Breast Mammography Screening Research Articles

Breast Cancer Diagnosis in Digital Mammogram Using Steerable Pyramid

This article is to explore the usefulness of steerable pyramid as feature extraction for breast cancer diagnosis in digital mammogram. The proposed approach is compared to some related feature extraction methods as Discrete Wavelet Transform (DWT), linear discriminant analysis (LDA) and principal component analysis (PCA). K-nearest neighbor, Support Vector Machine and Naive Bayesian is used separately to construct a supervised classifier. Experimental results on Digital Database Screening Mammography breast cancer database provides a better representation of the class information, and obtains much higher recognition accuracies compared with well established methods in literature.

Preparing women for breast screening mammography: A feasibility study to determine the potential value of an on-line social network and information hub

This feasibility study explored the attitudes of women towards social media for support about breast screening mammography. It sought their ideas about what a dedicated breast screening hub or Digital Support Network (DSN) might comprise; how they would network with other women on the DSN; what format information might take; and whether a health professional should be available on the DSN. Data comprised 94 survey questionnaires and two focus groups; one comprised women in the breast screening population age group, the other was a younger group. A socio-ecological framework was used to identify key influencers and potential barriers for the implementation of a mammography DSN. The study identified issues related to three intersecting concepts which influenced women's behaviour: on-line conversations about health in general; on-line conversations about breast screening mammography and the culture of privacy which makes conversing about intimate health (either face to face or on-line) difficult. Also, the transient nature of the mammography episode (three yearly), could mean an on-line breast screening digital network is challenging to sustain. super-users’ may be needed to continue on-line conversations. The health professional was also seen as essential for moderating potential misinformation shared by women although the participants were also insistent that ‘truth’ be shared.

Effect of rurality on screening for breast cancer: a systematic review and meta-analysis comparing mammography

The lower breast cancer survival rate observed among rural women may be related to differences in screening access and utilization. We evaluated existing evidence for rural and urban differences in mammography service use in adult women. A systematic search was conducted on 4 April 2012 and updated on 1 November 2012, which yielded 28 studies for inclusion. The rural population was less likely to have mammographic breast screening, and this difference was consistent in various areas of the USA as well as across a number of other countries. Meta-analyses using random effects models showed that women residing in rural areas were less likely than urban women to have ever had a mammogram (odds ratio (OR)=0.74, 95% confidence interval (CI)=0.62-0.89) or to have an up-to-date mammogram (OR=0.59, 95%CI=0.49-0.70). Mammography is currently the best tool for the early detection and diagnosis of breast cancer. The rural disadvantage this review has identified may contribute to the lower breast cancer survival among women living outside urban areas.

An Appropriate PMMA Phantom for Dose Reference Level (DRL) Estimation with Modern Digital Mammographic Breast Screening Systems

An Appropriate PMMA Phantom for Dose Reference Level (DRL) Estimation with Modern Digital Mammographic Breast Screening Systems

Sociodemographic and health-related predictors of self-reported mammogram, faecal occult blood test and prostate specific antigen test use in a large Australian study

BackgroundWhile several studies have examined factors that influence the use of breast screening mammography, faecal occult blood tests (FOBT) for bowel cancer screening and prostate specific antigen (PSA) tests for prostate disease in Australia, research directly comparing the use of these tests is sparse. We examined sociodemographic and health-related factors associated with the use of these tests in the previous two years either alone or in combination.MethodsCross-sectional analysis of self-reported questionnaire data from 96,711 women and 82,648 men aged 50 or over in The 45 and Up Study in NSW (2006–2010).Results5.9% of men had a FOBT alone, 44.9% had a PSA test alone, 18.7% had both tests, and 30.6% had neither test. 3.2% of women had a FOBT alone, 56.0% had a mammogram alone, 16.2% had both and 24.7% had neither test. Among men, age and socioeconomic factors were largely associated with having both FOBT and PSA tests. PSA testing alone was largely associated with age, family history of prostate cancer, health insurance status and visiting a doctor. Among women, age, use of hormone replacement therapy (HRT), health insurance status, family history of breast cancer, being retired and not having a disability were associated with both FOBT and mammograms. Mammography use alone was largely associated with age, use of HRT and family history of breast cancer. FOBT use alone among men was associated with high income, living in regional areas and being fully-retired and among women, being fully-retired or sick/disabled.ConclusionsThese results add to the literature on sociodemographic discrepancies related to cancer screening uptake and highlight the fact that many people are being screened for one cancer when they could be screened for two.

High-Grade Histologic Features of DCIS are Associated with R5 Rather than R3 Calcifications in Breast Screening Mammography

Mammographic calcification is an important radiologic feature of early breast carcinoma whose index of suspicion for malignancy may be reported by a five-tier R-category system. This study aims to describe the histologic diagnoses underlying screen-detected mammographic calcifications using both digital and screen-film mammography, and to correlate these findings with radiologic R-categories. Patients attending the Merrion Breast Screening Unit in Dublin between 2000 and 2011 were identified, who underwent needle-core biopsy for assessment of mammographic calcifications without associated mass or architectural distortion. Radiologic R-category was correlated with biopsy and excision histology reports. A total of 776 cases of calcification were identified, involving 769 individual patients. The radiologic R-categories were as follows: R3 513 (66.1%), R4 192 (24.7%), R5 71 (9.1%). The positive predictive values for malignancy were R3 32.6%, R4 69.8%, R5 95.8%. Several histologic features of DCIS were associated with R5 rather than R3 radiology: high nuclear grade, solid or cribriform architecture, necrosis, periductal inflammation or fibrosis, and associated microinvasive or invasive carcinoma. Mammographic lesions and histologic whole and invasive tumors increased in size from R3 to R5. Radiologic size of calcifications correlated with whole (but not invasive) tumor size, although it tended to underestimate it by several millimeters. Digital-detected calcifications were more likely than screen-film detected to be categorized as R3 and less likely R4 or R5, and there was no significant difference in positive predictive value between the two imaging techniques in any R-category. In conclusion, histologic features of DCIS, in particular those associated with high grade, are associated with R5 radiology. There is no significant difference in positive predictive value for malignancy in any R-category between digital and screen-film mammography.

The Level of Discomfort Experienced Among Patients Who Undergone Mammographic Examination

The study was designed to measure the level of discomfort experienced among patients who have undergone mammographic examination. First, to identify the profile of the patients in terms of age, size of breast, marital status, and number of mammogram examinations experienced and family history of breast tumor. Second, to determine the perception of discomfort experienced by patients before, during, and after the procedure. Third, to determine the relationship between the profiles of patients and their perception of pain during the procedure. To achieve the objectives, the study used the descriptive survey since the researchers decided to determine the extent or the level of pain experienced by the patient during mammographic examination. The respondents of this research were patients, who have undergone mammographic examination in selected hospitals, in Cagayan de Oro City namely; Polymedic General Hospital, Cagayan de Oro Medical Center and Madonna and Child’s Hospital. Majority of the respondents that had undergone mammographic examination belonged to the age bracket of 41-50 years old, with cup size B (breast), married and first time to undergo mammographic examination. It showed that most of the respondents felt nervous before examination. Moreover, the results showed that there is a significant relationship between the size of breast and number of mammograms experienced whereas ages, marital status, family history of breast cancer were not significant. KEYWORDS - Mammographic examination, Breast screening, Pain, Lump & Breast density.

English

Globally, the devastation that befalls women diagnosed of breast cancer remains inestimable. Early detection remains a major effective approach that should be employed to combat the disease. The issue of concern, however, is whether women in the rural underserved areas are aware of these early detection methods. This study was designed to assess rural women’s awareness and knowledge of breast cancer and their screening practices. The study was a descriptive cross-sectional study utilizing self developed structured questionnaire. Reliability of the instrument was determined and alpha correlation values range between 0.81 and 0.95 for the different components of the questionnaire. Data was processed using descriptive analysis and associations tested with Chi-square at 5% level of significance. The results of the findings showed that 52.7% of the women had adequate knowledge about breast cancer risk factors and symptoms. Regarding the women’s awareness about breast cancer screening methods, 52.8 and 51.7% of women have heard about Breast Self-Examination (BSE) and Clinical Breast Examination (CBE) respectively. However, few numbers of respondents (3.9%) were aware about mammography and these are people who did it for the purpose of diagnosing breast problem. Majority of the women (72.8%) did not practice BSE which is the most readily available screening method. Considering the lack of sophisticated diagnostic technology such as mammography for breast screening in the rural areas, BSE provided a unique opportunity for the women to be breast aware and to identify breast problems which may constitute danger to their health in the future. Health care professionals, most especially those at the primary health care level, should enhance the women’s skills to use this simple procedure effectively to promote their health.   Key words: Community health nurses, breast awareness, breast examination, knowledge, practice.

Changes in recall rate, biopsy rate and cancer detection since the introduction of digital mammography

Analogue mammography is gradually being replaced by digital mammography for breast screening. Digital mammography has been shown to be at least as good as analogue mammography at cancer detection, but the picture regarding other outcomes such as recall rate and biopsy rate is less clear.

Breast Hamartoma: Mammographic Findings

Breast Hamartoma: Mammographic Findings

Long term follow-up and risk of breast cancer after a radial scar or complex sclerosing lesion has been identified in a benign open breast biopsy

Aims Radial scars (RS)/complex sclerosing lesions (CSL) are rare, benign breast lesions of unknown aetiology. Associations with breast cancer have been suggested particularly with larger lesions. This study aims to identify the risk of developing subsequent breast cancer after excision of a benign RS/CSL with respect to lesion size and compared to expected rates in the normal UK population. Methods A prospective cohort analysis was performed on patients diagnosed with RS/CSL in benign, open breast biopsy specimens over a 20-year period. The rate of subsequent breast cancer development was compared to expected rates in the normal UK population. Subjects were divided into two groups according to lesion size and the rates of subsequent breast cancer compared. Results 149 women without proliferative breast disease were followed for an average of 68 months. Five women developed subsequent cancer, equating to a rate of 0.84% per year. This compares to 0.32% per year in the normal population (RR 2.6, 95% CI 0.86–6.0). There were two subsequent cancers in the RS group and three subsequent cancers in the CSL group, P = 0.64. Conclusions The study finds no evidence to suggest that lesions greater than 10 mm (CSL) have any greater risk of developing cancer after excision than those below 10 mm (RS). Women treated for RS/CSL do not need any additional follow-up beyond routine mammographic breast screening. Additional surveillance should only be performed if there is associated pathology indicating an increased risk of subsequent malignancy.

Evaluation of the benefits of mammographic breast cancer screening

Mammographic breast screening is one of the most popular cancer death preventive programmes worldwide and in Hungary as well. Breast cancer mortality and incidence started to decrease some years after introduction of the screening programme. The role played by mammography in the advantageous turn is not known. Potential points in evaluating the benefits of a screening programme are reviewed. The average lifetime gain is put into focus. For mammography, it does not exceed 1–3 weeks, according to age groups.

Health care professionals' preferences for extending mammographic breast screening to the over 70s

Abstract Background Breast screening improves survival in women aged 50–70. The relative benefits of screening in women over 70 are reduced but women up to age 80 may still benefit. In the UK the National Health Service provides screening by self referral to women > 70. This research has investigated health care professionals' (HCPs') preferences for extending screening to older women and factors they consider when advising about screening. Materials and methods UK HCPs for breast or elderly care were recruited. A questionnaire relating to screening in the > 70s was administered. A sample of respondents were also interviewed to give added insight. Results Questionnaires were distributed to 488 HCPs and 139 replies received, (29%). A total of 26 professionals were also interviewed. Most felt the current system of self referral was under-utilized due to poor user awareness. Predicted life expectancy, co-morbidity and patient preference were viewed as important factors influencing screening recommendation. Chronological age was thought less important. The present system was thought flawed, but there was little enthusiasm for extending screening due to perceived risks and reduced cost efficacy. Some form of selectivity for fitter women was advocated. Conclusions There was acceptance that fitter older women may benefit from screening whilst the less fit may be harmed suggesting that some form of selective invitation would be preferable to the present system but would be practically difficult and costly to administer. The present system of self referral was felt to be inadequate due to low levels of awareness and uptake.

22 ADHERENCE TO AND PERSISTENCE WITH AN ORAL METRONOMIC CHEMOTHERAPY WITH CAPECITABINE IN HEAVILY PRETREATED METASTATIC BREAST CANCER (MBC) PATIENTS

s / Cancer Treatment Reviews 36S3 (2010) S95–S119 S101 histochemical expression of HER-2 growth factor. With a median follow-up of 18 months (range 11–35) there were 16 pts (70%) with no evidence of disease; 4 patients (17%) were alive with disease; and 3 patients (13%) died of the disease. Relapse was detected in 7 women (30%), lung, brain, and chest wall recurrence being the most common sites of metastasis. Among those 7 cases, 5 are triple negative and one patient had obtained a complete pathological response. Conclusions: Our data suggest an improvement in locoregional control in patients treated by surgery, in conjunction with chemotherapy based on antracycline and radiotherapy, for LABD. Moreover, patients with triple-negative disease are a poor prognosis and at high incidence of early metastatic recurrence. 21 DUCTAL CARCINOMA IN SITU OF BREAST: ANALYSIS OF 232 CASES T.P. Latiano, C. D’Addetta, L. Lombardi, M. Morritti, A. Piano, R. Murgo, M. El Jaouni, M. Copetti, E. Maiello. Oncology Unit, Surgery Unit, Unit of Radiotherapy, Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy Background: Ductal carcinoma in situ (DCIS) is a heterogeneous, unicentric precursor of invasive breast cancer, which is frequently identified through mammographic breast screening programs. The prognostic factors of DCIS include anatomo-pathologic factors, age and molecular factors. Methods: Two-hundred-thirty-two woman with DCIS were retrospectively reviewed between 1996 and 2009 in our Institution. The main characteristics of these pts were: median age 53 years (range 23–78), menopause 154 pts (66.3%), fertility 192 pts (82.7%); 50 pts (21.5%) were treated with mastectomy, 182 (78.4%) with breast conservation, and 171 (93.3%) received radiotherapy. Moreover, 106 pts (45.6%) received tamoxifen. Results: With median follow-up of 55 months (range 4–170), recurrence rate was 4.7% (11 pts: 8 ipsilateral, 2 controlateral and 1 ipsilateral + controlateral synchronous). Median relapse free survival was 44.5 months (range 23–68). Approximately 90% of these recurrence have received a breast conservation developing invasive cancer. All these pts had more than 40 years (range 40–66; median 49) and 6/11 were between 40 and 50 yrs. Histologically, 10/11 pts presented comedocarcinoma and 8/11 positive surgical margins. Nine of these woman underwent breast irradiation (90%) and only four pts (36%) ormonal therapy with tamoxifen. The overall survival of all group was 98.2%. Conclusions: Our retrospective analysis confirm the usefulness of mastectomy for patients with DCIS: in fact, breast radical surgery was associated with optimal local control. Furthermore, we observed that pts with 40–50 yrs and comedocarcinoma histology might be considered at high risk of local recurrence and therefore the age and the histology might be considerate as predictors of

False-Positive Results in the Randomized Controlled Trial of Mammographic Screening from Age 40 (“Age” Trial)

False-positive recall is a recognized disadvantage of mammographic breast screening, and the rate of such recalls may be higher in younger women, potentially limiting the value of screening below age 50. Attendance and screening outcome data for 53,884 women in the intervention arm of the U.K. Age trial were analyzed to report observed false-positive recall rates during 13 years of trial fieldwork. The Age trial was a randomized controlled trial of the effect of mammographic screening from age 40 on breast cancer mortality, conducted in 23 National Health Service screening centers between 1991 and 2004. Women randomized to the intervention arm were offered annual invitation to mammography from age 40 or 41 to age 48. Overall, 7,893 women (14.6% of women the intervention arm and 18.1% of women attending at least one routine screen) experienced one or more false-positive screen during the trial. The rates of false-positive mammography at first and subsequent routine screens were 4.9% and 3.2%, respectively. The cumulative false-positive rate over seven screens was 20.5%. Eighty-nine percent of women who had a false-positive recall at their previous screen attended their next invitation to routine screening. The rates of false-positive recall in the Age trial were comparable with the national screening program; however, the positive predictive value of referral was lower. Experiencing a false-positive screen did not seem to lessen the likelihood of re-attendance in the trial. The question of greatly increased false-positive rates in this age group and of their compromising re-attendance is refuted by the findings of this study.

Trichoblastoma of the Breast Detected by Screening Mammography: A Diagnostic Pitfall

Trichoblastoma of the Breast Detected by Screening Mammography: A Diagnostic Pitfall

Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation

Ductal carcinoma in situ (DCIS) is a heterogeneous, unicentric precursor of invasive breast cancer, which is frequently identified through mammographic breast screening programs. The lesion can cause particular difficulties for specimen handling in the laboratory and typically requires even more diligent macroscopic assessment and sampling than invasive disease. Pitfalls and tips for macroscopic handling, microscopic diagnosis and assessment, including determination of prognostic factors, such as cytonuclear grade, presence or absence of necrosis, size of the lesion and distance to margins are described. All should be routinely included in histopathology reports of this disease; in order not to omit these clinically relevant details, synoptic reports, such as that produced by the College of American Pathologists are recommended. No biomarkers have been convincingly shown, and validated, to predict the behavior of DCIS till date.

“No Respecter of Youth”: Over-representation of Young Women in Australian Television Coverage of Breast Cancer

Ninety four percent of new breast cancer cases in Australian women occur in those aged over 40. Mammographic breast screening programs target women over 40, especially those aged 50-69, but participation rates in this age group have recently declined. To test the hypothesis that young women, at low risk for breast cancer, are overrepresented in television news, we analyzed all televised news reports on age and breast cancer shown on five free-to-air Sydney television stations, from 3 May 2005 to 28 February 2007, to determine the age of women shown with, or at risk for, the disease. Over half (55%) of statements about age and breast cancer referred to young women stated or known to be aged under 40. Sixty seven percent of images of women in breast cancer reports were known or judged to be women aged under 40. Three cases in young celebrity women accounted for 53% of all statements and 24% of all images about young women and breast cancer. Overrepresentation of young women with breast cancer in television news coverage does not reflect the epidemiology of the disease. This imbalance may contribute to public uncertainty regarding screening policy.

The Contribution of Clinical Breast Examination to the Accuracy of Breast Screening

There is controversy about whether adding clinical breast examination (CBE) to mammography improves the accuracy of breast screening. We compared the accuracy of screening among centers that offered CBE in addition to mammography with that among centers that offered only mammography. The cohort included 290 230 women aged 50-69 years who were screened at regional cancer centers or affiliated centers within the Ontario Breast Screening Program between January 1, 2002, and December 31, 2003, and were followed up for 12 months. The regional cancer centers offer screening mammography and CBE performed by a nurse. All affiliated centers provide mammography but not all provide CBE. Performance measures for 232 515 women who were screened by mammography and CBE at the nine regional cancer centers or 59 affiliated centers that provided CBE were compared with those for 57 715 women who were screened by mammography alone at 34 affiliated centers that did not provide CBE. Sensitivity of referrals was higher for women who were screened at regional cancer centers or affiliated centers that offered CBE in addition to mammography than for women screened at affiliated centers that did not offer CBE (initial screen: 94.9% and 94.6%, respectively, vs 88.6%; subsequent screen: 94.9% and 91.7%, respectively, vs 85.3%). Mammography sensitivity was similar between centers that offered CBE and those that did not. However, women without cancer who were screened at regional cancer centers or affiliated centers that offered CBE had a higher false-positive rate than women screened at affiliated centers that offered only mammography (initial screen: 12.5% and 12.4%, respectively, vs 7.4%; subsequent screen: 6.3% and 8.3%, respectively, vs 5.4%). Women should be informed of the benefits and risks of having a CBE in addition to mammography for breast screening.

Mean glandular doses for women undergoing mammographic breast screening in Oyo state, Nigeria

In this work, thermoluminescent dosimeters have been used to measure entrance surface doses (ESDs) of patients undergoing mammographic screening at the University College Hospital, Ibadan, Oyo state. The mean glandular doses (MGDs) were also calculated using the measured ESDs. The results showed that the ESDs ranged from 0.26 mGy to 21.26 mGy for the mediolateral oblique (MLO) views and 0.08 mGy to 5.36 mGy for the craniocaudal (CC) views. The calculated MGD ranged from 0.07 mGy to 3.57 mGy for the MLO views and 0.02 mGy to 0.98 mGy for the CC views. The possible reasons for the large variations in the individual ESD values and MGD values for both views are discussed using patients' data, equipment specific data and the technical parameters used for the examinations. Comparison showed that the mean ESD values and MGD values reported in this work are below published values. The mean of the calculated MGD values is also found to be lower than the recommended guidance level of 3.0 mGy when using grid. 92.5% of the patients had MGD values that are less than 2.5 mGy, hence a national reference MGD value of 2.5 mGy is proposed for Nigeria. Implementation of a dose reduction program in mammographic screening is also suggested because of the observed large variations in patients MGD values.