Mammography Practice Research Articles

Determinants of breast cancer screening behavior amongst Nigerian women using the transtheoretical model

Breast cancer is a leading cause of morbidity and mortality amongst women in developing and developed countries. Breast Self-Examination (BSE), mammography and clinical examination are amongst the most effective methods of early detection, however uptake remains low. The Transtheoretical Model (TTM) has been used in many other countries to characterize behavioral shifts related to enable the adoption of more focused tactics for improving breast cancer screening behaviors among Nigerian women. A cross-sectional research study was conducted to assess the level of knowledge and uptake of breast cancer screening practice based on the various stages of readiness and change predictors using the Transtheoretical Model (TTM). The model was applied to identify and characterise key behavioural determinants such as decision balance, stage of change, and process of change (POC) for breast cancer screening through breast self-examination and mammography. A total of 265 adult female respondents in Kaduna State, Northwest, Nigeria was sampled out of which ninety-one (91%) had no family history of breast cancer. Although 80.3% had knowledge of breast cancer disease, 68% of respondents knew how to conduct BSE and only 55% practiced it. In terms of BSE behaviour staging, 29.4% and 26.7% respondents are in the preparation and maintenance stages respectively. In terms of mammography adoption, most respondents (34%) are in the preparation stage. Review of process of change determinants show that breast cancer screening behaviour are driven more by experiential determinants as compared to behaviour determinants. Addressing the complex factors influencing BSE and mammography practice requires a comprehensive social behaviour change approach that may sustaining positive behaviour-driving factors and minimise inhibitive factors that can promote breast cancer screening.

Social determinants of breast cancer screening: a multilevel analysis of proximal and distal factors related to the practice of mammography.

Mammography is crucial for early breast cancer detection. In Latin America, Argentina faces a significant breast cancer burden, with varying mammography rates. The social factors influencing mammography practices remain unclear. This study aimed to identify the proximal and distal social determinants of this practice among Argentinean women using a multilevel approach. This nationwide cross-sectional study included 4,924 women aged 50-70 participating in the 2018 National Risk Factor Survey of Argentina. Two-level logistic models were used to estimate measures of association (ORs) between timely mammography practice (within the last 2 years) and selected covariates (sociodemographics, proximal environment, and distal-level variables). The intraclass correlation coefficient (ICC) and proportional change in variance (PCV) were calculated. 62.8% of women underwent timely mammography. Age (OR=0.96; 95%CI 0.94-0.97), health insurance (OR=2.22; 95%CI 1.87-2.63), education (OR=2.1; 95%CI 1.74-2.64), and income (OR=1.56; 95%CI 1.23-1.97) were associated with mammography practice. Women in non-marital (OR=0.61; 95%CI 0.52-0.72) or larger households (OR=0.61; 95%CI 0.51-0.63) were less likely to have timely mammograph; living in a larger city was positively associated (OR=1.28; 95%CI 1.12-1.46). Women in provinces with higher physician density (OR=1.06; 95%CI 1.01-1.11) and lower maternal mortality ratio (OR=0.9; 95%CI 0.87-0.96) had higher chances of timely mammography. The ICC and PCV suggested that the explored healthcare indicators largely explained the macro-contextual effect. Multilevel factors influenced mammography practices in Argentina. The results highlight disparities linked to sociodemographic characteristics and healthcare resources. Efforts to address social inequalities in breast cancer screening must consider multilevel determinants, including in healthcare settings.

Australian radiographers’ digital era practice in selecting the image receptor angle for female body habitus for the mediolateral oblique view of the breast

IntroductionCorrect alignment of the image receptor (IR) in mammography for the mediolateral oblique (MLO) view of the breast is fundamental to enable the maximum inclusion of breast tissue. This study aims to assess Australian radiographers' knowledge and digital era practice in selecting the IR angle for female body habitus in the MLO view of the breast. MethodsAn online survey was distributed to all members of the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) through their electronic newsletter and via direct email to radiographers holding the Certificate of Mammographic Practice (CMP). Descriptive analysis was undertaken, and a Pearson's chi-squared test of independence was used to compare associations between academic qualification and IR selection data. A value of p < 0.05 was deemed statistically significant. ResultsA total of 107 valid surveys were returned; 67.3 % reported using the posterior lateral margin to select the IR angle. For linear body habitus, 44.9 % reported using 50°; for all other body habitus, participants most commonly used 45° (59.1 %); 85.1 % used a range of angles between 40 and 55°; 16.8 % recognised the link between correct IR angle selection and breast tissue inclusion. ConclusionThe range of angles used in practice has reduced in the digital era; the frequency of the use of 45° across all body habitus may reflect tube angle movement automation. Few radiographers recognised the important link between correct selection of IR angle and breast tissue inclusion on the image. Implications for practiceUnderstanding of the link between IR angle selection and image quality enhances current practice in the digital era to maximise the inclusion of breast tissue and minimise the potential of missed breast cancer.

Highlights of the 2023 Amendments to the MQSA Implementing Regulations.

The Mammography Quality Standards Act (MQSA) of 1992 is intended to ensure that mammography practice nationwide meets consistent baseline quality standards. Amendments to the MQSA implementing regulations ("Amendments") were published on March 10, 2023, and are effective on September 10, 2024. The Amendments address various aspects of the program, including mammography technology, enforcement, the retention and transfer of personnel records and medical records, the medical outcomes audit, and mammography reporting, including (but not limited to) reporting of breast tissue density. The amended regulations are available online, and the Food and Drug Admininstration (FDA) offers several resources for mammography facilities and other stakeholders to receive additional information, including a facility hotline, a summary document distributed to all certified mammography facilities, and a Small Entity Compliance Guide (or SECG) written in question-and-answer format, which the FDA intends to be helpful to facilities of any size.

Exploring the role of proximal and distal socioenvironmental determinants on the practice of mammography among Argentine women

Exploring the role of proximal and distal socioenvironmental determinants on the practice of mammography among Argentine women

A Survey of Mean Glandular Doses and Suggestions on National Diagnostic Reference Levels for Digital Mammography in China.

The primary purpose of this study was to report the mean glandular doses and to determine the national diagnostic reference levels for digital mammography based on data between 2016 and 2018 in China. The data from 19,076 mammograms (4,769 examinations) by random sampling from 118 digital mammography systems were compiled. Exposure factors included age, compressed breast thickness, kVp, mAs, target/filter combination, entrance surface air kerma, and mean glandular doses, which were retrospectively surveyed and recorded from the monitor. The national diagnostic reference levels (75th percentiles) in mean glandular dose were calculated across median value obtained for all included data and stratified to specific compressed breast thickness ranges. The patients' ages ranged from 22 to 88 y, with a median age of 45. The applied voltage and output medians were 28 kVp and 75.1 mAs for all exposure, respectively. The median CBTs were 45 mm and 48 mm for craniocaudal views and mediolateral oblique views, and the corresponding median mean glandular doses were 1.32 mGy and 1.40 mGy, respectively. The national diagnostic reference level at compressed breast thickness of 40-50 mm was 1.67 mGy for CC views and 1.71 mGy for MLO views. The median mean glandular doses varied significantly and increased with compressed breast thickness, demonstrating the necessity of establishing DRL according to breast thickness and optimizing the clinic's digital mammography practice in China.

How Much Radiation Are Women in Saudi Arabia Receiving from Mammography? A Review

This review compiles and assesses data from recent studies on mammographic radiation doses in Saudi Arabia, aiming to evaluate mean glandular dose (MGD) exposure during mammography and its implications in breast cancer risk. The reviewed studies spanned from 2019 to 2023 and included a range of sample sizes and institutional settings, with patients’ ages from 27 to 85 years. Considerations such as the number of mammographic views and compressed breast thickness were examined. The studies reported average MGDs below the National Diagnostic Reference Level set by the Saudi Food and Drug Authority. However, limitations were noted regarding sample size selection and incomplete data on all mammographic projections. Despite these limitations, the findings highlight the need for continued assessment of patient doses to optimize mammography practices and address the absence of quality standardization acts in Saudi Arabia. These insights are critical for governing authorities to ensure that effective patient dose monitoring occurs regularly and that the establishment of minimum quality standards for breast cancer screening is intact.

Glandular doses and diagnostic reference levels (DRLs) for Saudi breast cancer screening programme (2012-2021).

The aim of this study was to report the diagnostic reference levels (DRLs) corresponding to different compressed breast thickness (CBT) ranges. To achieve this, mammographic examinations with 187,788 exposures were analysed. The mean average glandular (AGD) dose was calculated per view, examination, and center. Moreover, the DRL values corresponding to different CBT ranges were reported. The result of the mean AGD per view was found to be 1.36 mGy for craniocaudal (CC) and 1.54 mGy for Mediolateral oblique (MLO), while the mean AGD per examination for all women was 1.45 mGy. The DRL values corresponding to CBTs between 20 to 79 mm ranges were below 2 mGy. These results were from a population of mean age = 49 ± 8 years and mean CBT = 58 ± 8 mm, and was imaged with mean exposures of 29 ± 1 kVp and 74 ± 31 mAs, and a mean compression force of 135±37 N. In conclusion, good mammography practice has been shown, as DRL values are within the limits suggested by the international organizations.

Assessment of average glandular dose in mammography practice of a teaching hospital in Ghana.

above the age of 40, women are advised to begin breast examinations and screenings for early detection of breast cancer. The average glandular dose (AGD) provides dosimetric information about the quantity of radiation received by the mammary glands during mammographic exposures. There is, therefore, the need to analyse the radiation dose received by patients presenting for mammography examinations. a retrospective cross-sectional design was carried out on the data of 663 participants, conveniently sampled between the months of July 2021 and June 2022. Paired T-test was used to compare imaging parameters for cranio-caudal (CC), medio-lateral (ML), automatic exposure control (AEC), manual exposure control (MEC), and left and right breast. Pearson´s correlation was used to test for relationship between imaging parameters and AGD. the mean AGD per exposure was 1.9 ± 0.7 mGy for CC projections and 2.3 ± 1.2 mGy for ML projections. The mean AGD per examination for the study was 4.1 ± 1.4 mGy. A positive correlation was found between AGD per examination and exposure factors (tube loading and tube voltage), compressed breast thickness, and compression force. Patient age had no statistically significant relationship with the AGD per examination. average glandular dose (AGD) was consistent with other findings in literature studies. It was also observed that MEC yielded lower AGD per exposure values than AEC. There was no significant difference in the mean AGD per exposure for left and right breasts.

Enhancing early detection of breast cancer: a comprehensive analysis of mammography practices and their impact on women's health

Enhancing early detection of breast cancer: a comprehensive analysis of mammography practices and their impact on women's health

Knowledge, attitudes, and practices related to breast cancer screening among female Jordanian university employees: A cross-sectional study

IntroductionTo improve participation in breast screening programs, the level of knowledge about BC, attitudes, and practices of women in different sections of society must be understood. This study aimed to measure the level of knowledge of BC risk factors, signs and symptoms and determine current mammography practices among female employees at Jordanian universities. MethodsA cross-sectional descriptive study was conducted on female employees at Jordanian government universities. Data was collected using a structured questionnaire that included: sociodemographic characteristics, knowledge of BC risk factors, knowledge of BC symptoms and knowledge, attitude and practice of mammography as an early detection method. ResultsA total of 362 participants completed the questionnaire. Overall, 174 scored ≥50% correct answers regarding BC risk factors, while 231 scored ≥50% correct answers regarding BC signs and symptoms. Half of the participants (n = 184, 50.8%) understood mammography to be an early BC detection method. Among those participants, 95 (51.6%) were eligible for screening and 39 (21.2%) had had a previous mammogram. The main reason for not engaging in mammography was the absence of BC signs and symptoms (37.2%). Profession, educational level and family history of BC were associated with increased knowledge of BC risk factors, signs and symptoms (p = 0.01). Lecturers in medical faculties exhibited the highest level of knowledge about mammography compared to participants in other professions (p = 0.02). ConclusionOnly 79 participants had good to excellent knowledge about BC. Participants’ profession was the major indicator for awareness of BC and mammography as an early detection method. Implications for practiceThe findings of this study reinforce the importance of providing BC educational programs for university employees in Jordan to increase awareness of BC and mammography.

The Health Belief Model Attitudes of Iraqi Women towards Breast Cancer and Its Early Detection Methods

Health Belief Model (HBM) is a very effective paradigm designed to explore behaviours, especially in breast cancer prevention. This study aimed to determine women’s attitudes regarding breast cancer by using HBM and the interaction between attitudes and practice. This prevalence survey was performed on a consecutive sample of 657 women visiting the primary healthcare centres in Baghdad/ Iraq. The data was collected over four months in 2019. A specially designed questionnaire of modified and translated health belief model related to breast cancer was adopted and filled out through face-to-face interviews. The age of participants was between (20-59) years. Women with adequate practice of BSE (Breast Self-Exam) had higher perceived benefits, susceptibility, and motivation than those who inadequately practised it. Women with adequate practice of mammography had higher perceived benefits and health motivation, and lower barriers, threat, and severity of breast cancer other than those with inadequate practice. Those participants who were more likely to perform CBE (Clinical Breast Exam) adequately, those with higher levels of perceived seriousness and health motivation. Study results suggested that practices of screening for breast cancer were inadequate in a majority of participants and need to be improved by educational health programs.

Health Benefits and Cost-Effectiveness of Children's Oncology Group Breast Cancer Screening Guidelines for Chest-Irradiated Hodgkin Lymphoma Survivors.

To evaluate the outcomes and cost-effectiveness of the Children's Oncology Group Guideline recommendation for breast cancer (BC) screening using mammography (MAM) and breast magnetic resonance imaging (MRI) in female chest-irradiated childhood Hodgkin lymphoma (HL) survivors. Digital breast tomosynthesis (DBT), increasingly replacing MAM in practice, was also examined. Life years (LYs), quality-adjusted LYs (QALYs), BC mortality, health care costs, and false-positive screen frequencies of undergoing annual MAM, DBT, MRI, MAM + MRI, and DBT + MRI from age 25 to 74 years were estimated by microsimulation. BC risks and non-BC mortality were estimated from female 5-year survivors of HL in the Childhood Cancer Survivor Study and the US population. Test performance of MAM and MRI was synthesized from HL studies, and that of DBT from the general population. Costs (2017 US dollars [USD]) and utility weights were obtained from the medical literature. Incremental cost-effectiveness ratios (ICERs) were calculated. With 100% screening adherence, annual BC screening extended LYs by 0.34-0.46 years over no screening. If the willingness-to-pay threshold to gain a quality-adjusted LY was ICER < $100,000 USD, annual MAM at age 25-74 years was the only cost-effective strategy. When nonadherence was taken into consideration, only annual MAM at age 30-74 years (ICER = $56,972 USD) was cost-effective. Supplementing annual MAM with MRI costing $545 USD was not cost-effective under either adherence condition. If MRI costs were reduced to $300 USD, adding MRI to annual MAM at age 30-74 years could become more cost-effective, particularly in the reduced adherence condition (ICER = $133,682 USD). Annual BC screening using MAM at age 30-74 years is effective and cost-effective in female chest-irradiated HL survivors. Although annual adjunct MRI is not cost-effective at $545 USD cost, it could become cost-effective as MRI cost is reduced, a plausible scenario with the emergent use of abbreviated MRI.

Level of Awareness of Mammography among Breast Cancer Patients Attending Follow-up at a Tertiary Hospital, Addis Ababa, Ethiopia.

Breast cancer is the most common cancer type and the most common cancer related cause of death worldwide in women. This study was aimed to assess the awareness of mammography among breast cancer patients attending follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Hospital based cross sectional study was conducted from July 01 to August 30, 2017 at Tikur Anbessa Specialized Hospital. Interviewer administered questionnaire was used to obtain data from 270 breast cancer patients who came to radiology department for follow up imaging. Collected data were checked for completeness, coded and entered into Epi Info 3.1 software and exported to SPSS Version 21 for analysis. Two hundred and twenty four (83%) of the study participants had no awareness of mammography while 46 (17%) of them had awareness of mammography. Out of the total 270 women, only 38(14.1%) had mammography test. In multivariate logistic regression analysis; level of education was found to have significant association with awareness of mammography. Women with breast cancer who completed secondary education were 4.5 times (AOR= 4.5; 95% CI: 1.39, 14.77) more likely to have awareness of mammography compared to women with breast cancer who were illiterate. This study revealed low awareness, knowledge and practice of mammography among women with breast cancer. Knowledge of participants about risk factor for breast cancer was also low.

Evaluation of knowledge and practice regarding mammography among a group of Turkish women attending a tertiary hospital.

Early detection is the most important cornerstone of breast cancer in determining treatment outcome and survival. In this study, it was aimed to investigate the level of knowledge, attitude, and practice of mammography in the early diagnosis of breast cancer in a group of women. Data of this descriptive study were collected under observation with the help of a questionnaire. Female patients over 40 years of age or over 30 years of age with a family history of breast cancer admitted to our general surgery outpatient clinic for a health problem other than breast were included. A total of 300 female patients with a mean age of 48.7 ± 10.9 years (min-max, 33-83 years) were included. Median frequency of correct answers among the women participating in the study was 83.7% (76.0-92.0). Mean score obtained by the participants from the questionnaire was 75.7 ± 15.8 (the median score 80; 25th-75th centiles, 73.3-86.7). Slightly more than half of the patients (159 patients, 53%) had at least one mammography scan before. The level of mammography knowledge was negatively correlated with age and the number of previous mammographies, and positively correlated with education level (r= -0.700, p <0.001; r= -0.419, p <0.001 and r= 0.643, p <0.001, respectively). Although the level of knowledge about breast cancer and early diagnosis methods in women was at a satisfactory level, it is obvious that mammography screening practice of women without any breast symptoms is very low. Therefore, it should be aimed to increase women's awareness of cancer prevention and compliance with early diagnosis methods and to promote participation in mammography screening.

Estimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort.

Mammography screening can lead to overdiagnosis-that is, screen-detected breast cancer that would not have caused symptoms or signs in the remaining lifetime. There is no consensus about the frequency of breast cancer overdiagnosis. To estimate the rate of breast cancer overdiagnosis in contemporary mammography practice accounting for the detection of nonprogressive cancer. Bayesian inference of the natural history of breast cancer using individual screening and diagnosis records, allowing for nonprogressive preclinical cancer. Combination of fitted natural history model with life-table data to predict the rate of overdiagnosis among screen-detected cancer under biennial screening. Breast Cancer Surveillance Consortium (BCSC) facilities. Women aged 50 to 74 years at first mammography screen between 2000 and 2018. Screening mammograms and screen-detected or interval breast cancer. The cohort included 35986 women, 82677 mammograms, and 718 breast cancer diagnoses. Among all preclinical cancer cases, 4.5% (95% uncertainty interval [UI], 0.1% to 14.8%) were estimated to be nonprogressive. In a program of biennial screening from age 50 to 74 years, 15.4% (UI, 9.4% to 26.5%) of screen-detected cancer cases were estimated to be overdiagnosed, with 6.1% (UI, 0.2% to 20.1%) due to detecting indolent preclinical cancer and 9.3% (UI, 5.5% to 13.5%) due to detecting progressive preclinical cancer in women who would have died of an unrelated cause before clinical diagnosis. Exclusion of women with first mammography screen outside BCSC. On the basis of an authoritative U.S. population data set, the analysis projected that among biennially screened women aged 50 to 74 years, about 1 in 7 cases of screen-detected cancer is overdiagnosed. This information clarifies the risk for breast cancer overdiagnosis in contemporary screening practice and should facilitate shared and informed decision making about mammography screening. National Cancer Institute.

Assessment of knowledge and practice of mammography and breast self-examination among the general female population in Asir region of KSA.

Breast cancer is the most common malignancy in Kingdom of Saudi Arabia (KSA) and an increasing burden in terms of incidence, morbidity and mortality. It accounts for about 28.7% of all new cancers in women. In 2015, the Saudi cancer registry shows that breast cancer was graded first among women and it accounts for 16.7% of all cancers reported among Saudi nationals. This study was designed to assess breast cancer screening knowledge and practices among women in the Asir region, Kingdom of Saudi Arabia. A cross-sectional study recruiting 1,021 female participants was performed. The variables included breast cancer knowledge, socio-demographic features, breast self-examination knowledge and practice. Descriptive statistics was used to compare and analyze the collected data while chi-square test was used to check the statistical significance among the selected variables. Saudi married women from Asir region were the participants of this cross-sectional study. Our findings suggested that participants had a satisfactory level of knowledge about breast self-examination andmammograms at a rate of > 90% and 44.76% respectively. Over 90% of participants had good breast self-exam knowledge,however, only 6.37% was always performed breast self-examination. Similarly, nearly 40% of participants performed mammograms, while 40.5% were unaware. Leaflets and doctors were the primary sources of information for participants regarding the information of breast cancer screening. Breast self-examination is a crucial approach to the timely detection of breast cancer and is subsequently critical for effective treatment. From the findings of this study we concluded that most women in the Asir region have a good awareness of breast cancer screening methods. However, either screening of self-examination or mammogram for breast cancer was not carried out thoroughly and regularly. This means that we must continue to emphasize the importance of primary health care in the earliest stages of breast cancer.

Updates on Lobular Neoplasms and Papillary, Adenomyoepithelial, and Fibroepithelial Lesions of the Breast.

This review article is a result of the breast pathology lectures given at the Sixth Chinese American Pathologists Association annual diagnostic pathology course in October 2020 (held virtually due to COVID-19). To update recent developments, in this review article, the authors wrote minireviews in the following 4 areas: lobular neoplasm, adenomyoepithelial lesions, papillary lesions, and fibroepithelial lesions. The sources include extensive literature review, personal research, and experience. With the wide practice of screening mammography, these lesions are not uncommon in image-guided core biopsies and excisional specimens. Many recent developments have emerged in understanding these lesions. We aim to provide readers with concise updates for each of these lesions with a focus on recent updates in definitions, diagnostic criteria, management, and molecular profiles that are most relevant to the daily practice of pathology and patient management.

Mammographic Practice in Sokoto: An Overview of the Diagnostic and Screening Findings

Mammographic Practice in Sokoto: An Overview of the Diagnostic and Screening Findings

Frecuencia de la mamografía, ecografía, examen clínico y autoexamen de mama en población general

Introducción. El cáncer de mama es el cáncer que más afecta a las mujeres. Se estima que 1 en 8 mujeres desarrollarán cáncer de mama eventualmente. Una de las herramientas contra el cáncer de mama es crear estrategias de detección temprana de la enfermedad, y la mamografía ha demostrado ser de mucha utilidad. El objetivo del estudio fue determinar la frecuencia de la mamografía, ecografía, examen clínico y autoexamen mamario, y evaluar su uso como pruebas de tamización para cáncer de mama en una cohorte de pacientes atendidas en la Clínica del Prado en Medellín, Colombia. Metodología. Estudio descriptivo, transversal, efectuado a través de encuesta en 318 usuarias atendidas entre junio y diciembre de 2018. Se estimó la frecuencia de los diferentes métodos de tamización y se evaluaron las características sociodemográficas, antecedentes personales y antecedentes familiares. Adicionalmente, se buscó si había asociación significativa entre la práctica de la mamografía como prueba de tamización y las variables de estudio. Resultados. La media de la edad fue de 44,2 años. El método de tamización más usado fue el autoexamen (70,1%), en su mayoría mensual (76,7%), seguido por la mamografía (56%), en su mayoría ocasional (46%). El examen clínico de mama (ECM) se utilizó en el 45,9% de las pacientes, con una frecuencia anual en el 50% de ellas. Por último, la ecografía de mama se practicó en el 43,1% de las encuestadas, con una frecuencia en su mayoría ocasional (39,4%). Se realizó un análisis independiente para mujeres entre los 50 y 69 años, y aunque el 93,8% se habían realizado la mamografía, solo el 9,3% lo hizo bienal, como lo recomienda el Ministerio de Salud y Protección Social. No se hallaron diferencias estadísticamente significativas entre las variables de estudio y la realización de la mamografía como método de tamización. Conclusión. En la población estudiada, el autoexamen de mama es realizado por la mayoría de las mujeres con una frecuencia mensual. La frecuencia de la mamografía, el ECM y la ecografía de mama fue muy similar, y se esperaba encontrar un mayor porcentaje de mamografías realizadas como prueba de tamización. Se requiere fortalecer esta estrategia efectiva para la detección temprana de cáncer de mama, teniendo en consideración la situación particular de cada paciente, la efectividad y beneficio de la técnica, así como los costos asociados.