Breast Screening Methods Research Articles

Diagnostic Imaging of Late-Stage Breast Cancer

Diagnostic imaging has proven to be a beneficial tool in the screening, diagnosis, and prognosis of breast cancer. Most cancers are found early with breast screening methods, such as mammography. In some instances, breast cancer will go unidentified or untreated up to the point that the cancer becomes more advanced. This case study investigates a form of breast cancer that was diagnosed within a month after the patient’s first meeting with her physician. The breast cancer was examined with x-ray, computed tomography, and sonography. The role of sonography is discussed in detail with the aim of illustrating the usefulness of this technology in identifying cancerous breast tissue.

Knowledge About Breast Cancer Risk-Factors, Breast Screening Method And Practice Of Breast Screening Among Female Healthcare Professionals Working In Governmental Hospitals, Addis Ababa, Ethiopia

Breast cancer in women is a major health burden both in developed and developing countries. Although there is no cancer registry in Ethiopia cervical and breast cancers are the top two cancer types having a lion's share for the high maternal deaths in the country. Stratified random sampling with proportional allocation and systematic random sampling techniques were employed to assess the knowledge of breast cancer risk factors and practice of breast cancer screening methods among female healthcare professionals in governmental hospitals of Addis Ababa, Ethiopia. Data was analyzed using SPSS version 16 in bivariate analysis. In bivariate analysis age, marital status work experience and educational level had association with study participants' practice of the three breast cancer screening methods. These female health workers who were expected to act as role models and educate the public had adequate knowledge of breast cancer risk factors (85.0%)), BSE (77.6%), CBE (71.4%), and mammography (81.4%) but poor practice of BSE (35.5%), CBE (32.5%) and mammography (16%).Considering their leading role in breast cancer awareness and information dissemination, efforts should be made by Government to improve practice of breast cancer screening methods among female healthcare professionals.

Enhancing Breast Ultrasound Images: A Phantom Study

In this work we were to enhance ultrasound (US) images of a portable ultrasound machine and improve the efficiency of interpretation. Ultrasound has a major role in breast imaging, sometimes as a second procedure after popular breast screening method. It has some advantages over other modalities. But it has two major user dependencies: scanning and interpreting. Beside these, there are limitations for these types of ultrasound machines based on their integrity and dimension limits. We were to increase radiologist's efficiency on interpreting the results of portable ultrasound machine using Computer-Aided Detection (CAD) algorithm.For 6 most popular ultrasound machines, we swept: modes of operation, transducer, frequency and contrast, while making phantom images. As we were concerning in breast disease we focused our work on B-Mode. Then we captured 3300 Ultrasound images using a quality multi tissue Breast Phantom. We were focusing on two lesion types: Cyst and Solid. In each image set, we started with the lowest frequency and contrast. We selected a region of interest (ROI) in background. Comparing each image with the lowest one, we find a table of difference for each machine setting. Each row in produced table showed required data to improve image corresponding to its collected information. We used MATLAB image processing tool box and applied factors such as SNR, PSNR and MSE parameter to check the output image. For an unidentified ultrasound image, after selecting of ROI, comparing its data with table would give us the best data set. Then we applied data to original image and used MSE to maximize their similarities. Gamma correction, contrast stretching and edge enhancement would be next stage. Two experienced radiologists marked final images. Analyzing the results showed that our proposed framework enhanced visualization, decrease interpreting time while increase SNR.

Effect of false-positive results on reattendance at breast cancer screening programmes in Spain

Mammography is the only breast screening method, we are aware of today, which is able to reduce mortality from breast cancer. Nevertheless, this procedure carries an inherent risk of false-positive screening mammogram. The association between these results and reattendance at the next scheduled screening mammogram is controversial. The aim of this study was to examine the effect of a false-positive screening mammogram and women's characteristics on reattendance in eight regional population-based breast cancer screening programmes in Spain. This study included 1 383 032 women aged 44-67 years who were initially screened for breast cancer between 1990 and 2004. To investigate factors associated with reattendance, logistic regression models were used. The mean age of women at first screening was 53.6 years (SD = 6.1 years). Of 120 800 women with a false-positive screening mammogram, 78.3% returned for a subsequent screening mammogram compared with 81.9% of those with a negative result (P < 0.001). Multivariate analysis showed that women with a false-positive result at first screening mammogram were less likely to reattend (OR = 0.71; 95% CI 0.70-0.73) and that the likelihood was lower in those who had undergone invasive additional tests (OR = 0.56; 95% CI 0.53-0.59). A false-positive screening mammogram in the first screening negatively affected attendance at the subsequent screening. The results of this study could be useful to improve the screening process and to increase women's compliance.

Support Vector Machine-Based Ultrawideband Breast Cancer Detection System

Ultrawideband (UWB) microwave radar is a promising alternative breast screening method. Previous research has focused on the imaging and classification of early-stage breast cancer from backscattered microwave signals. The heterogeneous composition of breast tissue, prevalent among younger females, inhibits UWB scanning technologies to effectively localize cancerous regions within the breast. Rather than using UWB radar to image the breast or classify between types of cancer, the method proposed in this paper is to simply detect the presence of a tumor using a Support Vector Machine (SVM) based UWB cancer detection system. The SVM cancer detection system is evaluated using dielectrically realistic numerical breast models, and the performance of the detection system is compared to a Linear Discriminant Analysis (LDA) classification method.

Breast Cancer Screening Recommendations: Is Mammography the Only Answer?

Early detection of breast cancer is important to reduce mortality and morbidity. Traditionally, three methods of breast screening were recommended: mammography, clinical breast examination (CBE), and breast self-examination (BSE). At present, BSE and CBE are no longer widely recommended, while mammography is still broadly promoted in the Western world. The primary intent of this article is to examine whether current health policy recommendations related to breast cancer screening are informed by evidence. The issue of whether women are adequately aware of the potential benefits and risks of breast screening methods to make informed decisions is also discussed. It is argued that it is premature to caution women against BSE and CBE because the current evidence is inconclusive or incomplete. Moreover, women should be better informed about the potential harms associated with mammography screening. Recommendations for research and health policy are also discussed.

Ultrasound screening of breast cancer

Ultrasound (US) screening of breast cancer was surveyed with the results of breast screening combined with mammography (MMG), US and clinical breast examination (CBE) at Ibaraki Health Service Association. Breast cancer is common among women in their late 40s in Japan, who tend to have small and dense breasts. Our results showed that US works as well as MMG in detecting breast cancers in women in their 40s, and both modalities are compensatory. There are many reports that the combination of MMG and US is a suitable method for breast screening in Japan. A large-scale randomized control trial is now ongoing to investigate whether breast screening by both MMG and US is useful to decrease breast cancer mortality.

Interventions for relieving the pain and discomfort of screening mammography.

The pain of mammography is recognised as a significant deterrent for women considering this examination, and may affect participation in breast screening. To review interventions to reduce or relieve the pain and discomfort of screening mammography. For this update, the Cochrane Breast Cancer Group Specialised Register was searched on the 18th May 2006. Other databases searched were MEDLINE (1966 to November 2006), CINAHL (1982 to December 2006), EMBASE (1988 to 2006) and reference lists of articles. We also searched Current Controlled Trials (www.controlled-trials.com, accessed September 2007) and the UK National Research Register (www.update-software.com/national/, accessed September 2007) for ongoing and completed research projects. Researchers in the field were also contacted. Randomised controlled trials and quasi-randomised trials with a comparison group were considered. Studies had to include assessment of pain or discomfort and, if the intervention could have impacted on the quality of the mammograms, an assessment of image quality was also required. Two authors (DM and VL) reviewed identified studies to determine whether they met the inclusion criteria. Each study was reviewed for quality, including concealment and generation of allocation sequence, comparability between groups at baseline, inclusion of all randomised participants in analysis and blinding after allocation. Data extraction was performed by these two authors. Seven RCTs, involving 1671 women were identified for inclusion. The review found that giving women information about the procedure prior to the mammogram may reduce pain and discomfort. Increasing women's control over breast compression could reduce pain experienced during the procedure, though mammogram image quality was only maintained if the technologist controlled the first compression. If the technologist reduced compression force of the mammogram, discomfort experienced was unchanged. The use of breast cushions reduced pain of mammography; however, image quality was impaired in 2% of women in the intervention group. Acetoaminophen as a premedication did not affect discomfort of mammography. Differences in interventions, and inconsistency in measures, validation of pain scales, and in assessment of mammogram quality, mean that results of these studies cannot be combined. All results are based on single studies. Further research is required. Currently there are very few proven interventions to reduce pain and discomfort of screening mammography, especially procedures that can be readily introduced to screening programmes. With mammography continuing as the preferred method for breast screening, more research on such interventions is needed.

Using a Community‐Based Outreach Program to Improve Breast Health Awareness Among Women in Hong Kong

To evaluate the effectiveness of a community-based health education program via a mobile van to promote the awareness of breast cancer and breast self-examination (BSE) practice among women in Hong Kong. One group pretest/posttest design. SAMPLE AND MEASUREMENTS: Seven hundred and seventy-seven women in Hong Kong completed a self-administered questionnaire before and after a breast health education program from May 2002 to March 2003. About half were aware of breast health and breast diseases (53.7%) and breast screening methods (48.6%) before the intervention. It was found that women who had received instruction on BSE practice, and those who were aware of breast screening methods, breast health, and breast diseases were more likely to have had prior BSE practice. Most indicated their willingness to practice BSE regularly (93.3%) and to pass on the BSE knowledge to their relatives and friends (92%) in the posttest. The outreach health education program has successfully reached women living in the 18 districts in Hong Kong. It appears to be useful in raising the awareness of breast health and BSE practice among the women, but longer term follow-up is required to ascertain its sustainability.

Women With Cerebral Palsy and Breast Cancer Screening by Mammography

Poulos AE, Balandin S, Llewellyn G, Dew AH. Women with cerebral palsy and breast cancer screening by mammography. We emphasize the need to identify specific barriers to participation in breast cancer screening by mammography experienced by women with cerebral palsy (CP). Mammography screening has been found to reduce mortality rates by 30%, but women with disabilities such as CP underuse this important preventive medicine facility, potentially leading to delay in diagnosis of breast cancer and a less favorable prognosis. Because equity in health care is compromised through underutilization by these women, barriers to participation and successful outcomes must be investigated. Barriers such as appropriate information, transport, and assistance prevent women with CP from getting to the facility. Once there, communication difficulties, physical limitations, psychologic barriers, and staff attitudes become barriers to a successful outcome. Education for health personnel as well as adaptation of the mammographic technique to suit the physical limitations of women with CP are critical to increasing participation and ensuring successful outcomes. Importantly, there is a need to identify women for whom having a mammogram is not an option and for whom alternative breast screening methods should be provided.

Die Ein-Ebenen-Mammographie in Kombination mit der Mamma-Sonographie versus Zwei-Ebenen-Mammographie zur Untersuchung der weiblichen Brust. Neues Konzept für die Früherkennung von Brustkrebs

Two-view mammography is at present the only imaging method used for breast screening. But there are some deficits in differential diagnosis, especially in dense breast tissue and non-calcified tumors. Purpose: The purpose of this study was the demonstration that one-view mammography (EEMG) combined with ultrasound mammography (USMG) and clinical examination (TB) is equal to or more effective for breast screening than two-view mammography (ZEMG). Material and Methods: 3743 female patients examined from 1993-2003 in the Institute for mamma diagnostics (IMZE) in Esslingen/Germany underwent curative mammography with TB, ZEMG, USMG; after surgical excision a definitive histological diagnosis was made. To avoid interobserver variability, only patients examined by the same doctor were included. Applying these criteria 343 female patients with surgically and histologically proved 334 malignant lesions and 9 benign lesions were found. These patients were divided into five age-groups. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, false negatives and positives were calculated in succession for EEMG, ZEMG, USMG, EEMG + USMG combined and EEMG + USMG + TB combined for the different age-groups. For EEMG only the oblique view of the two-view mammograms was evaluated. Additionally, extended diagnostic methods, like magnetic-resonance mammography (MRM) were analysed, to document a possible diagnostic optimization. Results: The sensitivities for a malignant diagnosis (high-risk lesion, invasive cancer) was 83% for EEMG (95% Cl 78.4-86.8%: p<0.0001), 84% for ZEMG (95% Cl 79.4-87.6%; p<0.0001), 91% for USMG (95% CI 87-93.6%; p<0.0001), 97% for EEMG + USMG (95% Cl 94.5-98.5%; p<0.0001) and 98.5% for TB + EEMG + USMG (95% Cl 96.1-99.3%: p=0.7); the false negatives were 17% (EEMG), 16% (ZEMG), 9% (USMG), 3% (EEMG + USMG) and 1.5% (TB + EEMG + USMG 5/343 interval cancers). The cranio-caudal view was useful only in one case in 10 years. The differences in sensitivity and false negatives were visible in all age-groups and comparable with international studies. Problematic diagnoses (sensitivity: lobular 97%, ductal 97%, ductolobular 100%, apocrine carcinoma 100%, adenocarcinoma 100%) were detected better with EEMG + USMG than with ZEMG (lobular 82%, ductal 84%, ductolobular 40%, apocrine carcinoma 0%, adenocarcinoma 0%). The combination of EEMG + USMG + TB increased sensitivity in women older than 50 years. Below 50 years there was no difference to EEMG + USMG. EEMG + USMG was associated with lower costs than ZEMG (saving 4.4%). Conclusion: In a curative collective EEMG combined with USMG is not only able to replace ZEMG, but increases detection rates in imaging procedures. The advantages of both methods in the detection of high risk lesions and invasive cancer were combined. Therefore EEMG + USMG represent a possible alternative breast screening method with high patient acceptance, because of reduced costs and a lower radiation dose.

Using the Internet to Identify Women's Sources of Breast Health Education and Screening

ABSTRACT Health professionals, women's groups, the media and the Internet have all played a role in educating the public about breast health and breast screening methods. Yet, with all the information that is available to women, their participation rates have been less than optimal. This paradox has resulted in the need to learn more about the sources that influence women to participate in breast screening. In an innovative study using the Internet, over 800 women, primarily from Canada and the United States, were surveyed about their knowledge, attitudes and influences regarding their breast screening practices. Current health status, screening practices and influences of various health professionals on women's health promotion activities were analyzed. Comparisons of the women's perceptions across age groups and national differences between Canadian and American respondents are presented. Women in the older age group reported receiving more encouragement for breast screening activities from physicians, nurses and others than did younger women. American respondents reported perceiving more support from nurses for breast screening than did their Canadian counterparts. A high number of American respondents reported having been diagnosed with breast cancer, while only a small number of Canadian respondents reported this diagnosis. The results from this study can be used in planning health promotion activities relevant to various populations of women. Benefits and limitations of using the Internet as a research medium are briefly discussed.

Older Women and Mammography: Factors Influencing Their Attitudes

Breast disease is a leading factor in the morbidity of older women. Unfortunately, this population segment receives less education on breast screening methods and has a lower rate of mammography use than others. This article focuses on the misconceptions concerning elderly breast care and the reasons why mammography use is lowest in this population segment.

Volumetric imaging with ultrasonic spiral CT.

To examine the feasibility of implementing spiral computed tomography (CT) in ultrasonic imaging as a potential method for breast screening, an algorithm for x-ray spiral CT was applied to ultrasonic waves on a specially built ultrasonic tomographic system. Three-dimensional reconstructions of various phantoms were obtained. Spiral ultrasonic CT is feasible, and it may have clinical merit as a breast imaging method.

Analysis of mammographic microcalcifications using gray-level image structure features

At present, mammography associated with clinical breast examination and breast self-examination is the only effective and viable method for mass breast screening. The presence of microcalcifications is one of the primary signs of breast cancer. It is, difficult however, to distinguish between benign and malignant microcalcifications associated with breast cancer. Here, the authors define a set of image structure features for classification of malignancy. Two categories of correlated gray-level image structure features are defined for classification of "difficult-to-diagnose" cases. The first category of features includes second-order histogram statistics-based features representing the global texture and the wavelet decomposition-based features representing the local texture of the microcalcification area of interest. The second category of features represents the first-order gray-level histogram-based statistics of the segmented microcalcification regions and the size, number, and distance features of the segmented microcalcification cluster. Various features in each category were correlated with the biopsy examination results of 191 "difficult-to-diagnose" cases for selection of the best set of features representing the complete gray-level image structure information. The selection of the best features was performed using the multivariate cluster analysis as well as a genetic algorithm (GA)-based search method. The selected features were used for classification using backpropagation neural network and parameteric statistical classifiers. Receiver operating characteristic (ROC) analysis was performed to compare the neural network-based classification with linear and k-nearest neighbor (KNN) classifiers. The neural network classifier yielded better results using the combined set of features selected through the GA-based search method for classification of "difficult-to-diagnose" microcalcifications.

ARTIFICIAL NEURAL NETWORK BASED CLASSIFICATION OF MAMMOGRAPHIC MICROCALCIFICATIONS USING IMAGE STRUCTURE FEATURES

Mammography associated with clinical breast examination and breast self-examination is the only effective and viable method for mass breast screening. Most of the minimal breast cancers are detected by the presence of microcalcifications. It is however difficult to distinguish between benign and malignant microcalcifications associated with breast cancer. Most of the techniques used in the computerized analysis of mammographic microcalcifications segment the digitized grey-level image into regions representing microcalcifications. Since mammographic images usually suffer from poorly defined microcalcification features, the extraction of microcalcification features based on segmentation process is not reliable and accurate. We present a second-order grey-level histogram based feature extraction approach which does not require the segmentation of microcalcifications into binary regions to extract features to be used in classification. The image structure features, computed from the second-order grey-level histogram statistics, are used for classification of microcalcifications. Several image structure features were computed for 100 cases of “difficult to diagnose” microcalcification cases with known biopsy results. These features were analyzed in a correlation study which provided a set of five best image structure features. A feedforward backpropagation neural network was used to classify mammographic microcalcifications using the image structure features. Four networks were trained for different combinations of training and test cases, and number of nodes in hidden layers. False Positive (FP) and True Positive (TP) rates for microcalcification classification were computed to compare the performance of the trained networks. The results of the neural network based classification were compared with those obtained using multivariate Baye’s classifiers, and the k-nearest neighbor classifier. The neural network yielded good results for classification of “difficult-to-diagnose” micro-calcifications into benign and malignant categories using the selected image structure features.

A breast cancer screening educational intervention targeting medical office staff.

There is persistent evidence that breast cancer screening techniques remain under-utilized. While physicians cite lack of time as a barrier to the provision of preventive services, nurses and other medical office staff are in an ideal position to educate women and motivate adherence to screening recommendations. This paper describes the design, implementation and process evaluation of a breast cancer screening educational program targeting primary care medical office staff. This intervention was conducted in two Washington State counties as part of a larger community organization study. The PRECEDE model, educational outreach principles and focus groups were used to guide the program development. Consistent with 'academic detailing' concepts, the sessions were delivered at health care facilities. The program included a review of breast cancer-related data and screening methods, an overview of the nurse's role as a 'change agent' and breast self-examination instructor, and a discussion of women's barriers to mammography. Community-level penetration was relatively high, with sessions being completed by approximately 50% of the eligible staff. Overall, participants were positive about the value of the program. Medical office-based educational sessions have the potential of reaching a large proportion of primary health care workers and increasing disease prevention in communities.