994–95 (baseline) and such responses were more common among women aged 70+ years and those in poorer health. Conclusions Women with inconsistent responses of type (i), i.e., ever users at baseline but never users at follow-up, appeared to exhibit characteristics typical of never users of mammography screening. Although limited by sample size, our preliminary analyses suggest that type (ii) responses are more likely to be the result of recall bias due to competing morbidity and age. Inconsistent responses, if removed from the analyses, may be a greater source of loss to follow-up than deaths/institutionalization or item non-response. PMID:15541176

Professional and economic factors affecting access to mammography: a crisis today, or tomorrow? Results from a national survey.

PubMed

Farria, Dione M; Schmidt, Maria E; Monsees, Barbara S; Smith, Robert A; Hildebolt, Charles; Yoffie, Roberta; Monticciolo, Debra L; Feig, Stephen A; Bassett, Lawrence W

2005-08-01

Objective data and anecdotal reports have suggested that access to mammography may be declining because of facility closures and difficulty in recruiting and retaining radiologists and radiologic technologists. To gain insight into the practice patterns, use of emerging technologies, and concerns of breast imagers in current practice, the Society of Breast Imaging (SBI) conducted a national survey of breast imaging practices in the U.S. Between October 2003 and April 2004, the SBI conducted a survey of the SBI membership database, and received completed surveys from 575 breast imaging practices in the U.S. Responses to the survey regarding practice characteristics, the utilization of standard and emerging technologies, staffing, malpractice, finance, and morale were analyzed. Job vacancies for radiologists who read mammograms were reported in 163 practices (29%), 59 of which (10%) had 2 or more openings. A higher proportion of practices with job openings had long appointment waiting times for asymptomatic women when compared with fully staffed practices. Unfilled fellowship positions also were common, with 41 of 65 practices that offer fellowships reporting 47 openings. Among 554 responding practices, 55% reported that someone in their practice was sued because of a mammography related case within the past 5 years, and 50% of practices reported that the threat of lawsuits made radiologist staffing "moderately" or "a lot" more difficult. Of 521 responding practices, 35% reported financial losses in 2002. One in 5 respondents reported that they would prefer to spend less time in mammography, and fewer than 1 in 3 would recommend a breast imaging fellowship to a relative or friend. Emerging technologies, such as breast magnetic resonance imaging and screening ultrasound, currently are being performed in many practices. The survey results provide support for anecdotal reports that breast imaging practices face significant challenges and stresses, including shortages of key personnel, a lack of trainees, malpractice concerns, financial constraints, increased workload due to emerging technologies, low appeal of breast imaging as a career specialty, and the steady rise in the population of women of screening age. (c) 2005 American Cancer Society.

TH-A-18A-01: Innovation in Clinical Breast Imaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, B; Yang, K; Yaffe, M

Several novel modalities have been or are on the verge of being introduced into the breast imaging clinic. These include tomosynthesis imaging, dedicated breast CT, contrast-enhanced digital mammography, and automated breast ultrasound, all of which are covered in this course. Tomosynthesis and dedicated breast CT address the problem of tissue superimposition that limits mammography screening performance, by improved or full resolution of the 3D breast morphology. Contrast-enhanced digital mammography provides functional information that allows for visualization of tumor angiogenesis. 3D breast ultrasound has high sensitivity for tumor detection in dense breasts, but the imaging exam was traditionally performed by radiologists.more » In automated breast ultrasound, the scan is performed in an automated fashion, making for a more practical imaging tool, that is now used as an adjunct to digital mammography in breast cancer screening. This course will provide medical physicists with an in-depth understanding of the imaging physics of each of these four novel imaging techniques, as well as the rationale and implementation of QC procedures. Further, basic clinical applications and work flow issues will be discussed. Learning Objectives: To be able to describe the underlying physical and physiological principles of each imaging technique, and to understand the corresponding imaging acquisition process. To be able to describe the critical system components and their performance requirements. To understand the rationale and implementation of quality control procedures, as well as regulatory requirements for systems with FDA approval. To learn about clinical applications and understand risks and benefits/strength and weakness of each modality in terms of clinical breast imaging.« less

A simulation model approach to analysis of the business case for eliminating health care disparities

PubMed Central

2011-01-01

Background Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers. Methods To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers) and indirect (absenteeism, productivity) effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma. Results The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity) combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately $1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%. Conclusions For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates. PMID:21418594

A simulation model approach to analysis of the business case for eliminating health care disparities.

PubMed

Nerenz, David R; Liu, Yung-wen; Williams, Keoki L; Tunceli, Kaan; Zeng, Huiwen

2011-03-19

Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers. To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers) and indirect (absenteeism, productivity) effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma. The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity) combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately $1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%. For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates. © 2011 Nerenz et al; licensee BioMed Central Ltd.

Obesity, Gynecological Factors, and Abnormal Mammography Follow-Up in Minority and Medically Underserved Women

PubMed Central

Wujcik, Debra; Lin, Jin-Mann S.; Grau, Ana; Wilson, Veronica; Champion, Victoria; Zheng, Wei; Egan, Kathleen M.

2009-01-01

Abstract Background The relationship between obesity and screening mammography adherence has been examined previously, yet few studies have investigated obesity as a potential mediator of timely follow-up of abnormal (Breast Imaging Reporting and Data System [BIRADS-0]) mammography results in minority and medically underserved patients. Methods We conducted a retrospective cohort study of 35 women who did not return for follow-up >6 months from index abnormal mammography and 41 who returned for follow-up ≤6 months in Nashville, Tennessee. Patients with a BIRADS-0 mammography event in 2003–2004 were identified by chart review. Breast cancer risk factors were collected by telephone interview. Multivariate logistic regression was performed on selected factors with return for diagnostic follow-up. Results Obesity and gynecological history were significant predictors of abnormal mammography resolution. A significantly higher frequency of obese women delayed return for mammography resolution compared with nonobese women (64.7% vs. 35.3%). A greater number of hysterectomized women returned for diagnostic follow-up compared with their counterparts without a hysterectomy (77.8% vs. 22.2%). Obese patients were more likely to delay follow-up >6 months (adjusted OR 4.09, p = 0.02). Conversely, hysterectomized women were significantly more likely to return for timely mammography follow-up ≤6 months (adjusted OR 7.95, p = 0.007). Conclusions Study results suggest that weight status and gynecological history influence patients' decisions to participate in mammography follow-up studies. Strategies are necessary to reduce weight-related barriers to mammography follow-up in the healthcare system including provider training related to mammography screening of obese women. PMID:19558307

Bilateral Contrast-enhanced Dual-Energy Digital Mammography: Feasibility and Comparison with Conventional Digital Mammography and MR Imaging in Women with Known Breast Carcinoma

PubMed Central

Dershaw, D. David; Sung, Janice S.; Heerdt, Alexandra S.; Thornton, Cynthia; Moskowitz, Chaya S.; Ferrara, Jessica; Morris, Elizabeth A.

2013-01-01

Purpose To determine feasibility of performing bilateral dual-energy (DE) contrast agent–enhanced (CE) digital mammography and to evaluate its performance compared with conventional digital mammography and breast magnetic resonance (MR) imaging in women with known breast cancer. Materials and Methods This study was approved by the institutional review board and was HIPAA compliant. Written informed consent was obtained. Patient accrual began in March 2010 and ended in August 2011. Mean patient age was 49.6 years (range, 25–74 years). Feasibility was evaluated in 10 women with newly diagnosed breast cancer who were injected with 1.5 mL per kilogram of body weight of iohexol and imaged between 2.5 and 10 minutes after injection. Once feasibility was confirmed, 52 women with newly diagnosed cancer who had undergone breast MR imaging gave consent to undergo DE CE digital mammography. Positive findings were confirmed with pathologic findings. Results Feasibility was confirmed with no adverse events. Visualization of tumor enhancement was independent of timing after contrast agent injection for up to 10 minutes. MR imaging and DE CE digital mammography both depicted 50 (96%) of 52 index tumors; conventional mammography depicted 42 (81%). Lesions depicted by using DE CE digital mammography ranged from 4 to 67 mm in size (median, 17 mm). DE CE digital mammography depicted 14 (56%) of 25 additional ipsilateral cancers compared with 22 (88%) of 25 for MR imaging. There were two false-positive findings with DE CE digital mammography and 13 false-positive findings with MR imaging. There was one contralateral cancer, which was not evident with either modality. Conclusion Bilateral DE CE digital mammography was feasible and easily accomplished. It was used to detect known primary tumors at a rate comparable to that of MR imaging and higher than that of conventional digital mammography. DE CE digital mammography had a lower sensitivity for detecting additional ipsilateral cancers than did MR imaging, but the specificity was higher. © RSNA, 2012 PMID:23220903

Continuing screening mammography in women aged 70 to 79 years: impact on life expectancy and cost-effectiveness.

PubMed

Kerlikowske, K; Salzmann, P; Phillips, K A; Cauley, J A; Cummings, S R

1999-12-08

Mammography is recommended and is cost-effective for women aged 50 to 69 years, but the value of continuing screening mammography after age 69 years is not known. In particular, older women with low bone mineral density (BMD) have a lower risk of breast cancer and may benefit less from continued screening. To compare life expectancy and cost-effectiveness of screening mammography in elderly women based on 3 screening strategies. Decision analysis and cost-effectiveness analysis using a Markov model. General population of women aged 65 years or older. The analysis compared 3 strategies: (1) Undergoing biennial mammography from age 65 to 69 years; (2) undergoing biennial mammography from age 65 to 69 years, measurement of distal radial BMD at age 65 years, discontinuing screening at age 69 years in women in the lowest BMD quartile for age, and continuing biennial mammography to age 79 years in those in the top 3 quartiles of distal radius BMD; and (3) undergoing biennial mammography from age 65 to 79 years. Deaths due to breast cancer averted, life expectancy, and incremental cost-effectiveness ratios. Compared with discontinuing mammography screening at age 69 years, measuring BMD at age 65 years in 10000 women and continuing mammography to age 79 years only in women with BMD in the top 3 quartiles would prevent 9.4 deaths and add, on average, 2.1 days to life expectancy at an incremental cost of $66773 per year of life saved. Continuing mammography to age 79 years in all 10000 elderly women would prevent 1.4 additional breast cancer deaths and add only 7.2 hours to life expectancy at an incremental cost of $117689 per year of life saved compared with only continuing mammography to age 79 years in women with BMD in the top 3 quartiles. This analysis suggests that continuing mammography screening after age 69 years results in a small gain in life expectancy and is moderately cost-effective in those with high BMD and more costly in those with low BMD. Women's preferences for a small gain in life expectancy and the potential harms of screening mammography should play an important role when elderly women are deciding about screening.

Needs assessment for next generation computer-aided mammography reference image databases and evaluation studies.

PubMed

Horsch, Alexander; Hapfelmeier, Alexander; Elter, Matthias

2011-11-01

Breast cancer is globally a major threat for women's health. Screening and adequate follow-up can significantly reduce the mortality from breast cancer. Human second reading of screening mammograms can increase breast cancer detection rates, whereas this has not been proven for current computer-aided detection systems as "second reader". Critical factors include the detection accuracy of the systems and the screening experience and training of the radiologist with the system. When assessing the performance of systems and system components, the choice of evaluation methods is particularly critical. Core assets herein are reference image databases and statistical methods. We have analyzed characteristics and usage of the currently largest publicly available mammography database, the Digital Database for Screening Mammography (DDSM) from the University of South Florida, in literature indexed in Medline, IEEE Xplore, SpringerLink, and SPIE, with respect to type of computer-aided diagnosis (CAD) (detection, CADe, or diagnostics, CADx), selection of database subsets, choice of evaluation method, and quality of descriptions. 59 publications presenting 106 evaluation studies met our selection criteria. In 54 studies (50.9%), the selection of test items (cases, images, regions of interest) extracted from the DDSM was not reproducible. Only 2 CADx studies, not any CADe studies, used the entire DDSM. The number of test items varies from 100 to 6000. Different statistical evaluation methods are chosen. Most common are train/test (34.9% of the studies), leave-one-out (23.6%), and N-fold cross-validation (18.9%). Database-related terminology tends to be imprecise or ambiguous, especially regarding the term "case". Overall, both the use of the DDSM as data source for evaluation of mammography CAD systems, and the application of statistical evaluation methods were found highly diverse. Results reported from different studies are therefore hardly comparable. Drawbacks of the DDSM (e.g. varying quality of lesion annotations) may contribute to the reasons. But larger bias seems to be caused by authors' own decisions upon study design. RECOMMENDATIONS/CONCLUSION: For future evaluation studies, we derive a set of 13 recommendations concerning the construction and usage of a test database, as well as the application of statistical evaluation methods.

Early experience with pay-for-performance: from concept to practice.

PubMed

Rosenthal, Meredith B; Frank, Richard G; Li, Zhonghe; Epstein, Arnold M

2005-10-12

The adoption of pay-for-performance mechanisms for quality improvement is growing rapidly. Although there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care. To evaluate the impact of a prototypical physician pay-for-performance program on quality of care. We evaluated a natural experiment with pay-for-performance using administrative reports of physician group quality from a large health plan for an intervention group (California physician groups) and a contemporaneous comparison group (Pacific Northwest physician groups). Quality improvement reports were included from October 2001 through April 2004 issued to approximately 300 large physician organizations. Three process measures of clinical quality: cervical cancer screening, mammography, and hemoglobin A1c testing. Improvements in clinical quality scores were as follows: for cervical cancer screening, 5.3% for California vs 1.7% for Pacific Northwest; for mammography, 1.9% vs 0.2%; and for hemoglobin A1c, 2.1% vs 2.1%. Compared with physician groups in the Pacific Northwest, the California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6% difference in improvement [P = .02]). In total, the plan awarded 3.4 million dollars (27% of the amount set aside) in bonus payments between July 2003 and April 2004, the first year of the program. For all 3 measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments. Paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.

Mammogram

MedlinePlus

Mammography; Breast cancer - mammography; Breast cancer - screening mammography; Breast lump - mammogram; Breast tomosynthesis ... images. This does not always mean you have breast cancer. Your health care provider may simply need to ...

The Assessment of the Likelihood of Mammography Usage with Relevant Factors among Women with Disabilities

ERIC Educational Resources Information Center

Kung, Pei-Tseng; Tsai, Wen-Chen; Chiou, Shang-Jyh

2012-01-01

Research that identifies the determinants of low mammography use among disabled people is scant. This study examines the determining factors related to the low usage of mammography among women with disabilities. To identify the barriers that prevent women with disabilities from participating in mammography screening can help authorities conceive…

Family/Friend Recommendations and Mammography Intentions: The Roles of Perceived Mammography Norms and Support

ERIC Educational Resources Information Center

Molina, Yamile; Ornelas, India J.; Doty, Sarah L.; Bishop, Sonia; Beresford, Shirley A. A.; Coronado, Gloria D.

2015-01-01

Identifying factors that increase mammography use among Latinas is an important public health priority. Latinas are more likely to report mammography intentions and use, if a family member or friend recommends that they get a mammogram. Little is known about the mechanisms underlying the relationship between social interactions and mammography…

Impact on dose and image quality of a software-based scatter correction in mammography.

PubMed

Monserrat, Teresa; Prieto, Elena; Barbés, Benigno; Pina, Luis; Elizalde, Arlette; Fernández, Belén

2018-06-01

Background In 2014, Siemens developed a new software-based scatter correction (Progressive Reconstruction Intelligently Minimizing Exposure [PRIME]), enabling grid-less digital mammography. Purpose To compare doses and image quality between PRIME (grid-less) and standard (with anti-scatter grid) modes. Material and Methods Contrast-to-noise ratio (CNR) was measured for various polymethylmethacrylate (PMMA) thicknesses and dose values provided by the mammograph were recorded. CDMAM phantom images were acquired for various PMMA thicknesses and inverse Image Quality Figure (IQF inv ) was calculated. Values of incident entrance surface air kerma (ESAK) and average glandular dose (AGD) were obtained from the DICOM header for a total of 1088 pairs of clinical cases. Two experienced radiologists compared subjectively the image quality of a total of 149 pairs of clinical cases. Results CNR values were higher and doses were lower in PRIME mode for all thicknesses. IQF inv values in PRIME mode were lower for all thicknesses except for 40 mm of PMMA equivalent, in which IQF inv was slightly greater in PRIME mode. A mean reduction of 10% in ESAK and 12% in AGD in PRIME mode with respect to standard mode was obtained. The clinical image quality in PRIME and standard acquisitions resulted to be similar in most of the cases (84% for the first radiologist and 67% for the second one). Conclusion The use of PRIME software reduces, in average, the dose of radiation to the breast without affecting image quality. This reduction is greater for thinner and denser breasts.

Cost-effectiveness of strategies to enhance mammography use.

PubMed

Fishman, P; Taplin, S; Meyer, D; Barlow, W

2000-01-01

To estimate the cost-effectiveness of three strategies to increase breast cancer screening with mammography (reminder postcard, reminder telephone call, and motivational telephone call). Cost accounting for each strategy followed by cost-effectiveness analysis. DATA SOURCE FOR EFFECTIVENESS: Randomized trial of three strategies conducted at Group Health Cooperative of Puget Sound (GHC). Women 50 to 79 years of age who were enrolled in GHC's breast cancer screening program who did not schedule screening mammography within 2 months after it was recommended by letter. Health plan. Marginal cost-effectiveness of each additional woman screened. Because of its high cost (about $26 per call) and intermediate effectiveness, the motivational call was the least cost-effective strategy. If it was assumed that 50% of the women who scheduled mammography after receiving the reminder postcard would have scheduled mammography within 10 months even without it, marginal cost-effectiveness for the postcard among all women was $22 per woman screened versus $92 for the reminder call. Among women with no previous mammography, the marginal cost-effectiveness for the postcard was $70 versus $100 for the reminder call. Among women with no previous mammography, the choice between the reminder postcard and the reminder call was sensitive to assumptions about the percentage of women expected to receive mammography in the absence of other promotional strategies. A simple reminder postcard is the most cost-effective way to increase mammography. Choices about how to promote mammography will ultimately depend on plan values and willingness to invest in promotional strategies that increase participation at higher unit costs.

The role of cone-beam breast-CT for breast cancer detection relative to breast density.

PubMed

Wienbeck, Susanne; Uhlig, Johannes; Luftner-Nagel, Susanne; Zapf, Antonia; Surov, Alexey; von Fintel, Eva; Stahnke, Vera; Lotz, Joachim; Fischer, Uwe

2017-12-01

To evaluate the impact of breast density on the diagnostic accuracy of non-contrast cone-beam breast computed tomography (CBBCT) in comparison to mammography for the detection of breast masses. A retrospective study was conducted from August 2015 to July 2016. Fifty-nine patients (65 breasts, 112 lesions) with BI-RADS, 5th edition 4 or 5 assessment in mammography and/or ultrasound of the breast received an additional non-contrast CBBCT. Independent double blind reading by two radiologists was performed for mammography and CBBCT imaging. Sensitivity, specificity and AUC were compared between the modalities. Breast lesions were histologically examined in 85 of 112 lesions (76%). The overall sensitivity for CBBCT (reader 1: 91%, reader 2: 88%) was higher than in mammography (both: 68%, p<0.001), and also for the high-density group (p<0.05). The specificity and AUC was higher for mammography in comparison to CBBCT (p<0.05 and p<0.001). The interobserver agreement (ICC) between the readers was 90% (95% CI: 86-93%) for mammography and 87% (95% CI: 82-91%) for CBBCT. Compared with two-view mammography, non-contrast CBBCT has higher sensitivity, lower specificity, and lower AUC for breast mass detection in both high and low density breasts. • Overall sensitivity for non-contrast CBBCT ranged between 88%-91%. • Sensitivity was higher for CBBCT than mammography in both density types (p<0.001). • Specificity was higher for mammography than CBBCT in both density types (p<0.05). • AUC was larger for mammography than CBBCT in both density types (p<0.001).

Mammographic density is the main correlate of tumors detected on ultrasound but not on mammography.

PubMed

Häberle, Lothar; Fasching, Peter A; Brehm, Barbara; Heusinger, Katharina; Jud, Sebastian M; Loehberg, Christian R; Hack, Carolin C; Preuss, Caroline; Lux, Michael P; Hartmann, Arndt; Vachon, Celine M; Meier-Meitinger, Martina; Uder, Michael; Beckmann, Matthias W; Schulz-Wendtland, Rüdiger

2016-11-01

Although mammography screening programs do not include ultrasound examinations, some diagnostic units do provide women with both mammography and ultrasonography. This article is concerned with estimating the risk of a breast cancer patient diagnosed in a hospital-based mammography unit having a tumor that is visible on ultrasound but not on mammography. A total of 1,399 women with invasive breast cancer from a hospital-based diagnostic mammography unit were included in this retrospective study. For inclusion, mammograms from the time of the primary diagnosis had to be available for computer-assisted assessment of percentage mammographic density (PMD), as well as Breast Imaging Reporting and Data System (BIRADS) assessment of mammography. In addition, ultrasound findings were available for the complete cohort as part of routine diagnostic procedures, regardless of any patient or imaging characteristics. Logistic regression analyses were conducted to identify predictors of mammography failure, defined as BIRADS assessment 1 or 2. The probability that the visibility of a tumor might be masked at diagnosis was estimated using a regression model with the identified predictors. Tumors were only visible on ultrasound in 107 cases (7.6%). PMD was the strongest predictor for mammography failure, but age, body mass index and previous breast surgery also influenced the risk, independently of the PMD. Risk probabilities ranged from 1% for a defined low-risk group up to 40% for a high-risk group. These findings might help identify women who should be offered ultrasound examinations in addition to mammography. © 2016 UICC.

Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis

PubMed Central

Phi, Xuan-Anh; Saadatmand, Sepideh; De Bock, Geertruida H; Warner, Ellen; Sardanelli, Francesco; Leach, Martin O; Riedl, Christopher C; Trop, Isabelle; Hooning, Maartje J; Mandel, Rodica; Santoro, Filippo; Kwan-Lim, Gek; Helbich, Thomas H; Tilanus-Linthorst, Madeleine MA; van den Heuvel, Edwin R; Houssami, Nehmat

2016-01-01

Background: We investigated the additional contribution of mammography to screening accuracy in BRCA1/2 mutation carriers screened with MRI at different ages using individual patient data from six high-risk screening trials. Methods: Sensitivity and specificity of MRI, mammography and the combination of these tests were compared stratified for BRCA mutation and age using generalised linear mixed models with random effect for studies. Number of screens needed (NSN) for additional mammography-only detected cancer was estimated. Results: In BRCA1/2 mutation carriers of all ages (BRCA1=1219 and BRCA2=732), adding mammography to MRI did not significantly increase screening sensitivity (increased by 3.9% in BRCA1 and 12.6% in BRCA2 mutation carriers, P>0.05). However, in women with BRCA2 mutation younger than 40 years, one-third of breast cancers were detected by mammography only. Number of screens needed for mammography to detect one breast cancer not detected by MRI was much higher for BRCA1 compared with BRCA2 mutation carriers at initial and repeat screening. Conclusions: Additional screening sensitivity from mammography above that from MRI is limited in BRCA1 mutation carriers, whereas mammography contributes to screening sensitivity in BRCA2 mutation carriers, especially those ⩽40 years. The evidence from our work highlights that a differential screening schedule by BRCA status is worth considering. PMID:26908327

Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis.

PubMed

Phi, Xuan-Anh; Saadatmand, Sepideh; De Bock, Geertruida H; Warner, Ellen; Sardanelli, Francesco; Leach, Martin O; Riedl, Christopher C; Trop, Isabelle; Hooning, Maartje J; Mandel, Rodica; Santoro, Filippo; Kwan-Lim, Gek; Helbich, Thomas H; Tilanus-Linthorst, Madeleine M A; van den Heuvel, Edwin R; Houssami, Nehmat

2016-03-15

We investigated the additional contribution of mammography to screening accuracy in BRCA1/2 mutation carriers screened with MRI at different ages using individual patient data from six high-risk screening trials. Sensitivity and specificity of MRI, mammography and the combination of these tests were compared stratified for BRCA mutation and age using generalised linear mixed models with random effect for studies. Number of screens needed (NSN) for additional mammography-only detected cancer was estimated. In BRCA1/2 mutation carriers of all ages (BRCA1 = 1,219 and BRCA2 = 732), adding mammography to MRI did not significantly increase screening sensitivity (increased by 3.9% in BRCA1 and 12.6% in BRCA2 mutation carriers, P > 0.05). However, in women with BRCA2 mutation younger than 40 years, one-third of breast cancers were detected by mammography only. Number of screens needed for mammography to detect one breast cancer not detected by MRI was much higher for BRCA1 compared with BRCA2 mutation carriers at initial and repeat screening. Additional screening sensitivity from mammography above that from MRI is limited in BRCA1 mutation carriers, whereas mammography contributes to screening sensitivity in BRCA2 mutation carriers, especially those ⩽ 40 years. The evidence from our work highlights that a differential screening schedule by BRCA status is worth considering.

Screening for breast cancer in a high-risk series

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woodard, E.D.; Hempelmann, L.H.; Janus, J.

1982-01-01

A unique cohort of women at increased risk of breast cancer because of prior X-ray treatment of acute mastitis and their selected high-risk siblings were offered periodic breast cancer screening including physical examination of the breasts, mammography, and thermography. Twelve breast cancers were detected when fewer than four would have been expected based on age-specific breast cancer detection rates from the National Cancer institute/American Cancer Society Breast Cancer Demonstration Detection Projects. Mammograpy was positive in all cases but physical examination was positive in only three cases. Thermography was an unreliable indicator of disease. Given the concern over radiation-induced risk, usemore » of low-dose technique and of criteria for participation that select women at high risk of breast cancer will maximize the benefit/risk ratio for mammography screening.« less

Do physician communication skills influence screening mammography utilization?

PubMed

Meguerditchian, Ari-Nareg; Dauphinee, Dale; Girard, Nadyne; Eguale, Tewodros; Riedel, Kristen; Jacques, André; Meterissian, Sarkis; Buckeridge, David L; Abrahamowicz, Michal; Tamblyn, Robyn

2012-07-25

The quality of physician communication skills influences health-related decisions, including use of cancer screening tests. We assessed whether patient-physician communication examination scores in a national, standardized clinical skills examination predicted future use of screening mammography (SM). Cohort study of 413 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996, with follow up until 2006. Administrative claims for SM performed within 12 months of a comprehensive health maintenance visit for women 50-69 years old were reviewed. Multivariable regression was used to estimate the relationship between physician communication skills exam score and patients' SM use while controlling for other factors. Overall, 33.8 % of 96,708 eligible women who visited study physicians between 1993 and 2006 had an SM in the 12 months following an index visit. Patient-related factors associated with increased SM use included higher income, non-urban residence, low Charlson co-morbidity index, prior benign breast biopsy and an interval >12 months since the previous mammogram. Physician-related factors associated with increased use of SM included female sex, surgical specialty, and higher communication skills score. After adjusting for physician and patient-related factors, the odds of SM increased by 24 % for 2SD increase in communication score (OR: 1.24, 95 % CI: 1.11 - 1.38). This impact was even greater in urban areas (OR 1.30, 95 % CI: 1.16, 1.46) and did not vary with practice experience (interaction p-value 0.74). Physicians with better communication skills documented by a standardized licensing examination were more successful at obtaining SM for their patients.

Promoting mammography screening among Chinese American women using a message-framing intervention.

PubMed

Sun, Yiyuan; Sarma, Elizabeth A; Moyer, Anne; Messina, Catherine R

2015-07-01

This study examined the role of women's perceptions about the relative pros versus cons (decisional balance) of mammography in moderating Chinese American women's responses to gain- and loss-framed messages that promote mammography. One hundred and forty-three Chinese American women who were currently nonadherent to guidelines for receiving annual screening mammograms were randomly assigned to read either a gain- or loss-framed culturally appropriate print brochure about mammography screening. Mammography screening was self-reported at a 2-month follow-up. Although there was not a main effect for message frame, the hypothesized interaction between message frame and decisional balance was significant, indicating that women who received a framed message that matched their decisional balance were significantly more likely to have obtained a mammogram by the follow-up than women who received a mismatched message. Results suggest that decisional balance, and more generally, perceptions about mammography, may be an important moderator of framing effects for mammography among Chinese American women. The match between message frame and decisional balance should be considered when attempting to encourage Chinese American women to receive mammography screening, as a match between the two may be most persuasive. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

75 FR 70011 - Guidance for Industry, Mammography Quality Standards Act Inspectors, and Food and Drug...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-16

... label to assist that office in processing your request, or fax your request to 301-847-8149. See the.... Clarifying that original or lossless compressed digital image files may be acceptable for record transfer; 3... be acceptable to FDA; 4. Deleting the question and answer dealing with image labeling; 5. Modifying...

Customer focus in breast cancer screening services.

PubMed

Buttimer, Andreas

2009-01-01

The purpose of the paper is to demonstrate how a generic value chain and customer focused system as demonstrated by the Scottish and Irish breast screening programmes can be used to provide a high quality health service. Literature relevant to aligning the entire operating model--the companies' culture, business processes, management systems to serve one value discipline, i.e. customer intimacy, is reviewed and considered in the context of the NHS Scottish Breast Screening Programme in Edinburgh and BreastCheck--the National Breast Screening Programme in Ireland. This paper demonstrates how an emphasis on customer focus and operational excellence, as used in other service industries, can help to provide a better health service. It uses the Scottish and Irish breast screening programmes as illustrative examples. The paper applies the key requirements in the delivery of a quality service including an understanding of the characteristics of a service industry, the management of discontinuities involved in its delivery and the environment in which it operates. System failure is commonly the cause of quality failure in the health system. Breast screening programmes are designed to prevent such a failure. This paper promotes and describes the use of the generic value chain by using the knowledge gained in delivering a mammography-screening programme.

TMIST Breast Screening Study

Cancer.gov

TMIST is a randomized breast screening trial that compares two Food and Drug Administration (FDA)-approved types of digital mammography, standard digital mammography (2-D) with a newer technology called tomosynthesis mammography (3-D).

Turkish translation and adaptation of Champion's Health Belief Model Scales for breast cancer mammography screening.

PubMed

Yilmaz, Meryem; Sayin, Yazile Yazici

2014-07-01

To examine the translation and adaptation process from English to Turkish and the validity and reliability of the Champion's Health Belief Model Scales for Mammography Screening. Its aim (1) is to provide data about and (2) to assess Turkish women's attitudes and behaviours towards mammography. The proportion of women who have mammography is lower in Turkey. The Champion's Health Belief Model Scales for Mammography Screening-Turkish version can be helpful to determine Turkish women's health beliefs, particularly about mammography. Cross-sectional design was used to collect survey data from Turkish women: classical measurement method. The Champion's Health Belief Model Scales for Mammography Screening was translated from English to Turkish. Again, it was back translated into English. Later, the meaning and clarity of the scale items were evaluated by a bilingual group representing the culture of the target population. Finally, the tool was evaluated by two bilingual professional researchers in terms of content validity, translation validity and psychometric estimates of the validity and reliability. The analysis included a total of 209 Turkish women. The validity of the scale was confirmed by confirmatory factor analysis and criterion-related validity testing. The Champion's Health Belief Model Scales for Mammography Screening aligned to four factors that were coherent and relatively independent of each other. There was a statistically significant relationship among all of the subscale items: the positive and high correlation of the total item test score and high Cronbach's α. The scale has a strong stability over time: the Champion's Health Belief Model Scales for Mammography Screening demonstrated acceptable preliminary values of reliability and validity. The Champion's Health Belief Model Scales for Mammography Screening is both a reliable and valid instrument that can be useful in measuring the health beliefs of Turkish women. It can be used to provide data about healthcare practices required for mammography screening and breast cancer prevention. This scale will show nurses that nursing intervention planning is essential for increasing Turkish women's participation in mammography screening. © 2013 John Wiley & Sons Ltd.

Consensus review of discordant findings maximizes cancer detection rate in double-reader screening mammography: Irish National Breast Screening Program experience.

PubMed

Shaw, Colette M; Flanagan, Fidema L; Fenlon, Helen M; McNicholas, Michelle M

2009-02-01

To assesses consensus review of discordant screening mammography findings in terms of its sensitivity, safety, and effect on overall performance in the first 6 years of operation of the Irish National Breast Screening Program (NBSP). Women who participated in the Irish NBSP gave written informed consent for use of their data for auditing purposes. Local ethics committee approval was obtained. The study population consisted of women who participated in the Irish NBSP and underwent initial screening mammography at one of the two screening centers serving the eastern part of Ireland between 2000 and 2005. Independent double reading of mammograms was performed. When the readers disagreed regarding referral, the case was reviewed by a consensus panel. Of the 128 569 screenings performed, 1335 (1%) were discussed by consensus. Of the 1335 cases discussed by consensus, 606 (45.39%) were recalled for further assessment. This resulted in an overall recall rate of 4.41%. In those recalled to assessment, 71 cases of malignant disease were diagnosed (ductal carcinoma in situ, n = 24; invasive cancer, n = 47). The remaining 729 patients were returned to biennial screening. Of these 729 patients, seven had false-negative findings that were identified in the subsequent screening round. Use of the highest reader recall method, in which a patient is recalled if her findings are deemed abnormal by either reader, could potentially increase the cancer detection rate by 0.6 per 1000 women screened but would increase the recall rate by 12.69% and the number of false-positive findings by 15.37%. The consensus panel identified 71 (7.33%) of 968 cancers diagnosed. Consensus review substantially reduced the number of cases recalled and was associated with a low false-negative rate.

Women's participation in breast cancer screening in France--an ethical approach.

PubMed

Moutel, Grégoire; Duchange, Nathalie; Darquy, Sylviane; de Montgolfier, Sandrine; Papin-Lefebvre, Frédérique; Jullian, Odile; Viguier, Jérôme; Sancho-Garnier, Hélène

2014-08-16

Breast cancer is a major public health challenge. Organized mammography screening (OS) is considered one way to reduce breast cancer mortality. EU recommendations prone mass deployment of OS, and back in 2004, France introduced a national OS programme for women aged 50-74 years. However, in 2012, participation rate was still just 52.7%, well short of the targeted 70% objective. In an effort to re-address the (in) efficiency of the programme, the French National Cancer Institute has drafted an expert-group review of the ethical issues surrounding breast cancer mammography screening. Prompted by emerging debate over the efficiency of the screening scheme and its allied public information provision, we keynote the experts' report based on analysis of epidemiological data and participation rate from the public health authorities. The low coverage of the OS scheme may be partly explained by the fact that a significant number of women undergo mammography outside OS and thus outside OS criteria. These findings call for further thinking on (i) the ethical principles of beneficence and non-malfeasance underpinning this public health initiative, (ii) the reasons behind women's and professionals' behavior, and (iii) the need to analyze how information provision to women and the doctor-patient relationship need to evolve in response to scientific controversy over the risks and benefits of conducting mammographic screening. This work calls for a reappraisal of the provision of screening programme information. We advocate a move to integrate the points sparking debate over the efficiency of the screening scheme to guarantee full transparency. The perspective is to strengthen the respect for autonomy allowing women to make an informed choice in their decision on whether or not to participate.

Implementation of Synthesized Two-dimensional Mammography in a Population-based Digital Breast Tomosynthesis Screening Program

PubMed Central

Zuckerman, Samantha P.; Keller, Brad M.; Maidment, Andrew D. A.; Barufaldi, Bruno; Weinstein, Susan P.; Synnestvedt, Marie; McDonald, Elizabeth S.

2016-01-01

Purpose To evaluate the early implementation of synthesized two-dimensional (s2D) mammography in a population screened entirely with s2D and digital breast tomosynthesis (DBT) (referred to as s2D/DBT) and compare recall rates and cancer detection rates to historic outcomes of digital mammography combined with DBT (referred to as digital mammography/DBT) screening. Materials and Methods This was an institutional review board–approved and HIPAA-compliant retrospective interpretation of prospectively acquired data with waiver of informed consent. Compared were recall rates, biopsy rates, cancer detection rates, and radiation dose for 15 571 women screened with digital mammography/DBT from October 1, 2011, to February 28, 2013, and 5366 women screened with s2D/DBT from January 7, 2015, to June 30, 2015. Two-sample z tests of equal proportions were used to determine statistical significance. Results Recall rate for s2D/DBT versus digital mammography/DBT was 7.1% versus 8.8%, respectively (P < .001). Biopsy rate for s2D/DBT versus digital mammography/DBT decreased (1.3% vs 2.0%, respectively; P = .001). There was no significant difference in cancer detection rate for s2D/DBT versus digital mammography/DBT (5.03 of 1000 vs 5.45 of 1000, respectively; P = .72). The average glandular dose was 39% lower in s2D/DBT versus digital mammography/DBT (4.88 mGy vs 7.97 mGy, respectively; P < .001). Conclusion Screening with s2D/DBT in a large urban practice resulted in similar outcomes compared with digital mammography/DBT imaging. Screening with s2D/DBT allowed for the benefits of DBT with a decrease in radiation dose compared with digital mammography/DBT. © RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on August 11, 2016. PMID:27467468

Mammography

MedlinePlus

... Prior Mammograms Helps Radiologists Detect Breast Cancer MammographySavesLives.org A general information resource on breast imaging from ... doctors: Breast Density and Breast Cancer Screening RTAnswers.org Radiation Therapy for Breast Cancer MedLinePlus Mammography top ...

Quality of care in investor-owned vs not-for-profit HMOs.

PubMed

Himmelstein, D U; Woolhandler, S; Hellander, I; Wolfe, S M

1999-07-14

The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs. To compare quality-of-care measures for investor-owned and not-for-profit HMOs. Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States. Rates for 14 HEDIS quality-of-care indicators. Compared with not-for-profit HMOs, investor-owned plans had lower rates for all 14 quality-of-care indicators. Among patients discharged from the hospital after myocardial infarction, 59.2% of members in investor-owned HMOs vs 70.6% in not-for-profit plans received a beta-blocker (P<.001); 35.1% of patients with diabetes mellitus in investor-owned plans vs 47.9% in not-for-profit plans had annual eye examinations (P<.001). Investor-owned plans had lower rates than not-for-profit plans of immunization (63.9% vs 72.3%; P<.001), mammography (69.4% vs 75.1%; P<.001), Papanicolaou tests (69.2% vs 77.1%; P<.001), and psychiatric hospitalization (70.5% vs 77.1%; P<.001). Quality scores were highest for staff- and group-model HMOs. In multivariate analyses, investor ownership was consistently associated with lower quality after controlling for model type, geographic region, and the method each HMO used to collect data. Investor-owned HMOs deliver lower quality of care than not-for-profit plans.

The Efficacy of Mammography Boot Camp to Improve the Performance of Radiologists

PubMed Central

Lee, Eun Hye; Jung, Seung Eun; Kim, You Me; Choi, Nami

2014-01-01

Objective To evaluate the efficacy of a mammography boot camp (MBC) to improve radiologists' performance in interpreting mammograms in the National Cancer Screening Program (NCSP) in Korea. Materials and Methods Between January and July of 2013, 141 radiologists were invited to a 3-day educational program composed of lectures and group practice readings using 250 digital mammography cases. The radiologists' performance in interpreting mammograms were evaluated using a pre- and post-camp test set of 25 cases validated prior to the camp by experienced breast radiologists. Factors affecting the radiologists' performance, including age, type of attending institution, and type of test set cases, were analyzed. Results The average scores of the pre- and post-camp tests were 56.0 ± 12.2 and 78.3 ± 9.2, respectively (p < 0.001). The post-camp test scores were higher than the pre-camp test scores for all age groups and all types of attending institutions (p < 0.001). The rate of incorrect answers in the post-camp test decreased compared to the pre-camp test for all suspicious cases, but not for negative cases (p > 0.05). Conclusion The MBC improves radiologists' performance in interpreting mammograms irrespective of age and type of attending institution. Improved interpretation is observed for suspicious cases, but not for negative cases. PMID:25246818

Reader strategies: variability and error- methodology, findings, and health policy implications from a study of the U.S. population of mammographers

NASA Astrophysics Data System (ADS)

Beam, Craig A.

2002-04-01

Each year, approximately 60% of all US women over the age of 40 utilize mammography. Through the matrix of an imaging technology, this Population of Patients (POP) interacts with a population of approximately 20,000 physicians who interpret mammograms in the US. This latter Population of Diagnosticians (POD) operationally serves as the interface between an image-centric healthcare technology system and patient. Methods: using data collected from a large POD and POP based study, I evaluate the distribution of several ROC curve-related parameters in the POD and explore the health policy implications of a population ROC curve for mammography. Results and Conclusions: Principal Components Analysis suggests that two Binormal parameters are sufficient to explain variation in the POD and implies that the Binormal model is foundational to Health Policy Research in Mammography. A population ROC curve based on percentiles of the POD can be used to set targets to achieve national health policy goals. Medical Image Perception science provides the framework. Alternatively, a restrictive policy can be envisioned using performance criteria based on area. However, the data suggests this sort of policy would be too costly in terms of reduced healthcare service capacity in the US in the face of burgeoning demands.

Non-attendance in mammography screening and women's social network: a cohort study on the influence of family composition, social support, attitudes and cancer in close relations.

PubMed

Manjer, Åsa Ritenius; Emilsson, Ulla Melin; Zackrisson, Sophia

2015-06-28

Mammography screening can reduce breast cancer mortality. The aim of the present study was to investigate non-attendance in mammography screening in relation to different aspects of a women's social network, attitudes and cancer in close relations. Data from the Malmö Diet and Cancer Study baseline examination in 1991-1996 was used. A re-examination began in 2007, and 1452 women participated. Family composition, social support, sense of belonging, attitudes on screening and breast cancer risk and on previous cancer in close relations were investigated in relation to self-reported participation in mammography screening using logistic regression analysis, yielding odds ratios with 95 % confidence intervals. Both attendees (98.0 %) and non-attendees (95.2 %) considered mammography screening important. Non-attendance in mammography screening was associated with being unmarried vs. married (2.40:1.30-4.45) and with not having vs. having children (1.77:1.08-2.92). Non-attendees planned to abstain from mammography screening in the future more often than attendees (4.78:2.56-8.90), and they had often abstained from cervical cancer screening (1.69:1.04-2.75). No other statistically significant association was found. This study indicates that family composition, but not necessarily the presence or absence of social support, perceived cancer risk or cancer in close relations, may affect non-attendance in mammography screening. A positive attitude towards mammography screening was found among both attendees and non-attendees, although the latter group planned to a lesser degree to attend mammography screening in the future.

Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme.

PubMed

Lobbes, Marc B I; Lalji, Ulrich; Houwers, Janneke; Nijssen, Estelle C; Nelemans, Patty J; van Roozendaal, Lori; Smidt, Marjolein L; Heuts, Esther; Wildberger, Joachim E

2014-07-01

Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM. During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar's test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities. Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0% (+3.1%), specificity to 87.7% (+45.7%), PPV to 76.2% (+36.5%) and NPV to 100.0% (+2.9%) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p < 0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p < 0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed. CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening. • CESM is feasible in the workflow of referrals from routine breast screening. • CESM is superior to mammography, even in low disease prevalence populations. • CESM has an extremely high negative predictive value for breast cancer. • CESM is comparable to MRI in assessment of breast cancer extent. • CESM is comparable to histopathology in assessment of breast cancer extent.

Evaluation of the Utility of Screening Mammography for High-Risk Women Undergoing Screening Breast MR Imaging.

PubMed

Lo, Glen; Scaranelo, Anabel M; Aboras, Hana; Ghai, Sandeep; Kulkarni, Supriya; Fleming, Rachel; Bukhanov, Karina; Crystal, Pavel

2017-10-01

Purpose To evaluate the value of mammography in detecting breast cancer in high-risk women undergoing screening breast magnetic resonance (MR) imaging. Materials and Methods An ethics-approved, retrospective review of prospective databases was performed to identify outcomes of 3934 screening studies (1977 screening MR imaging examinations and 1957 screening mammograms) performed between January 2012 and July 2014 in 1249 high-risk women. Performance measures including recall and cancer detection rates, sensitivity, specificity, and positive predictive values were calculated for both mammography and MR imaging. Results A total of 45 cancers (33 invasive and 12 ductal carcinomas in situ) were diagnosed, 43 were seen with MR imaging and 14 with both mammography and MR imaging. Additional tests (further imaging and/or biopsy) were recommended in 461 screening MR imaging studies (recall rate, 23.3%; 95% confidence interval [CI]: 21.5%, 25.2%), and mammography recalled 217 (recall rate, 11.1%; 95% CI: 9.7%, 12.6%). The cancer detection rate for MR imaging was 21.8 cancers per 1000 examinations (95% CI: 15.78, 29.19) and that for mammography was 7.2 cancers per 1000 examinations (95% CI: 3.92, 11.97; P < .001). Sensitivity and specificity of MR imaging were 96% and 78% respectively, and those of mammography were 31% and 89%, respectively (P < .001). Positive predictive value for MR imaging recalls was 9.3% (95% CI: 6.83%, 12.36%) and that for mammography recalls was 6.5% (95% CI: 3.57%, 10.59%). Conclusion Contemporaneous screening mammography did not have added value in detection of breast cancer for women who undergo screening MR imaging. Routine use of screening mammography in women undergoing screening breast MR imaging warrants reconsideration. © RSNA, 2017 Online supplemental material is available for this article.

The variability of software scoring of the CDMAM phantom associated with a limited number of images

NASA Astrophysics Data System (ADS)

Yang, Chang-Ying J.; Van Metter, Richard

2007-03-01

Software scoring approaches provide an attractive alternative to human evaluation of CDMAM images from digital mammography systems, particularly for annual quality control testing as recommended by the European Protocol for the Quality Control of the Physical and Technical Aspects of Mammography Screening (EPQCM). Methods for correlating CDCOM-based results with human observer performance have been proposed. A common feature of all methods is the use of a small number (at most eight) of CDMAM images to evaluate the system. This study focuses on the potential variability in the estimated system performance that is associated with these methods. Sets of 36 CDMAM images were acquired under carefully controlled conditions from three different digital mammography systems. The threshold visibility thickness (TVT) for each disk diameter was determined using previously reported post-analysis methods from the CDCOM scorings for a randomly selected group of eight images for one measurement trial. This random selection process was repeated 3000 times to estimate the variability in the resulting TVT values for each disk diameter. The results from using different post-analysis methods, different random selection strategies and different digital systems were compared. Additional variability of the 0.1 mm disk diameter was explored by comparing the results from two different image data sets acquired under the same conditions from the same system. The magnitude and the type of error estimated for experimental data was explained through modeling. The modeled results also suggest a limitation in the current phantom design for the 0.1 mm diameter disks. Through modeling, it was also found that, because of the binomial statistic nature of the CDMAM test, the true variability of the test could be underestimated by the commonly used method of random re-sampling.

TU-A-18C-01: ACR Accreditation Updates in CT, Ultrasound, Mammography and MRI

DOE Office of Scientific and Technical Information (OSTI.GOV)

Price, R; Berns, E; Hangiandreou, N

2014-06-15

A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, the ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up-to-datemore » as the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, mammography, ultrasound, and computed tomography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements. Learning Objectives: To understand the requirements of the ACR MR accreditation program. The discussion will include accreditation of whole-body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program. To understand the new requirements of the ACR ultrasound accreditation program, and roles the physicist can play in annual equipment surveys and setting up and supervising the routine QC program. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process.« less

Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment.

PubMed

Taylor, K; Parashar, D; Bouverat, G; Poulos, A; Gullien, R; Stewart, E; Aarre, R; Crystal, P; Wallis, M

2017-11-01

Optimum mammography positioning technique is necessary to maximise cancer detection. Current criteria for mammography appraisal lack reliability and validity with a need to develop a more objective system. We aimed to establish current international practice in assessing image quality (IQ), of screening mammograms then develop and validate a reproducible assessment tool. A questionnaire sent to centres in countries undertaking population screening identified practice, participants for an expert panel (EP) of radiologists/radiographers and a testing panel (TP) of radiographers. The EP developed category criteria and descriptors using a modified Delphi process to agree definitions. The EP scored 12 screening mammograms to test agreement then a main set of 178 cases. Weighted scores were derived for each descriptor enabling calculation of numerical parameters for each new category. The TP then scored the main set. Statistical analysis included ANOVA, t-tests and Kendall's coefficient. 11 centres in 8 countries responded forming an EP of 7 members and TP of 44 members. The EP showed moderate agreement when the scoring the mini test set W = 0.50 p < 0.001 and the main set W = 0.55 p < 0.001, 'posterior nipple line' being the most difficult descriptor. The weighted total scores differentiated the 4 new categories Perfect, Good, Adequate and Inadequate (p < 0.001). We have developed an assessment tool by Delphi consensus and weighted consensus criteria. We have successfully tabulated a range of numerical scores for each new category providing the first validated and reproducible mammography IQ scoring system. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

MO-AB-207-04: ACR Update in Mammography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Berns, E.

2015-06-15

A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up-to-date asmore » the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, computed tomography, nuclear medicine, and mammography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements. Learning Objectives: To understand the requirements of the ACR MR Accreditation program. The discussion will include accreditation of whole-body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process. To understand the requirements of the ACR nuclear medicine accreditation program, and the role of the physicist in annual equipment surveys and the set up and supervision of the routine QC program. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program.« less

MO-AB-207-00: ACR Update in MR, CT, Nuclear Medicine, and Mammography

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up-to-date asmore » the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, computed tomography, nuclear medicine, and mammography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements. Learning Objectives: To understand the requirements of the ACR MR Accreditation program. The discussion will include accreditation of whole-body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process. To understand the requirements of the ACR nuclear medicine accreditation program, and the role of the physicist in annual equipment surveys and the set up and supervision of the routine QC program. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program.« less

Evaluation of mammography equipment performance, dose and image quality in five Latin American countries

NASA Astrophysics Data System (ADS)

Brandan, M.-E.; Ruiz-Trejo, C.; Caspani, C. E. M.; Fleitas, I.; de-la-Mora, R.; Miranda, A. A.; Plazas, M.-C.; Betancourt, C.-M.; Borras, C.

2001-10-01

Under the auspices of PAHO/WHO, a multicentric investigation is carried out in five Latin American countries. Its aim is to correlate quality indicators of radiology services with the accuracy of the radiological interpretation as determined by a panel of radiology experts. We present preliminary results from mammographic imaging facilities. Evaluation of the equipment performance and dose measurements in 21 mammographic units show that, on the average, 75% of the units comply with recommendations issued by various organizations. An independent evaluation of the quality of the clinical images show strong variations among the different radiological services.

Beliefs of Turkish female teaching staff regarding mammography scanning.

PubMed

Temel, Ayla Bayik; Ardahan, Melek; Sesli, Esra

2010-01-01

To our knowledge, there has hitherto been no research to determine the beliefs of female teaching staff, who are highly educated and form a special risk group regarding breast cancer, towards mammography scanning in Turkey. Definitive research was planned to determine the beliefs of the female teaching staff working in a university. Data were collected by researchers via face-to-face interview using a sociodemographic questionnaire and " Health Belief Model ". The point average of the teaching staff in the mammography benefits sub-scale is 19.6 ± 3.87, their average item score is 3.91. The point average of the teaching staff in the mammography obstacles sub-scale is 21.17 ± 6.87, their average item score is 1.92. They agree on the benefits of the mammography, but they do not agree on the obstacles to mammography.

Changing patterns of microcalcification on screening mammography for prediction of breast cancer.

PubMed

Kim, Kwan Il; Lee, Kyung Hee; Kim, Tae Ryung; Chun, Yong Soon; Lee, Tae Hoon; Choi, Hye Young; Park, Heung Kyu

2016-05-01

The presence of microcalcification on mammography is one of the earliest signs in breast cancer detection. However, it is difficult to distinguish malignant calcifications from benign calcifications. The aim of this study is to evaluate correlation between changing patterns of microcalcification on screening mammography and malignant breast lesions. Medical records and diagnostic images of 67 women who had previously undergone at least two digital mammograms at least 6 months apart and underwent mammography-guided needle localization and surgical excision between 2011 and 2013 were retrospectively reviewed and analyzed. Breast cancer was detected in the surgical specimens of 20 patients (29.9 %). Annual change of extent of microcalcification on mammography showed statistically significant correlation with pathologic outcome (P = 0.023). The changing pattern of new appearance or increased extent of microcalcification on mammography had positive predictive value of 54.8 % for breast cancer, and it was a statistically significant predictor for breast cancer (P = 0.012). Shape or number change of microcalcification without increased extent had less accurate predictive value for breast cancer, particularly in women younger than 50 years (P < 0.001). This study showed that the pattern of increased extent of microcalcification on screening mammography was a significant predictor for breast cancer. We suggest that mammography-guided needle localization and surgical excision should be considered when increased extent of microcalcification is observed on screening mammography and closed follow-up without pathologic confirmation can be permitted if absence of extension of microcalcification was confirmed in women younger than 50 years.

Improved visualization of breast cancer features in multifocal carcinoma using phase-contrast and dark-field mammography: an ex vivo study.

PubMed

Grandl, Susanne; Scherer, Kai; Sztrókay-Gaul, Anikó; Birnbacher, Lorenz; Willer, Konstantin; Chabior, Michael; Herzen, Julia; Mayr, Doris; Auweter, Sigrid D; Pfeiffer, Franz; Bamberg, Fabian; Hellerhoff, Karin

2015-12-01

Conventional X-ray attenuation-based contrast is inherently low for the soft-tissue components of the female breast. To overcome this limitation, we investigate the diagnostic merits arising from dark-field mammography by means of certain tumour structures enclosed within freshly dissected mastectomy samples. We performed grating-based absorption, absolute phase and dark-field mammography of three freshly dissected mastectomy samples containing bi- and multifocal carcinoma using a compact, laboratory Talbot-Lau interferometer. Preoperative in vivo imaging (digital mammography, ultrasound, MRI), postoperative histopathological analysis and ex vivo digital mammograms of all samples were acquired for the diagnostic verification of our results. In the diagnosis of multifocal tumour growth, dark-field mammography seems superior to standard breast imaging modalities, providing a better resolution of small, calcified tumour nodules, demarcation of tumour boundaries with desmoplastic stromal response and spiculated soft-tissue strands extending from an invasive ductal breast cancer. On the basis of selected cases, we demonstrate that dark-field mammography is capable of outperforming conventional mammographic imaging of tumour features in both calcified and non-calcified tumours. Presuming dose optimization, our results encourage further studies on larger patient cohorts to identify those patients that will benefit the most from this promising additional imaging modality. • X-ray dark-field mammography provides significantly improved visualization of tumour features • X-ray dark-field mammography is capable of outperforming conventional mammographic imaging • X-ray dark-field mammography provides imaging sensitivity towards highly dispersed calcium grains.

Dose assessment in contrast enhanced digital mammography using simple phantoms simulating standard model breasts.

PubMed

Bouwman, R W; van Engen, R E; Young, K C; Veldkamp, W J H; Dance, D R

2015-01-07

Slabs of polymethyl methacrylate (PMMA) or a combination of PMMA and polyethylene (PE) slabs are used to simulate standard model breasts for the evaluation of the average glandular dose (AGD) in digital mammography (DM) and digital breast tomosynthesis (DBT). These phantoms are optimized for the energy spectra used in DM and DBT, which normally have a lower average energy than used in contrast enhanced digital mammography (CEDM). In this study we have investigated whether these phantoms can be used for the evaluation of AGD with the high energy x-ray spectra used in CEDM. For this purpose the calculated values of the incident air kerma for dosimetry phantoms and standard model breasts were compared in a zero degree projection with the use of an anti scatter grid. It was found that the difference in incident air kerma compared to standard model breasts ranges between -10% to +4% for PMMA slabs and between 6% and 15% for PMMA-PE slabs. The estimated systematic error in the measured AGD for both sets of phantoms were considered to be sufficiently small for the evaluation of AGD in quality control procedures for CEDM. However, the systematic error can be substantial if AGD values from different phantoms are compared.

Design and image-quality performance of high resolution CMOS-based X-ray imaging detectors for digital mammography

NASA Astrophysics Data System (ADS)

Cha, B. K.; Kim, J. Y.; Kim, Y. J.; Yun, S.; Cho, G.; Kim, H. K.; Seo, C.-W.; Jeon, S.; Huh, Y.

2012-04-01

In digital X-ray imaging systems, X-ray imaging detectors based on scintillating screens with electronic devices such as charge-coupled devices (CCDs), thin-film transistors (TFT), complementary metal oxide semiconductor (CMOS) flat panel imagers have been introduced for general radiography, dental, mammography and non-destructive testing (NDT) applications. Recently, a large-area CMOS active-pixel sensor (APS) in combination with scintillation films has been widely used in a variety of digital X-ray imaging applications. We employed a scintillator-based CMOS APS image sensor for high-resolution mammography. In this work, both powder-type Gd2O2S:Tb and a columnar structured CsI:Tl scintillation screens with various thicknesses were fabricated and used as materials to convert X-ray into visible light. These scintillating screens were directly coupled to a CMOS flat panel imager with a 25 × 50 mm2 active area and a 48 μm pixel pitch for high spatial resolution acquisition. We used a W/Al mammographic X-ray source with a 30 kVp energy condition. The imaging characterization of the X-ray detector was measured and analyzed in terms of linearity in incident X-ray dose, modulation transfer function (MTF), noise-power spectrum (NPS) and detective quantum efficiency (DQE).

Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project.

PubMed

Özmen, Vahit; Gürdal, Sibel Ö; Cabioğlu, Neslihan; Özcinar, Beyza; Özaydın, A Nilüfer; Kayhan, Arda; Arıbal, Erkin; Sahin, Cennet; Saip, Pınar; Alagöz, Oğuzhan

2017-07-01

We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (2009-2019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of $2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.

Evolution of Breast Cancer Screening in the Medicare Population: Clinical and Economic Implications

PubMed Central

Killelea, Brigid K.; Long, Jessica B.; Chagpar, Anees B.; Ma, Xiaomei; Wang, Rong; Ross, Joseph S.

2014-01-01

Background Newer approaches to mammography, including digital image acquisition and computer-aided detection (CAD), and adjunct imaging (e.g., magnetic resonance imaging [MRI]) have diffused into clinical practice. The impact of these technologies on screening-related cost and outcomes remains undefined, particularly among older women. Methods Using the Surveillance, Epidemiology, and End Results–Medicare linked database, we constructed two cohorts of women without a history of breast cancer and followed each cohort for 2 years. We compared the use and cost of screening mammography including digital mammography and CAD, adjunct procedures including breast ultrasound, MRI, and biopsy between the period of 2001 and 2002 and the period of 2008 and 2009 using χ2 and t test. We also assessed the change in breast cancer stage and incidence rates using χ2 and Poisson regression. All statistical tests were two-sided. Results There were 137150 women (mean age = 76.0 years) in the early cohort (2001–2002) and 133097 women (mean age = 77.3 years) in the later cohort (2008–2009). The use of digital image acquisition for screening mammography increased from 2.0% in 2001 and 2002 to 29.8% in 2008 and 2009 (P < .001). CAD use increased from 3.2% to 33.1% (P < .001). Average screening-related cost per capita increased from $76 to $112 (P < .001), with annual national fee-for-service Medicare spending increasing from $666 million to $962 million. There was no statistically significant change in detection rates of early-stage tumors (2.45 vs 2.57 per 1000 person-years; P = .41). Conclusions Although breast cancer screening–related costs increased substantially from 2001 through 2009 among Medicare beneficiaries, a clinically significant change in stage at diagnosis was not observed. PMID:25031307

Digital Mammography Breast Dosimetry Using Copper-Doped Lithium Fluoride (LiF:MCP) Thermoluminescent Dosimeters (TLDs)

DTIC Science & Technology

2003-06-18

Mammography Breast Dosimetry Using Copper-Doped Lithium Fluoride (LiF:MCP) Thermoluminescent Dosimeters ( TLDs ) 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...34Digital Mammography Breast Dosimetry Using Copper- Doped Lithium Fluoride (LiF:MCP) Thermoluminescent Dosimeters ( TLDs )" Author: LT John J. Tomon...Title of Thesis: " Digital Mammography Breast Dosimetry Using Copper-Doped Lithium Fluoride (LiF:MCP) Thermoluminescent

Effects of a risk-based online mammography intervention on accuracy of perceived risk and mammography intentions.

PubMed

Seitz, Holli H; Gibson, Laura; Skubisz, Christine; Forquer, Heather; Mello, Susan; Schapira, Marilyn M; Armstrong, Katrina; Cappella, Joseph N

2016-10-01

This experiment tested the effects of an individualized risk-based online mammography decision intervention. The intervention employs exemplification theory and the Elaboration Likelihood Model of persuasion to improve the match between breast cancer risk and mammography intentions. 2918 women ages 35-49 were stratified into two levels of 10-year breast cancer risk (<1.5%; ≥1.5%) then randomly assigned to one of eight conditions: two comparison conditions and six risk-based intervention conditions that varied according to a 2 (amount of content: brief vs. extended) x 3 (format: expository vs. untailored exemplar [example case] vs. tailored exemplar) design. Outcomes included mammography intentions and accuracy of perceived breast cancer risk. Risk-based intervention conditions improved the match between objective risk estimates and perceived risk, especially for high-numeracy women with a 10-year breast cancer risk ≤1.5%. For women with a risk≤1.5%, exemplars improved accuracy of perceived risk and all risk-based interventions increased intentions to wait until age 50 to screen. A risk-based mammography intervention improved accuracy of perceived risk and the match between objective risk estimates and mammography intentions. Interventions could be applied in online or clinical settings to help women understand risk and make mammography decisions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Effects of a Risk-based Online Mammography Intervention on Accuracy of Perceived Risk and Mammography Intentions

PubMed Central

Seitz, Holli H.; Gibson, Laura; Skubisz, Christine; Forquer, Heather; Mello, Susan; Schapira, Marilyn M.; Armstrong, Katrina; Cappella, Joseph N.

2016-01-01

Objective This experiment tested the effects of an individualized risk-based online mammography decision intervention. The intervention employs exemplification theory and the Elaboration Likelihood Model of persuasion to improve the match between breast cancer risk and mammography intentions. Methods 2,918 women ages 35-49 were stratified into two levels of 10-year breast cancer risk (< 1.5%; ≥ 1.5%) then randomly assigned to one of eight conditions: two comparison conditions and six risk-based intervention conditions that varied according to a 2 (amount of content: brief vs. extended) × 3 (format: expository vs. untailored exemplar [example case] vs. tailored exemplar) design. Outcomes included mammography intentions and accuracy of perceived breast cancer risk. Results Risk-based intervention conditions improved the match between objective risk estimates and perceived risk, especially for high-numeracy women with a 10-year breast cancer risk <1.5%. For women with a risk < 1.5%, exemplars improved accuracy of perceived risk and all risk-based interventions increased intentions to wait until age 50 to screen. Conclusion A risk-based mammography intervention improved accuracy of perceived risk and the match between objective risk estimates and mammography intentions. Practice Implications Interventions could be applied in online or clinical settings to help women understand risk and make mammography decisions. PMID:27178707

Incremental cancer detection of locoregional restaging with diagnostic mammography combined with whole breast and regional nodal ultrasound in women with newly-diagnosed breast cancer

PubMed Central

Candelaria, Rosalind P.; Huang, Monica L.; Adrada, Beatriz E.; Bassett, Roland; Hunt, Kelly K.; Kuerer, Henry M.; Smith, Benjamin D.; Chavez-MacGregor, Mariana; Yang, Wei Tse

2016-01-01

RATIONALE AND OBJECTIVES To determine if locoregional restaging with diagnostic mammography and ultrasound of the whole breast and regional nodes performed for quality assurance in women with newly-diagnosed breast cancer referred to a tertiary care center yields incremental cancer detection. MATERIALS AND METHODS An institutional review board-approved retrospective, single institution database review was performed on the first 1000 women referred to our center in 2010 with a provisional breast cancer diagnosis. Locoregional restaging consisted of diagnostic full-field digital mammography combined with ultrasound of the whole breast and regional nodal basins. Bilateral whole breast ultrasound was performed in women with contralateral mammographic abnormality or had heterogeneously or extremely dense parenchyma. Demographic, clinical and pathologic factors were analyzed. RESULTS Final analyses included 401 women. 34% (138/401) of women did not have their outside images available for review upon referral. Median age was 54 years, range 21–92; median tumor size was 2.9 cm, range 0.6–18, for women whose disease was upstaged and 2.2 cm, range 0.4–15, for women whose disease was not upstaged. Incremental cancer detection rates were 15.5% (62/401) in the ipsilateral breast and 3.9% (6/154) in the contralateral breast (p<0.0001). Total upstage rate was 25% (100/401). Surgical management changed from segmentectomy to mastectomy in 12% (50/401). Re-excision rate after segmentectomy was 19% (35/189). CONCLUSION Locoregional restaging with diagnostic mammography combined with whole breast and regional nodal ultrasound that is performed for standardization of the imaging workup for newly-diagnosed breast cancer patients can reduce underestimation of disease burden and impact therapeutic planning. PMID:27955877

Retrospective observation on contribution and limitations of screening for breast cancer with mammography in Korea: detection rate of breast cancer and incidence rate of interval cancer of the breast.

PubMed

Lee, Kunsei; Kim, Hyeongsu; Lee, Jung Hyun; Jeong, Hyoseon; Shin, Soon Ae; Han, Taehwa; Seo, Young Lan; Yoo, Youngbum; Nam, Sang Eun; Park, Jong Heon; Park, Yoo Mi

2016-11-18

The purpose of this study was to determine the benefits and limitations of screening for breast cancer using mammography. Descriptive design with follow-up was used in the study. Data from breast cancer screening and health insurance claim data were used. The study population consisted of all participants in breast cancer screening from 2009 to 2014. Crude detection rate, positive predictive value and sensitivity and specificity of breast cancer screening and, incidence rate of interval cancer of the breast were calculated. The crude detection rate of breast cancer screening per 100,000 participants increased from 126.3 in 2009 to 182.1 in 2014. The positive predictive value of breast cancer screening per 100,000 positives increased from 741.2 in 2009 to 1,367.9 in 2014. The incidence rate of interval cancer of the breast per 100,000 negatives increased from 51.7 in 2009 to 76.3 in 2014. The sensitivities of screening for breast cancer were 74.6% in 2009 and 75.1% in 2014 and the specificities were 83.1% in 2009 and 85.7% in 2014. To increase the detection rate of breast cancer by breast cancer screening using mammography, the participation rate should be higher and an environment where accurate mammography and reading can be performed and reinforcement of quality control are required. To reduce the incidence rate of interval cancer of the breast, it will be necessary to educate women after their 20s to perform self-examination of the breast once a month regardless of participation in screening for breast cancer.

A review of screening mammography participation and utilization in Canada.

PubMed

Doyle, G P; Major, D; Chu, C; Stankiewicz, A; Harrison, M L; Pogany, L; Mai, V M; Onysko, J

2011-09-01

Participation rate is an important indicator for a screening program's effectiveness; however, the current approach to measuring participation rate in Canada is not comparable with other countries. The objective of this study is to review the measurement of screening mammography participation in Canada, make international comparisons, and propose alternative methods. Canadian breast cancer screening program data for women aged 50 to 69 years screened between 2004 and 2006 were extracted from the Canadian Breast Cancer Screening Database (CBCSD). The fee-for-services (FSS) mammography data (opportunistic screening mammography) were obtained from the provincial ministries of health. Both screening mammography program participation and utilization were examined over 24 and 30 months. Canada's screening participation rate increases from 39.4% for a 24-month cut-off to 43.6% for a 30-month cut-off. The 24-month mammography utilization rate is 63.1% in Canada, and the 30-month utilization rate is 70.4%. Due to the differences in health service delivery among Canadian provinces, both programmatic participation and overall utilization of mammography at 24 months and 30 months should be monitored.

Differential Effects of Social Networks on Mammography Use by Poverty Status.

PubMed

Yeo, Younsook

2016-01-01

This study examines whether social networks have differential effects on mammography use depending on poverty status. Data were analyzed on US women (40+), employing logistic regression and simple slope analyses for a post hoc probing of moderating effects. Among women not in poverty, living with a spouse/partner and attending church, regardless of frequency, were positively associated with mammography use; family size was negatively associated. Among women living in poverty, mammography showed a positive association only with weekly church attendance. Mammography was negatively associated with health-related social interactions occurring through the Internet. Post hoc probing showed significant moderating effects of poverty on the relationship between online health-related interactions and mammography use. To make the Internet a meaningful health empowerment tool for women in poverty, future research should identify how health-related interactions that occur online affect women in poverty's psychological and behavioral reactions that will contribute to our understanding of why they are discouraged from having mammograms. The mechanisms behind the differential effects of church attendance and poverty status on mammography also need further clarification.

Mammography screening: how important is cost as a barrier to use?

PubMed Central

Urban, N; Anderson, G L; Peacock, S

1994-01-01

OBJECTIVES. Recent legislation will improve insurance coverage for screening mammography and effectively lower its cost to many women. Although cost has been cited as a barrier to use, evidence of the magnitude of its effect on use is limited. METHODS. Mammography use in the past 2 years among women aged 50 to 75 residing in four suburban or rural counties in Washington State was estimated from 1989 survey data. Logistic regression analysis was used to estimate the odds ratio of mammography use as a function of economic and other variables. Within a residential area, averages were used to measure the market price of mammography and the time cost to obtain a mammogram. RESULTS. Use was lower among women who faced a higher net price or who preferred to obtain a mammogram during weekend or evening hours and higher among women with higher incomes. Visiting no doctor regularly and smoking were predictors of failure to use mammography. CONCLUSION. The effects of economic variables on mammography use are important and stable across subsets of the population, but they are modest in size. PMID:8279611

Mammography screening: how important is cost as a barrier to use?

PubMed

Urban, N; Anderson, G L; Peacock, S

1994-01-01

Recent legislation will improve insurance coverage for screening mammography and effectively lower its cost to many women. Although cost has been cited as a barrier to use, evidence of the magnitude of its effect on use is limited. Mammography use in the past 2 years among women aged 50 to 75 residing in four suburban or rural counties in Washington State was estimated from 1989 survey data. Logistic regression analysis was used to estimate the odds ratio of mammography use as a function of economic and other variables. Within a residential area, averages were used to measure the market price of mammography and the time cost to obtain a mammogram. Use was lower among women who faced a higher net price or who preferred to obtain a mammogram during weekend or evening hours and higher among women with higher incomes. Visiting no doctor regularly and smoking were predictors of failure to use mammography. The effects of economic variables on mammography use are important and stable across subsets of the population, but they are modest in size.

Socio-Cognitive Determinants of the Mammography Screening Uptake among Iranian Women

PubMed

Mirzaei-Alavijeh, Mehdi; Ghorbani, Parvaneh; Jalilian, Farzad

2018-05-26

Background: Mammography screening uptake is the most effective method in breast cancer screening. The aim of this study was to determine the determinants related to mammography screening uptake among Iranian women based on the theory of planned behavior. Materials and Methods: This cross-sectional study was conducted among 408 women who referred to health centers in Kermanshah city, the western of Iran, during 2016. Participants filled out a self-administered questionnaire. Data were analyzed by SPSS version 21 using Pearson correlation, linear and logistic regression statistical tests at 95% significant level. Results: The mean age of participants was 39.61 years [SD: 8.28], ranged from 30 to 60 years. Almost 13% of the participants had already mammography screening uptake at least once. Perceived behavioral control (OR=1.229) and behavioral intention (OR=1.283) were the more influential predictors on mammography screening uptake. Conclusions: Based on result, it seems increase perceived behavior control toward mammography screening uptake may be usefulness in promotion of mammography screening uptake among Iranian women. Creative Commons Attribution License

Study of quality perception in medical images based on comparison of contrast enhancement techniques in mammographic images

NASA Astrophysics Data System (ADS)

Matheus, B.; Verçosa, L. B.; Barufaldi, B.; Schiabel, H.

2014-03-01

With the absolute prevalence of digital images in mammography several new tools became available for radiologist; such as CAD schemes, digital zoom and contrast alteration. This work focuses in contrast variation and how the radiologist reacts to these changes when asked to evaluated image quality. Three contrast enhancing techniques were used in this study: conventional equalization, CCB Correction [1] - a digitization correction - and value subtraction. A set of 100 images was used in tests from some available online mammographic databases. The tests consisted of the presentation of all four versions of an image (original plus the three contrast enhanced images) to the specialist, requested to rank each one from the best up to worst quality for diagnosis. Analysis of results has demonstrated that CCB Correction [1] produced better images in almost all cases. Equalization, which mathematically produces a better contrast, was considered the worst for mammography image quality enhancement in the majority of cases (69.7%). The value subtraction procedure produced images considered better than the original in 84% of cases. Tests indicate that, for the radiologist's perception, it seems more important to guaranty full visualization of nuances than a high contrast image. Another result observed is that the "ideal" scanner curve does not yield the best result for a mammographic image. The important contrast range is the middle of the histogram, where nodules and masses need to be seen and clearly distinguished.

Breast cancer screening and problem solving using mammography, ultrasound, and magnetic resonance imaging.

PubMed

Hooley, Regina J; Andrejeva, Liva; Scoutt, Leslie M

2011-03-01

Although mammography is the mainstay of early breast cancer detection, it has known limitations, particularly in women with dense breasts. As a result, additional imaging modalities, including ultrasound and contrast-enhanced magnetic resonance imaging, are also being used to supplement mammography in the early detection of occult breast cancer. This article reviews the indications and efficacy of mammography, ultrasound, and magnetic resonance imaging as both screening and diagnostic tools.

Cultural views, language ability, and mammography use in Chinese American women.

PubMed

Liang, Wenchi; Wang, Judy; Chen, Mei-Yuh; Feng, Shibao; Yi, Bin; Mandelblatt, Jeanne S

2009-12-01

Mammography screening rates among Chinese American women have been reported to be low. This study examines whether and how culture views and language ability influence mammography adherence in this mostly immigrant population. Asymptomatic Chinese American women (n = 466) aged 50 and older, recruited from the Washington, D.C. area, completed a telephone interview. Regular mammography was defined as having two mammograms at age-appropriate recommended intervals. Cultural views were assessed by 30 items, and language ability measured women's ability in reading, writing, speaking, and listening to English. After controlling for risk perception, worry, physician recommendation, family encouragement, and access barriers, women holding a more Chinese/Eastern cultural view were significantly less likely to have had regular mammograms than those having a Western cultural view. English ability was positively associated with mammography adherence. The authors' results imply that culturally sensitive and language-appropriate educational interventions are likely to improve mammography adherence in this population.

Cultural Views, Language Ability, and Mammography Use in Chinese American Women

PubMed Central

Liang, Wenchi; Wang, Judy; Chen, Mei-Yuh; Feng, Shibao; Yi, Bin; Mandelblatt, Jeanne S.

2013-01-01

Mammography screening rates among Chinese American women have been reported to be low. This study examines whether and how culture views and language ability influence mammography adherence in this mostly immigrant population. Asymptomatic Chinese American women (n = 466) aged 50 and older, recruited from the Washington, D.C. area, completed a telephone interview. Regular mammography was defined as having two mammograms at age-appropriate recommended intervals. Cultural views were assessed by 30 items, and language ability measured women’s ability in reading, writing, speaking, and listening to English. After controlling for risk perception, worry, physician recommendation, family encouragement, and access barriers, women holding a more Chinese/Eastern cultural view were significantly less likely to have had regular mammograms than those having a Western cultural view. English ability was positively associated with mammography adherence. The authors’ results imply that culturally sensitive and language-appropriate educational interventions are likely to improve mammography adherence in this population. PMID:19233947

Determinants of Breast and Cervical Cancer Screening Uptake Among Women in Turkey.

PubMed

Sözmen, Kaan; Unal, Belgin; Sakarya, Sibel; Dinc, Gonul; Yardim, Nazan; Keskinkilic, Bekir; Ergör, Gül

2016-09-01

The aim of the study was to assess the influence of sociodemographic characteristics on breast and cervical cancer screening among women 30 years and older in Turkey. We used data from the National Chronic Diseases and Risk Factors Survey conducted by the Ministry of Health in 2011. Multivariate logistic regression analysis was used to assess the association of sociodemographic factors, lifestyle variables, and cancer screening. Overall, 22.0% of women ever had a Pap smear test for cervical cancer screening and 19.0% ever had a mammography for breast cancer screening(n = 6846). Individuals with a university degree, social security, doing moderate physical activity, and consuming 5 portions of fruit or vegetable/day were more likely to receive Pap smear test and mammography. Residing in the eastern region and living in rural area was associated with lower likelihood of receiving both types of screening. © 2016 APJPH.

Religious beliefs and mammography intention: findings from a qualitative study of a diverse group of American Muslim women.

PubMed

Padela, Aasim I; Vu, Milkie; Muhammad, Hadiyah; Marfani, Farha; Mallick, Saleha; Peek, Monica; Quinn, Michael T

2016-10-01

Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors, scant research has examined how religion-related beliefs inform Muslim women's intention for mammography. Our study identifies and examines such beliefs. Muslim women aged 40 years and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the theory of planned behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention. Fifty women participated in 6 focus groups and 19 in semistructured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past 2 years. Across differences in race/ethnicity and mammography status, women voiced four religion-related salient beliefs that inform mammography intention: (1) the perceived duty to care for one's health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant health care. Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one's body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously tailored messages in interventions have the potential to enhance cancer screening. Copyright © 2016 John Wiley & Sons, Ltd.

[Programs of early detection of breast cancer and access of mammography in Spain].

PubMed

Luengo, S; Azcona, B; Lázaro, P; Madero, R

1997-05-24

We studied availability to mammography among Spanish women aged 40 to 70 years, variation in use of the mammography by autonomous community, and the situation and importance of breast cancer screening programs among other factors, in the access to mammography. A cross-sectional population survey was conducted in 1994 in a sample of 3,218 women. A questionnaire was used to collect data on the variable access (receipt of at least one mammogram in the last 2 years) as well as different access-related variables. Information on breast cancer screening programs was collected by contacting the responsible institutions. We considered that a program had total coverage if it included all the municipalities in the province and partial if it did not include all municipalities. Twenty-eight percent of women had performed a mammogram. This proportion varied among autonomous communities (AACC) from 11.5 to 73.8%. Breast cancer screening programs existed in 8 AACC. The multivariant analysis revealed an association between access to mammography and the existence of a screening program, especially when the later had total coverage (OR = 7.64; 95% CI = 5.24-11.10). An association was also found between access to mammography and physician-related factors, place of residence and attitudes of women toward mammography. Less than one third of women aged 40-70 have performed a mammography in the last 2 years, and this proportion varies among AACC. Gynecologist visits and the existence of breast cancer screening programs are fundamental factors in the access to mammography in Spain.

Religious Beliefs and Mammography Intention: Findings from a Qualitative Study of a Diverse Group of American Muslim Women

PubMed Central

Padela, Aasim I.; Vu, Milkie; Muhammad, Hadiyah; Marfani, Farha; Mallick, Saleha; Peek, Monica; Quinn, Michael T.

2017-01-01

Objective Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors scant research has examined how religion-related beliefs inform Muslim women’s intention for mammography. Our study identifies and examines such beliefs. Methods Muslim women aged 40 and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the Theory of Planned Behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention. Results Fifty women participated in 6 focus groups and 19 in semi-structured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past two years. Across differences in race/ethnicity and mammography status women voiced four religion-related salient beliefs that inform mammography intention: (1) the perceived duty to care for one’s health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant healthcare. Conclusions Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one’s body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously-tailored messages in interventions have the potential to enhance cancer screening. PMID:27424488

Digital breast tomosynthesis plus synthesised images versus standard full-field digital mammography in population-based screening (TOSYMA): protocol of a randomised controlled trial.

PubMed

Weigel, Stefanie; Gerss, Joachim; Hense, Hans-Werner; Krischke, Miriam; Sommer, Alexander; Czwoydzinski, Jörg; Lenzen, Horst; Kerschke, Laura; Spieker, Karin; Dickmaenken, Stefanie; Baier, Sonja; Urban, Marc; Hecht, Gerold; Heidinger, Oliver; Kieschke, Joachim; Heindel, Walter

2018-05-14

Development of digital breast tomosynthesis (DBT) provides a technology that generates three-dimensional data sets, thus reducing the pitfalls of overlapping breast tissue. Observational studies suggest that the combination of two-dimensional (2D) digital mammography and DBT increases diagnostic accuracy. However, because of duplicate exposure, this comes at the cost of an augmented radiation dose. This undesired adverse impact can be avoided by using synthesised 2D images reconstructed from the DBT data (s2D).We designed a diagnostic superiority trial on a high level of evidence with the aim of providing a comparison of screening efficacy parameters resulting from DBT+s2D versus the current screening standard 2D full-field digital mammography (FFDM) in a multicentre and multivendor setting on the basis of the quality-controlled, population-based, biennial mammography screening programme in Germany. 80 000 women in the eligible age 50-69 years attending the routine mammography screening programme and willing to participate in the TOSYMA trial will be assigned by 1:1 randomisation to either the intervention arm (DBT+s2D) or the control arm (FFDM) during a 12-month recruitment period in screening units of North Rhine-Westphalia and Lower Saxony. State cancer registries will provide the follow-up of interval cancers.Primary endpoints are the detection rate of invasive breast cancers at screening examination and the cumulative incidence of interval cancers in the 2 years after a negative examination. Secondary endpoints are the detection rate of ductal carcinoma in situ and of tumour size T1, the recall rate for assessment, the positive predictive value of recall and the cumulative 12-month incidence of interval cancers. An adaptive statistical design with one interim analysis provides the option to modify the design. This protocol has been approved by the local medical ethical committee (2016-132-f-S). Results will be submitted to international peer-reviewed journals. NCT03377036; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Correlates of mammography utilization among working Muslim Iranian women.

PubMed

Hatefnia, Effat; Niknami, Shamsaddin; Bazargan, Mohsen; Mahmoodi, Mahmood; Lamyianm, Minoor; Alavi, Nasrien

2010-06-01

Most countries in Middle East have been successful in establishing and furthering basic facilities for screening, diagnosis, and treatment of breast cancer. The rate of compliance with mammography screening, however, remains well below North American and Western European countries. We utilized the Health Belief Model (HBM) to explore factors associated with mammography screening behavior among a sample of 320 Muslim women aged > or = 35. Carrying out this cross-sectional study, we found that screening behavior was associated with older age, higher perceived benefit of breast cancer screening, and lower perceived barrier. Additionally, we demonstrate the importance of religious beliefs in influencing mammography screening behavior and explaining the link between religious involvement and mammography behavior.

Influence of advertisement on women's attitudes toward mammography screening.

PubMed

Collins, C; Davis, L S; Rentz, K; Vannoy, D

1997-01-01

This project represents an effort to incorporate a feminist perspective into research on mammography screening. The purpose of this study was to assess women's attitudes toward four advertisements designed to encourage mammography screening. The goal was to create awareness about women's attitudes toward mammography advertisements in order to encourage the development of more effective and responsive motivational materials. The results indicated that each ad communicated different messages about the seriousness of breast cancer and the efficacy of mammography in detecting early breast cancer. Each ad also affected women differently regarding their feelings of control over breast cancer, their perceived loss of sex appeal resulting from a breast cancer diagnosis, and their general fear of breast cancer.

An ensemble-based approach for breast mass classification in mammography images

NASA Astrophysics Data System (ADS)

Ribeiro, Patricia B.; Papa, João. P.; Romero, Roseli A. F.

2017-03-01

Mammography analysis is an important tool that helps detecting breast cancer at the very early stages of the disease, thus increasing the quality of life of hundreds of thousands of patients worldwide. In Computer-Aided Detection systems, the identification of mammograms with and without masses (without clinical findings) is highly needed to reduce the false positive rates regarding the automatic selection of regions of interest that may contain some suspicious content. In this work, the introduce a variant of the Optimum-Path Forest (OPF) classifier for breast mass identification, as well as we employed an ensemble-based approach that can enhance the effectiveness of individual classifiers aiming at dealing with the aforementioned purpose. The experimental results also comprise the naïve OPF and a traditional neural network, being the most accurate results obtained through the ensemble of classifiers, with an accuracy nearly to 86%.

Measurements on a full-field digital mammography system with a photon counting crystalline silicon detector

NASA Astrophysics Data System (ADS)

Lundqvist, Mats; Danielsson, Mats; Cederstroem, Bjoern; Chmill, Valery; Chuntonov, Alexander; Aslund, Magnus

2003-06-01

Sectra Microdose is the first single photon counting mammography detector. An edge-on crystalline silicon detector is connected to application specific integrated circuits that individually process each photon. The detector is scanned across the breast and the rejection of scattered radiation exceeds 97% without the use of a Bucky. Processing of each x-rays individually enables an optimization of the information transfer from the x-rays to the image in a way previously not possible. Combined with an almost absence of noise from scattered radiation and from electronics we foresee a possibility to reduce the radiation dose and/or increase the image quality. We will discuss fundamental features of the new direct photon counting technique in terms of dose efficiency and present preliminary measurements for a prototype on physical parameters such as Noise Power Spectra (NPS), MTF and DQE.

Screening and prevention of breast cancer in primary care.

PubMed

Tice, Jeffrey A; Kerlikowske, Karla

2009-09-01

Mammography remains the mainstay of breast cancer screening. There is little controversy that mammography reduces the risk of dying from breast cancer by about 23% among women between the ages of 50 and 69 years, although the harms associated with false-positive results and overdiagnosis limit the net benefit of mammography. Women in their 70s may have a small benefit from screening mammography, but overdiagnosis increases in this age group as do competing causes of death. While new data support a 16% reduction in breast cancer mortality for 40- to 49-year-old women after 10 years of screening, the net benefit is less compelling in part because of the lower incidence of breast cancer in this age group and because mammography is less sensitive and specific in women younger than 50 years. Digital mammography is more sensitive than film mammography in young women with similar specificity, but no improvements in breast cancer outcomes have been demonstrated. Magnetic resonance imaging may benefit the highest risk women. Randomized trials suggest that self-breast examination does more harm than good. Primary prevention with currently approved medications will have a negligible effect on breast cancer incidence. Public health efforts aimed at increasing mammography screening rates, promoting regular exercise in all women, maintaining a healthy weight, limiting alcohol intake, and limiting postmenopausal hormone therapy may help to continue the recent trend of lower breast cancer incidence and mortality among American women.

Does Gender Discrimination Impact Regular Mammography Screening? Findings from the Race Differences in Screening Mammography Study

PubMed Central

DAILEY, AMY B.; KASL, STANISLAV V.; JONES, BETH A.

2011-01-01

Objective To determine if gender discrimination, conceptualized as a negative life stressor, is a deterrent to adherence to mammography screening guidelines. Methods African American and white women (1451) aged 40–79 years who obtained an index screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998 were enrolled in this study. This logistic regression analysis includes the 1229 women who completed telephone interviews at baseline and follow-up (average 29.4 months later) and for whom the study outcome, nonadherence to age-specific mammography screening guidelines, was determined. Gender discrimination was measured as lifetime experience in seven possible situations. Results Gender discrimination, reported by nearly 38% of the study population, was significantly associated with nonadherence to mammography guidelines in women with annual family incomes of ≥$50,000 (OR 1.99, 95% CI 1.33, 2.98) and did not differ across racial/ethnic group. Conclusions Our findings suggest that gender discrimination can adversely influence regular mammography screening in some women. With nearly half of women nonadherent to screening mammography guidelines in this study and with decreasing mammography rates nationwide, it is important to address the complexity of nonadherence across subgroups of women. Life stressors, such as experiences of gender discrimination, may have considerable consequences, potentially influencing health prevention prioritization in women. PMID:18321171

Does gender discrimination impact regular mammography screening? Findings from the race differences in screening mammography study.

PubMed

Dailey, Amy B; Kasl, Stanislav V; Jones, Beth A

2008-03-01

ABSTRACT Objective: To determine if gender discrimination, conceptualized as a negative life stressor, is a deterrent to adherence to mammography screening guidelines. African American and white women (1451) aged 40-79 years who obtained an index screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998 were enrolled in this study. This logistic regression analysis includes the 1229 women who completed telephone interviews at baseline and follow-up (average 29.4 months later) and for whom the study outcome, nonadherence to age-specific mammography screening guidelines, was determined. Gender discrimination was measured as lifetime experience in seven possible situations. Gender discrimination, reported by nearly 38% of the study population, was significantly associated with nonadherence to mammography guidelines in women with annual family incomes of > or =$50,000 (OR 1.99, 95% CI 1.33, 2.98) and did not differ across racial/ethnic group. Our findings suggest that gender discrimination can adversely influence regular mammography screening in some women. With nearly half of women nonadherent to screening mammography guidelines in this study and with decreasing mammography rates nationwide, it is important to address the complexity of nonadherence across subgroups of women. Life stressors, such as experiences of gender discrimination, may have considerable consequences, potentially influencing health prevention prioritization in women.

Effect of filter on average glandular dose and image quality in digital mammography

NASA Astrophysics Data System (ADS)

Songsaeng, C.; Krisanachinda, A.; Theerakul, K.

2016-03-01

To determine the average glandular dose and entrance surface air kerma in both phantoms and patients to assess image quality for different target-filters (W/Rh and W/Ag) in digital mammography system. The compressed breast thickness, compression force, average glandular dose, entrance surface air kerma, peak kilovoltage and tube current time were recorded and compared between W/Rh and W/Ag target filter. The CNR and the figure of merit were used to determine the effect of target filter on image quality. The mean AGD of the W/Rh target filter was 1.75 mGy, the mean ESAK was 6.67 mGy, the mean CBT was 54.1 mm, the mean CF was 14 1bs. The mean AGD of W/Ag target filter was 2.7 mGy, the mean ESAK was 12.6 mGy, the mean CBT was 75.5 mm, the mean CF was 15 1bs. In phantom study, the AGD was 1.2 mGy at 4 cm, 3.3 mGy at 6 cm and 3.83 mGy at 7 cm thickness. The FOM was 24.6, CNR was 9.02 at thickness 6 cm. The FOM was 18.4, CNR was 8.6 at thickness 7 cm. The AGD from Digital Mammogram system with W/Rh of thinner CBT was lower than the AGD from W/Ag target filter.

A prototype of mammography CADx scheme integrated to imaging quality evaluation techniques

NASA Astrophysics Data System (ADS)

Schiabel, Homero; Matheus, Bruno R. N.; Angelo, Michele F.; Patrocínio, Ana Claudia; Ventura, Liliane

2011-03-01

As all women over the age of 40 are recommended to perform mammographic exams every two years, the demands on radiologists to evaluate mammographic images in short periods of time has increased considerably. As a tool to improve quality and accelerate analysis CADe/Dx (computer-aided detection/diagnosis) schemes have been investigated, but very few complete CADe/Dx schemes have been developed and most are restricted to detection and not diagnosis. The existent ones usually are associated to specific mammographic equipment (usually DR), which makes them very expensive. So this paper describes a prototype of a complete mammography CADx scheme developed by our research group integrated to an imaging quality evaluation process. The basic structure consists of pre-processing modules based on image acquisition and digitization procedures (FFDM, CR or film + scanner), a segmentation tool to detect clustered microcalcifications and suspect masses and a classification scheme, which evaluates as the presence of microcalcifications clusters as well as possible malignant masses based on their contour. The aim is to provide enough information not only on the detected structures but also a pre-report with a BI-RADS classification. At this time the system is still lacking an interface integrating all the modules. Despite this, it is functional as a prototype for clinical practice testing, with results comparable to others reported in literature.

Time for a re-evaluation of mammography in the young? Results of an audit of mammography in women younger than 40 in a resource restricted environment.

PubMed

Taylor, Liezel; Basro, Sarinah; Apffelstaedt, Justus P; Baatjes, Karin

2011-08-01

Mammography in younger women is considered to be of limited value. In a resource restricted environment without access to magnetic resonance imaging (MRI) and with a high incidence of breast cancer in the young, mammography remains an important diagnostic tool. Recent technical advances and better regulation of mammography make a reassessment of its value in these conditions necessary. Data of all the mammograms performed at a tertiary hospital and private breast clinic between January 2003 and July 2009 in women less than 40 years of age were collected. Indications were the presence of a mass, follow-up after primary cancer therapy, and screening for patients perceived at high risk due to a family history or the presence of atypical hyperplasia. Data acquired were as follows: Demographics, prior breast surgery, indication for mammography, outcome of mammography, diagnostic procedures, and their results. Of 2,167 mammograms, 393 were performed for a palpable mass, diagnostic mammography. In these, the overall cancer detection rate was 40%. If the mammography was reported as breast imaging reporting and data system (BIRADS(®)) 5 versus BIRADS(®) 3 and 4 versus BIRADS(®) 1 and 2, a final diagnosis of malignancy was established in 96, 48, and 5%, respectively. Of 367 mammograms done for the follow-up after primary treatment of breast cancer, seven cancers were diagnosed for a detection rate of 1.9%. Of 1,312 mammograms performed for screening, the recall rate was 4%; the biopsy rate 2%, and the cancer diagnosis rate 3/1,000 examinations. In contrast to past series, this series has shown that recent advances in mammography have made it a useful tool in the management of breast problems in young women, notably in a resource-restricted environment. Women for screening should be selected carefully.

Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.

PubMed

2009-11-17

Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population. The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals. The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation) The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement) The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation) The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement).

Mammography facilities are accessible, so why is utilization so low?

PubMed

Mobley, Lee R; Kuo, Tzy-Mey May; Clayton, Laurel J; Evans, W Douglas

2009-08-01

This study examines new socio-ecological variables reflecting community context as predictors of mammography use. The conceptual model is a hybrid of traditional health-behavioral and socio-ecological constructs with an emphasis on spatial interaction among women and their environments, differentiating between several levels of influence for community context. Multilevel probability models of mammography use are estimated. The study sample includes 70,129 women with traditional Medicare fee-for-service coverage for inpatient and outpatient services, drawn from the SEER-Medicare linked data. The study population lives in heterogeneous California, where mammography facilities are dense but utilization rates are low. Several contextual effects have large significant impacts on the probability of mammography use. Women living in areas with higher proportions of elderly in poverty are 33% less likely to use mammography. However, dually eligible women living in these poor areas are 2% more likely to use mammography than those without extra assistance living in these areas. Living in areas with higher commuter intensity, higher violent crime rates, greater land use mix (urbanicity), or more segregated Hispanic communities exhibit -14%, -1%, -6%, and -3% (lower) probability of use, respectively. Women living in segregated American Indian communities or in communities where more elderly women live alone exhibit 16% and 12% (higher) probability of use, respectively. Minority women living in more segregated communities by their minority are more likely to use mammography, suggesting social support, but this is significant for Native Americans only. Women with disability as their original reason for entitlement are found 40% more likely to use mammography when they reside in communities with high commuter intensity, suggesting greater ease of transportation for them in these environments. Socio-ecological variables reflecting community context are important predictors of mammography use in insured elderly populations, often with larger magnitudes of effect than personal characteristics such as race or ethnicity (-3% to -7%), age (-2%), recent address change (-7%), disability (-5%) or dual eligibility status (-1%). Better understanding of community factors can enhance cancer control efforts.

Newly Diagnosed Breast Cancer: Comparison of Contrast-enhanced Spectral Mammography and Breast MR Imaging in the Evaluation of Extent of Disease.

PubMed

Lee-Felker, Stephanie A; Tekchandani, Leena; Thomas, Mariam; Gupta, Esha; Andrews-Tang, Denise; Roth, Antoinette; Sayre, James; Rahbar, Guita

2017-11-01

Purpose To compare the diagnostic performances of contrast material-enhanced spectral mammography and breast magnetic resonance (MR) imaging in the detection of index and secondary cancers in women with newly diagnosed breast cancer by using histologic or imaging follow-up as the standard of reference. Materials and Methods This institutional review board-approved, HIPAA-compliant, retrospective study included 52 women who underwent breast MR imaging and contrast-enhanced spectral mammography for newly diagnosed unilateral breast cancer between March 2014 and October 2015. Of those 52 patients, 46 were referred for contrast-enhanced spectral mammography and targeted ultrasonography because they had additional suspicious lesions at MR imaging. In six of the 52 patients, breast cancer had been diagnosed at an outside institution. These patients were referred for contrast-enhanced spectral mammography and targeted US as part of diagnostic imaging. Images from contrast-enhanced spectral mammography were analyzed by two fellowship-trained breast imagers with 2.5 years of experience with contrast-enhanced spectral mammography. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated for both imaging modalities and compared by using the Bennett statistic. Results Fifty-two women with 120 breast lesions were included for analysis (mean age, 50 years; range, 29-73 years). Contrast-enhanced spectral mammography had similar sensitivity to MR imaging (94% [66 of 70 lesions] vs 99% [69 of 70 lesions]), a significantly higher PPV than MR imaging (93% [66 of 71 lesions] vs 60% [69 of 115 lesions]), and fewer false-positive findings than MR imaging (five vs 45) (P < .001 for all results). In addition, contrast-enhanced spectral mammography depicted 11 of the 11 secondary cancers (100%) and MR imaging depicted 10 (91%). Conclusion Contrast-enhanced spectral mammography is potentially as sensitive as MR imaging in the evaluation of extent of disease in newly diagnosed breast cancer, with a higher PPV. © RSNA, 2017.

The influence of social support relationships on mammography screening in African-American women.

PubMed

Fowler, Barbara Ann

2007-07-01

Evidence indicates that mammography screenings have increased in African-American women who are 50 years of age or older; however, they continue to experience later-stage discovery and poorer survival rates from breast cancer compared to White women. Although research has consistently found that social support relationships affects mammography screening in African-American women, little is known about the preventive health behaviors of individuals in these relationships that may be associated with mammography screening. This study examined that association and found that social support relationships, defined as blood-relatives and extended kinship networks, stressed personal responsibility and accountability for preventive health; therefore, supporting mammography screening. Of perhaps the greatest importance, the relationships emphasized positive strengths of African-American culture and invoked the necessity to confront prior negative experiences in health-care systems. These relationships also negated the fears or fatalistic beliefs about breast cancer that had been perpetuated by myths through informal communication and "deliberate silence" from significant others who had previously discouraged or de-emphasized the importance of mammography screening. Further research is needed to determine if the emphasis on cultural heritage was the only motivator that encouraged personal responsibility for mammography screening.

Radiation exposure of contrast-enhanced spectral mammography compared with full-field digital mammography.

PubMed

Jeukens, Cécile R L P N; Lalji, Ulrich C; Meijer, Eduard; Bakija, Betina; Theunissen, Robin; Wildberger, Joachim E; Lobbes, Marc B I

2014-10-01

Contrast-enhanced spectral mammography (CESM) shows promising initial results but comes at the cost of increased dose as compared with full-field digital mammography (FFDM). We aimed to quantitatively assess the dose increase of CESM in comparison with FFDM. Radiation exposure-related data (such as kilovoltage, compressed breast thickness, glandularity, entrance skin air kerma (ESAK), and average glandular dose (AGD) were retrieved for 47 CESM and 715 FFDM patients. All examinations were performed on 1 mammography unit. Radiation dose values reported by the unit were validated by phantom measurements. Descriptive statistics of the patient data were generated using a statistical software package. Dose values reported by the mammography unit were in good qualitative agreement with those of phantom measurements. Mean ESAK was 10.5 mGy for a CESM exposure and 7.46 mGy for an FFDM exposure. Mean AGD for a CESM exposure was 2.80 mGy and 1.55 mGy for an FFDM exposure. Compared with our institutional FFDM, the AGD of a single CESM exposure is increased by 1.25 mGy (+81%), whereas ESAK is increased by 3.07 mGy (+41%). Dose values of both techniques meet the recommendations for maximum dose in mammography.

Mammography Prevalence within 2 Two Years (Age 40+) - Small Area Estimates

Cancer.gov

For mammography, a woman 40 years of age or older must have reported having at least one mammography in her life. Furthermore, she should have had the most recent one within the last two years by the time of interview.

Prospective study aiming to compare 2D mammography and tomosynthesis + synthesized mammography in terms of cancer detection and recall. From double reading of 2D mammography to single reading of tomosynthesis.

PubMed

Romero Martín, Sara; Raya Povedano, Jose Luis; Cara García, María; Santos Romero, Ana Luz; Pedrosa Garriguet, Margarita; Álvarez Benito, Marina

2018-06-01

To evaluate tomosynthesis compared with 2D-mammography in cancer detection and recalls in a screening-programme, and assess performing synthesized instead of 2D, and compare double reading of 2D with single reading of tomosynthesis. Women (age 50-69 years) participating in the screening-programme were included. 2D-mammography and tomosynthesis were performed. There were four reading models: 2D-mammography (first); 2D-mammography (second); tomosynthesis + synthesized (third); tomosynthesis + synthesized + 2D (fourth reading). Paired double reading of 2D (first+second) and tomosynthesis (third+fourth) were analysed. In 16,067 participants, there were 98 cancers and 1,196 recalls. Comparing double reading of 2D with single reading of tomosynthesis, there was an increase of 12.6 % in cancer detection with the third reading (p= 0.043) and 6.9 % with the fourth reading (p=0.210), and a decrease in recalls of 40.5 % (p<0.001) and 44.4 % (p<0.001), respectively. With double reading of both techniques, there was an increase in cancer detection of 17.4 % (p = 0.004) and a decrease in recalls of 12.5 % (p = 0.001) with tomosynthesis. Single reading of tomosynthesis plus synthesized increased cancer detection and decreased recalls compared with double reading 2D. 2D did not improve results when added to tomosynthesis. • Tomosynthesis increases cancer detection and decreases recall rates versus 2D mammography. • Synthesized-mammography avoids performing 2D, showing higher cancer detection. • Single reading of tomosynthesis + synthesized is feasible as a new practice.

A randomized trial of three videos that differ in the framing of information about mammography in women 40 to 49 years old.

PubMed

Lewis, Carmen L; Pignone, Michael P; Sheridan, Stacey L; Downs, Stephen M; Kinsinger, Linda S

2003-11-01

To assess the effect of providing structured information about the benefits and harms of mammography in differing frames on women's perceptions of screening. Randomized control trial. General internal medicine academic practice. One hundred seventy-nine women aged 35 through 49. Women received 1 of 3 5-minute videos about the benefits and harms of screening mammography in women aged 40 to 49. These videos differed only in the way the probabilities of potential outcomes were framed (positive, neutral, or negative). We measured the change in accurate responses to questions about potential benefits and harms of mammography, and the change in the proportion of participants who perceived that the benefits of mammography were more important than the harms. Before seeing the videos, women's knowledge about the benefits and harms of mammography was inaccurate (82% responded incorrectly to all 3 knowledge questions). After seeing the videos, the proportion that answered correctly increased by 52%, 43%, and 30% for the 3 knowledge questions, respectively, but there were no differences between video frames. At baseline, most women thought the benefits of mammography outweighed the harms (79% positive frame, 80% neutral frame, and 85% negative frame). After the videos, these proportions were similar among the 3 groups (84%, 81%, 83%, P =.93). Women improved the accuracy of their responses to questions about the benefits and harms of mammography after seeing the videos, but this change was not affected by the framing of information. Women strongly perceived that the benefits of mammography outweighed the harms, and providing accurate information had no effect on these perceptions, regardless of how it was framed.

Monte Carlo Simulation of X-Ray Spectra in Mammography and Contrast-Enhanced Digital Mammography Using the Code PENELOPE

NASA Astrophysics Data System (ADS)

Cunha, Diego M.; Tomal, Alessandra; Poletti, Martin E.

2013-04-01

In this work, the Monte Carlo (MC) code PENELOPE was employed for simulation of x-ray spectra in mammography and contrast-enhanced digital mammography (CEDM). Spectra for Mo, Rh and W anodes were obtained for tube potentials between 24-36 kV, for mammography, and between 45-49 kV, for CEDM. The spectra obtained from the simulations were analytically filtered to correspond to the anode/filter combinations usually employed in each technique (Mo/Mo, Rh/Rh and W/Rh for mammography and Mo/Cu, Rh/Cu and W/Cu for CEDM). For the Mo/Mo combination, the simulated spectra were compared with those obtained experimentally, and for spectra for the W anode, with experimental data from the literature, through comparison of distribution shape, average energies, half-value layers (HVL) and transmission curves. For all combinations evaluated, the simulated spectra were also compared with those provided by different models from the literature. Results showed that the code PENELOPE provides mammographic x-ray spectra in good agreement with those experimentally measured and those from the literature. The differences in the values of HVL ranged between 2-7%, for anode/filter combinations and tube potentials employed in mammography, and they were less than 5% for those employed in CEDM. The transmission curves for the spectra obtained also showed good agreement compared to those computed from reference spectra, with average relative differences less than 12% for mammography and CEDM. These results show that the code PENELOPE can be a useful tool to generate x-ray spectra for studies in mammography and CEDM, and also for evaluation of new x-ray tube designs and new anode materials.

At what age should screening mammography be recommended for Asian women?

PubMed

Tsuchida, Junko; Nagahashi, Masayuki; Rashid, Omar M; Takabe, Kazuaki; Wakai, Toshifumi

2015-07-01

Although regular screening mammography has been suggested to be associated with improvements in the relative survival of breast cancer in recent years, the appropriate age to start screening mammography remains controversial. In November 2009, the United States Preventive Service Task Force published updated guidelines for breast cancer, which no longer support routine screening mammography for women aged 40-49 years, but instead, defer the choice of screening in that age group to the patient and physician. The age to begin screening differs between guidelines, including those from the Task Force, the American Cancer Society and the World Health Organization. It remains unclear how this discrepancy impacts patient survival, especially among certain subpopulations. Although the biological characteristics of breast cancer and peak age of incidence differ among different ethnic populations, there have been few reports that evaluate the starting age for screening mammography based on ethnicity. Here, we discuss the benefits and harm of screening mammography in the fifth decade, and re-evaluate the starting age for screening mammography taking ethnicity into account, focusing on the Asian population. Breast cancer incidence peaked in the fifth decade in Asian women, which has been thought to be due to a combination of biological and environmental factors. Previous reports suggest that Asian women in their 40s may receive more benefit and less harm from screening mammography than the age-matched non-Asian US population. Therefore, starting screening mammography at age 40 may be beneficial for women of Asian ethnicity in well-resourced countries, such as Japanese women who reside in Japan. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

[Mammography screening of breast cancer in Tunisia. Results of first experience].

PubMed

Kribi, Lilia; Sellami, Dorra; el Amri, Aïda; Mnif, Nejla; Ellouze, Thouraya; Chebbi, Ali; Ben Romdhane, Khaled; Hamza, Radhi

2003-01-01

This article reports the results of a mammography screening program of breast cancer, realized in the department of Radiology, Charles Nicolle hospital. A free screening mammography with two incidences was offered to women aged from 40 to 70 years old. 2200 mammographies were realized from May 1995 till July 1997. Women having a positive test benefited of a diagnostic explorations in the same unity. The positive test rate was 24%. Predictive positive value was 31%. This program allowed to detect 10 subclinical cancers, corresponding to a rate of detection of 4.5 cancers for 1000 women. This program is a first experience which demonstrated the feasibility of the mammography screening to wide scale and allowed the medical and paramedical team to acquire an experience.

Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update from the American Cancer Society

PubMed Central

Oeffinger, Kevin C.; Fontham, Elizabeth T. H.; Etzioni, Ruth; Herzig, Abbe; Michaelson, James S.; Shih, Ya-Chen Tina; Walter, Louise C.; Church, Timothy R.; Flowers, Christopher R.; LaMonte, Samuel J.; Wolf, Andrew M. D.; DeSantis, Carol; Lortet-Tieulent, Joannie; Andrews, Kimberly; Manassaram-Baptiste, Deana; Saslow, Debbie; Smith, Robert A.; Brawley, Otis W.; Wender, Richard

2016-01-01

Importance Breast cancer is a leading cause of premature mortality among U.S. women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. This report updates the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer. Process The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update, and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. Evidence Synthesis Mammography screening in women aged 40–69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening in women who are age 70 years and older and are in good health. Estimates of the cumulative lifetime risk of false positive exams are greater if screening begins at younger ages due to the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs. biennially. Evidence does not support routine clinical breast examination as a screening method for average risk women. Recommendations The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women who are ages 45 to 54 years should be screened annually (qualified recommendation). Women who are age 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation). PMID:26501536

Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.

PubMed

Oeffinger, Kevin C; Fontham, Elizabeth T H; Etzioni, Ruth; Herzig, Abbe; Michaelson, James S; Shih, Ya-Chen Tina; Walter, Louise C; Church, Timothy R; Flowers, Christopher R; LaMonte, Samuel J; Wolf, Andrew M D; DeSantis, Carol; Lortet-Tieulent, Joannie; Andrews, Kimberly; Manassaram-Baptiste, Deana; Saslow, Debbie; Smith, Robert A; Brawley, Otis W; Wender, Richard

2015-10-20

Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. To update the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer. The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. Screening mammography in women aged 40 to 69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening for women 70 years and older who are in good health. Estimates of the cumulative lifetime risk of false-positive examination results are greater if screening begins at younger ages because of the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs biennially. Evidence does not support routine clinical breast examination as a screening method for women at average risk. The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually (qualified recommendation). Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation). These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. These recommendations should be considered by physicians and women in discussions about breast cancer screening.

Self-Report Versus Medical Record for Mammography Screening Among Minority Women.

PubMed

Nandy, Karabi; Menon, Usha; Szalacha, Laura A; Park, HanJong; Lee, Jongwon; Lee, Eunice E

2016-12-01

Self-report is the most common means of obtaining mammography screening data. The purpose of this study was to assess the accuracy of minority women's self-reported mammography by comparing their self-reported dates of mammograms with those in their medical records from a community-based randomized control trial. We found that out of 192 women, 116 signed the Health Information Portability and Accountability Act form and, among these, 97 had medical records that could be verified (97 / 116 = 83.6%). Ninety-two records matched where both sources confirmed a mammogram; 48 of 92 (52.2%) matched perfectly on self-reported date of mammogram. Complexities in the verification process warrant caution when verifying self-reported mammography screening in minority populations. In spite of some limitations, our findings support the usage of self-reported data on mammography as a validated tool for other researchers investigating mammography screening among minority women who continue to have low screening rates. © The Author(s) 2016.

Mammography screening among Arab American women in metropolitan Detroit.

PubMed

Schwartz, Kendra; Fakhouri, Monty; Bartoces, Monina; Monsur, Joseph; Younis, Amani

2008-12-01

Mammography screening behavior has not been well studied among Middle Eastern immigrant women. We conducted a telephone survey of 365 Arab American women residing in metropolitan Detroit, home to one of the largest populations of Middle Eastern immigrants in the US, to determine prevalence of factors associated with mammography, and attitudes and beliefs regarding mammography screening. Of 365 participants, only five were born in the US. Mean age was 53.2 years (SD 10.8). Two hundred twelve (58.1%) reported having mammogram every 1-2 years; 70% ever had mammogram. Age 50-64 years, having health insurance, married status, being in the US over 10 years, and being Lebanese were associated with mammography every 1-2 years. After adjusting for demographic factors, perceived seriousness of disease, general health motivation, and having fewer barriers were associated with more frequent screening. Appropriate mammography screening is decreased in this group. Targeted outreach regarding screening is appropriate for this population; however, lack of insurance may prevent adequate follow-up.

Performance evaluation of contrast-detail in full field digital mammography systems using ideal (Hotelling) observer vs. conventional automated analysis of CDMAM images for quality control of contrast-detail characteristics.

PubMed

Delakis, Ioannis; Wise, Robert; Morris, Lauren; Kulama, Eugenia

2015-11-01

The purpose of this work was to evaluate the contrast-detail performance of full field digital mammography (FFDM) systems using ideal (Hotelling) observer Signal-to-Noise Ratio (SNR) methodology and ascertain whether it can be considered an alternative to the conventional, automated analysis of CDMAM phantom images. Five FFDM units currently used in the national breast screening programme were evaluated, which differed with respect to age, detector, Automatic Exposure Control (AEC) and target/filter combination. Contrast-detail performance was analysed using CDMAM and ideal observer SNR methodology. The ideal observer SNR was calculated for input signal originating from gold discs of varying thicknesses and diameters, and then used to estimate the threshold gold thickness for each diameter as per CDMAM analysis. The variability of both methods and the dependence of CDMAM analysis on phantom manufacturing discrepancies also investigated. Results from both CDMAM and ideal observer methodologies were informative differentiators of FFDM systems' contrast-detail performance, displaying comparable patterns with respect to the FFDM systems' type and age. CDMAM results suggested higher threshold gold thickness values compared with the ideal observer methodology, especially for small-diameter details, which can be attributed to the behaviour of the CDMAM phantom used in this study. In addition, ideal observer methodology results showed lower variability than CDMAM results. The Ideal observer SNR methodology can provide a useful metric of the FFDM systems' contrast detail characteristics and could be considered a surrogate for conventional, automated analysis of CDMAM images. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

One more hurdle to increasing mammography screening: pubescent, adolescent, and prior mammography screening experiences.

PubMed

Thomas, Eileen; Usher, LaToya

2009-01-01

Approximately $8.1 billion dollars is spent each year in the United States alone on the treatment of breast cancer. Survival rates are dependent on access to, and utilization of, early detection services. The primary reason for disparity in breast cancer mortality is the delay in time to diagnosis, resulting in poor prognosis. Despite ongoing research to understand barriers to mammography screening, recent studies report a decrease in mammography screening among all racial groups. A qualitative approach was used to elicit information from 36 White non- Hispanic, African-American, Hispanic, and Native American women without a history of breast cancer. Women were invited to share written or audiotape-recorded narratives about experiences pertaining to their breasts and their mammography screening experiences. Major categories identified were: teasing, family norms and values, media/societal influence, body image, and mammography screening experiences. The resulting effects of these experiences left these women with feelings of shame and "conflict" regarding their breasts. The major theme identified was breast conflict. Findings suggest that breast conflict may persist throughout the lifespan and can have a negative influence on a woman's decision to participate in mammography screening. The authors hypothesize that experiences that occur during adolescence pertaining to young girls' breasts can influence a women's body image, which in turn can later in life affect health-seeking behaviors related to mammography screening. These findings have implications for public health practice in planning for breast cancer screening, education, and interventions for women from diverse racial/ethnics groups.

A multi-centre randomised trial comparing ultrasound vs mammography for screening breast cancer in high-risk Chinese women.

PubMed

Shen, S; Zhou, Y; Xu, Y; Zhang, B; Duan, X; Huang, R; Li, B; Shi, Y; Shao, Z; Liao, H; Jiang, J; Shen, N; Zhang, J; Yu, C; Jiang, H; Li, S; Han, S; Ma, J; Sun, Q

2015-03-17

Chinese women tend to have small and dense breasts and ultrasound is a common method for breast cancer screening in China. However, its efficacy and cost comparing with mammography has not been evaluated in randomised trials. At 14 breast centres across China during 2008-2010, 13 339 high-risk women aged 30-65 years were randomised to be screened by mammography alone, ultrasound alone, or by both methods at enrollment and 1-year follow-up. A total of 12 519 and 8692 women underwent the initial and second screenings, respectively. Among the 30 cancers (of which 15 were stage 0/I) detected, 5 (0.72/1000) were in the mammography group, 11 (1.51/1000) in the ultrasound group, and 14 (2.02/1000) in the combined group (P=0.12). In the combined group, ultrasound detected all the 14 cancers, whereas mammography detected 8, making ultrasound more sensitive (100 vs 57.1%, P=0.04) with a better diagnostic accuracy (0.999 vs 0.766, P=0.01). There was no difference between mammography and ultrasound in specificity (100 vs 99.9%, P=0.51) and positive predictive value (72.7 vs 70.0%; P=0.87). To detect one cancer, the costs of ultrasound, mammography, and combined modality were $7876, $45 253, and $21 599, respectively. Ultrasound is superior to mammography for breast cancer screening in high-risk Chinese women.

Community-based breast cancer intervention program for older African American women in beauty salons.

PubMed Central

Forte, D A

1995-01-01

African American women are at high risk for morbidity and mortality from breast cancer. African American women ages 50 and older have been a difficult group to reach through conventional breast cancer intervention programs. Cultural and health beliefs that differ from mainstream society are reported to be factors contributing to the low rates of breast screening among this group. In addition to these attitudinal factors, older African American women are disproportionately represented among uninsured and under-insured Americans. As a result, cost becomes a barrier to mammography screening for many of these women. This project proposes to increase breast cancer screening awareness and provide a referral or free breast screening, or both, for African American women ages 50 and older. This information will be offered in the culturally familiar setting of local beauty salons. The culturally sensitive educational pamphlets developed by the National Cancer Institute (NCI) and video developed by the NCI-funded project, Cancer Prevention Research Unit, will be used to promote mammography, clinical breast examinations, and breast self-examination. Providers staffing a mobile mammography van provided by Dr. Anitha Mitchell of the Association of Black Women Physicians through a grant from the Breast and Cervical Cancer Control Program, funded by the Centers for Disease Control and Prevention, will perform mammograms for women on site during scheduled intervals. A followup telephone survey will be conducted. PMID:7630996

Image quality, threshold contrast and mean glandular dose in CR mammography

NASA Astrophysics Data System (ADS)

Jakubiak, R. R.; Gamba, H. R.; Neves, E. B.; Peixoto, J. E.

2013-09-01

In many countries, computed radiography (CR) systems represent the majority of equipment used in digital mammography. This study presents a method for optimizing image quality and dose in CR mammography of patients with breast thicknesses between 45 and 75 mm. Initially, clinical images of 67 patients (group 1) were analyzed by three experienced radiologists, reporting about anatomical structures, noise and contrast in low and high pixel value areas, and image sharpness and contrast. Exposure parameters (kV, mAs and target/filter combination) used in the examinations of these patients were reproduced to determine the contrast-to-noise ratio (CNR) and mean glandular dose (MGD). The parameters were also used to radiograph a CDMAM (version 3.4) phantom (Artinis Medical Systems, The Netherlands) for image threshold contrast evaluation. After that, different breast thicknesses were simulated with polymethylmethacrylate layers and various sets of exposure parameters were used in order to determine optimal radiographic parameters. For each simulated breast thickness, optimal beam quality was defined as giving a target CNR to reach the threshold contrast of CDMAM images for acceptable MGD. These results were used for adjustments in the automatic exposure control (AEC) by the maintenance team. Using optimized exposure parameters, clinical images of 63 patients (group 2) were evaluated as described above. Threshold contrast, CNR and MGD for such exposure parameters were also determined. Results showed that the proposed optimization method was effective for all breast thicknesses studied in phantoms. The best result was found for breasts of 75 mm. While in group 1 there was no detection of the 0.1 mm critical diameter detail with threshold contrast below 23%, after the optimization, detection occurred in 47.6% of the images. There was also an average MGD reduction of 7.5%. The clinical image quality criteria were attended in 91.7% for all breast thicknesses evaluated in both patient groups. Finally, this study also concluded that the use of the AEC of the x-ray unit based on the constant dose to the detector may bring some difficulties to CR systems to operate under optimal conditions. More studies must be performed, so that the compatibility between systems and optimization methodologies can be evaluated, as well as this optimization method. Most methods are developed for phantoms, so comparative studies including clinical images must be developed.

Investigation of optimal parameters for penalized maximum-likelihood reconstruction applied to iodinated contrast-enhanced breast CT

NASA Astrophysics Data System (ADS)

Makeev, Andrey; Ikejimba, Lynda; Lo, Joseph Y.; Glick, Stephen J.

2016-03-01

Although digital mammography has reduced breast cancer mortality by approximately 30%, sensitivity and specificity are still far from perfect. In particular, the performance of mammography is especially limited for women with dense breast tissue. Two out of every three biopsies performed in the U.S. are unnecessary, thereby resulting in increased patient anxiety, pain, and possible complications. One promising tomographic breast imaging method that has recently been approved by the FDA is dedicated breast computed tomography (BCT). However, visualizing lesions with BCT can still be challenging for women with dense breast tissue due to the minimal contrast for lesions surrounded by fibroglandular tissue. In recent years there has been renewed interest in improving lesion conspicuity in x-ray breast imaging by administration of an iodinated contrast agent. Due to the fully 3-D imaging nature of BCT, as well as sub-optimal contrast enhancement while the breast is under compression with mammography and breast tomosynthesis, dedicated BCT of the uncompressed breast is likely to offer the best solution for injected contrast-enhanced x-ray breast imaging. It is well known that use of statistically-based iterative reconstruction in CT results in improved image quality at lower radiation dose. Here we investigate possible improvements in image reconstruction for BCT, by optimizing free regularization parameter in method of maximum likelihood and comparing its performance with clinical cone-beam filtered backprojection (FBP) algorithm.

Digital tomosynthesis in breast cancer: A systematic review.

PubMed

García-León, F J; Llanos-Méndez, A; Isabel-Gómez, R

2015-01-01

To estimate and compare the diagnostic validity of tomosynthesis and digital mammography for screening and diagnosing breast cancer. We systematically searched MedLine, EMBASE, and Web of Science for the terms breast cancer, screening, tomosynthesis, mammography, sensitivity, and specificity in publications in the period comprising June 2010 through February 2013. We included studies on diagnostic tests and systematic reviews. Two reviewers selected and evaluated the articles. We used QUADAS 2 to evaluate the risk of bias and the NICE criteria to determine the level of evidence. We compiled a narrative synthesis. Of the 151 original studies identified, we selected 11 that included a total of 2475 women. The overall quality was low, with a risk of bias and follow-up and limitations regarding the applicability of the results. The level of evidence was not greater than level II. The sensitivity of tomosynthesis ranged from 69% to 100% and the specificity ranged from 54% to 100%. The negative likelihood ratio was good, and this makes tomosynthesis useful as a test to confirm a diagnosis. One-view tomosynthesis was no better than two-view digital mammography, and the evidence for the superiority of two-view tomosynthesis was inconclusive. The results for the diagnostic validity of tomosynthesis in the diagnosis of breast cancer were inconclusive and there were no results for its use in screening. Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Average glandular dose in paired digital mammography and digital breast tomosynthesis acquisitions in a population based screening program: effects of measuring breast density, air kerma and beam quality

NASA Astrophysics Data System (ADS)

Helge Østerås, Bjørn; Skaane, Per; Gullien, Randi; Catrine Trægde Martinsen, Anne

2018-02-01

The main purpose was to compare average glandular dose (AGD) for same-compression digital mammography (DM) and digital breast tomosynthesis (DBT) acquisitions in a population based screening program, with and without breast density stratification, as determined by automatically calculated breast density (Quantra™). Secondary, to compare AGD estimates based on measured breast density, air kerma and half value layer (HVL) to DICOM metadata based estimates. AGD was estimated for 3819 women participating in the screening trial. All received craniocaudal and mediolateral oblique views of each breasts with paired DM and DBT acquisitions. Exposure parameters were extracted from DICOM metadata. Air kerma and HVL were measured for all beam qualities used to acquire the mammograms. Volumetric breast density was estimated using Quantra™. AGD was estimated using the Dance model. AGD reported directly from the DICOM metadata was also assessed. Mean AGD was 1.74 and 2.10 mGy for DM and DBT, respectively. Mean DBT/DM AGD ratio was 1.24. For fatty breasts: mean AGD was 1.74 and 2.27 mGy for DM and DBT, respectively. For dense breasts: mean AGD was 1.73 and 1.79 mGy, for DM and DBT, respectively. For breasts of similar thickness, dense breasts had higher AGD for DM and similar AGD for DBT. The DBT/DM dose ratio was substantially lower for dense compared to fatty breasts (1.08 versus 1.33). The average c-factor was 1.16. Using previously published polynomials to estimate glandularity from thickness underestimated the c-factor by 5.9% on average. Mean AGD error between estimates based on measurements (air kerma and HVL) versus DICOM header data was 3.8%, but for one mammography unit as high as 7.9%. Mean error of using the AGD value reported in the DICOM header was 10.7 and 13.3%, respectively. Thus, measurement of breast density, radiation dose and beam quality can substantially affect AGD estimates.

Average glandular dose in paired digital mammography and digital breast tomosynthesis acquisitions in a population based screening program: effects of measuring breast density, air kerma and beam quality.

PubMed

Østerås, Bjørn Helge; Skaane, Per; Gullien, Randi; Martinsen, Anne Catrine Trægde

2018-01-25

The main purpose was to compare average glandular dose (AGD) for same-compression digital mammography (DM) and digital breast tomosynthesis (DBT) acquisitions in a population based screening program, with and without breast density stratification, as determined by automatically calculated breast density (Quantra ™ ). Secondary, to compare AGD estimates based on measured breast density, air kerma and half value layer (HVL) to DICOM metadata based estimates. AGD was estimated for 3819 women participating in the screening trial. All received craniocaudal and mediolateral oblique views of each breasts with paired DM and DBT acquisitions. Exposure parameters were extracted from DICOM metadata. Air kerma and HVL were measured for all beam qualities used to acquire the mammograms. Volumetric breast density was estimated using Quantra ™ . AGD was estimated using the Dance model. AGD reported directly from the DICOM metadata was also assessed. Mean AGD was 1.74 and 2.10 mGy for DM and DBT, respectively. Mean DBT/DM AGD ratio was 1.24. For fatty breasts: mean AGD was 1.74 and 2.27 mGy for DM and DBT, respectively. For dense breasts: mean AGD was 1.73 and 1.79 mGy, for DM and DBT, respectively. For breasts of similar thickness, dense breasts had higher AGD for DM and similar AGD for DBT. The DBT/DM dose ratio was substantially lower for dense compared to fatty breasts (1.08 versus 1.33). The average c-factor was 1.16. Using previously published polynomials to estimate glandularity from thickness underestimated the c-factor by 5.9% on average. Mean AGD error between estimates based on measurements (air kerma and HVL) versus DICOM header data was 3.8%, but for one mammography unit as high as 7.9%. Mean error of using the AGD value reported in the DICOM header was 10.7 and 13.3%, respectively. Thus, measurement of breast density, radiation dose and beam quality can substantially affect AGD estimates.

Effectiveness and cost-effectiveness of double reading in digital mammography screening: A systematic review and meta-analysis.

PubMed

Posso, Margarita; Puig, Teresa; Carles, Misericòrdia; Rué, Montserrat; Canelo-Aybar, Carlos; Bonfill, Xavier

2017-11-01

Double reading is the strategy of choice for mammogram interpretation in screening programmes. It remains, however, unknown whether double reading is still the strategy of choice in the context of digital mammography. Our aim was to determine the effectiveness and cost-effectiveness of double reading versus single reading of digital mammograms in screening programmes. We performed a systematic review by searching the PubMed, Embase, and Cochrane Library databases up to April 2017. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist to assess the methodological quality of the diagnostic studies and economic evaluations, respectively. A proportion's meta-analysis approach, 95% Confidence Intervals (95% CI) and test of heterogeneity (P values) were used for pooled results. Costs are expressed US$ PPP (United States Dollar purchasing power parities). The PROSPERO ID of this Systematic Review's protocol is CRD42014013804. Of 1473 potentially relevant hits, four high-quality studies were included. The pooled cancer detection rate of double reading was 6.01 per 1000 screens (CI: 4.47‰-7.77‰), and it was 5.65 per 1000 screens (CI: 3.95‰-7.65‰) for single reading (P=0.76). The pooled proportion of false-positives of double reading was 47.03 per 1000 screens (CI: 39.13‰-55.62‰) and it was 40.60 per 1000 screens (CI: 38.58‰-42.67‰) for single reading (P=0.12). One study reported, for double reading, an ICER (Incremental Cost-Effectiveness Ratio) of 16,684 Euros (24,717 US$ PPP; 2015 value) per detected cancer. Single reading+CAD (computer-aided-detection) was cost-effective in Japan. The evidence of benefit for double reading compared to single reading for digital mammography interpretation is scarce. Double reading seems to increase operational costs, have a not significantly higher false-positive rate, and a similar cancer detection rate. Copyright © 2017 Elsevier B.V. All rights reserved.

Fetal Implications of Diagnostic Radiation Exposure During Pregnancy: Evidence-based Recommendations.

PubMed

Rimawi, Bassam H; Green, Victoria; Lindsay, Michael

2016-06-01

The purpose of this article is to review the fetal and long-term implications of diagnostic radiation exposure during pregnancy. Evidence-based recommendations for radiologic imaging modalities utilizing exposure of diagnostic radiation during pregnancy, including conventional screen-film mammography, digital mammography, tomosynthesis, and contrast-enhanced mammography are described.

Barriers to Mammography among Inadequately Screened Women

ERIC Educational Resources Information Center

Stoll, Carolyn R. T.; Roberts, Summer; Cheng, Meng-Ru; Crayton, Eloise V.; Jackson, Sherrill; Politi, Mary C.

2015-01-01

Mammography use has increased over the past 20 years, yet more than 30% of women remain inadequately screened. Structural barriers can deter individuals from screening, however, cognitive, emotional, and communication barriers may also prevent mammography use. This study sought to identify the impact of number and type of barriers on mammography…

From facts to arguments: A study of the 2014 Swiss controversy over systematic mammography screening.

PubMed

Perrenoud, Caroline; Stiefel, Friedrich; Bourquin, Céline

2018-06-01

The Swiss Medical Board (SMB) has recently revived the controversy over mammography screening by recommending to stop the introduction of new systematic mammography screening programs. This study aimed to examine the Swiss media coverage of the release of the SMB report. The dataset consisted of 25 newspaper and "medical magazine" articles, and TV/radio interviews. The analytic approach was based on argumentation theory. Authority and community arguments were the most frequent types of arguments. With respect to authority arguments, stakeholders for instance challenged or supported the expertise of the SMB by referring to the competence of external figures of authority. Community arguments were based on common values such as life (saved thanks to systematic mammography screening) and money (costs associated with unnecessary care induced by systematic mammography screening). The efficiency of mammography screening which was the key issue of the debate appeared to be largely eluded, and the question of what women should do endures. While interpersonal and interprofessional communication has become a major topic of interest in the medical community, it appears that media communication on mammography screening is still rather ineffective. We call in particular for a more fact-based discussion. Copyright © 2017 Elsevier B.V. All rights reserved.

Screening mammography--early detection or over-diagnosis? Contribution from Australian data.

PubMed

Bell, R J

2014-12-01

The aim of this review was to examine the benefits and harms of organized screening mammography, with particular reference to data from Australia. Published literature was examined relating to the impact of screening mammography on breast cancer-specific mortality, the trends in use of adjuvant treatments for breast cancer, the effectiveness of adjuvant treatment in terms of breast cancer-specific mortality, the impact of breast cancer treatment on non-breast cancer mortality and the magnitude of the issue of over-diagnosis. Most of the recent reduction in breast cancer-specific mortality is explained by use of adjuvant therapy rather than screening mammography. The impact of screening mammography in countries where women present with early disease and have access to adjuvant treatment is modest. There is a wide range of estimates for the magnitude of over-diagnosis. All-cause mortality (rather than breast cancer-specific mortality) should be used when assessing the impact of mammographic screening as otherwise the harm of breast cancer treatment in women who are over-diagnosed will be missed. The benefits and harms of screening mammography are finely balanced. The impact of screening mammography is at best neutral but may result in overall harm. Women should be informed of the issue of over-diagnosis. It is time to review whether organized mammographic screening programs should continue.

Knowledge, attitude and practice of mammography among women users of public health services.

PubMed

Marinho, Luiz Alberto Barcelos; Cecatti, José Guilherme; Osis, Maria José Duarte; Gurgel, Maria Salete Costa

2008-04-01

To evaluate knowledge, attitude and practice related to mammography among women users of local health services, identifying barriers to its performance. A total of 663 women were interviewed at 13 local health centers in a city of Southeastern Brazil, in 2001. Interviewees were randomly selected at each center and they were representative from different socioeconomic conditions. The number of interviewees at each center was proportional to monthly mean appointments. For data analysis, answers were described as knowledge, attitude, practice and their respective adequacies and then they were correlated with control variables through the chi-square test. Only 7.4% of the interviewees had adequate knowledge on mammography, while 97.1% of women had an adequate attitude. The same was seen for the practice of mammography that was adequate in 35.7% of the cases. The main barrier to mammography was lack of referral by physicians working at the health center (81.8%). There was an association between adequacy of attitude and five years or more of education and being married. There was also an association between adequacy of mammography practice and being employed and family income up to four minimum wages. Women users of local health services had no adequate knowledge and practice related to mammography despite having an adequate attitude about this exam.

[Evaluation of the national epidemiological program of breast cancer screening in the Grand Duchy of Luxembourg, 1999-2002].

PubMed

Scharpantgen, Astrid; Lux, Christiane; Wagnon, Marie-Christine; Shannoun, Ferid; Schank, Jean-Marie; Back, Carlo; Brochmann, Chantal; Hansen-Koenig, Danielle

2004-01-01

In 1992 a national breast cancer screening programme was launched in Luxembourg with following characteristics; invitation at 2-yearly interval, 2 views, double reading for women aged between 50 and 64 and since 2001, those aged 65-69 are as well included. From the beginning on, one of the main concern was to respect a rigorous methodology, in accordance with the recommendations of the European Commission. This paper presents the early performance indicators of the years 1999-2002 of the "Programme Mammographie". Almost all histopathological results were obtained, because only one national pathology laboratory exists in Luxembourg, where also the national tumor's register is located. In ten years, a total of 91.432 mammograms were performed. The results of the early performance indicators are in agreement with the European Recommendations. A 36% detection rate of small size cancers, < or = 10 mm, and since 2000, more then 70% of node negative cancers are observed among women aged 50-64 attending the Programme. The cancer rate with a good prognostic factor for the patients is high. Despite good results, the rate of interval cancers is still too high, and two conclusions can be drown: the women's participation at screening has to be steady in time without trespassing a two years intervals, and after the detection of small cancer a high quality assessment should be followed by an adequate treatment, leading to a reduction of mortality and also to a decrease of morbidity by treatment.

Benefits of the quality assured double and arbitration reading of mammograms in the early diagnosis of breast cancer in symptomatic women.

PubMed

Waldmann, Annika; Kapsimalakou, Smaragda; Katalinic, Alexander; Grande-Nagel, Isabell; Stoeckelhuber, Beate M; Fischer, Dorothea; Barkhausen, Joerg; Vogt, Florian M

2012-05-01

To address the benefits of double and arbitration reading regarding tumour detection rates, percentage of in situ tumours, and number (of patients) needed to send for expert reading (number needed to treat; NNT) for one additional tumour finding. QuaMaDi is a quality assured breast cancer diagnosis programme; with two-view mammography (craniocaudal, mediolateral oblique) and, in case of breast density ACR 3 or 4, routine ultrasound imaging; and with independent double reading of all images. A consecutive sample of symptomatic women, i.e. women at risk for breast cancer, women aged 70 and above, and/or women with preceding BI-RADS III findings, was analysed. 28,558 mammograms were performed (mean age of women: 57.3 [standard deviation: 12.3] years). Discordant findings were present in 3,837 double readings and were sent for arbitration reading. After histopathological assessment, 52 carcinomas were found (thereof 32% in situ). These carcinomas accounted for 1.8 tumours per 1,000 examinations in the total cohort and increased the tumour detection rate up to 16.4/1,000. The NNT in discordant cases was 74. Double and arbitration reading appears to be a useful tool to ensure the quality of early detection of breast lesions in symptomatic women during indication-based, standardised mammography. • Quality assured breast cancer diagnosis is feasible outside organised screening structures. • Double and arbitration reading is beneficial for populations ineligible for screening. • Double and arbitration reading increases the tumour detection rate. • Double and arbitration reading increases the percentage of in situ cancers.

The use of ultrasonography and digital mammography in women under 40 years with symptomatic breast cancer: a 7-year Irish experience.

PubMed

Redmond, C E; Healy, G M; Murphy, C F; O'Doherty, A; Foster, A

2017-02-01

Breast cancer in women under 40 years of age is rare and typically presents symptomatically. The optimal imaging modality for this patient group is controversial. Most women undergo ultrasonography with/without mammography. Young women typically have dense breasts, which can obscure the features of malignancy on film mammography, however, initial studies have suggested that digital mammography may have a more accurate diagnostic performance in younger women. Ultrasound generally performs well in this age group, although it is poor at detecting carcinoma in situ (DCIS). To evaluate the comparative diagnostic performance of ultrasonography and digital mammography in the initial diagnostic evaluation of women under 40 years of age with symptomatic breast cancer. Retrospective review of all women under the age of 40 years managed at our symptomatic breast cancer unit from January 2009 to December 2015. There were 120 patients that met the inclusion criteria for this study. The sensitivity of ultrasonography and digital mammography for breast cancer in this patient group was 95.8 and 87.5 %, respectively. The patients with a false negative mammographic examination were more likely to have dense breasts (p < 0.01). Five patients had a false negative ultrasonographic examination, withal of whom were diagnosed with DCIS detected by mammography. This study demonstrates the superior sensitivity of ultrasound for breast cancer in women under the age of 40 years, however, the results show that digital mammography has an important complimentary role in the comprehensive assessment of these patients, particularly in the diagnosis of DCIS.

Breast mass detection in mammography and tomosynthesis via fully convolutional network-based heatmap regression

NASA Astrophysics Data System (ADS)

Zhang, Jun; Cain, Elizabeth Hope; Saha, Ashirbani; Zhu, Zhe; Mazurowski, Maciej A.

2018-02-01

Breast mass detection in mammography and digital breast tomosynthesis (DBT) is an essential step in computerized breast cancer analysis. Deep learning-based methods incorporate feature extraction and model learning into a unified framework and have achieved impressive performance in various medical applications (e.g., disease diagnosis, tumor detection, and landmark detection). However, these methods require large-scale accurately annotated data. Unfortunately, it is challenging to get precise annotations of breast masses. To address this issue, we propose a fully convolutional network (FCN) based heatmap regression method for breast mass detection, using only weakly annotated mass regions in mammography images. Specifically, we first generate heat maps of masses based on human-annotated rough regions for breast masses. We then develop an FCN model for end-to-end heatmap regression with an F-score loss function, where the mammography images are regarded as the input and heatmaps for breast masses are used as the output. Finally, the probability map of mass locations can be estimated with the trained model. Experimental results on a mammography dataset with 439 subjects demonstrate the effectiveness of our method. Furthermore, we evaluate whether we can use mammography data to improve detection models for DBT, since mammography shares similar structure with tomosynthesis. We propose a transfer learning strategy by fine-tuning the learned FCN model from mammography images. We test this approach on a small tomosynthesis dataset with only 40 subjects, and we show an improvement in the detection performance as compared to training the model from scratch.

The Future of Mammography: Radiology Residents’ Experiences, Attitudes, and Opinions

PubMed Central

Baxi, Shrujal S.; Snow, Jacqueline G.; Liberman, Laura; Elkin, Elena B.

2011-01-01

OBJECTIVE The objective of our study was to assess the experiences and preferences of radiology residents with respect to breast imaging. MATERIALS AND METHODS We surveyed radiology residents at 26 programs in New York and New Jersey. Survey topics included plans for subspecialty training, beliefs, and attitudes toward breast imaging and breast cancer screening and the likelihood of interpreting mammography in the future. RESULTS Three hundred forty-four residents completed the survey (response rate, 62%). The length of time spent training in breast imaging varied from no dedicated time (37%) to 1–8 weeks (40%) to more than 9 weeks (23%). Most respondents (97%) agreed that mammography is important to women’s health. More than 85% of residents believed that mammography should be interpreted by breast imaging specialists. Respondents shared negative views about mammography, agreeing with statements that the field was associated with a high risk of malpractice (99%), stress (94%), and low reimbursement (68%). Respondents endorsed several positive attributes of mammography, including job availability (97%), flexible work schedules (94%), and few calls or emergencies (93%). Most radiology residents (93%) said that they were likely to pursue subspecialty training, and 7% expressed interest in breast imaging fellowships. CONCLUSION Radiology residents’ negative and positive views about mammography seem to be independent of time spent training in mammography and of future plans to pursue fellowship training in breast imaging. Systematic assessment of the plans and preferences of radiology residents can facilitate the development of strategies to attract trainees to careers in breast imaging. PMID:20489113

Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: interobserver blind-reading analysis.

PubMed

Cheung, Yun-Chung; Lin, Yu-Ching; Wan, Yung-Liang; Yeow, Kee-Min; Huang, Pei-Chin; Lo, Yung-Feng; Tsai, Hsiu-Pei; Ueng, Shir-Hwa; Chang, Chee-Jen

2014-10-01

To analyse the accuracy of dual-energy contrast-enhanced spectral mammography in dense breasts in comparison with contrast-enhanced subtracted mammography (CESM) and conventional mammography (Mx). CESM cases of dense breasts with histological proof were evaluated in the present study. Four radiologists with varying experience in mammography interpretation blindly read Mx first, followed by CESM. The diagnostic profiles, consistency and learning curve were analysed statistically. One hundred lesions (28 benign and 72 breast malignancies) in 89 females were analysed. Use of CESM improved the cancer diagnosis by 21.2 % in sensitivity (71.5 % to 92.7 %), by 16.1 % in specificity (51.8 % to 67.9 %) and by 19.8 % in accuracy (65.9 % to 85.8 %) compared with Mx. The interobserver diagnostic consistency was markedly higher using CESM than using Mx alone (0.6235 vs. 0.3869 using the kappa ratio). The probability of a correct prediction was elevated from 80 % to 90 % after 75 consecutive case readings. CESM provided additional information with consistent improvement of the cancer diagnosis in dense breasts compared to Mx alone. The prediction of the diagnosis could be improved by the interpretation of a significant number of cases in the presence of 6 % benign contrast enhancement in this study. • DE-CESM improves the cancer diagnosis in dense breasts compared with mammography. • DE-CESM shows greater consistency than mammography alone by interobserver blind reading. • Diagnostic improvement of DE-CESM is independent of the mammographic reading experience.

REPEAT MAMMOGRAPHY SCREENING AMONG UNMARRIED WOMEN WITH AND WITHOUT A DISABILITY

PubMed Central

Clark, Melissa A.; Rogers, Michelle L.; Wen, Xiaozhong; Wilcox, Victoria; McCarthy-Barnett, Kate; Panarace, Jeanne; Manning, Carol; Allen, Susan; Rakowski, William

2009-01-01

Objectives Unmarried women with disabilities may be a particularly vulnerable group for underutilization of repeat mammography screening. Our goal was to compare the breast cancer screening experiences of unmarried women with disabilities (WWD) versus women with no disabilities (WND), and determine whether these experiences are associated with adherence to repeat screening. Methods We conducted a matched cohort study of 93 WWD and 93 WND to compare mammography experiences by disability status, examine rates of repeat mammography by disability status, and identify factors that are associated with repeat mammography. Results WWD were less likely to be on-schedule than WND in univariable (54.8% vs. 71.0%; relative risk = 0.77, 95% CL = 0.61, 0.97), but not multivariable, analyses. In multivariable analyses, there was a significant interaction between disability status and positive experiences as the reasons for returning to the same mammography facility. Among WND, repeat screening ranged from 59% to 86%, depending on the number of positive experiences endorsed (range=1–5). In contrast, among WWD, screening rates were only 37% among those who did not report any positive experiences and increased to a maximum of 60% regardless of whether women endorsed one to four or all five positive experiences. Severity and type of disability were not associated with repeat screening. Conclusions WWD may be less likely than WND to remain on-schedule for mammography. WWD who do not report any positive experiences as reasons for returning to a mammography facility may be at particularly high risk of underutilization of screening. PMID:19775912

Informed decision making before initiating screening mammography: does it occur and does it make a difference?

PubMed

Nekhlyudov, Larissa; Li, Rong; Fletcher, Suzanne W

2008-12-01

Informed decision making regarding screening mammography is recommended for women under age 50. To what extent it occurs in clinical settings is unclear. Using a mailed instrument, we surveyed women aged 40-44 prior to their first screening mammogram. All women were members of a large health maintenance organization and received care at a large medical practice in the Greater Boston area. The survey measured informed decision making, decisional conflict, satisfaction, and screening mammography knowledge and intentions to undergo screening. Ninety-six women responded to the survey (response rate 47%). Overall, women reported limited informed decision making regarding screening mammography, both with respect to information exchange and involvement in the decision process. Less than half (47%) reported discussing the benefits of screening; 23% the uncertainties; and only 7% the harms. About 30% reported discussing the nature of the decision or clinical issue; and 29% reported their provider elicited their preferred role in the decision; 38% their preferences; and 24% their understanding of the information. Women who were uninformed had higher decisional conflict (2.37 vs. 1.83, P=0.005) about screening mammography and were more likely to be dissatisfied with the information and involvement. Women's screening mammography knowledge was limited in most areas; however being presented with information did not diminish their intentions to undergo screening. Informed decision making before initiating screening mammography is limited in this setting. There appears to be little indication that information about the benefits and harms decreases women's intentions to undergo screening. Methods to communicate information to women before initiating screening mammography are needed.

Value of mammography and breast ultrasound in male patients with nipple discharge.

PubMed

Muñoz Carrasco, Rafaela; Álvarez Benito, Marina; Rivin del Campo, Eleonor

2013-03-01

To assess the contribution of mammography and ultrasound in men with nipple discharge. All men with nipple discharge who underwent mammography and/or ultrasound between 1993 and 2011 in our hospital were retrospectively evaluated. Radiological findings were classified according to BI-RADS lexicon. The final diagnosis was made based on histopathological results or clinical-radiological follow-up. The diagnostic performance of physical examination, mammography and ultrasound was calculated and compared. 26 men with 21 mammograms and 19 ultrasounds were reviewed. The final diagnoses were: 6 carcinomas (23.1%), 10 gynaecomastias, 2 pseudogynaecomastias and 8 normal breast tissues. Mammograms and ultrasounds performed on all five patients with infiltrating carcinoma showed a mass (categories 4 and 5). In all these patients except one, a breast mass was also noted and the physical examination was positive or suspected malignancy. In the patient with carcinoma in situ, the only conspicuous clinical sign was bloody nipple discharge and the mammography showed calcifications (category 4) that were not visible on ultrasound. Radiological findings of all patients without malignancy were classified as categories 1 and 2. The diagnostic performance of physical examination was lower than mammography and ultrasound (P>0.05). Mammography was more sensitive than ultrasound (100% vs. 83.3%). Both techniques showed the same specificity (100%). Men with nipple discharge have a high incidence of breast carcinoma. Nipple discharge may be the only clinical sign of carcinoma in situ. Mammography and ultrasound are useful in the evaluation of men with nipple discharge, diagnosing carcinoma in initial stages, avoiding unnecessary biopsies. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Personalized estimates of radiation dose from dedicated breast CT in a diagnostic population and comparison with diagnostic mammography

PubMed Central

Vedantham, Srinivasan; Shi, Linxi; Karellas, Andrew; O’Connell, Avice M.; Conover, David L.

2013-01-01

This study retrospectively analyzed the mean glandular dose (MGD) to 133 breasts from 132 subjects, all women, who participated in a clinical trial evaluating dedicated breast CT in a diagnostic population. The clinical trial was conducted in adherence to a protocol approved by institutional review boards and the study participants provided written informed consent. Individual estimates of mean glandular dose to each breast from dedicated breast CT was obtained by combining x-ray beam characteristics with estimates of breast dimensions and fibroglandular fraction from volumetric breast CT images, and using normalized glandular dose coefficients. For each study participant and for the breast corresponding to that imaged with breast CT, an estimate of the MGD from diagnostic mammography (including supplemental views) was obtained from the DICOM image headers for comparison. This estimate uses normalized glandular dose coefficients corresponding to a breast with 50% fibroglandular weight fraction. The median fibroglandular weight fraction for the study cohort determined from volumetric breast CT images was 15%. Hence, the MGD from diagnostic mammography was corrected to be representative of the study cohort. Individualized estimates of MGD from breast CT ranged from 5.7 mGy to 27.8 mGy. Corresponding to the breasts imaged with breast CT, the MGD from diagnostic mammography ranged from 2.6 to 31.6 mGy. The mean (± inter-breast SD) and the median MGD (mGy) from dedicated breast CT exam were 13.9±4.6 and 12.6, respectively. For the corresponding breasts, the mean (± inter-breast SD) and the median MGD (mGy) from diagnostic mammography were 12.4±6.3 and 11.1, respectively. Statistical analysis indicated that at the 0.05 level, the distributions of MGD from dedicated breast CT and diagnostic mammography were significantly different (Wilcoxon signed ranks test, p = 0.007). While the interquartile range and the range (maximum-minimum) of MGD from dedicated breast CT was lower than diagnostic mammography, the median MGD from dedicated breast CT was approximately 13.5% higher than that from diagnostic mammography. The MGD for breast CT is based on a 1.45 mm skin layer and that for diagnostic mammography is based on a 4 mm skin layer; thus, favoring a lower estimate for MGD from diagnostic mammography. The median MGD from dedicated breast CT corresponds to the median MGD from 4 to 5 diagnostic mammography views. In comparison, for the same 133 breasts, the mean and the median number of views per breast during diagnostic mammography were 4.53 and 4, respectively. Paired analysis showed that there was approximately equal likelihood of receiving lower MGD from either breast CT or diagnostic mammography. Future work will investigate methods to reduce and optimize radiation dose from dedicated breast CT. PMID:24165162

Mammography and Other Screening Tests for Breast Problems

MedlinePlus

... in eight women will develop breast cancer by age 75 years. Regular breast screening can help find cancer at an early and more curable stage. Screening also can find problems in the breasts that are not cancer. What is mammography? Mammography is the primary tool used to screen for breast cancer and ...

Trimodel Mammography with Perfect Coregistration

DTIC Science & Technology

2017-02-01

background, the major confounding factor in reading mammography; the imaging characteristics suggest that this contrast mechanism would be preferable...image with enhanced edges and reduced anatomical background, the major confounding factor in reading mammography; the imaging characteristics suggest...subjects, vertebrate animals , biohazards, and/or select agents Describe significant deviations, unexpected outcomes, or changes in approved protocols

Screening Mammography Utilization in Tennessee Women: The Association with Residence

ERIC Educational Resources Information Center

Brown, Kathleen C.; Fitzhugh, Eugene C.; Neutens, James J.; Klein, Diane A.

2009-01-01

Context: Approximately 70% of US women over age 40 report mammography screening within 2 years. However, rates are likely to vary by age, income, educational level, and residence. Purpose: To describe the prevalence of screening mammography and associated factors in women living in rural and urban areas of Tennessee. Methods: Using pooled data…

Attitudes and Beliefs Associated with Mammography in a Multiethnic Population in Israel

ERIC Educational Resources Information Center

Baron-Epel, Orna

2010-01-01

This article highlights beliefs, attitudes, and barriers that are associated with mammography use in four distinct cultural and ethnic groups in Israel: veteran, ultra-orthodox, and immigrant Jewish and Arab women. A random telephone survey of 1,550 women was performed. Information from claims records concerning mammography use was obtained for…

Cultural Views, Language Ability, and Mammography Use in Chinese American Women

ERIC Educational Resources Information Center

Liang, Wenchi; Wang, Judy; Chen, Mei-Yuh; Feng, Shibao; Yi, Bin; Mandelblatt, Jeanne S.

2009-01-01

Mammography screening rates among Chinese American women have been reported to be low. This study examines whether and how culture views and language ability influence mammography adherence in this mostly immigrant population. Asymptomatic Chinese American women (n = 466) aged 50 and older, recruited from the Washington, D.C. area, completed a…

Beyond Mammography: New Frontiers in Breast Cancer Screening

PubMed Central

Drukteinis, Jennifer S.; Mooney, Blaise P.; Flowers, Chris I.; Gatenby, Robert A

2014-01-01

Breast cancer screening remains a subject of intense and, at times, passionate debate. Mammography has long been the mainstay of breast cancer detection and is the only screening test proven to reduce mortality. Although it remains the gold standard of breast cancer screening, there is increasing awareness of subpopulations of women for whom mammography has reduced sensitivity. Mammography has also undergone increased scrutiny for false positives and excessive biopsies, which increase radiation dose, cost and patient anxiety. In response to these challenges, new technologies for breast cancer screening have been developed, including; low dose mammography; contrast enhanced mammography, tomosynthesis, automated whole breast ultrasound, molecular imaging and MRI. Here we examine some of the current controversies and promising new technologies that may improve detection of breast cancer both in the general population and in high-risk groups, such as women with dense breasts. We propose that optimal breast cancer screening will ultimately require a personalized approach based on metrics of cancer risk with selective application of specific screening technologies best suited to the individual’s age, risk, and breast density. PMID:23561631

As mammography use increases, are some providers omitting clinical breast examination?

PubMed

Burns, R B; Freund, K M; Ash, A S; Shwartz, M; Antab, L; Hall, R

1996-04-08

To explore use of clinical breast examination (CBE) among women receiving mammography. A retrospective cohort analysis of 100 women aged 50 years or older with at least one bilateral mammogram. Chart review documented demographic information, severity of illness, and performance of CBE (from 1 year prior to 18 months after the mammogram). The mean age of the 100 women was 63 years. They were predominantly unmarried (60%), nonwhite (58%), and not currently employed (57%). Three quarters (76%) had mammography and CBE (comprehensive screening), while the remaining 24% had mammography only. Sociodemographic factors did not differ for women with and without comprehensive screening (P>.1). However, patients of female providers were more likely to receive comprehensive screening than patients of male providers. Specifically, 95% of women seen by female attending physicians or fellows had comprehensive screening vs 67% for male attending physicians or fellows and 61% for residents (P=.008). Mammography may be replacing CBE especially among patients of male providers. Interventions targeted to these providers could help improve the use of CBE and mammography.

[Malignant and benign diseases of the breast in 41 male patients: mammography, sonography and pathohistological correlations].

PubMed

Partik, B; Mallek, R; Rudas, M; Pokieser, P; Wunderbaldinger, P; Helbich, T H

2001-11-01

The goal of our study was to evaluate findings in mammography and sonography in male patients with pathohistologically proven diseases of the breast. Mammographies and sonographies, which were obtained in 41 male patients in a 6-year period, were retrospectively evaluated in accordance with the BI-RADS(R) classification. Histologically 13 carcinomas, 21 gynecomastias, 3 pseudogynecomastias, 2 epithelial inclusion cysts and 2 other benign lesions were diagnosed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of mammography in differentiation of benign versus malignant disease were 92 %, 89 %, 80 %, 96 % and 90 %, respectively. Additional sonography did not change these results. However, sonography increased diagnostic confidence in 18.2 % (2/11) of suspicious lesions. In our study the invasive ductal carcinoma of male patients was a predominantly lobulated, ill-defined lesion in mammography and sonography. The differentiation of carcinoma to pseudogynecomastia and diffuse or dendritic gynecomastia was securely feasible. However, we could not reliably distinguish between carcinoma and some benign mass lesions. In cases of mammographically diagnosed masses or unclear mammography, additional sonography should be performed to increase the diagnostic confidence.

Comparison of Two Different Educational Methods for Teachers' Mammography Based on the Health Belief Model.

PubMed

Heydari, Esmat; Noroozi, Azita

2015-01-01

Breast cancer is the most common cancer in women. One way to decrease the burden of this cancer is early detection through mammography. This study compared the effectiveness of two different educational methods for teachers' uptake of mammography based on the Health Belief Model. The current study was a randomised trial of 120 teachers over 40 years old in two groups receiving multimedia or group education, both based on the Health Belief Model. Participants completed questionnaires before, immediately and three months after educational intervention. Mammography was evaluated before and after educational intervention. The participants in the two groups were demographically similar. Comparison showed no difference noted in the scores of knowledge, perceived barriers, susceptibility, and severity constructs between two groups (p > 0.05). Health motivation and benefit were perceived to be higher in the group education compared to the multimedia group. There was a significant difference in mammography between two groups after the intervention (p= 0.003). Planning and implementation of educational program based on the Health Belief Model can raise knowledge and increase participation in mammography especially with group education.

Public transparency Web sites for radiology practices: prevalence of price, clinical quality, and service quality information.

PubMed

Rosenkrantz, Andrew B; Doshi, Ankur M

2016-01-01

To assess information regarding radiology practices on public transparency Web sites. Eight Web sites comparing radiology centers' price and quality were identified. Web site content was assessed. Six of eight Web sites reported examination prices. Other reported information included hours of operation (4/8), patient satisfaction (2/8), American College of Radiology (ACR) accreditation (3/8), on-site radiologists (2/8), as well as parking, accessibility, waiting area amenities, same/next-day reports, mammography follow-up rates, examination appropriateness, radiation dose, fellowship-trained radiologists, and advanced technologies (1/8 each). Transparency Web sites had a preponderance of price (and to a lesser extent service quality) information, risking fostering price-based competition at the expense of clinical quality. Copyright © 2016 Elsevier Inc. All rights reserved.

Surveillance mammography among female Department of Defense beneficiaries: a study by race and ethnicity.

PubMed

Enewold, Lindsey; McGlynn, Katherine A; Zahm, Shelia H; Jatoi, Ismail; Anderson, William F; Gill, Abegail A; Shriver, Craig D; Zhu, Kangmin

2013-10-01

Annual surveillance mammography is recommended after a diagnosis of breast cancer. Previous studies have suggested that surveillance mammography varies by demographics and initial tumor characteristics, which are related to an individual's access to health care. The Military Health System of the Department of Defense provides beneficiaries with equal access health care and thus offers an excellent opportunity to assess whether racial differences in surveillance mammography persist when access to care is equal. Among female beneficiaries with a history of breast cancer, logistic regression was used to assess racial/ethnic variations in the use of surveillance mammography during 3 periods of 12 months each, beginning 1 year after diagnosis adjusting for demographic, tumor, and health characteristics. The rate of overall surveillance mammography decreased from 70% during the first year to 59% during the third year (P < .01). Although there was an overall tendency for surveillance mammography to be higher among minority women compared with non-Hispanic white women, after adjusting for covariates, the difference was found to be significant only during the first year among black women (odds ratio [OR], 1.46; 95% confidence interval [95% CI], 1.10-1.95) and the second year among Asian/Pacific Islander (OR, 2.29; 95%CI, 1.52-3.44) and Hispanic (OR, 1.92; 95%CI, 1.17-3.18) women. When stratified by age at diagnosis and type of breast cancer surgery performed, significant racial differences tended to be observed among younger women (aged < 50 years) and only among women who had undergone mastectomies. Minority women were equally or more likely than non-Hispanic white women to receive surveillance mammography within the Military Health System. The racial disparities in surveillance mammography reported in other studies were not observed in a system with equal access to health care. Copyright © 2013 American Cancer Society.

Factors influencing elderly women's mammography screening decisions: implications for counseling.

PubMed

Schonberg, Mara A; McCarthy, Ellen P; York, Meghan; Davis, Roger B; Marcantonio, Edward R

2007-11-16

Although guidelines recommend that clinicians consider life expectancy before screening older women for breast cancer, many older women with limited life expectancies are screened. We aimed to identify factors important to mammography screening decisions among women aged 80 and older compared to women aged 65-79. Telephone surveys of 107 women aged 80+ and 93 women aged 65-79 randomly selected from one academic primary care practice who were able to communicate in English (60% response rate). The survey addressed the following factors in regards to older women's mammography screening decisions: perceived importance of a history of breast disease, family history of breast cancer, doctor's recommendations, habit, reassurance, previous experience, mailed reminder cards, family/friend's recommendations or experience with breast cancer, age, health, and media. The survey also assessed older women's preferred role in decision making around mammography screening. Of the 200 women, 65.5% were non-Hispanic white and 82.8% were in good to excellent health. Most (81.3%) had undergone mammography in the past 2 years. Regardless of age, older women ranked doctor's recommendations as the most important factor influencing their decision to get screened. Habit and reassurance were the next two highly ranked factors influencing older women to get screened. Among women who did not get screened, women aged 80 and older ranked age and doctor's counseling as the most influential factors and women aged 65-79 ranked a previous negative experience with mammography as the most important factor. There were no significant differences in preferred role in decision-making around mammography screening by age, however, most women in both age groups preferred to make the final decision on their own (46.6% of women aged 80+ and 50.5% of women aged 65-79). While a doctor's recommendation is the most important factor influencing elderly women's mammography screening decisions, habit and reassurance also strongly influence decision-making. Interventions aimed at improving clinician counseling about mammography, which include discussions around habit and reassurance, may result in better decision-making.

Mammography Screening Uptake among Female Health Care Workers in Primary Health Care Centers in Palestine - Motivators and Barriers.

PubMed

Nazzal, Zaher; Sholi, Hisham; Sholi, Suha; Sholi, Mohammad; Lahaseh, Rawya

2016-01-01

Early detection remains the cornerstone of breast cancer control in terms of outcome and survival. Thus far the only breast cancer screening method proven effective is mammography. The awareness of female health care workers (HCW) about breast cancer prevention is of vital importance, as their beliefs and behavior may have a major impact on other women. This study was designed to assess mammography screening uptake among female healthcare workers at primary healthcare centers, and to identify the primary motivators and barriers that affect uptake results. A cross sectional study design was used to assess mammography screening by 299 female healthcare workers who completed a self-administered questionnaire that assessed demographics, screening uptake, motivators and barriers. The mean age was 46 years (within age of risk). The majority (95.1%) demonstrated adequate knowledge about breast cancer and mammography screening and 50% of the participants reported having at least one mammogram; however only 21% of them had regularly scheduled mammograms. The most frequent reported motivator was the perceived benefit that early detection of breast cancer is important for its management (89.6%), followed by the belief that mammography can detect breast cancer before its symptoms appear (84.4%). On the other hand, the most frequent barrier reported was being busy (46.7%), followed by the lack of perceived susceptibility (41.5%). Mammography screening was found to be sub-optimal in a population of HCW's with 50 % stating that they received a mammogram at least once, and a minority reported regular screening. There is a pressing need for educational programs aimed at removing the barriers that limit compliance with recommendations for mammography screening, and to emphasize the importance of early detection in breast cancer treatment. Ensuring the availability and accessibility of screening services, particularly for healthcare workers within their work settings are other important factors that would improve the acceptance and compliance for mammography screening programs.

Comparison Between Digital and Synthetic 2D Mammograms in Breast Density Interpretation.

PubMed

Alshafeiy, Taghreed I; Wadih, Antoine; Nicholson, Brandi T; Rochman, Carrie M; Peppard, Heather R; Patrie, James T; Harvey, Jennifer A

2017-07-01

The purpose of this study was to compare assessments of breast density on synthetic 2D images as compared with digital 2D mammograms. This retrospective study included consecutive women undergoing screening with digital 2D mammography and tomosynthesis during May 2015 with a negative or benign outcome. In separate reading sessions, three radiologists with 5-25 years of clinical experience and 1 year of experience with synthetic 2D mammography read digital 2D and synthetic 2D images and assigned breast density categories according to the 5th edition of BI-RADS. Inter- and intrareader agreement was assessed for each BI-RADS density assessment and combined dense and nondense categories using percent agreement and Cohen kappa coefficient for consensus and all reads. A total of 309 patients met study inclusion criteria. Agreement between consensus BI-RADS density categories assigned for digital and synthetic 2D mammography was 80.3% (95% CI, 75.4-84.5%) with κ = 0.73 (95% CI, 0.66-0.79). For combined dense and nondense categories, agreement reached 91.9% (95% CI, 88.2-94.7%). For consensus readings, similar numbers of patients were shifted between nondense and dense categories (11 and 14, respectively) with the synthetic 2D compared with digital 2D mammography. Interreader differences were apparent; assignment to dense categories was greater with digital 2D mammography for reader 1 (odds ratio [OR], 1.26; p = 0.002), the same for reader 2 (OR, 0.91; p = 0.262), and greater with synthetic 2D mammography for reader 3 (OR, 0.86; p = 0.033). Overall, synthetic 2D mammography is comparable with digital 2D mammography in assessment of breast density, though there is some variability by reader. Practices can readily adopt synthetic 2D mammography without concern that it will affect density assessment and subsequent recommendations for supplemental screening.

First breast cancer mammography screening program in Mexico: initial results 2005-2006.

PubMed

Rodríguez-Cuevas, Sergio; Guisa-Hohenstein, Fernando; Labastida-Almendaro, Sonia

2009-01-01

Breast cancer is the most frequent malignant neoplasia worldwide. In emergent countries as Mexico, an increase has been shown in frequency and mortality, unfortunately, most cases in advanced loco-regional stages developed in young women. The success of breast screening in mortality reduction has been observed since 1995 in Western Europe and the United States, where as many as 40% mortality reduction has been achieved. Most countries guidelines recommends an annual or biannual mammography for all women >40 years of age. In 2005, FUCAM, a nonlucrative civil foundation in Mexico join with Mexico City government, initiated the first voluntary mammography screening program for women >40 years of age residing in Mexico City's Federal District. Mammographies were carried out with analogical mammographs in specially designed mobile units and were performed in the area of women's domiciles. This report includes data from the first 96,828 mammographies performed between March 2005 and December 2006. There were 1% of mammographies in Breast Imaging Reporting and Data System 0, 4, or 5 and 208 out of 949 women with abnormal mammographies (27.7%) had breast cancer, a rate of 2.1 per thousand, most of them in situ or stage I (29.4%) or stage II (42.2%) nevertheless 21% of those women with abnormal mammography did not present for further clinical and radiologic evaluation despite being personally notified at their home addresses. The breast cancer rate of Mexican women submitted to screening mammography is lower than in European or North American women. Family history of breast cancer, nulliparity, absence of breast feeding, and increasing age are factors that increase the risk of breast cancer. Most cancers were diagnosed in women's age below 60 years (68.5%) with a mean age of 53.55 corroborating previous data published. It is mandatory to sensitize and educate our population with regard to accepting to visit the Specialized Breast Centers.

Digital Mammography and Digital Breast Tomosynthesis.

PubMed

Moseley, Tanya W

2016-06-01

Breast imaging technology has advanced significantly from the 1930s until the present. American women have a 1 in 8 chance of developing breast cancer. Mammography has been proven in multiple clinical trials to reduce breast cancer mortality. Although a mainstay of breast imaging and improved from film-screen mammography, digital mammography is not a perfect examination. Overlapping obscuring breast tissue limits mammographic interpretation. Breast digital tomosynthesis reduces and/or eliminates overlapping obscuring breast tissue. Although there are some disadvantages with digital breast tomosynthesis, this relatively lost-cost technology may be used effectively in the screening and diagnostic settings.

Gold Nanoparticle Contrast Agents in Mammography: A Feasibility Study

DTIC Science & Technology

2008-08-01

grid and allowed to dry for 6 hours prior to imaging. The grid was then imaged using a high-resolution transmission electron microscopy, and the...9. Lasfargues EY , Coutinho WG, Redfield ES. Isolation of two human tumor epithelial cell lines from solid breast carcinomas. Journal of National...tissue [14]. These probes have also been used to track immune-stimulating cells implanted into cancer patients for treatment purposes. Targeted contrast

Determination of the anxiety level of women who present for mammography.

PubMed

Bölükbaş, Nurgül; Erbil, Nülüfer; Kahraman, Azize Nuran

2010-01-01

This paper was to examine the role of anxiety in mammography screening. Breast cancer screening with mammography has been shown to be effective for preventing breast cancer death. However mammography screening can be harmful to women. One of the major problems is anxiety or lack of peace of mind in mammography screening. This study was conducted between November 3, 2007, and December 30, 2007, in Ordu Maternity and Childbirth Hospital. 93 women participated in the study. A 23-item questionnaire and the 20-item State Anxiety Inventory, developed by Spielberger et al. were completed by the participants. All numerical values were given as average ± standard deviation; p<0.05 was accepted for level of significance. The average age of the participants was 47.83 ± 7.50, the average age at marriage was 20.03 ± 4.18, the average birth number 2.91 ± 1.21, and the average age at menopause was 46.10 ± 4.70. The average anxiety level was found to be 46.20 ± 4.9. Significant differences (p<0.05) were found between education level, age at marriage, status of doing breast self examination, status of having a mammography for a breast-related complaint, and the number of mammograms done. It was determined that women who had mammography had a moderate level of anxiety.

Geographic access to mammography and its relationship to breast cancer screening and stage at diagnosis: a systematic review

PubMed Central

Khan-Gates, Jenna A.; Ersek, Jennifer L.; Eberth, Jan M.; Adams, Swann A.; Pruitt, Sandi

2016-01-01

Introduction A review was conducted to summarize the current evidence and gaps in the literature on geographic access to mammography and its relationship to breast cancer-related outcomes. Methods Ovid Medline and PubMed were searched for articles published between January 1, 2000 and April 1, 2013 using Medical Subject Headings and key terms representing geographic accessibility and breast cancer-related outcomes. Due to a paucity of breast cancer treatment and mortality outcomes meeting the criteria (N=6), outcomes were restricted to breast cancer screening and stage at diagnosis. Studies included one or more of the following types of geographic accessibility measures: capacity, density, distance and travel time. Study findings were grouped by outcome and type of geographic measure. Results Twenty-one articles met inclusion criteria. Fourteen articles included stage at diagnosis as an outcome, five included mammography utilization, and two included both. Geographic measures of mammography accessibility varied widely across studies. Findings also varied, but most articles found either increased geographic access to mammography associated with increased utilization and decreased late-stage at diagnosis or no statistically significant association. Conclusion The gaps and methodologic heterogeneity in the literature to date limit definitive conclusions about an underlying association between geographic mammography access and breast cancer-related outcomes. Future studies should focus on the development and application of more precise and consistent measures of geographic access to mammography. PMID:26219677

Racial/Ethnic Differences Affecting Adherence to Cancer Screening Guidelines Among Women.

PubMed

Hirth, Jacqueline M; Laz, Tabassum Haque; Rahman, Mahbubur; Berenson, Abbey B

2016-04-01

Race/ethnicity has been shown to modify the effects between obesity and cancer screening among women. The purpose of this article is to update the literature with recent data to examine how the association between different characteristics, including body mass index (BMI), and cancer screening compliance varies by race/ethnicity in a national sample of women. Three cycles of the Health Information National Trends Survey (HINTS) were combined for this cross-sectional study. Weighted descriptive statistics were evaluated using chi-square tests. Multivariable logistic regression evaluated associations between women with underweight or normal (<25), overweight (25-29.9), and obese (>30) BMIs and cancer screening concordant with guidelines (Papanicolaou [Pap] testing ≤3 years, ages 21+ years; mammography ≤2 years, ages 40+ years) in analyses stratified by race/ethnicity. We also assessed variance between racial/ethnic groups in how age, income, and insurance status were associated with cancer screening compliance. This study included 4992 women who were evaluated for Pap testing and 3773 for mammography. In analyses stratified by race/ethnicity, whites with a higher household income were more likely to report having a Pap test (adjusted prevalence ratio [aPR] 2.16, 95% confidence interval [95% CI] 1.38-3.40) and a mammogram (aPR 1.63, 95% CI 1.04-2.55) compared to lower income white women. Black women with BMIs between 25 and 30 were less likely to receive a Pap test (aPR 0.38, 95% CI 0.19-0.76) than black women with BMIs <25, while no association was observed among the other groups. Insurance was associated with increased likelihood of Pap testing among white and black women. Insurance coverage was positively associated with mammography only among white and Hispanic women. We found variations in adherence to cancer screening guidelines by age, insurance coverage, and income between racial/ethnic groups. Little evidence was observed for variations in screening by BMI.

Patterns of Breast Magnetic Resonance Imaging Use in Community Practice

PubMed Central

Wernli, Karen J.; DeMartini, Wendy B.; Ichikawa, Laura; Lehman, Constance D.; Onega, Tracy; Kerlikowske, Karla; Henderson, Louise M.; Geller, Berta M.; Hofmann, Mike; Yankaskas, Bonnie C.

2014-01-01

Importance Breast magnetic resonance imaging (MRI) is increasingly used for breast cancer screening, diagnostic evaluation, and surveillance However, we lack data on national patterns of breast MRI use in community practice. Objective To describe 2005–2009 patterns of breast magnetic resonance imaging (MRI) use in U.S. community practice. Design Observational cohort study Setting Data collected from 2005–2009 on breast MRI and mammography from five national Breast Cancer Surveillance Consortium registries. Participants Data included 8931 breast MRI examinations and 1,288,924 screening mammograms from women aged 18–79 years. Main measures We calculated the rate of breast MRI examinations per 1000 women with breast imaging within the same year and described the clinical indications for the breast MRI examinations by year and age. We compared women screened with breast MRI to women screened with mammography alone for patient characteristics and lifetime breast cancer risk. Results The overall rate of breast MRI from 2005 through 2009 nearly tripled from 4.2 to 11.5 examinations per 1000 women with the most rapid rise from 2005–2007 (p=0.02). The most common clinical indication was diagnostic evaluation (40.3%), followed by screening (31.7%). Compared to women who received screening mammography alone, women who underwent screening breast MRI were more likely to be <50 years, white non-Hispanic, nulliparous, and have extremely dense breast tissue, a family history of breast cancer, and a personal history of breast cancer. The proportion of women screened by breast MRI at high lifetime risk for breast cancer (>20%) increased during the study period from 9% in 2005 to 29% in 2009. Conclusions and relevance Use of breast MRI for screening in high-risk women is increasing. However, our findings suggest there is a need to improve appropriate utilization, including among women who may benefit from screening breast MRI. PMID:24247555

COLLABORATIVE MODELING OF THE BENEFITS AND HARMS ASSOCIATED WITH DIFFERENT U.S. BREAST CANCER SCREENING STRATEGIES

PubMed Central

Mandelblatt, Jeanne S.; Stout, Natasha K.; Schechter, Clyde B.; van den Broek, Jeroen J.; Miglioretti, Diana; Krapcho, Martin; Trentham-Dietz, Amy; Munoz, Diego; Lee, Sandra J.; Berry, Donald A.; van Ravesteyn, Nicolien T.; Alagoz, Oguzhan; Kerlikowske, Karla; Tosteson, Anna N.A.; Near, Aimee M.; Hoeffken, Amanda; Chang, Yaojen; Heijnsdijk, Eveline A.; Chisholm, Gary; Huang, Xuelin; Huang, Hui; Ergun, Mehmet Ali; Gangnon, Ronald; Sprague, Brian L.; Plevritis, Sylvia; Feuer, Eric; de Koning, Harry J.; Cronin, Kathleen A.

2016-01-01

Background Controversy persists about optimal mammography screening strategies. Objective To evaluate mammography strategies considering screening and treatment advances. Design Collaboration of six simulation models. Data Sources National data on incidence, risk, breast density, digital mammography performance, treatment effects, and other-cause mortality. Target Population An average-risk cohort. Time Horizon Lifetime. Perspective Societal. Interventions Mammograms from age 40, 45 or 50 to 74 at annual or biennial intervals, or annually from 40 or 45 to 49 then biennially to 74, assuming 100% screening and treatment adherence. Outcome Measures Screening benefits (vs. no screening) include percent breast cancer mortality reduction, deaths averted, and life-years gained. Harms include number of mammograms, false-positives, benign biopsies, and overdiagnosis. Results for Average-Risk Women Biennial strategies maintain 79.8%-81.3% (range across strategies and models: 68.3–98.9%) of annual screening benefits with almost half the false-positives and fewer overdiagnoses. Screening biennially from ages 50–74 achieves a median 25.8% (range: 24.1%-31.8%) breast cancer mortality reduction; annual screening from ages 40–74 years reduces mortality an additional 12.0% (range: 5.7%-17.2%) vs. no screening, but yields 1988 more false-positives and 7 more overdiagnoses per 1000 women screened. Annual screening from ages 50–74 had similar benefits as other strategies but more harms, so would not be recommended. Sub-population Results Annual screening starting at age 40 for women who have a two- to four-fold increase in risk has a similar balance of harms and benefits as biennial screening of average-risk women from 50–74. Limitations We do not consider other imaging technologies, polygenic risk, or non-adherence. Conclusion These results suggest that biennial screening is efficient for average-risk groups, but decisions on strategies depend on the weight given to the balance of harms and benefits. Primary Funding Source National Institutes of Health PMID:26756606

Imaging characteristics of different mammographic screens.

PubMed

Kuhn, H; Knüpfer, W

1992-01-01

A study of mammography systems with green-emitting screens was conducted to determine how the image quality parameters (apart from dose requirement), such as modulation transfer function (MTF) and Wiener spectrum (WS), depend on the dye content of the compound and coating weight of the screen. In addition, the contribution to total noise of the individual components, i.e., film, screen, and quantum noise, was studied. The quantities derived from MTF and WS, namely detective quantum efficiency (DQE) and noise equivalent quanta (NEQ), were also investigated in regard to their dose dependency. It can be demonstrated that the MTF of the screens becomes more favorable when the dye content is increased, while noise is not significantly affected. This suggests the use of a mammography screen capable of greater detail recognition, requiring at least double the dose of today's conventional systems with approximately 80 microGy system dose. On the other hand, the manufacture of a screen with about 60% of the dose of the conventional system is possible with very little loss in image quality. For the systems in common use today (80 microGy), quantum noise represents a considerable share of the total noise at low spatial frequencies, whereas in high spatial frequencies, the graininess of the film dominates quantum noise and screen structure.

Establishing daily quality control (QC) in screen-film mammography using leeds tor (max) phantom at the breast imaging unit of USTH-Benavides Cancer Institute

NASA Astrophysics Data System (ADS)

Acaba, K. J. C.; Cinco, L. D.; Melchor, J. N.

2016-03-01

Daily QC tests performed on screen film mammography (SFM) equipment are essential to ensure that both SFM unit and film processor are working in a consistent manner. The Breast Imaging Unit of USTH-Benavides Cancer Institute has been conducting QC following the test protocols in the IAEA Human Health Series No.2 manual. However, the availability of Leeds breast phantom (CRP E13039) in the facility made the task easier. Instead of carrying out separate tests on AEC constancy and light sensitometry, only one exposure of the phantom is done to accomplish the two tests. It was observed that measurements made on mAs output and optical densities (ODs) using the Leeds TOR (MAX) phantom are comparable with that obtained from the usual conduct of tests, taking into account the attenuation characteristic of the phantom. Image quality parameters such as low contrast and high contrast details were also evaluated from the phantom image. The authors recognize the usefulness of the phantom in determining technical factors that will help improve detection of smallest pathological details on breast images. The phantom is also convenient for daily QC monitoring and economical since less number of films is expended.

Patient Navigation in Breast Cancer Treatment and Survivorship: A Systematic Review.

PubMed

Baik, Sharon H; Gallo, Linda C; Wells, Kristen J

2016-07-25

Patient navigation is an intervention approach that improves cancer outcomes by reducing barriers and facilitating timely access to cancer care. Little is known about the benefits of patient navigation during breast cancer treatment and survivorship. This systematic review evaluates the efficacy of patient navigation in improving treatment and survivorship outcomes in women with breast cancer. The review included experimental and quasi-experimental studies of patient navigation programs that target breast cancer treatment and breast cancer survivorship. Articles were systematically obtained through electronic database searches of PubMed/MEDLINE, PsycINFO, Web of Science, CINAHL, and Cochrane Library. The Effective Public Health Practice Project Quality Assessment Tool was used to evaluate the methodologic quality of individual studies. Thirteen studies met the inclusion criteria. Most were of moderate to high quality. Outcomes targeted included timeliness of treatment initiation, adherence to cancer treatment, and adherence to post-treatment surveillance mammography. Heterogeneity of outcome assessments precluded a meta-analysis. Overall, results demonstrated that patient navigation increases surveillance mammography rates, but only minimal evidence was found with regard to its effectiveness in improving breast cancer treatment outcomes. This study is the most comprehensive systematic review of patient navigation research focused on improving breast cancer treatment and survivorship. Minimal research has indicated that patient navigation may be effective for post-treatment surveillance; however, more studies are needed to draw definitive conclusions about the efficacy of patient navigation during and after cancer treatment. © 2016 by American Society of Clinical Oncology.

Patient Navigation in Breast Cancer Treatment and Survivorship: A Systematic Review

PubMed Central

Baik, Sharon H.; Gallo, Linda C.

2016-01-01

Purpose Patient navigation is an intervention approach that improves cancer outcomes by reducing barriers and facilitating timely access to cancer care. Little is known about the benefits of patient navigation during breast cancer treatment and survivorship. This systematic review evaluates the efficacy of patient navigation in improving treatment and survivorship outcomes in women with breast cancer. Methods The review included experimental and quasi-experimental studies of patient navigation programs that target breast cancer treatment and breast cancer survivorship. Articles were systematically obtained through electronic database searches of PubMed/MEDLINE, PsycINFO, Web of Science, CINAHL, and Cochrane Library. The Effective Public Health Practice Project Quality Assessment Tool was used to evaluate the methodologic quality of individual studies. Results Thirteen studies met the inclusion criteria. Most were of moderate to high quality. Outcomes targeted included timeliness of treatment initiation, adherence to cancer treatment, and adherence to post-treatment surveillance mammography. Heterogeneity of outcome assessments precluded a meta-analysis. Overall, results demonstrated that patient navigation increases surveillance mammography rates, but only minimal evidence was found with regard to its effectiveness in improving breast cancer treatment outcomes. Conclusion This study is the most comprehensive systematic review of patient navigation research focused on improving breast cancer treatment and survivorship. Minimal research has indicated that patient navigation may be effective for post-treatment surveillance; however, more studies are needed to draw definitive conclusions about the efficacy of patient navigation during and after cancer treatment. PMID:27458298

Automated and Clinical Breast Imaging Reporting and Data System Density Measures Predict Risk for Screen-Detected and Interval Cancers: A Case-Control Study.

PubMed

Kerlikowske, Karla; Scott, Christopher G; Mahmoudzadeh, Amir P; Ma, Lin; Winham, Stacey; Jensen, Matthew R; Wu, Fang Fang; Malkov, Serghei; Pankratz, V Shane; Cummings, Steven R; Shepherd, John A; Brandt, Kathleen R; Miglioretti, Diana L; Vachon, Celine M

2018-06-05

In 30 states, women who have had screening mammography are informed of their breast density on the basis of Breast Imaging Reporting and Data System (BI-RADS) density categories estimated subjectively by radiologists. Variation in these clinical categories across and within radiologists has led to discussion about whether automated BI-RADS density should be reported instead. To determine whether breast cancer risk and detection are similar for automated and clinical BI-RADS density measures. Case-control. San Francisco Mammography Registry and Mayo Clinic. 1609 women with screen-detected cancer, 351 women with interval invasive cancer, and 4409 matched control participants. Automated and clinical BI-RADS density assessed on digital mammography at 2 time points from September 2006 to October 2014, interval and screen-detected breast cancer risk, and mammography sensitivity. Of women whose breast density was categorized by automated BI-RADS more than 6 months to 5 years before diagnosis, those with extremely dense breasts had a 5.65-fold higher interval cancer risk (95% CI, 3.33 to 9.60) and a 1.43-fold higher screen-detected risk (CI, 1.14 to 1.79) than those with scattered fibroglandular densities. Associations of interval and screen-detected cancer with clinical BI-RADS density were similar to those with automated BI-RADS density, regardless of whether density was measured more than 6 months to less than 2 years or 2 to 5 years before diagnosis. Automated and clinical BI-RADS density measures had similar discriminatory accuracy, which was higher for interval than screen-detected cancer (c-statistics: 0.70 vs. 0.62 [P < 0.001] and 0.72 vs. 0.62 [P < 0.001], respectively). Mammography sensitivity was similar for automated and clinical BI-RADS categories: fatty, 93% versus 92%; scattered fibroglandular densities, 90% versus 90%; heterogeneously dense, 82% versus 78%; and extremely dense, 63% versus 64%, respectively. Neither automated nor clinical BI-RADS density was assessed on tomosynthesis, an emerging breast screening method. Automated and clinical BI-RADS density similarly predict interval and screen-detected cancer risk, suggesting that either measure may be used to inform women of their breast density. National Cancer Institute.

The Effect of California's Breast Density Notification Legislation on Breast Cancer Screening.

PubMed

Chau, Stephanie Lynn; Alabaster, Amy; Luikart, Karin; Brenman, Leslie Manace; Habel, Laurel A

2017-04-01

Half of US states mandate women be notified if they have dense breasts on their mammogram, yet guidelines and data on supplemental screening modalities are limited. Breast density (BD) refers to the extent that breast tissue appears radiographically dense on mammograms. High BD reduces the sensitivity of screening mammography and increases breast cancer risk. The aim of this study was to determine the potential impact of California's 2013 BD notification legislation on breast cancer screening patterns. We conducted a cohort study of women aged 40 to 74 years who were members of a large Northern California integrated health plan (approximately 3.9 million members) in 2011-2015. We calculated pre- and post-legislation rates of screening mammography and magnetic resonance imaging (MRI). We also examined whether women with dense breasts (defined as BI-RADS density c or d) had higher MRI rates than women with nondense breasts (defined as BI-RADS density a or b). After adjustment for race/ethnicity, age, body mass index, medical facility, neighborhood median income, and cancer history, there was a relative 6.6% decrease (relative risk [RR] 0.934, confidence interval [CI] 0.92-0.95) in the rate of screening mammography, largely driven by a decrease among women <50 years. While infrequent, there was a relative 16% increase (RR 1.16, CI 1.07-1.25) in the rate of screening MRI, with the greatest increase among the youngest women. In the postlegislation period, women with extremely dense breasts (BI-RADS d) had 2.77 times (CI 1.93-3.95) the odds of a MRI within 9 months of a screening mammogram compared with women with nondense breasts (BI-RADS b). In this setting, MRI rates increased in the postlegislation period. In addition, women with higher BD were more likely to have supplementary MRI. The decrease in mammography rates seen primarily among younger women may have been due to changes in national screening guidelines.

Evolution of breast cancer screening in the Medicare population: clinical and economic implications.

PubMed

Killelea, Brigid K; Long, Jessica B; Chagpar, Anees B; Ma, Xiaomei; Wang, Rong; Ross, Joseph S; Gross, Cary P

2014-08-01

Newer approaches to mammography, including digital image acquisition and computer-aided detection (CAD), and adjunct imaging (e.g., magnetic resonance imaging [MRI]) have diffused into clinical practice. The impact of these technologies on screening-related cost and outcomes remains undefined, particularly among older women. Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we constructed two cohorts of women without a history of breast cancer and followed each cohort for 2 years. We compared the use and cost of screening mammography including digital mammography and CAD, adjunct procedures including breast ultrasound, MRI, and biopsy between the period of 2001 and 2002 and the period of 2008 and 2009 using χ(2) and t test. We also assessed the change in breast cancer stage and incidence rates using χ(2) and Poisson regression. All statistical tests were two-sided. There were 137150 women (mean age = 76.0 years) in the early cohort (2001-2002) and 133097 women (mean age = 77.3 years) in the later cohort (2008-2009). The use of digital image acquisition for screening mammography increased from 2.0% in 2001 and 2002 to 29.8% in 2008 and 2009 (P < .001). CAD use increased from 3.2% to 33.1% (P < .001). Average screening-related cost per capita increased from $76 to $112 (P < .001), with annual national fee-for-service Medicare spending increasing from $666 million to $962 million. There was no statistically significant change in detection rates of early-stage tumors (2.45 vs 2.57 per 1000 person-years; P = .41). Although breast cancer screening-related costs increased substantially from 2001 through 2009 among Medicare beneficiaries, a clinically significant change in stage at diagnosis was not observed. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Comparison of gadobenate dimeglumine-enhanced breast MRI and gadopentetate dimeglumine-enhanced breast MRI with mammography and ultrasound for the detection of breast cancer.

PubMed

Gilbert, Fiona J; van den Bosch, Harrie C M; Petrillo, Antonella; Siegmann, Katja; Heverhagen, Johannes T; Panizza, Pietro; Gehl, Hans-Björn; Pediconi, Federica; Diekmann, Felix; Peng, Wei-Jun; Ma, Lin; Sardanelli, Francesco; Belli, Paolo; Corcione, Stefano; Zechmann, Christian M; Faivre-Pierret, Matthieu; Martincich, Laura

2014-05-01

To compare gadobenate dimeglumine-enhanced magnetic resonance imaging (MRI) with gadopentetate dimeglumine-enhanced MRI, mammography, and ultrasound for breast cancer detection across different malignant lesion types and across different densities of breast tissue. In all, 153 women with Breast Imaging Reporting and Data System (BI-RADS) 3–5 findings on mammography and/or ultrasound underwent identical breast MRI exams at 1.5T with gadobenate dimeglumine and gadopentetate dimeglumine. Images were evaluated by three independent blinded radiologists. Mammography, ultrasound, and combined mammography and/or ultrasound findings were available for 108, 109, and 131 women. Imaging findings were matched with histology data by a fourth, independent, blinded radiologist. Malignant lesion detection rates and diagnostic performance were compared. In all, 120, 120, and 140 confirmed malignant lesions were present in patients undergoing MRI+mammography, MRI+ultrasound, and MRI+mammography and/or ultrasound, respectively. Significantly greater cancer detection rates were noted by all three readers for comparisons of gadobenate dimeglumine-enhanced MRI with mammography (Δ15.8–17.5%; P < 0.0001), ultrasound (Δ18.3–20.0%; P < 0.0001), and mammography and/or ultrasound (Δ8.6–10.7%; P ≤ 0.0105) but not for comparisons of gadopentetate dimeglumine-enhanced MRI with conventional techniques (P > 0.05). The false-positive detection rates were lower on gadobenate dimeglumine-enhanced MRI than on conventional imaging (4.0–5.5% vs. 11.1% at mammography; 6.3–8.4% vs. 15.5% at ultrasound). Significantly improved cancer detection on MRI was noted in heterogeneously dense breast (91.2–97.3% on gadobenate dimeglumine-enhanced MRI vs. 77.2–84.9% on gadopentetate dimeglumine-enhanced MRI vs. 71.9-84.9% with conventional techniques) and for invasive cancers (93.2–96.2% for invasive ductal carcinoma [IDC] on gadobenate dimeglumine-enhanced MRI vs. 79.7–88.5% on gadopentetate dimeglumine-enhanced MRI vs. 77.0–84.4% with conventional techniques). Overall diagnostic performance for the detection of cancer was superior on gadobenate dimeglumine-enhanced MRI than on conventional imaging or gadopentetate dimeglumine-enhanced MRI. Gadobenate dimeglumine-enhanced MRI significantly improves cancer detection compared to gadopentetate dimeglumine-enhanced MRI, mammography, and ultrasound in a selected group of patients undergoing breast MRI for preoperative staging or because of inconclusive findings at conventional imaging.

What Do Patients Want to Know? Questions and Concerns Regarding Mammography Expressed Through Social Media.

PubMed

Charlie, Abbas M; Gao, Yiming; Heller, Samantha L

2017-12-05

The purpose of this project is to identify questions and concerns patients have regarding breast cancer screening mammography to establish priorities in patient education and health care communication. A content analysis of posted questions (June 2010 to February 2017) containing the keywords mammogram and mammography was conducted on the social media question and answer website Quora (Quora Inc, Mountainview, California). Question topic, responses, and number of views were recorded. Comparisons were made by respondent type (medical professional or nonmedical professional) for screening recommendations and accompanying evidence. Descriptive statistics were employed to summarize the results. Overall, 197,620 views of mammography-related questions were identified, focused on 51 questions and 172 responses (51 of 172 [29.7%] by medical professionals [n = 25]; 121 of 172 [70.3%] by nonmedical professionals [n = 121]). Mammographic efficacy (16 of 51 [31.4%]) and screening guidelines (10 of 51 [19.6%]) were the most frequently queried topics. Overall, the majority of respondents were supportive of screening mammography. Most medical professionals recommended screening mammography starting at age 40, even after revisions in guidelines. Among nonmedical professionals, 4 of 22 (18.2%) were against screening mammography with less consensus regarding appropriate age of initial screen. Health society websites and journal articles were the most commonly referenced sources among medical and nonmedical professionals, respectively. A considerable interest in screening mammography guidelines and mammographic efficacy exists among users who seek health information on a social media question and answer website. Awareness of such platforms allows a unique opportunity for targeted health education and dissemination of accurate information, which may be able to reach a potentially untapped or hard-to-reach patient population. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

‘It’s Easier Said Than Done’: Perspectives on Mammography From Women With Intellectual Disabilities

PubMed Central

Wilkinson, Joanne E.; Deis, Cristina E.; Bowen, Deborah J.; Bokhour, Barbara G.

2011-01-01

PURPOSE Women with intellectual disabilities (or mental retardation) are living longer, receiving primary care in the community, and have equal rates of breast cancer compared with women in the general population, but they have lower rates of mammography. Although several public campaigns have successfully raised the mammography rate for racial and ethnic minority women, they have not penetrated the community of women with intellectual disabilities. No research to date has explored potential barriers to mammography for these women by involving the women themselves as participants. METHODS We undertook a qualitative study to explore the perceptions and understanding of mammography for women with intellectual disabilities and some of the potential reasons they would or would not have the test. Twenty-seven intellectually disabled women were recruited through a variety of community groups and interviewed using a semistructured interview guide. Data were analyzed using qualitative techniques from grounded theory. RESULTS Participants in this study described being poorly prepared for mammography: they did not understand its purpose and were not prepared for the logistics of the experience. The latter was more upsetting to participants and contributed to their negative perceptions of mammography. Participants reported feeling unprepared and singled out for being unprepared, despite their desire to have at least 1 mammogram, as do other women their age. CONCLUSIONS Women with intellectual disabilities perceive mammography differently than do women who do not have intellectual disabilities, and their perception is informed by inadequate knowledge, anxiety, and inadequate preparation. These themes should be considered when planning cancer prevention interventions with this population and when counseling individual women in the clinical setting. PMID:21403141

Benefits, harms, and costs for breast cancer screening after US implementation of digital mammography.

PubMed

Stout, Natasha K; Lee, Sandra J; Schechter, Clyde B; Kerlikowske, Karla; Alagoz, Oguzhan; Berry, Donald; Buist, Diana S M; Cevik, Mucahit; Chisholm, Gary; de Koning, Harry J; Huang, Hui; Hubbard, Rebecca A; Miglioretti, Diana L; Munsell, Mark F; Trentham-Dietz, Amy; van Ravesteyn, Nicolien T; Tosteson, Anna N A; Mandelblatt, Jeanne S

2014-06-01

Compared with film, digital mammography has superior sensitivity but lower specificity for women aged 40 to 49 years and women with dense breasts. Digital has replaced film in virtually all US facilities, but overall population health and cost from use of this technology are unclear. Using five independent models, we compared digital screening strategies starting at age 40 or 50 years applied annually, biennially, or based on density with biennial film screening from ages 50 to 74 years and with no screening. Common data elements included cancer incidence and test performance, both modified by breast density. Lifetime outcomes included mortality, quality-adjusted life-years, and screening and treatment costs. For every 1000 women screened biennially from age 50 to 74 years, switching to digital from film yielded a median within-model improvement of 2 life-years, 0.27 additional deaths averted, 220 additional false-positive results, and $0.35 million more in costs. For an individual woman, this translates to a health gain of 0.73 days. Extending biennial digital screening to women ages 40 to 49 years was cost-effective, although results were sensitive to quality-of-life decrements related to screening and false positives. Targeting annual screening by density yielded similar outcomes to targeting by age. Annual screening approaches could increase costs to $5.26 million per 1000 women, in part because of higher numbers of screens and false positives, and were not efficient or cost-effective. The transition to digital breast cancer screening in the United States increased total costs for small added health benefits. The value of digital mammography screening among women aged 40 to 49 years depends on women's preferences regarding false positives. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Incremental Cancer Detection of Locoregional Restaging with Diagnostic Mammography Combined with Whole-Breast and Regional Nodal Ultrasound in Women with Newly Diagnosed Breast Cancer.

PubMed

Candelaria, Rosalind P; Huang, Monica L; Adrada, Beatriz E; Bassett, Roland; Hunt, Kelly K; Kuerer, Henry M; Smith, Benjamin D; Chavez-MacGregor, Mariana; Yang, Wei Tse

2017-02-01

This study aims to determine if locoregional restaging with diagnostic mammography and ultrasound (US) of the whole breast and regional nodes performed for quality assurance in women with newly diagnosed breast cancer who were referred to a tertiary care center yields incremental cancer detection. An institutional review board-approved retrospective, single-institution database review was performed on the first 1000 women referred to our center in 2010 with a provisional breast cancer diagnosis. Locoregional restaging consisted of diagnostic full-field digital mammography combined with US of the whole breast and regional nodal basins. Bilateral whole-breast US was performed in women with contralateral mammographic abnormality or had heterogeneously or extremely dense parenchyma. Demographic, clinical, and pathologic factors were analyzed. Final analyses included 401 women. Of the 401 women, 138 (34%) did not have their outside images available for review upon referral. The median age was 54 years (range 21-92); the median tumor size was 2.9 cm (range 0.6-18.0) for women whose disease was upstaged and 2.2 cm (range 0.4-15.0) for women whose disease was not upstaged. Incremental cancer detection rates were 15.5% (62 of 401) in the ipsilateral breast and 3.9% (6 of 154) in the contralateral breast (P < 0.0001). The total upstage rate was 25% (100 of 401). Surgical management changed from segmentectomy to mastectomy in 12% (50 of 401). The re-excision rate after segmentectomy was 19% (35 of 189). Locoregional restaging with diagnostic mammography combined with whole-breast and regional nodal US that is performed for standardization of the imaging workup for newly diagnosed breast cancer patients can reduce underestimation of disease burden and impact therapeutic planning. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Computational Simulation of Breast Compression Based on Segmented Breast and Fibroglandular Tissues on Magnetic Resonance Images

PubMed Central

Shih, Tzu-Ching; Chen, Jeon-Hor; Liu, Dongxu; Nie, Ke; Sun, Lizhi; Lin, Muqing; Chang, Daniel; Nalcioglu, Orhan; Su, Min-Ying

2010-01-01

This study presents a finite element based computational model to simulate the three-dimensional deformation of the breast and the fibroglandular tissues under compression. The simulation was based on 3D MR images of the breast, and the craniocaudal and mediolateral oblique compression as used in mammography was applied. The geometry of whole breast and the segmented fibroglandular tissues within the breast were reconstructed using triangular meshes by using the Avizo® 6.0 software package. Due to the large deformation in breast compression, a finite element model was used to simulate the non-linear elastic tissue deformation under compression, using the MSC.Marc® software package. The model was tested in 4 cases. The results showed a higher displacement along the compression direction compared to the other two directions. The compressed breast thickness in these 4 cases at 60% compression ratio was in the range of 5-7 cm, which is the typical range of thickness in mammography. The projection of the fibroglandular tissue mesh at 60% compression ratio was compared to the corresponding mammograms of two women, and they demonstrated spatially matched distributions. However, since the compression was based on MRI, which has much coarser spatial resolution than the in-plane resolution of mammography, this method is unlikely to generate a synthetic mammogram close to the clinical quality. Whether this model may be used to understand the technical factors that may impact the variations in breast density measurements needs further investigation. Since this method can be applied to simulate compression of the breast at different views and different compression levels, another possible application is to provide a tool for comparing breast images acquired using different imaging modalities – such as MRI, mammography, whole breast ultrasound, and molecular imaging – that are performed using different body positions and different compression conditions. PMID:20601773

Computational simulation of breast compression based on segmented breast and fibroglandular tissues on magnetic resonance images.

PubMed

Shih, Tzu-Ching; Chen, Jeon-Hor; Liu, Dongxu; Nie, Ke; Sun, Lizhi; Lin, Muqing; Chang, Daniel; Nalcioglu, Orhan; Su, Min-Ying

2010-07-21

This study presents a finite element-based computational model to simulate the three-dimensional deformation of a breast and fibroglandular tissues under compression. The simulation was based on 3D MR images of the breast, and craniocaudal and mediolateral oblique compression, as used in mammography, was applied. The geometry of the whole breast and the segmented fibroglandular tissues within the breast were reconstructed using triangular meshes by using the Avizo 6.0 software package. Due to the large deformation in breast compression, a finite element model was used to simulate the nonlinear elastic tissue deformation under compression, using the MSC.Marc software package. The model was tested in four cases. The results showed a higher displacement along the compression direction compared to the other two directions. The compressed breast thickness in these four cases at a compression ratio of 60% was in the range of 5-7 cm, which is a typical range of thickness in mammography. The projection of the fibroglandular tissue mesh at a compression ratio of 60% was compared to the corresponding mammograms of two women, and they demonstrated spatially matched distributions. However, since the compression was based on magnetic resonance imaging (MRI), which has much coarser spatial resolution than the in-plane resolution of mammography, this method is unlikely to generate a synthetic mammogram close to the clinical quality. Whether this model may be used to understand the technical factors that may impact the variations in breast density needs further investigation. Since this method can be applied to simulate compression of the breast at different views and different compression levels, another possible application is to provide a tool for comparing breast images acquired using different imaging modalities--such as MRI, mammography, whole breast ultrasound and molecular imaging--that are performed using different body positions and under different compression conditions.

Digital mammography, cancer screening: Factors important for image compression

NASA Technical Reports Server (NTRS)

Clarke, Laurence P.; Blaine, G. James; Doi, Kunio; Yaffe, Martin J.; Shtern, Faina; Brown, G. Stephen; Winfield, Daniel L.; Kallergi, Maria

1993-01-01

The use of digital mammography for breast cancer screening poses several novel problems such as development of digital sensors, computer assisted diagnosis (CAD) methods for image noise suppression, enhancement, and pattern recognition, compression algorithms for image storage, transmission, and remote diagnosis. X-ray digital mammography using novel direct digital detection schemes or film digitizers results in large data sets and, therefore, image compression methods will play a significant role in the image processing and analysis by CAD techniques. In view of the extensive compression required, the relative merit of 'virtually lossless' versus lossy methods should be determined. A brief overview is presented here of the developments of digital sensors, CAD, and compression methods currently proposed and tested for mammography. The objective of the NCI/NASA Working Group on Digital Mammography is to stimulate the interest of the image processing and compression scientific community for this medical application and identify possible dual use technologies within the NASA centers.

Understanding women's mammography intentions: a theory-based investigation.

PubMed

Naito, Mikako; O'Callaghan, Frances V; Morrissey, Shirley

2009-01-01

The present study compared the utility of two models (the Theory of Planned Behavior and Protection Motivation Theory) in identifying factors associated with intentions to undertake screening mammography, before and after an intervention. The comparison was made between the unique components of the two models. The effect of including implementation intentions was also investigated. Two hundred and fifty-one women aged 37 to 69 years completed questionnaires at baseline and following the delivery of a standard (control) or a protection motivation theory-based informational intervention. Hierarchical multiple regressions indicated that theory of planned behavior variables were associated with mammography intentions. Results also showed that inclusion of implementation intention in the model significantly increased the association with mammography intentions. The findings suggest that future interventions aiming to increase screening mammography participation should focus on the theory of planned behavior variables and that implementation intention should also be targeted.

Healthcare Use and Mammography Among Latinas With and Without Health Insurance Near the US-Mexico Border.

PubMed

Lapeyrouse, Lisa M; Miranda, Patricia Y; Morera, Osvaldo F; Heyman, Josiah McC; Balcazar, Hector G

2017-04-01

Among Latinas, lacking health insurance and having lower levels of acculturation are associated with disparities in mammography screening. We seek to investigate whether differences in lifetime mammography exist between Latina border residents by health insurance status and health care site (i.e., U.S. only or a combination of U.S. and Mexican health care). Using data from the 2009 to 2010 Ecological Household Study on Latino Border Residents, mammography screening was examined among (n = 304) Latinas >40 years old. While more acculturated women were significantly (p < .05) more likely to report ever having a mammogram than less acculturated women, ever having a mammogram was not predicted by health care site or insurance status. Latinas who utilize multiple systems of care have lower levels of acculturation and health insurance, thus representing an especially vulnerable population for experiencing disparities in mammography screening.

Mammography screening services: market segments and messages.

PubMed

Scammon, D L; Smith, J A; Beard, T

1991-01-01

Mammography has become a vital tool for the early detection of breast cancer. Although many organizations and health care facilities are working to educate and motivate women to take advantage of the life saving opportunity that is offered through screening mammography, only twenty percent of women who should be screened actually have the procedure performed. In order to reach women who have not been screened, it is important to learn which factors most strongly motivate those women who do choose to have a mammogram. Depth interviews with 18 women attending a mobile mammography unit were conducted to explore the decision making process of women obtaining mammography screening services and to develop a profile of prevalent emotions, attitudes, and feelings associated with receiving breast cancer screening services. Analysis of the interview transcripts revealed several important themes to which health care professionals can direct marketing and health promotion strategies.

Subgroup-specific effects of questionnaire wording on population-based estimates of mammography prevalence.

PubMed Central

Siegel, P Z; Qualters, J R; Mowery, P D; Campostrini, S; Leutzinger, C; McQueen, D V

2001-01-01

OBJECTIVES: This study investigated whether an apparent downturn in prevalence rates of mammography use reported in the 1992 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire resulted from a change in questionnaire wording. METHODS: In a pretest-posttest design (1990-1991 vs 1992), piecewise linear regression analyses were based on monthly prevalence estimates of mammography use among female BRFSS respondents 40 years or older. RESULTS: Self-reported mammography use was lower by 3.5 percentage points (95% confidence interval [CI] = 1.5, 5.5) overall--and lower by 13.6 percentage points (95% CI = 2.6, 24.6) among Black women with less than a high school education--when predicted from 1992 data than when predicted from 1990-1991 data. CONCLUSIONS: A change in questionnaire wording in the BRFSS caused demographic-specific effects in population-based estimates of mammography use. PMID:11344896

[Estimated mammogram coverage in Goiás State, Brazil].

PubMed

Corrêa, Rosangela da Silveira; Freitas-Júnior, Ruffo; Peixoto, João Emílio; Rodrigues, Danielle Cristina Netto; Lemos, Maria Eugênia da Fonseca; Marins, Lucy Aparecida Parreira; Silveira, Erika Aparecida da

2011-09-01

This cross-sectional study aimed to estimate mammogram coverage in the State of Goiás, Brazil, describing the supply, demand, and variations in different age groups, evaluating 98 mammography services as observational units. We estimated the mammogram rates by age group and type of health service, as well as the number of tests required to cover 70% and 100% of the target population. We assessed the association between mammograms, geographical distribution of mammography machines, type of service, and age group. Full coverage estimates, considering 100% of women in the 40-69 and 50-69-year age brackets, were 61% and 66%, of which the Brazilian Unified National Health System provided 13% and 14%, respectively. To achieve 70% coverage, 43,424 additional mammograms would be needed. All the associations showed statistically significant differences (p < 0.001). We conclude that mammogram coverage is unevenly distributed in the State of Goiás and that fewer tests are performed than required.

Perceived Susceptibility to Illness and Perceived Benefits of Preventive Care: An Exploration of Behavioral Theory Constructs in a Transcultural Context

PubMed Central

Joseph, Galen; Burke, Nancy J.; Tuason, Noe; Barker, Judith C.; Pasick, Rena J.

2010-01-01

This article describes how the social context of transculturation (cultural change processes) and transmigration (migration in which relationships are sustained across national boundaries) can directly influence use of mammography screening. The authors conducted semistructured interviews with Latino and Filipino academics and social service providers and with U.S.-born and immigrant Latinas and Filipinas to explore direct and indirect influences of social context on health behavior (Behavioral Constructs and Culture in Cancer Screening study). Iterative analyses identified themes of the transcultural domain: colonialism, immigration, discrimination, and therapeutic engagement. In this domain, the authors examine two key behavioral theory constructs, perceptions of susceptibility to illness and perceptions of benefits of preventive medical care. The findings raise concerns about interventions to promote mammography screening primarily based on provision of scientific information. The authors conclude that social context affects behavior directly rather than exclusively through beliefs as behavioral theory implies and that understanding contextual influences, such as transculturation, points to different forms of intervention. PMID:19805792

HIN7/440: Evidence-based Consumer Health Information - The need for unbiased risk communication

PubMed Central

Hoeldke, B; Muehlhauser, I

1999-01-01

Online consumer health information is rapidly growing. At the same time an active part of patients and consumers in decision making about preventive or therapeutic interventions is increasingly demanded. The basis for informed consumer choice is the communication of evidence-based scientific data in a format that is clearly understood by most lay persons. The way study results are presented influence decisions by health care providers and patients or consumers alike. The impact of framing of outcome data as either relative or absolute differences is well recognized. Outcome data should be reported as absolute numbers, absolute risk reductions or numbers needed to treat or to screen rather than as relative risk reductions. Beyond the question of whether relative or absolute differences are used, outcome data can be framed by either emphasising achievable benefits or the lack of such benefits. Presentation of data as the proportion of patients who remain free of a target outcome rather than the proportion of patients who benefit from a certain intervention could substantially influence decision making. So far, studies evaluating the communication of treatment results to patients were focussed on the benefits of the respective interventions. Such an approach is incompatible with unbiased informed decision making by the patient, client or consumer. In order to communicate outcome data in an objective manner the whole possible spectrum of data presentation should be considered. Both, the proportion of persons who are likely to benefit as well as the proportion of persons who are unlikely to benefit or likely to be harmed should be presented with equal emphasis. Instruments to judge the quality of printed or online consumer health information do not include rating the framing of outcome data (e.g. http:/www.discern.org.uk).In order to establish an online system of evidence-based consumer health information that provides unbiased evidence-based communication of outcome data mammography screening was used as a model. After screening the literature according to evidence-based medicine criteria the information on benefits and risks of mammography screening has been compiled. Results are communicated as simple self explaining illustrations as well as original numbers equally emphasising the various aspects of the outcome. In addition, unbiased information is provided on the test efficacy of mammography screening (false positive, false negative results), on other potential side effects or other beneficial effects of mammography screening such as the number of diagnostic surgical interventions following mammography or the psychological sequaele thereof, data on total mortality and precision or lack of precision of results. The described mammography screening consumer information system is being evaluated with experts and the target consumer population with the final goal of an online evidence-based consumer health information

Physical characterization of a scanning photon counting digital mammography system based on Si-strip detectors.

PubMed

Aslund, Magnus; Cederström, Björn; Lundqvist, Mats; Danielsson, Mats

2007-06-01

The physical performance of a scanning multislit full field digital mammography system was determined using basic image quality parameters. The system employs a direct detection detector comprised of linear silicon strip sensors in an edge-on geometry connected to photon counting electronics. The pixel size is 50 microm and the field of view 24 x 26 cm2. The performance was quantified using the presampled modulation transfer function, the normalized noise power spectrum and the detective quantum efficiency (DQE). Compared to conventional DQE methods, the scanning geometry with its intrinsic scatter rejection poses additional requirements on the measurement setup, which are investigated in this work. The DQE of the photon counting system was found to be independent of the dose level to the detector in the 7.6-206 microGy range. The peak DQE was 72% and 73% in the scan and slit direction, respectively, measured with a 28 kV W-0.5 mm Al anode-filter combination with an added 2 mm Al filtration.

HMO penetration and quality of care: the case of breast cancer.

PubMed

Decker, S L; Hempstead, K

1999-01-01

In theory, health maintenance organizations (HMOs) receiving a fixed payment rate per enrolled member have an incentive to coordinate services and emphasize prevention and early detection of disease in order to minimize costs of care. This article tests whether higher HMO penetration rates across counties in the United States and across time improve the use of mammography services, the chance of early rather than late detection of breast cancer, and ultimately improve breast cancer survival. We use two data sets to test the effect of HMO penetration on use of breast cancer services and on breast cancer health outcomes for women aged 55 to 64 years. These data sources are matched with county-level data on HMO penetration and other market variables from the Bureau of Health Profession's Area Resource File. Results of logit regression show evidence that HMO penetration positively affects the probability of recent mammography receipt. However, we do not find a statistically significant relationship between HMO penetration and either stage of diagnosis or breast cancer survival.

[Comparative study between film mammography and xeromammography; including specimen radiography].

PubMed

Maeda, M; Hayakawa, K; Okuno, Y; Torizuka, T; Mitsumori, M; Soga, T; Misaki, T; Dokou, S; Ito, K

1990-10-01

We retrospectively evaluated preoperative film- and xeromammography of 23 cases with breast cancers, and compared with postoperative specimen radiography to assess tumor delineation and microcalcification detectability. In tumor detection and margin delineation, film mammography was superior to xeromammography, and in microcalcification, film mammography was equal to xeromammography. These results had a effect on the diagnosis of breast cancers.

Dual-energy contrast-enhanced mammography.

PubMed

Travieso Aja, M M; Rodríguez Rodríguez, M; Alayón Hernández, S; Vega Benítez, V; Luzardo, O P

2014-01-01

The degree of vascularization in breast lesions is related to their malignancy. For this reason, functional diagnostic imaging techniques have become important in recent years. Dual-energy contrast-enhanced mammography is a new, apparently promising technique in breast cancer that provides information about the degree of vascularization of the lesion in addition to the morphological information provided by conventional mammography. This article describes the state of the art for dual-energy contrast-enhanced mammography. Based on 15 months' clinical experience, we illustrate this review with clinical cases that allow us to discuss the advantages and limitations of this technique. Copyright © 2014 SERAM. Published by Elsevier Espana. All rights reserved.

[False positive result in mammography and its association with the presence of obesity: a case-control study].

PubMed

Castro-Ibarra, Marisela; Menchaca-Díaz, Rufino; Cabrales-Ruvalcaba, J Jesús; Luna-V Gómez, Rosa Alicia

2016-01-01

To analyze the association between a false positive result in mammography and obesity, inside the breast cancer early detection program in women affiliated to the Institute of Security and Social Services for Government and Municipality workers of the State of Baja California (ISSSTECALI). A case-control, retrospective study was done in women affiliated to ISSSTECALI to whom a mammography was performed between 2009 and 2012. Women with a false positive result in mammography were included as cases. Controls were women with a true negative result in mammography. Three controls were randomly selected for each case. Obesity was established with the body mass index (BMI) consigned in the woman's clinical file. Age and estrogen replacement therapy were included as co-variables. Seventy nine cases were identified and 237 controls were included. Obesity was observed in 54.4% of cases and in 41.3% of controls (odds ratio: 1.69; 95% confidence interval for odds ratio: 1.01-2.82; p value: 0.043). A logistic regression model including covariables maintained the observed association (p = 0.044). No association was found with analyzed co-variables. A false positive result in mammography was associated with the presence of obesity.

Knowledge about breast cancer and participation in a faith-based breast cancer program and other predictors of mammography screening among African American women and Latinas.

PubMed

Darnell, Julie S; Chang, Chih-Hung; Calhoun, Elizabeth A

2006-07-01

This article assessed the impact of knowledge of breast cancer and type and intensity of participation in a church-based breast cancer education program and other factors on mammography screening among African Americans and Latinas. Logistic regression was used to assess the impact of these factors on self-reported mammography utilization. Passive participation in church-sponsored activities, measured by breast cancer information that was heard, seen, or read, was found to be significantly associated with the likelihood of mammography use among African Americans. Moreover, African Americans who reported hearing, seeing, or reading about mammograms at their churches four or more times were 15 times more likely to report mammography use within the past year than were those who encountered information only once. Messages from pastors and church bulletin announcements were the most significant predictors. An increase in knowledge was not associated with higher mammography use. For Latinas, none of the hypothesized knowledge or participation variables was found to be significant. The results suggest that faith-based breast cancer programs can be effective by adopting tailored strategies to raise awareness about the importance of early detection.

Factors influencing the mammography utilization among Taiwanese women with intellectual disabilities, a nationwide population-based study.

PubMed

Lai, Hsien-Tang; Kung, Pei-Tseng; Tsai, Wen-Chen

2014-12-01

Women with intellectual disabilities (ID) have cognitive impairment and communication difficulties; for both caregivers and clinical personnel, discovering the early symptoms of breast cancer among women with ID is challenging. The mammography utilization rate of women with ID was significantly lower than that of women in the general population. This study employed a 2008 database of people with disabilities in Taiwan as a research target and analyzed the mammography utilization rate of women with ID aged 50–69 years. In addition, relevant factors influencing mammography utilization among women with ID were also investigated. A total of 4370 participants were recruited and the majority were illiterate or had elementary-level educations (82.27%). The majority of the participants had ID that was more severe than mild (83.80%). The mammography utilization rate of women with ID was 4.32%, which was significantly lower than that of women in the general population (12%). The mammography utilization rate among women with ID who were married, had higher education levels, and had been diagnosed with cancer, diabetes, or mild ID was significantly higher. However, the mammography utilization rate among women with ID, who had elementary-level educations or were illiterate, was only 4.03%. The utilization rate among women with profound ID was only 2.65%. Women with ID who had undergone pap smears or had utilized adult preventive health services demonstrated a significantly higher mammography utilization rate. This study identified that education level, a diagnosis of diabetes, and the application of pap smears or adult preventive health services were primary factors that influenced the mammography utilization rate among women with ID. This study also observed that in Taiwan, the mammography utilization rate of women with ID was lower than that of pap smears and adult preventive health services, and was only half of that of people with disabilities. An unequal situation existed in regard to the acceptance of breast cancer screening among women with ID, and a different form of strategic planning must be adopted in public health policy. Because ID differs from other disabilities and most women with ID are illiterate, tailored courses are required to train primary caregivers and clinical personnel in providing knowledge and services. The objectives are to diagnose breast cancer at an early stage to decrease the risk of mortality and ensure their rights to health.

Attitudes of women after the age of 50 towards preventive screening.

PubMed

Skórzyńska, Hanna; Krawczyk-Suszek, Marlena; Kulik, Teresa B; Pacian, Anna; Stefanowicz, Agata; Skowronek, Anna

2017-12-23

Prevention is one of the major branches of the health sector. The National Health Programme encompasses main risk factors, elimination of which may lead to a reduced incidence of illnesses in the society. At the same time, the criteria of selecting people eligible for preventive screening are established according to risk groups determined by sex, as well as age in the population of women. The perimenopausal and menopausal period contributes to occurrence of numerous systemic diseases and to an increased risk of illnesses, especially cancers. The objective of the research was to evaluate the performance of preventive screening tests of women after 50 aimed at early detection of cervical and breast cancer. Furthermore, the research estimated frequency of pathological lesions detected and regularity of their monitoring. The research covered 150 women after 50 years of age. The database was statistically examined with STATISTICA software. A low percentage of the respondents, in comparison to the risk increasing with age, had a Pap test (61.3%) and mammography (51.3%) in the last two years. In the case of women whose latest Pap test or mammography showed abnormalities and was the basis for diagnosing pathological lesions, 69.2% of them were under regular medical supervision if abnormalities were identified by a Pap test and 68.7% if lesions were detected in breast structure. In the examined group we observed a small percentage of women undergo Pap tests and mammography. Furthermore, medical recommendations regarding early detection of cancers are frequently ignored and disregarded by patients.

Dual-energy in mammography: feasibility study

NASA Astrophysics Data System (ADS)

Jafroudi, Hamid; Lo, Shih-Chung B.; Li, Huai; Steller Artz, Dorothy E.; Freedman, Matthew T.; Mun, Seong K.

1996-04-01

The purpose of this work is to examine the feasibility of dual-energy techniques to enhance the detection of microcalcifications in digital mammography. The digital mammography system used in this study consists of two different mammography systems; one is the conventional mammography system with molybdenum target and Mo filtration and the other is the clinical version of a low dose x-ray system with tungsten target and aluminum filtration. The low dose system is optimized for screen-film mammography with a highly efficient scatter rejection device built by Fischer Imaging Systems for evaluation at NIH. The system was designed by the University of Southern California based on multiparameter optimization techniques. Prototypes of this system have been constructed and evaluated at the Center for Devices and Radiological Health. The digital radiography system is based on the Fuji 9000 computed radiography (CR) system which uses a storage phosphor imaging plate as the receptor. High resolution plates (HR-V) are used in this study. Dual-energy is one technique to reduce the structured noise associated with the complexity of the background of normal anatomy surrounding a lesion. This can be done by taking the advantage of the x-ray attenuation characteristics of two different structures such as soft tissue and bone in chest radiography. We have applied this technique to the detection of microcalcifications in mammography. The overall system performance based on this technique is evaluated. Results presented are based on the evaluation of phantom images.

Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessment.

PubMed

Tan, Alai; Freeman, Daniel H; Goodwin, James S; Freeman, Jean L

2006-12-01

The accuracy of mammography reading varies among radiologists. We conducted a population-based assessment on radiologist variation in false- positive rates of screening mammography and its associated radiologist characteristics. About 27,394 screening mammograms interpreted by 1067 radiologists were identified from a 5% non-cancer sample of Medicare claims during 1998-1999. The data were linked to the American Medical Association Masterfile to obtain radiologist characteristics. Multilevel logistic regression models were used to examine the radiologist variation in false-positive rates of screening mammography and the associated radiologist characteristics. Radiologists varied substantially in the false-positive rates of screening mammography (ranging from 1.5 to 24.1%, adjusting for patient characteristics). A longer time period since graduation is associated with lower false-positive rates (odds ratio [OR] for every 10 years increase: 0.87, 95% Confidence Interval [CI], 0.81-0.94) and female radiologists had higher false-positive rates than male radiologists (OR = 1.25, 95% CI, 1.05-1.49), adjusting for patient and other radiologist characteristics. The unmeasured factors contributed to about 90% of the between-radiologist variance. Radiologists varied greatly in accuracy of mammography reading. Female and more recently trained radiologists had higher false-positive rates. The variation among radiologists was largely due to unmeasured factors, especially unmeasured radiologist factors. If our results are confirmed in further studies, they suggest that system-level interventions would be required to reduce variation in mammography interpretation.

Intentions to Maintain Adherence to Mammography

PubMed Central

Bowling, J. Michael; Brewer, Noel T.; Lipkus, Isaac M.; Skinner, Celette Sugg; Strigo, Tara S.; Rimer, Barbara K.

2008-01-01

Abstract Objective Recent attention has focused on moving women from having initial mammograms to maintaining adherence to regular mammography schedules. We examined behavioral intentions to maintain mammography adherence, which include the likelihood of performing a behavior, and implementation intentions, specific action plans to obtain mammograms. Potential predictors were Theory of Planned Behavior constructs, previous barriers, previous mammography maintenance, and age. Methods Respondents were 2062 currently adherent women due for their next mammograms in 3–4 months according to American Cancer Society recommendations for annual screening. Statistical models were used to examine predictors of behavioral and two implementation intentions, including having thought about where women would get their next mammograms and having thought about making appointments. Results With the exception of pros, cons, and subjective norms, all variables predicted behavioral intentions (p ≤ 0.05). Stronger perceived control, previous mammography maintenance, and one barrier (vs. none) predicted being more likely to have thought about where to get their next mammograms. Previous maintenance and no barriers (vs. two) predicted being more likely to have thought about making appointments. Conclusions Our findings suggest that among women currently adherent to mammography, volitional factors, such as barriers, may be better predictors of implementation intentions than motivational factors, such as attitudes. Implementation variables may be useful in understanding how women move from intentions to action. Future research should examine how such factors relate to mammography maintenance behaviors and can be integrated into behavior change interventions. PMID:18657041

Accuracy of Physical Examination, Ultrasonography, and Mammography in Predicting Residual Pathologic Tumor Size in Patients Treated With Neoadjuvant Chemotherapy

PubMed Central

Chagpar, Anees B.; Middleton, Lavinia P.; Sahin, Aysegul A.; Dempsey, Peter; Buzdar, Aman U.; Mirza, Attiqa N.; Ames, Fredrick C.; Babiera, Gildy V.; Feig, Barry W.; Hunt, Kelly K.; Kuerer, Henry M.; Meric-Bernstam, Funda; Ross, Merrick I.; Singletary, S Eva

2006-01-01

Objective: To assess the accuracy of physical examination, ultrasonography, and mammography in predicting residual size of breast tumors following neoadjuvant chemotherapy. Background: Neoadjuvant chemotherapy is an accepted part of the management of stage II and III breast cancer. Accurate prediction of residual pathologic tumor size after neoadjuvant chemotherapy is critical in guiding surgical therapy. Although physical examination, ultrasonography, and mammography have all been used to predict residual tumor size, there have been conflicting reports about the accuracy of these methods in the neoadjuvant setting. Methods: We reviewed the records of 189 patients who participated in 1 of 2 protocols using doxorubicin-containing neoadjuvant chemotherapy, and who had assessment by physical examination, ultrasonography, and/or mammography no more than 60 days before their surgical resection. Size correlations were performed using Spearman rho analysis. Clinical and pathologic measurements were also compared categorically using the weighted kappa statistic. Results: Size estimates by physical examination, ultrasonography, and mammography were only moderately correlated with residual pathologic tumor size after neoadjuvant chemotherapy (correlation coefficients: 0.42, 0.42, and 0.41, respectively), with an accuracy of ±1 cm in 66% of patients by physical examination, 75% by ultrasonography, and 70% by mammography. Kappa values (0.24–0.35) indicated poor agreement between clinical and pathologic measurements. Conclusion: Physical examination, ultrasonography, and mammography were only moderately useful for predicting residual pathologic tumor size after neoadjuvant chemotherapy. PMID:16432360

A method to measure paddle and detector pressures and footprints in mammography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hogg, Peter; Szczepura, Katy; Darlington, Alison

2013-04-15

Purpose: Compression is necessary in mammography to improve image quality and reduce radiation burden. Maximizing the amount of breast in contact with the image receptor (IR) is important. To achieve this, for the craniocaudal projection, there is no consensus within the literature regarding how the IR should be positioned relative to the inframammary fold (IMF). No information exists within the literature to describe how pressure balancing between IR and paddle, and IR breast footprint, might be optimized. This paper describes a novel method for measuring the respective pressures applied to the breast from the IR and the paddle and amore » method to simultaneously measure the breast footprints on the IR and the paddle. Methods: Using a deformable breast phantom and electronic pressure-sensitive mat, area and pressure readings were gathered from two mammography machines and four paddles at 60, 80, and 100 N with the IR positioned at -2, -1, 0, +1, and +2 cm relative to the IMF (60 combinations in total). Results: Paddle and IR footprints were calculated along with a uniformity index (UI). For all four paddle/machine/pressure combinations the greatest IR footprint was achieved at IMF +2 cm. The UI indicates that the best pressure/footprint balance is achieved at IMF +1 cm. Conclusions: The authors' method appears to be suited to measuring breast footprints and pressures on IR and paddle and a human female study is planned.« less

[Prioritizing prescriptions in a ambulatory care setting: a tool to achieve appropriateness of care in public health management].

PubMed

Semeraro, V; Zantedeschi, E; Pasquarella, A; Guerrera, C; Guasticchi, G

2012-01-01

Waiting lists are one of the main Public Health issues within developed countries. To promote appropriateness about General Practitioners' (GPs) prescriptions, during 2009 the project "Priority setting in outpatient prescriptions" in Latium Region has been approved. Regional referees, Latium Public Health Agency managers and advisors, managers and advisors of three Local Public Health Units (LPHUs) within the Latium region and some voluntarily recruited General Practitioners (each one with more than 800 patients enrolled) were included in a team work with the duty to develop the project. During two selected months of 2010, 46 GPs have forwarded overall 2.229 medical prescriptions. The six most numerous prescriptions were picked out and analyzed by the team work. 42% of these prescriptions were identified as belonging to category D of the priority level--"standard", while 42% and 41% of prescriptions bore the expressions of "control" and "diagnostic purpose" respectively. Among these ones, 75% were represented by bilateral mammography, prescribed to women aged between 50 and 69 years: but for those people bilateral mammography is already provided free of charge within the regional program of breast cancer screening, making the routine prescription by their physician a useless duplication, unacceptable in a healthcare system of good quality. Therefore at the conclusion of the project, the team work suggests proper standards be applied by healthcare professionals and GPs to achieve a significant objective: mammography appropriateness prescriptions.

High Energy Resolution Hyperspectral X-Ray Imaging for Low-Dose Contrast-Enhanced Digital Mammography.

PubMed

Pani, Silvia; Saifuddin, Sarene C; Ferreira, Filipa I M; Henthorn, Nicholas; Seller, Paul; Sellin, Paul J; Stratmann, Philipp; Veale, Matthew C; Wilson, Matthew D; Cernik, Robert J

2017-09-01

Contrast-enhanced digital mammography (CEDM) is an alternative to conventional X-ray mammography for imaging dense breasts. However, conventional approaches to CEDM require a double exposure of the patient, implying higher dose, and risk of incorrect image registration due to motion artifacts. A novel approach is presented, based on hyperspectral imaging, where a detector combining positional and high-resolution spectral information (in this case based on Cadmium Telluride) is used. This allows simultaneous acquisition of the two images required for CEDM. The approach was tested on a custom breast-equivalent phantom containing iodinated contrast agent (Niopam 150®). Two algorithms were used to obtain images of the contrast agent distribution: K-edge subtraction (KES), providing images of the distribution of the contrast agent with the background structures removed, and a dual-energy (DE) algorithm, providing an iodine-equivalent image and a water-equivalent image. The high energy resolution of the detector allowed the selection of two close-by energies, maximising the signal in KES images, and enhancing the visibility of details with the low surface concentration of contrast agent. DE performed consistently better than KES in terms of contrast-to-noise ratio of the details; moreover, it allowed a correct reconstruction of the surface concentration of the contrast agent in the iodine image. Comparison with CEDM with a conventional detector proved the superior performance of hyperspectral CEDM in terms of the image quality/dose tradeoff.

BREAST: a novel method to improve the diagnostic efficacy of mammography

NASA Astrophysics Data System (ADS)

Brennan, P. C.; Tapia, K.; Ryan, J.; Lee, W.

2013-03-01

High quality breast imaging and accurate image assessment are critical to the early diagnoses, treatment and management of women with breast cancer. Breast Screen Reader Assessment Strategy (BREAST) provides a platform, accessible by researchers and clinicians world-wide, which will contain image data bases, algorithms to assess reader performance and on-line systems for image evaluation. The platform will contribute to the diagnostic efficacy of breast imaging in Australia and beyond on two fronts: reducing errors in mammography, and transforming our assessment of novel technologies and techniques. Mammography is the primary diagnostic tool for detecting breast cancer with over 800,000 women X-rayed each year in Australia, however, it fails to detect 30% of breast cancers with a number of missed cancers being visible on the image [1-6]. BREAST will monitor the mistakes, identify reasons for mammographic errors, and facilitate innovative solutions to reduce error rates. The BREAST platform has the potential to enable expert assessment of breast imaging innovations, anywhere in the world where experts or innovations are located. Currently, innovations are often being assessed by limited numbers of individuals who happen to be geographically located close to the innovation, resulting in equivocal studies with low statistical power. BREAST will transform this current paradigm by enabling large numbers of experts to assess any new method or technology using our embedded evaluation methods. We are confident that this world-first system will play an important part in the future efficacy of breast imaging.

Dissemination of periodic mammography and patterns of use, by birth cohort, in Catalonia (Spain)

PubMed Central

Rue, Montserrat; Carles, Misericordia; Vilaprinyo, Ester; Martinez-Alonso, Montserrat; Espinas, Josep-Alfons; Pla, Roger; Brugulat, Pilar

2008-01-01

Background In Catalonia (Spain) breast cancer mortality has declined since the beginning of the 1990s. The dissemination of early detection by mammography and the introduction of adjuvant treatments are among the possible causes of this decrease, and both were almost coincident in time. Thus, understanding how these procedures were incorporated into use in the general population and in women diagnosed with breast cancer is very important for assessing their contribution to the reduction in breast cancer mortality. In this work we have modeled the dissemination of periodic mammography and described repeat mammography behavior in Catalonia from 1975 to 2006. Methods Cross-sectional data from three Catalan Health Surveys for the calendar years 1994, 2002 and 2006 was used. The dissemination of mammography by birth cohort was modeled using a mixed effects model and repeat mammography behavior was described by age and survey year. Results For women born from 1938 to 1952, mammography clearly had a period effect, meaning that they started to have periodic mammograms at the same calendar years but at different ages. The age at which approximately 50% of the women were receiving periodic mammograms went from 57.8 years of age for women born in 1938–1942 to 37.3 years of age for women born in 1963–1967. Women in all age groups experienced an increase in periodic mammography use over time, although women in the 50–69 age group have experienced the highest increase. Currently, the target population of the Catalan Breast Cancer Screening Program, 50–69 years of age, is the group that self-reports the highest utilization of periodic mammograms, followed by the 40–49 age group. A higher proportion of women of all age groups have annual mammograms rather than biennial or irregular ones. Conclusion Mammography in Catalonia became more widely implemented during the 1990s. We estimated when cohorts initiated periodic mammograms and how frequently women are receiving them. These two pieces of information will be entered into a cost-effectiveness model of early detection in Catalonia. PMID:19014679

Remote Patient Management in a Mammographic Screening Environment in Underserved Areas

DTIC Science & Technology

2005-09-01

PERFORMING ORGANIZATION NAME(S) AND ADDRESS( ES ) 8. PERFORMING ORGANIZATION REPORT NUMBER University of Pittsburgh Pittsburgh, PA 15260 9. SPONSORING...MONITORING AGENCY NAME(S) AND ADDRESS( ES ) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012...Langer, JL Lichtenfeld, JR Osuch, LN Reynolds, ES de Paredes, RE Williams, "Responsibilities of the mammography facility," In: Quality determinants of

Automatic patient dose registry and clinical audit on line for mammography.

PubMed

Ten, J I; Vano, E; Sánchez, R; Fernandez-Soto, J M

2015-07-01

The use of automatic registry systems for patient dose in digital mammography allows clinical audit and patient dose analysis of the whole sample of individual mammography exposures while fulfilling the requirements of the European Directives and other international recommendations. Further parameters associated with radiation exposure (tube voltage, X-ray tube output and HVL values for different kVp and target/filter combinations, breast compression, etc.) should be periodically verified and used to evaluate patient doses. This study presents an experience in routine clinical practice for mammography using automatic systems. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Competitive testing of health behavior theories: how do benefits, barriers, subjective norm, and intention influence mammography behavior?

PubMed Central

Murphy, Caitlin C.; Vernon, Sally W.; Diamond, Pamela M.; Tiro, Jasmin A.

2013-01-01

Background Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories. Purpose We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior. Methods We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n=704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ2 difference testing. Results Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers. Conclusions Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography. PMID:23868613

[Hierarchy structuring for mammography technique by interpretive structural modeling method].

PubMed

Kudo, Nozomi; Kurowarabi, Kunio; Terashita, Takayoshi; Nishimoto, Naoki; Ogasawara, Katsuhiko

2009-10-20

Participation in screening mammography is currently desired in Japan because of the increase in breast cancer morbidity. However, the pain and discomfort of mammography is recognized as a significant deterrent for women considering this examination. Thus quick procedures, sufficient experience, and advanced skills are required for radiologic technologists. The aim of this study was to make the point of imaging techniques explicit and to help understand the complicated procedure. We interviewed 3 technologists who were highly skilled in mammography, and 14 factors were retrieved by using brainstorming and the KJ method. We then applied Interpretive Structural Modeling (ISM) to the factors and developed a hierarchical concept structure. The result showed a six-layer hierarchy whose top node was explanation of the entire procedure on mammography. Male technologists were related to as a negative factor. Factors concerned with explanation were at the upper node. We gave attention to X-ray techniques and considerations. The findings will help beginners improve their skills.

Radiology workstation for mammography: preliminary observations, eyetracker studies, and design

NASA Astrophysics Data System (ADS)

Beard, David V.; Johnston, Richard E.; Pisano, Etta D.; Hemminger, Bradley M.; Pizer, Stephen M.

1991-07-01

For the last four years, the UNC FilmPlane project has focused on constructing a radiology workstation facilitating CT interpretations equivalent to those with film and viewbox. Interpretation of multiple CT studies was originally chosen because handling such large numbers of images was considered to be one of the most difficult tasks that could be performed with a workstation. The authors extend the FilmPlane design to address mammography. The high resolution and contrast demands coupled with the number of images often cross- compared make mammography a difficult challenge for the workstation designer. This paper presents the results of preliminary work with workstation interpretation of mammography. Background material is presented to justify why the authors believe electronic mammographic workstations could improve health care delivery. The results of several observation sessions and a preliminary eyetracker study of multiple-study mammography interpretations are described. Finally, tentative conclusions of what a mammographic workstation might look like and how it would meet clinical demand to be effective are presented.

Digital Mammography with a Mosaic of CCD-Arrays

NASA Technical Reports Server (NTRS)

Jalink, Antony, Jr. (Inventor); McAdoo, James A. (Inventor)

1996-01-01

The present invention relates generally to a mammography device and method and more particularly to a novel digital mammography device and method to detect microcalcifications of precancerous tissue. A digital mammography device uses a mosaic of electronic digital imaging arrays to scan an x-ray image. The mosaic of arrays is repositioned several times to expose different portions of the image, until the entire image is scanned. The data generated by the arrays during each exposure is stored in a computer. After the final exposure, the computer combines data of the several partial images to produce a composite of the original x-ray image. An aperture plate is used to reduce scatter and the overall exposure of the patient to x-rays. The novelty of this invention is that it provides a digital mammography device with large field coverage, high spatial resolution, scatter rejection, excellent contrast characteristics and lesion detectability under clinical conditions. This device also shields the patient from excessive radiation, can detect extremely small calcifications and allows manipulation and storage of the image.

Study of signal-to-noise ratio in digital mammography

NASA Astrophysics Data System (ADS)

Kato, Yuri; Fujita, Naotoshi; Kodera, Yoshie

2009-02-01

Mammography techniques have recently advanced from those using analog systems (the screen-film system) to those using digital systems; for example, computed radiography (CR) and flat-panel detectors (FPDs) are nowadays used in mammography. Further, phase contrast mammography (PCM)-a digital technique by which images with a magnification of 1.75× can be obtained-is now available in the market. We studied the effect of the air gap in PCM and evaluated the effectiveness of an antiscatter x-ray grid in conventional mammography (CM) by measuring the scatter fraction ratio (SFR) and relative signal-to-noise ratio (rSNR) and comparing them between PCM and the digital CM. The results indicated that the SFRs for the CM images obtained with a grid were the lowest and that these ratios were almost the same as those for the PCM images. In contrast, the rSNRs for the PCM images were the highest, which means that the scattering of x-rays was sufficiently reduced by the air gap without the loss of primary x-rays.

Artificial neural networks in mammography interpretation and diagnostic decision making.

PubMed

Ayer, Turgay; Chen, Qiushi; Burnside, Elizabeth S

2013-01-01

Screening mammography is the most effective means for early detection of breast cancer. Although general rules for discriminating malignant and benign lesions exist, radiologists are unable to perfectly detect and classify all lesions as malignant and benign, for many reasons which include, but are not limited to, overlap of features that distinguish malignancy, difficulty in estimating disease risk, and variability in recommended management. When predictive variables are numerous and interact, ad hoc decision making strategies based on experience and memory may lead to systematic errors and variability in practice. The integration of computer models to help radiologists increase the accuracy of mammography examinations in diagnostic decision making has gained increasing attention in the last two decades. In this study, we provide an overview of one of the most commonly used models, artificial neural networks (ANNs), in mammography interpretation and diagnostic decision making and discuss important features in mammography interpretation. We conclude by discussing several common limitations of existing research on ANN-based detection and diagnostic models and provide possible future research directions.

Assessing the patient's mammogram experience.

PubMed

Dodendorf, Diane M; Deogun, Gurvinder K; Rodie, Amy Risch; Pol, Louis G

2004-01-01

This study overviews an operational blueprint that diagrams the activities and interactions of all participants in a typical screening mammography appointment in a large medical center. The blueprint is constructed from multiple sources of data collected from mammography patients, service providers in the radiology department, and medical records. The benefits from using patient perspectives, the insights gained from the blueprint development process, and the value of the resulting screening mammography appointment blueprint are included.

Comparative Study Of Image Enhancement Algorithms For Digital And Film Mammography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Delgado-Gonzalez, A.; Sanmiguel, R. E.

2008-08-11

Here we discuss the application of edge enhancement algorithms on images obtained with a Mammography System which has a Selenium Detector and on the other hand, on images obtained from digitized film mammography. Comparative analysis of such images includes the study of technical aspects of image acquisition, storage, compression and display. A protocol for a local database has been created as a result of this study.

Cancer preventive screening: A cross-border comparison of United States and Canadian Chinese women

PubMed Central

Tu, Shin-Ping; Jackson, Sara L.; Yasui, Yutaka; Deschamps, Michéle; Hislop, T. Gregory; Taylor, Vicky M.

2006-01-01

Objective To compare screening mammography and Pap testing among Chinese women in Seattle, Washington to Vancouver, and British Columbia. Methods Using community-based sampling methods, trilingual female interviewers surveyed Chinese women in Seattle and Vancouver. Multiple preventive health behaviors and health care access variables were assessed. Mammography analysis included 409 women aged 50–74 years. Pap testing analysis included 973 women aged 20–69 years. Main outcome measures were ever use and use in the last 2 years of screening mammography and Pap testing. Results Chinese women in Vancouver were younger, more educated and fluent in English. Unadjusted rates of mammography and Pap testing were similar between the two cities. Provider type was consistently associated with screening in both cities; female providers had the highest rates and Chinese male providers the lowest. Adjusted logistic regression analysis demonstrated similar mammography use in the two cities. However, for Pap testing, women in Seattle had higher odds of screening compared to Vancouver. Conclusion Despite universal health care coverage and baseline characteristics typically associated with greater utilization of preventive screening services, Chinese women in Vancouver did not have higher rates of screening mammography and Pap testing compared to Chinese women in Seattle. PMID:15916991

Contrast-enhanced spectral mammography based on a photon-counting detector: quantitative accuracy and radiation dose

NASA Astrophysics Data System (ADS)

Lee, Seungwan; Kang, Sooncheol; Eom, Jisoo

2017-03-01

Contrast-enhanced mammography has been used to demonstrate functional information about a breast tumor by injecting contrast agents. However, a conventional technique with a single exposure degrades the efficiency of tumor detection due to structure overlapping. Dual-energy techniques with energy-integrating detectors (EIDs) also cause an increase of radiation dose and an inaccuracy of material decomposition due to the limitations of EIDs. On the other hands, spectral mammography with photon-counting detectors (PCDs) is able to resolve the issues induced by the conventional technique and EIDs using their energy-discrimination capabilities. In this study, the contrast-enhanced spectral mammography based on a PCD was implemented by using a polychromatic dual-energy model, and the proposed technique was compared with the dual-energy technique with an EID in terms of quantitative accuracy and radiation dose. The results showed that the proposed technique improved the quantitative accuracy as well as reduced radiation dose comparing to the dual-energy technique with an EID. The quantitative accuracy of the contrast-enhanced spectral mammography based on a PCD was slightly improved as a function of radiation dose. Therefore, the contrast-enhanced spectral mammography based on a PCD is able to provide useful information for detecting breast tumors and improving diagnostic accuracy.

A Comparison of the effectiveness of Mammographic Film-Screen and Standard Film-Screen in the Detection of Small Bone Fractures

PubMed Central

Sani, Karim Ghazikhanlou; Jafari, Mahmoodreza; Rostampoor, Nima

2011-01-01

The use of mammography film-screen is limited in general radiography. The purpose of this study was to compare the effectiveness of mammographic film-screen and standard film-screen systems in the detection of small bone fractures. Radiographs were taken from patients' extremities and neck areas using mammography film-screen and standard film-screen (n=57 each). Fourteen other radiographs were taken from other views (predominantly oblique views), making a total number of 128 radiographs. Paired radiographs, taken from the same areas, were compared by two radiologists in terms of image visual sharpness, presence of bony fractures, and soft tissue injuries. The surface dose received by patients in the two systems was also compared. The radiographs taken by mammography film-screen had a statistically better visual sharpness compared to those taken by the standard film-screen system. However, there was no statistically significant difference between the diagnostic accuracy of the two systems. Mammography film-screen was able to detect only one out of 57 lesions, whereas standard film-screen system did not detec any lesion. The surface dose received by patients in mammography film-screen was higher than that in standard film-screen system. The findings of the present study suggest that mammography film-screen may be recommended as a diagnostic tool for the detection of small fractures of tinny parts of body such as fingers, hand or foot. They also suggest that mammography film-screen has no advantage over standard film-screen for radiography of thick body parts such as neck and knee. PMID:23115417

Entertainment-Education Narrative Versus Nonnarrative Interventions to Educate and Motivate Latinas to Engage in Mammography Screening.

PubMed

Borrayo, Evelinn A; Rosales, Monica; Gonzalez, Patricia

2017-06-01

The evidence is limited comparing the effects of entertainment-education (E-E) narrative versus nonnarrative interventions to educate and motivate Latinas to engage in mammography screening. This study compared an E-E narrative intervention to two nonnarrative interventions' effects among Latinas on breast cancer knowledge and motivation, as measured by changes in self-efficacy, behavioral norms, and behavioral intentions to engage in mammography screening. A sample of 141 Spanish-speaking Latinas was randomly assigned to one of three arms: an E-E narrative video, a nonnarrative educational video, and printed educational materials. Using a repeated measures design, the influence of the E-E narrative on pretest to posttest measures was assessed and compared to the influence of the other two interventions. The E-E narrative and nonnarrative interventions significantly increased Latinas' breast cancer knowledge, mammography self-efficacy, and behavioral norms from pretest to posttest. However, the E-E narrative participants' pretest to posttest difference in mammography self-efficacy was significantly higher when compared to the difference of the other two interventions. The effect of the E-E narrative intervention on self-efficacy and behavioral norms was moderated by the participants' absorption in the story and identification with the story characters. E-E narrative and nonnarrative interventions significantly educated and motivated Latinas to engage in mammography screening. The effects on mammography self-efficacy, an important precursor to behavior change, can be more strongly influenced by E-E narratives. Although E-E narrative and nonnarrative interventions were effective, the need still exists to assess if they can ultimately influence lifesaving breast cancer screening behaviors.

Role of ultrasonography in detecting mammographically occult breast carcinoma in women with dense breasts.

PubMed

Corsetti, V; Ferrari, A; Ghirardi, M; Bergonzini, R; Bellarosa, S; Angelini, O; Bani, C; Ciatto, S

2006-04-01

The purpose of this study was to assess the usefulness of routine ultrasonography in women with negative mammography and dense breasts [Breast Imaging Reporting and Data System (BIRADS D3-4)]. We applied a protocol involving routine ultrasonography in a consecutive series of subjects with negative mammography and dense breasts. After evaluation by internal and external reviewers of cancers detected by ultrasonography performed to confirm negative mammography, we determined the additional cancer detection rate of ultrasonography and the cost of the protocol. Out of 17,883 total mammographies, 167 cancers were diagnosed (detection rate: 0.93%). Out of 257 suspicious mammographies, 138 cancers were detected. Out of 17,626 negative mammographies, 6,449 (36.5%) were classified as "dense breast" and underwent ultrasonography: 29 cancers were detected (detection rate: 0.44%, or 17.3% of total cancers). Out of 25 cancer cases reviewed, negative mammography and asymptomatic status was confirmed in 15 (detection rate 0.23%, or 8.9% of total cancers). The cancer detection rate was 0.11%, 0.22%, 0.32% and 0.14% for age groups <40, 40-49, 50-59 and >59, respectively. The cost per additional carcinoma detected by ultrasonography alone was euro 25,847.85 whereas that per examined woman was euro 21.68. The study confirms the possibility that ultrasonography can detect mammographically occult breast carcinoma in dense breasts. The evidence is insufficient to recommend this policy in routine screening practice but suggests that, at least in current clinical practice, adding ultrasonography in dense breasts may be useful despite the substantial costs.

Mammography Decision Aid Reduces Decisional Conflict for Women in Their Forties Considering Screening.

PubMed

Eden, Karen B; Scariati, Paula; Klein, Krystal; Watson, Lindsey; Remiker, Mark; Hribar, Michelle; Forro, Vanessa; Michaels, LeAnn; Nelson, Heidi D

2015-12-01

Clinical guidelines recommend a personalized approach to mammography screening for women in their forties; however, methods to do so are lacking. An evidence-based mammography screening decision aid was developed as an electronic mobile application and evaluated in a before-after study. The decision aid (Mammopad) included modules on breast cancer, mammography, risk assessment, and priority setting about screening. Women aged 40-49 years who were patients of rural primary care clinics, had no major risk factors for breast cancer, and no mammography during the previous year were invited to use the decision aid. Twenty women participated in pretesting of the decision aid and 75 additional women completed the before-after study. The primary outcome was decisional conflict measured before and after using Mammopad. Secondary outcomes included decision self-efficacy and intention to begin or continue mammography screening. Differences comparing measures before versus after use were determined using Wilcoxon signed rank tests. After using Mammopad, women reported reduced decisional conflict based on mean Decisional Conflict Scale scores overall (46.33 versus 8.33; Z = -7.225; p < 0.001) and on all subscales (p < 0.001). Women also reported increased mean Decision Self-Efficacy Scale scores (79.67 versus 95.73; Z = 6.816, p < 0.001). Although 19% of women changed their screening intentions, this was not statistically significant. Women reported less conflict about their decisions for mammography screening, and felt more confident to make decisions after using Mammopad. This approach may help guide women through the decision making process to determine personalized screening choices that are appropriate for them.

Patterns and determinants of mammography screening in Lebanese women.

PubMed

Elias, Nadia; Bou-Orm, Ibrahim R; Adib, Salim M

2017-03-01

The associations of ever using and/or repeating a mammography test with psychosocial and socio-demographic factors were surveyed in 2014 among Lebanese women ≥ 40. A sample of 2400 women was selected across Lebanon. Variables with significant bivariate associations with various types of behaviors were entered in multivariate analysis. Of the total, 105 women (4·4%) had never heard of mammography as a tool for early breast cancer detection. Among the remaining 2295, 45% had ever used it, of whom 10% had obtained it for the first time within the 12 months preceding the survey. Repeaters were 67% of 926 women who had the time opportunity to do so (median lifetime frequency: 2). Older age, higher socio-economic status (SES) and living within the Greater Beirut (GB) area were significantly associated with ever-use. Within GB, psychosocial factors such as perceived susceptibility and benefits were most strongly associated with ever-use. Outside GB, socio-economic advantage seemed to mostly affect ever-use. Only 4% reported opposition from husbands to their mammography, and husband's support was significant for adherence to mammography guidelines mostly outside GB. Higher education emerged also as a significant socio-demographic determinant for ever-repeating in all regions. Perceived comfort of the previous test strongly affected the likelihood of repeating it. Providing mammography free-of-charge may alleviate some obstacles among women with socio-economic disadvantage. Stressing that good results one year do not make the cancer less likely or repeating the test less important, as well as improving the comfort of mammography testing could ensure test repeating.

Mammograms

MedlinePlus

... mammography facility know about breast implants when scheduling a mammogram. The technologist and radiologist must be experienced in performing mammography on women who have breast implants. If the technologist ...

Digital Breast Tomosynthesis guided Near Infrared Spectroscopy: Volumetric estimates of fibroglandular fraction and breast density from tomosynthesis reconstructions

PubMed Central

Vedantham, Srinivasan; Shi, Linxi; Michaelsen, Kelly E.; Krishnaswamy, Venkataramanan; Pogue, Brian W.; Poplack, Steven P.; Karellas, Andrew; Paulsen, Keith D.

2016-01-01

A multimodality system combining a clinical prototype digital breast tomosynthesis with its imaging geometry modified to facilitate near-infrared spectroscopic imaging has been developed. The accuracy of parameters recovered from near-infrared spectroscopy is dependent on fibroglandular tissue content. Hence, in this study, volumetric estimates of fibroglandular tissue from tomosynthesis reconstructions were determined. A kernel-based fuzzy c-means algorithm was implemented to segment tomosynthesis reconstructed slices in order to estimate fibroglandular content and to provide anatomic priors for near-infrared spectroscopy. This algorithm was used to determine volumetric breast density (VBD), defined as the ratio of fibroglandular tissue volume to the total breast volume, expressed as percentage, from 62 tomosynthesis reconstructions of 34 study participants. For a subset of study participants who subsequently underwent mammography, VBD from mammography matched for subject, breast laterality and mammographic view was quantified using commercial software and statistically analyzed to determine if it differed from tomosynthesis. Summary statistics of the VBD from all study participants were compared with prior independent studies. The fibroglandular volume from tomosynthesis and mammography were not statistically different (p=0.211, paired t-test). After accounting for the compressed breast thickness, which were different between tomosynthesis and mammography, the VBD from tomosynthesis was correlated with (r =0.809, p<0.001), did not statistically differ from (p>0.99, paired t-test), and was linearly related to, the VBD from mammography. Summary statistics of the VBD from tomosynthesis were not statistically different from prior studies using high-resolution dedicated breast computed tomography. The observation of correlation and linear association in VBD between mammography and tomosynthesis suggests that breast density associated risk measures determined for mammography are translatable to tomosynthesis. Accounting for compressed breast thickness is important when it differs between the two modalities. The fibroglandular volume from tomosynthesis reconstructions is similar to mammography indicating suitability for use during near-infrared spectroscopy. PMID:26941961

SU-E-I-60: Validation of An Optically Stimulated Luminescent (OSL) Dosimeter for Use in Output Exposure Control Verification of Mammography Imaging Systems.

PubMed

Ranger, R; Butler, P; Yahnke, C; Valentino, D

2012-06-01

To develop and validate an Optically Stimulated Luminescent (OSL) dosimeter for exposure control verification of x-ray projection mammography imaging systems. The active detection element of the dosimeter is a strip of OSL material 3.0 mm wide, 0.13 mm thick and 30.0 mm long with an overlying aluminum step wedge with thicknesses of 0, 0.2, 0.4 and 0.6 mm Al, encapsulated in a light-tight plastic enclosure with outer dimensions of 10.0 mm wide, 5.4 mm thick, and 54.0 mm long. The dosimeter is used in conjunction with a breast phantom for the purpose of estimating the half-value layer (HVL), entrance surface exposure (ESE), and average glandular dose (AGD) in conventional projection mammography. ESE and HVL were computed based on analysis of exposure profiles obtained from exposed strip dosimeters. The AGD was estimated by multiplying the ESE by the appropriate exposure to dose conversion factor for the thickness and % glandular tissue fraction represented by the phantom and target-filter combination employed. The accuracy and reproducibility of the ESE, HVL and AGD estimates obtained using the dosimeter positioned on the surface of the ACR phantom at the chest wall edge, was evaluated using mammography systems utilizing different imaging receptor technology, i.e. screen-film (SF), computed radiography (CR) and direct radiography (DR) and compared against results obtained using a calibrated ion chamber fitted with a mammography probe. ESE, AGD and HVL results obtained using the OSL mammography QA dosimeter agreed with results obtained using an ion chamber to within 5-10%, depending on the target-filter combination used. Repeat readings were highly consistent with a coefficient of variation = 5%. The OSL mammography QA dosimeter has been shown to effectively estimate ESE, HVL and AGD, demonstrating its usefulness for secondary monitoring of output exposure of mammography imaging systems. © 2012 American Association of Physicists in Medicine.

Dedicated breast CT: geometric design considerations to maximize posterior breast coverage

NASA Astrophysics Data System (ADS)

Vedantham, Srinivasan; Karellas, Andrew; Emmons, Margaret M.; Moss, Lawrence J.; Hussain, Sarwat; Baker, Stephen P.

2013-06-01

An Institutional Review Board-approved protocol was used to quantify breast tissue inclusion in 52 women, under conditions simulating both craniocaudal (CC) and mediolateral oblique (MLO) views in mammography, dedicated breast CT in the upright subject position, and dedicated breast CT in the prone subject position. Using skin as a surrogate for the underlying breast tissue, the posterior aspect of the breast that is aligned with the chest-wall edge of the breast support in a screen-film mammography system was marked with the study participants positioned for CC and MLO views. The union of skin marks with the study participants positioned for CC and MLO views was considered to represent chest-wall tissue available for imaging with mammography and served as the reference standard. For breast CT, a prone stereotactic breast biopsy unit and a custom-fabricated barrier were used to simulate conditions during prone and upright breast CT, respectively. For the same breast marked on the mammography system, skin marks were made along the breast periphery that was just anterior to the apertures of the prone biopsy unit and the upright barrier. The differences in skin marks between subject positioning simulating breast CT (prone, upright) and mammography were quantified at six anatomic locations. For each location, at least one study participant had a skin mark from breast CT (prone, upright) posterior to mammography. However for all study participants, there was at least one anatomic location where the skin mark from mammography was posterior to that from breast CT (prone, upright) positioning. The maximum amount by which the skin mark from mammography was posterior to breast CT (prone and upright) over all six locations was quantified for each study participant and pair-wise comparison did not exhibit statistically significant difference between prone and upright breast CT (paired t- test, p = 0.4). Quantitatively, for 95% of the study participants the skin mark from mammography was posterior to breast CT (prone or upright) by at the most 9 mm over all six locations. Based on the study observations, geometric design considerations targeting chest-wall coverage with breast CT equivalent to mammography, wherein part of the x-ray beam images through the swale during breast CT are provided. Assuming subjects can extend their chest in to a swale, the optimal swale-depth required to achieve equivalent coverage with breast CT images as mammograms for 95% of the subjects varies in the range of ˜30-50 mm for clinical prototypes and was dependent on the system geometry.

Who gets a mammogram amongst European women aged 50-69 years?

PubMed Central

2012-01-01

On the basis of the Survey of Health, Ageing, and Retirement (SHARE), we analyse the determinants of who engages in mammography screening focusing on European women aged 50-69 years. A special emphasis is put on the measurement error of subjective life expectancy and on the measurement and impact of physician quality. Our main findings are that physician quality, better education, having a partner, younger age and better health are associated with higher rates of receipt. The impact of subjective life expectancy on screening decision substantially increases after taking measurement error into account. JEL Classification C 36, I 11, I 18 PMID:22828268

X-ray imaging with amorphous silicon active matrix flat-panel imagers (AMFPIs)

NASA Astrophysics Data System (ADS)

El-Mohri, Youcef; Antonuk, Larry E.; Jee, Kyung-Wook; Maolinbay, Manat; Rong, Xiujiang; Siewerdsen, Jeffrey H.; Verma, Manav; Zhao, Qihua

1997-07-01

Recent advances in thin-film electronics technology have opened the way for the use of flat-panel imagers in a number of medical imaging applications. These novel imagers offer real time digital readout capabilities (˜30 frames per second), radiation hardness (>106cGy), large area (30×40 cm2) and compactness (˜1 cm). Such qualities make them strong candidates for the replacement of conventional x-ray imaging technologies such as film-screen and image intensifier systems. In this report, qualities and potential of amorphous silicon based active matrix flat-panel imagers are outlined for various applications such as radiation therapy, radiography, fluoroscopy and mammography.

Mammography with and without radiolucent positioning sheets: Comparison of projected breast area, pain experience, radiation dose and technical image quality.

PubMed

Timmers, Janine; Voorde, Marloes Ten; Engen, Ruben E van; Landsveld-Verhoeven, Cary van; Pijnappel, Ruud; Greve, Kitty Droogh-de; Heeten, Gerard J den; Broeders, Mireille J M

2015-10-01

To compare projected breast area, image quality, pain experience and radiation dose between mammography performed with and without radiolucent positioning sheets. 184 women screened in the Dutch breast screening programme (May-June 2012) provided written informed consent to have one additional image taken with positioning sheets. 5 cases were excluded (missing data). Pain was scored using the Numeric Rating Scale. Radiation dose was estimated using the Dance model and projected breast area using computer software. Two radiologists and two radiographers assessed image quality. With positioning sheets significantly more pectoral muscle, lateral and medial breast tissue was projected (CC-views) and more and deeper depicted pectoral muscle (MLO-views). In contrast, visibility of white and darker areas was better on images without positioning sheets, radiologists were therefore better able to detect abnormalities (MLO-views). Women experienced more pain with positioning sheets (MLO-views only, mean difference NRS 0.98; SD 1.71; p=0,00). Mammograms with positioning sheets showed more breast tissue. Increased breast thickness after compression with sheets resulted in less visibility of white and darker areas and thus reduced detection of abnormalities. Also, women experienced more pain (MLO-views) due to the sheet material. A practical consideration is the fact that more subcutaneous fat tissue and skin are being pulled forward leading to folds in the nipple area. On balance, improvement to the current design is required before implementation in screening practice can be considered. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Update on new technologies in digital mammography

PubMed Central

Patterson, Stephanie K; Roubidoux, Marilyn A

2014-01-01

Despite controversy regarding mammography’s efficacy, it continues to be the most commonly used breast cancer-screening modality. With the development of digital mammography, some improved benefit has been shown in women with dense breast tissue. However, the density of breast tissue continues to limit the sensitivity of conventional mammography. We discuss the development of some derivative digital technologies, primarily digital breast tomosynthesis, and their strengths, weaknesses, and potential patient impact. PMID:25152634

The Future of Contrast-Enhanced Mammography.

PubMed

Covington, Matthew F; Pizzitola, Victor J; Lorans, Roxanne; Pockaj, Barbara A; Northfelt, Donald W; Appleton, Catherine M; Patel, Bhavika K

2018-02-01

The purpose of this article is to discuss facilitators of and barriers to future implementation of contrast-enhanced mammography (CEM) in the United States. CEM provides low-energy 2D mammographic images analogous to digital mammography and contrast-enhanced recombined images that allow assessment of neovascularity similar to that offered by MRI. The utilization of CEM in the United States is currently low but could increase rapidly given the many potential indications for its clinical use.

Dual-energy contrast-enhanced spectral mammography (CESM).

PubMed

Daniaux, Martin; De Zordo, Tobias; Santner, Wolfram; Amort, Birgit; Koppelstätter, Florian; Jaschke, Werner; Dromain, Clarisse; Oberaigner, Willi; Hubalek, Michael; Marth, Christian

2015-10-01

Dual-energy contrast-enhanced mammography is one of the latest developments in breast care. Imaging with contrast agents in breast cancer was already known from previous magnetic resonance imaging and computed tomography studies. However, high costs, limited availability-or high radiation dose-led to the development of contrast-enhanced spectral mammography (CESM). We reviewed the current literature, present our experience, discuss the advantages and drawbacks of CESM and look at the future of this innovative technique.

[What kind of information do German health information pamphlets provide on mammography screening?].

PubMed

Kurzenhäuser, Stephanie

2003-02-01

To make an informed decision on participation in mammography screening, women have to be educated about all the risks and benefits of the procedure in a manner that is detailed and understandable. But an analysis of 27 German health pamphlets on mammography screening shows that many relevant pieces of information about the benefits, the risks, and especially the meaning of screening results are only insufficiently communicated. Many statements were presented narratively rather than as precise statistics. Depending on content, 17 to 62% of the quantifiable statements were actually given as numerical data. To provide comprehensive information and to avoid misunderstandings, it is necessary to supplement the currently available health pamphlets and make the information on mammography screening more precise.

[Population screening for breast cancer: an interim assessment].

PubMed

van der Maas, P J

2000-06-03

The Dutch national breast cancer programme started in 1989 and ten years later complete coverage of the target population was realised. Screening will save the lives of 27% of all women with screen detected breast cancer. In the other 73% survival will not change, but they will know some years earlier that they have breast cancer. There are 4 lessons from the 12 year experience: (a) mortality reduction due to the present programme can only be identified in individual follow-up data of all women with breast cancer; (b) systematic improvement of the programme's performance can only be based on feedback from a detailed quality and outcome monitoring system; (c) the advice to increase the upper age limit to 75 years was based on the interpretation of trial results for younger age groups and model analysis; (d) breast cancer screening contributed to the systematic improvement of clinical procedures. Current scientific and practical challenges are mortality evaluation, optimising test properties, setting upper and lower age limits, understanding regional differences, developing optimal screening frequencies in women with an elevated breast cancer risk, digital mammography and computer assisted diagnosis.

Singular-value decomposition of a tomosynthesis system

PubMed Central

Burvall, Anna; Barrett, Harrison H.; Myers, Kyle J.; Dainty, Christopher

2010-01-01

Tomosynthesis is an emerging technique with potential to replace mammography, since it gives 3D information at a relatively small increase in dose and cost. We present an analytical singular-value decomposition of a tomosynthesis system, which provides the measurement component of any given object. The method is demonstrated on an example object. The measurement component can be used as a reconstruction of the object, and can also be utilized in future observer studies of tomosynthesis image quality. PMID:20940966

Real space channelization for generic DBT system image quality evaluation with channelized Hotelling observer

NASA Astrophysics Data System (ADS)

Petrov, Dimitar; Cockmartin, Lesley; Marshall, Nicholas; Vancoillie, Liesbeth; Young, Kenneth; Bosmans, Hilde

2017-03-01

Digital breast tomosynthesis (DBT) is a relatively new 3D mammography technique that promises better detection of low contrast masses than conventional 2D mammography. The parameter space for DBT is large however and finding an optimal balance between dose and image quality remains challenging. Given the large number of conditions and images required in optimization studies, the use of human observers (HO) is time consuming and certainly not feasible for the tuning of all degrees of freedom. Our goal was to develop a model observer (MO) that could predict human detectability for clinically relevant details embedded within a newly developed structured phantom for DBT applications. DBT series were acquired on GE SenoClaire 3D, Giotto Class, Fujifilm AMULET Innovality and Philips MicroDose systems at different dose levels, Siemens Inspiration DBT acquisitions were reconstructed with different algorithms, while a larger set of DBT series was acquired on Hologic Dimensions system for first reproducibility testing. A channelized Hotelling observer (CHO) with Gabor channels was developed The parameters of the Gabor channels were tuned on all systems at standard scanning conditions and the candidate that produced the best fit for all systems was chosen. After tuning, the MO was applied to all systems and conditions. Linear regression lines between MO and HO scores were calculated, giving correlation coefficients between 0.87 and 0.99 for all tested conditions.

Breast cancer stage at diagnosis and geographic access to mammography screening (New Hampshire, 1998-2004).

PubMed

Celaya, Maria O; Berke, Ethan M; Onega, Tracy L; Gui, Jiang; Riddle, Bruce L; Cherala, Sai S; Rees, Judy R

2010-01-01

Early detection of breast cancer by screening mammography aims to increase treatment options and decrease mortality. Recent studies have shown inconsistent results in their investigations of the possible association between travel distance to mammography and stage of breast cancer at diagnosis. The purpose of the study was to investigate whether geographic access to mammography screening is associated with the stage at breast cancer diagnosis. Using the state's population-based cancer registry, all female residents of New Hampshire aged > or =40 years who were diagnosed with breast cancer during 1998-2004 were identified. The factors associated with early stage (stages 0 to 2) or later stage (stages 3 and 4) diagnosis of breast cancer were compared, with emphasis on the distance a woman lived from the closest mammography screening facility, and residence in rural and urban locations. A total of 5966 New Hampshire women were diagnosed with breast cancer during 1998-2004. Their mean driving distance to the nearest mammography facility was 8.85 km (range 0-44.26; 5.5 miles, range 0-27.5), with a mean estimated travel time of 8.9 min (range 0.0-42.2). The distribution of travel distance (and travel time) was substantially skewed to the right: 56% of patients lived within 8 km (5 miles) of a mammography facility, and 65% had a travel time of less than 10 min. There was no significant association between later stage of breast cancer and travel time to the nearest mammography facility. Using 3 categories of rural/urban residence based on Rural Urban Commuting Area classification, no significant association between rural residence and stage of diagnosis was found. New Hampshire women were more likely to be diagnosed with breast cancer at later stages if they lacked private health insurance (p<0.001), were not married (p<0.001), were older (p<0.001), and there was a borderline association with diagnosis during non-winter months (p=0.074). Most women living in New Hampshire have good geographical access to mammography, and no indication was found that travel time or travel distance to mammography significantly affected stage at breast cancer diagnosis. Health insurance, age and marital status were the major factors associated with later stage breast cancer. The study contributes to an ongoing debate over geographic access to screening mammography in different states, which have given contradictory results. These inconsistencies in the rural health literature highlight a need to understand the complexity of defining rural and urban residence; to characterize more precisely the issues that contribute to good preventive care in different rural communities; and to appreciate the efforts already made in some rural states to provide good geographic access to preventive care. In New Hampshire, specific subgroups such as the uninsured and the elderly remain at greatest risk of being diagnosed with later stage breast cancer and may benefit from targeted interventions to improve early detection.

Identifying Women at Risk for Hereditary Breast and Ovarian Cancer Syndrome Utilizing Breast Care Nurse Navigation at Mammography and Imaging Centers.

PubMed

Appel, Susan J; Cleiment, Rosemary J

2015-12-01

Approximately 5-10% of breast cancer cases appear in families at a higher rate and at an earlier onset than in the average population. Two known gene defects, BRCA1 and BRCA2, account for the majority of these hereditary related breast cancers. Additionally, BRCA1 and BRCA2 are related to the Hereditary Breast and Ovarian Cancer syndrome (HBOC), where risk for other related cancers are increased. Various health-care professional organizations provide guidelines that speak to the need for conducting risk assessments, but little research has been conducted focusing on the initial screening for this syndrome. This quality improvement project attempts to determine if Nurse Navigators can effectively perform the initial education and screening for HBOC syndrome within a mammography and women's breast imaging setting using a simplified patient history tool. E. M. Rodgers' Diffusion of Innovation model, a map of how new ideas and programs have become adopted and accepted, guided this project's development and implementation. Over the course of 8 weeks, 1,420 women seeking service at 3 mammography and imaging sites were given a new risk assessment tool for HBOC. Additionally, the use of Nurse Navigation to identify women who may be at risk for HBOC was implemented. Two populations seeking service at the study sites were evaluated: (1) women obtaining breast screening/imaging services and (2) women receiving breast biopsy results. Patients identified as "at-risk" were defined by evidence-based practice guidelines from the National Comprehensive Cancer Network and were referred for further genetic evaluation by a genetic professional. During this initial implementation of the HBOC risk assessment program, low participation of screening/imaging patients requesting HBOC education and evaluation occurred (129 screening patients or 9%). High rates of positive biopsy patients (5 patients or 34.7%) werefound to be at risk for HBOC compared to similar studies. Identifying HBOC risk at the time of breast biopsy results gave the opportunity to impact the timing and kind of surgical management of patients at risk for this syndrome.The Commission on Cancer (CoC), an arm of the American College of Surgeons, provides practice guideline standards and accreditation for cancer programs. Patients will become more familiar with being assessed for HBOC and other hereditary cancers during their annual health-care visits and more identification of patients at riskfor HBOC should occur as new CoC 2012 standards requiring hereditary cancer risk assessments for a cancer program's certification are enacted.

Characterization of scatter in digital mammography from physical measurements

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leon, Stephanie M., E-mail: Stephanie.Leon@uth.tmc.edu; Wagner, Louis K.; Brateman, Libby F.

2014-06-15

Purpose: That scattered radiation negatively impacts the quality of medical radiographic imaging is well known. In mammography, even slight amounts of scatter reduce the high contrast required for subtle soft-tissue imaging. In current clinical mammography, image contrast is partially improved by use of an antiscatter grid. This form of scatter rejection comes with a sizeable dose penalty related to the concomitant elimination of valuable primary radiation. Digital mammography allows the use of image processing as a method of scatter correction that might avoid effects that negatively impact primary radiation, while potentially providing more contrast improvement than is currently possible withmore » a grid. For this approach to be feasible, a detailed characterization of the scatter is needed. Previous research has modeled scatter as a constant background that serves as a DC bias across the imaging surface. The goal of this study was to provide a more substantive data set for characterizing the spatially-variant features of scatter radiation at the image detector of modern mammography units. Methods: This data set was acquired from a model of the radiation beam as a matrix of very narrow rays or pencil beams. As each pencil beam penetrates tissue, the pencil widens in a predictable manner due to the production of scatter. The resultant spreading of the pencil beam at the detector surface can be characterized by two parameters: mean radial extent (MRE) and scatter fraction (SF). The SF and MRE were calculated from measurements obtained using the beam stop method. Two digital mammography units were utilized, and the SF and MRE were found as functions of target, filter, tube potential, phantom thickness, and presence or absence of a grid. These values were then used to generate general equations allowing the SF and MRE to be calculated for any combination of the above parameters. Results: With a grid, the SF ranged from a minimum of about 0.05 to a maximum of about 0.16, and the MRE ranged from about 3 to 13 mm. Without a grid, the SF ranged from a minimum of 0.25 to a maximum of 0.52, and the MRE ranged from about 20 to 45 mm. The SF with a grid demonstrated a mild dependence on target/filter combination and kV, whereas the SF without a grid was independent of these factors. The MRE demonstrated a complex relationship as a function of kV, with notable difference among target/filter combinations. The primary source of change in both the SF and MRE was phantom thickness. Conclusions: Because breast tissue varies spatially in physical density and elemental content, the effective thickness of breast tissue varies spatially across the imaging field, resulting in a spatially-variant scatter distribution in the imaging field. The data generated in this study can be used to characterize the scatter contribution on a point-by-point basis, for a variety of different techniques.« less

Cervical and Breast Cancer Screening After CARES: A Community Program for Immigrant and Marginalized Women.

PubMed

Dunn, Sheila F; Lofters, Aisha K; Ginsburg, Ophira M; Meaney, Christopher A; Ahmad, Farah; Moravac, M Catherine; Nguyen, Cam Tu Janet; Arisz, Angela M

2017-05-01

Marginalized populations such as immigrants and refugees are less likely to receive cancer screening. Cancer Awareness: Ready for Education and Screening (CARES), a multifaceted community-based program in Toronto, Canada, aimed to improve breast and cervical screening among marginalized women. This matched cohort study assessed the impact of CARES on cervical and mammography screening among under-screened/never screened (UNS) attendees. Provincial administrative data collected from 1998 to 2014 and provided in 2015 were used to match CARES participants who were age eligible for screening to three controls matched for age, geography, and pre-education screening status. Dates of post-education Pap and mammography screening up to June 30, 2014 were determined. Analysis in 2016 compared screening uptake and time to screening for UNS participants and controls. From May 15, 2012 to October 31, 2013, a total of 1,993 women attended 145 educational sessions provided in 20 languages. Thirty-five percent (118/331) and 48% (99/206) of CARES participants who were age eligible for Pap and mammography, respectively, were UNS on the education date. Subsequently, 26% and 36% had Pap and mammography, respectively, versus 9% and 14% of UNS controls. ORs for screening within 8 months of follow-up among UNS CARES participants versus their matched controls were 5.1 (95% CI=2.4, 10.9) for Pap and 4.2 (95%=CI 2.3, 7.8) for mammography. Hazard ratios for Pap and mammography were 3.6 (95% CI=2.1, 6.1) and 3.2 (95% CI=2.0, 5.3), respectively. CARES' multifaceted intervention was successful in increasing Pap and mammography screening in this multiethnic under-screened population. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Accuracy of screening women at familial risk of breast cancer without a known gene mutation: Individual patient data meta-analysis.

PubMed

Phi, Xuan-Anh; Houssami, Nehmat; Hooning, Maartje J; Riedl, Christopher C; Leach, Martin O; Sardanelli, Francesco; Warner, Ellen; Trop, Isabelle; Saadatmand, Sepideh; Tilanus-Linthorst, Madeleine M A; Helbich, Thomas H; van den Heuvel, Edwin R; de Koning, Harry J; Obdeijn, Inge-Marie; de Bock, Geertruida H

2017-11-01

Women with a strong family history of breast cancer (BC) and without a known gene mutation have an increased risk of developing BC. We aimed to investigate the accuracy of screening using annual mammography with or without magnetic resonance imaging (MRI) for these women outside the general population screening program. An individual patient data (IPD) meta-analysis was conducted using IPD from six prospective screening trials that had included women at increased risk for BC: only women with a strong familial risk for BC and without a known gene mutation were included in this analysis. A generalised linear mixed model was applied to estimate and compare screening accuracy (sensitivity, specificity and predictive values) for annual mammography with or without MRI. There were 2226 women (median age: 41 years, interquartile range 35-47) with 7478 woman-years of follow-up, with a BC rate of 12 (95% confidence interval 9.3-14) in 1000 woman-years. Mammography screening had a sensitivity of 55% (standard error of mean [SE] 7.0) and a specificity of 94% (SE 1.3). Screening with MRI alone had a sensitivity of 89% (SE 4.6) and a specificity of 83% (SE 2.8). Adding MRI to mammography increased sensitivity to 98% (SE 1.8, P < 0.01 compared to mammography alone) but lowered specificity to 79% (SE 2.7, P < 0.01 compared with mammography alone). In this population of women with strong familial BC risk but without a known gene mutation, in whom BC incidence was high both before and after age 50, adding MRI to mammography substantially increased screening sensitivity but also decreased its specificity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Socio-demographic correlates of participation in mammography: a survey among women aged between 35- 69 in Tehran, Iran.

PubMed

Samah, Asnarulkhadi Abu; Ahmadian, Maryam

2012-01-01

The rates of breast cancer have increased over the past two decades, and this raises concern about physical, psychological and social well-being of women with breast cancer. Further, few women really want to do breast cancer screening. We here investigated the socio-demographic correlates of mammography participation among 400 asymptomatic Iranian women aged between 35 and 69. A cross-sectional survey was conducted at the four outpatient clinics of general hospitals in Tehran during the period from July through October, 2009. Bi-variate analyses and multi-variate binary logistic regression were employed to find the socio- demographic predictors of mammography utilization among participants. The rate of mammography participation was 21.5% and relatively high because of access to general hospital services. More women who had undergone mammography were graduates from university or college, had full-time or part-time employment, were insured whether public or private, reported a positive family history of breast cancer, and were in the middle income level (P <0.01).The largest number of participating women was in the age range of 41 to 50 years. The results of multivariate logistic regression further showed that education (95%CI: 0.131-0.622), monthly income (95%CI: 0.038-0.945), and family history of breast cancer (95%CI: 1.97-9.28) were significantly associated (all P <0.05)with mammography participation. The most important issue for a successful screening program is participation. Using a random sample, this study found that the potential predictor variables of mammography participation included a higher education level, a middle income level, and a positive family history of breast cancer for Iranian women after adjusting for all other demographic variables in the model.

Comparison of Background Parenchymal Enhancement at Contrast-enhanced Spectral Mammography and Breast MR Imaging.

PubMed

Sogani, Julie; Morris, Elizabeth A; Kaplan, Jennifer B; D'Alessio, Donna; Goldman, Debra; Moskowitz, Chaya S; Jochelson, Maxine S

2017-01-01

Purpose To assess the extent of background parenchymal enhancement (BPE) at contrast material-enhanced (CE) spectral mammography and breast magnetic resonance (MR) imaging, to evaluate interreader agreement in BPE assessment, and to examine the relationships between clinical factors and BPE. Materials and Methods This was a retrospective, institutional review board-approved, HIPAA-compliant study. Two hundred seventy-eight women from 25 to 76 years of age with increased breast cancer risk who underwent CE spectral mammography and MR imaging for screening or staging from 2010 through 2014 were included. Three readers independently rated BPE on CE spectral mammographic and MR images with the ordinal scale: minimal, mild, moderate, or marked. To assess pairwise agreement between BPE levels on CE spectral mammographic and MR images and among readers, weighted κ coefficients with quadratic weights were calculated. For overall agreement, mean κ values and bootstrapped 95% confidence intervals were calculated. The univariate and multivariate associations between BPE and clinical factors were examined by using generalized estimating equations separately for CE spectral mammography and MR imaging. Results Most women had minimal or mild BPE at both CE spectral mammography (68%-76%) and MR imaging (69%-76%). Between CE spectral mammography and MR imaging, the intrareader agreement ranged from moderate to substantial (κ = 0.55-0.67). Overall agreement on BPE levels between CE spectral mammography and MR imaging and among readers was substantial (κ = 0.66; 95% confidence interval: 0.61, 0.70). With both modalities, BPE demonstrated significant association with menopausal status, prior breast radiation therapy, hormonal treatment, breast density on CE spectral mammographic images, and amount of fibroglandular tissue on MR images (P < .001 for all). Conclusion There was substantial agreement between readers for BPE detected on CE spectral mammographic and MR images. © RSNA, 2016.

Effect of age on breast cancer screening using tomosynthesis in combination with digital mammography.

PubMed

Rafferty, Elizabeth A; Rose, Stephen L; Miller, Dave P; Durand, Melissa A; Conant, Emily F; Copit, Debra S; Friedewald, Sarah M; Plecha, Donna M; Ott, Ingrid L; Hayes, Mary K; Carlson, Kara L; Cink, Thomas M; Barke, Lora D; Greer, Linda N; Niklason, Loren T

2017-08-01

To determine the effect of tomosynthesis imaging as a function of age for breast cancer screening. Screening performance metrics from 13 institutions were examined for 12 months prior to introduction of tomosynthesis (period 1) and compared to those after introduction of tomosynthesis (period 2, range 3-22 months). Screening metrics for women ages 40-49, 50-59, 60-69, and 70+ , included rates per 1000 screens for recalls, biopsies, cancers, and invasive cancers detected. Performance parameters were compared for women screened with digital mammography alone (n = 278,908) and digital mammography + tomosynthesis (n = 173,414). Addition of tomosynthesis to digital mammography produced significant reductions in recall rates for all age groups and significant increases in cancer detection rates for women 40-69. Largest recall rate reduction with tomosynthesis was for women 40-49, decreasing from 137 (95% CI 117-156) to 115 (95% CI 95-135); difference, -22 (95% CI -26 to -18; P < .001). Simultaneous increase in invasive cancer detection rate for women 40-49 from 1.6 (95% CI 1.2-1.9) to 2.7 (95% CI 2.2-3.1) with tomosynthesis (difference, 1.1; 95% CI 0.6-1.6; P < .001) was observed. Addition of tomosynthesis to digital mammography increased invasive cancer detection rates for women 40-69 and decreased recall rates for all age groups with largest performance gains seen in women 40-49. The similar performance seen with tomosynthesis screening for women in their 40s compared to digital mammography for women in their 50s argues strongly for commencement of mammography screening at age 40 using tomosynthesis.

Cross-domain and multi-task transfer learning of deep convolutional neural network for breast cancer diagnosis in digital breast tomosynthesis

NASA Astrophysics Data System (ADS)

Samala, Ravi K.; Chan, Heang-Ping; Hadjiiski, Lubomir; Helvie, Mark A.; Richter, Caleb; Cha, Kenny

2018-02-01

We propose a cross-domain, multi-task transfer learning framework to transfer knowledge learned from non-medical images by a deep convolutional neural network (DCNN) to medical image recognition task while improving the generalization by multi-task learning of auxiliary tasks. A first stage cross-domain transfer learning was initiated from ImageNet trained DCNN to mammography trained DCNN. 19,632 regions-of-interest (ROI) from 2,454 mass lesions were collected from two imaging modalities: digitized-screen film mammography (SFM) and full-field digital mammography (DM), and split into training and test sets. In the multi-task transfer learning, the DCNN learned the mass classification task simultaneously from the training set of SFM and DM. The best transfer network for mammography was selected from three transfer networks with different number of convolutional layers frozen. The performance of single-task and multitask transfer learning on an independent SFM test set in terms of the area under the receiver operating characteristic curve (AUC) was 0.78+/-0.02 and 0.82+/-0.02, respectively. In the second stage cross-domain transfer learning, a set of 12,680 ROIs from 317 mass lesions on DBT were split into validation and independent test sets. We first studied the data requirements for the first stage mammography trained DCNN by varying the mammography training data from 1% to 100% and evaluated its learning on the DBT validation set in inference mode. We found that the entire available mammography set provided the best generalization. The DBT validation set was then used to train only the last four fully connected layers, resulting in an AUC of 0.90+/-0.04 on the independent DBT test set.

With the Advent of Tomosynthesis in the Workup of Mammographic Abnormality, is Spot Compression Mammography Now Obsolete? An Initial Clinical Experience.

PubMed

Ni Mhuircheartaigh, Neasa; Coffey, Louise; Fleming, Hannah; O' Doherty, Ann; McNally, Sorcha

2017-09-01

To determine if the routine use of spot compression mammography is now obsolete in the assessment of screen detected masses, asymmetries and architectural distortion since the availability of digital breast tomosynthesis. We introduced breast tomosynthesis in the workup of screen detected abnormalities in our screening center in January 2015. During an initial learning period with tomosynthesis standard spot compression views were also performed. Three consultant breast radiologists retrospectively reviewed all screening mammograms recalled for assessment over the first 6-month period. We assessed retrospectively whether there was any additional diagnostic information obtained from spot compression views not already apparent on tomography. All cases were also reviewed for any additional lesions detected by tomosynthesis, not detected on routine 2-view screening mammography. 548 women screened with standard 2-view digital screening mammography were recalled for assessment in the selected period and a total of 565 lesions were assessed. 341 lesions were assessed by both tomosynthesis and routine spot compression mammography. The spot compression view was considered more helpful than tomosynthesis in only one patient. This was because the breast was inadequately positioned for tomosynthesis and the area in question was not adequately imaged. Apart from this technical error there was no asymmetry, distortion or mass where spot compression provided more diagnostic information than tomosynthesis alone. We detected three additional cancers on tomosynthesis, not detected by routine screening mammography. From our initial experience with tomosynthesis we conclude that spot compression mammography is now obsolete in the assessment of screen detected masses, asymmetries and distortions where tomosynthesis is available. © 2017 Wiley Periodicals, Inc.

Randomized trial of a lay health advisor and computer intervention to increase mammography screening in African American women.

PubMed

Russell, Kathleen M; Champion, Victoria L; Monahan, Patrick O; Millon-Underwood, Sandra; Zhao, Qianqian; Spacey, Nicole; Rush, Nathan L; Paskett, Electra D

2010-01-01

Low-income African American women face numerous barriers to mammography screening. We tested the efficacy of a combined interactive computer program and lay health advisor intervention to increase mammography screening. In this randomized, single blind study, participants were 181 African American female health center patients of ages 41 to 75 years, at < or =250% of poverty level, with no breast cancer history, and with no screening mammogram in the past 15 months. They were assigned to either (a) a low-dose comparison group consisting of a culturally appropriate mammography screening pamphlet or (b) interactive, tailored computer instruction at baseline and four monthly lay health advisor counseling sessions. Self-reported screening data were collected at baseline and 6 months and verified by medical record. For intent-to-treat analysis of primary outcome (medical record-verified mammography screening, available on all but two participants), the intervention group had increased screening to 51% (45 of 89) compared with 18% (16 of 90) for the comparison group at 6 months. When adjusted for employment status, disability, first-degree relatives with breast cancer, health insurance, and previous breast biopsies, the intervention group was three times more likely (adjusted relative risk, 2.7; 95% confidence interval, 1.8-3.7; P < 0.0001) to get screened than the low-dose comparison group. Similar results were found for self-reported mammography stage of screening adoption. The combined intervention was efficacious in improving mammography screening in low-income African American women, with an unadjusted effect size (relative risk, 2.84) significantly higher (P < 0.05) than that in previous studies of each intervention alone.

Effects of different information brochures on women's decision-making regarding mammography screening: study protocol for a randomized controlled questionnaire study.

PubMed

Gummersbach, Elisabeth; in der Schmitten, Jürgen; Abholz, Heinz-Harald; Wegscheider, Karl; Pentzek, Michael

2013-10-01

In order to give informed consent for mammography screening, women need to be told the relevant facts; however, screening information often remains vague because of the worry that detailed information might deter women from participating in recommended screening programs. Since September 2010, German women aged 50 to 69 invited for mammography screening have received a new, comprehensive information brochure that frankly discusses the potential benefit and harm of mammography screening. In contrast, the brochure that was in use before September 2010 contained little relevant information.The aim of this study is to compare the impact of the two different brochures on the intention of women to undergo mammography screening, and to broaden our understanding of the effect that factual information has on the women's decision-making. This is a controlled questionnaire study comparing knowledge, views and hypothetical preferences of women aged 48-49 years after receiving the old versus the new information brochure. German GP's in the region of North Rhine-Westfalia will be asked by mail and telephone to participate in the study. Eligible women will be recruited via their general practitioners (GPs) and randomized to groups A ('new brochure') and B ('old brochure'), with an intended recruitment of 173 participants per group. The study is powered to detect a 15% higher or lower intention to undergo mammography screening in women informed by the new brochure. This study will contribute to our understanding of the decision-making of women invited to mammography screening. From both ethical and public health perspectives, it is important to know whether frank, factual information leads to a change in the intention of women to participate in a recommended breast cancer screening program. DRKS00004271.

Effects of different information brochures on women’s decision-making regarding mammography screening: study protocol for a randomized controlled questionnaire study

PubMed Central

2013-01-01

Background In order to give informed consent for mammography screening, women need to be told the relevant facts; however, screening information often remains vague because of the worry that detailed information might deter women from participating in recommended screening programs. Since September 2010, German women aged 50 to 69 invited for mammography screening have received a new, comprehensive information brochure that frankly discusses the potential benefit and harm of mammography screening. In contrast, the brochure that was in use before September 2010 contained little relevant information. The aim of this study is to compare the impact of the two different brochures on the intention of women to undergo mammography screening, and to broaden our understanding of the effect that factual information has on the women’s decision-making. Methods This is a controlled questionnaire study comparing knowledge, views and hypothetical preferences of women aged 48–49 years after receiving the old versus the new information brochure. German GP’s in the region of North Rhine-Westfalia will be asked by mail and telephone to participate in the study. Eligible women will be recruited via their general practitioners (GPs) and randomized to groups A ('new brochure’) and B ('old brochure’), with an intended recruitment of 173 participants per group. The study is powered to detect a 15% higher or lower intention to undergo mammography screening in women informed by the new brochure. Discussion This study will contribute to our understanding of the decision-making of women invited to mammography screening. From both ethical and public health perspectives, it is important to know whether frank, factual information leads to a change in the intention of women to participate in a recommended breast cancer screening program. Trial registration DRKS00004271 PMID:24083811

Prognostic value of contrast-enhanced MR mammography in patients with breast cancer.

PubMed

Fischer, U; Kopka, L; Brinck, U; Korabiowska, M; Schauer, A; Grabbe, E

1997-01-01

The objective of this study was to evaluate the prognostic value of contrast-enhanced MR mammography in patients with breast cancer. A total of 190 patients with breast cancer (37 noninvasive carcinomas, 153 invasive carcinomas) underwent dynamic contrast-enhanced MR mammography preoperatively. Using 1.5-T unit, T1-weighted sequences (2D FLASH) were obtained repeatedly one time before and five times after IV administration of 0.1 mmol gadopentetate-dimeglumine per kilogram body weight. The findings on MR imaging were correlated with histopathologically defined prognostic factors (histological type, tumor size, tumor grading, metastasis in lymph nodes). In addition, immunohistochemically defined prognostic factors (c-erbB-1, c-erbB-2, p53, Ki-67) were correlated with the signal increase on MR mammogram in 40 patients. There was no significant correlation between the findings on MR mammography and the histopathological type of carcinoma, the grading, and the lymphonodular status. Noninvasive carcinomas showed a higher rate of moderate (38 %) or low (27 %) enhancement on MR imaging than invasive carcinomas (6 and 3 %). The results on MR mammography and the results of immunohistochemical stainings did not correlate significantly. Noninvasive carcinomas showed significantly lower enhancement than invasive carcinomas. However, the signal behavior of contrast-enhanced MR mammography is not related to established histopathological prognostic parameters as subtyping, grading, nodal status, and the expression of certain oncogenes/tumor suppressor genes.

Breast Volume Measurement by Recycling the Data Obtained From 2 Routine Modalities, Mammography and Magnetic Resonance Imaging.

PubMed

Itsukage, Shizu; Sowa, Yoshihiro; Goto, Mariko; Taguchi, Tetsuya; Numajiri, Toshiaki

2017-01-01

Objective: Preoperative prediction of breast volume is important in the planning of breast reconstructive surgery. In this study, we prospectively estimated the accuracy of measurement of breast volume using data from 2 routine modalities, mammography and magnetic resonance imaging, by comparison with volumes of mastectomy specimens. Methods: The subjects were 22 patients (24 breasts) who were scheduled to undergo total mastectomy for breast cancer. Preoperatively, magnetic resonance imaging volume measurement was performed using a medical imaging system and the mammographic volume was calculated using a previously proposed formula. Volumes of mastectomy specimens were measured intraoperatively using a method based on Archimedes' principle and Newton's third law. Results: The average breast volumes measured on magnetic resonance imaging and mammography were 318.47 ± 199.4 mL and 325.26 ± 217.36 mL, respectively. The correlation coefficients with mastectomy specimen volumes were 0.982 for magnetic resonance imaging and 0.911 for mammography. Conclusions: Breast volume measurement using magnetic resonance imaging was highly accurate but requires data analysis software. In contrast, breast volume measurement with mammography requires only a simple formula and is sufficiently accurate, although the accuracy was lower than that obtained with magnetic resonance imaging. These results indicate that mammography could be an alternative modality for breast volume measurement as a substitute for magnetic resonance imaging.

Improving mammography screening among the medically underserved.

PubMed

Davis, Terry C; Rademaker, Alfred; Bennett, Charles L; Wolf, Michael S; Carias, Edson; Reynolds, Cristalyn; Liu, Dachao; Arnold, Connie L

2014-04-01

We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings. A three-arm, quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana. Mammography screening efforts included: 1) enhanced care, 2) health literacy-informed education of patients, and 3) education plus nurse support. Outcomes included mammography screening completion within 6 months and incremental cost-effectiveness. Overall, 1,181 female patients ages 40 and over who were eligible for routine mammography were recruited. Baseline screening rates were < 10%. Post intervention screening rates were 55.7% with enhanced care, 51.8% with health literacy-informed education and 65.8% with education and nurse support. After adjusting for race, marital status, self-efficacy and literacy, patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care; those additionally receiving nurse support were 1.37-fold more likely to complete mammographic screening than those receiving the brief education (95% Confidence Interval 1.08-1.74, p = 0.01). The incremental cost per additional women screened was $2,457 for literacy-informed education with nurse support over literacy-informed education alone. Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative, with nurse support and follow-up being the most effective option. However, it is not likely to be cost-effective or affordable in resource-limited clinics.

Breast Volume Measurement by Recycling the Data Obtained From 2 Routine Modalities, Mammography and Magnetic Resonance Imaging

PubMed Central

Itsukage, Shizu; Goto, Mariko; Taguchi, Tetsuya; Numajiri, Toshiaki

2017-01-01

Objective: Preoperative prediction of breast volume is important in the planning of breast reconstructive surgery. In this study, we prospectively estimated the accuracy of measurement of breast volume using data from 2 routine modalities, mammography and magnetic resonance imaging, by comparison with volumes of mastectomy specimens. Methods: The subjects were 22 patients (24 breasts) who were scheduled to undergo total mastectomy for breast cancer. Preoperatively, magnetic resonance imaging volume measurement was performed using a medical imaging system and the mammographic volume was calculated using a previously proposed formula. Volumes of mastectomy specimens were measured intraoperatively using a method based on Archimedes’ principle and Newton's third law. Results: The average breast volumes measured on magnetic resonance imaging and mammography were 318.47 ± 199.4 mL and 325.26 ± 217.36 mL, respectively. The correlation coefficients with mastectomy specimen volumes were 0.982 for magnetic resonance imaging and 0.911 for mammography. Conclusions: Breast volume measurement using magnetic resonance imaging was highly accurate but requires data analysis software. In contrast, breast volume measurement with mammography requires only a simple formula and is sufficiently accurate, although the accuracy was lower than that obtained with magnetic resonance imaging. These results indicate that mammography could be an alternative modality for breast volume measurement as a substitute for magnetic resonance imaging. PMID:29308107

Online information about risks and benefits of screening mammography in 10 European countries: An observational Web sites analysis.

PubMed

Spagnoli, Laura; Navaro, Monica; Ferrara, Pietro; Del Prete, Viola; Attena, Francesco

2018-06-01

Most publications about breast cancer do not provide accurate and comprehensive information, giving few or no data about risk/benefit ratios. We conducted a comparative study among 10 European countries about health information on breast cancer screening, assessing the first 10 Web sites addressing the general public that appeared following an Internet search.With the help of medical residents involved in the EuroNet MRPH Association, we analyzed the first 30 results of an Internet search in 10 European countries to determine the first 10 sites that offered screening mammography. We searched for the following information: source of information, general information on mammography and breast cancer screening, potential harms and risks (false positives, false positives after biopsy, false negatives, interval cancer, overdiagnosis, lead-time bias, and radiation exposure), and potential benefits (reduced mortality and increased survival).The United Kingdom provided the most information: 39 of all 70 possible identified risks (56%) were reported on its sites. Five nations presented over 35% of the possible information (United Kingdom, Spain, France, Ireland, and Italy); the others were under 30% (Portugal, Poland, Slovenia, Netherlands, and Croatia). Regarding the benefits, sites offering the most complete information were those in France (95%) and Poland (90%).Our results suggest that, despite consensus in the scientific community about providing better information to citizens, further efforts are needed to improve information about breast cancer screening. That conclusion also applies to countries showing better results. We believe that there should be greater coordination in this regard throughout Europe.

Patient expectations and costs of immediate reporting of screening mammography: talk isn't cheap.

PubMed

Raza, S; Rosen, M P; Chorny, K; Mehta, T S; Hulka, C A; Baum, J K

2001-09-01

Our purpose was to determine whether patients prefer immediate or delayed results of screening mammography and to determine the cost of immediate reporting at our institution. A survey was anonymously and randomly distributed to 129 women who were 35-70 years old during a visit to their primary care physician, asking the women's preference for receiving mammography results by one of two systems: by letter with a return visit for any additional tests; or by speaking at once with the radiologist, with the option of additional tests being performed during the same visit. Patients' willingness to pay for the latter service was also determined. A cost identification model was constructed using commercially available software. We considered the impact on radiologists' and technologists' time and the need for additional equipment and space, and we analyzed the effect on the cost of immediate reporting. One hundred twenty (93%) surveys were completed. Eighty women (67%) preferred immediate reporting, and 62 (78%) of these 80 patients would wait 30-60 min. The additional cost of immediate reporting is $28.22 per patient. Only 11% of patients were willing to pay this additional cost. When new equipment and space were not required, the cost would increase by $4.38. This cost was most influenced by the time required to give patients normal results. Most surveyed patients preferred speaking with a radiologist immediately but were unwilling to pay additional fees. Radiologists, hospital administrators, and health care planners must be aware of the costs of immediate reporting and must factor these costs into any change in hospital or national policy.

Psychosocial Determinants of Mammography Follow-up after Receipt of Abnormal Mammography Results in Medically Underserved Women

PubMed Central

Fair, Alecia Malin; Wujcik, Debra; Lin, Jin-Mann Sally; Zheng, Wei; Egan, Kathleen M.; Grau, Ana M.; Champion, Victoria L.; Wallston, Kenneth A.

2010-01-01

This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR = 2.53, 95% CI = 1.12–5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value = .02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value<.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted. PMID:20173286

Psychosocial determinants of mammography follow-up after receipt of abnormal mammography results in medically underserved women.

PubMed

Fair, Alecia Malin; Wujcik, Debra; Lin, Jin-Mann Sally; Zheng, Wei; Egan, Kathleen M; Grau, Ana M; Champion, Victoria L; Wallston, Kenneth A

2010-02-01

This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR=2.53, 95% CI=1.12-5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value=.02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value<.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted.

Mammography Adherence in African-American Women: Results of a Randomized Controlled Trial.

PubMed

Gathirua-Mwangi, Wambui G; Monahan, Patrick O; Stump, Timothy; Rawl, Susan M; Skinner, Celette Sugg; Champion, Victoria L

2016-02-01

Breast cancer is the second leading cause of cancer mortality among women in the developed world. Mammography screening is especially important for African-Americans because they experience a greater mortality (OR = 1.38) than Caucasians despite having a lower incidence of breast cancer. The purpose of this study was to compare the effects of two interventions with usual care on mammography adherence among African-American women. A subsample of African-American women (n = 244) aged 41-65 years who had not had a mammogram in the last 15 months and no history of breast cancer was randomly assigned to receive (1) mailed interactive DVD, (2) computer-tailored telephone counseling, or (3) usual care. The DVD intervention was five times more effective than usual care for promoting mammography screening at 6 months follow-up among women who earned less than $30,000 (OR = 5.3). Compared to usual care, neither the DVD nor phone produced significant effects for women with household incomes >$30,000. Use of a mailed DVD for low-income African-American women may be an effective way to increase mammography adherence.

Predictors of mammography screening among ethnically diverse low-income women.

PubMed

Cronan, Terry A; Villalta, Ian; Gottfried, Emily; Vaden, Yavette; Ribas, Mabel; Conway, Terry L

2008-05-01

Breast cancer is the second leading cause of cancer deaths among women in the United States. Minority women are less likely to be screened and more likely to die from breast cancer than are Caucasian women. Although some studies have examined ethnic disparities in mammography screening, no study has examined whether there are ethnic disparities among low-income, ethnically diverse women. The present study was designed to determine whether there are ethnic disparities in mammography screening and predictors of screening among low-income African American, Mexican American, and Caucasian women, and to determine whether the disparities and predictors vary across ethnic groups. The participants were 146 low-income women who were Mexican American (32%), African American (31%), or Caucasian (37%). Statistical analyses were performed to assess the relationships between mammography screening during the past 2 years and potential predictors of screening, both within ethnic groups and for the combined sample. The results varied depending on whether analyses combined ethnic groups or were performed within each of the three ethnic groups. It is, therefore, important to examine within-group differences when examining ethnic disparities in predictors of mammography.

Screening mammography uptake within Australia and Scotland in rural and urban populations

PubMed Central

Leung, Janni; Macleod, Catriona; McLaughlin, Deirdre; Woods, Laura M.; Henderson, Robert; Watson, Angus; Kyle, Richard G.; Hubbard, Gill; Mullen, Russell; Atherton, Iain

2015-01-01

Objective To test the hypothesis that rural populations had lower uptake of screening mammography than urban populations in the Scottish and Australian setting. Method Scottish data are based upon information from the Scottish Breast Screening Programme Information System describing uptake among women residing within the NHS Highland Health Board area who were invited to attend for screening during the 2008 to 2010 round (N = 27,416). Australian data were drawn from the 2010 survey of the 1946–51 cohort of the Australian Longitudinal Study on Women's Health (N = 9890 women). Results Contrary to our hypothesis, results indicated that women living in rural areas were not less likely to attend for screening mammography compared to women living in urban areas in both Scotland (OR for rural = 1.17, 95% CI = 1.06–1.29) and Australia (OR for rural = 1.15, 95% CI = 1.01–1.31). Conclusions The absence of rural–urban differences in attendance at screening mammography demonstrates that rurality is not necessarily an insurmountable barrier to screening mammography. PMID:26844118

Screening mammography uptake within Australia and Scotland in rural and urban populations.

PubMed

Leung, Janni; Macleod, Catriona; McLaughlin, Deirdre; Woods, Laura M; Henderson, Robert; Watson, Angus; Kyle, Richard G; Hubbard, Gill; Mullen, Russell; Atherton, Iain

2015-01-01

To test the hypothesis that rural populations had lower uptake of screening mammography than urban populations in the Scottish and Australian setting. Scottish data are based upon information from the Scottish Breast Screening Programme Information System describing uptake among women residing within the NHS Highland Health Board area who were invited to attend for screening during the 2008 to 2010 round (N = 27,416). Australian data were drawn from the 2010 survey of the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (N = 9890 women). Contrary to our hypothesis, results indicated that women living in rural areas were not less likely to attend for screening mammography compared to women living in urban areas in both Scotland (OR for rural = 1.17, 95% CI = 1.06-1.29) and Australia (OR for rural = 1.15, 95% CI = 1.01-1.31). The absence of rural-urban differences in attendance at screening mammography demonstrates that rurality is not necessarily an insurmountable barrier to screening mammography.

[Radiation dose evaluation in a photon-counting digital mammography unit].

PubMed

Matsubara, Kosuke; Matsumoto, China; Mochiya, Yuko; Toda, Kanako; Noto, Kimiya; Koshida, Kichiro

2014-05-01

The purpose of our study was to evaluate radiation dose and beam quality in photon-counting digital mammography (PCDM) and compare them with those in a full-field digital mammography (FFDM) unit. Dose variation in the X-ray tube axis direction, aluminum half-value layer, average glandular and skin doses, and contrast-to-noise ratio (CNR) were evaluated for the PCDM and FFDM units. In PCDM, the dose variation in the X-ray tube axis direction was greater than that in FFDM. At a tube voltage of 28 kV, the first half-value layers were 0.407 mmAl for PCDM, 0.357 mmAl for FFDM with a molybdenum target and molybdenum filter (Mo/Mo), and 0.579 mmAl for FFDM with a tungsten target and rhodium filter (W/Rh). The average glandular doses with 45-mm-equivalent breast thickness were 0.723 mGy for the PCDM, 1.55 mGy for the FFDM with Mo/Mo in low-dose mode, and 0.835 mGy for the FFDM with W/Rh in low-dose mode. In PCDM, the skin dose was equivalent to or lower than that in FFDM. The CNR was 2.65±0.04, 2.35±0.04, and 2.52±0.03 for the PCDM, FFDM with Mo/Mo, and that with W/Rh, respectively. The CNR for PCDM was significantly higher than that for FFDM (p<0.001). It is therefore possible to reduce the radiation dose to the patient by using a PCDM unit while maintaining a significantly higher CNR than with the FFDM unit.

Breast cancer screening (breast self-examination, clinical breast exam, and mammography) in women referred to health centers in Tabriz, Iran.

PubMed

Khalili, Azizeh Farshbaf; Shahnazi, Mahnaz

2010-04-01

Breast cancer is the most common cancer and the most common cause of death in Iranian women aged 35-55 years. Breast cancer screening comprises breast self-examination (BSE), clinical breast examination (CBE) and mammography. The study aimed to examine the performance of screening methods among women referring to health centers of Tabriz, Iran. This was a descriptive-analytical research carried out on 400 women aged 20-50 years. The samples were chosen through random multistage sampling among health centers of Tabriz then active records of women. A questionnaire and observational checklist was used to elicit socio-demographic information and performance of women towards breast cancer screening methods. Descriptive and inferential statistics (chi-square and Fisher's exact test) were used to analyze the data. Only 18.8% of women did breast self-examination, 19.1% had clinical breast examination and 3.3% had mammogram. Statistical test showed a significant relationship between performing BSE and educational level, employment, income, number of children, breastfeeding history, breastfeeding quality and family history of breast cancer. There was a significant correlation between performing CBE and history of breast tumor and also, between performing the mammography and family history of breast cancer and history of breast tumor (P < 0.05). The findings showed that the performance of breast cancer screening methods was not satisfactory. Performance in high risk women was very desirable than others. The presentation of imperative education about breast cancer screening methods through health staff especially in pregnancy, post-partum and even in pre marriage counseling periods seems necessary.

Dense Breasts

MedlinePlus

... fatty tissue. On a mammogram, fatty tissue appears dark (radio-lucent) and the glandular and connective tissues ... white on mammography) and non-dense fatty tissue (dark on mammography) using a visual scale and assign ...

Mammogram screening in Chile: Using mixed methods to implement health policy planning at the primary care level

PubMed Central

Puschel, Klaus; Thompson, Beti

2011-01-01

Summary Breast cancer has the highest incidence of all cancers among women in Chile. In 2005, a national health program progressively introduced free mammography screening for women aged 50 and older; however, three years later the rates of compliance with mammographic screening was only 12% in Santiago, the capital city of Chile. This implementation article combines the findings of two previous studies that applied qualitative and quantitative methods to improve mammography screening in an area of Santiago. Socio-cultural and accessibility factors were identified as barriers and facilitators during the qualitative phase of the study and then applied to the design of a quantitative randomized clinical trial. After six months of intervention, 6% of women in the standard care group, 51.8% in the low intensity intervention group, and 70.1% in the high intensity intervention group had undergone a screening mammogram. This review discusses how the utilization of mixed methods research can contribute to the improvement of the implementation of health policies in local communities. PMID:21334897

Status and awareness of cervical, breast, and colon cancer screening in a Turkish city.

PubMed

Zafer, E; Tanrιkulu, P; Atakul, T; Ömürlü, I K; Yüksel, H

2017-01-01

Mortality and morbidity rates of cervical, breast, and colorectal cancers (CRC) can be decreased via effective screening strategies. Developing countries are to be expected to establish and implement their own programs. To evaluate regional awareness and status of cervical, breast, and CRC screening, a questionnaire-based study was conducted in 500 volunteers from a Turkish community hospital. Awareness rates were 57.4% for Pap smear, 61.2% for mammography, and 25.4% for CRC. Implementation rates were 19.2%, 23.9%, and 12%, respectively. Positive family history for gynecologic cancer and past cervical ablative procedure parameters were related to higher Pap smear rates. Educational level, breast self-exam, and positive Pap smear history parameters were related to higher mammography rates. Factors related to higher colorectal cancer screening rates were nulliparity and positive Pap smear history. Cancer screening rates for this Turkish city are still below the expected levels despite recently revitalized national screening program. For success, it is essential not only to educate rural populations but also to train negligent healthcare providers regularly.

SIMULATING LOCAL DENSE AREAS USING PMMA TO ASSESS AUTOMATIC EXPOSURE CONTROL IN DIGITAL MAMMOGRAPHY.

PubMed

Bouwman, R W; Binst, J; Dance, D R; Young, K C; Broeders, M J M; den Heeten, G J; Veldkamp, W J H; Bosmans, H; van Engen, R E

2016-06-01

Current digital mammography (DM) X-ray systems are equipped with advanced automatic exposure control (AEC) systems, which determine the exposure factors depending on breast composition. In the supplement of the European guidelines for quality assurance in breast cancer screening and diagnosis, a phantom-based test is included to evaluate the AEC response to local dense areas in terms of signal-to-noise ratio (SNR). This study evaluates the proposed test in terms of SNR and dose for four DM systems. The glandular fraction represented by the local dense area was assessed by analytic calculations. It was found that the proposed test simulates adipose to fully glandular breast compositions in attenuation. The doses associated with the phantoms were found to match well with the patient dose distribution. In conclusion, after some small adaptations, the test is valuable for the assessment of the AEC performance in terms of both SNR and dose. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Early detection of breast cancer in Brazil: data from the National Health Survey, 2013.

PubMed

Silva, Gulnar Azevedo E; Souza-Júnior, Paulo Roberto Borges de; Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann

2017-06-01

To analyze whether the actions of early detection of breast cancer, initiated with the medical request for mammography, differ between users of the Brazilian Unified Health System (SUS) and those who have private health insurance. From the data collected in the National Health Survey, we estimated the proportions of women who had medical request for mammography according to presence or absence of private health insurance. For assessing the factors related to having mammography medical request, we estimated crude and adjusted odds ratios and respective 95%CI by logistic regression. We also analyzed the main reasons reported for not having performed mammography after medical request, as well as the time between examination and result. Of the women interviewed, 66.7% had a medical request for mammography (59.4% among SUS users and 83.9% among those with private health insurance). Having private health insurance, higher education level, and being white were positively associated with having the medical request. Only 5.4% (95%CI 4.8-6.0) of women who received medical request failed to perform mammography - 7.6% were SUS users and 1.7% had health insurance. The most reported reasons for not being able to perform the examination were: not thinking it was necessary; having the test scheduled, but not yet performed; and not being able to schedule it. More than 70% of women received the result with less than one month from its execution. The barriers to access a medical request for mammographic screening for breast cancer are higher among women who depend exclusively on SUS. Analisar se as ações de detecção precoce para o câncer de mama, iniciadas com o pedido médico de mamografia, diferem entre usuárias do Sistema Único de Saúde (SUS) e aquelas que possuem plano de saúde privado. A partir dos dados coletados na Pesquisa Nacional de Saúde, foram calculadas as proporções de mulheres que tiveram pedido médico para realização de mamografia segundo ter ou não plano de saúde privado. Para avaliar os fatores relacionados a ter pedido médico de mamografia, foram calculadas odds ratios brutas e ajustadas e os respectivos IC95% por regressão logística. Foram também analisados os principais motivos informados para não ter realizado mamografia após ter o pedido médico, assim como o tempo entre ter realizado o exame e o recebimento do resultado. Das mulheres entrevistadas, 66,7% tiveram um pedido médico para mamografia (59,4% entre as que eram usuárias do SUS e 83,9% entre as portadoras de plano de saúde privado). Ter plano de saúde privado, maior nível de escolaridade e ser de cor branca se associaram positivamente a ter o pedido médico. Apenas 5,4% (IC95% 4,8-6,0) das mulheres que receberam solicitação médica não conseguiram fazer mamografia - 7,6% eram dependentes do SUS enquanto 1,7% eram portadoras de plano de saúde. Os motivos mais reportados de não conseguir realizar o exame foram: não achar necessário; ter o exame marcado, mas ainda não realizado; e não ter conseguido marcar. Mais de 70% das mulheres receberam o resultado antes de completar um mês da realização. As barreiras de acesso a ter pedido médico para rastreamento mamográfico para o câncer de mama são maiores entre mulheres que dependem exclusivamente do SUS.

Potential impact of legislation mandating breast density notification: benefits, harms, and cost effectiveness of supplemental ultrasound screening

PubMed Central

Sprague, Brian L.; Stout, Natasha K.; Schechter, Clyde; van Ravesteyn, Nicolien T.; Cevik, Mucahit; Alagoz, Oguzhan; Lee, Christoph I.; van den Broek, Jeroen J.; Miglioretti, Diana L.; Mandelblatt, Jeanne S.; de Koning, Harry J.; Kerlikowske, Karla; Lehman, Constance D.; Tosteson, Anna N. A.

2014-01-01

Background At least nineteen states have laws that require telling women with dense breasts and a negative screening mammogram to consider supplemental screening. The most readily available supplemental screening modality is ultrasound, yet little is known about its effectiveness. Objective To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Design Comparative modeling with 3 validated simulation models. Data Sources Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; the medical literature. Target Population A contemporary cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Payer. Interventions Supplemental ultrasound screening for women with dense breasts following a negative screening mammogram. Outcome Measures Breast cancer deaths averted, quality-adjusted life years (QALYs) gained, false positive ultrasound biopsy recommendations, costs, costs per QALY gained. Results of Base-Case Analysis Supplemental ultrasound screening after a negative mammogram for women aged 50–74 with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models: 0.14–0.75), gained 1.7 QALYs (0.9–4.7), and resulted in 354 false-positive ultrasound biopsy recommendations (345–421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained ($112,000-$766,000). Restricting supplemental ultrasound screening to women with extremely dense breasts cost $246,000 per QALY gained ($74,000-$535,000). Results of Sensitivity Analysis The conclusions were not sensitive to ultrasound performance characteristics, screening frequency, or starting age. Limitations Provider costs for coordinating supplemental ultrasound were not considered. Conclusions Supplemental ultrasound screening for women with dense breasts undergoing screening mammography would substantially increase costs while producing relatively small benefits in breast cancer deaths averted and QALYs gained. Primary Funding Source National Institutes of Health PMID:25486550