One more hurdle to increasing mammography screening: pubescent, adolescent, and prior mammography screening experiences.

Science.gov (United States)

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.

Statistical methods for determining the effect of mammography screening

DEFF Research Database (Denmark)

Lophaven, Søren

2016-01-01

In an overview of five randomised controlled trials from Sweden, a reduction of 29% was found in breast cancer mortality in women aged 50-69 at randomisation after a follow up of 5-13 years. Organised, population based, mammography service screening was introduced on the basis of these resultsin...... in 2007-2008. Women aged 50-69 were invited to screening every second year. Taking advantage of the registers of population and health, we present statistical methods for evaluating the effect of mammography screening on breast cancer mortality (Olsen et al. 2005, Njor et al. 2015 and Weedon-Fekjær etal...

Baseline Screening Mammography: Performance of Full-Field Digital Mammography Versus Digital Breast Tomosynthesis.

Science.gov (United States)

McDonald, Elizabeth S; McCarthy, Anne Marie; Akhtar, Amana L; Synnestvedt, Marie B; Schnall, Mitchell; Conant, Emily F

2015-11-01

Baseline mammography studies have significantly higher recall rates than mammography studies with available comparison examinations. Digital breast tomosynthesis reduces recalls when compared with digital mammographic screening alone, but many sites operate in a hybrid environment. To maximize the effect of screening digital breast tomosynthesis with limited resources, choosing which patient populations will benefit most is critical. This study evaluates digital breast tomosynthesis in the baseline screening population. Outcomes were compared for 10,728 women who underwent digital mammography screening, including 1204 (11.2%) baseline studies, and 15,571 women who underwent digital breast tomosynthesis screening, including 1859 (11.9%) baseline studies. Recall rates, cancer detection rates, and positive predictive values were calculated. Logistic regression estimated the odds ratios of recall for digital mammography versus digital breast tomosynthesis for patients undergoing baseline screening and previously screened patients, adjusted for age, race, and breast density. In the baseline subgroup, recall rates for digital mammography and digital breast tomosynthesis screening were 20.5% and 16.0%, respectively (p = 0.002); digital breast tomosynthesis screening in the baseline subgroup resulted in a 22% reduction in recall compared with digital mammography, or 45 fewer patients recalled per 1000 patients screened. Digital breast tomosynthesis screening in the previously screened patients resulted in recall reduction of 14.3% (p tomosynthesis than from digital mammography alone.

Quality Imaging - Comparison of CR Mammography with Screen-Film Mammography

International Nuclear Information System (INIS)

Gaona, E.; Azorin Nieto, J.; Iran Diaz Gongora, J. A.; Arreola, M.; Casian Castellanos, G.; Perdigon Castaneda, G. M.; Franco Enriquez, J. G.

2006-01-01

The aim of this work is a quality imaging comparison of CR mammography images printed to film by a laser printer with screen-film mammography. A Giotto and Elscintec dedicated mammography units with fully automatic exposure and a nominal large focal spot size of 0.3 mm were used for the image acquisition of phantoms in screen-film mammography. Four CR mammography units from two different manufacturers and three dedicated x-ray mammography units with fully automatic exposure and a nominal large focal spot size of 0.3 mm were used for the image acquisition of phantoms in CR mammography. The tests quality image included an assessment of system resolution, scoring phantom images, Artifacts, mean optical density and density difference (contrast). In this study, screen-film mammography with a quality control program offers a significantly greater level of quality image relative to CR mammography images printed on film

Societal costs and effects of implementing population-based mammography screening in Greenland

DEFF Research Database (Denmark)

Christensen, Maria Klitgaard; Niclasen, Birgit; Moesgaard Iburg, Kim

2017-01-01

With a low breast cancer incidence and low population density, Greenland is geographically and organisationally challenged in implementing a cost effective breast cancer screening programme where a large proportion of the Greenlandic women will have to travel far to attend. The aim of this paper ...... transportation and accommodation costs and loss of productivity, and none would be accepted as cost-effective per YLS/QALY gained within a conventional threshold level. The least expensive strategy was regional screening with hotel accommodation.......With a low breast cancer incidence and low population density, Greenland is geographically and organisationally challenged in implementing a cost effective breast cancer screening programme where a large proportion of the Greenlandic women will have to travel far to attend. The aim of this paper...... is to evaluate the cost effectiveness and cost utility of different strategies for implementing population-based breast cancer screening in Greenland. Two strategies were evaluated: Centralised screening in the capital Nuuk and decentralised screening in the five municipal regions of Greenland. A cost...

Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening.

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Haas, Brian M; Kalra, Vivek; Geisel, Jaime; Raghu, Madhavi; Durand, Melissa; Philpotts, Liane E

2013-12-01

To compare screening recall rates and cancer detection rates of tomosynthesis plus conventional digital mammography to those of conventional digital mammography alone. All patients presenting for screening mammography between October 1, 2011, and September 30, 2012, at four clinical sites were reviewed in this HIPAA-compliant retrospective study, for which the institutional review board granted approval and waived the requirement for informed consent. Patients at sites with digital tomosynthesis were offered screening with digital mammography plus tomosynthesis. Patients at sites without tomosynthesis underwent conventional digital mammography. Recall rates were calculated and stratified according to breast density and patient age. Cancer detection rates were calculated and stratified according to the presence of a risk factor for breast cancer. The Fisher exact test was used to compare the two groups. Multivariate logistic regression was used to assess the effect of screening method, breast density, patient age, and cancer risk on the odds of recall from screening. A total of 13 158 patients presented for screening mammography; 6100 received tomosynthesis. The overall recall rate was 8.4% for patients in the tomosynthesis group and 12.0% for those in the conventional mammography group (P tomosynthesis reduced recall rates for all breast density and patient age groups, with significant differences (P tomosynthesis versus 5.2 per 1000 in patients receiving conventional mammography alone (P = .70). Patients undergoing tomosynthesis plus digital mammography had significantly lower screening recall rates. The greatest reductions were for those younger than 50 years and those with dense breasts. A nonsignificant 9.5% increase in cancer detection was observed in the tomosynthesis group. © RSNA, 2013.

A comparison of the accuracy of film-screen mammography, full-field digital mammography, and digital breast tomosynthesis

International Nuclear Information System (INIS)

Michell, M.J.; Iqbal, A.; Wasan, R.K.; Evans, D.R.; Peacock, C.; Lawinski, C.P.; Douiri, A.; Wilson, R.; Whelehan, P.

2012-01-01

Aim: To measure the change in diagnostic accuracy of conventional film-screen mammography and full-field digital mammography (FFDM) with the addition of digital breast tomosynthesis (DBT) in women recalled for assessment following routine screening. Materials and methods: Ethics approval for the study was granted. Women recalled for assessment following routine screening with screen-film mammography were invited to participate. Participants underwent bilateral, two-view FFDM and two-view DBT. Readers scored each lesion separately for probability of malignancy on screen-film mammography, FFDM, and then DBT. The scores were compared with the presence or absence of malignancy based on the final histopathology outcome. Results: Seven hundred and thirty-eight women participated (93.2% recruitment rate). Following assessment 204 (26.8%) were diagnosed as malignant (147 invasive and 57 in-situ tumours), 286 (37.68%) as benign, and 269 (35.4%) as normal. The diagnostic accuracy was evaluated by using receiving operating characteristic (ROC) and measurement of area under the curve (AUC). The AUC values demonstrated a significant (p = 0.0001) improvement in the diagnostic accuracy with the addition of DBT combined with FFDM and film-screen mammography (AUC = 0.9671) when compared to FFDM plus film-screen mammography (AUC = 0.8949) and film-screen mammography alone (AUC = 0.7882). The effect was significantly greater for soft-tissue lesions [AUC was 0.9905 with the addition of DBT and AUC was 0.9201 for FFDM with film-screen mammography combined (p = 0.0001)] compared to microcalcification [with the addition of DBT (AUC = 0.7920) and for FFDM with film-screen mammography combined (AUC = 0.7843; p = 0.3182)]. Conclusion: The addition of DBT increases the accuracy of mammography compared to FFDM and film-screen mammography combined and film-screen mammography alone in the assessment of screen-detected soft-tissue mammographic abnormalities.

Mammography screening: A major issue in medicine.

Science.gov (United States)

Autier, Philippe; Boniol, Mathieu

2018-02-01

Breast cancer mortality is declining in most high-income countries. The role of mammography screening in these declines is much debated. Screening impacts cancer mortality through decreasing the incidence of number of advanced cancers with poor prognosis, while therapies and patient management impact cancer mortality through decreasing the fatality of cancers. The effectiveness of cancer screening is the ability of a screening method to curb the incidence of advanced cancers in populations. Methods for evaluating cancer screening effectiveness are based on the monitoring of age-adjusted incidence rates of advanced cancers that should decrease after the introduction of screening. Likewise, cancer-specific mortality rates should decline more rapidly in areas with screening than in areas without or with lower levels of screening but where patient management is similar. These two criteria have provided evidence that screening for colorectal and cervical cancer contributes to decreasing the mortality associated with these two cancers. In contrast, screening for neuroblastoma in children was discontinued in the early 2000s because these two criteria were not met. In addition, overdiagnosis - i.e. the detection of non-progressing occult neuroblastoma that would not have been life-threatening during the subject's lifetime - is a major undesirable consequence of screening. Accumulating epidemiological data show that in populations where mammography screening has been widespread for a long time, there has been no or only a modest decline in the incidence of advanced cancers, including that of de novo metastatic (stage IV) cancers at diagnosis. Moreover, breast cancer mortality reductions are similar in areas with early introduction and high penetration of screening and in areas with late introduction and low penetration of screening. Overdiagnosis is commonplace, representing 20% or more of all breast cancers among women invited to screening and 30-50% of screen

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

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Addition of tomosynthesis to conventional digital mammography: effect on image interpretation time of screening examinations.

Science.gov (United States)

Dang, Pragya A; Freer, Phoebe E; Humphrey, Kathryn L; Halpern, Elkan F; Rafferty, Elizabeth A

2014-01-01

To determine the effect of implementing a screening tomosynthesis program on real-world clinical performance by quantifying differences between interpretation times for conventional screening mammography and combined tomosynthesis and mammography for multiple participating radiologists with a wide range of experience in a large academic center. In this HIPAA-compliant, institutional review board-approved study, 10 radiologists prospectively read images from screening digital mammography or screening combined tomosynthesis and mammography examinations for 1-hour-long uninterrupted sessions. Images from 3665 examinations (1502 combined and 2163 digital mammography) from July 2012 to January 2013 were interpreted in at least five sessions per radiologist per modality. The number of cases reported during each session was recorded for each reader. The experience level for each radiologist was also correlated to the average number of cases reported per hour. Analysis of variance was used to assess the number of studies interpreted per hour. A linear regression model was used to evaluate correlation between breast imaging experience and time taken to interpret images from both modalities. The mean number of studies interpreted in hour was 23.8 ± 0.55 (standard deviation) (range, 14.4-40.4) for combined tomosynthesis and mammography and 34.0 ± 0.55 (range, 20.4-54.3) for digital mammography alone. A mean of 10.2 fewer studies were interpreted per hour during combined tomosynthesis and mammography compared with digital mammography sessions (P tomosynthesis and mammography and 1.9 minutes ± 0.6 (range, 1.1-3.0) for digital mammography; interpretation time with combined tomosynthesis and mammography was 0.9 minute longer (47% longer) compared with digital mammography alone (P tomosynthesis and mammography examinations decreased (R(2) = 0.52, P = .03). Addition of tomosynthesis to mammography results in increased time to interpret images from screening examinations compared

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

Science.gov (United States)

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.

Cost-effectiveness of the Norwegian breast cancer screening program.

Science.gov (United States)

van Luijt, P A; Heijnsdijk, E A M; de Koning, H J

2017-02-15

The Norwegian Breast Cancer Screening Programme (NBCSP) has a nation-wide coverage since 2005. All women aged 50-69 years are invited biennially for mammography screening. We evaluated breast cancer mortality reduction and performed a cost-effectiveness analysis, using our microsimulation model, calibrated to most recent data. The microsimulation model allows for the comparison of mortality and costs between a (hypothetical) situation without screening and a situation with screening. Breast cancer incidence in Norway had a steep increase in the early 1990s. We calibrated the model to simulate this increase and included recent costs for screening, diagnosis and treatment of breast cancer and travel and productivity loss. We estimate a 16% breast cancer mortality reduction for a cohort of women, invited to screening, followed over their complete lifetime. Cost-effectiveness is estimated at NOK 112,162 per QALY gained, when taking only direct medical costs into account (the cost of the buses, examinations, and invitations). We used a 3.5% annual discount rate. Cost-effectiveness estimates are substantially below the threshold of NOK 1,926,366 as recommended by the WHO guidelines. For the Norwegian population, which has been gradually exposed to screening, breast cancer mortality reduction for women exposed to screening is increasing and is estimated to rise to ∼30% in 2020 for women aged 55-80 years. The NBCSP is a highly cost-effective measure to reduce breast cancer specific mortality. We estimate a breast cancer specific mortality reduction of 16-30%, at the cost of 112,162 NOK per QALY gained. © 2016 UICC.

The Role of Effective Communication to Enhance Participation in Screening Mammography: A New Zealand Case

Directory of Open Access Journals (Sweden)

Margaret A. Brunton

2009-02-01

Full Text Available Changes in the organisation of health care have dominated policy initiatives over the past two decades in many countries. An increasing reliance on public health initiatives to prevent or detect disease early has resulted in an increase in programs that screen for cancer in the community. In turn, this accentuates the need to persuasively communicate the value of such initiatives to encourage continued participation. Merely placing screening programs into a community setting is not sufficient to ensure that adequate numbers will voluntarily participate regularly to achieve anticipated cost and mortality savings in the population. In this research the influence of managing communication in a public screening mammography program was investigated. The results revealed that significant opportunities were overlooked for reassurance and information during the physical mammography process. In turn, this highlights the influence of constraints imposed by the structure of the screening program and the resources allocated to the process. This research suggests that it is important to address multiple influences, including ethnic differences, when asking questions about the effectiveness of public health policy, particularly when considering the choices women make about ongoing participation in breast screening programs.

Effect of adding screening ultrasonography to screening mammography on patient recall and cancer detection rates: A retrospective study in Japan

International Nuclear Information System (INIS)

Tohno, Eriko; Umemoto, Takeshi; Sasaki, Kyoko; Morishima, Isamu; Ueno, Ei

2013-01-01

Purpose: To determine whether adding screening ultrasonography to screening mammography can reduce patient recall rates and increase cancer detection rates. Materials and methods: We analyzed the results of mammography and ultrasonography breast screenings performed at the Total Health Evaluation Center Tsukuba, Japan, between April 2011 and March 2012. We also reviewed the modalities and results of diagnostic examinations from women with mammographic abnormalities who visited the Tsukuba Medical Center Hospital for further testing. Results: Of 11,753 women screened, cancer was diagnosed in 10 (0.22%) of the 4529 participants who underwent mammography alone, 23 (0.37%) of the 6250 participants who underwent ultrasonography alone, and 5 (0.51%) of the 974 participants who underwent mammography and ultrasonography. The recall rate due to mammographic abnormalities was 4.9% for women screened only with mammography and 2.6% for those screened with both modalities. The cancer detection rate was 0.22% for women screened only with mammography (positive predictive value, 4.5%) and 0.31% for those screened with both modalities (positive predictive value, 12.0%). Of the 211 lesions presenting as mammographic abnormalities investigated further, diagnostic ultrasonography found no abnormalities in 63 (29.9%) and benign findings in 69 (33.7%). The rest 36.4% needed mammography, cytological or histological examinations or follow-up in addition to diagnostic ultrasonography. Conclusions: It is possible to reduce the recall rate in screening mammography by combining mammography and ultrasonography for breast screening

Effect of age on breast cancer screening using tomosynthesis in combination with digital mammography.

Science.gov (United States)

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 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 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.

[Cost-effectiveness of multiple screening modalities on breast cancer in Chinese women from Shanghai].

Science.gov (United States)

Wu, F; Mo, M; Qin, X X; Fang, H; Zhao, G M; Liu, G Y; Chen, Y Y; Cao, Z G; Yan, Y J; Lyu, L L; Xu, W H; Shao, Z M

2017-12-10

Objective: To determine the most cost-effective modality for breast cancer screening in women living in Shanghai. Methods: A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district, Shanghai, during 2008 to 2012. Parameters of the model were derived from literatures. General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years. Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality. Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness. Results: The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one. The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved, which were within the threshold of 2-3 times of local per capita Gross Domestic Product. Results from sensitivity analysis showed that, due to higher incidence rate of breast cancer in Shanghai, the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China. Conclusion: Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai, and thus be widely promoted in this population elsewhere.

Mammography screening services: market segments and messages.

Science.gov (United States)

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.

Mammography screening in Denmark

DEFF Research Database (Denmark)

Vejborg, Ilse; Mikkelsen, Ellen Margrethe; Garne, Jens Peter

2011-01-01

Mammography screening is offered healthy women, and a high standard on professional and organizational level is mandatory not only in the screening programme but even in the diagnostic work-up and treatment. The main goal is to achieve a substantial reduction in disease specific mortality......, but it is not possible to evaluate the effect on mortality until several years later, and continuously monitoring of the quality of all aspects of a screening programme is necessary. Based on other European guidelines, 11 quality indicators have been defined, and guidelines concerning organizational requirements...... for a Danish screening programme as well as recommendations for the radiographic and radiological work have been drawn up....

Breast cancer screening using tomosynthesis in combination with digital mammography.

Science.gov (United States)

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 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 tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P tomosynthesis was associated with an increase

Cost-Effective Screening for Breast Cancer Worldwide: Current State and Future Directions

Directory of Open Access Journals (Sweden)

A. Sarvazyan

2008-01-01

Full Text Available Affordability of healthcare is highly limited by its skyrocketing cost. Access to screening and diagnostic medical equipment and medicine in developing countries is inadequate for the majority of the population. There is a tremendous worldwide need to detect breast cancer at its earliest stage. These needs must be balanced by the ability of countries to provide breast cancer screening technology to their populations. We reviewed the diagnostic accuracy, procedure cost and cost-effectiveness of currently available technique for breast screening and diagnosis including clinical breast examination, mammography, ultrasound, magnetic resonance imaging, biopsy and a new modality for cancer diagnostics termed elasticity imaging that has emerged in the last decade. Clinical results demonstrate that elasticity imaging even in its simplest and least sophisticated versions, like tactile imaging, has significant diagnostic potential comparable and exceeding that of conventional imaging techniques. In view of many countries with limited resources, effective yet less expensive modes of screening must be considered worldwide. The tactile imaging is one method that has the potential to provide cost-effective breast cancer screening and diagnostics.

Mammography screening credit card and compliance.

Science.gov (United States)

Schapira, D V; Kumar, N B; Clark, R A; Yag, C

1992-07-15

Screening for breast cancer using mammography has been shown to be effective in reducing mortality from breast cancer. The authors attempted to determine if use of a wallet-size plastic screening "credit" card would increase participants' compliance for subsequent mammograms when compared with traditional methods of increasing compliance. Two hundred and twenty consecutive women, ages 40-70 years, undergoing their first screening mammography were recruited and assigned randomly to four groups receiving (1) a reminder plastic credit card (2) reminder credit card with written reminder; (3) appointment card; and (4) verbal recommendation. Return rates of the four groups were determined after 15 months. The return rate for subsequent mammograms was significantly higher for participants (72.4%) using the credit card than for participants (39.8%) exposed to traditional encouragement/reminders (P less than 0.0001). The credit card was designed to show the participant's screening anniversary, and the durability of the card may have been a factor in increasing the return rate. The use of reminder credit cards may increase compliance for periodic screening examinations for other cancers and other chronic diseases.

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

Science.gov (United States)

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.

Pain during mammography: Implications for breast screening programmes

International Nuclear Information System (INIS)

Andrews, F.J.

2001-01-01

Pain experienced during mammography can deter women from attending for breast cancer screening. Review of the current literature on pain experienced during mammography reveals three main areas of interest: reports of the frequency of pain, identification of predictors of pain and strategies for responding to pain. Implications of this literature for breast screening programmes include the need for appropriate measurements of pain during mammography that are valid for screening populations, a further understanding of organizational factors involved in screening programmes that may be predictors of pain and for the development of valid strategies for responding to pain within breast screening programmes. Copyright (2001) Blackwell Science Pty Ltd

From facts to arguments: A study of the 2014 Swiss controversy over systematic mammography screening.

Science.gov (United States)

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.

Information on mammography-screening - from deception to insight

International Nuclear Information System (INIS)

Muehlhauser, I.; Hoeldke, B.

2002-01-01

Information about mammography-screening as a basis for informed-decision making has to be evidence-based and presented in an unbiased format. This includes communication of results about effectiveness/lack of effectiveness of screening programmes (breast cancer mortality, total mortality), the quality of mammography as a screening test (sensitivity, specificity, positive and negative predictive values), and possible harm (consequences of false positive and false negative results, overdiagnosis of breast cancer, overtreatment). Outcome data have to be communicated as natural frequencies rather than relative differences. In order to avoid framing of data equal emphasis has to be put on the proportion of persons who are likely to benefit and those who are unlikely to benefit or likely to be harmed. (orig.) [de

Mammography - recent technical developments and their clinical potential

Energy Technology Data Exchange (ETDEWEB)

Hemdal, Bengt; Mattsson, Soeren [Malmoe Univ. Hospital (Sweden). Dept. of Radiation Physics; Andersson, Ingvar [Malmoe Univ. Hospital (Sweden). Dept. of Diagnostic Radiology; Thilander Klang, Anne [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Medical Physics and Biomedical Engineering; Bengtsson, Gert; Jarlman, O. [Lund Univ. Hospital (Sweden). Dept. of Diagnostic Radiology; Leitz, Wolfram [Swedish Radiation Protection Authority, Stockholm (Sweden); Bjurstam, Nils [Univ. of North Norway, Troms (Norway). Dept. of Radiology

2002-05-01

The recent technical developments in digital as well as screen-film X-ray mammography have been reviewed in order to evaluate their clinical potential and to analyse possible lines for future development. Material and methods: The scientific literature has been reviewed, conferences covered and contacts with colleagues developed. Companies in the field have been inquired and invited for presentations. Own experience has been gathered from different screen-film and digital mammography systems. Results and conclusions: Although there are important complementary techniques such as ultrasound and magnetic resonance imaging (MRI), X-ray mammography is still the golden standard for breast imaging. It is relatively simple and cost-effective, and it is presently the only realistic technique for screening in a large scale. It is still largely the only technique that can detect breast cancer in a pre invasive stage. Equipment for digital mammography is commercially available both with small area and full field technique (FFDM). The development of FFDM systems is now intense, as well as the development of dedicated workstations and computer-aided detection (CAD). In spite of this, the introduction of digital mammography has been very slow compared to most other X-ray examinations due to high costs and technical challenges to meet the high demands on image quality and dose in mammography as well as the demands on specialised workflow support for screening mammography and suitable display techniques. Film reading of digital mammograms has been the most common display mode so far, but to take full advantage of the digital concept, diagnostic as well as logistic, monitor reading must be applied. There is a potential of FFDM systems for significantly higher image quality or significantly lower dose than screen-film mammography (SFM), or both. Further research is necessary to fully use this potential. The investment costs are much higher for digital than screen-film mammography

Mammography - recent technical developments and their clinical potential

International Nuclear Information System (INIS)

Hemdal, Bengt; Mattsson, Soeren; Bjurstam, Nils

2002-05-01

The recent technical developments in digital as well as screen-film X-ray mammography have been reviewed in order to evaluate their clinical potential and to analyse possible lines for future development. Material and methods: The scientific literature has been reviewed, conferences covered and contacts with colleagues developed. Companies in the field have been inquired and invited for presentations. Own experience has been gathered from different screen-film and digital mammography systems. Results and conclusions: Although there are important complementary techniques such as ultrasound and magnetic resonance imaging (MRI), X-ray mammography is still the golden standard for breast imaging. It is relatively simple and cost-effective, and it is presently the only realistic technique for screening in a large scale. It is still largely the only technique that can detect breast cancer in a pre invasive stage. Equipment for digital mammography is commercially available both with small area and full field technique (FFDM). The development of FFDM systems is now intense, as well as the development of dedicated workstations and computer-aided detection (CAD). In spite of this, the introduction of digital mammography has been very slow compared to most other X-ray examinations due to high costs and technical challenges to meet the high demands on image quality and dose in mammography as well as the demands on specialised workflow support for screening mammography and suitable display techniques. Film reading of digital mammograms has been the most common display mode so far, but to take full advantage of the digital concept, diagnostic as well as logistic, monitor reading must be applied. There is a potential of FFDM systems for significantly higher image quality or significantly lower dose than screen-film mammography (SFM), or both. Further research is necessary to fully use this potential. The investment costs are much higher for digital than screen-film mammography

Barriers to Mammography among Inadequately Screened Women

Science.gov (United States)

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…

Potential impact of legislation mandating breast density notification: benefits, harms, and cost effectiveness of supplemental ultrasound screening

Science.gov (United States)

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

Mammography screening among Arab American women in metropolitan Detroit.

Science.gov (United States)

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.

Does health status influence intention regarding screening mammography?

International Nuclear Information System (INIS)

Park, Keeho; Park, Jong-Hyock; Park, Jae-Hyun; Kim, Hui-Jeong; Park, Bo-Yoon

2010-01-01

We analyzed information surveyed from a community-based sample of Korean women older than 40 years of age to understand the relationships between health status and screening behavior. In a cross-sectional population-based study, a two-stage, geographically stratified household-based sampling design was used for assembly of a probability sample of women aged 40-69 years living in Gunpo in Korea, resulting in a total sample size of 503 women. The primary outcome variable for this analysis was the respondent's intention to obtain a mammogram. Predictor variables included health status and other factors known to influence the use of cancer screening, such as age, education, income, marital status and the presence of co-morbid illnesses. Health status was assessed by using the EuroQol (EQ-5D). The median EQ visual analogue scale score was 75.0, ranging from 20 to 100. In bivariate analyses, the percentage of women reporting to have intention toward mammography use decreased with worsening health status. Women who had problems with mobility or anxiety/depression showed lower intention to undergo future screening mammography. Multivariate logistic regression confirmed that health status was significantly associated with intention toward mammography use. Anxiety or depression was an independent predictor of future screening mammography use. Health status is significantly associated with intention regarding screening mammography use. Physicians or other health professionals should be aware that health status is an important component for health promotion, and should pay more attention to clients' possible vulnerability in screening mammography use due to their poor health status. (author)

Mechanistic modeling for mammography screening risks

International Nuclear Information System (INIS)

Bijwaard, Harmen

2008-01-01

Full text: Western populations show a very high incidence of breast cancer and in many countries mammography screening programs have been set up for the early detection of these cancers. Through these programs large numbers of women (in the Netherlands, 700.000 per year) are exposed to low but not insignificant X-ray doses. ICRP based risk estimates indicate that the number of breast cancer casualties due to mammography screening can be as high as 50 in the Netherlands per year. The number of lives saved is estimated to be much higher, but for an accurate calculation of the benefits of screening a better estimate of these risks is indispensable. Here it is attempted to better quantify the radiological risks of mammography screening through the application of a biologically based model for breast tumor induction by X-rays. The model is applied to data obtained from the National Institutes of Health in the U.S. These concern epidemiological data of female TB patients who received high X-ray breast doses in the period 1930-1950 through frequent fluoroscopy of their lungs. The mechanistic model that is used to describe the increased breast cancer incidence is based on an earlier study by Moolgavkar et al. (1980), in which the natural background incidence of breast cancer was modeled. The model allows for a more sophisticated extrapolation of risks to the low dose X-ray exposures that are common in mammography screening and to the higher ages that are usually involved. Furthermore, it allows for risk transfer to other (non-western) populations. The results have implications for decisions on the frequency of screening, the number of mammograms taken at each screening, minimum and maximum ages for screening and the transfer to digital equipment. (author)

Effect on sensitivity and specificity of mammography screening with or without comparison of old mammograms

International Nuclear Information System (INIS)

Thurfjell, M.G.; Vitak, B.; Azavedo, E.; Svane, G.; Thurfjell, E.

2000-01-01

In order to evaluate the effect of old mammograms on the specificity and sensitivity of radiologists in mammography screening, one hundred and fifty sets of screening mammograms were examined by 3 experienced screeners twice: once without and once in comparison with older mammograms. The films came from a population-based screening done during the first half of 1994 and comprised all 35 cancers detected during screening in 1994, 12/24 interval cancers, 14/34 cancers detected in the following screening and 89 normal mammograms. Without old mammograms, the screeners detected an average of 40.3 cancers (range 37-42), with a specificity of 87% (85-88%). With old mammograms, the screeners detected 37.7 cancers (range 34-42) with a specificity of 96% (94-99%). The change in detection rate was not significant. However, the increase in specificity was significant for each screener. Mammography screening with old mammograms available for comparison decreased the false-positive recall rate. The effect on sensitivity, however, was unclear

Budget Impact Analysis of Switching to Digital Mammography in a Population-Based Breast Cancer Screening Program: A Discrete Event Simulation Model

Science.gov (United States)

Comas, Mercè; Arrospide, Arantzazu; Mar, Javier; Sala, Maria; Vilaprinyó, Ester; Hernández, Cristina; Cots, Francesc; Martínez, Juan; Castells, Xavier

2014-01-01

Objective To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program. Methods A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared. Results Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term. Conclusions Switching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs. PMID:24832200

Understanding recall rates in screening mammography: A conceptual framework review of the literature

International Nuclear Information System (INIS)

Mohd Norsuddin, N.; Reed, W.; Mello-Thoms, C.; Lewis, S.J.

2015-01-01

Recall rates are one of the performance measures used to evaluate the effectiveness of mammography screening programs. There is conflicting evidence regarding the link between recall rates and cancer detection rates and a variety of differing recall rates exist between countries and readers. This variability in recall rates may have important clinical and economic implications such as unnecessary follow-up procedures, additional costs to the health care system and psychological effects for the women themselves associated with false-positive mammograms results. In order to reduce the impact of false positive recall rates in screening mammography, it is essential for all multidisciplinary health care providers, especially those in medical imaging, to fully understand the factors that may contribute and affect recall rates. The multifactorial nature of recall rates is explored in this paper through the construction of a conceptual map based on a review of the current literature. - Highlights: • Recall rates vary across countries and readers and for initial and subsequent screens. • Falsely recalling women has important clinical, cost and psycho-social implications. • Imaging technology, readers' expertise and patient presentation affect recall rates. • Higher recall rates do not translate into improved sensitivity at higher thresholds. • Multidisciplinary approaches to reduce recall rates may improve women experiences.

At what age should screening mammography be recommended for Asian women?

International Nuclear Information System (INIS)

Tsuchida, Junko; Nagahashi, Masayuki; Rashid, Omar M; Takabe, Kazuaki; Wakai, Toshifumi

2015-01-01

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

Screen-film mammography versus full-field digital mammography in a population-based screening program: The Sogn and Fjordane study

International Nuclear Information System (INIS)

Juel, Inger-Marie; Johannessen, Gunnar; Skaane, Per; Roth Hoff, Solveig; Hofvind, Solveig

2010-01-01

Background: Studies comparing analog and digital mammography in breast cancer screening have shown conflicting results. Little is known about the use of digital photon-counting detectors. Purpose: To retrospectively compare performance indicators in screen-film (SFM) and full-field digital mammography (FFDM) using a photon-counting detector in a population-based screening program. Material and Methods: The Norwegian Social Science Data Services approved the study, which was part of the Norwegian Breast Cancer Screening Program. The program invites women aged 50-69 years to two-view mammography biannually. The study period was January 2005 to June 2006 for SFM and August 2006 to December 2007 for FFDM. Independent double reading was performed using a five-point rating scale for probability of cancer. Recalls due to abnormal mammography were retrospectively reviewed by an expert panel. Performance indicators for the two techniques were compared. Attendance rate was 83.6% (7442/8901) for SFM and 82.0% (6932/8451) for FFDM. Results: The recall rate due to abnormal mammography, cancer detection rate and positive predictive value did not differ significantly between SFM and FFDM: recall 2.3% (174/7442) versus 2.4% (168/6932), cancer detection 0.39% (29/7442) versus 0.48% (33/6932), positive predictive value 16.7% (29/174) versus 19.6% (33/168), respectively (P>0.05 for all). The recall rate due to technically inadequate mammograms was 0.3% (19/7442) for SFM and 0.01% (1/6932) for FFDM. In the retrospective review, a significantly higher proportion of calcifications and asymmetric density were categorized as normal or definitively benign in FFDM compared with SFM. The average glandular dose was 2.17 mGy for SFM and 1.25 mGy for FFDM. Conclusion: Performance indicators show that FFDM using photon-counting detector is suitable for breast cancer screening. The lower radiation dose and lower recalls due to technically inadequate mammograms are of importance in mammography

Tests with films and film-screens using grid-mammography

International Nuclear Information System (INIS)

Wolf, G.; Kallinger, G.

1982-01-01

A comparison was made between mammography using grid-technique with a film-screen-system and mammography without grid, and with film-screens and also using industrial films. The image-quality of grid mammography looks like the same than using conventional techniques and industrial films. The problem of soft tissue grid techniques lies in the dose requirements, which was more than using film-screen-techniques without grid. New and improved recording systems, which reduce radiation dose when using the grid technique were analyzed. (orig.) [de

Potential Cost Savings of Contrast-Enhanced Digital Mammography.

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Breast cancer screening: the underuse of mammography

International Nuclear Information System (INIS)

Fox, S.; Baum, J.K.; Klos, D.S.; Tsou, C.V.

1985-01-01

The early detection of breast cancer is promoted by the American Cancer Society (ACS) and the American College of Radiology (ACR) by encouraging the regular use of three types of screening: breast self-examination (BSE), the clinical breast examination, and mammography. In August 1983, the ACS publicized seven recommendations pertaining to screening, including a revised statement about the routine use of mammography for women between the ages of 40 and 49 years. In response to the ACS statement, the present study assessed compliance with the updated recommendations for all three types of screening. The results show reasonable rates of compliance for the BSE (53%-69%) and clinical examination (70%-78%). In contrast, only 19% of the women between the ages of 35 and 49 and 25% of the women older than 50 reported complying with the recommendation to undergo one baseline screening mammogram. Some implications for health education by physicians and the professional education of physicians in the use of mammography are discussed

Study of mammography in mass screening for breast cancer

International Nuclear Information System (INIS)

Kitada, Masahiro; Sakai, Hiroko; Kubo, Yoshihiko; Samejima, Natsuki; Kurowarabi, Kunio; Iwabuchi, Shuji.

1995-01-01

In order to examine the rate of correct diagnosis by mammography at initial mass screening for breast cancer, we carried out a retrospective study of mammography findings in 267 cases of breast cancer detected at Asahikawa Cancer Screening Center. The screening was performed by physical examination, and in cases where disease was suspected, mammography, ultrasonography, and needle biopsy were done. Mammographically, 172 cases (64.4%) were cancer-positive, 58 cases (21.7%) were suspicious for cancer, and 37 cases (13.9%) were cancer-negative. Patients below 50 years of age and those with tumors of small diameter (<20 mm) showed a significantly lower rate of cancer positivity than patients aged 50 years or more and those with tumors 20 mm or more in diameter. Mammographic abnormalities were not specific, since these changes were also found in normal subjects and patients with benign diseases. Therefore, we concluded that mammography without physical examination at initial mass screening has a high risk of missing breast cancer. Mass screening for breast cancer should be performed by physical examination involving inspection and palpation at the first instance. If any suspicious findings are obtained, mammography, ultrasonography, and needle biopsy should be done. (author)

Radiology Residents' Performance in Screening Mammography Interpretation

International Nuclear Information System (INIS)

Lee, Eun Hye; Lyou, Chae Yeon

2013-01-01

To evaluate radiology residents' performance in screening mammography interpretation and to analyze the factors affecting performance. We enrolled 203 residents from 21 institutions and performed mammography interpretation tests. Between the trainee and non-trainee groups, we compared the interpretation score, recall rate, sensitivity, positive predictive value (PPV) and false-positive rate (FPR). We estimated the training effect using the score differences between trainee and non-trainee groups. We analyzed the factors affecting performance between training-effective and non-effective groups. Trainees were superior to non-trainees regarding interpretation score (43.1 vs. 37.1), recall rate (11.0 vs. 15.5%), sensitivity (83.6 vs. 72.0%), PPV (53.0 vs. 32.4%) and FPR (13.5 vs. 25.5). The longer the training period, the better were the interpretation score, recall rate, sensitivity, PPV and FPR (rho = 0.486, -0.375, 0.343, 0.504, -0.446, respectively). The training affected an increase by an average of 6 points; however, 31.6% of institutions showed no effect. A difference was noted in the volume of mammography interpretation during a month (594.0 vs. 476.9) and dedication of breast staff (61.5 vs. 0%) between training-effective and non-effective groups. Trainees showed better performance in mammography interpretation compared to non-trainees. Moreover, performance was correlated with the training period. The factors affecting performance were the volume of mammography interpretation and the dedication of the breast staff.

Mammography screening in Nigeria – A critical comparison to other countries

International Nuclear Information System (INIS)

Lawal, O.; Murphy, F.J.; Hogg, P.; Irurhe, N.; Nightingale, J.

2015-01-01

Breast cancer is a leading cause of death among women, and according to the World Health Organisation (WHO) there will be a significant increase in the incidence of breast cancer in developing countries such as Nigeria by 2030. However, mammography screening can significantly reduce the mortality and morbidity of women as a result of breast cancer. Therefore, the aim of this review is to evaluate the mammography screening program in Nigeria, compare it with four developed countries and then draw inferences. The Nigerian screening program was evaluated using the following factors: - mode of invitation, frequency of screening, age of the participants, image projections, imaging staff, quality assurance program, and availability. Similarities exist between Nigeria and four developed countries (the United States of America, United Kingdom, Australia and Canada), for instance trained Radiographers do the imaging and the image projections obtained are the same. However, important differences exist, these include mode of invitation, financial model, quality assurance program and availability. On comparison with the four developed countries, various issues have been identified within the Nigerian breast screening programmes. No one simple solution can be offered to address these as the challenges are multi-factorial. - Highlights: • The mammography screening program in Nigeria is compared to four structured screening programs. • There is poor participation of Nigerian women in the screening program. • The cost of mammogram is associated with poor attendance. • The Nigerian screening program lags behind with the age of women invited for screening and lack of quality assurance program.

Factors influencing elderly women's mammography screening decisions: implications for counseling.

Science.gov (United States)

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

At what age should screening mammography be recommended for Asian women?

Science.gov (United States)

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.

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

Directory of Open Access Journals (Sweden)

Vlahiotis A

2018-03-01

Full Text Available Anna Vlahiotis,1 Brian Griffin,2 A Thomas Stavros,3 Jay Margolis1 1Value Based Care, Outcomes Research, Truven Health Analytics, an IBM Company, Bethesda, MD USA; 2Value Based Care, Outcomes Research, Truven Health Analytics, an IBM Company, Newark, NJ, USA; 3Seno Medical Instruments, Inc., San Antonio, TX, USA Background: Little data exist on real-world patterns and associated costs of downstream breast diagnostic procedures following an abnormal screening mammography or clinical exam.Objectives: 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.Materials and methods: 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.Results: 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

The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria.

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Schiller-Fruehwirth, Irmgard; Jahn, Beate; Einzinger, Patrick; Zauner, Günther; Urach, Christoph; Siebert, Uwe

2017-09-01

In 2014, Austrian health authorities implemented an organized breast cancer screening program. Until then, there has been a long-standing tradition of opportunistic screening. To evaluate the cost-effectiveness of organized screening compared with opportunistic screening, as well as to identify factors influencing the clinical and economic outcomes. We developed and validated an individual-level state-transition model and assessed the health outcomes and costs of organized and opportunistic screening for 40-year-old asymptomatic women. The base-case analysis compared a scenario involving organized biennial screening with a scenario reflecting opportunistic screening practice for an average-risk woman aged 45 to 69 years. We applied an annual discount rate of 3% and estimated the incremental cost-effectiveness ratio in terms of the cost (2012 euros) per life-year gained (LYG) from a health care perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. Compared with opportunistic screening, an organized program yielded on average additional 0.0118 undiscounted life-years (i.e., 4.3 days) and cost savings of €41 per woman. In the base-case analysis, the incremental cost-effectiveness ratio of organized screening was approximately €20,000 per LYG compared with no screening. Assuming a willingness-to-pay threshold of €50,000 per LYG, there was a 70% probability that organized screening would be considered cost-effective. The attendance rate, but not the test accuracy of mammography, was an influential factor for the cost-effectiveness. The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Evidence on Synthesized Two-dimensional Mammography Versus Digital Mammography When Using Tomosynthesis (Three-dimensional Mammography) for Population Breast Cancer Screening.

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Houssami, Nehmat

2017-09-28

One limitation of using digital breast tomosynthesis (3-dimensional [3D] mammography) technology with conventional (2-dimensional [2D]) mammography for breast cancer (BC) screening is the increased radiation dose from dual acquisitions. To resolve this problem, synthesized 2D (s2D) reconstruction images similar to 2D mammography were developed using tomosynthesis acquisitions. The present review summarizes the evidence for s2D versus digital mammography (2D) when using tomosynthesis (3D) for BC screening to address whether using s2D instead of 2D (alongside 3D) will yield similar detection measures. Comparative population screening studies have provided consistent evidence that cancer detection rates do not differ between integrated 2D/3D (range, 5.45-8.5/1000 screens) and s2D/3D (range, 5.03-8.8/1000 screens). Also, although the recall measures were relatively heterogeneous across included studies, little difference was found between the 2 modalities. The mean glandular dose for s2D/3D was 55% to 58% of that for 2D/3D. In the context of BC screening, s2D/3D involves substantially less radiation than 2D/3D and provides similar detection measures. Thus, consideration of transitioning to tomosynthesis screening should aim to use s2D/3D to minimize harm. Copyright © 2017 Elsevier Inc. All rights reserved.

Breast Cancer Screening, Mammography, and Other Modalities.

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Fiorica, James V

2016-12-01

This article is an overview of the modalities available for breast cancer screening. The modalities discussed include digital mammography, digital breast tomosynthesis, breast ultrasonography, magnetic resonance imaging, and clinical breast examination. There is a review of pertinent randomized controlled trials, studies and meta-analyses which contributed to the evolution of screening guidelines. Ultimately, 5 major medical organizations formulated the current screening guidelines in the United States. The lack of consensus in these guidelines represents an ongoing controversy about the optimal timing and method for breast cancer screening in women. For mammography screening, the Breast Imaging Reporting and Data System lexicon is explained which corresponds with recommended clinical management. The presentation and discussion of the data in this article are designed to help the clinician individualize breast cancer screening for each patient.

Digital mammography in breast cancer screening: Evaluation and innovation

NARCIS (Netherlands)

Bluekens, A.M.J.

2015-01-01

With all other imaging modalities in radiology being digitised and conventional mammography being ready to phase out the transition to digital mammography was inevitable. This thesis describes the performance of digital screening mammography and the consequences of implementation in a

Cost-effectiveness of breast cancer screening policies using simulation.

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Gocgun, Y; Banjevic, D; Taghipour, S; Montgomery, N; Harvey, B J; Jardine, A K S; Miller, A B

2015-08-01

In this paper, we study breast cancer screening policies using computer simulation. We developed a multi-state Markov model for breast cancer progression, considering both the screening and treatment stages of breast cancer. The parameters of our model were estimated through data from the Canadian National Breast Cancer Screening Study as well as data in the relevant literature. Using computer simulation, we evaluated various screening policies to study the impact of mammography screening for age-based subpopulations in Canada. We also performed sensitivity analysis to examine the impact of certain parameters on number of deaths and total costs. The analysis comparing screening policies reveals that a policy in which women belonging to the 40-49 age group are not screened, whereas those belonging to the 50-59 and 60-69 age groups are screened once every 5 years, outperforms others with respect to cost per life saved. Our analysis also indicates that increasing the screening frequencies for the 50-59 and 60-69 age groups decrease mortality, and that the average number of deaths generally decreases with an increase in screening frequency. We found that screening annually for all age groups is associated with the highest costs per life saved. Our analysis thus reveals that cost per life saved increases with an increase in screening frequency. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors influencing elderly women's mammography screening decisions: implications for counseling

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Davis Roger B

2007-11-01

Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusion While a doctor's recommendation is the most important factor influencing

Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program.

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Skaane, Per; Bandos, Andriy I; Gullien, Randi; Eben, Ellen B; Ekseth, Ulrika; Haakenaasen, Unni; Izadi, Mina; Jebsen, Ingvild N; Jahr, Gunnar; Krager, Mona; Niklason, Loren T; Hofvind, Solveig; Gur, David

2013-04-01

To assess cancer detection rates, false-positive rates before arbitration, positive predictive values for women recalled after arbitration, and the type of cancers detected with use of digital mammography alone and combined with tomosynthesis in a large prospective screening trial. A prospective, reader- and modality-balanced screening study of participants undergoing combined mammography plus tomosynthesis, the results of which were read independently by four different radiologists, is under way. The study was approved by a regional ethics committee, and all participants provided written informed consent. The authors performed a preplanned interim analysis of results from 12,631 examinations interpreted by using mammography alone and mammography plus tomosynthesis from November 22, 2010, to December 31, 2011. Analyses were based on marginal log-linear models for binary data, accounting for correlated interpretations and adjusting for reader-specific performance levels by using a two-sided significance level of .0294. Detection rates, including those for invasive and in situ cancers, were 6.1 per 1000 examinations for mammography alone and 8.0 per 1000 examinations for mammography plus tomosynthesis (27% increase, adjusted for reader; P = .001). False-positive rates before arbitration were 61.1 per 1000 examinations with mammography alone and 53.1 per 1000 examinations with mammography plus tomosynthesis (15% decrease, adjusted for reader; P tomosynthesis; P = .72). Twenty-five additional invasive cancers were detected with mammography plus tomosynthesis (40% increase, adjusted for reader; P tomosynthesis (P tomosynthesis in a screening environment resulted in a significantly higher cancer detection rate and enabled the detection of more invasive cancers. Clinical trial registration no. NCT01248546. RSNA, 2013

Benefits, risks, and costs of mammography

International Nuclear Information System (INIS)

Richter, B.; Rausch, L.

1977-01-01

The risk seems to be acceptable if the age-dependency of the frequency of breast cancer is disregarded, i.e. if calculation is done with average values, as is being done frequently (15, 25, 32, 48). This procedure however veils the real circumstances in the examination of young women thus also veiling a risk which could otherwise be made precise and avoidable. The risk of radiation-induced cancerogenesis in the female breast was verified by similar statements made by several empiric investigations on man. The course of the dose-effect-relation in the region of few rad is still unexplained however, although the results do not contradict to the assumption of a linear dose-effect-relation. Thus it seems not advisable to ignore the induction of carcinomas by x-radiation for the sphere of mammography with the doses usually applied today. A reduction of radiation exposition by dose-saving measures to one tenth of the present value (or less) however would make the risk highly unimportant. Advantage/risk/cost-analyses should encourage the responsible persons to make reasonable proposals for the application of methods, in this case mammography. The discouraging of patients whom mammography is indicated for would be a side-effect which is not desired. Just as wrong would be the stimulation of an unjustified feeling of being sure and the demand for costly medical measures by uncritical reports of success. The indication of the considerably high costs of mammography should, together with the advantage expected, be a quantitative criterion for the optimal distribution of limited means the necessity of which cannot be denied. (orig.) [de

Body weight and sensitivity of screening mammography

DEFF Research Database (Denmark)

Njor, Sisse H.; von Euler-Chelpin, My; Tjønneland, Anne

2016-01-01

benefit more from screening than other women. Methods: We combined data from the Danish Diet, Cancer and Health study and the organised population-based screening mammography programme in Copenhagen, Denmark. Women were categorised according to body mass index (BMI) (...Aim: Obese women tend to participate less in breast cancer screening than normal weight women. However, obese women have fattier breast than normal weight women, and screening mammography works better in fatty than in dense breasts. One might, therefore, hypothesise that obese women would actually......, and 35+). We measured recall rate, sensitivity and specificity for subsequent screens with a 2-year follow-up period. Results: The study included 6787 women. The recall rate varied from 1.4% for women with BMI women with BMI 35+, test for trend p = 0.86. Sensitivity varied from 42% (95...

Value of mammography screening in women under age 50 years

International Nuclear Information System (INIS)

Eddy, D.M.; Hasselblad, V.; McGivney, W.; Hendee, W.

1988-01-01

Two quantitative methods, Confidence Profiles and CAN*TROL, are used to analyze evidence and estimate the health and economic consequences of adding annual mammography to annual breast physical examinations in asymptomatic women aged 40 to 49 years who are at average risk for breast cancer. Such women have about a 128 in 10,000 chance of having breast cancer in the next ten years and about an 82 in 10,000 chance of dying of such a cancer. Adding annual mammograms to annual breast physical examinations each year during that age decade would reduce the probability of death to about 60 in 10,000, a reduction of about 26%. Screening would increase the expected lifetime of a woman destined to get breast cancer between ages 40 and 49 years by about 3.5 years. Ten years of screening with mammography in that age decade carries a risk of radiation-induced cancer of about one in 25,000 and a risk of a surgery recommendation for a lesion that is not cancer of about one in ten. If 25% of the women in this age group in the United States were screened every year, breast cancer mortality in the year 2000 would be decreased by about 373 deaths. In 1984 dollars, the cost of screening, workups, and continuing care in the year 2000 would be about $408 million. Treatment costs would be decreased by about $6 million, leaving a net increase in costs in the year of 2000 of approximately $402 million (1984 dollars)

Digital versus screen-film mammography: impact of mammographic density and hormone therapy on breast cancer detection.

Science.gov (United States)

Chiarelli, Anna M; Prummel, Maegan V; Muradali, Derek; Shumak, Rene S; Majpruz, Vicky; Brown, Patrick; Jiang, Hedy; Done, Susan J; Yaffe, Martin J

2015-11-01

Most studies that have examined the effects of mammographic density and hormone therapy use on breast cancer detection have included screen-film mammography. This study further examines this association in post-menopausal women screened by digital mammography. Approved by the University of Toronto Research Ethics Board, this study identified 688,418 women of age 50-74 years screened with digital or screen-film mammography from 2008 to 2009 within the Ontario Breast Screening Program. Of 2993 eligible women with invasive breast cancer, 2450 were contacted and 1421 participated (847 screen-film mammography, 574 digital direct radiography). Mammographic density was measured by study radiologists using the standard BI-RADS classification system and by a computer-assisted method. Information on hormone therapy use was collected by a telephone-administered questionnaire. Logistic regression and two-tailed tests for significance evaluated associations between factors and detection method by mammography type. Women with >75 % radiologist-measured mammographic density compared to those with diagnosed with an interval than screen-detected cancer, with the difference being greater for those screened with screen-film (OR = 6.40, 95 % CI 2.30-17.85) than digital mammography (OR = 2.41, 95 % CI 0.67-8.58) and aged 50-64 years screened with screen-film mammography (OR = 10.86, 95 % CI 2.96-39.57). Recent former hormone therapy users were also at an increased risk of having an interval cancer with the association being significant for women screened with digital mammography (OR = 2.08, 95 % CI 1.17-3.71). Breast screening using digital mammography lowers the risk of having an interval cancer for post-menopausal women aged 50-64 with greater mammographic density.

[Commentary on the planned restructuring of mammography screening in Austria].

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Vutuc, Christian; Haidinger, Gerald

2011-08-01

With regards to the planned reorganisation of screening mammography in Austria - from an opportunistic to an organised system - the problems related with such a change are depicted from an epidemiological point of view. We were able to demonstrate earlier that opportunistic screening mammography matches the results of controlled screening mammography in Finland and Sweden. Switching to a controlled system in Austria would - besides the need for a change in legislation - lead to enormous expenditures in terms of resources needed and moreover, it could be not evaluated for years.

Cost-Effectiveness Analysis of Breast Cancer Control Interventions in Peru

Science.gov (United States)

Zelle, Sten G.; Vidaurre, Tatiana; Abugattas, Julio E.; Manrique, Javier E.; Sarria, Gustavo; Jeronimo, José; Seinfeld, Janice N.; Lauer, Jeremy A.; Sepulveda, Cecilia R.; Venegas, Diego; Baltussen, Rob

2013-01-01

Objectives In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. Methods We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. Results The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Conclusions Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this

Cost-effectiveness analysis of screening modalities for breast cancer in Japan with special reference to women aged 40-49 years

International Nuclear Information System (INIS)

Ohnuki, Koji; Kuriyama, Shinichi; Shoji, Narumi; Tsuji, Ichiro; Ohuchi, Noriaki; Nishino, Yoshikazu

2006-01-01

Although the introduction of screening mammography in Japan would be expected to reduce mortality from breast cancer, the optimal screening modality in terms of cost-effectiveness remains unclear. We compared the cost-effectiveness ratio, defined as the cost required for a life-year saved, among the following three strategies: annual clinical breast examination; annual clinical breast examination combined with mammography; and biennial clinical breast examination combined with mammography for women aged 30-79 years using a hypothetical cohort of 100,000. The sensitivity, specificity and early breast cancer rates were derived from studies conducted from 1995 to 2000 in Miyagi Prefecture. The treatment costs were based on a questionnaire survey conducted at 13 institutions in Japan. We used updated parameters that were needed in the analysis. Although the effectiveness of treatment in terms of the number of expected survival years was highest for annual combined modality, biennial combined modality had a higher cost-effectiveness ratio, followed by annual combined modality and annual clinical breast examination in all age groups. In women aged 40-49 years, annual combined modality saved 852.9 lives and the cost/survival duration was 3,394,300 yen/year, whereas for biennial combined modality the corresponding figures were 833.8 and 2,025,100 yen/year, respectively. Annual clinical breast examination did not confer any advantages in terms of effectiveness (815.5 lives saved) or cost-effectiveness (3,669,900 yen/year). While the annual combined modality was the most effective with respect to life-years saved among women aged 40-49 years, biennial combined modality was found to provide the highest cost-effectiveness. (author)

Implications of Overdiagnosis: Impact on Screening Mammography Practices

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Morris, Elizabeth; Feig, Stephen A.; Drexler, Madeline

2015-01-01

Abstract This review article explores the issue of overdiagnosis in screening mammography. Overdiagnosis is the screen detection of a breast cancer, histologically confirmed, that might not otherwise become clinically apparent during the lifetime of the patient. While screening mammography is an imperfect tool, it remains the best tool we have to diagnose breast cancer early, before a patient is symptomatic and at a time when chances of survival and options for treatment are most favorable. In 2015, an estimated 231,840 new cases of breast cancer (excluding ductal carcinoma in situ) will be diagnosed in the United States, and some 40,290 women will die. Despite these data, screening mammography for women ages 40–69 has contributed to a substantial reduction in breast cancer mortality, and organized screening programs have led to a shift from late-stage diagnosis to early-stage detection. Current estimates of overdiagnosis in screening mammography vary widely, from 0% to upwards of 30% of diagnosed cancers. This range reflects the fact that measuring overdiagnosis is not a straightforward calculation, but usually one based on different sets of assumptions and often biased by methodological flaws. The recent development of tomosynthesis, which creates high-resolution, three-dimensional images, has increased breast cancer detection while reducing false recalls. Because the greatest harm of overdiagnosis is overtreatment, the key goal should not be less diagnosis but better treatment decision tools. (Population Health Management 2015;18:S3–S11) PMID:26414384

Evaluation of the mammography screening studies conducted in Europe and North America; Auswertung der bisherigen Mammographie-Screening-Studien in Europa und in Nordamerika

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Schreer, I. [Mammazentrum des Universitaetsklinikums Kiel (Germany)

2001-04-01

The ancient randomized-controlled trials of breast cancer screening have offered clear evidence that invitation to participate in mammography screening with/without clinical examination is effective in breast cancer mortality reduction and underline the detection sensitivity of mammography. Recently published criticism of both the effect and fundamental data handling could be shown to be untenable. Randomized studies underestimate the effect while well-designed observational studies do not systematically overestimate the magnitude of the effect. To transform high-quality study results in all-day's practice is a huge challenge, but affordable as has been demonstrated in Great Britain, the Netherlands and Sweden. (orig.) [German] Die alten randomisiert-kontrollierten Studien erbrachten den Nachweis, dass durch Einladung zur Teilnahme an einem Mammmographiescreening mit/ohne klinische Untersuchung der Effekt der Mortalitaetsreduktion erreicht wird und unterstreichen die Sensitivitaet der Mammographie als Detektionstest. Juengste Kritik hat sich in der wissenschaftlichen Auseinandersetzung als unbegruendet herausgestellt. Randomisierte Studien unterschaetzen den Effekt, Beobachtungsstudien spiegeln besser das Ausmass des individuellen Nutzens. Die Uebertragung von Studienergebnissen in den Versorgungsalltag ist aeusserst schwierig, stellt hoechste Anforderungen an ein umfassendes Qualitaetsmanagement, ist jedoch machbar, wie Laender wie Grossbritannien, die Niederlande und Schweden zeigen. (orig.)

Barriers to Mammography Screening: How to Overcome Them

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Yasmin Hassoun

2015-10-01

Full Text Available Background: Screening mammography is an established intervention that leads to early breast cancer detection and reduced mortality. The Lebanese Ministry of Health has initiated yearly awareness campaigns and provided free mammography in multiple centers around the country. Methods: The study took place in two major areas of Lebanon - Beirut and South Lebanon. This cross-sectional survey aimed to assess knowledge about breast cancer screening and screening behaviors in the Lebanese population. The primary outcome of the study was to assess the reasons that prevented women from performing screening mammography based on our categories of questions: lack of knowledge about breast cancer, lack of access to screening facilities, failure of primary care physician to encourage screening behavior, and other reasons. Results: The major barriers to seek screening that had statistically significant P-values, in order of prevalence, included: lack of knowledge about breast cancer, followed by social reasons and lack of access. Conclusion: Given the prevalence of breast cancer in our population, it is important to understand the pitfalls that we experience in promoting awareness. Our study is the first study to reach out to the community to assess perceived barriers against screening and provide solutions for such barriers.

Estimating the relative utility of screening mammography.

Science.gov (United States)

Abbey, Craig K; Eckstein, Miguel P; Boone, John M

2013-05-01

The concept of diagnostic utility is a fundamental component of signal detection theory, going back to some of its earliest works. Attaching utility values to the various possible outcomes of a diagnostic test should, in principle, lead to meaningful approaches to evaluating and comparing such systems. However, in many areas of medical imaging, utility is not used because it is presumed to be unknown. In this work, we estimate relative utility (the utility benefit of a detection relative to that of a correct rejection) for screening mammography using its known relation to the slope of a receiver operating characteristic (ROC) curve at the optimal operating point. The approach assumes that the clinical operating point is optimal for the goal of maximizing expected utility and therefore the slope at this point implies a value of relative utility for the diagnostic task, for known disease prevalence. We examine utility estimation in the context of screening mammography using the Digital Mammographic Imaging Screening Trials (DMIST) data. We show how various conditions can influence the estimated relative utility, including characteristics of the rating scale, verification time, probability model, and scope of the ROC curve fit. Relative utility estimates range from 66 to 227. We argue for one particular set of conditions that results in a relative utility estimate of 162 (±14%). This is broadly consistent with values in screening mammography determined previously by other means. At the disease prevalence found in the DMIST study (0.59% at 365-day verification), optimal ROC slopes are near unity, suggesting that utility-based assessments of screening mammography will be similar to those found using Youden's index.

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

Science.gov (United States)

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

Evaluation of the mammography screening studies conducted in Europe and North America

International Nuclear Information System (INIS)

Schreer, I.

2001-01-01

The ancient randomized-controlled trials of breast cancer screening have offered clear evidence that invitation to participate in mammography screening with/without clinical examination is effective in breast cancer mortality reduction and underline the detection sensitivity of mammography. Recently published criticism of both the effect and fundamental data handling could be shown to be untenable. Randomized studies underestimate the effect while well-designed observational studies do not systematically overestimate the magnitude of the effect. To transform high-quality study results in all-day's practice is a huge challenge, but affordable as has been demonstrated in Great Britain, the Netherlands and Sweden. (orig.) [de

Long-term psychosocial consequences of false-positive screening mammography

DEFF Research Database (Denmark)

Brodersen, John; Siersma, Volkert Dirk

2013-01-01

Cancer screening programs have the potential of intended beneficial effects, but they also inevitably have unintended harmful effects. In the case of screening mammography, the most frequent harm is a false-positive result. Prior efforts to measure their psychosocial consequences have been limite...... by short-term follow-up, the use of generic survey instruments, and the lack of a relevant benchmark-women with breast cancer....

Using Mammography Screening: Hmong Women’s Perceptions and Beliefs

Directory of Open Access Journals (Sweden)

Pang Vang

2010-01-01

Full Text Available Breast cancer is the second leading cause of cancer deaths among all women in the United States. Although mammography screening has been shown to be effective in detecting breast cancer, Hmong women, one of the Asian American/Pacific Islander subgroups, have a very low screening rate. The purpose of this study was to explore factors that influence Hmong women‘s willingness to be screened for breast cancer. Grounded Theory methodology guided the analysis of fifteen qualitative interviews with Midwestern Hmong women between the ages of40-64. Regardless of age, length of US residency, and language spoken, the results showed one core theme and three interrelated themes regarding the women‘s decision to seek mammographyscreening. The three interrelated themes of Breast Health Messages, Screening Barriers, and Screening Facilitators can have negative and/or positive influences on the core theme of mammography-screening decision-making processes. The first related theme of Breast HealthMessages included professional and lay breast health messages. The second related theme, Screening Facilitators, included breast health messages from professionals, abnormal findings, social support, risk for getting breast cancer, doctor‘s recommendations, and insurance. The third related theme, Screening Barriers, identified symptomatic health seeking behavior, instrumental barriers, fear, social influence (which included lay breast health messages, use of traditional Hmong healing practices, embarrassment, and perception of breast cancer risk. This study suggested that the healthcare professionals need to use a culturally sensitive and multidisciplinaryapproach to provide breast health education as well as to assess and provide instrumental support, while encouraging social support to influence Hmong women to attain mammography screening.

Evaluation of costs and benefits of mammography screening for breast cancer in the context of French resources

International Nuclear Information System (INIS)

Bouhnik, H.; Renaud-Salis, J.L.; Maccia, C.

1987-01-01

Breast cancer is one of the major causes of mortality among American and European adult women. In the last two decades the probability for a woman of developing breast cancer in one's lifetime has changed from 1 in 20 to 1 in 11. The overall ten years survival is no more than 50% and the death rate from breast cancer has been stationary for the last 40 years. According to the available data from some regional tumor registries the annual incidence of breast cancer in France is about 0.8%. Approximately 25,000 new cases of breast cancer are annually diagnosed among the 12 000 000 French women above 40 years old. About 9,000 of them will die of the disease. This represents about 20% of the deaths from cancers, and 4% of deaths from all causes among women. The overall five years survival rate is approximately 60% for white females. However, if breast cancer is diagnosed and treated while localized, the five years survival is greater than 85% for women without nodal involvement while it drops to 47% when nodes are involved. Moreover, while the standard treatment of breast tumors more than 3 cm involves at least a simple mastectomy, a more conservative approach is increasingly accepted as a safe solution for tumors less than 3 cm in size. The Rational behind Breast Cancer Screening (BSC) is that early detection provides the chance to treat patients at a time when the treatment is more likely to be effective in reducing morbidity, mortality or both. The only diagnostic test whose effectiveness for early detection of breast cancer has been proven is mammography. However, this radiologic test involves risks and costs that have led to considerable controversies concerning its overall efficacy and safety. We shall present in this paper the current evidences and assumptions about the effectiveness, the costs, and the benefits of mammography as a breast cancer screening test. We shall focus in the last section on the feasibility of such a program in France taking into account

Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists

International Nuclear Information System (INIS)

Torres-Mejía, Gabriela; Smith, Robert A.; Carranza-Flores, María de la Luz; Bogart, Andy; Martínez-Matsushita, Louis; Miglioretti, Diana L.; Kerlikowske, Karla; Ortega-Olvera, Carolina; Montemayor-Varela, Ernesto; Angeles-Llerenas, Angélica; Bautista-Arredondo, Sergio; Sánchez-González, Gilberto; Martínez-Montañez, Olga G.; Uscanga-Sánchez, Santos R.; Lazcano-Ponce, Eduardo; Hernández-Ávila, Mauricio

2015-01-01

An alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries. We evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed. Radiographer’s sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7–86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7–57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6–0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms. Given the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists

Determinants of mammography screening behavior in Iranian women: A population-based study

Directory of Open Access Journals (Sweden)

Mitra Moodi

2012-01-01

Full Text Available Background: Breast cancer remains a substantial health concern in Iran due to delay and late stage at diagnosis and treatment. Despite the potential benefits of mammography screening for early detection of breast cancer, the performance of this screening among Iranian women is low. For planning appropriate intervention, this study was carried out to identify mammography rates and explore determinants of mammography screening behavior in females of Isfahan, Iran. Materials and Methods: In this population-based study, 384 women of 40 years and older were interviewed by telephone. The Farsi version of Champion′s Health Belief Model scale (CHBMS was used to examine factors associated with mammography screening. The obtained data were analyzed by SPSS (version 16.0 using statistical Chi-square, Fisher Exact test, t-test and multiple logistic regression model to identify the importance rate of socio-demographic and Health Belief Model (HBM variables to predict mammography screening behavior. In all of tests, the level of significant was considered a = 0.05. Results: Mean age ΁ SD of women was 52.24 ΁ 8.2 years. Of the 384 participants, 44.3% reported at least one mammogram in their lifetime. Logistic regression analysis indicated that women were more likely to have mammography if they heard/read about breast cancer (OR = 4.17, 95% CI 2.09, 8.34, menopause in lower age (OR = 0.2, 95% CI 0.87, 0.99 and history of breast problem (OR = 0.9, 95% CI 0.12, 0.32. Also, women who perceived more benefits of mammography (OR = 1.84, 95% CI 1.63, 2.09, fewer barriers of mammography (OR = 0.91, 95% CI 0.86, 0.96 and had more motivation for health (OR = 0.94, 95% CI 0.89, 1 were more likely to have mammography. Conclusion: The findings indicated that the rate of mammography screening among women in Isfahan province is low and highlights the need for developing a comprehensive national breast cancer control program, which should be considered as the first

Digital mammography screening: average glandular dose and first performance parameters

International Nuclear Information System (INIS)

Weigel, S.; Girnus, R.; Czwoydzinski, J.; Heindel, W.; Decker, T.; Spital, S.

2007-01-01

Purpose: The Radiation Protection Commission demanded structured implementation of digital mammography screening in Germany. The main requirements were the installation of digital reference centers and separate evaluation of the fully digitized screening units. Digital mammography screening must meet the quality standards of the European guidelines and must be compared to analog screening results. We analyzed early surrogate indicators of effective screening and dosage levels for the first German digital screening unit in a routine setting after the first half of the initial screening round. Materials and Methods: We used three digital mammography screening units (one full-field digital scanner [DR] and two computed radiography systems [CR]). Each system has been proven to fulfill the requirements of the National and European guidelines. The radiation exposure levels, the medical workflow and the histological results were documented in a central electronic screening record. Results: In the first year 11,413 women were screened (participation rate 57.5 %). The parenchymal dosages for the three mammographic X-ray systems, averaged for the different breast sizes, were 0.7 (DR), 1.3 (CR), 1.5 (CR) mGy. 7 % of the screened women needed to undergo further examinations. The total number of screen-detected cancers was 129 (detection rate 1.1 %). 21 % of the carcinomas were classified as ductal carcinomas in situ, 40 % of the invasive carcinomas had a histological size ≤ 10 mm and 61 % < 15 mm. The frequency distribution of pT-categories of screen-detected cancer was as follows: pTis 20.9 %, pT1 61.2 %, pT2 14.7 %, pT3 2.3 %, pT4 0.8 %. 73 % of the invasive carcinomas were node-negative. (orig.)

Is mammography screening history a predictor of future breast cancer risk?

DEFF Research Database (Denmark)

Andersen, Sune Bangsbøll; Törnberg, Sven; Kilpeläinen, Sini

2015-01-01

Inspired by the model by Walter and Day for risk of cervical cancer following negative screens, one might hypothesize that women in a mammography screening programme with a certain number of negative screens had a lower remaining breast cancer risk than that of women in general. We studied whether...... number of negative screens was a predictor for a low remaining breast cancer risk in women participating in the mammography screening programmes in Stockholm, Copenhagen and Funen. Data were collected from the mammography screening programmes in Stockholm, Sweden (1989-2012), Copenhagen, Denmark (1991......-2009) and Funen, Denmark (1993-2009), and linked to the respective cancer registries. We calculated cumulative hazard rates for breast cancer in women in cohorts defined by age at entry and number of negative screens for the maximum follow-up period in each screening centre. For all centres and cohorts...

[Mammography screening of breast cancer in Tunisia. Results of first experience].

Science.gov (United States)

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.

The effects of music on pain and anxiety during screening mammography.

Science.gov (United States)

Zavotsky, Kathleen Evanovich; Banavage, Adrienne; James, Patricia; Easter, Kathy; Pontieri-Lewis, Vicky; Lutwin, Lynn

2014-06-01

One in four women who are diagnosed with breast cancer die annually, and the single most important way to prevent this is early detection; therefore, women older than 40 years should have an annual screening mammography. Many barriers have been reported that prevent compliance with this recommendation, including lack of insurance, fear, anxiety, pain, worry, and mistrust of the medical community. Nurses are in a position to use creative interventions, such as music therapy, to help minimize barriers. Although this study did not show that music therapy during screening mammograms decreased the amount of pain that the participants experienced, it did suggest that music therapy has the potential to decrease the amount of anxiety. Assisting patients in decreasing anxiety reduces barriers for screening mammography. The literature does suggest that music is a distraction for many populations of patients; however, when patients are faced with the possible diagnosis of breast cancer, it may be difficult to find an intervention to distract a woman's mind, which was supported by the findings of this study.

Does digital mammography in a decentralized breast cancer screening program lead to screening performance parameters comparable with film-screen mammography?

International Nuclear Information System (INIS)

Ongeval, Chantal van; Steen, Andre van; Zanca, Federica; Bosmans, Hilde; Marchal, Guy; Putte, Gretel vande; Limbergen, Erik van

2010-01-01

To evaluate if the screening performance parameters of digital mammography (DM) in a decentralized screening organization were comparable with film-screen mammography (FSM). A nationwide screening program was launched in 2001, and since 2005 screening with DM has been allowed. Firstly, the parameters of the three regional screening units (RSUs) that first switched to DM (11,355 women) were compared with the FSM period of the same three RSUs (23,325 women). Secondly, they were compared with the results of the whole central breast unit (CBU). The recall rate (RR) of the DM group in the initial round was 2.64% [2.40% for FSM (p = 0.43)] and in the subsequent round 1.20% [1.58% for FSM (p = 0.03)]. The cancer detection rate (CDR) was 0.59% for DM and 0.64% for FSM (p = 0.56). The percentage of ductal carcinoma in situ was 0.07% for DM and 0.16% for FSM (p = 0.02). The positive predictive value was high in the subsequent rounds (DM 48.00%, FSM 45.93%) and lower in the initial round (DM 24.05%, FSM 24.86%). Compared with the results of the whole CBU, DM showed no significant difference. DM can be introduced in a decentralized screening organization with a high CDR without increasing the RR. (orig.)

Quality assurance programme for screen film mammography

International Nuclear Information System (INIS)

2009-01-01

The application of radiation in human health, for both the diagnosis and treatment of disease, is an important component of the work of the IAEA. In the area of diagnostic radiology, this work is focused on quality assurance methods to both the promotion of the effective use of radiation for diagnostic outcome, through achieving and maintaining appropriate image quality, and also on dose determination to allow the monitoring and reduction of dose to the patient. In response to heightened awareness of the importance of patient dose contributed by radiology procedures, the IAEA published Dosimetry in Diagnostic Radiology: An International Code of Practice (Technical Reports Series No. 457) in 2007, to form a basis for patient dose determination for the Member States. Further to this, it is recognized that for complex diagnostic procedures, such as mammography, a detailed guidance document is required to give the professionals in the clinical centre the knowledge necessary to assess the patient dose, as well as to ensure that the procedure gives the maximal patient benefit possible. It is well documented that without the implementation of a quality culture and a systematic quality assurance programme with appropriate education, the detection of breast cancer cannot be made at an early enough stage to allow effective curative treatment to be undertaken. Currently there are a number of established quality assurance protocols in mammography from national and regional institutions, however, many of these protocols are distinctive and so a harmonized approach is required. This will allow the Member States to facilitate quality assurance in mammography in a standardized way which will also facilitate the introduction of national quality assurance programmes that are needed to underpin effective population screening programmes for breast cancer. Development of a quality assurance document for screen film mammography was started in 2005 with the appointment of a drafting

Film-Screen Mammography versus digital storage plate mammography: Hard copy and monitor display of microcalcifications and focal findings - A retrospective clinical and histologic analysis

International Nuclear Information System (INIS)

Schulz-Wendtland, R.; Wenkel, E.; Aichinger, U.; Tartsch, M.; Kuchar, I.; Bautz, W.

2003-01-01

Purpose: A retrospective clinical-histological study to determine the diagnostic accuracy of mammography using conventional screen-film cassettes (hard copy), high-resolution digital phosphor storage plates (hard copy) and monitor display (soft copy) for microcalcifications and focal lesions (BI-RADS TM category 4 or 5). Materials and methods: From April to November 2001, 76 patients underwent conventional film-screen mammography and, after diagnosis and preoperative wire localization, digital mammography with the same exposure parameters. Five investigators retrospectively determined the diagnosis after the operation from randomly distributed mediolateral views (hard-copy reading) and from the monitor display (soft-copy reading). These results were correlated with the final histology. Results: The accuracy of conventional screen-film mammography, digital mammography and monitor-displayed mammography was 67%, 65% and 68% for all findings, (n = 76), 59%, 59% and 68% for microcalcifications (n = 44) and 75%, 72% and 63% for focal lesions (n = 32). The overall results showed no difference. Conclusions: Our findings indicate equivalence of conventional screen-film mammography, high-resolution digital phosphor storage plate mammography and monitor-displayed mammography. (orig.) [de

Image quality in conventional film screen system, digital phosphor storage plate mammography in magnification technique and digital mammography in CCD-technique

International Nuclear Information System (INIS)

Schulz-Wendtland, R.; Aichinger, U.; Boehner, C.; Dobritz, M.; Bautz, W.; Saebel, M.

2000-01-01

Purpose: Comparison of image quality between conventional film screen system, digital phosphor storage plate mammography in magnification technique and digital mammography in CCD-technique. Materials and Methods: Radiograms of a RMI-mammography phantom were acquired using a conventional film screen system, two digital storage plate systems and two digital systems in CCD-technique. Additionally, the radiograms of one digital phosphor storage plate system were post-processed emphasizing contrast and included in the comparison. Results: The detectability of details was the best with the digital mammography in CCD-technique in comparison with the conventional film screen technique resp. digital phosphor storage plate in magnification technique. Conclusions: Based on these results there is the possibility to replace the conventional film screen system by further studies - this has to be confirmed. (orig.) [de

Mammography with rare earth intensifying screens

International Nuclear Information System (INIS)

Maurer, H.J.; Goos, F.

1987-01-01

Screens basing on rare earth phosphors with suitable films green or blue sensitive may be used in mammography with grids without diagnostic losses. Highest definition will be obtained with medium densities on film. High-speed screens may reduce dose, but definition is poor. Best compromise between speed and high definition may be reached with relative low thickness of phosphor layers. A system of high definition films (Medichrome) and special rare earth screens give best results. (orig.) [de

Mammography Screening Among African-American Women with a Family History of Breast Cancer

National Research Council Canada - National Science Library

Lipkus, Issac

1997-01-01

Comparisons were made between African-American women with and without a family history of breast cancer with respect to mammography screening, attitudes towards mammography screening and perceptions...

Introduction of organised mammography screening in tyrol: results of a one-year pilot phase

Directory of Open Access Journals (Sweden)

Daniaux Martin

2011-02-01

Full Text Available Abstract Background Efficiency and efficacy of organised mammography screening programs have been proven in large randomised trials. But every local implementation of mammography screening has to check whether the well established quality standards are met. Therefore it was the aim of this study to analyse the most common quality indices after introducing organised mammography screening in Tyrol, Austria, in a smooth transition from the existing system of opportunistic screening. Methods In June 2007, the system of opportunistic mammography screening in Tyrol was changed to an organised system by introducing a personal invitation system, a training program, a quality assurance program and by setting up a screening database. All procedures are noted in a written protocol. Most EU recommendations for organised mammography screening were followed, except double reading. All women living in Tyrol and covered by social insurance are now invited for a mammography, in age group 40-59 annually and in age group 60-69 biannually. Screening mammography is offered mainly by radiologists in private practice. We report on the results of the first year of piloting organised mammography screening in two counties in Tyrol. Results 56,432 women were invited. Estimated participation rate was 34.5% at one year of follow-up (and 55.5% at the second year of follow-up; 3.4% of screened women were recalled for further assessment or intermediate screening within six months. Per 1000 mammograms nine biopsies were performed and four breast cancer cases detected (N = 68. Of invasive breast cancer cases 34.4% were ≤ 10 mm in size and 65.6% were node-negative. In total, six interval cancer cases were detected during one year of follow-up; this is 19% of the background incidence rate. Conclusions In the Tyrolean breast cancer screening program, a smooth transition from a spontaneous to an organised mammography screening system was achieved in a short time and with minimal

Reader practice in mammography screen reporting in Australia

International Nuclear Information System (INIS)

Reed, W.; Poulos, A.; Brennan, P.

2009-01-01

Full text: Reader variability is a problem in mammography image reporting and compromises the efficacy of screening programmes. The purpose of this exploratory study was to survey reader practice in reporting screening mammograms in Australia to identify aspects of practice that warrant further investigation. Mammography reporting practice and influences on concentration and attention were investigated by using an original questionnaire distributed to screen readers in Australia. A response rate of 71% (83 out of 117) was achieved. Demographic data indicated that the majority of readers were over 46 years of age (73%), have been reporting on screening mammograms for over 10 years (61%), take less than 1 min to report upon a screening mammogram examination (66%), report up to 200 examinations in a single session (83%) and take up to 2 h to report one session (61%). A majority report on more than 5000 examinations annually (66%); 93% of participants regard their search strategy as systematic, 87% agreed that their concentration can vary throughout a session, 64% agreed that the relatively low number of positives can lead to lapses in concentration and attention and almost all (94%) participants agreed that methods to maximise concentration should be explored. Participants identified a range of influences on concentration within their working environment including volume of images reported in one session, image types and aspects of the physical environment. This study has provided important evidence of the need to investigate adverse influences on concentration during mammography screen reporting

Screening mammography uptake within Australia and Scotland in rural and urban populations.

Science.gov (United States)

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.

Interval breast cancers in the 'screening with tomosynthesis or standard mammography' (STORM) population-based trial.

Science.gov (United States)

Houssami, Nehmat; Bernardi, Daniela; Caumo, Francesca; Brunelli, Silvia; Fantò, Carmine; Valentini, Marvi; Romanucci, Giovanna; Gentilini, Maria A; Zorzi, Manuel; Macaskill, Petra

2018-04-01

The prospective 'screening with tomosynthesis or standard mammography' (STORM) trial recruited women participating in biennial breast screening in Italy (2011-2012), and compared sequential screen-readings based on 2D-mammography alone or based on tomosynthesis (integrated 2D/3D-mammography). The STORM trial showed that tomosynthesis screen-reading significantly increased breast cancer detection compared to 2D-mammography alone. The present study completes reporting of the trial by examining interval breast cancers ascertained at two year follow-up. 9 interval breast cancers were identified; the estimated interval cancer rate was 1.23/1000 screens [9/7292] (95%CI 0.56 to 2.34) or 1.24/1000 negative screens [9/7235] (95%CI 0.57 to 2.36). In concurrently screened women who attended the same screening services and received 2D-mammography, interval cancer rate was 1.60/1000 screens [40/25,058] (95% CI 1.14 to 2.17) or 1.61/1000 negative screens [40/24,922] (95% CI 1.15 to 2.18). Estimated screening sensitivity for the STORM trial was 85.5% [59/69] (95%CI 75.0%-92.8%), and that for 2D-mammography screening was 77.3% [136/176] (95%CI 70.4%-83.2%). Interval breast cancer rate amongst screening participants in the STORM trial was marginally lower (and screening sensitivity higher) than estimates amongst 2D-screened women; these findings should be interpreted with caution given the small number of interval cases and the sample size of the trial. Much larger screening studies, or pooled analyses, are required to examine interval cancer rates arising after breast tomosynthesis screening versus digital mammography screening. Copyright © 2018 Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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.

Mammography in breast screening and in the evaluation and management of breast cancer

International Nuclear Information System (INIS)

Onyesoh, C.N.

2006-01-01

This paper aims to discuss the importance of breast screening most especially amongst women above the age of 40 years.the limitation of the screening procedure is due to lack of special machines and power awareness campaigns. the application of Mammography and ultrasound in the examination of the breast and other breast imaging techniques will be considered in this paper. The paper will look at the indications for mammography, indications for breast ultrasound, signs of breast carcinoma on mammography, breast enlargement and also the need for breast ultrasound in cases of discrete Mammography

Mammography screening in Greece: An exploratory survey of women's views, experiences and behaviours

Directory of Open Access Journals (Sweden)

Athena Kalokerinou

2012-01-01

Full Text Available Background: Internationally, breast cancer comprises 29% of all cancer incidences. In Greece, 1,500-1,800women die annually from breast cancer out of the 4,000 who are affected. Only 5% are detected at an early diseasestage through mammography screening.Aim: This paper presents findings from a study exploring the factors that influence Greek women’smammography screening behaviour.Methodology: Data were collected in Athens-Greece, during the period March-July 2008, from individuals whowere members of six women’s associations. One hundred and eighty six questionnaires were completed and 33interviews were conducted from a sub-sample. This paper reports the findings from the questionnaire survey.Results: Participants had a variety of demographic characteristics with 85% of them having attendedmammography screening. Only 61% of them intended to continue in the future. Τhe majority of women agreedwith a number of factors which supported their decision to participate in regular mammography screening, such asdoctors’ encouragement and mammogram efficacy to detect breast cancer at an early stage, while anxiety wasidentified as a possible inhibitor to their participation.Conclusion: Women’s mammography screening behaviour and perceptions of mammography screening appearedto be positive in relation to their participation. However, the reasons as to why a large number of women indicatedthey were unlikely to go for mammography screening again is not known, and needs further investigation.

Breast cancer mortality in Norway after the introduction of mammography screening

DEFF Research Database (Denmark)

Olsen, Anne Helene; Lynge, Elsebeth; Njor, Sisse H

2013-01-01

An organized mammography screening program was gradually implemented in Norway during the period 1996-2004. Norwegian authorities have initiated an evaluation of the program. Our study focused on breast cancer mortality. Using Poisson regression, we compared the change in breast cancer mortality ...... to the program, the implementation of the organized mammography screening program was associated with a statistically nonsignificant decrease in breast cancer mortality of around 11%....

Relation between breast cancer mortality and screening effectiveness: systematic review of the mammography trials

DEFF Research Database (Denmark)

Gøtzsche, Peter C

2011-01-01

The mammography screening trials have shown varying results. This could be because screening was better in some trials than in others at advancing the time of diagnosis. If so, more cancers would be identified in such trials relative to the control group, and fewer of the cancers would have reach...

Comparison of average glandular dose in screen-film and digital mammography using breast tissue-equivalent phantom

International Nuclear Information System (INIS)

Shin, Gwi Soon; Kim, Jung Min; Kim, You Hyun; Choi, Jong Hak; Kim, Chang Kyun

2007-01-01

In recent years, mammography system is changed rapidly from conventional screen-film system to digital system for application to screening and diagnosis. Digital mammography system provides several advantages over screen-film mammography system. According to the information provided by the manufacturer, digital mammography system offers radiation dose reduction in comparison with screen-film mammography system, because of digital detector, particularly direct digital detector has higher x-ray absorption efficiency than screen-film combination or imaging plate (IP). We measured average glandular doses (ADG) in screen-film mammography (SFM) system with slow screen-film combination, computed mammography (CM) system, indirect digital mammography (IDM) system and direct digital mammography (DDM) system using breast tissue-equivalent phantom (glandularity 30%, 50% and 70%). The results were shown as follows: AGD values for DDM system were highest than those for other systems. Although automatic exposure control (AEC) mode was selected, the curve of the AGD values against thickness or glandularity increased significantly for the SFM system with the uniform target/filter (Mo/Mo) combination. Therefore, the AGD values for the high energy examinations were highest in the SFM system, and those for the low energy examinations were highest in the DDM system. But the curve of the AGD values against thickness and glandularity increased gently for CM system with the automatic selection of the target/filter combination (from Mo/Mo to Mo/Rh or from Mo/Rh to Rh/Rh), and the AGD values were lowest. Consequently, the parameters in mammography for each exposure besides detection efficiency play an important role in order to estimate a patient radiation dose

Richtlijn 'screening en diagnostiek van het mammacarcinoom' (herziening).

NARCIS (Netherlands)

Zonderland, H.M.; Tuut, M.K.; den Heeten, G.J.; Asperen, C.J.; de Bock, G.H.; Rutqers, E.J.; Westenend, P.J.; Smit, G.M.; Benraadt, J.

2008-01-01

Revised practice guideline 'Screening and diagnosis of breast cancer' The evidence-based revision of the practice guideline 'Screening and diagnosis of breast cancer' was necessitated by new insights, for instance on the cost-effectiveness of screening modalities other than mammography. Mammography

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

Science.gov (United States)

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 Screening Uptake among Female Health Care Workers in Primary Health Care Centers in Palestine - Motivators and Barriers.

Science.gov (United States)

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

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

Science.gov (United States)

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 mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p 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.

Quality control for the mammography screening program in Serbia: Physical and technical aspects

International Nuclear Information System (INIS)

Ciraj-Bjelac, O.; Bozovic, P.; Lazarevic, D.; Arandjic, D.; Kosutic, D.

2012-01-01

Breast cancer is the major cause of mortality among female population in Serbia. It is presumed that the introduction of screening programme will reduce mortality and therefore, 47 new mammography units were installed for the purpose of population-based screening program in 2011. In parallel, Quality assurance and Quality control (QC) in mammography has received increasing attention as an essential element of the successful breast cancer campaign that is for the first time initialed in Serbia. The purpose of this study is to investigate the need for and the possible implementation of the comprehensive QC programme for the mammography screening in Serbia, with special focus on physical and technical aspect. In the first phase, a QC protocols containing list of parameters, methodology, frequency of tests and reference values for screen-film, computed radiography and full-filed digital mammography) units, were developed. The second phase is focused on the initial implementation of these protocols. The paper presents results of tests of the selected parameters in 35 mammography units, with special emphasis on patient dose and image quality descriptors. After initial implementation at the beginning of the population based breast cancer screening campaign, it is essential to establish system of regular and periodic QC equipment monitoring and to ensure high quality mammograms with minimal possible radiation dose to population included in the screening. (authors)

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

Energy Technology Data Exchange (ETDEWEB)

Monnin, P [Institut Universitaire de Radiophysique Appliquee (IRA), CH-1007 Lausanne (Switzerland); Gutierrez, D [Institut Universitaire de Radiophysique Appliquee (IRA), CH-1007 Lausanne (Switzerland); Bulling, S [Institut Universitaire de Radiophysique Appliquee (IRA), CH-1007 Lausanne (Switzerland); Lepori, D [Department of Radiology, University Hospital Center (CHUV), CH-1011 Lausanne (Switzerland); Valley, J-F [Institut Universitaire de Radiophysique Appliquee (IRA), CH-1007 Lausanne (Switzerland); Verdun, F R [Institut Universitaire de Radiophysique Appliquee (IRA), CH-1007 Lausanne (Switzerland)

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.

Investigation of breast dose in five screening mammography centres in Greece

International Nuclear Information System (INIS)

Tsapaki, V; Tsalafoutas, I A; Poga, V; Louizi, A; Kottou, S; Koulentianos, E

2008-01-01

The objectives of this study were to investigate the techniques currently used for screening mammography in Greece, to estimate the mean glandular dose (MGD) for establishing a baseline radiation dose database, to analyse the effects of various factors on MGD, and to compare the results with others in the literature. Five mammographic facilities and 250 women having as a routine screening mammogram one craniocaudal (CC) and one mediolateral oblique (MLO) projection in each breast were included in the study. The parameters recorded were age, weight, compressed breast thickness (CBT), tube potential (kV), tube loading (mA s) and MLO projection angle. Large differences were observed among the different mammography facilities, mainly in terms of the tube potential setting and the MLO angle used. The average MGD per exposure was 1.4 ± 0.6 mGy while the respective averages separately for the CC and MLO projections were 1.2 ± 0.5 and 1.5 ± 0.7 mGy, respectively. The average MGD values recorded in this study were below the limit of 2 mGy established for the reference medium-sized breast of 4.5 cm CBT. However, the variety of techniques observed revealed the need for a nationwide survey concerning screening mammography in Greece

Investigation of breast dose in five screening mammography centres in Greece

Energy Technology Data Exchange (ETDEWEB)

Tsapaki, V [Medical Physics Department, Konstantopoulio Hospital, Nea Ionia, 142 33, Athens (Greece); Tsalafoutas, I A [Medical Physics Department, Agios Savvas Hospital, 171 Alexandras Avenue, 115 22, Athens (Greece); Poga, V; Louizi, A; Kottou, S [Medical Physics Department, Medical School, Athens University, University of Athens, 75 Mikras Asias, 115 27, Athens (Greece); Koulentianos, E [Radiology Department, Konstantopoulio Hospital, Nea Ionia, 142 33, Athens (Greece)

2008-09-01

The objectives of this study were to investigate the techniques currently used for screening mammography in Greece, to estimate the mean glandular dose (MGD) for establishing a baseline radiation dose database, to analyse the effects of various factors on MGD, and to compare the results with others in the literature. Five mammographic facilities and 250 women having as a routine screening mammogram one craniocaudal (CC) and one mediolateral oblique (MLO) projection in each breast were included in the study. The parameters recorded were age, weight, compressed breast thickness (CBT), tube potential (kV), tube loading (mA s) and MLO projection angle. Large differences were observed among the different mammography facilities, mainly in terms of the tube potential setting and the MLO angle used. The average MGD per exposure was 1.4 {+-} 0.6 mGy while the respective averages separately for the CC and MLO projections were 1.2 {+-} 0.5 and 1.5 {+-} 0.7 mGy, respectively. The average MGD values recorded in this study were below the limit of 2 mGy established for the reference medium-sized breast of 4.5 cm CBT. However, the variety of techniques observed revealed the need for a nationwide survey concerning screening mammography in Greece.

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

Science.gov (United States)

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.

Screening for breast cancer with mammography

DEFF Research Database (Denmark)

Gøtzsche, Peter C; Nielsen, Margrethe

2009-01-01

BACKGROUND: A variety of estimates of the benefits and harms of mammographic screening for breast cancer have been published and national policies vary. OBJECTIVES: To assess the effect of screening for breast cancer with mammography on mortality and morbidity. SEARCH STRATEGY: We searched Pub...... excluded a biased trial and included 600,000 women in the analyses. Three trials with adequate randomisation did not show a significant reduction in breast cancer mortality at 13 years (relative risk (RR) 0.90, 95% confidence interval (CI) 0.79 to 1.02); four trials with suboptimal randomisation showed...... a significant reduction in breast cancer mortality with an RR of 0.75 (95% CI 0.67 to 0.83). The RR for all seven trials combined was 0.81 (95% CI 0.74 to 0.87). We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential...

Effectiveness of a Mobile Mammography Program.

Science.gov (United States)

Stanley, Elizabeth; Lewis, Madelene C; Irshad, Abid; Ackerman, Susan; Collins, Heather; Pavic, Dag; Leddy, Rebecca J

2017-12-01

Mobile mammography units have increasingly been used to address patient health care disparities; however, there are limited data comparing mobile units to stationary sites. This study aims to evaluate the characteristics of women who underwent mammography screening in a mobile unit versus those who underwent mammography screening at a cancer center. In this retrospective study, we analyzed all screening mammography examinations performed in a mobile unit in 2014 (n = 1433 examinations). For comparison, we randomized and reviewed an equivalent number of screening mammography examinations performed at our cancer center in 2014 (n = 1434 examinations). BI-RADS assessment, adherence to follow-up, biopsies performed, cancer detection rate, and sociodemographic variables were recorded. An independent-samples t test was conducted to identify potential differences in age between cancer center patients and mobile unit patients. Chi-square analyses were used to test for associations between location and factors such as health insurance, race, marital status, geographic area, adherence to screening guidelines, recall rate, adherence to follow-up, and cancer detection rates. Patients visiting our cancer center (mean = 57.74 years; SD = 10.55) were significantly older than those visiting the mobile unit (mean = 52.58 years; SD = 8.19; p mobile van (cancer center = 3.70%, mobile unit = 38.73%). There was a significant association between screening location and patient race (χ 2 = 118.75, p mobile unit = 33.30%), more black patients being screened in the mobile van (cancer center = 49.30%, mobile unit = 54.15%), and more Hispanic patients being screened in the mobile van (cancer center = 1.05%, mobile unit = 6.77%). There was a significant association between location and patient marital status (χ 2 = 135.61, p mobile unit = 38.31%), more single patients screened in the mobile van (cancer center = 25.17%, mobile unit = 34.47%), and more widowed patients being screened at the

Breast Cancer Screening Coverage with clinical examination and Mammography Among insured women in Bogota

International Nuclear Information System (INIS)

Arboleda, Walter; Murillo Raul; Pinero, Marion

2009-01-01

The objective is to determine the coverage of clinical breast examination (CBE) and mammography for screening of breast cancer among a group of insured women in Bogota. Methods: A telephone survey was carried out with 4,526 women between the ages of 50 and 69, residing in Bogota or its suburbs, who were insured by one of three commercial health plans. Women with a history of breast cancer were excluded. Screening coverage was estimated as the proportion of women who had had a mammography or CBE. Estimates were established for lifetime frequency, two years prior the survey, and one year prior the survey. Factors associated with screening procedures were analyzed with calculations based on adjusted OR. Results: Lifetime frequency of CBE was 59.3% and 79.8% for mammography; and 49.7% and 65.6% of women respectively underwent the tests for screening purposes; the remainder, for diagnostic purposes (breast symptoms). CBE reported a 34.2% one year coverage and mammography reported a 54% two years coverage. Screening was associated to cancer education and family history of breast cancer. Conclusion: Coverage of CBE for screening purposes is low. Mammography coverage is above that required by the Colombian Health Ministry, but below that reported by developed countries.

Organisational aspects of mammography screening in digital settings: First experiences of Luxembourg

International Nuclear Information System (INIS)

Shannoun, F.; Schanck, J. M.; Scharpantgen, A.; Wagnon, M. C.; Ben Daoud, M.; Back, C.

2008-01-01

Luxembourg has been conducting a breast cancer screening programme since 1992, like a large number of other European countries, as early detection and treatment of breast cancer have been proven to reduce mortality. The majority of these screening programmes are based on analogue X-ray technology and have optimised their organisation of transporting, archiving and reading with respect to films. Last decade is marked by enormous developments in digital mammography. Different technologies such as flat panel-, computed radiography- and scanning systems became available. Digital mammography is expected to have a major impact on quality and organisation of breast cancer screening programmes. Screening programmes are now faced with a huge challenge of incorporating the digital technology, including implementation of electronic image exchange, conception of new electronic work-flow, establishing adapted quality assurance programmes and training of radiologists and technical personnel. Initial experiences of the Luxembourg approach in organising digital mammography screening and its quality assurance are reported. (authors)

Characteristics and screening outcome of women referred twice at screening mammography

International Nuclear Information System (INIS)

Setz-Pels, Wikke; Duijm, Lucien E.M.; Jansen, Frits H.; Louwman, Marieke W.J.; Roumen, Rudi M.H.; Voogd, Adri C.

2012-01-01

To determine the characteristics and screening outcome of women referred twice at screening mammography. We included 424,703 consecutive screening mammograms and collected imaging, biopsy and surgery reports of women with screen-detected breast cancer. Review of screening mammograms was performed to determine whether or not an initial and second referral comprised the same lesion. The overall positive predictive value of referral for cancer was 38.6% (95% CI 37.3-39.8%). Of 147 (2.6%) women referred twice, 86 had been referred for a different lesion at second referral and 32 of these proved malignant (37.2%, 95% CI 27.0-47.4%). Sixty-one women had been referred twice for the same lesion, of which 22 proved malignant (36.1%, 95% CI 24.1-48.0%). Characteristics of these women were comparable to women with cancer diagnosed after first referral. Compared with women without cancer at second referral for the same lesion, women with cancer more frequently showed suspicious densities at screening mammography (86.4% vs 53.8%, P = 0.02) and work-up at first referral had less frequently included biopsy (22.7% vs 61.5%, P = 0.004). Cancer risk in women referred twice for the same lesion is similar to that observed in women referred once, or referred for a second time but for a different lesion. (orig.)

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

Science.gov (United States)

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.

Screening mammography in Finland--1.5 million examinations with 97 percent specificity

International Nuclear Information System (INIS)

Dean, P.B.; Pamilo, M.

1999-01-01

A nationwide mammography screening program including women aged 50-59 years at the time of the first invitation and involving more than 100 radiologists was started in Finland in January, 1987. From 1987 through 1997, a total of 1,690,496 invitations to biennial two-view mammography screening was sent out. The compliance for screening was 88.5% with 1,495,744 screening examinations performed during this 11-year period. There were 49,020 recalls for further work-up studies and 9,689 women were referred for surgery. The total number of screening-detected breast cancers was 5,595, giving a detection rate of 3.7 cancers per 1000 screening studies. More than half of all surgical biopsies revealed breast cancer and 67.8% of the invasive cancers were at Stage I. The positive predictive value of referral to surgical biopsy increased from 33.2% in 1987 to 65.5% in 1997. and the ratio of malignant to benign biopsies more than tripled from the first to the fifth year of screening. The observed/expected ratio of invasive cancer detection was 2.44. Only 0.27% of all screening mammograms were followed by a benign biopsy, and 2.90% of all screening mammograms were followed by the women being recalled for further studies and not found to have breast cancer. This gave a specificity of recall after screening mammography greater than 97.0% and a specificity of referral to surgical biopsy greater than 99.7%. Measures of specificity improved considerably during the first three years of the screening program. The high specificity of screening mammography can be attributed to the nature of the screening process as well as to the opportunity for individual radiologists to attain a greater level of experience and competence. The decision to recall appears to have been crucial in determining the specificity

Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: improving information on the effects of attending screening mammography

Science.gov (United States)

Jacklyn, Gemma; Glasziou, Paul; Macaskill, Petra; Barratt, Alexandra

2016-01-01

Background: Women require information about the impact of regularly attending screening mammography on breast cancer mortality and overdiagnosis to make informed decisions. To provide this information we aimed to meta-analyse randomised controlled trials adjusted for adherence to the trial protocol. Methods: Nine screening mammography trials used in the Independent UK Breast Screening Report were selected. Extending an existing approach to adjust intention-to-treat (ITT) estimates for less than 100% adherence rates, we conducted a random-effects meta-analysis. This produced a combined deattenuated prevented fraction and a combined deattenuated percentage risk of overdiagnosis. Results: In women aged 39–75 years invited to screen, the prevented fraction of breast cancer mortality at 13-year follow-up was 0.22 (95% CI 0.15–0.28) and it increased to 0.30 (95% CI 0.18–0.42) with deattenuation. In women aged 40–69 years invited to screen, the ITT percentage risk of overdiagnosis during the screening period was 19.0% (95% CI 15.2–22.7%), deattenuation increased this to 29.7% (95% CI 17.8–41.5%). Conclusions: Adjustment for nonadherence increased the size of the mortality benefit and risk of overdiagnosis by up to 50%. These estimates are more appropriate when developing quantitative information to support individual decisions about attending screening mammography. PMID:27124337

Volumetric breast density affects performance of digital screening mammography

OpenAIRE

Wanders, JO; Holland, K; Veldhuis, WB; Mann, RM; Pijnappel, RM; Peeters, PH; Van Gils, CH; Karssemeijer, N

2016-01-01

PURPOSE: To determine to what extent automatically measured volumetric mammographic density influences screening performance when using digital mammography (DM). METHODS: We collected a consecutive series of 111,898 DM examinations (2003-2011) from one screening unit of the Dutch biennial screening program (age 50-75 years). Volumetric mammographic density was automatically assessed using Volpara. We determined screening performance measures for four density categories comparable to the Ameri...

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

Science.gov (United States)

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

Mammography screening. Benefits, harms, and informed choice.

Science.gov (United States)

Jørgensen, Karsten Juhl

2013-04-01

The rationale for breast cancer screening with mammography is deceptively simple: catch it early and reduce mortality from the disease and the need for mastectomies. But breast cancer is a complex problem, and complex problems rarely have simple solutions. Breast screening brings forward the time of diagnosis only slightly compared to the lifetime of a tumour, and screen-detected tumours have a size where metastases are possible. A key question is if screening can prevent metastases, and if the screen-detected tumours are small enough to allow breast conserving surgery rather than mastectomy. A mortality reduction can never justify a medical intervention in its own right, but must be weighed against the harms. Overdiagnosis is the most important harm of breast screening, but has gained wider recognition only in recent years. Screening leads to the detection and treatment of breast cancers that would otherwise never have been detected because they grow very slowly or not at all and would not have been detected in the woman's lifetime in the absence of screening. Screening therefore turns women into cancer patients unnecessarily, with life-long physical and psychological harms. The debate about the justification of breast screening is therefore not a simple question of whether screening reduces breast cancer mortality. This dissertation quantifies the primary benefits and harms of screening mammography. Denmark has an unscreened "control group" because only two geographical regions offered screening over a long time-period, which is unique in an international context. This was used to study breast cancer mortality, overdiagnosis, and the use of mastectomies. Also, a systematic review of overdiagnosis in five other countries allowed us to show that about half of the screen-detected breast cancers are overdiagnosed. An effect on breast cancer mortality is doubtful in today's setting, and overdiagnosis causes an increase in the use of mastectomies. These findings are

Breast density as indicator for the use of mammography or MRI to screen women with familial risk for breast cancer (FaMRIsc: a multicentre randomized controlled trial

Directory of Open Access Journals (Sweden)

Saadatmand Sepideh

2012-10-01

Full Text Available Abstract Background To reduce mortality, women with a family history of breast cancer often start mammography screening at a younger age than the general population. Breast density is high in over 50% of women younger than 50 years. With high breast density, breast cancer incidence increases, but sensitivity of mammography decreases. Therefore, mammography might not be the optimal method for breast cancer screening in young women. Adding MRI increases sensitivity, but also the risk of false-positive results. The limitation of all previous MRI screening studies is that they do not contain a comparison group; all participants received both MRI and mammography. Therefore, we cannot empirically assess in which stage tumours would have been detected by either test. The aim of the Familial MRI Screening Study (FaMRIsc is to compare the efficacy of MRI screening to mammography for women with a familial risk. Furthermore, we will assess the influence of breast density. Methods/Design This Dutch multicentre, randomized controlled trial, with balanced randomisation (1:1 has a parallel grouped design. Women with a cumulative lifetime risk for breast cancer due to their family history of ≥20%, aged 30–55 years are eligible. Identified BRCA1/2 mutation carriers or women with 50% risk of carrying a mutation are excluded. Group 1 receives yearly mammography and clinical breast examination (n = 1000, and group 2 yearly MRI and clinical breast examination, and mammography biennially (n = 1000. Primary endpoints are the number and stage of the detected breast cancers in each arm. Secondary endpoints are the number of false-positive results in both screening arms. Furthermore, sensitivity and positive predictive value of both screening strategies will be assessed. Cost-effectiveness of both strategies will be assessed. Analyses will also be performed with mammographic density as stratification factor. Discussion Personalized breast cancer screening

Transformative learning theory: facilitating mammography screening in rural women.

Science.gov (United States)

Purtzer, Mary Anne; Overstreet, Lindsey

2014-03-01

To use transformative learning to investigate what experiences serve as catalysts for mammography screening, the cognitive and affective responses that result from the catalyst, and how screening behavior is impacted. A descriptive qualitative study. Southeastern Wyoming. 25 low-income, rural women aged 40 years and older. Four focus group interviews. Cancer experiences triggered universal responses of fear by screeners and nonscreeners. The manner in which that fear response was interpreted was a critical factor in the facilitation of, or impedance to, screening. Dichotomous interpretations of fear responses provided the context for screening behavior. Immobilizing and isolating experiences were associated with nonscreening behavior, whereas motivation and self-efficacy were associated with screening behavior. Transformative learning theory is a useful framework from which to explain differences in mammography screening behavior. Creating opportunities that facilitate dialogue and critical reflection hold the potential to change immobilizing and isolating frames of reference in nonscreening women. To help women transcend their fear and become self-efficacious, nurses can assess how cancer and the screening experience is viewed and, if indicated, move beyond standard education and offer opportunities for dialogue and critical reflection.

Screening mammography beliefs and recommendations: a web-based survey of primary care physicians

Directory of Open Access Journals (Sweden)

Yasmeen Shagufta

2012-02-01

Full Text Available Abstract Background The appropriateness and cost-effectiveness of screening mammography (SM for women younger than 50 and older than 74 years is debated in the clinical research community, among health care providers, and by the American public. This study explored primary care physicians' (PCPs perceptions of the influence of clinical practice guidelines for SM; the recommendations for SM in response to hypothetical case scenarios; and the factors associated with perceived SM effectiveness and recommendations in the US from June to December 2009 before the United States Preventive Services Task Force (USPSTF recently revised guidelines. Methods A nationally representative sample of 11,922 PCPs was surveyed using a web-based questionnaire. The response rate was 5.7% (684; (41% 271 family physicians (FP, (36% 232 general internal medicine physicians (IM, (23% 150 obstetrician-gynaecologists (OBG, and (0.2% 31 others. Cross-sectional analysis examined PCPs perceived effectiveness of SM, and recommendation for SM in response to hypothetical case scenarios. PCPs responses were measured using 4-5 point adjectival scales. Differences in perceived effectiveness and recommendations for SM were examined after adjusting for PCPs specialty, race/ethnicity, and the US region. Results Compared to IM and FP, OBG considered SM more effective in reducing breast cancer mortality among women aged 40-49 years (p = 0.003. Physicians consistently recommended mammography to women aged 50-69 years with no differences by specialty (p = 0.11. However, 94% of OBG "always recommended" SM to younger and 86% of older women compared to 81% and 67% for IM and 84% and 59% for FP respectively (p = p = Conclusions A majority of physicians, especially OBG, favour aggressive breast cancer screening for women from 40 through 79 years of age, including women with short life expectancy. Policy interventions should focus on educating providers to provide tailored recommendations for

Breast cancer mortality in organised mammography screening in Denmark: comparative study

DEFF Research Database (Denmark)

Juhl Jørgensen, Karsten; Zahl, Per-Henrik; Gøtzsche, Peter C

2010-01-01

To determine whether the previously observed 25% reduction in breast cancer mortality in Copenhagen following the introduction of mammography screening was indeed due to screening, by using an additional screening region and five years additional follow-up....

Factors contributing to low participation in mammography screening in Papua New Guinea

International Nuclear Information System (INIS)

Pape, R.; Spuur, K.M.; Umo, P.

2016-01-01

Aim: The aim of this paper is to describe the current state of mammography screening services in Papua New Guinea (PNG) and to document factors thought to contribute to low participation in the free mammography screening service at the Pacific International Hospital (PIH), Port Moresby. Method: Women attending for mammography screening at PIH between August 2006 and July 2010 were invited to complete a survey investigating environmental, political, social, financial, cultural and health factors thought to be contributing to low participation in the mammography screening service. Ethics approval and permission to collect data was granted through the University of Papua New Guinea, School of Medicine and Health Sciences Research and Ethics Committee and by the Medical Director and Chief Operating Officer of PIH. Results: The reasons for low participation were found to be multifactorial; difficult environmental factors 42.86%; financial dependency factors 40.54%; cultural factors related to exposing the body 50.03%, social factors (sexual harassment) 77.6%, political factors 4.29% and health factors including poor health 54.54%. Conclusion: The study demonstrated that in this snapshot of PNG women, the low participation rate in the free mammography screening program at PIH was influenced by various interrelated factors inherent in both the PNG environment and culture, in particular lack of transport infrastructure, financial burden and sexual harassment. As low participation directly impacts upon the high breast cancer mortality in PNG women, a more comprehensive study of the women of PNG is required to validate this research. - Highlights: • Snap shot of issues surrounding low participation in the free screening program. • Geography and poor transport infrastructure made participation almost impossible. • Lack of funds for transport by either road or air deterred participation. • Sexual harassment was the main social factor that deterred access.

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

Science.gov (United States)

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.

Interval breast cancer characteristics before, during and after the transition from screen-film to full-field digital screening mammography.

Science.gov (United States)

van Bommel, Rob M G; Weber, Roy; Voogd, Adri C; Nederend, Joost; Louwman, Marieke W J; Venderink, Dick; Strobbe, Luc J A; Rutten, Matthieu J C; Plaisier, Menno L; Lohle, Paul N; Hooijen, Marianne J H; Tjan-Heijnen, Vivianne C G; Duijm, Lucien E M

2017-05-05

To determine the proportion of "true" interval cancers and tumor characteristics of interval breast cancers prior to, during and after the transition from screen-film mammography screening (SFM) to full-field digital mammography screening (FFDM). We included all women with interval cancers detected between January 2006 and January 2014. Breast imaging reports, biopsy results and breast surgery reports of all women recalled at screening mammography and of all women with interval breast cancers were collected. Two experienced screening radiologists reviewed the diagnostic mammograms, on which the interval cancers were diagnosed, as well as the prior screening mammograms and determined whether or not the interval cancer had been missed on the most recent screening mammogram. If not missed, the cancer was considered an occult ("true") interval cancer. A total of 442 interval cancers had been diagnosed, of which 144 at SFM with a prior SFM (SFM-SFM), 159 at FFDM with a prior SFM (FFDM-SFM) and 139 at FFDM with a prior FFDM (FFDM-FFDM). The transition from SFM to FFDM screening resulted in the diagnosis of more occult ("true") interval cancers at FFDM-SFM than at SFM-SFM (65.4% (104/159) versus 49.3% (71/144), P screened digitally for the second time (57.6% (80/139) at FFDM-FFDM versus 49.3% (71/144) at SFM-SFM). Tumor characteristics were comparable for the three interval cancer cohorts, except of a lower porportion (75.7 and 78.0% versus 67.2% af FFDM-FFDM, P cancers at FFDM with prior FFDM. An increase in the proportion of occult interval cancers is observed during the transition from SFM to FFDM screening mammography. However, this increase seems temporary and is no longer detectable after the second round of digital screening. Tumor characteristics and type of surgery are comparable for interval cancers detected prior to, during and after the transition from SFM to FFDM screening mammography, except of a lower proportion of invasive ductal cancers after the

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

Energy Technology Data Exchange (ETDEWEB)

Lobbes, Marc B.I.; Wildberger, Joachim E. [Maastricht University Medical Center, Department of Radiology, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands); Lalji, Ulrich; Houwers, Janneke; Nijssen, Estelle C. [Maastricht University Medical Center, Department of Radiology, Maastricht (Netherlands); Nelemans, Patty J. [Maastricht University, Department of Epidemiology, Maastricht (Netherlands); Roozendaal, Lori van; Heuts, Esther [Maastricht University Medical Center, Department of Surgical Oncology, Maastricht (Netherlands); Smidt, Marjolein L. [Maastricht University Medical Center, Department of Surgical Oncology, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands)

2014-07-15

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. (orig.)

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

International Nuclear Information System (INIS)

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

2014-01-01

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. (orig.)

Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil

Directory of Open Access Journals (Sweden)

René Aloisio da Costa Vieira

2015-09-01

Full Text Available Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40–69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn’t done de mammography in their lives and these women were principally from low socio-economic status (OR = 2.99, low education (OR = 3.00. The best strategies to include these women were mobile unit (OR = 1.43 and Family Health Program (OR = 1.79. The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.

Digital mammography in a screening programme and its implications for pathology: a comparative study.

LENUS (Irish Health Repository)

Feeley, Linda

2011-03-01

Most studies comparing full-field digital mammography (FFDM) with conventional screen-film mammography (SFM) have been radiology-based. The pathological implications of FFDM have received little attention in the literature, especially in the context of screening programmes. The primary objective of this retrospective study is to compare FFDM with SFM in a population-based screening programme with regard to a number of pathological parameters.

Mammography and Pap test screening among low-income foreign-born Hispanic women in the USA

Directory of Open Access Journals (Sweden)

Fernandez Maria E.

1998-01-01

Full Text Available Little is known about the factors influencing screening among low-income Hispanic women particularly among recent immigrants. A sample of 148 low-income, low-literate, foreign-born Hispanic women residing in the Washington DC metropolitan area participated in the study. The mean age of the sample was 46.2 (SD = 11.5, 84% reported annual household incomes<=$15,000. All women were Spanish speakers and had low acculturation levels. Ninety six percent had reported having a Pap smear, but 24% were not in compliance with recommended screening (Pap test within the last 3 years. Among women 40 and older, 62% had received a mammogram, but only 33% were compliant with age appropriate recommended mammography screening guidelines. Women in this study had more misconceptions about cancer than Hispanics in other studies. Multivariate logistic models for correlates of Pap test and mammography screening behavior indicate that factors such as fear of the screening test, embarrassment, and lack of knowledge influenced screening behavior. In conclusion, women in this study had lower rates of mammography screening than non-Hispanic women and lower rates of compliance with recommended Mammography and Pap test screening guidelines.

Four Principles to Consider Before Advising Women on Screening Mammography

DEFF Research Database (Denmark)

Keen, John D; Juhl Jørgensen, Karsten

2015-01-01

This article reviews four important screening principles applicable to screening mammography in order to facilitate informed choice. The first principle is that screening may help, hurt, or have no effect. In order to reduce mortality and mastectomy rates, screening must reduce the rate of advanced...... of a screening intervention. Disease-specific mortality is biased due to difficulties in attribution of cause of death and to increased mortality due to overdiagnosis and the resulting overtreatment with radiotherapy and chemotherapy. To enhance participation, the benefit from screening is often presented...... in relative instead of absolute terms. Third, some screening statistics must be interpreted with caution. Increased survival time and the percentage of early-stage tumors at detection sound plausible, but are affected by lead-time and length biases. In addition, analyses that only include women who attend...

Screening mammography in women 65 years old and older

International Nuclear Information System (INIS)

Rubin, E.; Mulligan, S.A.; Han, S.Y.; Bernreuter, W.K.; Stanley, R.J.

1990-01-01

This paper compares the results of mammographic screening in women aged 65 years and older to those of women aged 50--64 years, to define risk factors and prior use of mammography in these women, and to determine whether mammographic abnormalities are managed differently in the two age groups. Historical data, mammographic findings, and biopsy results were analyzed for all women over 50 years of age screened during 1988 (2,862 patients) at a university hospital-based outpatient center and mobile van, excluding those referred by oncologists. The following factors were determined for patients screened at the outpatient center and the mobile van, with both groups divided according to patient age (50--64 vs ≥ 65 years): presence of risk factors, previous biopsy, exogenous hormones, percentage of black patients, previous mammography, biopsy rate, cancer detection rate, positive nodes, and presence of tumors smaller than 1 cm or ductal carcinoma in-situ

The Potential Cost-Effectiveness of Amblyopia Screening Programs

Science.gov (United States)

Rein, David B.; Wittenborn, John S.; Zhang, Xinzhi; Song, Michael; Saaddine, Jinan B.

2013-01-01

Background To estimate the incremental cost-effectiveness of amblyopia screening at preschool and kindergarten, we compared the costs and benefits of 3 amblyopia screening scenarios to no screening and to each other: (1) acuity/stereopsis (A/S) screening at kindergarten, (2) A/S screening at preschool and kindergarten, and (3) photoscreening at preschool and A/S screening at kindergarten. Methods We programmed a probabilistic microsimulation model of amblyopia natural history and response to treatment with screening costs and outcomes estimated from 2 state programs. We calculated the probability that no screening and each of the 3 interventions were most cost-effective per incremental quality-adjusted life year (QALY) gained and case avoided. Results Assuming a minimal 0.01 utility loss from monocular vision loss, no screening was most cost-effective with a willingness to pay (WTP) of less than $16,000 per QALY gained. A/S screening at kindergarten alone was most cost-effective between a WTP of $17,000 and $21,000. A/S screening at preschool and kindergarten was most cost-effective between a WTP of $22,000 and $75,000, and photoscreening at preschool and A/S screening at kindergarten was most cost-effective at a WTP greater than $75,000. Cost-effectiveness substantially improved when assuming a greater utility loss. All scenarios were cost-effective when assuming a WTP of $10,500 per case of amblyopia cured. Conclusions All 3 screening interventions evaluated are likely to be considered cost-effective relative to many other potential public health programs. The choice of screening option depends on budgetary resources and the value placed on monocular vision loss prevention by funding agencies. PMID:21877675

Mammography

Science.gov (United States)

... breast cancer Whether there is any harm from breast cancer screening, such as side effects from testing or overtreatment of cancer when it's discovered Mammography is performed to screen women to detect early breast cancer when it is ...

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

Science.gov (United States)

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.

Mammography accreditation program

Energy Technology Data Exchange (ETDEWEB)

Wilcox, P.

1993-12-31

In the mid-1980`s, the movement toward the use of dedicated mammography equipment provided significant improvement in breast cancer detection. However, several studies demonstrated that this change was not sufficient to ensure optimal image quality at a low radiation dose. In particular, the 1985 Nationwide Evaluation of X-ray Trends identified the wide variations in image quality and radiation dose, even from dedicated units. During this time period, the American Cancer Society (ACS) launched its Breast Cancer Awareness Screening Campaign. However, there were concerns about the ability of radiology to respond to the increased demand for optimal screening examinations that would result from the ACS program. To respond to these concerns, the ACS and the American College of Radiology (ACR) established a joint committee on mammography screening in 1986. After much discussion, it was decided to use the ACR Diagnostic Practice Accreditation Program as a model for the development of a mammography accreditation program. However, some constraints were required in order to make the program meet the needs of the ACS. This voluntary, peer review program had to be timely and cost effective. It was determined that the best way to address these needs would be to conduct the program by mail. Finally, by placing emphasis on the educational nature of the program, it would provide an even greater opportunity for improving mammographic quality. The result of this effort was that, almost six years ago, in May 1987, the pilot study for the ACR Mammography Accreditation Program (MAP) began, and in August of that year, the first applications were received. In November 1987, the first 3-year accreditation certificates were awarded.

Mammography accreditation program

International Nuclear Information System (INIS)

Wilcox, P.

1993-01-01

In the mid-1980's, the movement toward the use of dedicated mammography equipment provided significant improvement in breast cancer detection. However, several studies demonstrated that this change was not sufficient to ensure optimal image quality at a low radiation dose. In particular, the 1985 Nationwide Evaluation of X-ray Trends identified the wide variations in image quality and radiation dose, even from dedicated units. During this time period, the American Cancer Society (ACS) launched its Breast Cancer Awareness Screening Campaign. However, there were concerns about the ability of radiology to respond to the increased demand for optimal screening examinations that would result from the ACS program. To respond to these concerns, the ACS and the American College of Radiology (ACR) established a joint committee on mammography screening in 1986. After much discussion, it was decided to use the ACR Diagnostic Practice Accreditation Program as a model for the development of a mammography accreditation program. However, some constraints were required in order to make the program meet the needs of the ACS. This voluntary, peer review program had to be timely and cost effective. It was determined that the best way to address these needs would be to conduct the program by mail. Finally, by placing emphasis on the educational nature of the program, it would provide an even greater opportunity for improving mammographic quality. The result of this effort was that, almost six years ago, in May 1987, the pilot study for the ACR Mammography Accreditation Program (MAP) began, and in August of that year, the first applications were received. In November 1987, the first 3-year accreditation certificates were awarded

Risk-benefit analysis for mass screening of breast cancer utilizing mammography as a screening test

International Nuclear Information System (INIS)

Iinuma, T.A.; Tateno, Yukio

1989-01-01

Incidence of breast cancers in Japanese women is increasing steadily. Mass screening of breast cancer was started in Japan under auspices of Adult Health Promotion Act of the Japanese Government from 1987. As the first screening method, the palpation of breasts is employed at present, but it is expected to be replaced by the mammography. In this report, the risk-benefit analysis is presented between risk of breast carcinogenesis due to radiation and benefit of mass screening of breast cancer. The benefit of mass screening is taken as the net elongation of average life expectancy of women due to survival from breast cancers. The risk of mammography is taken as the net loss of average life expectancy of women due to breast carcinogenesis. In the latter, the latency time and plateau period of radiation carcinogenesis were taken into consideration in the calculation. The results show that the ages at which the benefit and risk become equal are between 30 and 35 years old when dose equivalent of mammography is between 10 and 20 mSv, that are conventionally used. However, the critical age will be reduced to 20 years old if the dose equivalent becomes 1 mSv. Therefore, it is strongly recommended that a low dose mammographic system should be developed in order to achieve 1 mSv for the mass screening of breast cancer of Japanese women. In author's opinion, this is quite feasible by employing a new digital radiography with imaging plate. (author)

Mathematical simulation for estimating reduction of breast cancer mortality in mass screening using mammography

International Nuclear Information System (INIS)

Iinuma, Takeshi; Matsumoto, Tohru; Tateno, Yukio

1999-01-01

In Japan it is considered that mammography should be introduced with physical examination for the mass screening of breast cancer instead of physical examination alone, which is performed at present. Before the introduction of mammography, a mathematical simulation should be performed to show the reduction in breast cancer mortality by mass screening compared with an unscreened population. A mathematical model of cancer screening devised by the authors was used to estimate the number of deaths due to breast cancer (A) in the screened group and those (B) in the unscreened group within the same population. Then the relative risk (RR) and attributable risk (RD) were calculated as (A/B) and (B-A) respectively. Three methods of mass screening were compared: (1) physical examination (1-year interval), (2) mammography with physical examination (1-year interval), (3) mammography with physical examination (2-year interval). The calculated RR values were 0.85 for (1), 0.60 for (2) and 0.69 for (3). Assuming that the incidence of breast cancer was 100/10 5 person-years, the calculated RD values were 3.0, 8.1 and 6.2 persons/10 5 person-years for (1), (2) and (3), respectively. The 95% confidence interval of RR for three methods was over 1.0, and thus the reduction of breast cancer mortality was not statistically significant in the present population. In conclusion, mammography with physical examination may reduce breast cancer mortality in comparison with physical examination alone, but a larger number of women must be screened in order to obtain a significant RR value. (author)

Mammography Screening Trends: The Perspective of African American Women Born Pre/Post World War II

Science.gov (United States)

Williams, Karen Patricia; Mabiso, Athur; Lo, Yun-Jia; Penner, Louis A.

2013-01-01

Researchers have traditionally combined aging women (aged ≥50 years) when reporting their mammography use. This may inadvertently mask important cohort effects in mammography use, which are likely to result from distinct personal life experiences and generational differences. Using the Health and Retirement Study samples of 1998, 2000, and 2004, we examined cohort differences in mammography use between African American women born before 1946 (non–baby boomers) and those born in 1946 to 1953 (baby boomers). Between 1998 and 2004, screening rates for non–baby boomers declined, while those for baby boomers remained relatively steady. Hierarchical linear modeling (HLM) analyses suggest that while screening rates decreased with age (OR, 0.957; 95% CI, 0.947–0.968) cohort effects may have partially reversed the age effect, with non–baby boomers having an increased likelihood of receiving a mammogram compared to baby boomers (OR, 1.697; 95% CI, 1.278–2.254). Because African American women are diagnosed at later stages of breast cancer, documentation of cohort differences in mammography use among older African American women is important as health care professionals design intervention programs that are maximally effective for women from different cohorts. This is particularly critical as more African American women in the baby boomer cohort become part of the aging population. PMID:20575209

Use of prior mammograms in the transition to digital mammography: A performance and cost analysis

International Nuclear Information System (INIS)

Taylor-Phillips, S.; Wallis, M.G.; Duncan, A.; Gale, A.G.

2012-01-01

Breast screening in Europe is gradually changing from film to digital imaging and reporting of cases. In the transition period prior mammograms (from the preceding screening round) are films thereby potentially causing difficulties in comparison to current digital mammograms. To examine this breast screening performance was measured at a digital mammography workstation with prior mammograms displayed in different formats, and the associated costs calculated. 160 selected difficult cases (41% malignant) were read by eight UK qualified mammography readers in three conditions: with film prior mammograms; with digitised prior mammograms; or without prior mammograms. Lesion location and probability of malignancy were recorded, alongside a decision of whether to recall each case for further tests. JAFROC analysis showed a difference between conditions (p = .006); performance with prior mammograms in either film or digitised formats was superior to that without prior mammograms (p < .05). There was no difference in the performance when the prior mammograms were presented in film or digitised form. The number of benign or normal cases recalled was 26% higher without prior mammograms than with digitised or film prior mammograms (p < .05). This would correspond to an increase in recall rate at the study hospital from 4.3% to 5.5% with no associated increase in cancer detection rate. The cost of this increase was estimated to be £11,581 (€13,666) per 10,000 women screened, which is higher than the cost of digitised (£11,114/€13,115), or film display (£6451/€7612) of the prior mammograms. It is recommended that, where available, prior mammograms are used in the transition to digital breast screening.

Breast cancer incidence after the introduction of mammography screening: what should be expected?

DEFF Research Database (Denmark)

Svendsen, Anne Louise; Olsen, Anne Helene; von Euler-Chelpin, My

2006-01-01

BACKGROUND: A prevalence peak is expected in breast cancer incidence when mammography screening begins, but afterward the incidence still may be elevated compared with prescreening levels. It is important to determine whether this is due to overdiagnosis (ie, the detection of asymptomatic disease...... that would otherwise not have arisen clinically). In the current study, the authors examined breast cancer incidence after the introduction of mammography screening in Denmark. METHODS: Denmark has 2 regional screening programs targeting women ages 50 years to 69 years. The programs were initiated in 1991...

Social processes used by African American women in making decisions about mammography screening.

Science.gov (United States)

Fowler, Barbara Ann

2006-01-01

To describe the social processes used by African American (AA) women ages > or = 50 years in making decisions about mammography screening. Grounded theory methodology. Tape-recorded interviews with a researcher-designed, semi-structured interview guide with an initial and theoretical sample of 30 AA women ages 52 to 71 of diverse socioeconomic status. Interviews occurred in various settings such as the church rectory, women's homes, and work settings. Extensive written field notes and tapes were transcribed verbatim immediately after the interviews by an experienced transcriptionist. The women's decisions about mammography screening were associated with five social processes: (a) acknowledging prior experiences with healthcare providers and systems; (b) reporting fears and fatalistic beliefs of breast cancer and related treatment; (c) valuing the opinions of significant others; (d) relying on religious beliefs and supports; and (e) caregiving responsibilities of significant others. The processes were further differentiated by three distinct decision-making styles: taking charge, enduring, and protesting. Each of the social processes was reported equally and emphasized by the diverse sample of AA women in decisions related to mammography screening. Mammography screening decisions were heavily influenced by caregiving responsibilities. Further research is needed to explain and understand this social process on the health and well-being of AA women over time.

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

Science.gov (United States)

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.

Estimates of over-diagnosis of breast cancer due to population-based mammography screening in South Australia after adjustment for lead time effects.

Science.gov (United States)

Beckmann, Kerri; Duffy, Stephen W; Lynch, John; Hiller, Janet; Farshid, Gelareh; Roder, David

2015-09-01

To estimate over-diagnosis due to population-based mammography screening using a lead time adjustment approach, with lead time measures based on symptomatic cancers only. Women aged 40-84 in 1989-2009 in South Australia eligible for mammography screening. Numbers of observed and expected breast cancer cases were compared, after adjustment for lead time. Lead time effects were modelled using age-specific estimates of lead time (derived from interval cancer rates and predicted background incidence, using maximum likelihood methods) and screening sensitivity, projected background breast cancer incidence rates (in the absence of screening), and proportions screened, by age and calendar year. Lead time estimates were 12, 26, 43 and 53 months, for women aged 40-49, 50-59, 60-69 and 70-79 respectively. Background incidence rates were estimated to have increased by 0.9% and 1.2% per year for invasive and all breast cancer. Over-diagnosis among women aged 40-84 was estimated at 7.9% (0.1-12.0%) for invasive cases and 12.0% (5.7-15.4%) when including ductal carcinoma in-situ (DCIS). We estimated 8% over-diagnosis for invasive breast cancer and 12% inclusive of DCIS cancers due to mammography screening among women aged 40-84. These estimates may overstate the extent of over-diagnosis if the increasing prevalence of breast cancer risk factors has led to higher background incidence than projected. © The Author(s) 2015.

Quality assurance for screening mammography data collection systems in 22 countries.

NARCIS (Netherlands)

Klabunde, C.N.; Sancho-Garnier, H.; Broeders, M.E.A.C.; Thoresen, S.; Rodrigues, V.J.; Ballard-Barbash, R.

2001-01-01

OBJECTIVES: To document the mammography data that are gathered by the organized screening programs participating in the International Breast Cancer Screening Network (IBSN), the nature of their procedures for data quality assurance, and the measures used to assess program performance and impact.

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

Science.gov (United States)

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.

Trends in breast cancer mortality in Sweden before and after implementation of mammography screening.

Directory of Open Access Journals (Sweden)

Jari Haukka

Full Text Available Incidence-based mortality modelling comparing the risk of breast cancer death in screened and unscreened women in nine Swedish counties has suggested a 39% risk reduction in women 40 to 69 years old after introduction of mammography screening in the 1980s and 1990s.We evaluated changes in breast cancer mortality in the same nine Swedish counties using a model approach based on official Swedish breast cancer mortality statistics, robust to effects of over-diagnosis and treatment changes. Using mortality data from the NordCan database from 1974 until 2003, we estimated the change in breast cancer mortality before and after introduction of mammography screening in at least the 13 years that followed screening start.Breast mortality decreased by 16% (95% CI: 9 to 22% in women 40 to 69, and by 11% (95% CI: 2 to 20% in women 40 to 79 years of age.Without individual data it is impossible to completely separate the effects of improved treatment and health service organisation from that of screening, which would bias our results in favour of screening. There will also be some contamination of post-screening mortality from breast cancer diagnosed prior to screening, beyond our attempts to adjust for delayed benefit. This would bias against screening. However, our estimates from publicly available data suggest considerably lower benefits than estimates based on comparison of screened versus non-screened women.

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

Science.gov (United States)

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.

Pain and discomfort during mammography

DEFF Research Database (Denmark)

Aro, A R; Absetz-Ylöstalo, P; Eerola, T

1996-01-01

was the most powerful factor explaining pain and discomfort among women with earlier mammography. However, it had no effect among women without earlier mammography, for whom screening-related nervousness and perceptions of staff were crucial. Suggested interventions include better information before screening......The aim of this prospective study was to investigate associations of mammography pain and discomfort with sociodemographics, personal history and psychological and situational factors. Subjects were women with a negative screening finding (n = 883) from a random sample of 50-year-old Finnish women...... attending their first breast cancer screening. Questionnaires were sent 1 month before the screening invitation and 2 months after screening. Sixty-one per cent reported painful and 59% uncomfortable mammograms (4% severely). Linear regression analyses showed that anticipation of pain and discomfort...

Average glandular dose in routine mammography screening using a Sectra Microdose Mammography unit

International Nuclear Information System (INIS)

Hemdal, B.; Herrnsdorf, L.; Andersson, I.; Bengtsson, G.; Heddson, B.; Olsson, M.

2005-01-01

The Sectra MicroDose Mammography system is based on direct photon counting (with a solid-state detector), and a substantially lower dose to the breast than when using conventional system can be expected. In this work absorbed dose measurements have been performed for the first unit used in routine mammography screening (at the Hospitals of Helsingborg (Sweden)). Two European protocols on dosimetry in mammography have been followed. Measurement of half value layer (HVL) cannot be performed as prescribed, but this study has demonstrated than non-invasive measurements of HVL can be performed accurately with a sensitive and well collimated solid-state detector with simultaneous correction for the energy dependence. The average glandular dose for a 50 mm standard breast with 50% glandularity, simulated by 45 mm polymethylmethacrylate, was found to be 0.21 and 0.28 mGy in March and December 2004, respectively. These values are much lower than for any other mammography system on the market today. It has to be stressed that the measurement were made using the current clinical settings and that no systematic optimisation of the relationship between absorbed dose and diagnostic image quality has been performed within the present study. In order to further increase the accuracy of absorbed dose measurements for this unit, the existing dose protocols should be revised to account also for the tungsten/aluminium anode/filter combination, the multi-slit pre-collimator device and the occurrence of a dose profile in the scanning direction. (authors)

Examining the Influence of Cost Concern and Awareness of Low-cost Health Care on Cancer Screening among the Medically Underserved.

Science.gov (United States)

Best, Alicia L; Strane, Alcha; Christie, Omari; Bynum, Shalanda; Wiltshire, Jaqueline

2017-01-01

African Americans suffer a greater burden of mortality from breast, cervical, and colorectal cancers than other groups in the United States. Early detection through timely screening can improve survival outcomes; however, cost is frequently reported as a barrier to screening. Federally qualified health centers (FQHCs) provide preventive and primary care to underserved populations regardless of ability to pay, positioning them to improve cancer screening rates. The purpose of this study was to examine the influence of concern about health care cost (cost concern) and awareness of low-cost health care (awareness) on cancer screening among 236 African Americans within an FQHC service area using self-report surveys. Multiple logistic regression indicated that awareness was positively associated with cervical and colorectal cancer screening, while cost concern was negatively associated with mammography screening. Results indicate that improving awareness and understanding of low-cost health care could increase cancer screening among underserved African Americans.

Comparing sensitivity and specificity of screening mammography in the United States and Denmark

DEFF Research Database (Denmark)

Kemp Jacobsen, Katja; O'Meara, Ellen S; Key, Dustin

2015-01-01

Delivery of screening mammography differs substantially between the United States (US) and Denmark. We evaluated whether there are differences in screening sensitivity and specificity. We included screens from women screened at age 50-69 years during 1996-2008/2009 in the US Breast Cancer...

Breast dose variability in a bi-racial population undergoing screening mammography

International Nuclear Information System (INIS)

Schubauer-Berigan, M.K.; Baron, L.; Frey, G.D.; Hoel, D.G.

2002-01-01

This study evaluated individual and population dose variability during screening mammography among 570 white and black women in South Carolina, USA. Aspects of dosimetry that were considered include compressed breast thickness (CBT), number of films per screening session, and dose in previous or subsequent sessions. Breast dose was log-normally distributed in the population, with a geometric mean of 6.6 mGy per session. Doses were significantly higher for black women, for women with high CBT or who receive more than two views per breast, and for the mediolateral oblique, compared to the craniocaudal view. No relationship was observed between age and dose. Total dose per breast varied by a factor of 20 across the study population, but the individual's dose varied little among repeat screening sessions, especially after adjusting for the number of films received per session. These results may inform assessments of the projected risks of inducing breast cancer from screening mammography. (author)

Physical image quality of computed radiography in mammography system

International Nuclear Information System (INIS)

Norriza Mohd Isa; Muhammad Jamal Isa; Wan Muhamad Saridan Wan Hassan; Fatimah Othman

2013-01-01

Full-text: Mammography is a screening procedure that mostly used for early detection of breast cancer. In digital imaging system, Computed Radiography is a cost-effective technology that applied indirect conversion detector. The paper presents physical image quality parameter measurements namely modulation transfer function (MTF), normalized noise power spectrum (NNPS) and detective quantum efficiency (DQE) of Computed Radiography in mammography system. MTF was calculated from two different orientations of slanted images of an edge test device and NNPS was estimated using flat-field image. Both images were acquired using a standard mammography beam quality. DQE was determined by applying the MTF and NNPS values into our developed software program. Both orientations have similar DQE characteristics. (author)

Screen film vs full-field digital mammography: image quality, detectability and characterization of lesions

International Nuclear Information System (INIS)

Obenauer, S.; Luftner-Nagel, S.; Heyden, D. von; Baum, F.; Grabbe, E.; Munzel, U.

2002-01-01

The objective of this study was to compare screen-film mammography (SFM) to full-field digital mammography (FFDM) regarding image quality as well as detectability and characterization of lesions using equivalent images of the same patient acquired with both systems. Two mammography units were used, one with a screen-film system (Senographe DMR) and the other with a digital detector (Senographe 2000D, both GEMS). Screen-film and digital mammograms were performed on 55 patients with cytologically or histologically proven tumors on the same day. Together with these, 75 digital mammograms of patients without tumor and the corresponding previous screen-film mammograms not older than 1.5 years were reviewed by three observers in a random order. Contrast, exposure, and the presence of artifacts were evaluated. Different details, such as the skin, the retromamillary region, and the parenchymal structures, were judged according to a three-point ranking scale. Finally, the detectability of microcalcifications and lesions were compared and correlated to histology. Image contrast was judged to be good in 76%, satisfactory in 20%, and unsatisfactory in 4% of screen-film mammograms. Digital mammograms were judged to be good in 99% and unsatisfactory in 1% of cases. Improper exposure of screen-film system occurred in 18% (10% overexposed and 8% underexposed). Digital mammograms were improperly exposed in 4% of all cases but were of acceptable quality after post-processing. Artifacts, most of them of no significance, were found in 78% of screen-film and in none of the digital mammograms. Different anatomical regions, such as the skin, the retromamillary region, and dense parenchymal areas, were better visualized in digital than in screen-film mammography. All malignant tumors were seen by the three radiologists; however, digital mammograms allowed a better characterization of these lesions to the Breast Imaging Reporting and Data System (BI-RADSZZZ;) categories (FFDM better than

Magnification mammography: a comparison of full-field digital mammography and screen-film mammography for the detection of simulated small masses and microcalcifications

International Nuclear Information System (INIS)

Hermann, K.P.; Obenauer, S.; Funke, M.; Grabbe, E.H.

2002-01-01

The objective of this study was a comparison of a full-field digital mammography (FFDM) system and a conventional screen-film mammography (SFM) system with respect to the detectability of simulated small masses and microcalcifications in the magnification mode. All images were obtained using 1.8 times magnification. The FFDM images were obtained at radiation dose levels of 1.39, 1.0, 0.7, 0.49 and 0.24 times that of the SFM images. A contrast-detail phantom was used to compare the detection of simulated lesions using a four alternative forced-choice reader study with three readers. The correct observation ratio (COR) was calculated as the fraction of correctly identified lesions to the total number of simulated lesions. Soft-copy reading was performed for all digital images. Direct magnification images acquired with the digital system showed a lower object contrast threshold than those acquired with the conventional system. For equal radiation dose, the digital system provided a significantly increased COR (0.95) compared with the screen-film system (0.82). For simulated microcalcifications, the corresponding difference was 0.90 to 0.72. The digital system allowed equal detection to screen-film at 40% of the radiation dose used for screen film. Digital magnification images are superior to screen-film magnification images for the detection of simulated small masses and microcalcifications even at a lower radiation dose. (orig.)

Comparative evaluation of average glandular dose and image of digital mammography and film mammography in Minas Gerais, Brazil

International Nuclear Information System (INIS)

Nogueira, M.; Leyton, F.; Rodrigue, L. L.C.; Oliveira, M.A.; Joana, G.S.; Silva, S.D.

2015-01-01

Breast cancer is the most common cancer among women, and early detection is critical to its diagnosis and treatment. Mammography is the best method for breast-cancer screening and is capable of reducing mortality rates To date, the most effective method for early detection of breast cancer has been x-ray mammography for which the screen/film (SF) technique has been the gold standard. Digital mammography has been proposed as a substitute for film mammography given the benefits inherent to digital technology. The purpose of our study was to compare the technical performance of digital mammographic and screen-film mammography. A PMMA phantom with objects to simulate breast structures. For the screen/film (SF) technique the results showed that 54% mammography units did not achieve the minimum acceptable performance as far the image quality. Besides, 67% services showed inadequate performance in their processing systems, which had significant influence on the image quality. At the mean glandular dose only 44% of digital systems evaluated were compliant in all thicknesses of PMMA. The average glandular dose AGD was 90 % higher than in screen/film systems. (authors)

Digital breast tomosynthesis (3D-mammography) screening: A pictorial review of screen-detected cancers and false recalls attributed to tomosynthesis in prospective screening trials.

Science.gov (United States)

Houssami, Nehmat; Lång, Kristina; Bernardi, Daniela; Tagliafico, Alberto; Zackrisson, Sophia; Skaane, Per

2016-04-01

This pictorial review highlights cancers detected only at tomosynthesis screening and screens falsely recalled in the course of breast tomosynthesis screening, illustrating both true-positive (TP) and false-positive (FP) detection attributed to tomosynthesis. Images and descriptive data were used to characterise cases of screen-detection with tomosynthesis, sourced from prospective screening trials that performed standard (2D) digital mammography (DM) and tomosynthesis (3D-mammography) in the same screening participants. Exemplar cases from four trials highlight common themes of relevance to screening practice including: the type of lesions frequently made more conspicuous or perceptible by tomosynthesis (spiculated masses, and architectural distortions); the histologic findings (both TP and FP) of tomosynthesis-only detection; and the need to extend breast work-up protocols (additional imaging including ultrasound and MRI, and tomosynthesis-guided biopsy) if tomosynthesis is adopted for primary screening. Copyright © 2016 Elsevier Ltd. All rights reserved.

Breast screening with mammography: Overview of Swedish randomized trials

International Nuclear Information System (INIS)

Nystroem, L.; Wall, S.; Lindqvist, M.; Ryden, S.; Andersson, J.; Bjurstam, N.; Fagerberg, G.; Frisell, J.; Tabar, L.; Larson, L.G.

1993-01-01

Despite encouraging results from screening trials the efficacy of mammography in reducing mortality remains somewhat controversial. Five studies have been done in Sweden. This overview, reveals a 24% significant reduction of breast cancer mortality among those invited to mammography screening compared with those not invited. To avoid the potential risk of differential misclassification causes of death were assessed by an independent end-point committee after a blinded review of all fatal breast cancer cases. The mortality reduction was similar, irrespective of the end-point used for evaluation (breast cancer as underlying cause of death or breast cancer present at death). There was a consistent risk reduction associated with screening in all studies, although the point estimate of the relative risk for all ages varied non-significantly between 0.68 and 0.84. The cumulative breast cancer mortality by time since randomization was estimated at 1.3 per 1,000 within 6 years in the invited group compared with 1.6 in the control group. The corresponding figures after 9 years are 2.6 and 3.3 and after 12 years 3.9 and 5.1

Factors influencing elderly women's mammography screening decisions: implications for counseling

OpenAIRE

Schonberg, Mara A; McCarthy, Ellen P; York, Meghan; Davis, Roger B; Marcantonio, Edward R

2007-01-01

Abstract Background 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. Methods 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 ...

Quality control: comparison of images quality with screen film system and digital mammography CR

International Nuclear Information System (INIS)

Alvarenga, Frederico L.; Nogueira, Maria do Socorro

2008-01-01

The mammography screen film system should be used as part of processing chemicals, revelation process, equipment and this system has have a progressive replacing by the digital technology Full Field Digital Mammography FFDM, Computed Radiography (CR) Mammography and hardcopy. This new acquisition process of medical images has improved radiology section; however it is necessary efficient means for evaluating of the quality parameters. It should be considered taking into account the adaptation of the existent equipment and that procedures adopted for the exam, as well the adaptation of the new mammography films, the radiologist view box constitutes a part of the quality control program. This program aims at obtaining radiography with good quality that allows obtaining more information for the diagnosis and decreases the patient dose. For evaluation the quality image, this article is focused on presenting the differences regarding the acquired images through simulator mammography radiographic PMMA (Poly methyl methacrylate) in CR Mammography system and screen film system. The tests were accomplished at the same equipment of Mammography with the Automatic Exposure Control using a tension of 28 kV for both systems. The quality tests evaluated the spatial resolution, the own structures of the phantom, artifacts, optical density and contrast with conventional and laser films by mammography system. The installation for the accomplishment of the test has a quality control program. The evaluation was based on the pattern developed by the competent organ of the State of Minas Gerais. In this study, it was verified that the suitable Phantom Mama used by the Brazilian School of Radiology for conventional mammography did not obtain satisfactory result for Spatial Resolution in the digital mammography system CR. The final aim of this work is to obtain parameters to characterize the reference phantom quality image in an objective way. These parameters will be used to compare

The 20-year effort to reduce access to mammography screening: historical facts dispute a commentary in Cancer.

Science.gov (United States)

Kopans, Daniel B; Webb, Matthew L; Cady, Blake

2014-09-15

Mammography screening fulfills all requirements for an effective screening test. It detects many cancers earlier when they are at a smaller size and earlier stage, and it has been demonstrated that this reduces breast cancer deaths in randomized controlled trials. When screening is introduced into the population, the death rate from breast cancer declines. Nevertheless, scientifically unsupported arguments that appear in the medical literature are passed on to the public and continue to confuse women and physicians regarding the value of screening. Methodologically flawed challenges to mammography have been almost continuous since the 1990s. And, as each challenge has been invalidated, a new, specious challenge has been raised. The authors of this report address the long history of misinformation that has developed in the effort to reduce access to screening, and they address the issues raised by commentators concerning their recent publication in this journal. © 2014 American Cancer Society.

Digital mammography

International Nuclear Information System (INIS)

Bick, Ulrich; Diekmann, Felix

2010-01-01

This state-of-the-art reference book provides in-depth coverage of all aspects of digital mammography, including detector technology, image processing, computer-aided diagnosis, soft-copy reading, digital workflow, and PACS. Specific advantages and disadvantages of digital mammography in comparison to screen-film mammography are thoroughly discussed. By including authors from both North America and Europe, the book is able to outline variations in the use, acceptance, and quality assurance of digital mammography between the different countries and screening programs. Advanced imaging techniques and future developments such as contrast mammography and digital breast tomosynthesis are also covered in detail. All of the chapters are written by internationally recognized experts and contain numerous high-quality illustrations. This book will be of great interest both to clinicians who already use or are transitioning to digital mammography and to basic scientists working in the field. (orig.)

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

Science.gov (United States)

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.

Significance of screening mammography in the detection of breast diseases

International Nuclear Information System (INIS)

Ham, Soo Youn; Kim, Kyoung Ah; Oh, Yu Whan; Kim, Hong In; Chung, Kyoo Byung

1995-01-01

To evaluate the clinical significance of the screening mammography in the detection of the breast diseases, especially breast carcinoma. We analyzed 1,800 cases of mammography retrospectively. The mammography was done as a part of routine check in Health Counselling Center, Korea University Medical Center, during 9 months from November 1993 to July 1994. The age range was from 23 years to 76 years, mean 49.8 years, and the largest age group was 6th decade (31.4%). According to the mammographic findings, we divided the subjects into three groups; normal group, abnormal group in need of follow-up study, abnormal group requiring biopsy. On mammography, the normal group consisted of 1,534 cases (85%), and the abnormal group consisted of 266 cases (15%). The abnormal findings were benign-looking calcification (n = 140), fibroadeno ma (n = 29), fibrocystic changes (n = 27), cyst (n = 23), malignant lesion (n = 15) lipoma (n = 7), and others. In four of 15 cases, which were suspected to be malignant on mammograms, breast carcinoma was confirmed pathologically. In four cases of breast carcinoma, one was under 40 and the other 3 were over 50 years of age. All of the breast cancers were under 3 cm in size, and the mammographic findings of breast cancer included spiculated margin (n = 3), parenchymal distortion (n = 3), malignant calcification (n = 2) and enlarged axillary node (n = 1). Screening mammogram is helpful for early detection of non-palpable breast cancer, especially for women over 50 years of age

Significance of screening mammography in the detection of breast diseases

Energy Technology Data Exchange (ETDEWEB)

Ham, Soo Youn; Kim, Kyoung Ah; Oh, Yu Whan; Kim, Hong In; Chung, Kyoo Byung [College of Medicine Korea University, Seoul (Korea, Republic of)

1995-02-15

To evaluate the clinical significance of the screening mammography in the detection of the breast diseases, especially breast carcinoma. We analyzed 1,800 cases of mammography retrospectively. The mammography was done as a part of routine check in Health Counselling Center, Korea University Medical Center, during 9 months from November 1993 to July 1994. The age range was from 23 years to 76 years, mean 49.8 years, and the largest age group was 6th decade (31.4%). According to the mammographic findings, we divided the subjects into three groups; normal group, abnormal group in need of follow-up study, abnormal group requiring biopsy. On mammography, the normal group consisted of 1,534 cases (85%), and the abnormal group consisted of 266 cases (15%). The abnormal findings were benign-looking calcification (n = 140), fibroadeno ma (n = 29), fibrocystic changes (n = 27), cyst (n = 23), malignant lesion (n = 15) lipoma (n = 7), and others. In four of 15 cases, which were suspected to be malignant on mammograms, breast carcinoma was confirmed pathologically. In four cases of breast carcinoma, one was under 40 and the other 3 were over 50 years of age. All of the breast cancers were under 3 cm in size, and the mammographic findings of breast cancer included spiculated margin (n = 3), parenchymal distortion (n = 3), malignant calcification (n = 2) and enlarged axillary node (n = 1). Screening mammogram is helpful for early detection of non-palpable breast cancer, especially for women over 50 years of age.

Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment.

Directory of Open Access Journals (Sweden)

Smita Nayak

Full Text Available Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women.Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA, and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of $20 through $800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs; and incremental cost-effectiveness ratios (ICERs in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed.Base-case analysis results showed that at annual alendronate costs of $200 or less, osteoporosis screening followed by treatment was cost-saving, resulting in lower total costs than no screening as well as more QALYs (10.6 additional quality-adjusted life-days. When assuming alendronate costs of $400 through $800, screening and treatment resulted in greater lifetime costs than no screening but was highly cost-effective, with ICERs ranging from $714 per QALY gained through $13,902 per QALY gained. Probabilistic sensitivity analyses revealed that the cost-effectiveness of osteoporosis screening followed by alendronate treatment was robust to joint input parameter estimate variation at a willingness-to-pay threshold of $50,000/QALY at all alendronate costs evaluated.Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost

Effectiveness of population-based service screening with mammography for women ages 40 to 49 years with a high or low risk of breast cancer: socioeconomic status, parity, and age at birth of first child.

Science.gov (United States)

Hellquist, Barbro Numan; Czene, Kamila; Hjälm, Anna; Nyström, Lennarth; Jonsson, Håkan

2015-01-15

Invitation to mammography screening of women aged 40 to 49 years is a matter of debate in many countries and a cost-effective alternative in countries without screening among women aged 40 to 49 years could be inviting those at higher risk. The relative effectiveness of mammography screening was estimated for subgroups based on the breast cancer risk factors parity, age at time of birth of first child, and socioeconomic status (SES). The SCReening of Young Women (SCRY) database consists of all women aged 40 to 49 years in Sweden between 1986 and 2005 and was split into a study and control group. The study group consisted of women residing in areas in which women aged 40 to 49 years were invited to screening and the control group of women in areas in which women aged 40 to 49 years were not invited to screening. Rate ratio (RR) estimates were calculated for 2 exposures: invitation and attendance. There were striking similarities noted in the RR pattern for women invited to and attending screening and no statistically significant difference or trend in the RR was noted by risk group. The RR estimates increased by increasing parity for parity of 0 to 2 and ranged from 0.55 (95% confidence interval [95% CI], 0.38-0.79) to 0.79 (95% CI, 0.65-0.95) for attending women. The RR for women with high SES was lower than that for women with low SES (RR, 0.72 [95% CI, 0.60-0.86] and RR, 0.79 [95% CI, 0.63-0.99], respectively). For women aged 20 to 24 years at the time of the birth of their first child, the RR was 0.73 (95% CI, 0.58-0.91) and estimates for other ages were similar. There was no statistically significant difference noted in the relative effectiveness of mammography screening by parity, age at the time of birth of the first child, or SES. © 2014 American Cancer Society.

Screening mammography. A risk versus risk decision

International Nuclear Information System (INIS)

Ritenour, E.R.; Hendee, W.R.

1989-01-01

The potential risk of a radiologic procedure often is compared with the potential benefit of the procedure. While risk vs. benefit analysis has been useful as a step toward increased communication and understanding among radiologists, referring physicians, and the general public, it has the disadvantage that risk and benefit are fundamentally different quantities. Hence, their juxtaposition for purposes of comparison presents contextual difficulties. In this article, the concept is presented of comparing the risk of doing a procedure with the risk of choosing not to do the procedure. An example of risk vs. risk analysis of screening mammography for women over the age of 50 is given, with the conclusion that the risk of having yearly mammograms is less than 1/10 the risk of early death caused by failure to diagnose breast cancer by x-ray mammography. This approach to risk analysis would yield interesting data for examinations that are part of more complicated diagnostic pathways.19 references

Cost-effectiveness of colorectal cancer screening

NARCIS (Netherlands)

I. Lansdorp-Vogelaar (Iris); A.B. Knudsen (Amy); H. Brenner (Hermann)

2011-01-01

textabstractColorectal cancer is an important public health problem. Several screening methods have been shown to be effective in reducing colorectal cancer mortality. The objective of this review was to assess the cost-effectiveness of the different colorectal cancer screening methods and to

Comparative performance of modern digital mammography systems in a large breast screening program

Energy Technology Data Exchange (ETDEWEB)

Yaffe, Martin J., E-mail: martin.yaffe@sri.utoronto.ca; Bloomquist, Aili K.; Hunter, David M.; Mawdsley, Gordon E. [Physical Sciences Division, Sunnybrook Research Institute, Departments of Medical Biophysics and Medical Imaging, University of Toronto, Ontario M4N 3M5 (Canada); Chiarelli, Anna M. [Prevention and Cancer Control, Cancer Care Ontario, Dalla Lana School of Public Health, University of Toronto, Ontario M4N 3M5, Canada and Ontario Breast Screening Program, Cancer Care Ontario, Toronto, Ontario M5G 1X3 (Canada); Muradali, Derek [Ontario Breast Screening Program, Cancer Care Ontario, Toronto, Ontario M5G 1X3 (Canada); Mainprize, James G. [Physical Sciences Division, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5 (Canada)

2013-12-15

Purpose: To compare physical measures pertaining to image quality among digital mammography systems utilized in a large breast screening program. To examine qualitatively differences in these measures and differences in clinical cancer detection rates between CR and DR among sites within that program. Methods: As part of the routine quality assurance program for screening, field measurements are made of several variables considered to correlate with the diagnostic quality of medical images including: modulation transfer function, noise equivalent quanta, d′ (an index of lesion detectability) and air kerma to allow estimation of mean glandular dose. In addition, images of the mammography accreditation phantom are evaluated. Results: It was found that overall there were marked differences between the performance measures of DR and CR mammography systems. In particular, the modulation transfer functions obtained with the DR systems were found to be higher, even for larger detector element sizes. Similarly, the noise equivalent quanta, d′, and the phantom scores were higher, while the failure rates associated with low signal-to-noise ratio and high dose were lower with DR. These results were consistent with previous findings in the authors’ program that the breast cancer detection rates at sites employing CR technology were, on average, 30.6% lower than those that used DR mammography. Conclusions: While the clinical study was not large enough to allow a statistically powered system-by-system assessment of cancer detection accuracy, the physical measures expressing spatial resolution, and signal-to-noise ratio are consistent with the published finding that sites employing CR systems had lower cancer detection rates than those using DR systems for screening mammography.

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

Science.gov (United States)

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

Impact of organised mammography screening on breast cancer mortality in a case–control and cohort study

Science.gov (United States)

Heinävaara, Sirpa; Sarkeala, Tytti; Anttila, Ahti

2016-01-01

Background: The usefulness of case–control studies has been questioned. Our aim was to evaluate the long-term effect of screening on breast cancer mortality within the population-based mammography programme in Finland using a case–control design, and to compare the analyses with the earlier cohort study. Methods: The cases were women invited to screening, diagnosed and died from breast cancer in 1992–2011 while being 50–84 years at death. We chose 10 controls for each case with non-restrictive eligibility criteria. Our data included 1907 cases and 18 978 matched controls. We analysed associations between the screening participation and the risk of breast cancer death using the conditional Cox proportional hazards model. The effect estimates were corrected for self-selection bias. Results: An overall effect of screening was 0.67 (95% confidence interval (CI): 0.49–0.90), and that remained unchanged over time. Analyses with matching criteria comparable to the cohort study yielded an effect (0.70, 95% CI: 0.49–1.00) in 1992–2003 similar to that of the previous cohort analysis (0.72, 95% CI: 0.56–0.88). Conclusions: Organised mammography screening decreases mortality from breast cancer by 33% among the participants. If made comparable, a case–cohort study can yield effect estimates similar to a cohort study. PMID:27010748

Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.

Science.gov (United States)

Derdeyn, C P; Powers, W J

1996-11-01

The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy. The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery. A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period. The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved. Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature. Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials. Doppler ultrasound sensitivity and specificity were obtained through review of local experience. Estimates of costs were obtained from local Medicare reimbursement data. A one-time screening program of a population with a high prevalence (20%) of > or = 60% stenosis cost $35130 per incremental QALY gained. Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs. Annual screening cost $457773 per incremental QALY gained. In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. The cost-effectiveness of a one-time screening program for an asymptomatic population with a high prevalence of carotid stenosis may be cost-effective. Annual screening is detrimental. The most sensitive variables in this simulation model were long-term stroke risk reduction after surgery and annual discount rate for accumulated costs and QALYs.

[Cost-effectiveness of breast cancer screening policies in Mexico].

Science.gov (United States)

Valencia-Mendoza, Atanacio; Sánchez-González, Gilberto; Bautista-Arredondo, Sergio; Torres-Mejía, Gabriela; Bertozzi, Stefano M

2009-01-01

Generate cost-effectiveness information to allow policy makers optimize breast cancer (BC) policy in Mexico. We constructed a Markov model that incorporates four interrelated processes of the disease: the natural history; detection using mammography; treatment; and other competing-causes mortality, according to which 13 different strategies were modeled. Strategies (starting age, % of coverage, frequency in years)= (48, 25, 2), (40, 50, 2) and (40, 50, 1) constituted the optimal method for expanding the BC program, yielding 75.3, 116.4 and 171.1 thousand pesos per life-year saved, respectively. The strategies included in the optimal method for expanding the program produce a cost per life-year saved of less than two times the GNP per capita and hence are cost-effective according to WHO Commission on Macroeconomics and Health criteria.

Corporate-sponsored low-cost screening program at the workplace

International Nuclear Information System (INIS)

Kessler, H.B.; Engstrom, P.F.; Devine, P.J.; Rimer, B.; Gatenby, R.A.

1989-01-01

This paper reports the results of a mobile screening mammography program offered to employees of a large corporation. The examination was available to women 35 or older. Women were charged $30 for a standard two-view examination; the remaining costs were underwritten by the employer. In the first year of the program 3,627 examination were performed; 63 biopsies were recommended. To date, 54 biopsies have been completed. Nine cancers were identified; seven state I and two stage II cancers were diagnosed. The distribution and prevalence rates were similar to (slightly higher than) statewide statistics. Mobile screening programs conducted at the worksite provide an inexpensive convenient alternation to more traditional screening programs. The inherent advantages of this program are the low cost, relative ease with which the examination can be obtained, and the positive role that corporate medical personnel assume in encouraging participation

Socioeconomic status as determinant for participation in mammography screening: assessing the difference between using women's own versus their partner's

DEFF Research Database (Denmark)

Kjellén, Malin; von Euler-Chelpin, My

2010-01-01

Earlier research has shown that participation in mammography screening tends to vary across socioeconomic levels. We assessed the difference between using the woman's own socioeconomic status (SES) and using that of her household or partner as determinant of participation in mammography screening....

A cross sectional study on the motivators for Asian women to attend opportunistic mammography screening in a private hospital in Malaysia: the MyMammo study.

Science.gov (United States)

Hassan, Norhashimah; Ho, Weang Kee; Mariapun, Shivaani; Teo, Soo Hwang

2015-06-12

To date, because of limited budgets and lower incidence of breast cancer, the majority of Asian countries do not have population-based screening programmes, but instead offer opportunistic screening. However, there have been few studies which have assessed the motivators for women attending such programmes and the appropriateness of the programmes in terms of targeting women at risk. We conducted a prospective cross-sectional study of 1,619 women aged 40 to 74 years attending a subsidized opportunistic screening mammogram from October 2011 to October 2013 at a private hospital in Malaysia. Breast cancer risk was estimated using the Gail Model and two-step cluster analysis was used to examine the motivators of attending screening. Although Malaysia comprises 54.5% Malay, 24.5% Chinese and 7.3% Indian, the majority of women in the MyMammo Study were Chinese (70.1%) and 99.2% had a motivators. Of those with only secondary school education, their main motivators were doctors. Taken together, our results suggest the women attending opportunistic mammography screening in Asia are at low risk of breast cancer and this poses challenges to cost-effective and equitable strategies for cancer control. We propose that to improve uptake of screening mammography, awareness programmes should target both doctors and members of the public.

Breast density in screening mammography in Indian population - Is it different from western population?

Science.gov (United States)

Singh, Tulika; Khandelwal, Niranjan; Singla, Veenu; Kumar, Dileep; Gupta, Madhu; Singh, Gurpreet; Bal, Amanjit

2018-05-01

Mammography is the only method presently considered appropriate for mass screening of breast cancer. However, higher breast density was strongly associated with lower mammographic sensitivity. Breast density is also identified as independent and strongest risk factors for breast cancer. Studies have shown women with high breast density have four to six times increased risk of breast cancer as compare to women with fatty breast. It varies between different age group it generally decreases with increasing age in postmenopausal women and it can be different in different ethnic groups and people from different geographical areas. This study evaluates the breast density in Indian population and its relationship with the age. We reviewed of all screening mammography examinations performed from May 2012 to January 2015 at our institute PGIMER, Chandigarh, INDIA. Descriptive analyses were used to examine the association between age and breast density. A total of 6132 screening mammograms were performed. Each subgroup categorized by decade of age. There was a significant inverse relationship between age and breast density (P density in Indian and Western population with more Indians having ACR Grade 1 and 2 and Western population having 2 and 3. We found an inverse relationship between patient age and mammographic breast density. However, there were a large proportion of young women who had lower grades of mammographic density which could potentially benefit from the use of routine screening mammography in this subgroup of patients. Moreover, the breast density of Indian population is less when compared to the Western population. This might suggest that mammography is a good modality of choice for screening Indian population. © 2017 Wiley Periodicals, Inc.

Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial.

Science.gov (United States)

Tagliafico, Alberto S; Calabrese, Massimo; Mariscotti, Giovanna; Durando, Manuela; Tosto, Simona; Monetti, Francesco; Airaldi, Sonia; Bignotti, Bianca; Nori, Jacopo; Bagni, Antonella; Signori, Alessio; Sormani, Maria Pia; Houssami, Nehmat

2016-03-09

Debate on adjunct screening in women with dense breasts has followed legislation requiring that women be informed about their mammographic density and related adjunct imaging. Ultrasound or tomosynthesis can detect breast cancer (BC) in mammography-negative dense breasts, but these modalities have not been directly compared in prospective trials. We conducted a trial of adjunct screening to compare, within the same participants, incremental BC detection by tomosynthesis and ultrasound in mammography-negative dense breasts. Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts is a prospective multicenter study recruiting asymptomatic women with mammography-negative screens and dense breasts. Eligible women had tomosynthesis and physician-performed ultrasound with independent interpretation of adjunct imaging. Outcome measures included cancer detection rate (CDR), number of false-positive (FP) recalls, and incremental CDR for each modality; these were compared using McNemar's test for paired binary data in a preplanned interim analysis. Among 3,231 mammography-negative screening participants (median age, 51 years; interquartile range, 44 to 78 years) with dense breasts, 24 additional BCs were detected (23 invasive): 13 tomosynthesis-detected BCs (incremental CDR, 4.0 per 1,000 screens; 95% CI, 1.8 to 6.2) versus 23 ultrasound-detected BCs (incremental CDR, 7.1 per 1,000 screens; 95% CI, 4.2 to 10.0), P = .006. Incremental FP recall occurred in 107 participants (3.33%; 95% CI, 2.72% to 3.96%). FP recall (any testing) did not differ between tomosynthesis (FP = 53) and ultrasound (FP = 65), P = .26; FP recall (biopsy) also did not differ between tomosynthesis (FP = 22) and ultrasound (FP = 24), P = .86. The Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts' interim analysis shows that ultrasound has better incremental BC detection than tomosynthesis in mammography

In vivo comparison of screen-film mammography and xeromammography

International Nuclear Information System (INIS)

Yagan, R.; Skubic, S.E.; Oravec, D.; Green, H.Y.

1987-01-01

In vivo comparison of film-screen with grid and xeromammography was performed in 97 patients by three mammographers experienced with both modalities. The results show that file-screen modality is superior to xeromammography in the following areas: (1) in identifying of microcalcifications and determining their topographic characteristics; (2) in visualizing masses; and (3) in visualizing the nipple and entire skin line without artifacts. Both methods were equal in imaging of the parenchyma of dense breasts. The chest wall is somewhat better visualized with xeromammography, without providing any clinical advantage in the cases reviewed. The authors conclude that film-screen mammography with antiscatter grid is the preferred method in breast evaluation

Differences in radiological patterns, tumour characteristics and diagnostic precision between digital mammography and screen-film mammography in four breast cancer screening programmes in Spain

International Nuclear Information System (INIS)

Domingo, Laia; Sala, Maria; Romero, Anabel; Belvis, Francesc; Macia, Francesc; Castells, Xavier; Sanchez, Mar; Ferrer, Joana; Salas, Dolores; Ibanez, Josefa; Vega, Alfonso; Ferrer, Francesc; Laso, M.S.

2011-01-01

To compare tumour characteristics between cancers detected with screen-film mammography (SFM) and digital mammography (DM) and to evaluate changes in positive predictive values (PPVs) for further assessments, for invasive procedures and for distinct radiological patterns in recalled women. 242,838 screening mammograms (171,191 SFM and 71,647 DM) from 103,613 women aged 45-69 years, performed in four population-based breast cancer screening programmes in Spain, were included. The tumour characteristics and PPVs of each group were compared. Radiological patterns (masses, calcifications, distortions and asymmetries) among recalled women were described and PPVs were evaluated. The percentages of ductal carcinoma in situ (DCIS) were higher in DM than in SFM both in the first [18.5% vs. 15.8%(p = 0.580)] and in successive screenings [23.2% vs. 15.7%(p = 0.115)]. PPVs for masses, asymmetries and calcifications were higher in DM, being statistically significant in masses (5.3% vs. 3.9%; proportion ratio: 1.37 95%CI: 1.08-1.72). Among cancers detected by calcifications, the percentage of DCIS was higher in DM (60.3% vs. 46.4%, p = 0.060). PPVs were higher when DM was used, both for further assessments and for invasive procedures, with similar cancer detection rates and no statistically significant differences in tumour characteristics. The greatest improvements in PPVs were found for masses. (orig.)

Differences in radiological patterns, tumour characteristics and diagnostic precision between digital mammography and screen-film mammography in four breast cancer screening programmes in Spain

Energy Technology Data Exchange (ETDEWEB)

Domingo, Laia; Sala, Maria [IMIM-Hospital del Mar, Department of Epidemiology and Evaluation, Barcelona (Spain); CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona (Spain); Universitat Autonoma de Barcelona (UAB), EHEA Doctoral Program in Public Health. Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Barcelona (Spain); Romero, Anabel; Belvis, Francesc; Macia, Francesc; Castells, Xavier [IMIM-Hospital del Mar, Department of Epidemiology and Evaluation, Barcelona (Spain); CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona (Spain); Sanchez, Mar [Government of Cantabria, General Directorate of Public Health, Department of Health, Santander (Spain); Ferrer, Joana [Radiology Unit. Hospital Santa Caterina, Girona (Spain); Salas, Dolores; Ibanez, Josefa [General Directorate Public Health and Centre for Public Health Research (CSISP), Valencia (Spain); Vega, Alfonso [Hospital Universitario Marques de Valdecilla, Radiology Unit, Santander (Spain); Ferrer, Francesc [Hospital del Mar, Radiology and Nuclear Medicine Service, Barcelona (Spain); Laso, M.S. [Breast Cancer Screening Unit Burjassot, Valencia (Spain)

2011-09-15

To compare tumour characteristics between cancers detected with screen-film mammography (SFM) and digital mammography (DM) and to evaluate changes in positive predictive values (PPVs) for further assessments, for invasive procedures and for distinct radiological patterns in recalled women. 242,838 screening mammograms (171,191 SFM and 71,647 DM) from 103,613 women aged 45-69 years, performed in four population-based breast cancer screening programmes in Spain, were included. The tumour characteristics and PPVs of each group were compared. Radiological patterns (masses, calcifications, distortions and asymmetries) among recalled women were described and PPVs were evaluated. The percentages of ductal carcinoma in situ (DCIS) were higher in DM than in SFM both in the first [18.5% vs. 15.8%(p = 0.580)] and in successive screenings [23.2% vs. 15.7%(p = 0.115)]. PPVs for masses, asymmetries and calcifications were higher in DM, being statistically significant in masses (5.3% vs. 3.9%; proportion ratio: 1.37 95%CI: 1.08-1.72). Among cancers detected by calcifications, the percentage of DCIS was higher in DM (60.3% vs. 46.4%, p = 0.060). PPVs were higher when DM was used, both for further assessments and for invasive procedures, with similar cancer detection rates and no statistically significant differences in tumour characteristics. The greatest improvements in PPVs were found for masses. (orig.)

What determines the effects and costs of breast cancer screening? A protocol of a systematic review of reviews.

Science.gov (United States)

Mandrik, O; Ekwunife, O I; Zielonke, N; Meheus, F; Severens, J L; Lhachimi, S K; Murillo, R

2017-06-28

Multiple reviews demonstrated high variability in effectiveness and cost-effectiveness outcomes among studies on breast cancer screening (BCS) programmes. No study to our knowledge has summarized the current evidence on determinants of effectiveness and cost-effectiveness of the most used BCS approaches or tried to explain differences in conclusions of systematic reviews on this topic. Based on published reviews, this systematic review aims to assess the degree of variability of determinants for (a) effectiveness and (b) cost-effectiveness of BCS programmes using mammography, clinical breast examination, breast self-examination, ultrasonography, or their combinations among the general population. We will perform a comprehensive systematic literature search in Cochrane, Scopus, Embase, and Medline (via Pubmed). The search will be supplemented with hand searching of references of the included reviews, with hand searching in the specialized journals, and by contacting prominent experts in the field. Additional search for grey literature will be conducted on the websites of international cancer associations and networks. Two trained research assistants will screen titles and abstracts of publications independently, with at least random 10% of all abstracts being also screened by the principal researcher. The full texts of the systematic reviews will then be screened independently by two authors, and disagreements will be solved by consensus. The included reviews will be grouped by publication year, outcomes, designs of original studies, and quality. Additionally, for reviews published since 2011, transparency in reporting will be assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for the review on determinants of effectiveness and a modified PRISMA checklist for the review on determinants for cost-effectiveness. The study will apply the Assessing the Methodological Quality of Systematic Reviews checklist to assess

Breast cancer screening: Evidence of the effect of adjunct ultrasound screening in women with unilateral mammography-negative dense breasts

Directory of Open Access Journals (Sweden)

Atoosa Adibi

2015-01-01

Full Text Available Background: Patients with the previous history of breast cancer are in risk of contralateral breast cancer. On the other hand, increased breast density is a risk factor for breast cancer and the sensitivity of detecting nonpalpable cancers in screening mammography in radiographically dense breasts is low. The use of ultrasonography in dense breast remains a controversial topic. The purpose of this study was to assess the usefulness of routine ultrasonography in follow-up of women with the previous history of breast cancer and negative mammography but dense breasts. Materials and Methods: In a cross-sectional study, a total of 267 individuals with unilateral postmastectomy mammogram screened and 153 subjects assigned to study. There were 28 subjects with American College of Radiology (ACR breast density 2 and 125 with ACR breast density 3-4, which there was no new finding in their mammogram in comparison to previous studies. We assumed subjects with ACR breast density 3-4 as mammographic Breast Imaging Reporting and Data System (BI-RADS category 0 for malignancy. Standard two-view mammogram was performed for all participants, and breast ultrasound (US examinations were performed by an expert radiologist in radial and anti-radial planes. The data were analyzed using SPSS version 20.0 (SPSS Inc., Chicago, Illinois, USA. Results: The results showed that in subjects with ACR breast density 3-4, when there was no new density in two consecutive mammograms in comparison to previous studies, US also showed no possibility for malignancy (BI-RADS 1-2. And also in subjects with ACR breast density 2, when the mammographic results were BI-RADS 1-2, the US results was the same. Conclusion: Our data indicate that for the detection of breast cancer, sensitivity of US was not greater than mammography in patients with postmastectomy unilateral dense breast if there is not any new density.

The Cost-Effectiveness of School-Based Eating Disorder Screening

Science.gov (United States)

Austin, S. Bryn; LeAnn Noh, H.; Jiang, Yushan; Sonneville, Kendrin R.

2014-01-01

Objectives. We aimed to assess the value of school-based eating disorder (ED) screening for a hypothetical cohort of US public school students. Methods. We used a decision-analytic microsimulation model to model the effectiveness (life-years with ED and quality-adjusted life-years [QALYs]), total direct costs, and cost-effectiveness (cost per QALY gained) of screening relative to current practice. Results. The screening strategy cost $2260 (95% confidence interval [CI] = $1892, $2668) per student and resulted in a per capita gain of 0.25 fewer life-years with ED (95% CI = 0.21, 0.30) and 0.04 QALYs (95% CI = 0.03, 0.05) relative to current practice. The base case cost-effectiveness of the intervention was $9041 per life-year with ED avoided (95% CI = $6617, $12 344) and $56 500 per QALY gained (95% CI = $38 805, $71 250). Conclusions. At willingness-to-pay thresholds of $50 000 and $100 000 per QALY gained, school-based ED screening is 41% and 100% likely to be cost-effective, respectively. The cost-effectiveness of ED screening is comparable to many other accepted pediatric health interventions, including hypertension screening. PMID:25033131

Influence of breast compression pressure on the performance of population-based mammography screening.

Science.gov (United States)

Holland, Katharina; Sechopoulos, Ioannis; Mann, Ritse M; den Heeten, Gerard J; van Gils, Carla H; Karssemeijer, Nico

2017-11-28

In mammography, breast compression is applied to reduce the thickness of the breast. While it is widely accepted that firm breast compression is needed to ensure acceptable image quality, guidelines remain vague about how much compression should be applied during mammogram acquisition. A quantitative parameter indicating the desirable amount of compression is not available. Consequently, little is known about the relationship between the amount of breast compression and breast cancer detectability. The purpose of this study is to determine the effect of breast compression pressure in mammography on breast cancer screening outcomes. We used digital image analysis methods to determine breast volume, percent dense volume, and pressure from 132,776 examinations of 57,179 women participating in the Dutch population-based biennial breast cancer screening program. Pressure was estimated by dividing the compression force by the area of the contact surface between breast and compression paddle. The data was subdivided into quintiles of pressure and the number of screen-detected cancers, interval cancers, false positives, and true negatives were determined for each group. Generalized estimating equations were used to account for correlation between examinations of the same woman and for the effect of breast density and volume when estimating sensitivity, specificity, and other performance measures. Sensitivity was computed using interval cancers occurring between two screening rounds and using interval cancers within 12 months after screening. Pair-wise testing for significant differences was performed. Percent dense volume increased with increasing pressure, while breast volume decreased. Sensitivity in quintiles with increasing pressure was 82.0%, 77.1%, 79.8%, 71.1%, and 70.8%. Sensitivity based on interval cancers within 12 months was significantly lower in the highest pressure quintile compared to the third (84.3% vs 93.9%, p = 0.034). Specificity was lower in the

Effect of Reminder Telephone Calls on Mammography Compliance in High Risk

National Research Council Canada - National Science Library

Snyder, Carrie

2006-01-01

Even though mammography has been proven to be effective in reducing breast cancer mortality this simple screening measure is underutilized by women who are at an inordinately high risk for developing breast cancer...

Are benefits and harms in mammography screening given equal attention in scientific articles? A cross-sectional study.

Science.gov (United States)

Jørgensen, Karsten Juhl; Klahn, Anders; Gøtzsche, Peter C

2007-05-30

The CONSORT statement specifies the need for a balanced presentation of both benefits and harms of medical interventions in trial reports. However, invitations to screening and newspaper articles often emphasize benefits and downplay or omit harms, and it is known that scientific articles can be influenced by conflicts of interest. We wanted to determine if a similar imbalance occurs in scientific articles on mammography screening and if it is related to author affiliation. We searched PubMed in April 2005 for articles on mammography screening that mentioned a benefit or a harm and that were published in 2004 in English. Data extraction was performed by three independent investigators, two unblinded and one blinded for article contents, and author names and affiliation, as appropriate. The extracted data were compared and discrepancies resolved by two investigators in a combined analysis. We defined three groups of authors: (1) authors in specialties unrelated to mammography screening, (2) authors in screening-affiliated specialties (radiology or breast cancer surgery) who were not working with screening, or authors funded by cancer charities, and (3) authors (at least one) working directly with mammography screening programmes. We used a data extraction sheet with 17 items described as important benefits and harms in the 2002 WHO/IARC-report on breast cancer screening. We identified 854 articles, and 143 were eligible for the study. Most were original research. Benefits were mentioned more often than harms (96% vs 62%, P articles mentioned only benefits, whereas seven (5%) mentioned only harms (P articles (24%), but was more often downplayed or rejected in articles that had authors working with screening, (6/15; 40%) compared with authors affiliated by specialty or funding (1/6; 17%), or authors unrelated with screening (1/14; 7%) (P = 0.03). Benefits in terms of reduced breast cancer mortality were mentioned in 109 (76%) articles, and was more often provided as a

Screening mammography in a health promotion center for 5 years : results of medical audits

International Nuclear Information System (INIS)

Kim, Mi Hye; Lee, Mi Ja; Oh, Ki Keun; Lee, Kyong Sik

2000-01-01

The purpose of this study was to perform a medical audit of the screening of mammographic results according to ACR BI-RADS Follow-Up and Outcome Monitoring and to evaluate the efficacy of screening mammography in the early detection of breast cancer. We reviewed the results of 15,300 mammographic examinations of 13,889 women aged 30-75 years who underwent mammography at least once at the Severance Health Promotion Center between 1994-1998. Women with abnormal mammographic findings were recalled for additional study and those with dense breast composition (3, 4) underwent additional ultrasound. All results were categorized on the basis of the ACR BI-RADS final assessment scale, 1-5. We reviewed the pathologic or follow-up results of all women in categories 4 and 5, and/or those in any category who took the films out of the health center. The recall rate was 13%. Biopsy or surgical consultation was recommended for 92 women and biopsy was performed in 52. Pathology revealed 17 cancers and 35 benign lesions. Positive predictive value 2 was found in 18.5% of cases, and positive predictive value 3 in 33%. The cancer detection rate was 1.2/1,000, and sensitivity was 89.5%. Invasive cancers smaller than 1 cm or in situ ductal cancers were found in eight of 17 cases (47%), while node-positive invasive cancers were found in nine of 14 cases (64%). Four of 17 mammographically detected cancers were palpated by a surgeon. In asymptomatic women, screening mammography is an effective method for the detection of early breast cancer. (author)

Cost-effectiveness and cost utility of community screening for glaucoma in urban India.

Science.gov (United States)

John, Denny; Parikh, Rajul

2017-07-01

Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding

Relative and combined performance of mammography and ultrasonography for breast cancer screening in the general population. A pilot study in Tochigi prefecture, Japan

International Nuclear Information System (INIS)

Honjo, Satoshi; Ando, Jiro; Tsukioka, Takeo

2007-01-01

Breast cancer screening by mammography is thought to be effective in reducing breast cancer mortality while ultrasonography is not accepted as a population screening modality, although the latter has been suggested to be useful in detection of cancer in the dense breast, relatively more typical for a younger woman. Mammography with medio-lateral oblique view was offered on trial in 1999-2000 for 3453 female residents in Tochigi prefecture who also underwent clinical breast examination and ultrasonography. The municipalities that provided cancer screening were informed of the final diagnosis for women with positive findings in the screening trial by doctors who performed the diagnostic evaluation. Linkage was also made between the list of participants in the trial and registrations at Tochigi Cancer Registry for breast cancer cases diagnosed during 1999-2001. Thirteen cases with breast cancer were identified during a 2-year follow-up period: 10 were diagnosed subsequent to positive finding in the trial; two were negative in the trial and diagnosed 23 and 24 months after, respectively; and one had a positive finding at the trial but was undiagnosed at first and then diagnosed 18 months after the trial. Among the 11 cases judged as positive in the trial, four were judged only by mammography while three were judged only by ultrasonography. Those mammography alone-detected cases were relatively young, at 36, 40, 47 and 54 years of age, respectively, while the ultrasonography alone-detected cases were aged 50, 55 and 68, respectively. Combined screening with mammography and ultrasonography may be feasible. A larger study is required to evaluate relative performance of mammography and ultrasonography in detail by characteristics of examinees and their breasts. (author)

Abnormality Detection in Mammography using Deep Convolutional Neural Networks

OpenAIRE

Xi, Pengcheng; Shu, Chang; Goubran, Rafik

2018-01-01

Breast cancer is the most common cancer in women worldwide. The most common screening technology is mammography. To reduce the cost and workload of radiologists, we propose a computer aided detection approach for classifying and localizing calcifications and masses in mammogram images. To improve on conventional approaches, we apply deep convolutional neural networks (CNN) for automatic feature learning and classifier building. In computer-aided mammography, deep CNN classifiers cannot be tra...

Cost-Effectiveness of Old and New Technologies for Aneuploidy Screening.

Science.gov (United States)

Sinkey, Rachel G; Odibo, Anthony O

2016-06-01

Cost-effectiveness analyses allow assessment of whether marginal gains from new technology are worth increased costs. Several studies have examined cost-effectiveness of Down syndrome (DS) screening and found it to be cost-effective. Noninvasive prenatal screening also appears to be cost-effective among high-risk women with respect to DS screening, but not for the general population. Chromosomal microarray (CMA) is a genetic sequencing method superior to but more expensive than karyotype. In light of CMAs greater ability to detect genetic abnormalities, it is cost-effective when used for prenatal diagnosis of an anomalous fetus. This article covers methodology and salient issues of cost-effectiveness. Copyright © 2016 Elsevier Inc. All rights reserved.

The effects of gray scale image processing on digital mammography interpretation performance.

Science.gov (United States)

Cole, Elodia B; Pisano, Etta D; Zeng, Donglin; Muller, Keith; Aylward, Stephen R; Park, Sungwook; Kuzmiak, Cherie; Koomen, Marcia; Pavic, Dag; Walsh, Ruth; Baker, Jay; Gimenez, Edgardo I; Freimanis, Rita

2005-05-01

To determine the effects of three image-processing algorithms on diagnostic accuracy of digital mammography in comparison with conventional screen-film mammography. A total of 201 cases consisting of nonprocessed soft copy versions of the digital mammograms acquired from GE, Fischer, and Trex digital mammography systems (1997-1999) and conventional screen-film mammograms of the same patients were interpreted by nine radiologists. The raw digital data were processed with each of three different image-processing algorithms creating three presentations-manufacturer's default (applied and laser printed to film by each of the manufacturers), MUSICA, and PLAHE-were presented in soft copy display. There were three radiologists per presentation. Area under the receiver operating characteristic curve for GE digital mass cases was worse than screen-film for all digital presentations. The area under the receiver operating characteristic for Trex digital mass cases was better, but only with images processed with the manufacturer's default algorithm. Sensitivity for GE digital mass cases was worse than screen film for all digital presentations. Specificity for Fischer digital calcifications cases was worse than screen film for images processed in default and PLAHE algorithms. Specificity for Trex digital calcifications cases was worse than screen film for images processed with MUSICA. Specific image-processing algorithms may be necessary for optimal presentation for interpretation based on machine and lesion type.

Mammography-oncogenecity at low doses

International Nuclear Information System (INIS)

Heyes, G J; Mill, A J; Charles, M W

2009-01-01

Controversy exists regarding the biological effectiveness of low energy x-rays used for mammography breast screening. Recent radiobiology studies have provided compelling evidence that these low energy x-rays may be 4.42 ± 2.02 times more effective in causing mutational damage than higher energy x-rays. These data include a study involving in vitro irradiation of a human cell line using a mammography x-ray source and a high energy source which matches the spectrum of radiation observed in survivors from the Hiroshima atomic bomb. Current radiation risk estimates rely heavily on data from the atomic bomb survivors, and a direct comparison between the diagnostic energies used in the UK breast screening programme and those used for risk estimates can now be made. Evidence highlighting the increase in relative biological effectiveness (RBE) of mammography x-rays to a range of x-ray energies implies that the risks of radiation-induced breast cancers for mammography x-rays are potentially underestimated by a factor of four. A pooled analysis of three measurements gives a maximal RBE (for malignant transformation of human cells in vitro) of 4.02 ± 0.72 for 29 kVp (peak accelerating voltage) x-rays compared to high energy electrons and higher energy x-rays. For the majority of women in the UK NHS breast screening programme, it is shown that the benefit safely exceeds the risk of possible cancer induction even when this higher biological effectiveness factor is applied. The risk/benefit analysis, however, implies the need for caution for women screened under the age of 50, and particularly for those with a family history (and therefore a likely genetic susceptibility) of breast cancer. In vitro radiobiological data are generally acquired at high doses, and there are different extrapolation mechanisms to the low doses seen clinically. Recent low dose in vitro data have indicated a potential suppressive effect at very low dose rates and doses. Whilst mammography is a low

Measurement of the radiation dose and assessment of the risk in mammography screening for early detection of cancer of the breast, in Israel

International Nuclear Information System (INIS)

Broisman, A.; Schlesinger, T.; Alfassi, Z. B.

2011-01-01

The mean glandular doses to samples of women attending for mammographic screening are measured routinely at screening centres in Israel. As at present, no detailed and systematic data have been collected regarding the average glandular dose in mammography screening procedures carried out in Israel for the last 20 y. Especially data are lacking related to the glandular dose (GD) involved in mammography with the new digital mammography systems. In this work, partial results of the measurements are presented to asses the radiation dose to the breast and to the glandular tissue within the Israeli national mammography programme updated to year 2009. (authors)

Determining the spatial heterogeneity underlying racial and ethnic differences in timely mammography screening

Directory of Open Access Journals (Sweden)

Joseph Gibbons

2016-11-01

Full Text Available Abstract Background The leading cause of cancer death for women worldwide continues to be breast cancer. Early detection through timely mammography has been recognized to increase the probability of survival. While mammography rates have risen for many women in recent years, disparities in screening along racial/ethnic lines persist across nations. In this paper, we argue that the role of local context, as identified through spatial heterogeneity, is an unexplored dynamic which explains some of the gaps in mammography utilization by race/ethnicity. Methods We apply geographically weighted regression methods to responses from the 2008 Public Health Corporations’ Southeastern Household Health Survey, to examine the spatial heterogeneity in mammograms in the Philadelphia metropolitan area. Results We find first aspatially that minority identity, in fact, increases the odds of a timely mammogram: 74% for non-Hispanic Blacks and 80% for Hispanic/Latinas. However, the geographically weighted regression confirms the relation of race/ethnicity to mammograms varies by space. Notably, the coefficients for Hispanic/Latinas are only significant in portions of the region. In other words, the increased odds of a timely mammography we found are not constant spatially. Other key variables that are known to influence timely screening, such as the source of healthcare and social capital, measured as community connection, also vary by space. Conclusions These results have ramifications globally, demonstrating that the influence of individual characteristics which motivate, or inhibit, cancer screening may not be constant across space. This inconsistency calls for healthcare practitioners and outreach services to be mindful of the local context in their planning and resource allocation efforts.

Cost-effectiveness of cervical-cancer screening in five developing countries.

Science.gov (United States)

Goldie, Sue J; Gaffikin, Lynne; Goldhaber-Fiebert, Jeremy D; Gordillo-Tobar, Amparo; Levin, Carol; Mahé, Cédric; Wright, Thomas C

2005-11-17

Cervical-cancer screening strategies that involve the use of conventional cytology and require multiple visits have been impractical in developing countries. We used computer-based models to assess the cost-effectiveness of a variety of cervical-cancer screening strategies in India, Kenya, Peru, South Africa, and Thailand. Primary data were combined with data from the literature to estimate age-specific incidence and mortality rates for cancer and the effectiveness of screening for and treatment of precancerous lesions. We assessed the direct medical, time, and program-related costs of strategies that differed according to screening test, targeted age and frequency, and number of clinic visits required. Single-visit strategies involved the assumption that screening and treatment could be provided in the same day. Outcomes included the lifetime risk of cancer, years of life saved, lifetime costs, and cost-effectiveness ratios (cost per year of life saved). The most cost-effective strategies were those that required the fewest visits, resulting in improved follow-up testing and treatment. Screening women once in their lifetime, at the age of 35 years, with a one-visit or two-visit screening strategy involving visual inspection of the cervix with acetic acid or DNA testing for human papillomavirus (HPV) in cervical cell samples, reduced the lifetime risk of cancer by approximately 25 to 36 percent, and cost less than 500 dollars per year of life saved. Relative cancer risk declined by an additional 40 percent with two screenings (at 35 and 40 years of age), resulting in a cost per year of life saved that was less than each country's per capita gross domestic product--a very cost-effective result, according to the Commission on Macroeconomics and Health. Cervical-cancer screening strategies incorporating visual inspection of the cervix with acetic acid or DNA testing for HPV in one or two clinical visits are cost-effective alternatives to conventional three

Ultrasonic mammography

International Nuclear Information System (INIS)

Hueneke, B.

1982-01-01

608 women are examined by means of ultrasonic mammography during the period of 1 year. 432 patients were examined with the compound method with the U.I. Octoson, a water tank scanner, and 176 patients with the real time method with a directly connected linear-array-scanner. The following results were obtained at the end of the examination period: In the ultrasonic and also in the X-ray mammogram tumour diameters can be determined with an error rate of +- 30%. In the diagnosing of carcinomas, a significant dependence of the exactness on the sice of the tumour is found for the combination of the five methods tested (clinical examination, X-ray mammography, ultrasonic mammography, thermography, cytology). Classifying the individual methods with regard to their exactness, X-ray mammography ranks in front of ultrasonic mammography. Mastopathic changes in the breast can be screened by means of ultrasonic mammography. The structure of the changes can be determined more exactly than with an X-ray picture which is due to the possibility of differentiating solid and cystic structures. In diagnosing fibro-adenomas and establishing diagnoses on young women with dense gland bodies, ultrasonic mammography is superior to radiology both in the ability of screening a finding of a fibro-adenoma (US=88%, X-ray=75%) and in the possibility of classifying it as ''more benign than malignant''. (orig./MG) [de

Vasa previa screening strategies: a decision and cost-effectiveness analysis.

Science.gov (United States)

Sinkey, R G; Odibo, A O

2018-05-22

The aim of this study is to perform a decision and cost-effectiveness analysis comparing four screening strategies for the antenatal diagnosis of vasa previa among singleton pregnancies. A decision-analytic model was constructed comparing vasa previa screening strategies. Published probabilities and costs were applied to four transvaginal screening scenarios which occurred at the time of mid-trimester ultrasound: no screening, ultrasound-indicated screening, screening pregnancies conceived by in vitro fertilization (IVF), and universal screening. Ultrasound-indicated screening was defined as performing a transvaginal ultrasound at the time of routine anatomy ultrasound in response to one of the following sonographic findings associated with an increased risk of vasa previa: low-lying placenta, marginal or velamentous cord insertion, or bilobed or succenturiate lobed placenta. The primary outcome was cost per quality adjusted life years (QALY) in U.S. dollars. The analysis was from a healthcare system perspective with a willingness to pay (WTP) threshold of $100,000 per QALY selected. One-way and multivariate sensitivity analyses (Monte-Carlo simulation) were performed. This decision-analytic model demonstrated that screening pregnancies conceived by IVF was the most cost-effective strategy with an incremental cost effectiveness ratio (ICER) of $29,186.50 / QALY. Ultrasound-indicated screening was the second most cost-effective with an ICER of $56,096.77 / QALY. These data were robust to all one-way and multivariate sensitivity analyses performed. Within our baseline assumptions, transvaginal ultrasound screening for vasa previa appears to be most cost-effective when performed among IVF pregnancies. However, both IVF and ultrasound-indicated screening strategies fall within contemporary willingness-to-pay thresholds, suggesting that both strategies may be appropriate to apply in clinical practice. This article is protected by copyright. All rights reserved. This

Overdiagnosis in organised mammography screening in Denmark. A comparative study

DEFF Research Database (Denmark)

Jørgensen, Karsten J; Zahl, Per-Henrik; Gøtzsche, Peter C

2009-01-01

% of the Danish population has been offered organised mammography screening over a long time-period. METHODS: We collected incidence rates of carcinoma in situ and invasive breast cancer in areas with and without screening over 13 years with screening (1991-2003), and 20 years before its introduction (1971...... an overdiagnosis of 35% when we compared unadjusted incidence rates for the screened and non-screened areas, but after compensating for a small decline in incidence in older, previously screened women. Our adjusted Poisson regression analysis indicated a relative risk of 1.40 (95% CI: 1.35-1.45) for the whole...... screening period, and a potential compensatory drop in older women of 0.90 (95% CI: 0.88-0.96), yielding an overdiagnosis of 33%, which we consider the most reliable estimate. The drop in previously screened women was only present in one of the two screened regions and was small in absolute numbers...

Reduction in advanced breast cancer after introduction of a mammography screening program in Tyrol/Austria.

Science.gov (United States)

Oberaigner, W; Geiger-Gritsch, Sabine; Edlinger, M; Daniaux, M; Knapp, R; Hubalek, M; Siebert, U; Marth, C; Buchberger, W

2017-06-01

We analysed all female breast cancer (BC) cases in Tyrol/Austria regarding the shift in cancer characteristics, especially the shift in advanced BC, for the group exposed to screening as compared to the group unexposed to screening. The analysis was based on all BC cases diagnosed in women aged 40-69 years, resident in Tyrol, and diagnosed between 2009 and 2013. The data were linked to the Tyrolean mammography screening programme database to classify BC cases as "exposed to screening" or "unexposed to screening". Age-adjusted relative risks (RR) were estimated by relating the exposed to the unexposed group. In a total of about 145,000 women aged 40-69 years living in Tyrol during the study period, 1475 invasive BC cases were registered. We estimated an age-adjusted relative risk (RR) for tumour size ≥ 21 mm of 0.72 (95% confidence interval (CI) 0.60 to 0.86), for metastatic BC of 0.27 (95% CI 0.17 to 0.46) and for advanced BC of 0.83 (95% CI 0.71 to 0.96), each comparing those exposed to those unexposed to screening, respectively. In our population-based registry analysis we observed that participation in the mammography screening programme in Tyrol is associated with a 28% decrease in risk for BC cases with tumour size ≥ 21 mm and a 17% decrease in risk for advanced BC. We therefore expect the Tyrolean mammography programme to show a reduction in BC mortality. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effect of Reminder Telephone Calls on Mammography Compliance in High Risk Women

National Research Council Canada - National Science Library

Synder, Carrie L

2007-01-01

Even though mammography has been proven to be effective in reducing breast cancer mortality this simple screening measure is underutilized by women who are at an inordinately high risk for developing breast cancer...

Population-based mammography screening below age 50: Balancing radiation-induced vs prevented breast cancer deaths

NARCIS (Netherlands)

R. de Gelder (Rianne); G. Draisma (Gerrit); E.A.M. Heijnsdijk (Eveline); H.J. de Koning (Harry)

2011-01-01

textabstractIntroduction:Exposure to ionizing radiation at mammography screening may cause breast cancer. Because the radiation risk increases with lower exposure age, advancing the lower age limit may affect the balance between screening benefits and risks. The present study explores the

Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates

Energy Technology Data Exchange (ETDEWEB)

Bluekens, Adriana M.J. [National Expert and Training Centre for Breast Cancer Screening, Nijmegen (Netherlands); St. Elisabeth Hospital, Department of Radiology, Tilburg (Netherlands); Karssemeijer, Nico [Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen (Netherlands); Beijerinck, David; Deurenberg, Jan J.M. [Preventicon Screening Centre/Mid-West, Utrecht (Netherlands); Engen, Ruben E. van [National Expert and Training Centre for Breast Cancer Screening, Nijmegen (Netherlands); Broeders, Mireille J.M. [National Expert and Training Centre for Breast Cancer Screening, Nijmegen (Netherlands); Radboud University Nijmegen Medical Centre, Department of Epidemiology, Biostatistics and HTA, Nijmegen (Netherlands); Heeten, Gerard J. den [National Expert and Training Centre for Breast Cancer Screening, Nijmegen (Netherlands); Academic Medical Centre (AMC), Department of Radiology, Amsterdam (Netherlands)

2010-09-15

To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme. Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed. A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p <.001), with a significant increase in cancer detection (p =.010). As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection. (orig.)

Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates.

Science.gov (United States)

Bluekens, Adriana M J; Karssemeijer, Nico; Beijerinck, David; Deurenberg, Jan J M; van Engen, Ruben E; Broeders, Mireille J M; den Heeten, Gerard J

2010-09-01

To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme. Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed. A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p < .001), with a significant increase in cancer detection (p = .010). As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.

Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates

International Nuclear Information System (INIS)

Bluekens, Adriana M.J.; Karssemeijer, Nico; Beijerinck, David; Deurenberg, Jan J.M.; Engen, Ruben E. van; Broeders, Mireille J.M.; Heeten, Gerard J. den

2010-01-01

To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme. Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed. A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p <.001), with a significant increase in cancer detection (p =.010). As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection. (orig.)

Cost-effectiveness analysis of neonatal hearing screening program in china: should universal screening be prioritized?

Directory of Open Access Journals (Sweden)

Huang Li-Hui

2012-04-01

Full Text Available Abstract Background Neonatal hearing screening (NHS has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China. Methods A cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs, average cost-effectiveness ratio (ACER, and incremental cost-effectiveness ratio (ICER for universal screening compared to targeted screening in eight provinces. Results and discussion A multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This

Digital mammography; Mamografia digital

Energy Technology Data Exchange (ETDEWEB)

Chevalier, M.; Torres, R.

2010-07-01

Mammography represents one of the most demanding radiographic applications, simultaneously requiring excellent contrast sensitivity, high spatial resolution, and wide dynamic range. Film/screen is the most widely extended image receptor in mammography due to both its high spatial resolution and contrast. The film/screen limitations are related with its narrow latitude, structural noise and that is at the same time the medium for the image acquisition, storage and presentation. Several digital detector made with different technologies can overcome these difficulties. Here, these technologies as well as their main advantages and disadvantages are analyzed. Also it is discussed its impact on the mammography examinations, mainly on the breast screening programs. (Author).

Health-related lifestyle factors and mammography screening attendance in a Swedish cohort study.

Science.gov (United States)

Lagerlund, Magdalena; Drake, Isabel; Wirfält, Elisabet; Sontrop, Jessica M; Zackrisson, Sophia

2015-01-01

To determine whether health-related lifestyle factors are associated with attendance at a population-based invitational mammography screening program in southern Sweden, data on health-related lifestyle factors (smoking, alcohol use, physical activity, BMI, diet, self-rated health, and stress) were obtained from the Malmö Diet and Cancer Study and linked to the Malmö mammography register (Sweden, 1992-2009). Women (n=11 409) who were free from breast cancer at study entry were included in the cohort, and mammography attendance was followed from cohort entry to 31 December 2009. Generalized estimating equations were used to account for repeated measures within patients. Adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported. Nonattendance occurred in 8% of the 69 746 screening opportunities that were observed. Nonattendance was more common among women who were current or former smokers [OR=1.60 (1.45-1.76) and OR=1.15 (1.05-1.28)], had not used alcohol in the past year [OR=1.55 (1.32-1.83)], were less physically active outside of work [OR=1.10 (1.00-1.20)], had high physical activity at work (OR=1.13, 95% CI: 1.00-1.28), were vegetarians or vegans [OR=1.49 (1.11-1.99)], had not used dietary supplements [OR=1.11 (1.01-1.21)], had poor self-rated health [OR=1.24 (1.14-1.36)], and were experiencing greater stress [OR=1.25 (1.14-1.36)]. In this cohort, nonattendance was associated with smoking, alcohol abstinence, physical activity, poor self-rated health, stress, and following a vegetarian/vegan diet. These findings generally support the notion that women with less healthy lifestyles are less likely to engage in mammography screening.

Computer-aided detection of masses in full-field digital mammography using screen-film mammograms for training

International Nuclear Information System (INIS)

Kallenberg, Michiel; Karssemeijer, Nico

2008-01-01

It would be of great value when available databases of screen-film mammography (SFM) images can be used to train full-field digital mammography (FFDM) computer-aided detection (CAD) systems, as compilation of new databases is costly. In this paper, we investigate this possibility. Firstly, we develop a method that converts an FFDM image into an SFM-like representation. In this conversion method, we establish a relation between exposure and optical density by simulation of an automatic exposure control unit. Secondly, we investigate the effects of using the SFM images as training samples compared to training with FFDM images. Our FFDM database consisted of 266 cases, of which 102 were biopsy-proven malignant masses and 164 normals. The images were acquired with systems of two different manufacturers. We found that, when we trained our FFDM CAD system with a small number of images, training with FFDM images, using a five-fold crossvalidation procedure, outperformed training with SFM images. However, when the full SFM database, consisting of 348 abnormal cases (including 204 priors) and 810 normal cases, was used for training, SFM training outperformed FFDMA training. These results show that an existing CAD system for detection of masses in SFM can be used for FFDM images without retraining.

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

Science.gov (United States)

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

Breast cancer screening; cost-effective in practice?

International Nuclear Information System (INIS)

Koning, Harry J. de

2000-01-01

The main aim of national breast screening is a reduction in breast cancer mortality. The data on the reduction in breast cancer mortality from three (of the five) Swedish trials in particular gave rise to the expectation that the Dutch programme of 2-yearly screening for women aged 50-70 would produce a 16% reduction in the total population. In all likelihood, many of the years of life gained as a result of screening are enjoyed in good health. According to its critics the actual benefit that can be achieved from the national breast cancer screening programmes is overstated. Considerable benefits have recently been demonstrated in England and Wales. However, the fall was so considerable in such a relatively short space of time that screening (started in 1987) was thought to only have played a small part. As far as the Dutch screening programme is concerned it is still too early to reach any conclusions about a possible reduction in mortality. The first short-term results of the screening are favourable and as good as (or better than) expectations. In Swedish regions where mammographic screening was introduced, a 19% reduction in breast cancer mortality can be estimated at population level, and recently a 20% reduction was presented in the UK. In countries where women are expected to make appointments for screening themselves, the attendance figures are significantly lower and the quality of the process as a whole is sometimes poorer. The benefits of breast cancer screening need to be carefully balanced against the burden to women and to the health care system. Mass breast screening requires many resources and will be a costly service. Cost-effectiveness of a breast cancer screening programme can be estimated using a computer model. Published cost-effectiveness ratios may differ tremendously, but are often the result of different types of calculation, time periods considered, including or excluding downstream cost. The approach of simulation and estimation is here

Mammography - importance, possibilities, current screening situation of the breast cancer and further expansion possibilities

International Nuclear Information System (INIS)

Bella, V.

2006-01-01

Breast cancer still remains the most frequent cancer in women population. Incidence of breast cancer is increasing, but mortality is decreasing. The most important for decreasing of breast cancer mortality is early diagnostic, especially screening. Screening is a form of secondary prevention. Although many screening studies have shown that mammography decreases of the breast cancer death, there are still many controversies. The published recommendations for the breast screening are sometimes very different. (author)

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

Science.gov (United States)

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.

Computer-aided diagnostics of screening mammography using content-based image retrieval

Science.gov (United States)

Deserno, Thomas M.; Soiron, Michael; de Oliveira, Júlia E. E.; de A. Araújo, Arnaldo

2012-03-01

Breast cancer is one of the main causes of death among women in occidental countries. In the last years, screening mammography has been established worldwide for early detection of breast cancer, and computer-aided diagnostics (CAD) is being developed to assist physicians reading mammograms. A promising method for CAD is content-based image retrieval (CBIR). Recently, we have developed a classification scheme of suspicious tissue pattern based on the support vector machine (SVM). In this paper, we continue moving towards automatic CAD of screening mammography. The experiments are based on in total 10,509 radiographs that have been collected from different sources. From this, 3,375 images are provided with one and 430 radiographs with more than one chain code annotation of cancerous regions. In different experiments, this data is divided into 12 and 20 classes, distinguishing between four categories of tissue density, three categories of pathology and in the 20 class problem two categories of different types of lesions. Balancing the number of images in each class yields 233 and 45 images remaining in each of the 12 and 20 classes, respectively. Using a two-dimensional principal component analysis, features are extracted from small patches of 128 x 128 pixels and classified by means of a SVM. Overall, the accuracy of the raw classification was 61.6 % and 52.1 % for the 12 and the 20 class problem, respectively. The confusion matrices are assessed for detailed analysis. Furthermore, an implementation of a SVM-based CBIR system for CADx in screening mammography is presented. In conclusion, with a smarter patch extraction, the CBIR approach might reach precision rates that are helpful for the physicians. This, however, needs more comprehensive evaluation on clinical data.

Cost-effectiveness of antenatal screening for neonatal alloimmune thrombocytopenia

DEFF Research Database (Denmark)

Killie, M K; Kjeldsen-Kragh, J; Husebekk, A

2007-01-01

OBJECTIVES: To estimate the costs and health consequences of three different screening strategies for neonatal alloimmune thrombocytopenia (NAIT). DESIGN: Cost-utility analysis on the basis of a decision tree that incorporates the relevant strategies and outcomes. SETTING: Three health regions......-4 weeks before term. Severely thrombocytopenic newborn were transfused immediately with compatible platelets. MAIN OUTCOME MEASUREMENTS: Quality-adjusted life years (QALYs) and costs. RESULTS: Compared with no screening, a programme of screening and subsequent treatment would generate between 210 and 230...... additional QALYs among 100,000 pregnant women, and at the same time, reduce health care costs by approximately 1.7 million euros. The sensitivity analyses indicate that screening is cost effective or even cost saving within a wide range of probabilities and costs. CONCLUSION: Our calculations indicate...

Practical digital mammography

Energy Technology Data Exchange (ETDEWEB)

Hashimoto, Beverly E. [Washington Univ., Seattle, WA (United States)]|[Virginia Mason Medical Center, VA (United States)

2008-07-01

This book is meant for the radiologist who is facing the challenge of organizing a digital mammographic imaging center. This text is meant to be a practical book that provides information about digital mammographic physics and equipment which will allow one to intelligently compare technologies and systems. Some of the major challenges include: large expense; rapidly changing technology, and inconsistent connectivity; and finally, need for strong information technology support. The initial conversion cost to digital mammographic imaging is relatively expensive due to the cost of digital mammography hardware, software, and storage. Virtually all other imaging modalities are being converted to purely digital storage and transfer, and the digital trend in mammography is inevitable. Technical advantages of digital mammography are described. However, the improved flexibility in image display and transfer are some of its strongest features. In conclusion, although there are increasing imaging modalities that may be used to evaluate breast disease, mammography will continue to play a key role in detecting breast cancer. To be an effective imager, the radiologist should become familiar with digital mammography and understand its role within the increasing complex structure of breast imaging techniques.

Practical digital mammography

International Nuclear Information System (INIS)

Hashimoto, Beverly E.

2008-01-01

This book is meant for the radiologist who is facing the challenge of organizing a digital mammographic imaging center. This text is meant to be a practical book that provides information about digital mammographic physics and equipment which will allow one to intelligently compare technologies and systems. Some of the major challenges include: large expense; rapidly changing technology, and inconsistent connectivity; and finally, need for strong information technology support. The initial conversion cost to digital mammographic imaging is relatively expensive due to the cost of digital mammography hardware, software, and storage. Virtually all other imaging modalities are being converted to purely digital storage and transfer, and the digital trend in mammography is inevitable. Technical advantages of digital mammography are described. However, the improved flexibility in image display and transfer are some of its strongest features. In conclusion, although there are increasing imaging modalities that may be used to evaluate breast disease, mammography will continue to play a key role in detecting breast cancer. To be an effective imager, the radiologist should become familiar with digital mammography and understand its role within the increasing complex structure of breast imaging techniques

Breast cancer incidence and mortality in the Nordic capitals, 1970-1998. Trends related to mammography screening programmes

DEFF Research Database (Denmark)

Törnberg, Sven; Kemetli, Levent; Lynge, Elsebeth

2006-01-01

The aim of the present study was to relate the time trends in breast cancer incidence and mortality to the introduction of mammography screening in the Nordic capitals. Helsinki offered screening to women aged 50-59 starting in 1986. The other three capitals offered screening to women aged 50......-69 starting in 1989 in Stockholm, 1991 in Copenhagen, and 1996 in Oslo. Prevalence peaks in breast cancer incidence depended on the age groups covered by the screening, the length of the implementation of screening, and the extent of background opportunistic screening. No mortality reduction following...... the introduction of screening was visible after seven to 12 years of screening in any of the three capitals where significant effects of the screening on the breast cancer mortality had already been demonstrated by using other analytical methods for the evaluation. No visible effect on mortality reduction...

Estimation of patient dose in mammography screening examinations

International Nuclear Information System (INIS)

Suzuki, S.; Fujii, S.; Orito, T.; Asada, Y.; Koga, S.; Horita, K.; Kido, C.

1996-01-01

Mammography is one of the most effective examinations for detecting breast carcinoma. Although the dose is usually much higher than that in other types of X-ray examination, that is accepted by the patient because for fears of suffering cancer. Benefit of relatively high doses derived from mammographic examinations is considered to well exceed the risk of cancer induction by radiation exposure. The purpose of this study is to investigate patient dose of mammography in Japan by questionnaire sent to 531 institutions selected from whole Japan and direct measurements carried out in 28 hospitals in Aichi Prefecture. The user's guide in mammography published by NCRP and Quality Assurance Program of American College of Radiology were used to assess the exposure and image quality of mammogram. (author)

Results of breast cancer screening with mammography carried out in Koriyama City over a three-year period (2001- 2003)

International Nuclear Information System (INIS)

Yoshida, Hatsuo; Iwanami, Hiroshi; Urazumi, Koujirou

2005-01-01

In 2001, biennial breast cancer screening with mammography was started in Koriyama City for women aged 40 years or over. The screening involved both physical examination, including inspection and palpation, and mammography performed separately. Women with abnormal findings on physical examination were recalled, while those without such findings underwent medio-lateral oblique projection mammography. There were a total of 15,246 responders during the three-year period 2001 -2003. The recall rate after physical examination was 3.1% and breast cancer was detected in 25 women (0.16%). For 13,310 women who underwent mammography, the recall rate was 3.9% and 25 breast cancers (0.18%) were detected. Combining these two subgroups, the overall recall rate was 6.5%, the cancer detection rate was 0.33%, the ratio of cancers detected among women who were asked to attend for a recall examination was 5.0%, and the ratio of cancers detected among women who underwent a recall examination was 5.6%. Early cancers detected at Stage 0 or 1 comprised 32 (64%), and lymph node metastasis was positive in 12 women (24%). Thus the results of our screening reached satisfactory levels in terms of the five items proposed by the Breast Imaging Reporting and Data System of the American Radiology Association. In order to further increase the quality of breast cancer screening, proper determination of categories at mammography reading and standardization of recall examination techniques, including histopathological study, are required. (author)

Response costs of mammography adherence: Iranian women’sperceptions

Directory of Open Access Journals (Sweden)

Mahsa Khodayarian

2016-06-01

Conclusion: 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.

st Tomosynthesis Plus Full Field Digital Mammography or Full Field Digital Mammography Alone in the Screening Environment

Directory of Open Access Journals (Sweden)

Stamatia Destounis

2014-01-01

Full Text Available Objectives: Initial review of patients undergoing screening mammography imaged with a combination of digital breast tomosynthesis (DBT plus full field digital mammography (FFDM compared with FFDM alone. Materials and Methods: From June 2011 to December 2011, all patients presenting for routine screening mammography were offered a combination DBT plus FFDM exam. Under institutional review board approval, we reviewed 524 patients who opted for combination DBT plus FFDM and selected a sample group of 524 FFDM screening exams from the same time period for a comparative analysis. The χ2 (Chi-square test was used to compare recall rates, breast density, personal history of breast cancer, and family history of breast cancer between the two groups. Results: Recall rate for FFDM, 11.45%, was significantly higher (P < 0001 than in the combination DBT plus FFDM group (4.20%. The biopsy rate in the FFDM group was 2.29% (12/524, with a cancer detection rate of 0.38% (2/524, or 3.8 per 1000 and positive predictive value (PPV of 16.7% (2/12. The biopsy rate for the DBT plus FFDM group was 1.14% (n = 6/524, with a cancer detection rate 0.57% (n = 3/524, or 5.7 per 1000 and PPV of 50.0% (n = 3/6. Personal history of breast cancer in the FFDM group was significantly lower (P < 0.0001 than in the combination DBT plus FFDM group; 2.5% and 5.7%, respectively. A significant difference in family history of breast cancer (P < 0.0001 was found, with a higher rate in the combination DBT plus FFDM group (36.0% vs. 53.8%. There was a significant difference between the combination DBT plus FFDM group and FFDM alone group, when comparing breast density (P < 0.0147, 61.64% vs. 54.20% dense breasts, respectively with a higher rate of dense breasts in the DBT plus FFDM group. In follow-up, one cancer was detected within one year of normal screening mammogram in the combination DBT plus FFDM group. Conclusion: Our initial experience found the recall rate in the combination DBT

Survey of breast cancer screening by mammography. Results of a questionnaire sent to local self-governing bodies

International Nuclear Information System (INIS)

Ishibashi, Tadashi; Yamada, Takayuki; Sai, Masahiro; Ohnuki, Koji; Uematsu, Takayoshi; Matsumoto, Masao; Uchiyama, Nachiko; Hara, Takeshi

2009-01-01

In order to grasp the current status of breast cancer screening in Japan, a questionnaire was distributed to all local self-governing bodies (LSGB). The results indicated that breast cancer screening with mammography was performed by 97.9% of LSGB. Breast cancer screening was started for women aged less than 40 years at 11.9% of the LSGB, and from 40 years of age at 86.8%. Breast cancer screening for women aged 30-39 years was performed at 51.2% of the LSGB. The proportions of studies involving palpation, mammography, and ultrasonography (US) were 34.0%, 24.5%, and 41.6%, respectively. The coverage of screening invitations between April 2006 and March 2007 was grasped at 94.7% of LSGB. At 23.2%, the coverage was less than 10%, and at 33.8% was 10-19.9%. At 7.1%, the coverage was 50% or more. The national average for coverage was 10%, and was especially low in large cities. The recall rate for LSBG between April 2006 and March 2007 was 85.2%. At 22.4% of the LSBG, recall rates were less than 5%, and at 15.6% the recall rates were 50% or more. Screening mammography for women aged 30-39 years needs to be examined in the future. When recall rates exceed 20%, it is necessary to re-examine the accuracy management of breast cancer screening. (author)

Advanced Breast Cancer as Indicator of Quality Mammography

International Nuclear Information System (INIS)

Gaona, Enrique

2003-01-01

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

An investigation into why two-view mammography is better than one-view in breast cancer screening

International Nuclear Information System (INIS)

Hackshaw, A.K.; Wald, N.J.; Michell, M.J.; Field, S.; Wilson, A.R.M.

2000-01-01

AIM: To determine why two-view mammography in screening for breast cancer is more effective than using a single medio-lateral oblique view. MATERIALS AND METHODS: In the United Kingdom Coordinating Committee on Cancer Research randomized trial of one- vs two-view mammography in breast cancer screening the oblique view was assessed by one radiologist and two views (oblique and cranio-caudal) assessed by another. For the present study the mammographic films were retrieved from the screening centres and assessed by three consultant radiologists. Mammographic films were available from 110 women; 87 had their breast cancer detected by both one and two views and in 23 it was missed by one view but detected using two views. Outcome measures were breast size, location and size of the cancer, mammographic features, presence of microcalcification and overall radiological assessment. RESULTS: Although 23 cancers were missed in the original trial when one view was used, only two were not visible on the oblique view. Cancers missed using a single oblique view (and only detected if the cranio-caudal view was available with the oblique) tended to be smaller by about 4 mm (P = 0.05), centrally located in the breast (P = 0.16), not spiculated or round, (P ≤ 0.001) and lacked microcalcification (P = 0.15). Breast size and breast radiographic density were not significantly associated with breast cancer detection. CONCLUSIONS: The results provide the basis for the observation that two-view mammographic screening is more effective than one-view mammographic screening. Hackshaw, A. (2000). Clinical Radiology 55, 454-458

Evaluation of the "Angelina Jolie Effect" on Screening Mammography Utilization in an Academic Center.

Science.gov (United States)

Huesch, Marco D; Schetter, Susann; Segel, Joel; Chetlen, Alison

2017-08-01

The aim of this study was to understand the impact on screening mammography at our institution, comparing weekly utilization in the 2 years before and the 2 years after Ms Angelina Jolie disclosed in the New York Times on May 13, 2013, that she had had a prophylactic double mastectomy. All 48,110 consecutive screening mammograms conducted at our institution between May 16, 2011, and May 16, 2015, were selected from our electronic medical record system. We used interrupted time series statistical models and graphical methods on utilization data to understand utilization changes before and after Ms Jolie's news. The graphed trend of weekly screening mammogram utilization failed to show changes around the time of interest. Analytical models and statistical tests also failed to show a step change increase or acceleration of utilization around May 2013. However, graphical and time series analyses showed a flattening of utilization in the middle of 2014. In our well-powered analysis in a large regional breast imaging center, we found no support for the hypothesis that this celebrity news drove increased screening. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Communication, Cultural Models of Breast Cancer Beliefs and Screening Mammography: An Assessment of Attitudes Among Haitian Immigrant Women in Eastern Massachusetts

National Research Council Canada - National Science Library

David, Michele

2000-01-01

... forthcoming about this adherence. Many Haitian immigrant women are not aware of the purpose of screening mammography, and present late for evaluation of breast lumps and abnormal findings at mammography...

Communication, Cultural Models of Breast Cancer Beliefs and Screening Mammography: An Assessment of Attitudes Among Haitian Immigrant Women in Eastern MA

National Research Council Canada - National Science Library

David, Michele

2001-01-01

... forthcoming about this adherence. Many Haitian immigrant women are not aware of the purpose of screening mammography, and present late for evaluation of breast lumps and abnormal findings at mammography...

Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends

DEFF Research Database (Denmark)

Jørgensen, Karsten Juhl; Gøtzsche, Peter C

2009-01-01

. DATA SOURCES: PubMed (April 2007), reference lists, and authors. Review methods One author extracted data on incidence of breast cancer (including carcinoma in situ), population size, screening uptake, time periods, and age groups, which were checked independently by the other author. Linear regression......OBJECTIVE: To estimate the extent of overdiagnosis (the detection of cancers that will not cause death or symptoms) in publicly organised screening programmes. DESIGN: Systematic review of published trends in incidence of breast cancer before and after the introduction of mammography screening...... was used to estimate trends in incidence before and after the introduction of screening and in older, previously screened women. Meta-analysis was used to estimate the extent of overdiagnosis. RESULTS: Incidence data covering at least seven years before screening and seven years after screening had been...

Barriers to Organized Mammography Screening Programs in Hungary: A Questionnaire-based Study of 3,313 Women.

Science.gov (United States)

Újhelyi, Mihály; Pukancsik, Dávid; Kelemen, Péter; Kovács, Eszter; Kenessey, István; Bak, Mihály; Kásler, Miklós; Kovács, Tibor; Mátrai, Zoltán

2018-03-01

Despite well-organized Hungarian invitational mammography screening, participation rates have never reached 50%. This is similar to rates in Central Eastern Europe. In order to reduce breast cancer mortality, the participation rate should be at least 70%. This questionnaire-based study assessed the barriers associated with low adherence rates. Women 45-65 years of age were interviewed by questionnaire containing 15 structured questions focused on socioeconomic status and barriers to screening. A total of 3,313 women completed the questionnaire. The main reasons for avoiding screening were work absenteeism (18.9%), fear of painful examination (18.39%), and poor understanding of mammography screening (14.94%). Education is required to increase awareness among women about the utility and availability of breast screening services. This report provides information on the appropriate level of intervention needed to increase screening participation in Hungary and other developing countries in Central Eastern Europe to reduce breast cancer-related mortality. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

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

Directory of Open Access Journals (Sweden)

Sukanya Chongthawonsatid

Full Text Available 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.

Benefit, risks and cost-effectiveness of screening for abdominal aortic aneurysm

International Nuclear Information System (INIS)

Schmidt, T.; Muehlberger, N.; Siebert, U.; Chemelli-Steingruber, I.E.; Chemelli, Andreas; Strasak, A.; Kofler, B.

2010-01-01

Purpose: abdominal aortic aneurysms (AAA) cause a considerable number of deaths. A ruptured AAA is associated with a mortality rate of 80%. The purpose of this study was to summarize the current evidence from published health economic models for the long-term effectiveness and cost-effectiveness of screening programs for AAA. Materials and methods: medical, economic and health technology assessment (HTA) databases were systematically searched for cost-effectiveness models up to October 2007. Only models with a lifetime time horizon of evaluating AAA screening in men over 65 years were included in the review. Study data were extracted, standardized and summarized in evidence tables and cost-effectiveness plots. Results: we reviewed 8 cost-effectiveness models published between 1993 and 2007 comparing AAA screening and lack of screening in men over 60. One model yielded a loss of life-years at additional costs. The remaining seven models yielded gains in life expectancy ranging from 0.02 to 0.28LYs. Gains in quality-adjusted life expectancy reported by six of the seven models ranged from 0.015 to 0.059 QALYs. Incremental costs ranged from 96 to 721 Euros. Incremental cost-effectiveness ratios (ICER) ranged from 1443 to 13299 Euros per LY or QALY gained. Conclusion: based on our analysis, the introduction of a screening program to identify AAA will probably gain additional life years and quality of life at acceptable extra costs. The target population for a screening program should be men 65 years and older. (orig.)

Psychosocial predictors of first attendance for organised mammography screening

DEFF Research Database (Denmark)

Aro, A R; de Koning, H J; Absetz, P

1999-01-01

Scale, Illness Attitude Scale, Health Locus of Control Scale, Anxiety Inventory, and Depression Inventory. Univariate and multivariate logistic regression analyses were used to predict attendance. RESULTS: Those most likely to attend were working, middle income, and averagely educated women, who had...... not had a mass mammogram recently, but who regularly visited gynaecologists, attended for Pap smear screening, practised breast self examination, and who did not smoke. Low confidence in their own capabilities in breast cancer prevention, overoptimism about the sensitivity of mammography, and perception...

Performance of screening mammography: A report of the alliance for breast cancer screening in Korea

Energy Technology Data Exchange (ETDEWEB)

Lee, Eun Hye [Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Kim, Keum Woo [Konyang University Hospital, Konyang University College of Medicine, Daejeon (Korea, Republic of); Kim, Young Joong [Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung (Korea, Republic of); and others

2016-07-15

To analyze the diagnostic accuracy and trend in screening mammography in Korea. We retrospectively linked the information from hospitals participating in the Alliance of Breast Cancer Screening in Korea (ABCS-K) and the database of the National Cancer Screening Program. We calculated performance indicators, including the recall rate, cancer detection rate (CDR), positive predictive value (PPV), sensitivity, specificity, false-positive rate (FPR), and interval cancer rate (ICR). Changes in the performance indicators were calculated as the annual percent change with 95% confidence interval (CI). We enrolled 128756 cases from 10 hospitals from 2005 to 2010. The recall rate was 19.1% with a downward trend over time (-12.1% per year; 95% CI, -15.9 to -8.2). The CDR was 2.69 per 1000 examinations, without a significant trend. The PPV was 1.4% with an upward trend (20.8% per year; 95% CI, 15.2 to 26.7). The sensitivity was 86.5% without a significant trend, whereas the specificity was 81.1% with an upward trend (3.3% per year; 95% CI, 2.1 to 4.5). The FPR was 18.9% with a downward trend (-12.4% per year; 95% CI, -16.2 to -8.4). The ICR was 0.5 per 1000 negative examinations without a significant trend. There were institutional variations in the diagnostic accuracy and trend except for the CDR, sensitivity, and ICR. The sensitivity and CDR of screening mammography in the ABCS-K from 2005 to 2010 were compatible with those for Western women. The recall rate, PPV and specificity, however, were suboptimal, although they showed significant improvements over this period. A further analysis is required to explain institutional variations.

Cost-effectiveness and radiation risk of breast cancer screening

International Nuclear Information System (INIS)

Rombach, J.J.

1987-01-01

Base cost effectiveness risk associated with radiological screening for tuberculosis and lung tumor the Government of Netherlands advised against mass screening. However, mass screening remains an important method in the case of breast cancer

Comparing the visualization of microcalcifications with direct magnification in digital full-field mammography vs. film-screen mammography

International Nuclear Information System (INIS)

Diekmann, F.; Diekmann, S.; Rogalla, P.; Hamm, B.; Bick, U.; Blohmer, J.U.; Winzer, K.J.

2002-01-01

Purpose: To evaluate the conspicuity of microcalcifications in magnified mammographic views of preparations obtained with full field digital mammography (FFDM), film-screen mammography (FSM), and the DIMA technique. Material and Methods: Twelve preparations were examined by FFDM and FSM using 1.8 x magnification and DIMA using 7 x magnification. Parameter settings were identical for all three techniques. The number of visible microcalcifications was then determined for each modality by three radiologists. As far as possible, all preparations were X-rayed at 22 kV and 10 mAS. Results: Altogether 9705 calcifications were counted (DIMA: 1609/1542/1534; FFDM: 1020/753/881; FSM: 901/643/822). The total number of microcalcifications identified with the DIMA technique was 4685 as compared to 2654 with FFDM and 2366 with FSM. The calcifications counted with FFDM and FSM thus corresponded to 56.6% and 50.5%, respectively, of those identified with DIMA. The differences between the groups were statistically significant (F-Test, p [de

Comparison of screen-film and full-field digital mammography in Japanese population-based screening

International Nuclear Information System (INIS)

Yamada, Takayuki; Saito, Mioko; Ishibashi, Tadashi

2004-01-01

The purpose of this study was to investigate how the greater contrast of full-field digital mammography (FFDM) affects the detection of suspicious lesions in Japanese population-based screening. Screen-film mammography (SFM) and FFDM were performed in 480 women aged 50 years or more. A set of mediolateral oblique views was obtained with each modality. All mammograms were independently double-read. The five-scale category assessment and type of finding using the Breast Imaging Reporting and Data System (BIRADS) nomenclature were given. Intraobserver variance, recall rates, and positive predictive value were calculated. The findings between the two modalities were discordant. κ-values for each reader were 0.619 and 0.385, respectively. Almost half of the microcalcifications were called with both modalities. The detection of masses was less concordant between the readers (27%). The masses were detected more frequently with FFDM (73%). Other findings were only detected with one modality. The recall rate was not significantly different (2.9% with SFM vs. 4.2% with FFDM; p=0.253). The positive predictive value was not significantly different (14% with SFM vs. 10% with FFDM; p=0.69), either. Two patients with breast cancer were detected with both modalities. Recall rates and positive predictive value were not significantly different between SFM and FFDM. Cancers were detected with both modalities. (author)

Cost-Effectiveness of a School-Based Emotional Health Screening Program

Science.gov (United States)

Kuo, Elena; Stoep, Ann Vander; McCauley, Elizabeth; Kernic, Mary A.

2009-01-01

Background: School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening…

Breast cancer screening, outside the population-screening program, of women from breast cancer families without proven BRCA1/BRCA2 mutations : a simulation study

NARCIS (Netherlands)

Jacobi, C.E.; Nagelkerke, N.J.D.; van Houwelingen, J.C.; de Bock, G.H.

Purpose: We assessed the cost-effectiveness of mammography screening for women under the age of 50, from breast cancer families without proven BRCA1./BRCA2 mutations, because current criteria for screening healthy women from breast cancer families are not evidence-based. Methods: We did simulation

Breast cancer screening, outside the population-screening program, of women from breast cancer families without proven BRCA1/BRCA2 mutations: a simulation study

NARCIS (Netherlands)

Jacobi, C.E.; Nagelkerke, N.J.D.; van Houwelingen, J.C.; de Bock, Truuske

2006-01-01

Purpose: We assessed the cost-effectiveness of mammography screening for women under the age of 50, from breast cancer families without proven BRCA1./BRCA2 mutations, because current criteria for screening healthy women from breast cancer families are not evidence-based. Methods: We did simulation

Clinical evaluation of mammography using a screen-film system. Pt. 3

International Nuclear Information System (INIS)

Wurm, J.; Behrends, E.; Hofmann-Preiss, K.; Paterok, E.M.; Saebel, M.; Weishaar, J.

1983-01-01

In a clinical image quality test, the parameter image quality is analysed using the ROC method and on the basis of mammograms already classified by means of histological findings into ''benign'' and ''malignant'' cases. The results of this analysis confirmed those of the first two studies: The screen-film system, due to its almost equally good image quality, achieves a diagnostic accuracy as good as the Definix test film without screen. In addition, the following two parameters have been investigated in this clinical test: Different knowledge and experience of the evaluating experts in the field of mammography, and the learning progress in the course of expert training. The difference in knowledge and experience of the various evaluators becomes apparent in ROC analysis only with an evaluator having much more experience than the others in the field of mammography. The parameter learning progress - as shown by repeating the evaluation after three months of intensive training - does not come forth clear enough in the ROC curves. An analysis of the frequency distribution of the five decision thresholds reveals the approach of the individual evaluator. (orig.) [de

Cost-effectiveness and radiological risk associated with mass chest screening

International Nuclear Information System (INIS)

Stieve, F.E.

1987-01-01

This report presents in summary the cost effectiveness and radiological risks associated with mass chest tuberculosis screening in major European countries. The state of tuberculosis in west Europe, the cost effectiveness of mass screening, international standards regarding radiation doses as well as the need for quality control are addressed

A Case-Control Study to Estimate the Impact of the Icelandic Population-Based Mammography Screening Program on Breast Cancer Death

Energy Technology Data Exchange (ETDEWEB)

Gabe, R.; Tryggvadottir, L.; Sigfusson, B.F.; Olafsdottir, G.H.; Sigurarsson , K. [Icelandic Cancer Society (Krabbameinsfelag Islands), Reykjavik (Iceland); Duffy, S.W. [Cancer Research UK, Centre for Epidemiology, Mathematics and Stati stics, Wolfson Inst. of Preventive Medicine, London (United Kingdom)

2007-11-15

Background: The Icelandic breast cancer screening program, initiated November 1987 in Reykjavik and covering the whole country from December 1989, comprises biennial invitation to mammography for women aged 40-69 years old. Purpose: To estimate the impact of mammography service screening in Iceland on deaths from breast cancer. Material and Methods: Cases were deaths from breast cancer from 1990 onwards in women aged 40 and over at diagnosis, during the period November 1987 to December 31, 2002. Age- and screening-area-matched, population-based controls were women who had also been invited to screening but were alive at the time their case died. Results: Using conditional logistic regression on the data from 226 cases and 902 controls, the odds ratio for the risk of death from breast cancer in those attending at least one screen compared to those never screened was 0.59 (95% CI 0.41-0.84). After adjustment for healthy-volunteer bias and screening-opportunity bias, the odds ratio was 0.65 (95% CI 0.39-1.09). Conclusion: These results indicate a 35-40% reduction in breast cancer deaths by attending the Icelandic breast cancer screening program. These results are consistent with the overall evidence from other observational evaluations of mammography-based programs.

A Case-Control Study to Estimate the Impact of the Icelandic Population-Based Mammography Screening Program on Breast Cancer Death

International Nuclear Information System (INIS)

Gabe, R.; Tryggvadottir, L.; Sigfusson, B.F.; Olafsdottir, G.H.; Sigurarsson, K.; Duffy, S.W.

2007-01-01

Background: The Icelandic breast cancer screening program, initiated November 1987 in Reykjavik and covering the whole country from December 1989, comprises biennial invitation to mammography for women aged 40-69 years old. Purpose: To estimate the impact of mammography service screening in Iceland on deaths from breast cancer. Material and Methods: Cases were deaths from breast cancer from 1990 onwards in women aged 40 and over at diagnosis, during the period November 1987 to December 31, 2002. Age- and screening-area-matched, population-based controls were women who had also been invited to screening but were alive at the time their case died. Results: Using conditional logistic regression on the data from 226 cases and 902 controls, the odds ratio for the risk of death from breast cancer in those attending at least one screen compared to those never screened was 0.59 (95% CI 0.41-0.84). After adjustment for healthy-volunteer bias and screening-opportunity bias, the odds ratio was 0.65 (95% CI 0.39-1.09). Conclusion: These results indicate a 35-40% reduction in breast cancer deaths by attending the Icelandic breast cancer screening program. These results are consistent with the overall evidence from other observational evaluations of mammography-based programs

The effect of population-based mammography screening in Dutch municipalities on breast cancer mortality: 20 years of follow-up.

Science.gov (United States)

Sankatsing, Valérie D V; van Ravesteyn, Nicolien T; Heijnsdijk, Eveline A M; Looman, Caspar W N; van Luijt, Paula A; Fracheboud, Jacques; den Heeten, Gerard J; Broeders, Mireille J M; de Koning, Harry J

2017-08-15

Long-term follow-up data on the effects of screening are scarce, and debate exists on the relative contribution of screening versus treatment to breast cancer mortality reduction. Our aim was therefore to assess the long-term effect of screening by age and time of implementation. We obtained data on 69,630 breast cancer deaths between 1980 and 2010 by municipality (N = 431) and age of death (40-79) in the Netherlands. Breast cancer mortality trends were analyzed by defining the municipality-specific calendar year of introduction of screening as Year 0. Additionally, log-linear Poisson regression was used to estimate the turning point in the trend after Year 0, per municipality, and the annual percentage change (APC) before and after this point. Twenty years after introduction of screening breast cancer mortality was reduced by 30% in women aged 55-74 and by 34% in women aged 75-79, compared to Year 0. A similar and significant decrease was present in municipalities that started early (1987-1992) and late (1995-1997) with screening, despite the difference in availability of effective adjuvant treatment. In the age groups 55-74 and 75-79, the turning point in the trend in breast cancer mortality was estimated in Years 2 and 6 after the introduction of screening, respectively, after which mortality decreased significantly by 1.9% and 2.6% annually. These findings show that the implementation of mammography screening in Dutch municipalities is associated with a significant decline in breast cancer mortality in women aged 55-79, irrespective of time of implementation. © 2017 UICC.

Informed Choice in the German Mammography Screening Program by Education and Migrant Status: Survey among First-Time Invitees.

Directory of Open Access Journals (Sweden)

Eva-Maria Berens

Full Text Available Breast cancer is the most prevalent cancer among women and mammography screening programs are seen as a key strategy to reduce breast cancer mortality. In Germany, women are invited to the population-based mammography screening program between ages 50 to 69. It is still discussed whether the benefits of mammography screening outweigh its harms. Therefore, the concept of informed choice comprising knowledge, attitude and intention has gained importance. The objective of this observational study was to assess the proportion of informed choices among women invited to the German mammography screening program for the first time. A representative sample of 17,349 women aged 50 years from a sub-region of North Rhine Westphalia was invited to participate in a postal survey. Turkish immigrant women were oversampled. The effects of education level and migration status on informed choice and its components were assessed. 5,847 (33.7% women responded to the postal questionnaire of which 4,113 were used for analyses. 31.5% of the women had sufficient knowledge. The proportion of sufficient knowledge was lower among immigrants and among women with low education levels. The proportion of women making informed choices was low (27.1%, with similar associations with education level and migration status. Women of low (OR 2.75; 95% CI 2.18-3.46 and medium education level (OR 1.49; 95% CI 1.27-1.75 were more likely to make an uninformed choice than women of high education level. Turkish immigrant women had the greatest odds for making an uninformed choice (OR 5.30, 95% CI 1.92-14.66 compared to non-immigrant women. Other immigrant women only had slightly greater odds for making an uninformed choice than non-immigrant women. As immigrant populations and women with low education level have been shown to have poor knowledge, they need special attention in measures to increase knowledge and thus informed choices.

Efficacy of storage phosphor-based digital mammography in diagnosis of breast cancer

International Nuclear Information System (INIS)

Kitahama, Hiroyuki

1991-01-01

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<0.05). Efficacy of storage phosphor-based digital mammography in diagnosis of breast cancer was discussed and demonstrated in this study. (author)

Screening Mammography: Science, Policy and Politics–The Good, the Bad and the Ugly

Science.gov (United States)

Diana Petitti, MD, MPH, FACPM, an epidemiologic expert on women's health and evidence based medicine, with posts as vice chair and spokesperson for the U.S. Preventive Service Task Force, presented "Screening Mammography: Science, Policy and Politics–The Good, the Bad and the Ugly." 

Mammography for women in their 40s : to screen or not to screen

International Nuclear Information System (INIS)

Le Heron, J.

1997-01-01

In the United States there is currently a raging controversy as to whether women in their 40s should be screened for breast cancer, with responsible medical bodies each issuing divergent recommendations. With the imminent commencement of the national breast screening programme in New Zealand, it is relevant to briefly review what underlies these differences. The evicence from international studies is that breast cancer deaths on the population of women aged 50 to 69 can be reduced by about 30% by good mammography screening programes. However the evidence in not so unequivocal for the 40 to 49 age group. Breast cancer in younger women tends to be more virulent, growing faster, and killing faster, and detection of cancer in younger breasts is more difficult than in breasts of older women due to the presence of greater amounts of glandular tissue. Where does this leave breast screening in New Zealand? The nationwide breast screening programme will commence with asymmptomatic women aged 50-64 eligible for screening. Extension to women older than 64 will be considered again once the programme is in place and running well. The Ministry of Health has not recommended routine screening for women in their 40s, but will continue to monitor the latest information and if, sufficient new evidence becomes availabe, the screening guidelines will be reassessed. (author)

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

Science.gov (United States)

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

False-positive findings in mammography screening induces short-term distress - breast cancer-specific concern prevails longer

DEFF Research Database (Denmark)

Aro, A R; Pilvikki Absetz, S; van Elderen, T M

2000-01-01

The aim of this study was to examine psychological distress in a mammography screening process as a consequence of screening after adjusting for background, personality and prescreening distress. Subjects, aged 50 years, were invitees at their first screening. There were three groups; normal find...... perceived breast cancer risk and susceptibility. Distress related to screening and false-positive findings seems to be moderate, but prevailing cancer-specific concerns call for improvements in screening programmes....

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis.

Science.gov (United States)

Welton, Nicky J; McAleenan, Alexandra; Thom, Howard Hz; Davies, Philippa; Hollingworth, Will; Higgins, Julian Pt; Okoli, George; Sterne, Jonathan Ac; Feder, Gene; Eaton, Diane; Hingorani, Aroon; Fawsitt, Christopher; Lobban, Trudie; Bryden, Peter; Richards, Alison; Sofat, Reecha

2017-05-01

Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources. To conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model. Systematic review, meta-analysis and cost-effectiveness analysis. Primary care. Adults. Screening strategies, defined by screening test, age at initial and final screens, screening interval and format of screening {systematic opportunistic screening [individuals offered screening if they consult with their general practitioner (GP)] or systematic population screening (when all eligible individuals are invited to screening)}. Sensitivity, specificity and diagnostic odds ratios; the odds ratio of detecting new AF cases compared with no screening; and the mean incremental net benefit compared with no screening. Two reviewers screened the search results, extracted data and assessed the risk of bias. A DTA meta-analysis was perfomed, and a decision tree and Markov model was used to evaluate the cost-effectiveness of the screening strategies. Diagnostic test accuracy depended on the screening test and how it was interpreted. In general, the screening tests identified in our review had high sensitivity (> 0.9). Systematic population and systematic opportunistic screening strategies were found to be similarly effective, with an estimated 170 individuals needed to be screened to detect one additional AF case compared with no screening. Systematic opportunistic screening was more likely to be cost-effective

Mammography and mammographic screening in the United Kingdom: Practices, regulations and radiation dosimetry

International Nuclear Information System (INIS)

Fitzgerald, M.

1987-01-01

The radiation-induced cancers due to mammography represent about 0.6 % of the natural incidence in this survey and would seem to be a very small risk. If the frequency or period of screening was increased, the risk would be enhanced. However, it should be possible to reduce the radiation dose to less than the mean value used here. For example, if film screen mammography alone was used for this population, the quoted risk would be reduced by 25%. The dose is also reduced by the use of a single view. The relatively low risk to the breast is a consequence partly of the low dose mammographic techniques that can now be practised, and partly of the acceptance of mean breast dose, which may be an order to magnitude less than the surface dose, as the measure of risk. The risk to other organs should be negligible provided that the X-ray field is carefully collimated and that the breast table incorporates a primary absorber

Travel Times for Screening Mammography: Impact of Geographic Expansion by a Large Academic Health System.

Science.gov (United States)

Rosenkrantz, Andrew B; Liang, Yu; Duszak, Richard; Recht, Michael P

2017-09-01

This study aims to assess the impact of off-campus facility expansion by a large academic health system on patient travel times for screening mammography. Screening mammograms performed from 2013 to 2015 and associated patient demographics were identified using the NYU Langone Medical Center Enterprise Data Warehouse. During this time, the system's number of mammography facilities increased from 6 to 19, reflecting expansion beyond Manhattan throughout the New York metropolitan region. Geocoding software was used to estimate driving times from patients' homes to imaging facilities. For 147,566 screening mammograms, the mean estimated patient travel time was 19.9 ± 15.2 minutes. With facility expansion, travel times declined significantly (P travel times between such subgroups. However, travel times to pre-expansion facilities remained stable (initial: 26.8 ± 18.9 minutes, final: 26.7 ± 18.6 minutes). Among women undergoing mammography before and after expansion, travel times were shorter for the postexpansion mammogram in only 6.3%, but this rate varied significantly (all P travel burden and reduce travel time variation among sociodemographic populations. Nonetheless, existing patients strongly tend to return to established facilities despite potentially shorter travel time locations, suggesting strong site loyalty. Variation in travel times likely relates to various factors other than facility proximity. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Global cost-effectiveness of GDM screening and management

DEFF Research Database (Denmark)

Weile, Louise K K; Kahn, James G; Marseille, Elliot

2015-01-01

a systematic search and abstraction of cost-effectiveness and cost-utility studies from 2002 to 2014. We standardized all findings to 2014 US dollars. We found that cost-effectiveness ratios varied widely. Most variation was found to be due to differences in geographic setting, diagnostic criteria...... and intervention approaches, and outcomes (e.g., inclusion or exclusion of long-term type 2 diabetes risk and associated costs). We concluded that incorporation of long-term benefits of GDM screening and treatment has huge impact on cost-effectiveness estimates. Based on the large methodological heterogeneity...

[Quality assurance of fine-needle aspiration cytology of the organized mammography screening].

Science.gov (United States)

Bak, Mihály; Konyár, Eva; Schneider, Ferenc; Bidlek, Mária; Szabó, Eva; Nyári, Tibor; Godény, Mária; Kásler, Miklós

2010-08-08

The National Public Health Program has established the organized mammography screening in Hungary. The aim of our study was to determine the quality assurance of breast aspiration cytology. Cytology results were rated to 5 categories (C1, C2, C3, C4 and C5). All cytology reports were compared with the final histology diagnosis. 1361 women had aspiration cytology diagnosis performed from a total of 47718 mammography non-negative lesions. There were 805 (59.1%) benign and 187 (13.7%) malignant alterations. Sensitivity was 91%, specificity 88%, positive predictive value 96.6% and negative predictive value turned to be 71% (pauditing values of fine needle aspiration cytology in our laboratory meet, or in certain aspects exceed the proposed minimum threshold values.

On the possibility of reducing doses received by patients during mammography screening

International Nuclear Information System (INIS)

Tolwinski, J.; Fabiszewska, E.; Gwiazdowska, B.; Bulski, W.

2005-01-01

possibility of decreasing the individual doses by proper selection of the high voltage value. The parameters, resulting from the histograms of the Di values (mode, median, mean),shown in Figures 2, 3 and 4 are summarized and compared with the standard AGD calculated for the same unit (Table I). The results show that the acceptance of a single parameter for evaluation of doses received by patients during mammography examinations is insufficient. The assessment of the standard AGD is insufficient for the evaluation of the procedures of mammography screening. The histograms of individual dose distribution should be used for controlling of the conditions of these examinations. (author)

Mammography at reduced doses: present performance and future possibilities

International Nuclear Information System (INIS)

Muntz, E.P.; Wilkinson, E.; George, F.W.

1980-01-01

Reduced dose mammography is assessed with the aid of very recent work. It is concluded that there are technical and clinical reasons for believing that the reduced dose systems and their interpreters should perform more effectively than their predecessors. Review of known technologic achievements suggests a possible 6 to 7 reduction factor from present screen-film mammography dose levels without sacficifing image quality. Reasonable estimates of representative doses presently achieved by both xeroradiography and screen-film systems are given. The screen-film value is about 3 times higher than some previous

Scrutinizing screening: a critical interpretive review of primary care provider perspectives on mammography decision-making with average-risk women.

Science.gov (United States)

Siedlikowski, Sophia; Ells, Carolyn; Bartlett, Gillian

2018-01-01

A decision to undertake screening for breast cancer often takes place within the primary care setting, but current controversies such as overdiagnosis and inconsistent screening recommendations based on evolving evidence render this a challenging process, particularly for average-risk women. Given the responsibility of primary care providers in counseling women in this decision-making process, it is important to understand their thoughts on these controversies and how they manage uncertainty in their practice. To review the perspectives and approaches of primary care providers regarding mammography decision-making with average-risk women. This study is a critical interpretive review of peer-review literature that reports primary care provider perspectives on mammography screening decision-making. Ovid MEDLINE®, Ovid PsycInfo, and Scopus databases were searched with dates from 2002 to 2017 using search terms related to mammography screening, uncertainty, counseling, decision-making, and primary health care providers. Nine articles were included following a review process involving the three authors. Using an inductive and iterative approach, data were grouped into four thematic categories: (1) perceptions on the effectiveness of screening, screening initiation age, and screening frequency; (2) factors guiding primary care providers in the screening decision-making process, including both provider and patient-related factors, (3) uncertainty faced by primary care providers regarding guidelines and screening discussions with their patients; and (4) informed decision-making with average-risk women, including factors that facilitate and hinder this process. The discussion of results addresses several factors about the diversity of perspectives and practices of physicians counseling average-risk women regarding breast cancer screening. This has implications for the challenge of understanding and explaining evidence, what should be shared with average-risk women

Costs and cost effectiveness of different strategies for chlamydia screening and partner notification: an economic and mathematical modelling study.

Science.gov (United States)

Turner, Katy; Adams, Elisabeth; Grant, Arabella; Macleod, John; Bell, Gill; Clarke, Jan; Horner, Paddy

2011-01-04

To compare the cost, cost effectiveness, and sex equity of different intervention strategies within the English National Chlamydia Screening Programme. To develop a tool for calculating cost effectiveness of chlamydia control programmes at a local, national, or international level. An economic and mathematical modelling study with cost effectiveness analysis. Costs were restricted to those of screening and partner notification from the perspective of the NHS and excluded patient costs, the costs of reinfection, and costs of complications arising from initial infection. England. Population Individuals eligible for the National Chlamydia Screening Programme. Cost effectiveness of National Chlamydia Screening Programme in 2008-9 (as cost per individual tested, cost per positive diagnosis, total cost of screening, number screened, number infected, sex ratio of those tested and treated). Comparison of baseline programme with two different interventions-(i) increased coverage of primary screening in men and (ii) increased efficacy of partner notification. In 2008-9 screening was estimated to cost about £46.3m in total and £506 per infection treated. Provision for partner notification within the screening programme cost between £9 and £27 per index case, excluding treatment and testing. The model results suggest that increasing male screening coverage from 8% (baseline value) to 24% (to match female coverage) would cost an extra £22.9m and increase the cost per infection treated to £528. In contrast, increasing partner notification efficacy from 0.4 (baseline value) to 0.8 partners per index case would cost an extra £3.3m and would reduce the cost per infection diagnosed to £449. Increasing screening coverage to 24% in men would cost over six times as much as increasing partner notification to 0.8 but only treat twice as many additional infections. In the English National Chlamydia Screening Programme increasing the effectiveness of partner notification is likely

A comparison of digital mammography detectors and emerging technology

International Nuclear Information System (INIS)

Diffey, J.L.

2015-01-01

The overall diagnostic accuracy of digital mammography in the context of screening has been shown to be similar or slightly better than screen-film mammography. However, digital mammography encompasses both Computed Radiography (CR) and integrated Digital Radiography (DR) and there is increasing evidence to suggest that differences in detector technology are associated with variations in cancer detection rate, dose and image quality. These differences are examined in detail. Although digital mammography offers many advantages compared to screen-film, there are still some limitations with its use as a screening tool and reduced cancer detection in dense breasts remains an issue. Digital mammography detectors have paved the way for emerging technologies which may offer improvements. Taking the definition of mammography to only include X-ray imaging of the breast, this article focuses on tomosynthesis, contrast-enhanced digital mammography, stereoscopic mammography and dedicated breast computed tomography. Advanced software applications such as Computed Aided Detection (CAD) and quantitative breast density assessment are also presented. The benefits and limitations of each technique are discussed. - Highlights: • Digital detector technology affects cancer detection rate, dose and image quality. • Digital detectors have facilitated new technologies such as tomosynthesis. • 3-D techniques reduce superimposition and increase cancer detection in dense breasts. • Contrast-enhanced mammography demonstrates improved sensitivity and specificity.

Adherence to Mammography Screening Guidelines Among Transgender Persons and Sexual Minority Women.

Science.gov (United States)

Bazzi, Angela Robertson; Whorms, Debra S; King, Dana S; Potter, Jennifer

2015-11-01

We used retrospective (2012-2013) chart review to examine breast cancer screening among transgender persons and sexual minority women (n = 1263) attending an urban community health center in Massachusetts. Transgender were less likely than cisgender patients and bisexuals were less likely than heterosexuals and lesbians to adhere to mammography screening guidelines (respectively, adjusted odds ratios = 0.53 and 0.56; 95% confidence intervals = 0.31, 0.91 and 0.34, 0.92) after adjustment for sociodemographics. Enhanced cancer prevention outreach is needed among gender and sexual minorities.

Efficacy of computer-aided detection system for screening mammography

International Nuclear Information System (INIS)

Saito, Mioko; Ohnuki, Koji; Yamada, Takayuki; Saito, Haruo; Ishibashi, Tadashi; Ohuchi, Noriaki; Takahashi, Shoki

2002-01-01

A study was conducted to evaluate the efficacy of a computer-aided detection (CAD) system for screening mammography (MMG). Screening mammograms of 2,231 women aged over 50 yr were examined. Medio-lateral oblique (MLO) images were obtained, and two expert observers interpreted the mammograms by consensus. First, each mammogram was interpreted without the assistance of CAD, followed immediately by a re-evaluation of areas marked by the CAD system. Data were recorded to measure the effect of CAD on the recall rate, cancer detection rate and detection rate of masses, microcalcifications and other findings. The CAD system increased the recall rate from 2.3% to 2.6%. Six recalled cases were diagnosed as breast cancer pathologically, and CAD detected all of these lesions. Seven additional cases in which CAD detected abnormal findings had no malignancy. The detection rate of CAD for microcalcifications was high (95.0%). However, the detection rate for mass lesions and other findings was low (29.2% and 25.0% respectively). The false positivity rate was 0.13/film for microcalcifications, and 0.25/film for mass lesions. The efficacy of the CAD system for detecting microcalcifications on screening mammograms was confirmed. However, the low detection rate of mass lesions and relatively high rate of false positivity need to be further improved. (author)

Cost-effectiveness of hysteroscopy screening for infertile women.

Science.gov (United States)

Kasius, Jenneke C; Eijkemans, René J C; Mol, Ben W J; Fauser, Bart C J M; Fatemi, Human M; Broekmans, Frank J M

2013-06-01

This study assessed the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared with the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine pathology was treated during hysteroscopy. Two models were constructed and evaluated in a decision analysis. In model I, all patients had an increase in pregnancy rate after screening hysteroscopy prior to IVF; in model II, only patients with intrauterine pathology would benefit. For each strategy, the total costs and live birth rates after a total of three IVF cycles were assessed. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For the Routinehyst strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥ 2.8%. In model II (only patients with pathology benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance resulted in considerable costs. In conclusion, the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the effectiveness of hysteroscopy are needed. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Understanding women's mammography intentions: a theory-based investigation.

Science.gov (United States)

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.

Cost-effectiveness of computed tomography colonography in colorectal cancer screening: a systematic review.

Science.gov (United States)

Hanly, Paul; Skally, Mairead; Fenlon, Helen; Sharp, Linda

2012-10-01

The European Code Against Cancer recommends individuals aged ≥ 50 should participate in colorectal cancer screening. CT-colonography (CTC) is one of several screening tests available. We systematically reviewed evidence on, and identified key factors influencing, cost-effectiveness of CTC screening. PubMed, Medline, and the Cochrane library were searched for cost-effectiveness or cost-utility analyses of CTC-based screening, published in English, January 1999 to July 2010. Data was abstracted on setting, model type and horizon, screening scenario(s), comparator(s), participants, uptake, CTC performance and cost, effectiveness, ICERs, and whether extra-colonic findings and medical complications were considered. Sixteen studies were identified from the United States (n = 11), Canada (n = 2), and France, Italy, and the United Kingdom (1 each). Markov state-transition (n = 14) or microsimulation (n = 2) models were used. Eleven considered direct medical costs only; five included indirect costs. Fourteen compared CTC with no screening; fourteen compared CTC with colonoscopy-based screening; fewer compared CTC with sigmoidoscopy (8) or fecal tests (4). Outcomes assessed were life-years gained/saved (13), QALYs (2), or both (1). Three considered extra-colonic findings; seven considered complications. CTC appeared cost-effective versus no screening and, in general, flexible sigmoidoscopy and fecal occult blood testing. Results were mixed comparing CTC to colonoscopy. Parameters most influencing cost-effectiveness included: CTC costs, screening uptake, threshold for polyp referral, and extra-colonic findings. Evidence on cost-effectiveness of CTC screening is heterogeneous, due largely to between-study differences in comparators and parameter values. Future studies should: compare CTC with currently favored tests, especially fecal immunochemical tests; consider extra-colonic findings; and conduct comprehensive sensitivity analyses.

Experience with digital mammography

Directory of Open Access Journals (Sweden)

G. P. Korzhenkova

2011-01-01

Full Text Available The use of digital techniques in mammography has become a last step for completing the process of digitization in diagnostic imaging. It is assumed that such a spatial decision will be required for digital mammography, as well as for high-resolution intensifying screen-film systems used in conventional mammography and that the digital techniques will be limited by the digitizer pixel size on detecting minor structures, such as microcalcifications. The introduction of digital technologies in mammography involves a tight control over an image and assures its high quality.

Predictors of Participation in Mammography Screening among non-Hispanic Black, non-Hispanic White, and Hispanic Women

Directory of Open Access Journals (Sweden)

Cathy Melvin

2016-09-01

Full Text Available Introduction: Many factors influence women’s decisions to participate in guideline recommended screening mammography. We evaluated the influence of women’s socioeconomic characteristics, healthcare access, and cultural and psychological healthcare preferences on timely mammography screening participation.Materials and methods: A random digit dial survey of United States non-Hispanic Black, non-Hispanic White, and Hispanic women ages 40-75, from January-August 2009 determined self- reported time of most recent mammogram. Screening rates were assessed based on receipt of a screening mammogram within the prior 12 months, the interval recommended at the time by the American Cancer Society.Results: Thirty-nine percent of women reported not having a mammogram within the last 12 months. The odds of not having had a screening mammography was higher for non-Hispanic White women than for non-Hispanic Black (OR=2.16, 95% CI=0.26, 0.82, p=0.009 or Hispanic (OR=4.17, 95% CI=0.12, 0.48, p=0.01 women. Lack of health insurance (OR=3.22, 95% CI=1.54, 6.73, p=0.002 and lack of usual source of medical care (OR=3.37, 95% CI=1.43, 7.94, p=0.01 were associated with not being screened as were lower self-efficacy to obtain screening (OR=2.43, 95% CI=1.26, 4.73, p=0.01 and greater levels of religiosity and spirituality (OR=1.42, 95% CI=1.00, 2.00, p=0.05. Neither perceived risk nor present temporal orientation was significant.Discussion: Odds of not having a mammogram increased if women were uninsured, without medical care, non-Hispanic white, older in age, not confident in their ability to obtain screening, or held passive or external religious/spiritual values. Results are encouraging given racial disparities in healthcare participation and suggest that efforts to increase screening among minority women may be working.

Cost-Effectiveness of Breast Cancer Control Strategies in Central America: The Cases of Costa Rica and Mexico

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Niëns, Laurens M.; Zelle, Sten G.; Gutiérrez-Delgado, Cristina; Rivera Peña, Gustavo; Hidalgo Balarezo, Blanca Rosa; Rodriguez Steller, Erick; Rutten, Frans F. H.

2014-01-01

This paper reports the most cost-effective policy options to support and improve breast cancer control in Costa Rica and Mexico. Total costs and effects of breast cancer interventions were estimated using the health care perspective and WHO-CHOICE methodology. Effects were measured in disability-adjusted life years (DALYs) averted. Costs were assessed in 2009 United States Dollars (US$). To the extent available, analyses were based on locally obtained data. In Costa Rica, the current strategy of treating breast cancer in stages I to IV at a 80% coverage level seems to be the most cost-effective with an incremental cost-effectiveness ratio (ICER) of US$4,739 per DALY averted. At a coverage level of 95%, biennial clinical breast examination (CBE) screening could improve Costa Rica's population health twofold, and can still be considered very cost-effective (ICER US$5,964/DALY). For Mexico, our results indicate that at 95% coverage a mass-media awareness raising program (MAR) could be the most cost-effective (ICER US$5,021/DALY). If more resources are available in Mexico, biennial mammography screening for women 50–70 yrs (ICER US$12,718/DALY), adding trastuzumab (ICER US$13,994/DALY) or screening women 40–70 yrs biennially plus trastuzumab (ICER US$17,115/DALY) are less cost-effective options. We recommend both Costa Rica and Mexico to engage in MAR, CBE or mammography screening programs, depending on their budget. The results of this study should be interpreted with caution however, as the evidence on the intervention effectiveness is uncertain. Also, these programs require several organizational, budgetary and human resources, and the accessibility of breast cancer diagnostic, referral, treatment and palliative care facilities should be improved simultaneously. A gradual implementation of early detection programs should give the respective Ministries of Health the time to negotiate the required budget, train the required human resources and understand possible

Is screening for pancreatic cancer in high-risk groups cost-effective?

DEFF Research Database (Denmark)

Jørgensen, Maiken Thyregod; Gerdes, Anne-Marie; Sørensen, Jan

2016-01-01

OBJECTIVE: Pancreatic cancer (PC) is the fourth leading cause of cancer death worldwide, symptoms are few and diffuse, and when the diagnosis has been made only 10-15% would benefit from resection. Surgery is the only potentially curable treatment for pancreatic cancer, and the prognosis seems to......$ per QALY. CONCLUSIONS: With a threshold value of 50,000 US$ per QALY this screening program appears to constitute a cost-effective intervention although screening of HP patients appears to be less cost-effective than FPC patients....... with Hereditary pancreatitis or with a disposition of HP and 40 first-degree relatives of patients with Familial Pancreatic Cancer (FPC) were screened for development of Pancreatic Ductal Adenocarcinoma (PDAC) with yearly endoscopic ultrasound. The cost-effectiveness of screening in comparison with no......-screening was assessed by the incremental cost-utility ratio (ICER). RESULTS: By screening the FPC group we identified 2 patients with PDAC who were treated by total pancreatectomy. One patient is still alive, while the other died after 7 months due to cardiac surgery complications. Stratified analysis of patients...

Should breast cancer survivors be excluded from, or invited to, organised mammography screening programmes?

Directory of Open Access Journals (Sweden)

Bucchi Lauro

2011-10-01

Full Text Available Abstract Background The prevalence of breast cancer in developed countries has steadily risen over recent decades. Immediate and long-term health needs of patients, including preventive care and screening services, are receiving increasing attention. A question still unresolved is whether breast cancer survivors should receive mammographic surveillance in the clinical or screening setting and, thus, whether they should be excluded from, or invited to, organised mammography screening programmes. The objective of this article is to discuss the many contradictory aspects of this matter. Discussion Problems with mammographic surveillance of breast cancer survivors include: weak evidence of a reduction in mortality; lack of evidence in favour of one setting or the other; lack of evidence-based guidelines for the frequency and duration of surveillance; disproportionate emphasis placed on the first few years post-treatment, probably dictated by surgical and oncological priorities; a variety of screening policies, as these women are permanently or temporarily or partially excluded from many - but not all - organised screening programmes worldwide; an even greater disparity in follow-up protocols used in the clinical setting; a paucity of data on compliance to mammographic surveillance in both settings; and a difficulty in coordinating the roles of health care providers. In the future, the use of mammography in breast cancer survivors will be influenced by the inclusion of women aged > 69 years in organised screening programmes and the implementation of multidisciplinary breast units, and will probably be investigated by research activities on individual risk assessment and risk-tailored screening. In the interim, current problems can be partially alleviated with some technical solutions in screening data recording, patient flows, and care coordination. Summary Mammographic surveillance of breast cancer survivors is situated at the crossroads of numerous

American Indian Women and Screening Mammography: Findings from a Qualitative Study in Oklahoma

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Tolma, Eleni; Batterton, Chasity; Hamm, Robert M.; Thompson, David; Engelman, Kimberly K.

2012-01-01

Background: Breast cancer is an important public health issue within the American Indian (AI) community in Oklahoma; however, there is limited information to explain the low screening mammography rates among AI women. Purpose: To identify the motivational factors affecting an AI woman's decision to obtain a mammogram. Methods: Through the use of…

Cost-effectiveness of implementing computed tomography screening for lung cancer in Taiwan.

Science.gov (United States)

Yang, Szu-Chun; Lai, Wu-Wei; Lin, Chien-Chung; Su, Wu-Chou; Ku, Li-Jung; Hwang, Jing-Shiang; Wang, Jung-Der

2017-06-01

A screening program for lung cancer requires more empirical evidence. Based on the experience of the National Lung Screening Trial (NLST), we developed a method to adjust lead-time bias and quality-of-life changes for estimating the cost-effectiveness of implementing computed tomography (CT) screening in Taiwan. The target population was high-risk (≥30 pack-years) smokers between 55 and 75 years of age. From a nation-wide, 13-year follow-up cohort, we estimated quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures per case of lung cancer stratified by pathology and stage. Cumulative stage distributions for CT-screening and no-screening were assumed equal to those for CT-screening and radiography-screening in the NLST to estimate the savings of loss-of-QALE and additional costs of lifetime healthcare expenditures after CT screening. Costs attributable to screen-negative subjects, false-positive cases and radiation-induced lung cancer were included to obtain the incremental cost-effectiveness ratio from the public payer's perspective. The incremental costs were US$22,755 per person. After dividing this by savings of loss-of-QALE (1.16 quality-adjusted life year (QALY)), the incremental cost-effectiveness ratio was US$19,683 per QALY. This ratio would fall to US$10,947 per QALY if the stage distribution for CT-screening was the same as that of screen-detected cancers in the NELSON trial. Low-dose CT screening for lung cancer among high-risk smokers would be cost-effective in Taiwan. As only about 5% of our women are smokers, future research is necessary to identify the high-risk groups among non-smokers and increase the coverage. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

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.

Science.gov (United States)

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.

[Fine needle aspiration cytology of mammography screening

DEFF Research Database (Denmark)

Engvad, B.; Laenkholm, A.V.; Schwartz, Thue W.

2009-01-01

INTRODUCTION: In the year 2000 a quality assurance programme for the preoperative breast diagnostics was introduced in Denmark. The programme was based on the "European guidelines for quality assurance in breast cancer screening and diagnosis" where - among other measures - five cytological......-choice treatment. MATERIAL AND METHODS: 767 women had FNAC performed from a total of 783 lesions at the Mammography Clinic, University Hospital Odense. All FNACs were compared with the final histology diagnosis. Nine statistical parameters were calculated according to the European guidelines. RESULTS: A total...... of 66% of the 783 FNACs had a malignant cytology diagnosis, which in 99% of the cases turned out to be the correct diagnosis. Four lesions were false positives all of which represented benign proliferative breast diseases. The surgical procedures in these cases were either excisional biopsy...

Breast cancer incidence and mortality in the Nordic capitals, 1970-1998. Trends related to mammography screening programmes

International Nuclear Information System (INIS)

Toernberg, Sven; Kemetli, Levent; Anttila, Ahti; Hakama, Matti; Nystroem, Lennarth

2006-01-01

The aim of the present study was to relate the time trends in breast cancer incidence and mortality to the introduction of mammography screening in the Nordic capitals. Helsinki offered screening to women aged 50-59 starting in 1986. The other three capitals offered screening to women aged 50-69 starting in 1989 in Stockholm, 1991 in Copenhagen, and 1996 in Oslo. Prevalence peaks in breast cancer incidence depended on the age groups covered by the screening, the length of the implementation of screening, and the extent of background opportunistic screening. No mortality reduction following the introduction of screening was visible after seven to 12 years of screening in any of the three capitals where significant effects of the screening on the breast cancer mortality had already been demonstrated by using other analytical methods for the evaluation. No visible effect on mortality reduction was expected in Oslo due to too short an observation period. The study showed that the population-based breast cancer mortality trend is too crude a measure to detect the effect of screening on breast cancer mortality during the first years after the start of a programme

Bavarian mammography screening program; Bayerisches Mammographiescreening (BMS)

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Willgeroth, F. [Lenkungsausschuss BMS (Germany); Universitaetsfrauenklinik Innenstadt, Muenchen (Germany); Baumann, M.; Blaser, D.; Froschauer, S.; Kaeaeb, V.; Stich, V.; Thomaschewski, S.; Walter, D. [Kassenaerztliche Vereinigung Bayern (Germany); Crispin, A. [Klinikum Grosshadern der LMU Muenchen, Institut fuer Medizinische Informationsverarbeitung (Germany); Waal, J. de; Heywang-Koebrunner, S.; Rothe, R. [Lenkungsausschuss BMS (Germany); Hoelzel, D. [Lenkungsausschuss BMS (Germany); Klinikum Grosshadern der LMU Muenchen, Institut fuer Medizinische Informationsverarbeitung (Germany)

2005-03-01

In Bavaria since the 1st April 2003 we have been conducting a high quality mammography-screening carried out in individual practises (BMS). We have used the European and the S 3 guidelines. The best diagnosis is an early diagnosis of the breast carcinoma to save human life. Because of this and the high mortality rate due to this disease it is essential to have a mammogram screening program. There is no single one ideal way of constructing a screening program, it is always based on compromise within the particular health care-systems. Arising problems cannot be avoided, it is only possible when all parties work closely together that the BMS works properly. (orig.) [German] In Bayern laeuft seit dem 01.04.2003 ein qualitaetsgesichertes, flaechendeckendes Mammographiescreening mit dezentralem Charakter (BMS). Zugrunde liegen die Empfehlungen der European Guidelines sowie der S-3-Leitlinie. Die Vorverlegung der Diagnostik ist beim Mammakarzinom bis heute die effektivste Moeglichkeit, um das Leben von Frauen zu retten, die an diesem Krebs erkrankt sind. Daraus und aufgrund der hohen Mortalitaetsrate dieser Erkrankung leitet sich die Notwendigkeit eines Screeningprogramms ab. Dessen Aufbau kann unterschiedlich sein, denbesten Weg gibt es nicht; es wird sich immer eine Kompromissloesung ergeben, die sehr stark vom jeweiligen Gesundheitssystem beeinflusst wird. Auftretende Probleme sind vielschichtig. Nur durch gemeinsame Anstrengungen aller Beteiligten liess sich das Bayerische Mammographiescreening installieren. (orig.)

Radiation hazards of X-ray mammography

International Nuclear Information System (INIS)

Bailar, J.C. III

1978-01-01

X-ray mammography delivers significant amounts of ionizing radiation to the breast, and the female breast is more susceptible to radiation carcinogenesis than any other human organ. On the other hand, breast cancer is least likely to cause serious illness and death when it is detected at a very early stage. The risks and benefits of mammography can be estimated. This paper summarizes current risk estimates, then proceeds to a comparison of risks and benefits. As for breast cancer mortality, the addition of mammography to a programme of annual breast examinations of average U.S. women is of questionable value for women under age 50 but it is probably beneficial for older women. However, the break-even point is closely related to the average radiation exposure of breast tissue, and would be earlier in a few centres now using optimum techniques and equipment. For women with below-average risks of breast cancer, the age would be higher, and for a few women with a high probability of developing breast cancer it would be lower. Breast cancer screening programmes have been improved significantly since criticisms were first publicized in mid-1975. Partial improvements include reduction in radiation exposure (at least in some centres), guidelines from the National Cancer Institute (NCI) and the American Cancer Society (ACS) for restricting the screening of women under age 50, and changes in the patient consent form signed by participants in the NCI-ACS programme. Professional and public awareness of the need to balance the benefits of screening with its risks and costs has rapidly and markedly increased. Future improvements should further define the optimum design and application of breast cancer screening programmes

Screening mammography. A missed clinical opportunity? Results of the NCI [National Cancer Institute] Breast Cancer Screening Consortium and national health interview survey studies

International Nuclear Information System (INIS)

Anon.

1990-01-01

Data from seven studies sponsored by the National Cancer Institute (NCI) were used to determine current rates of breast cancer screening and to identify the characteristics of and reasons for women not being screened. All seven studies were population-based surveys of women aged 50 to 74 years without breast cancer. While over 90% of non-Hispanic white respondents had regular sources of medical care, 46% to 76% had a clinical breast examination within the previous year, and only 25% to 41% had a mammogram. Less educated and poorer women had fewer mammograms. The two most common reasons women gave for never having had a mammogram were that they did not known they needed it and that their physician had not recommended it. Many physicians may have overlooked the opportunity to recommend mammography for older women when performing a clinical breast examination and to educate their patients about the benefit of screening mammography

Quality control for digital mammography: Part II recommendations from the ACRIN DMIST trial

International Nuclear Information System (INIS)

Yaffe, Martin J.; Bloomquist, Aili K.; Mawdsley, Gordon E.

2006-01-01

The Digital Mammography Imaging Screening Trial (DMIST), conducted under the auspices of the American College of Radiology Imaging Network (ACRIN), is a clinical trial designed to compare the accuracy of digital versus screen-film mammography in a screening population [E. Pisano et al., ACRIN 6652--Digital vs. Screen-Film Mammography, ACRIN (2001)]. Part I of this work described the Quality Control program developed to ensure consistency and optimal operation of the digital equipment. For many of the tests, there were no failures during the 24 months imaging was performed in DMIST. When systems failed, they generally did so suddenly rather than through gradual deterioration of performance. In this part, the utility and effectiveness of those tests are considered. This suggests that after verification of proper operation, routine extensive testing would be of minimal value. A recommended set of tests is presented including additional and improved tests, which we believe meet the intent and spirit of the Mammography Quality Standards Act regulations to ensure that full-field digital mammography systems are functioning correctly, and consistently producing mammograms of excellent image quality

Exploring the potential of context-sensitive CADe in screening mammography

International Nuclear Information System (INIS)

Tourassi, Georgia D.; Mazurowski, Maciej A.; Harrawood, Brian P.; Krupinski, Elizabeth A.

2010-01-01

Purpose: Conventional computer-assisted detection (CADe) systems in screening mammography provide the same decision support to all users. The aim of this study was to investigate the potential of a context-sensitive CADe system which provides decision support guided by each user's focus of attention during visual search and reporting patterns for a specific case. Methods: An observer study for the detection of malignant masses in screening mammograms was conducted in which six radiologists evaluated 20 mammograms while wearing an eye-tracking device. Eye-position data and diagnostic decisions were collected for each radiologist and case they reviewed. These cases were subsequently analyzed with an in-house knowledge-based CADe system using two different modes: Conventional mode with a globally fixed decision threshold and context-sensitive mode with a location-variable decision threshold based on the radiologists' eye dwelling data and reporting information. Results: The CADe system operating in conventional mode had 85.7% per-image malignant mass sensitivity at 3.15 false positives per image (FPsI). The same system operating in context-sensitive mode provided personalized decision support at 85.7%-100% sensitivity and 0.35-0.40 FPsI to all six radiologists. Furthermore, context-sensitive CADe system could improve the radiologists' sensitivity and reduce their performance gap more effectively than conventional CADe. Conclusions: Context-sensitive CADe support shows promise in delineating and reducing the radiologists' perceptual and cognitive errors in the diagnostic interpretation of screening mammograms more effectively than conventional CADe.

Update on new technologies in digital mammography

Directory of Open Access Journals (Sweden)

Patterson SK

2014-08-01

Full Text Available Stephanie K Patterson, Marilyn A Roubidoux Division of Breast Imaging, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA Abstract: 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. Keywords: screening mammography, breast cancer, contrast media, digital breast tomosynthesis

Beyond the mammography debate: a moderate perspective.

Science.gov (United States)

Kaniklidis, C

2015-06-01

After some decades of contention, one can almost despair and conclude that (paraphrasing) "the mammography debate you will have with you always." Against that sentiment, in this review I argue, after reflecting on some of the major themes of this long-standing debate, that we must begin to move beyond the narrow borders of claim and counterclaim to seek consensus on what the balance of methodologically sound and critically appraised evidence demonstrates, and also to find overlooked underlying convergences; after acknowledging the reality of some residual and non-trivial harms from mammography, to promote effective strategies for harm mitigation; and to encourage deployment of new screening modalities that will render many of the issues and concerns in the debate obsolete. To these ends, I provide a sketch of what this looking forward and beyond the current debate might look like, leveraging advantages from abbreviated breast magnetic resonance imaging technologies (such as the ultrafast and twist protocols) and from digital breast tomosynthesis-also known as three-dimensional mammography. I also locate the debate within the broader context of mammography in the real world as it plays out not for the disputants, but for the stakeholders themselves: the screening-eligible patients and the physicians in the front lines who are charged with enabling both the acts of screening and the facts of screening at their maximally objective and patient-accessible levels to facilitate informed decisions.

Cost-effectiveness of human papillomavirus vaccination and cervical cancer screening in Thailand.

Science.gov (United States)

Sharma, M; Ortendahl, J; van der Ham, E; Sy, S; Kim, J J

2012-01-01

To assess the health and economic outcomes of various screening and vaccination strategies for cervical cancer prevention. Cost-effectiveness analysis from a societal perspective. Thailand. Females aged 9 years and older. Using a mathematical model of human papillomavirus (HPV) infection and cervical cancer, calibrated to epidemiological data from Thailand, we estimated the cost-effectiveness of pre-adolescent HPV vaccination, screening [visual inspection with acetic acid (VIA), HPV DNA testing, and cytology] between one and five times per lifetime in adulthood, and combined pre-adolescent vaccination and screening. Vaccine efficacy, coverage, cost, and screening frequency were varied in sensitivity analyses. Incremental cost-effectiveness ratios, expressed as cost per year of life saved (YLS). Assuming lifelong efficacy and 80% coverage, pre-adolescent HPV vaccination alone was projected to reduce the lifetime risk of cervical cancer by 55%, which was greater than any strategy of screening alone. When cost per vaccinated girl was I$10 (approximately $2 per dose) or less, HPV vaccination alone was cost saving. Pre-adolescent vaccination and HPV DNA testing five times per lifetime, starting at age 35 years, reduced the lifetime cervical cancer risk by 70%, and had a cost-effectiveness ratio less than Thailand's GDP per capita (I$8100), provided the cost per vaccinated girl was I$200 or less. Low cost pre-adolescent HPV vaccination followed by HPV screening five times per lifetime is an efficient strategy for Thailand. Costs may need to be lower, however, for this strategy to be affordable. If vaccination is not feasible, HPV DNA testing five times per lifetime is efficient. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

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

Science.gov (United States)

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.

Experimental investigations of image quality in X-ray mammography with conventional screen film system (SFS), digital phosphor storage plate in/without magnification technique (CR) and digital CCD-technique (CCD)

International Nuclear Information System (INIS)

Schulz-Wendtland, R.; Aichinger, U.; Boehner, C.; Dobritz, M.; Wenkel, E.; Bautz, W.; Saebel, M.

2001-01-01

Comparison of image quality in X-ray mammography between conventional film screen film system (SFS), digital phosphor storage plate in and without magnification technique (CR) and digital CCD-technique (CCD). Radiograms of an RMI-mammography phantom were acquired using a conventional screen film system, three digital storage plate systems and two digital systems in CCD-technique. Additionally the radiograms of one digital phosphor storage plate system were post-processed regarding contrast and included in the comparison. The detectability of details was best with the digital mammography in CCD-technique. After confirming these promising results in clinical studies, digital mammography should be able to replace conventional screen film technique. (orig.)

Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective.

Science.gov (United States)

Ferguson, Thomas W; Tangri, Navdeep; Tan, Zhi; James, Matthew T; Lavallee, Barry D A; Chartrand, Caroline D; McLeod, Lorraine L; Dart, Allison B; Rigatto, Claudio; Komenda, Paul V J

2017-07-01

Canadian indigenous (First Nations) have rates of kidney failure that are 2- to 4-fold higher than the non-indigenous general Canadian population. As such, a strategy of targeted screening and treatment for CKD may be cost-effective in this population. Our objective was to assess the cost utility of screening and subsequent treatment for CKD in rural Canadian indigenous adults by both estimated glomerular filtration rate and the urine albumin-to-creatinine ratio. A decision analytic Markov model was constructed comparing the screening and treatment strategy to usual care. Primary outcomes were presented as incremental cost-effectiveness ratios (ICERs) presented as a cost per quality-adjusted life-year (QALY). Screening for CKD was associated with an ICER of $23,700/QALY in comparison to usual care. Restricting the model to screening in communities accessed only by air travel (CKD prevalence 34.4%), this ratio fell to $7,790/QALY. In road accessible communities (CKD prevalence 17.6%) the ICER was $52,480/QALY. The model was robust to changes in influential variables when tested in univariate sensitivity analyses. Probabilistic sensitivity analysis found 72% of simulations to be cost-effective at a $50,000/QALY threshold and 93% of simulations to be cost-effective at a $100,000/QALY threshold. Thus, targeted screening and treatment for CKD using point-of-care testing equipment in rural Canadian indigenous populations is cost-effective, particularly in remote air access-only communities with the highest risk of CKD and kidney failure. Evaluation of targeted screening initiatives with cluster randomized controlled trials and integration of screening into routine clinical visits in communities with the highest risk is recommended. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

[Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain].

Science.gov (United States)

Donnay Candil, Sergio; Balsa Barro, José Antonio; Álvarez Hernández, Julia; Crespo Palomo, Carlos; Pérez-Alcántara, Ferrán; Polanco Sánchez, Carlos

2015-01-01

To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Review of Dosimetric Methods for Mammography in the UK Breast Screening Programme

International Nuclear Information System (INIS)

Young, K.C.; Ramsdale, M.L.; Bignell, F.

1998-01-01

The two methods used to monitor dose in mammography in the UK Breast Screening Programme are reviewed. The first is the measurement of mean glandular dose to a standard breast. The second is the estimation of mean glandular dose for individual women using the X ray exposure factors. Neither method takes account of variations in breast composition and the effect of this on estimates of glandular dose are reported. Applying the standard breast model using PMMA resulted in substantial overestimates of breast doses for women with large compressed breast thicknesses because they tend to have low glandular content. Conversely the use of post-exposure data to estimate the MGDs in women attending screening with large breasts resulted in underestimates of their doses unless the relatively low levels of glandularity were taken into account. When estimating the MGDs for breasts of different sizes, it is important that the models and methods used take account of the strong variation in breast composition with compressed thickness. (author)

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

Science.gov (United States)

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

Organization and standards of screening and diagnostic mammography

International Nuclear Information System (INIS)

Linderbraten, L.D.; Chikirdin, Eh.G.; Rozhkova, N.I.

1999-01-01

Problem of organizing and standards of the reference and diagnostic mammography in our country is discussed. Attention is paid to the terminology, accreditation of mammographic establishments and specialists, specifications of equipment, image quality, mammography results processing, radiation doses [ru

Cost-Effectiveness of Alternative Blood-Screening Strategies for West Nile Virus in the United States.

Directory of Open Access Journals (Sweden)

2006-01-01

Full Text Available BACKGROUND: West Nile virus (WNV is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for selecting cost-effective strategies for screening blood for WNV do not exist. METHODS AND FINDINGS: We conducted a cost-effectiveness analysis for screening blood for WNV using a computer-based mathematical model, and using data from prospective studies, retrospective studies, and published literature. For three geographic areas with varying WNV-transmission intensity and length of transmission season, the model was used to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios associated with alternative screening strategies in a target population of blood-transfusion recipients. We compared the status quo (baseline screening using a donor questionnaire to several strategies which differed by nucleic acid testing of either pooled or individual samples, universal versus targeted screening of donations designated for immunocompromised patients, and seasonal versus year-long screening. In low-transmission areas with short WNV seasons, screening by questionnaire alone was the most cost-effective strategy. In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients was the most cost-effective strategy. Seasonal screening of the entire recipient pool added minimal clinical benefit, with incremental cost-effectiveness ratios exceeding US$1.7 million per quality-adjusted life-year gained. Year-round screening offered no additional benefit compared to seasonal screening in any of the transmission settings. CONCLUSIONS: In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations

Cost-effectiveness of alternative blood-screening strategies for West Nile Virus in the United States.

Directory of Open Access Journals (Sweden)

Caroline T Korves

2006-02-01

Full Text Available West Nile virus (WNV is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for selecting cost-effective strategies for screening blood for WNV do not exist.We conducted a cost-effectiveness analysis for screening blood for WNV using a computer-based mathematical model, and using data from prospective studies, retrospective studies, and published literature. For three geographic areas with varying WNV-transmission intensity and length of transmission season, the model was used to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios associated with alternative screening strategies in a target population of blood-transfusion recipients. We compared the status quo (baseline screening using a donor questionnaire to several strategies which differed by nucleic acid testing of either pooled or individual samples, universal versus targeted screening of donations designated for immunocompromised patients, and seasonal versus year-long screening. In low-transmission areas with short WNV seasons, screening by questionnaire alone was the most cost-effective strategy. In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients was the most cost-effective strategy. Seasonal screening of the entire recipient pool added minimal clinical benefit, with incremental cost-effectiveness ratios exceeding USD 1.7 million per quality-adjusted life-year gained. Year-round screening offered no additional benefit compared to seasonal screening in any of the transmission settings.In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients is cost

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

Science.gov (United States)

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.

Mammography

International Nuclear Information System (INIS)

1975-01-01

This patent reveals a method and instrument for the detection and registration of breast cancer with the aid of X-radiation, i.e. mammography. The breast is irradiated with soft X-rays whereby the radiation beam is scanned with a moving 'stripform' screen and whereby the picture from the 'stripform' screen is recorded by a television camera that moves simultaneously with the strip. The image is then projected on a monitor

Balancing sensitivity and specificity: sixteen year's of experience from the mammography screening programme in Copenhagen, Denmark

DEFF Research Database (Denmark)

Utzon-Frank, Nicolai; Vejborg, Ilse; von Euler-Chelpin, My Catarina

2011-01-01

To report on sensitivity and specificity from 7 invitation rounds of the organised, population-based mammography screening programme started in Copenhagen, Denmark, in 1991, and offered biennially to women aged 50-69. Changes over time were related to organisation and technology....

Final Technical Report. A critical evaluation of patent doses in screening mammography

International Nuclear Information System (INIS)

Hintenlang, David E.

2004-01-01

This project was designed to develop tools that would permit an accurate assessment of the patient doses that are received in screening mammography, and to subsequently demonstrate those tools to perform an objective evaluation of patient doses. The project also provides an educational component through the integration of multiple aspects of applied radiological engineering to provide students with realistic applications of many of the theoretical principles that are studied as part of their graduate curriculum

Radiogenic breast cancer risk and mammography

International Nuclear Information System (INIS)

Jayaprakash, Shobha; Nair, C.P.R.; Rao, B.S.; Sawant, S.G.

2001-01-01

There is a general concern that the risks from mammography screening in inducting radiogenic breast cancer may outweigh the possible benefits to be derived from it. A review of epidemiological, case-control and cohort studies of radiogenic breast cancer, age-specific incidence and dose and dose-rate relationship reveals that such a fear is unfounded. The dose to the breast tissues in a quality assured mammography screening programme falls far below the levels that were observed to produce increased relative risk. The age-specific incidence rates also indicate that the need for mammography is for the women of age at which the relative risk is minimum

Randomized controlled trial on effectiveness of ultrasonography screening for breast cancer in women aged 40-49 (J-START). Research design

International Nuclear Information System (INIS)

Ohuchi, Noriaki; Ishida, Takanori; Kawai, Masaaki; Narikawa, Yoko; Yamamoto, Seiichiro; Sobue, Tomotaka

2011-01-01

In cancer screening, it is essential to undertake effective screening with appropriate methodology, which should be supported by evidence of a reduced mortality rate. At present, mammography is the only method for breast cancer screening with such evidence. However, mammography does not achieve sufficient accuracy in breasts with high density at ages below 50. Although ultrasonography achieves better accuracy in Breast Cancer detection even in dense breasts, the effectiveness has not been verified. We have planned a randomized controlled trial to assess the effectiveness of ultrasonography in women aged 40-49, with a design to study 50,000 women with mammography and ultrasonography (intervention group), and 50,000 controls with mammography only (control group). The participants are scheduled to take second round screening with the same modality 2 years on. The primary endpoints are sensitivity and specificity, and the secondary endpoint is the rate of advanced breast cancers. (author)

Comparison of Diagnostic Accuracy of Breast Masses Using Digitized Images Versus Screen-Film Mammography

International Nuclear Information System (INIS)

Zhigang Liang; Xiangying Du; Jiabin Liu; Xinyu Yao; Yanhui Yang; Kuncheng Li

2008-01-01

Background: Medical film digitizers play an important transitory role as digital-analogue bridges in radiology. Digitized mammograms require evaluation of performance to assure medical image quality. Purpose: To compare the diagnostic accuracy in the interpretation of breast masses using original screen-film mammograms versus digitized images. Material and Methods: A total of 72 female patients between 55 and 81 years of age suspected of having breast cancer were selected by two non-observing radiologists. Of these, 31 cases were benign lesions and 41 cases were cancer. The mammography films were digitized using a laser film digitizer. Three radiologists, each with more than 10 years of experience in mammography, interpreted the screen-film mammograms and digitized images respectively. The time interval was 4 weeks. A four-point malignancy scale was used, with 1 defined as definitely not malignant, 2 as probably not malignant, 3 as probably malignant, and 4 as definitely malignant. Receiver operating characteristic (Roc) curves, sensitivity, and specificity were compared. Results: The average area-under-the-curve (Az) value of the original screen-film mammograms was 0.921, and the average Az value of the digitized images was 0.859. This difference was not statistically significant (P=0.131). The detection specificity of extremely dense breasts was lower than that for other breast compositions for both digitized images and screen-film mammograms. No statistical significance in sensitivity and specificity was observed between digitized images and mammograms for each breast composition. Original screen-film mammograms were observed to perform better than digitized images. Conclusion: Digitized images with a spatial resolution of 175 μm can be used instead of screen-film mammograms in the diagnosis of breast cancer

The self-referred mammography patient

International Nuclear Information System (INIS)

Reynolds, H.E.; Jackson, V.P.

1990-01-01

This paper compares the demographics, knowledge, and attitudes of women who refer themselves for screening mammography with those who undergo mammography on the advice of their physicians. Four hundred eighty-five consecutive mammography patients (437 doctor preferred [DR], 48 self-referred [SR]) completed a survey during their mammography appointment. The sample population contained a wide range of socioeconomic groups. While similar in age, race, and employment status to DR patients, SR patients were significantly more likely to have a family income of more than 30,000 per year, be college graduates, and report that they were in good or excellent health

Mammography-based screening program: preliminary results from a first 2-year round in a Brazilian region using mobile and fixed units

Directory of Open Access Journals (Sweden)

Haikel Raphael

2012-10-01

Full Text Available Abstract Background Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer deaths among women worldwide. The use of mobile mammography units to offer screening to women living in remote areas is a rational strategy to increase the number of women examined. This study aimed to evaluate results from the first 2 years of a government-organized mammography screening program implemented with a mobile unit (MU and a fixed unit (FU in a rural county in Brazil. The program offered breast cancer screening to women living in Barretos and the surrounding area. Methods Based on epidemiologic data, 54 238 women, aged 40 to 69 years, were eligible for breast cancer screening. The study included women examined from April 1, 2003 to March 31, 2005. The chi-square test and Bonferroni correction analyses were used to evaluate the frequencies of tumors and the importance of clinical parameters and tumor characteristics. Significance was set at p Results Overall, 17 964 women underwent mammography. This represented 33.1% of eligible women in the area. A mean of 18.6 and 26.3 women per day were examined in the FU and MU, respectively. Seventy six patients were diagnosed with breast cancer (41 (54% in the MU. This represented 4.2 cases of breast cancer per 1000 examinations. The number of cancers detected was significantly higher in women aged 60 to 69 years than in those aged 50 to 59 years (p Conclusions Preliminary results indicate that this mammography screening program is feasible for implementation in a rural Brazilian territory and favor program continuation.

A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.

Science.gov (United States)

Levin, Lars-Åke; Husberg, Magnus; Sobocinski, Piotr Doliwa; Kull, Viveka Frykman; Friberg, Leif; Rosenqvist, Mårten; Davidson, Thomas

2015-02-01

The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke. The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400. Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

The outcome of a quality-controlled mammography screening program: Experience from a population-based study in Taiwan

Directory of Open Access Journals (Sweden)

Huay-Ben Pan

2014-10-01

Conclusion: From the outcome review of this national mammography screening, there is still room to ameliorate our performance through comprehensive and continued education, to improve the competence of cancer detection and decrease false negative (FN cases.

Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data

NARCIS (Netherlands)

van der Ploeg, C. P B; van den Akker-van Marle, M. E.; Vernooij-van Langen, A. M M; Elvers, L. H.; Gille, J. J P; Verkerk, P. H.; Dankert-Roelse, J. E.; Dankert-Roelse, J. E.; Vernooij-van Langen, A. M M; Loeber, J. G.; Elvers, L. H.; Triepels, R. H.; Gille, J. J P; Van der Ploeg, C. P B; van der Pal, S. M.; Dompeling, E.; Pals, G.; van den Akker van Marle, M. E.; Gulmans, V. A M; Oey-Spauwen, M. J W; Wijnands, Y. H H M; Castricum, L. M.; Arets, H. G M; van der Ent, C. K.; Tiddens, H. A W M; de Rijke, Y. B.; Yntema, J. B.

2015-01-01

Background: Previous cost-effectiveness studies using data from the literature showed that newborn screening for cystic fibrosis (NBSCF) is a good economic option with positive health effects and longer survival. Methods: We used primary data to compare cost-effectiveness of four screening

Digital mammography: what do we and what don't we know?

International Nuclear Information System (INIS)

Bick, Ulrich; Diekmann, Felix

2007-01-01

High-quality full-field digital mammography has been available now for several years and is increasingly used for both diagnostic and screening mammography. A number of different detector technologies exist, which all have their specific advantages and disadvantages. Diagnostic accuracy of digital mammography has been shown to be at least equivalent to film-screen mammography in a general screening population. Digital mammography is superior to screen-film mammography in younger women with dense breasts due to its ability to selectively optimize contrast in areas of dense parenchyma. This advantage is especially important in women with a genetic predisposition for breast cancer, where intensified early detection programs may have to start from 25 to 30 years of age. Tailored image processing and computer-aided diagnosis hold the potential to further improve the early detection of breast cancer. However, at present no consensus exists among radiologists on which processing is optimal for digital mammograms. Image processing may also vary significantly among vendors with so far limited interoperability. This review aims to summarize the available information regarding the impact of digital mammography on workflow and breast cancer diagnosis. (orig.)

Cost-Effectiveness/Cost-Benefit Analysis of Newborn Screening for Severe Combined Immune Deficiency in Washington State.

Science.gov (United States)

Ding, Yao; Thompson, John D; Kobrynski, Lisa; Ojodu, Jelili; Zarbalian, Guisou; Grosse, Scott D

2016-05-01

To evaluate the expected cost-effectiveness and net benefit of the recent implementation of newborn screening (NBS) for severe combined immunodeficiency (SCID) in Washington State. We constructed a decision analysis model to estimate the costs and benefits of NBS in an annual birth cohort of 86 600 infants based on projections of avoided infant deaths. Point estimates and ranges for input variables, including the birth prevalence of SCID, proportion detected asymptomatically without screening through family history, screening test characteristics, survival rates, and costs of screening, diagnosis, and treatment were derived from published estimates, expert opinion, and the Washington NBS program. We estimated treatment costs stratified by age of identification and SCID type (with or without adenosine deaminase deficiency). Economic benefit was estimated using values of $4.2 and $9.0 million per death averted. We performed sensitivity analyses to evaluate the influence of key variables on the incremental cost-effectiveness ratio (ICER) of net direct cost per life-year saved. Our model predicts an additional 1.19 newborn infants with SCID detected preclinically through screening, in addition to those who would have been detected early through family history, and 0.40 deaths averted annually. Our base-case model suggests an ICER of $35 311 per life-year saved, and a benefit-cost ratio of either 5.31 or 2.71. Sensitivity analyses found ICER values <$100 000 and positive net benefit for plausible assumptions on all variables. Our model suggests that NBS for SCID in Washington is likely to be cost-effective and to show positive net economic benefit. Published by Elsevier Inc.

Screening methods(clinical breast examination and mammography to detect breast cancer in women aged 40–49 years

Directory of Open Access Journals (Sweden)

Navneet Takkar

2017-01-01

Conclusion: The study findings are in agreement with the recommendations of the World Health Organization, US preventive task force and UK guidelines that recommend screening mammography in women starting at 50 years.

The effect of changing from one to two views at incident (subsequent) screens in the NHS breast screening programme in England: impact on cancer detection and recall rates

International Nuclear Information System (INIS)

Blanks, R.G.; Bennett, R.L.; Patnick, J.; Cush, S.; Davison, C.; Moss, S.M.

2005-01-01

AIM: To assess the effect on cancer detection and recall rates of changing from one to two views for incident (subsequent) screens. METHODS: Controlled, comparative, observational study of programmes in NHS breast screening programme in England. Subjects: women aged 50-64 years were screened by the NHSBSP between 1 April 2001 and 31 March 2003. RESULTS: The effect of changing to two-view mammography was a 20% increase in overall incident screen cancer detection rate, with the biggest effect seen for small (<15 mm) invasive cancers. This increased detection rate was achieved with an 11% drop-in recall rate. CONCLUSION: The introduction of two-view mammography for incident screens has resulted in considerable improvements in overall NHS breast screening performance

Cost-effectiveness of targeted screening for abdominal aortic aneurysm. Monte Carlo-based estimates.

Science.gov (United States)

Pentikäinen, T J; Sipilä, T; Rissanen, P; Soisalon-Soininen, S; Salo, J

2000-01-01

This article reports a cost-effectiveness analysis of targeted screening for abdominal aortic aneurysm (AAA). A major emphasis was on the estimation of distributions of costs and effectiveness. We performed a Monte Carlo simulation using C programming language in a PC environment. Data on survival and costs, and a majority of screening probabilities, were from our own empirical studies. Natural history data were based on the literature. Each screened male gained 0.07 life-years at an incremental cost of FIM 3,300. The expected values differed from zero very significantly. For females, expected gains were 0.02 life-years at an incremental cost of FIM 1,100, which was not statistically significant. Cost-effectiveness ratios and their 95% confidence intervals were FIM 48,000 (27,000-121,000) and 54,000 (22,000-infinity) for males and females, respectively. Sensitivity analysis revealed that the results for males were stable. Individual variation in life-year gains was high. Males seemed to benefit from targeted AAA screening, and the results were stable. As far as the cost-effectiveness ratio is considered acceptable, screening for males seemed to be justified. However, our assumptions about growth and rupture behavior of AAAs might be improved with further clinical and epidemiological studies. As a point estimate, females benefited in a similar manner, but the results were not statistically significant. The evidence of this study did not justify screening of females.

Supplementary methods in breast cancer screening: ultrasonography and magnetic resonance tomography of the breast; Mammasonographie und Magnetresonanz-Mammographie als ergaenzende Methoden im Mammographiescreening

Energy Technology Data Exchange (ETDEWEB)

Delorme, S. [Deutsches Krebsforschungszentrum Heidelberg (Germany). Abt. fuer Onkologische Diagnostik und Therapie

2001-04-01

Ultrasonography and magnetic resonance (MR) tomography are helpful tools to evaluate unclear lesions found at screening mammography. Ultrasound is particularly useful to prove the presence of a cyst or to further examine unclear, asymmetrical densities. With MR mammography, carcinomas can be found even when X-ray mammography or ultrasonography are limited due to diffuse, benign, proliferative changes. Ultrasound guidance has greatly facilitated core needle biopsy for suspicious lesions. Additionally, approved devices for MR-guided biopsy are commercially available. As a primary screening tool, ultrasound or MR mammography may be used only in women who are positive for BRCA-1 or BRCA-2 mutations or who are otherwise at high risk for breast cancer. (orig.) [German] Sonographie und Magnetresonanz-Mammographie koennen zur Abklaerung unklarer Befunde eingesetzt werden, die im Rahmen des Mammographiescreenings auffallen. Die Mammosonographie eignet sich besonders zum Nachweis von Zysten und zur Abklaerung unklarer Dichte-Asymmetrien. Mit der Magnetresonanz-Mammographie koennen Karzinome auch dann nachgewiesen werden, wenn die Untersuchungsbedingungen fuer die Roentgenmammographie oder die Sonographie aufgrund einer Mastopathie unguenstig sind. Bei der differenzialdiagnostischen Abklaerung von Herdbefunden hat die Moeglichkeit der sonographischen Fuehrung einer Stanz- oder Vakuumbiopsie das Verfahren wesentlich vereinfacht. Fuer die MR-gesteuerte Biopsie sind inzwischen zugelassene Fuehrungshilfen kommerziell erhaeltlich. Als primaere Screeningmethode kommen sowohl die Sonographie als auch die Magnetresonanz-Mammographie nur fuer wenige Frauen in Frage, in der Regel bei nachgewiesenen BRCA-1- oder BRCA-2-Mutationen oder bei sonstiger Brustkrebsdisposition. (orig.)

FDA & digital mammography: why has FDA required full field digital mammography systems to be regulated as potentially dangerous devices for more than 10 years?

Science.gov (United States)

Nields, Morgan W

2010-05-01

Digital mammography is routinely used in the US to screen asymptomatic women for breast cancer and currently over 50% of US screening centers employ the technology. In spite of FDAs knowledge that digital mammography requires less radiation than film mammography and that its equivalence has been proven in a prospective randomized trial, the agency has failed to allow the technology market access via the 510(k) pre market clearance pathway. As a result of the restrictive Pre Market Approval process, only four suppliers have received FDA approval. The resulting lack of a competitive market has kept costs high, restricted technological innovation, and impeded product improvements as a result of PMA requirements. Meanwhile, at least twelve companies are on the market in the EU and the resulting competitive market has lowered costs and provided increased technological choice. A cultural change with new leadership occurred in the early 90's at FDA. The historical culture at the Center for Devices and Radiological Health of collaboration and education gave way to one characterized by a lack of reliance on outside scientific expertise, tolerance of decision making by unqualified reviewers, and an emphasis on enforcement and punishment. Digital mammography fell victim to this cultural change and as a result major innovations like breast CT and computer aided detection technologies are also withheld from the market. The medical device law, currently under review by the Institute of Medicine, should be amended by the Congress so that new technologies can be appropriately classified in accordance with the risk based assessment classification system detailed in Chapter V of the Federal Food, Drug, and Cosmetic Act. A panel of scientific experts chartered by the NIH or IOM should determine the classification appropriate for new technologies that have no historical regulatory framework. This would be binding on FDA. Unless the law is changed we will likely again experience

Cost-effectiveness of community screening for glaucoma in rural India: a decision analytical model.

Science.gov (United States)

John, D; Parikh, R

2018-02-01

Studies in several countries have demonstrated the cost-effectiveness of population-based screening for glaucoma when targeted at high-risk groups such as older adults and with familial history of disease. This study conducts a cost-effective analysis of a hypothetical community screening and subsequent treatment programme in comparison to opportunistic case finding for glaucoma in rural India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in rural areas of India. A decision analytical model was built to model events, costs and treatment pathways with and without a hypothetical screening programme for glaucoma for a rural-based population aged between 40 and 69 years in India. The treatment pathway included both primary open-angle glaucoma and angle-closure disease. The data on costs of screening and treatment were provided by an administrator of a tertiary eye hospital in Eastern India. The probabilities for the screening and treatment pathway were derived from published literature and a glaucoma specialist. The glaucoma prevalence rates were adapted from the Chennai Glaucoma Study findings. An incremental cost-effectiveness ratio value of ₹7292.30 per quality-adjusted life-year was calculated for a community-screening programme for glaucoma in rural India. The community screening for glaucoma would treat an additional 2872 cases and prevent 2190 person-years of blindness over a 10-year period. Community screening for glaucoma in rural India appears to be cost-effective when judged by a ratio of willingness-to-pay thresholds as per WHO-CHOICE guidelines. For community screening to be cost-effective, adequate resources, such as trained medical personnel and equipment would need to be made available. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

A novel case-control design to estimate the extent of over-diagnosis of breast cancer due to organised population-based mammography screening.

Science.gov (United States)

Beckmann, Kerri R; Lynch, John W; Hiller, Janet E; Farshid, Gelareh; Houssami, Nehmat; Duffy, Stephen W; Roder, David M

2015-03-15

Debate about the extent of breast cancer over-diagnosis due to mammography screening has continued for over a decade, without consensus. Estimates range from 0 to 54%, but many studies have been criticized for having flawed methodology. In this study we used a novel study design to estimate over-diagnosis due to organised mammography screening in South Australia (SA). To estimate breast cancer incidence at and following screening we used a population-based, age-matched case-control design involving 4,931 breast cancer cases and 22,914 controls to obtain OR for yearly time intervals since women's last screening mammogram. The level of over-diagnosis was estimated by comparing the cumulative breast cancer incidence with and without screening. The former was derived by applying ORs for each time window to incidence rates in the absence of screening, and the latter, by projecting pre-screening incidence rates. Sensitivity analyses were undertaken to assess potential biases. Over-diagnosis was estimated to be 8% (95%CI 2-14%) and 14% (95%CI 8-19%) among SA women aged 45 to 85 years from 2006-2010, for invasive breast cancer and all breast cancer respectively. These estimates were robust when applying various sensitivity analyses, except for adjustment for potential confounding assuming higher risk among screened than non-screened women, which reduced levels of over-diagnosis to 1% (95%CI 5-7%) and 8% (95%CI 2-14%) respectively when incidence rates for screening participants were adjusted by 10%. Our results indicate that the level of over-diagnosis due to mammography screening is modest and considerably lower than many previous estimates, including others for Australia. © 2014 UICC.

Comparison of low contrast detectability of computed tomography and screen/film mammography systems

International Nuclear Information System (INIS)

Noriah Jamal; Kwan Hoong Ng; McLean, D.

2006-01-01

The objective of this study was to compare low contrast detectability of computed radiography (CR) and screen/film (SF) mammography systems. The Nijimegen contrast detail test object (CDMAM type 3.4) was imaged at 28 kV, in automatic exposure control mode separately. Six medical imaging physicists read each CDMAM phantom image. Contrast detail curves were plotted to compare low contrast detectability of CR (soft copy and hard copy) and SF mammography systems. Effect of varying exposure parameters, namely kV, object position inside the breast phantom, and entrance surface exposure (ESE) on the contrast detail curve were also investigated using soft copy CR. The significant of the difference of contrast between CR and SF, and for each exposure parameter was tested using non-parametric Kruskal-Wallis test. We found that the low contrast detectability of CR (soft copy and hard copy) system is not significantly different to that of SF system (p>0.05, Kruskal-Wallis test). For CR soft copy, no significant relationship (p>0.05, Kruskal-Wallis test) was seen for variation of kV, object position inside the breast phantom and ESE. This indicates that CR is comparable with SF for useful detection and visualization of low contrast objects such as small low contrast areas corresponding to breast pathology